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NURSE PRACTITIONER

SCOPE OF PRACTICE

GUIDELINES FOR APPLICANTS

First published September 2002Updated June 2014

Updated August 2016

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ContentsIntroduction..................................................................................................................................................................3

Nurse practitioner scope of practice.........................................................................................................................3

Requirements.......................................................................................................................................................3

Non-prescribing nurse practitioners.....................................................................................................................3

Continuing competence requirements for prescribing nurse practitioners..........................................................4

Nurse practitioners applying for a change of condition........................................................................................4

Applications..................................................................................................................................................................5

Application criteria...................................................................................................................................................5

Nurse practitioner areas of practice.........................................................................................................................6

Breadth of the nurse practitioner area of practice...................................................................................................8

Section One: The Assessment Process..........................................................................................................................9

Overview of assessment process............................................................................................................................10

Aim of the assessment process...............................................................................................................................10

Educational equivalence.........................................................................................................................................11

Desk audit...............................................................................................................................................................11

Preparation for panel assessment..........................................................................................................................12

Panel assessment....................................................................................................................................................13

Clinical scenario / viva.........................................................................................................................................14

Assessment criteria for NP clinical scenario........................................................................................................14

Nursing Council decision.........................................................................................................................................15

Review process.......................................................................................................................................................15

Section Two: Portfolio Development..........................................................................................................................16

Guidelines for submitting a portfolio for registration in the nurse practitioner scope of practice.........................17

Content Guide........................................................................................................................................................18

E-Portfolio...............................................................................................................................................................22

Tips for portfolio.....................................................................................................................................................22

Section Three: Application and Desk Audit Forms......................................................................................................25

Appendix One.........................................................................................................................................................26

Appendix Two.........................................................................................................................................................27

Appendix Three......................................................................................................................................................28

Appendix Five.........................................................................................................................................................30

Competencies for nurse practitioners: desk audit and evidence record................................................................32

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Introduction

These guidelines have been developed to assist New Zealand registered nurses who are considering making an application to become a nurse practitioner. The guidelines are divided into three sections:

1. The assessment process

2. Portfolio development

3. Application and desk audit forms

Nurse practitioner scope of practiceNurse practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills. They practise bo th independently and in collaboration with other health care professionals to promote health, and prevent disease, and to diagnose, assess and manage people’s health needs. They provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering, conducting and interpreting diagnostic and laboratory tests, and administering therapies for the management of potential or actual health needs. They work in partnership with individuals, families, whānau and communities across a range of settings. Nurse practitioners prescribe medicines within their specific area of practice. Nurse practitioners also demonstrate leadership as consultants, educators, managers and researchers, and actively participate in professional activities, and in local and national policy development.

Requirementsa) Registration with the Nursing Council of New Zealand (the Council) in the registered nurse scope of

practice, and

b) A minimum of four years of experience in a specific area of practice, and

c) The completion of an approved clinical master’s degree programme which includes demonstration of the competencies for advanced practice and prescribing applied within a defined area of practice of the nurse practitioner. The programme must include relevant theory and concurrent practice, or

d) The completion of an equivalent overseas, clinically focussed master’s degree qualification which meets the requirement specified in c) above, and

e) Passing an assessment against the nurse practitioner competencies by an approved panel.

Non-prescribing nurse practitioners Non-prescribing nurse practitioners (registered before 1 July 2014) can achieve prescribing competency by either of the following pathways:

a) Those nurse practitioners with qualifications that include pharmacology and a prescribing practicum will be required to complete 100 hours of supervised prescribing practice and a competence assessment by a medical mentor and a nurse practitioner (a change of condition fee is applicable), or

b) Those nurse practitioners who do not have the appropriate qualification must complete a Council approved pharmacology paper and a prescribing practicum that includes 100 hours of supervised prescribing practice and a competence assessment by a medical practitioner and a nurse practitioner (a change of condition fee is applicable), or supply a portfolio that demonstrates they have the equivalent knowledge and skills, and complete a panel review (a prescribing panel fee is applicable).

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Continuing competence requirements for prescribing nurse practitionersPrescribing nurse practitioners must provide evidence every three years that they have maintained their competence, with their application for a practising certificate.

This includes:

a) evidence of ongoing peer review of their prescribing practice by an authorised prescriber; and

b) a minimum of 40 hours per year of professional development aggregated over a three-year period; and

c) a minimum of 40 days per year ongoing nursing practice aggregated over a three-year period within their defined area of practice.

Nurse practitioners applying for a change of condition Nurse practitioners who wish to change their area of practice can apply for a change of condition. To apply for a change of condition in the nurse practitioner scope of practice, a nurse practitioner is required to submit to the Council an application form, supporting evidence and a non-refundable fee of $200.00.

The supporting evidence must include:

a current curriculum vitae detailing the nurse’s work history since registration as a nurse practitioner;

certified copies of transcripts of qualifications gained;

detailed evidence of professional development;

a competence assessment against the nurse practitioner competencies with reference to the ‘new’ area of practice, and completed by a nurse practitioner or medical practitioner.

Please see the Education section on the Council website, change of condition, for the application form.

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Applications

To apply you must complete the following:

Statutory declaration (see Appendix One).

Desk audit and evidence record, and competencies (see Appendix Five).

Portfolio (and two further copies once application has passed desk audit), or E-portfolio, describing and verifying your practice.

Payment of application fee (please see www.nursingcouncil.org.nz for the current application fee).

Application criteriaThe following are the minimum criteria that must be met by all applicants applying for nurse practitioner registration:

Registration in New Zealand as a registered nurse.

Any conditions on the registered nurse scope of practice should be appropriate to the intended area of practice for the nurse practitioner scope.

Current annual practising certificate.

Good professional and personal standing.

Clinical master’s degree or, for internationally qualified nurses, a recognised equivalent qualification with the required courses.

