Review of the National Competencies Standards for Australian Nurse Practitioners

National competency standards for Registered Nurses (RNs) were first adopted by the Australian Nursing and Midwifery Council in the early 1990s, and shortly thereafter, competency standards for Enrolled Nurses, Midwives and Nurse Practitioners (NPs) were developed. These standards were adopted by the Nursingand Midwifery Board of Australia in 2010. Subsequently, there have been substantial developments in both the role and scope of practice of NPs (Fotheringham, Dickie, & Cooper, 2011; Gardner & Gardner, 2005). The recent move to a national system of regulation and accreditation of health related courses provides an ideal opportunity for a review of the NP competency standards. This review will ensure that the standards accurately reflect contemporary NP practice, and that the educational preparation which NPs currently receive is appropriate for the tasks and duties which they perform as part of their role.

The aim of the project is to develop a revised document, called the “National competency standards for the NP”. The project is being undertaken for and funded by the Nursing and Midwifery Board of Australia under the management of the Australian Health Practitioner Regulation Agency (APHRA). It is expected that the document will reflect actual practice (rather than “aspirational” practice), be current and useful. 

The project will be undertaken in three phases.

Phase 1- Research Foundation Phase

• The project will include an extensive review of the literature surrounding the current scope of practice and role responsibilities of NPs across Australia, with some analysis of the international literature included where relevant. In particular, the review will note variations in practice between jurisdictions and/or sectors (and the possible reasons for these variations); the impact of employment arrangements on role and scope of practice, and relevant legislation and regulations.
• To supplement this literature review and synthesis, audio-taped interviews are planned to be held with the Chief Nurses and relevant professional officer/advisor for NPs in each state and territory and the APHRA representatives in each State/Territory. Interviews seek to identify how the NP competencies are monitored and whether additions or deletions are required in the Standards. Participants will also have an opportunity to check on the definitional accuracy of significant terms.
• An analysis of the gap between the current competency standards for the NP and the findings from the interpretative synthesis will be undertaken. A discussion document and revised standards will be submitted to the Nursing and Midwifery Board of Australia. Once approved by the Board, the discussion document and draft standards will be released for consultation with stakeholders in accordance with the guidelines.

Phase 2 – Consultation phase

• The consultation phase provides participants with an opportunity to review and comment on the draft of the revised standards. Three NP focus groups and several consumer and carer focus groups will be conducted. These groups will explore current understanding of the standards and their applicability to knowledge of what a NP is and does. Key informants, including those involved in the first phase will be contacted with the request to participate in telephone interviews. The key informant group will be increased to include the Council ofDeans of Nursing and Midwifery and representatives from the Australian College ofNP. Telephone interviews will be negotiated for the Chief Nurses, Information sheet 17/07/12
• Principal Advisors NP, AHPRA staff in each jurisdiction and representative from the CDNM and ACNP.
• Written comments will be sought from other interested parties via the AHPRA website. The discussion document and draft standards will be available in the form of a structured Survey Monkey response document. For consumers and carers, the researchers will circulate the structured response document through the national Consumer and Carer groups. A narrative synthesis will bring together the multiple data points into a coherent narrative (Popay et al., 2006)

Phase 3- Validation

• The revised standards will be validated through a real time observation process examining and documenting NP practice in a range of clinical settings throughout Australia. The elements of practice will be reviewed against the revised standards. Participants will be selected so as to reflect the range of settings, sectors and clinical areas within which NPs practice. A stratified sample of NPs based on distribution identified in Australian literature and triangulated with AHRPA registration details will be used. The draft standards will form the schedule for observation of samples of work. It is anticipated that 100 work samples will be collected.
• As the sample will be selected from across Australia, including remote locations, a team of nursing peer observers will be sourced from local service providers. Video conference sessions will be conducted to educate observers on the use of the observation schedule. Inter-rater reliability will be promoted through scenario-based simulation. The observers will record practice against the standards and using the structured response format will document practice that is not captured in the standards. Peer observers will be offered a per diem in recognition of their time.
• As part of the validation process, employers of NPs from across Australia will be asked to submit position descriptions to allow the team to map criteria against the draft standards. This will determine transferability to the practice setting. Further to this, the standards will be circulated to a sample of Consumers and Carers to determine effectiveness in informing this group of what HPs do and are.

References

Australian Nursing and Midwifery Council. (2006). National Competency Standards for the Nurse Practitioner. Melbourne: ANMC.

Fotheringham, D., Dickie, S., & