A Generic Competence Framework for Advanced Practice Nurses

  1. Key domains of the competence framework for advanced practice nurses
    Domain 1
    Managing clients with complex health conditions
    Domain 2
    Enhancing therapeutic nurse-client relationship
    Domain 3
    Demonstrating effective leadership and team work
    Domain 4
    Enhancing quality assurance and improvement
    Domain 5
    Managing and negotiating innovative and effective approaches to care delivery
    Domain 6
    Enhancing professional attributes of general and advanced practice
    Domain 7
    Enhancing personal attributes
  2. Statements describing the competence for advanced practice nurses
    • Domain 1
      Managing clients with complex health conditions
      1. Manages complete episode of care for complicated health cases and refer aspects of care to own and other professions.
      2. Provides case management services to meet multiple client health care needs.
      3. Plans and implements diagnostic strategies and therapeutic interventions to help clients with unstable and complex health care problems regain stability and restore health in collaboration with the client and multidisciplinary health care team.
      4. Rapidly assesses client's unstable and complex health care problems through synthesis and prioritization of historically and immediately derived data.
      5. Selects, may perform, and interprets common screening and diagnostic laboratory tests.
      6. Diagnoses and manages acute and chronic diseases while attending to the illness experience.
      7. Diagnoses unstable and complex health care problems utilizing collaboration and consultation with the multidisciplinary health care team as indicated by setting, specialty, and individual knowledge and experience.
      8. Reviews medication regime and counsels clients concerning drug regimens, drug side effects, and interactions.
      9. Assesses and adjusts plans for continuous management of client's health status by monitoring variation in wellness and illness.
      10. Obtains specialist and referral care for clients while remaining the primary care provider.
      11. Monitors client data base for follow-up, consultation, referral, and outcomes.
    • Domain 2
      Enhancing therapeutic nurse-client relationship
      1. Demonstrates skills in promoting therapeutic interaction to effect clients' change in health behaviour.
      2. Provides guidance and counseling regarding symptom management.
      3. Provides emotional and informational support to clients and their families.
      4. Uses human skills to enhance effectiveness of relationship.
      5. Applies principles of self-efficacy/empowerment in promoting behaviour change.
      6. Monitors and reflects own emotional response to client interaction and uses as data to further therapeutic interaction.
      7. Facilitates staff to debrief on overwhelming emotion and grief associated with nurse-client relationship.
      8. Communicates a sense of "being present" with the client.
    • Domain 3
      Demonstrating effective leadership and team work
      1. Coordinates human and environmental resources necessary to manage rapidly changing situations.
      2. Leads hospital/community health education and promotional activities.
      3. Empowers staff to assume increasing responsibilities for complicated client care with delegation, support and supervision.
      4. Provides leadership in the interdisciplinary team through the development of collaborative practices or innovative partnerships.
      5. Demonstrate effective leadership skills and be able to exert influence in a group.
      6. Provides leadership in professional activities.
    • Domain 4
      Enhancing quality assurance and improvement
      1. Leads the on-going process of setting and revising guidelines, protocols, standards and contingency plan.
      2. Develops a tracking system within the practice to ensure that clients receive appropriate preventive services.
      3. Monitors peers, self and delivery system through Quality Assurance, Total Quality management, as part of Continuous Quality Improvement.
      4. Manages complaints and monitors malpractice.
      5. Benchmarks various care programs with outcome measures and advise on clinical management or recommend review of intervention as indicated.
      6. Initiates and implements quality improvement strategies and clinical audits in collaboration with various health disciplines.
    • Domain 5
      Managing and negotiating innovative and effective approaches to care delivery
      1. Employs appropriate diagnostic and therapeutic interventions and regimens for specific client groups with attention to safety, cost, acceptability, efficacy and cost-effectiveness.
      2. Suggests implementation of evidenced-based practice and facilitates changes.
      3. Uses evidence and rationale to leverage senior and other on decision making.
      4. Contributes to the development of overall client care delivery system and adopts appropriate nursing models in system to achieve optimal outcomes.
      5. Re-engineers the work process.
      6. Establishes detailed implementation schedules, resources planning, achievement indicators, and monitoring mechanism to support the service development plan.
      7. Envisions change impacts. Be prepared to take reasonable risk to facilitate change and open to innovations.
    • Domain 6
      Enhancing professional attributes of general and advanced practice
      1. Applies principles of epidemiology and demography in clinical practice.
      2. Promotes and faster ethical practice and advocacy for clients.
      3. Applies/develops a theory-based conceptual framework to guide practice.
      4. Attains self-advancement professionally through initiating and involving in evidence based practice and research activities.
      5. Masters the application of advanced health care technology in specific area and show knowledge on the evidence found.
      6. Critically evaluates and applies research studies pertinent to client care management and outcomes.
      7. Applies/conducts research studies pertinent to primary care and/or specialty practice management.
      8. Demonstrates expertise on area(s) of nursing. Be a resource person for referrals in this area.
      9. Interpretes own professional strengths, role, and scope of ability to peers, clients and colleagues.
      10. Acts as a role model and set exemplary standard of professional behaviours.
      11. Supports socialization, education, and training of novice practitioners by serving as a preceptor, role model and mentor.
      12. Motivates and supports staff to be self-developing and achieve higher professional goals.
      13. Interprets and markets the advanced practising nurse role to the public and other health care professionals.
      14. Participates in legislative and policy-making activities which influence advanced nursing practice and health services.
    • Domain 7
      Enhancing personal attributes
      1. Analyzes situation critically and draw relationship among issues.
      2. Maintains active membership in professional organization.

References

Hospital Authority, Hong Kong (2002) Core competencies for registered nurses & advanced nursing practice in the Hospital Authority. Hong Kong: the Author.

American Association of Colleges of Nursing (1996). The Essentials of Master’s Education for advanced practice nursing. Washington: the Author.

Key elements that need to be present in curriculum that prepares APN

  • Therapeutic and caring relationships
  • Client-centered culture of care
  • Theoretical foundations of advanced nursing practice
  • Managing clients with complex health conditions
  • Health promotion and disease prevention
  • Evaluation of the outcomes of care
  • Evidence based practice
  • Innovative effective approaches to care delivering
  • Advanced nursing role development
  • Clinical decision making informed by critical thinking
  • Ethical practice and advocacy for clients
  • Effective leadership and change strategies
  • Teamwork and a culture of care and support
  • Implementation of clinical supervision to empower staff development
  • Policy, organization, and financing of health care

Accreditation

For New comers

  • Has graduated from a Master program recognized by the Academy
  • Passes an exit assessment for qualifying APNs recognized by the Academy

For Existing APNs

  • Grandfathering those who are currently appointed as APNs
  • In renewal of certification, the applicant needs to meet the requirements of an exit assessment for qualifying APNs recognized by the Academy