Demonstrated ability to meet the competencies for the nurse practitioner scope of practice.

Need help with your application?

College of Nurses Aotearoa (ww w . n u r se.o r g . n z )

New Zealand Nurses Organisation (w w w . n z n o . org . n z )

Te Ao Māramatanga, New Zealand College of Mental Health Nurses (www . n z c m h n . o r g . n z )

Te Kaunihera o Ngā Neehi Maori o Aotearoa, National Council of Maori Nurses (htt p:/ /m aor ihealt h. co.nz)

The Council strongly recommends you have a mentor before submitting your portfolio and that you use multiple sources of support while preparing your application.

Can the Council help you with your application?

The Council welcomes inquiries from nurses wanting to know more about how to apply to become a nurse practitioner. Please contact the Nurse Advisor to Registration on (04) 385 9589 or a d m i n @ n u r s i n g co u nc il . o r g.nz . Council staff can only provide guidance on the application process.

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http://www.nursingcouncil.org.nz/

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Nurse practitioner areas of practice

The Council has defined the broad areas of practice using population groups. The system for identifying the population groups (and practice areas) is illustrated in Table 1 below. However, the nurse practitioner role in New Zealand is evolving and it is envisaged that the nurse practitioner title will become broadened and then no area of population will be required.

Table 1: Matrix for nurse practitioner areas of practice (examples)

Acute Care

Primary Health Care

Health Condition(Specify)

Mental Health

Palliative Care

Public Health

Women’s Health

Child & Youth

Family/Whānau Ora

Adult

Older Adult

Lifespan

Māori

Pacific Peoples

Other culturalgroups

Applicants will need to identify the population group and area of practice for registration as a nurse practitioner. The matrix will help define the areas of practice in most circumstances.

Table 2: Examples of nurse practitioner areas of practice

Nurse Practitioner Specific Area of Practice

Type of nursing practice Example of NP Area of PracticeEmergency Acute Care - LifespanIntensive Care Acute Care - Adult

Acute Care - ChildSexual and Reproductive Health (Health condition) - Youth/AdultGeneral or Orthopaedic Surgical Acute Care - AdultRenal Renal conditions - Adult/Older Adult

Long term conditions – Adult/Older AdultPain Management Pain Management - LifespanAdolescent Addictions Youth Mental HealthForensic Mental Health Mental Health - AdultRespiratory Conditions (Health conditions) - Youth/Adult

Primary Health Care - Adult

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SOME THINGS TO CONSIDER WHEN

LOOKING AT AREAS OF PRACTICE

Acute Care versus Health ConditionYou may think your area of practice fits under both Acute Care and Health Condition. For example, you might be providing long-term follow-up or there might be a small operative component. An example is urology commonly defined as:

“Care (operative and non-operative) of patients with disorders of the urinary tract males and females and male genital organs. It can include the management of trauma to these organs and the management of male sterilisation, infertility and sexual dysfunction.”

If your practice area has a significant surgical and acute component – for example, you manage/are involved in clinics preparing people for surgery, surgical interventions and then following up clients post surgery, as opposed to a role predominantly involved in the chronic (non-operative) management of clients - it might be more appropriate to apply for the Acute Care area of practice as opposed to the specific Health Condition area of practice.

While some conditions could appropriately sit under alternative practice areas, it is up to you to decide where your practice best fits before you submit your portfolio.

Health Condition versus Primary HealthThe Primary Health area of practice is synonymous with general practice. Whilst most nurse practitioners who have a Primary Health registration are providing the broad range of general practice services, some may choose at a particular point in time, based on the health needs of the population in their practice setting, to focus on a particular condition or conditions.

For example, in a big health centre a nurse practitioner may take over management of people with diabetes or cardiovascular conditions, or in a small general practice they may manage the “chronic disease management clients” (diabetes, asthma/chronic obstructive pulmonary disease and cardiovascular conditions). In this situation you would still be a Primary Health nurse practitioner who is different from a nurse practitioner who practises in the area of diabetes, who will likely be working across acute, specialist and primary services providing specialist, consultative services to more complex patients. This nurse practitioner would therefore have a clinical focus of diabetes under the Health Condition area of practice.

Primary Health versus Primary Health with Rural focusMany nurse practitioners working in the Rural Primary Health setting have felt strongly about having rural added to their title. However, if a nurse practitioner practising in a rural setting was to move to an urban setting, the expectation is that the Primary Health skills and knowledge would be transferable. There would be specific knowledge and skills associated to particular communities that the nurse practitioner would need to gain. Likewise a Primary Health nurse practitioner working in an urban area would have the generic skills necessary to begin working in a rural setting.

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Mental HealthApplicants working in mental health will have Mental Health as the broad practice area and will need to identify a population group such as e.g. Lifespan, Adult, Older adult, or Youth. The applicant is expected to have general mental health skills and knowledge alongside any specific knowledge in her/his current practice area.

It is not necessary to nominate a clinical focus area based on where you are currently practising even though your interview may well focus on this area. This is because your generic mental health skills are transferable and will enable working in another clinical setting.

Breadth of the nurse practitioner area of practice

No matter what your area of practice or the conditions you may have on your registered nurse scope of practice, you will be expected to be able to do a full health assessment and examination, i.e. full review of systems and physical examination.

There is an expectation that you can differentiate between normal and abnormal findings in a comprehensive assessment, and appropriately refer on conditions that are out of your area of expertise.

This means an applicant applying to be a Mental Health nurse practitioner is still required to be able to do a full physical health assessment and examination, and likewise an applicant applying for a physical health scope will be expected to be able to assess the client’s mental health. The expectation is not that you can diagnose a condition outside your area of practice, but that you can assess abnormalities so you can appropriately refer on.

