What does an NP ‘look’ like?

Michelle ThomasNurse Policy Officer

Policy, Research and Practice Standards

Role of NBV (any Role of NBV (any regulator)regulator)

The Nurses Board of Victoria’s purpose under the Health Professions Registration Act 2005 is to safeguard the public.

• Approve Masters and Therapeutic Medication Management Units

• Endorsement process

• Conduct oral examinations

What is a Nurse Practitioner?

What they are not…

Another thing NP endorsement is not…

It is not a badge of honour awarded for a nurse’s hard work

It is an ‘expert’ advanced practice nurse moving to a ‘novice’ autonomous nurse practitioner to meet a service need

It is not about you!

The acknowledged definition…

A nurse practitioner is a registered nurse educated and authorised to function AUTONOMOUSLY and COLLABORATIVELY in an advanced and extended clinical role

The NP role includes ASSESSMENT and MANAGEMENT of clients using nursing knowledge and skills and may include but is not limited to the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations

The NP role is grounded in the nursing profession’s values, knowledge, theories and practise and provides innovative and flexible health care delivery that complements other health care providers.

The scope of practice of the NP is determined by the context in which the NP is authorised to practise.

ANMC 2004

The Two Pillars…

National Competency Standards for the Nurse

PractitionerDynamic practice that incorporates

application of high level knowledge and skills in extended practice across stable, unpredictable and complex situations

Professional efficacy whereby practice is structured in a nursing model and enhanced by autonomy and accountability

Clinical leadership that influences and progresses clinical care, policy and collaboration through all levels of health care

How are these standards used?

Accepted standards for practice of NPs in Victoria

Basis for standards for course approval

Basis for equivalency assessments

Basis for course assessmentsBasis for oral examinations

assessmentProfessional conductCPD

Get a copy of them and make them your own

Nurse practitioner vs. other advanced nursing

rolesCompetency standards are a

continuum

NP standards are built on the RN, ARN standards

A vital exercise…. Map the model of care against the ARN and NP competency standards and ensure the NP components are clear

Where to start?

Guidelines: Scope of Nursing & Midwifery Practice

…equivalent to expanding scope of practice

The Guidelines were developed to assist registered nurses with and

without endorsement to:• Determine their current scope of practice and identify own level of competence

• Manage changes and expansion to scope of practice

• Practice according to agreed principles of supervision and delegation

SOP Pre Endorsement

LegislationProfessional standards

HPRA 2005DP&CSA 1981ANMC NP Competency standardNP Endorsement process

Will the increase in SOPlead to an increase in health outcomes of the health consumer?

What is the service need and is it a NP you need?

SOP Pre Endorsement

Hazards?Policies and ProceduresOrganisational Change

Model developmentSteering committeesP&PsCPGs

Acceptable level of education?Level of supervised Practice?Process for assessingcompetency?Ongoing education to maintain competence

Masters NPANMC StandardsCPD GuidelinesPerformance management

SOP Pre Endorsement

Are you educationally prepared and competent to perform the activity?

Are you confident of your ability to perform the activity safely?

Apply for endorsement

How do you develop a model?

Identified service need best met by NP

IN

What clients?When? When not?

Where?By whom?

OUT

Referrals?Admission?Discharge?Transfer?

HOW, WHAT?Advanced assessment

Diagnostics?Therapeutic interventionsAdvanced technical skills

CPGs & Policies

What learning needs does the NPC have?

How do you meet these?

How do I get endorsed?

Michelle ThomasNurse Policy Officer

Policy, Research and Practice Standards

The endorsement processThe endorsement process

Education - Masters level

- Approved Masters -Equivalent Masters

-Therapeutic MedicationModules

Candidacy- service need

- model of care-identifying mentors

- employment agreements

Endorsement Application

- paperwork - expert panel oral exam

CandidacyCandidacy

Pathways for Pathways for EndorsementEndorsement

Pathway 1Masters commenced

2009

Approved against 2008 course approval standards

Model of care

Formulary

Case Studies

Organisation support

Professional indemnity insurance

Pathway 2Masters approved against

‘’old” course approval standards OR

Masters deemed equivalent

Model of careFormularyCase StudiesOrganisation supportProfessional indemnity

insuranceCVDetailed evidence against

competency standards

What happens when we move to

national registration?