For example, if you are applying for nurse practitioner in a physical health scope you should be able to assess if the client is possibly depressed, confused or showing evidence of thought disturbance, and likewise a Mental Health nurse practitioner should be able to identify possible physical abnormalities in the client group with which (s)he works.

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Section One: The Assessment Process

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Overview of assessment process

The table below outlines the application and assessment process for the nurse practitioner scope of practice.

Application with Portfolio

Assessment of Educational Credentials

Desk Audit

Preparation for Assessment

Panel Assessment

Nursing Council Decision

Application completed

Submission of eithera)-One copy ofportfolio (further two copies to beprovided onceapplication has passed desk audit),

orb)-Email submission with e-portfolio link included

Completion of desk audit and evidencerecord

Has the applicant achieved the required content and level of education?

Does theapplicant demonstrate equivalence (for internationally qualified nurses)?

Review of portfoliousing desk audit and evidence record

Domains one and three to be met from portfolio evidence at desk audit assessment, in order to proceed to panel assessment

Liaison with applicant regarding moreevidence (if required)within three months of initial desk audit assessment

Review of portfolio

Referee checks

Panel teleconference meeting

Assessment interview for domains two and four

Deliberation and decision

Recommendation to the Nursing Council

Applicant informedof recommendation

NursingCouncildecision

Applicant (with mentor support)

Nursing Council Nursing Council and external auditor (completed within4 – 6 weeks of receipt of application)

Panel Panel and ApplicantPanel date within 8 - 12 weeks* of successful desk audit (for e-portfolio), or date of Council receiving two copies plus original

NursingCouncil

* Excluding public holidays

Aim of the assessment process

Under the Health Practitioners Competence Assurance Act 2003 (the Act), the role of the Council is to protect public safety. For nurse practitioner registration this is achieved by ensuring the assessment process conforms to set standards, including the requirements of the Medicines Amendment Act 2013.

Assessment panels have the key role of undertaking a peer evaluation of an applicant’s practice and making a recommendation to the Council based on their assessment.

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Educational equivalence

All applicants must have successfully completed a clinical master’s degree programme. The clinical master’s degree programmes approved by the Council are on the website: w w w . n u r s i n g c o u nc il . o r g.n z / e d uc a t i on .

Those applicants who do not have a clinical master’s degree will need to contact an approved programme provider to identify any additional papers required.

The required courses are those that focus on advanced assessment, pathophysiology, pharmacology, and prescribing practice.

For internationally qualified nurses to determine educational equivalence they will need to contact Council approved clinical masters programme providers for information.

Alternatively they can be assessed by Council staff and/or the Education Committee at the time of portfolio submission. Applicants will need to supply transcripts and course descriptors as part of their portfolio.

The nurse practitioner competencies are focused on the clinical context within New Zealand. This makes it difficult for registered nurse practitioners from other countries to make the transition to a different health care system, cultural practices and legislative requirements, particularly prescribing, without first practising as a registered nurse in New Zealand. Therefore applicants are required to be practising as a nurse in New Zealand when they apply.

Desk auditOnce an application and portfolio h av e b e en received by the Council, a desk audit is completed by an auditor.

The purpose of the desk audit is to carry out a preliminary assessment of the portfolio to:

1. confirm the professional good standing of the applicant;

2. ensure the applicant has provided all required information for review by the assessment panel;

3. confirm the applicant has completed a clinical master’s degree programme or, if an internationally qualified nurse, an equivalent qualification;

4. confirm the evidence supplied by the applicant appears to reflect the nurse practitioner competencies;

5. assess for meeting of domains one and three of the nurse practitioner competencies.

Desk audit will assess the application/written evidence for the meeting of competencies in domains one and three.

Regarding domains two and four the desk audit only indicates there is sufficient evidence for the applicant to attend panel interview. The panel assesses and decides whether the applicant meets the competencies of domains two and four, and therefore the requirements for nurse practitioner registration.

The desk audit stage of the assessment may involve dialogue between the applicant and Nursing Council staff to finalise documentation for the formal panel assessment.

Portfolios will be returned to applicants if incomplete or insufficient. The portfolio must be returned to the Council with the requested additions/alterations within three months. After three months the application will be treated as a new application and a new application fee will be payable.

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Preparation for panel assessmentWhen all required documentation is present and an applicant has established her/his readiness for formal assessment, an assessment panel is convened.

The role of the assessment panel is to fully evaluate applications against the competencies for nurse practitioner in domains two and four, and triangulate the evidence (portfolio, referee checks, panel interview). To do this the panel works through a number of tasks before the assessment, including:

Panel review

Full review of the applicant’s portfolio

Teleconference

Two to three weeks before to the panel convenes panel members hold a teleconference to discuss the evidence provided in the portfolio. The purpose of the teleconference is to determine if more evidence is required; to discuss questions for the panel interview; to establish the clinical scenario to be used at interview; and to request additional information from the applicant before the panel convenes (if applicable).

The Council staff member who is present at the teleconference will contact the applicant with any requests for additional information.

Reference checks

Referee reports will be obtained from individuals nominated by the applicant. The panel may also request permission to seek further references.

Assessment panels

Generally panels will consist of three members. There may also be an observer panel member present.

Panels will normally consist of a Chair plus two nurse practitioner panellists.

Right of appeal: An applicant may elect to challenge the nomination of a panel member if it is believed (s)he may have a conflict of interest in relation to their application. The conflict of interest must be put in writing to the Registration Manager for this to be considered.

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Panel assessmentThe purpose of the assessment interview is to give you an opportunity to present your practice and your achievement of nurse practitioner competencies. The panel assessment builds on the evidence already provided in the portfolio and allows panel members to explore some areas in more depth and seek clarification of information provided. A clinical scenario will be used as part of the panel assessment.

Key areas of focus within the interview may include:

assessment, differential diagnosis, treatment and evaluation;

critical and reflective thinking/practice;

application of nursing knowledge and evidence-based practice;

cultural safety;

clinical judgment and management of complex situations;

competencies related to prescribing.

You should expect the formal panel interview to take up to three hours, including 20 minutes preparation time for your clinical viva (the clinical scenario given to you at panel interview).

You are welcome to bring a support person with you to the panel assessment. The role of the support person is to support the applicant, rather than actively participate. This means the support person is not able to assist you with the clinical viva or oral questions but has the opportunity to comment at the end of the panel interview.

Applicants may bring to the panel any usual resources they would use in their clinical practice.

Following completion of the assessment interview, the assessment panel completes the formal evaluation using the nurse practitioner domains and competencies.

When the assessment panel has completed deliberations, the outcome of the assessment is documented and a recommendation is made to the Council. You will be informed of the recommendation at the conclusion of the panel’s evaluation.

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Clinical scenario / vivaThe purpose of clinical scenario assessment is to test the candidate on their clinical knowledge, their critical thinking, and their assessment and diagnostic skill. Candidates are expected to highlight their clinical strengths and demonstrate clinical reasoning.

During the panel assessment interview for nurse practitioner scope of practice a candidate is given a written scenario of a clinical situation. This scenario includes standard questions which will assess competencies 2.1, 2.2, 2.3, 2.4, 2.5, 4.2, 4.3, 4.5:

1. Provide a comprehensive overview of your assessment. The panel will provide answers to questions you may want to ask.

2. List the provisional (differential) diagnoses in order of priority. Discuss rationale to rule in or rule out diagnoses.

3. Present your plan of care based on your assessment and diagnosis.

Candidates are given 20 minutes to prepare for their response and discussion. During the preparation time the candidate has access to any resource material they have brought with them to the panel interview session.

Additional questioning around the scenario can be used to assess competencies 4.1, 4.4, 4.6, 4.7, 4.8, 4.9 if required.

Assessment criteria for NP clinical scenario A candidate is assessed as having achieved, or not, each criteria. A candidate must achieve all criteria, unless criteria are not applicable, in order to pass the clinical scenario assessment.

1. Patient/client assessment is systematic and comprehensive.

2. Patient/client assessment includes full or focused (as appropriate) physical examination.

3. Patient/client assessment presentation requires minimal or no prompting.

4. Most relevant/critical differential diagnoses are identified.

5. Ruling in and ruling out of differential diagnoses shows critical thinking.

6. Ruling in and ruling out of differential diagnoses includes clear and correct rationale

7. Diagnosis is able to be identified by candidate or confirmed/provided by assessor(s).

8. Management plan for definitive diagnosis is according to evidence and guidelines.

9. Prescribes appropriate dose, duration, and route of medications for the person and clinical condition.

10. Prescribing decisions can be justified.

11. Prescribing decisions are supported by correct explanation of pharmacokinetics and pharmacodynamics, including age related considerations.

12. Explanations of physiology, pathophysiology and pharmacotherapy are correct.

13. Patient education information, if relevant, is appropriate and correct.

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Nursing Council decisionThe recommendation of the assessment panel will be considered by the Registrar. Successful applicants will be registered in the nurse practitioner scope of practice.

An updated practising certificate including nurse practitioner scope of practice will be issued upon the return of the applicant’s current practising certificate.

Continuing competence requirementsEvery three years prescribing nurse practitioners are required to provide evidence that they have maintained competence, when they apply for their practising certificate. This evidence includes: Ongoing peer review of their prescribing practice by an authorised prescriber; and A minimum of 40 hours per year of professional development over a 3 year period; and A minimum of 40 days per year of ongoing nursing practice over a 3 year period within

their defined area of practice.

Review processSecond panel

Unsuccessful applicants will be informed in writing of the competencies they have not met and in some instances advised they may meet with the panel again within six months to provide further evidence for the competencies not met.

Applicants may request a reassessment in writing to the Registration Manager within 20 working days of receiving the panel outcome letter.

Council review

Applicants who have been declined registration in the nurse practitioner scope of practice may request a review of the decision by the Council. The request for a review to the Council must be made in writing within 20 working days of receiving the letter declining registration.

Grounds for a review of the decline decision are: that there are issues of justice and fairness related to the assessment process; and/or that the decision clearly is incorrect.

Requests for review of the decline decision must be made in writing to the Registration Manager. The Council will consider any written or oral submission made by the applicant in support of their request and may make one of two decisions:

1. Uphold the decline decision, or2. Recommend a new assessment panel is convened.

Appeal

Alternatively, applicants who have been declined registration may also appeal to the District Court under section 106 of the Health Practitioners Competence Assurance Act 2003.

Should such an appeal be made through the District Court, applicants will no longer be able to seek a Council review.

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Section Two: Portfolio Development

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Guidelines for submitting a portfolio for registration in the nurse practitioner scope of practice

The portfolio can be either a hard copy version sent to Council, or an e-portfolio and the link emailed to Council.

The aim of the portfolio is to demonstrate evidence of meeting the nurse practitioner competencies.

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Remember

The portfolio must not exceed one folder (in the case of hard copy portfolio).

One administration section including index, plus eight sections as outlined in the ‘Content Guide’ and all pages must be clearly and sequentially numbered (in the case of hard copy portfolio).

You must document in the ‘desk audit and evidence record’ where and what information demonstrates how you are meeting each competency.

Be judicious in content choice. Only include quality evidence that showcases your recent advanced nursing practice.

Include certified copies of original documents, e.g. transcripts, qualifications, referee letters, attestations, etc. Do not send in photocopies of verified documents and original certificates.

Do not include identifiable patient details or information which could compromise privacy.

Ensure consent is included from any third-party correspondence to verify that you have permission to use this in your portfolio.