Why national registration?

Protection of the publicWorkforce mobilityAccess to services provided by health practitionersTo enable the continuous development of a flexible, responsive [innovative] and sustainable Australian health workforce

National Registration and Accreditation Scheme

National system for health practitionerregulation Public national register for 10 healthprofessions Independence of course accreditationFunctions (NB already the case in Victoria) National boards to exercise regulatoryfunctions Australian Health Practitioner Regulation Agency (AHPRA) provides operation side

National Registration and Accreditation Scheme

Medical practitioners Nurses and Midwives Pharmacists Physiotherapists Podiatrists Psychologists Osteopaths Chiropractors Optometrists Dentists (including dental hygienists, dental prosthetists and therapists)

Key New Elements

Criminal history and identity checks

Mandatory reporting

Professional indemnity insurance

Student registration

Independent course accreditation processes

Complaints access for health consumers

Mandatory continuing professionaldevelopment

Changes for Nurses and Midwives

Registration cost – unknown*

Renewal date – 31 May commencing 2011

Renewal period – 12 months + one month

Two registers:- Nursing (RN and EN) & Midwifery

Nurses Board of Victoria (NBV) will become a state committee of the Nursing and Midwifery Board of Australia

http://www.nursingmidwiferyboard.gov.au

Registration Standards

Criminal history Same standards for all health professions

English language skills Initial course not taught or assessed in English IELTS 7 or OET B

Professional indemnity insurance arrangements

Self declaration

Continuing Professional Development (CPD)

20 hours annually If endorsed 10 hours of the 20 hours must be relatedto endorsement Evidence verified Mandatory activities can be included

Registration Standards

Recency of Practice Five year period Practice period of three months full time over fiveyears or equivalent

Endorsement Standards Nurse practitioner Scheduled medicines (eligible midwives) Scheduled medicines (registered nurse)

Criminal History and Identity Checks

From 1 July 2010 boards to complete criminal and identity history checks for all health practitioners registering for the first time in Australia

All other registrants to make an annual declaration on criminal history matters when renewing

Boards to have power to conduct ad hoc criminal history and identity checks

Professional Indemnity Insurance

Must not practice unless the nurse or midwife is covered in the conduct of their practice by appropriate professional indemnity insurance arrangements

All registrants to make an annual declaration that insurance is or will be when they practice in place.

Nurse and midwives responsibility to understand the nature of the cover under which they are practicing

Mandatory Reporting Registered Health Practitioners and employers(e.g. hospitals) must report a registrant whothey believe has engaged in reportable conduct.

Reportable conduct is:- Practising while intoxicated by drugs or alcohol Engaging in sexual misconduct in professionalpractice Placing the public at risk of substantial harmthrough practitioners physical or mental

impairment A significant departure from accepted

professional standards

For Students A student who has an impairment that during

clinical placement may place the public at substantial risk of harm

Student Registration

National boards will register students

Each board will decide the point in the program from which students must be registered according to level of risk for the public

From 2011 all boards will register students

Complaints Arrangements

Single point of contact for members of the public with assistance provided where required – National Agency

Complaints passed to the relevant board

Board and Health Complaints Commissioners must attempt to reach agreement with most serious action prevailing

Role of individual Health Complaints Commissioners continues

Mandatory Continuing Professional Development

Continuing professional development (CPD) to be a condition of practice for all registrants other than non-practising and students

National boards to determine profession-specific requirements

Requirements in existence at 30 June 2010 will satisfy initial annual renewal requirements

Self declaration upon renewal

Annual audit

But where does this But where does this leave NP endorsement?leave NP endorsement?ANMC definition and standardsMasters level of education Different timing for endorsement Prescribing authority in Victoria

linked to the individual Prescribing authority in other states

linked to role with protocols/CPGs

We need to focus on what is similar

not different….Look out for consultation

Contact Details

Nurses Board of VictoriaWebsite www.nbv.org.au Phone 03 8635 1200STD callers 1300 362 309

Nursing and Midwifery Board ofAustraliaWebsite

www.nursingmidwiferyboard.gov.au

Victorian Practitioner Regulation website

Website

www.health.vic.gov.au/pracreg/natdev