Do not use plastic sleeves.

For more information follow the Content Guide.

Content GuideThis content guide has been adapted from the Nursing & Midwifery Board, Australia Guide for submitting a portfolio (December 2013). It is important to remember you need to clearly demonstrate evidence of meeting each competency and that some documents can provide evidence for a number of competencies.

Application/declaration sheet, cover letter (if desired), completed competency record (Appendix Five of this document), content index (for a hard copy portfolio).

Curriculum vitae (CV), practice and philosophical statement, position description

CV; this must outline your work history showing how your practice has developed. You should include summaries of key achievements and responsibilities for each position (related to the NP competencies) to highlight the development of your practice over time with cumulative experience. You must sign and date your CV as a “true and accurate record” of your professional identity.

Practice and philosophical statement should:

o define range and parameters of your practice and your area of clinical focus. It should include: population group; key clinical roles/responsibilities; interventions/treatments you provide and health consumer outcomes you are seeking to achieve,

o demonstrate an advanced autonomous clinical role, along with evidence of collaborative approach,

o outline the nursing models/theories/frameworks/values which underpin and guide your practice,

o not exceed two pages.

Include your position description only if it demonstrates advanced practice.

Professional references/attestations

Attestations are a good way of showing evidence of meeting specific competencies, and can be presented in different ways. Sometimes it may be one person attesting to a specific competency, for example, cultural appropriateness. At other times it might be co-signed by two or more colleagues attesting to a broader range of competencies. When attesting to competencies it is important that referees provide some examples/context rather than just listing indicators from the competencies document.

Include a minimum of two letters (maximum five) of support from senior colleagues (one of which must be from a senior nurse and one from your prescribing mentor). These letters must

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Administration Section

Section One

Section Two

be on letterhead and be no more than six months old at the time of application. The letters must address the following:

o Their relationship to you as nurse practitioner applicant.

o Details of how you demonstrate advanced nursing practice, with reference to the nurse practitioner competencies.

You may include recent performance reviews (within the last 12 months) if they demonstrate your advanced nursing practice.

Provide the names and contact details of two referees with current knowledge of your advanced nursing practice and who are able to comment on your nursing and prescribing practice. This should include one medical practitioner and one nurse practitioner or expert nurse.

Education

Include certified copies of your Council approved clinical master’s degree programme (transcript detailing papers completed and the date the qualification was awarded). If you are an internationally qualified applicant please submit details of your equivalent qualification (transcript detailing papers completed and date qualification awarded).

Clinical – case studies

Include two comprehensive case studies which show evidence of meeting the competencies for domains two and four (see page 23 for suggested framework). These must include a full health assessment, relevant examination, differential diagnoses, ordering and interpretation of diagnostic tests, and therapeutic management at an advanced level. They should showcase your clinical decision making justified by the application of advanced knowledge, including an understanding of pathophysiological processes and pharmacotherapeutic knowledge.

The case studies must review clients whose care you have led and managed. The case studies must demonstrate clinical practice and decision making at an advanced level, confirming your ability as an autonomous practitioner. You must also include any evaluation and follow-up interventions you completed about the case studies.

You may choose to submit two comprehensive case studies demonstrating all of the above or submit four less comprehensive cases but among them demonstrate competencies for domains two and four. If you choose to submit two case studies, you should also provide any documentation related to those particular case studies, e.g. referrals, treatment plans or case notes.

Case studies must not exceed 10 pages.

If appropriate attach referrals or letters to other health professionals generated by the case study.

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Section Three

Section Four

Practice/work diary

You may also choose to submit a brief practice/work diary which provides supporting evidence against domains two and four. This must not exceed five pages.

Competence assessment

You may choose to submit a competence assessment against domains two and four of the nurse practitioner competencies written by a senior clinician (clinical mentor/supervisor or colleague) attesting to your advanced practice. Inclusion of a competence assessment is not essential.

Prescribing

Your comprehensive case studies should showcase your knowledge of pharmacological issues for your client and more broadly regarding your skills and knowledge across the domain four competencies. Other types of evidence to support domain four are likely to include your professional references, performance reviews and written feedback from your prescribing mentor.

You also need to submit evidence to show how you will continue to update your prescribing knowledge and how you propose to audit outcomes of your prescribing activity.

NB Remember to maintain privacy in all documents. If you are including correspondence from or

with other professionals please ensure their identity is either deleted or their permission to use these documents in your portfolio is explicit.

Professional activities and leadershipActivities in which you have taken an active/lead role, including any of the following examples: Involvement in forums/committees/working or reference groups at service, community,

regional and/or national level. Involvement in policy development at local, regional and/or national level. Active involvement in quality service improvement/programmes. Utilisation as a consultant/advisor and/or a resource to other colleagues/teams/community

agencies. Involvement in research activities within your area of practice and/or publications/peer reviews

of publications. Involvement in the development of clinical/procedure guidelines/resources. Professional body membership and activity/leadership within such groups. Provision of supervision/mentoring/coaching/professional development assistance to

colleagues. Involvement in conferences (presenting and/or organising) and/or if attending please include

summary of learning. Peer review received and given (ensure confidentiality).

This evidence must be provided in table form, as shown in Appendix Two of this document.

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Section Five

Section Six

Professional development

Include evidence of your continuing professional development relevant to your area of practice in the nurse practitioner scope. This evidence must be presented in table form (see Appendix Three). The table must be verified by a registered health practitioner.

Teaching

Include evidence of teaching/lecturing within your area of practice. This evidence must be presented in table form (see Appendix Four) and can be augmented with a maximum of three PowerPoint presentations, if you are using this evidence to demonstrate your evidence based knowledge/practice. If you are including PowerPoint presentations please present a printout of six slides per page.

Miscellaneous

If you have not been able to provide evidence against all the nurse practitioner competencies within the first seven sections, you may submit additional information in this section, for example: exemplar(s), and/or reflective diary.

Exemplars and reflective diaries can be a legitimate way of providing evidence, for example: ethical situations encountered in practice; cultural appropriateness; to demonstrate legal implications or to demonstrate evidence based practice; clinical judgment or critical reasoning. Exemplars need to be more extensive than just a narrative of the situation. To show evidence of meeting particular competencies they generally require detailed reflective analysis, for example: a description of what happened, evaluation and analysis of the experience, with a conclusion and, if relevant, the action taken as a consequence.

It is also possible to use journal articles or conference presentations to provide evidence of meeting certain competencies. For example, you may read an article and based on that you may change your practice/service delivery, but you need to include a description, evaluation/analysis and a conclusion in relation to the article/presentation.

This section must not exceed four pages.

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Section Seven

Section Eight

E-PortfolioApplicants are offered the option of submitting an e-portfolio instead of a hard copy version.

The e-portfolio will include the sections as indicated above in Content Guide. All portfolio information must be included in Sections as attachments (pdf form), in order for Nursing Council to save the portfolio contents to the applicant’s file. Any information that is not attached as above, may be missed and not included in the assessment process.

Applicant must post to Nursing Council the originals or verified copies of attestation letters included in the e-portfolio and also the educational transcripts and certificates included in the e-portfolio. These will be retained by Nursing Council in the applicant’s file.

It is imperative the applicant does not revisit and alter the e-portfolio once application is made unless requested to after initial desk audit if there are matters to address, as the link will be shared with all panel members, and any alterations will not enable consistency.

Tips for portfolioThe portfolio is your opportunity to describe and provide evidence of your advanced nursing practice.

Documents included in your portfolio as e x amp l es o f y o u r prac t i ce should be signed by you and by a second party to verify their accuracy.

Verification of content by a second party assists you to evidence that your portfolio accurately reflects your practice. This verification can be completed by another registered health professional. The verification must include their full names, profession, signature, date, and contact details.

Certification of copies for official documents such as your academic transcripts, marriage certificates, etc. must be completed by a Justice of the Peace, Solicitor, Notary Public, Registrar of the Court, or other officer authorised to take statutory declarations.

PrivacyPlease refer to the Council’s Code of Conduct and the Privacy Act.

Any inclusion of patient details or identifiable situations will be considered a privacy breach and your portfolio will be returned.

If you decide to use test results, case notes or referrals, all patient identifiers and other health professionals’ details must be removed or effectively edited.

Photocopied notes are hard to read, so consider retyping if they need to be included.

Thank you cards are private personal notes do not verify evidence of your advanced nursing practice. Formal thank you letters from an organisation or a service about the care you gave or role you have held may be acceptable if you have shown you have permission to use them and they demonstrate how you are meeting the nurse practitioner competencies.

You must have permission from all parties to include emails, but please ensure they show evidence of your advanced practice and are not subject to any confidentiality disclaimer.

Meeting minutes: Do not include minutes of meetings. You could instead a report on your involvement in projects or professional groups verified by a senior colleague.

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Comprehensive case studyInclusive of assessment, diagnosis, treatment, pharmacotherapy, and evaluation

1. Chief complaint/presenting problems/illness

2. Full history Demographics Statement of reliability Past medical history Family history Personal and social history Medication history and current medications Review of systems detailing any organ impairment

3. Physical examination

4. Review of previous laboratory tests and ordering/review of new tests

5. Diagnosis/differential diagnos(es) List all the differential diagnoses and discuss how these were eliminated by you until final

diagnosis (or diagnoses) was identified.

6. Patient treatment plan Include problem identification and prioritisation. Include interventions/treatments, including health education. The patient’s attitude and expectations, including patient’s participation in the decision-

making/health care plan, his/her ability to participate in the treatment plan, self-management goals.

Show a nursing focus.

7. Drug therapy assessment, prescribing, monitoring and evaluation List all medications you have prescribed for the patient and the rationale for their inclusion as

part of care (i.e. indication/purpose for drug). Discuss pharmacodynamics, pharmacokinetics, dosing and administration issues. Discuss adverse effects, appropriateness for the patient – contraindications/patient

precautions List the potential adverse reactions for each of the medications prescribed. Identify any potential emergencies or crises arising from the use of these medications and

outline how you would address these. Discuss how medications were monitored. Discuss effectiveness. Discuss any revisions in plan of care or referrals made based upon response to your initial

therapy.

8. Collaboration Outline any collaboration with other health professionals.

9. Review of patient outcomes and reflection on your practice Evaluation of your patient’s response to intervention(s) and/or effectiveness of the plan, and

appropriate modification of the care plan. Describe the nursing model or framework that underpinned and guided your practice in

caring for this patient.

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Practice/Work Diary

A good piece of evidence for clinical practice is to show an outline or snapshot of your recent clinical practice by way of a clinical diary. For example, a calendar outline of a typical working month or week.

If you require further evidence for the clinical competencies you can select some assessments/consultations and add the clinical evidence you are seeking to demonstrate, e.g. they may be mini (condensed/bullet-pointed) case studies.

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Section Three: Application and Desk Audit Forms

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Appendix One

Application for nurse practitioner registration (under section 17 of the Health Practitioners Competence Assurance Act 2003)

Surname: ……………………………….… Given names:…………………………………………………

Address:…………………………………………………………………………………………………….…..

Phone (home): …………..…….....….... Phone (work): ………........….…… Mobile: ………..……......

Nurse practitioner area of practice: ……………………………………………………………………….

Date of birth: ……………………........... Registration number: ...........................................................

Purpose of application/declaration:This application and declaration below must accompany your portfolio to confirm:

I solemnly and sincerely declare that: (Please circle)

a) The information given by me in support of my application for registration as a nurse practitioner is true and correct.

b) I am in good professional standing as a registered nurse.c) I am not the subject of an investigation into professional matters, disciplinary or

criminal proceedings, or a disciplinary order in New Zealand or any other country.d) I have not been convicted of any offences against the law in New Zealand or any

other country.e) Once it is lodged, I agree to conduct all correspondence regarding my application

through the Registrar/Registration Manager of the Nursing Council of New Zealand and will not contact any person involved with my assessment either during or following the assessment process without the prior written authority of the Nursing Council of New Zealand.

f) I give my authorisation to the Nursing Council to seek further information as to my standing within my specific area of practice if this is considered necessary.

True False

True False

True False

True False

True False

True FalseNB: If you have circled ‘False’ for any of the declarations above, please provide details separately.

DECLARATION

I make this solemn declaration conscientiously believing the same to be true and correct by virtue of the Oaths and Declarations Act 1957.

Declared at this day of 20

and signed by me ..............................................................

in the presence of .............................................................

Justice of the Peace, Solicitor, Notary Public, Registrar of the Court, or other officer authorised to take statutorydeclarations (please indicate category).

In accordance with the Privacy Act 1993, the personal information collected by the Nursing Council of New Zealand (‘the Council’) is confidential to the Council and is used for the purpose of processing an application for registration as a nurse practitioner under Section 17 of the Health Practitioners Competence Assurance Act 2003. The Council may disclose the information to a third party for assessment purposes. The applicant has the right of access to and correction of personal information held by the Council.

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Appendix Two

NPRegistration Professional activities / leadership

Date Activity Others involved My role in the activity Verified

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Appendix Three

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NPRegistration Continuing professional development

recordDate Course/Conference/Seminar/Forum/

Symposium/Workshop, etc.My learning Hours of

attendanceVerified

Appendix Four

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NPRegistration Teaching

Date Topic Audience Aim of education Verified

Appendix Five

PRIVATE AND CONFIDENTIAL Competencies for nurse practitioners: desk audit and evidence record

Applicant name: Registration number:

Administrative (Council to complete) Achieved

Yes NoNursing registration appropriate to identified scope

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Current NZ annual practising certificate

Statutory declaration

Names of referees included

Fee paid

Portfolio includes:Scope of practice Approved area of practice (from nurse practitioner matrix)

Personal statement of scope/philosophy

Meets length of practice requirements within scope, e.g. CV details relevant advanced

Demonstration of scope Practice roles over four years minimum

Appropriate practice experience, setting, client age range and conditions

Verified exemplars, e.g. case studies, diary/schedule

Prescribing evidence

Scholarly activity Publications, e.g. journal article, academic publications

Presentations, e.g. conference presentations, teaching sessions

Research involvement, e.g. submissions/working parties/thesis

Quality improvement Quality activities, e.g. clinical quality audits/working parties/resources developed

Policy development, e.g. submissions/working parties

Teaching activity, e.g. evidence of teaching sessions, conference presentations, mentorship

Ongoing practice development Involvement in professional activities, e.g. working parties, local, regional, national

Relevant professional memberships

Educational requirementsTranscripts of master’s (clinical) (certified)

Internationally qualified nurses- complete educational equivalence checklists (maybe need to be considered by the Education Committee)

Evidence of collegial support Attestations, references

Other evidence provided

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All evidence must be certified/verified copies or original documents.

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Competencies for nurse practitioners: desk audit and evidence record

1. Professional responsibility and leadership

Nurse practitionercompetenciesThe nursepractitioner:

IndicatorsApplicant to complete Desk auditor

to completePanel to complete

Met/ Not met

Evidence source and page number


Evidence of notes

1.1 Practices within a nursing model to apply advanced nursing practice in the provision of health care services to client/population groups.

Suggested evidence:Practice statementPhilosophical statementCase studiesInvolvement in reference / guideline/ policy groups

Describes the nursing model/framework identifying the values andbeliefs that underpin and guide practice.

Defines area of nursing practice in relation to client/population group including activities of health promotion, maintenance and restoration of health, preventative care, rehabilitation and/or palliative care.

Articulates a coherent and clearly defined nurse practitioner area

of practice that is characterised by advanced practice, evidencebased nursing knowledge and skills.

Demonstrates autonomous, interdependent and collaborativepractice in relation to client care and within the health care team.

Engages in activities at a local systems level that promote the positive contribution of nursing to health care delivery and health outcomes for population groups.

Describes clinical d e c i s i o n m a k i n g p r o c e s s e s i n v o l v e d in response to actual and potential health needs, and characteristics of the population group.

Articulates an advanced level of knowledge and describes the evidence that underpins decision making.

Demonstrates an advanced level of critical thinking in practice.

Demonstrates ability to use advanced knowledge to achieve equity of health outcomes for all clients.

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Evidence of notes Met/Not met

1.2 Demonstrates accountabilityfor practice inrelation to the population/client group and the parameters of practice within health care settings.

Suggested evidence:ReferencesCase studiesReferralsProfessional development

Demonstrates advanced practice competencies within a specific area of practice that is autonomous and collaborative.

Demonstrates timely referral and consultation when an issue is outside scope of practice or level of expertise/experience.

Collaborates, initiates and leads to ensure practice is informed by ethical decision making.

Demonstrates consideration of access and quality when making client care decisions.

Initiates and leads professional development processes based on professional practice standards and legal and ethical guidelines.

Collaborates, initiates and/or leads professional development processes based on peer supervision and review of currency of practice.

1.3 Demonstrates nursing leadership that positively influences the health outcomes of client/population group and the profession of nursing.

Suggested evidence:Quality/service development

Utilisation as a consultant/advisor

Professional body membership

Professional development

Takes leadership roles in complex situations across settings and disciplines.

Considers the impact of the wider determinants of health including emerging health policy and funding, and modifies practice accordingly.

Promotes opportunities to achieve equity of health outcomes across the population group.

Takes leadership roles in community and professional groups to achieve positive outcomes for the client or population group.

Shows leadership in professional activities such as research, scholarship and policy development.

Demonstrates skilled mentoring, coaching and teaching of health care colleagues.

Contributes to, and participates in, national and local health and socio-economic policy development.

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2. Management of nursing care

Nurse practitionercompetencies The nurse practitioner:





Evidence of notes Met/ Not met

2.1 Demonstrates advanced comprehensive client health assessment skills and diagnostic decision making relevant to specific area of practice.

Suggested evidence:Case studiesReferralsReferences

Demonstrates advanced clinical decision-making processes to:

- assess the client’s health status

- make differential, probable and definitive diagnoses

- implement appropriate interventions based on a systematic decision-making process

- evaluate the client’s response to care.

Orders and interprets diagnostic tests and makes decisions/ interventions based on diagnostic information, current evidence and local practice information.

Prioritises data collection and assessment processes in complex situations according to the client’s immediate and/or ongoing needs.

Consults and refers to other health professionals appropriately.

1.2 Demonstrates advanced practice in direct client care within a range of contexts and situations.

Suggested evidence:Case studiesReferences

Anticipates situations and acts appropriately to manage risk in complex client care situations.

Demonstrates a creative, innovative approach to client care and nursing practice.Decision making is justified by extensive knowledge base and contextual data.

Uses critical thinking to plan practice according to contextual factors.

Identifies a clear process for consultation and collaboration with the client and other health professionals.

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2.3 Consistently involves client in decision- making processes and uses client information to determine management strategies.

Suggested evidence:Case studiesReferrals, References

Actively explores the client’s cultural preferences, health behaviours and attitudes regarding care and incorporates information into management plan.

Actively explores the client’s ability to participate in care and incorporates information into management plan.

Ensures the client has access to, and understands, relevant information and resources used to make informed decisions regarding care.

Documents the client’s involvement in decision making.

2.4 Demonstrates confident and independent practice that isbased on the synthesis oftheoretical andpractical knowledge fromnursing and other disciplines.


Decision making is based on an advanced level of clinical judgment, scientific evidence, critical reasoning and client determined outcomes.

Demonstrates an extensive knowledge base in specific area of practice and applies knowledge of biological, pharmacological and human sciences.

Demonstrates advanced level skills and performance of interventions relevant to specific area of practice.

Provides clinical leadership in the effective use of information technologies to support practice decisions.

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2.5 Uses a formal approach to monitor and evaluate client responses to interventions.

Suggested evidence:Case studiesReferencesReferralsClinical notes

Provides clinical leadership in evaluating client responses to interventions and directs the modification of the care plan accordingly.

Systematically documents and communicates evaluation process and changes to management plan.

Demonstrates evaluation processes that measure the efficacy of practice to client outcomes, population based outcomes and the health care environment.

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3. Interpersonal and interprofessional practice and quality improvement







3.1 Establishes therapeutic relationships with client that recognises the client in context and respects cultural identity and lifestyle choices.

Suggested evidence:Case studiesReferencesQuality development activities

Actively assesses the client’s preferences and abilities, and ensures the client has access to appropriate information on which to base decisions.

Is proactive in meeting the cultural, social and developmental needs of clients.

Demonstrates respect for differences in cultural, social and developmental responses to health and illness, and incorporates health beliefs of the individual/community into assessments and plans of care.

Promotes the client’s participation in health care decision making and self management of health needs.

Advocates for the client within the health care team and with relevant agencies in a timely and respectful manner.

3.2 Contributes to clinical collaboration that optimises health outcomes for the client.

Suggested evidence:Case studiesQuality improvement activitiesActive membership of reference/ guideline groups,Teaching activitiesReferences

Leads and collaborates with other health agencies/professionals to ensure timely access and smooth transition to quality services for the client. Lead case reviews and debriefing activities.

Initiates change and responds proactively to changing systems.

Is an effective resource and consultant for interdisciplinary clinical staff, and disseminates research findings.

Acts as an agent to foster collaboration between members of all disciplines in the health care team to work towards seamless client care.

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3.3 Actively involved in quality assurance activities that monitor and improve the quality of health care and the effectiveness of own practice.

Suggested evidence:Case studiesReferencesTeaching activities Supervision contract

Demonstrates responsibility for quality of health care, risk management and effective resource utilisation.

Critiques and develops clinical standards.

Influences purchasing and allocation of resources through use of evidence based findings.

Participates in regular and formal professional supervision.

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4. Prescribing practice

Nurse practitionercompetenciesThe nurse practitioner:

Applicant to complete Desk auditorto complete

Panel to complete




4.1 Understands the regulatory and legislative frameworks, contractual environment, subsidies, professional ethics and roles of key government agencies associated with prescribing.


4.2 Prescribes and administers medications within legislation, codes, scope and specific area of practice, and according to established prescribingprocesses and NewZealand guidelines.


4.3 Demonstrates accountability and responsibility in prescribing practices using evidence to make risk-benefit assessment.


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4.4 Collaborates and consults with, and provides accurate information to the client and other health professionals about prescribing relevant interventions, appliances, treatments or medications.


4.5 Demonstrates an understanding of the use, implications, contra-indications and interactions of prescription medications andwith any other medications.


4.6 Applies knowledge of the age-related pharmacokinetic differences and the implications for prescriptive practice on clients within the specific area of practice.


4.7 Demonstrates an ability to limit and manage adverse reactions/ emergencies/crises.


4.8 Recognises situations of drug misuse, underuse and overuse, and acts appropriately.


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4.9 Monitors the effectiveness of the client’s response to prescribing and is actively involved in pharmacovigilance and drug monitoring.


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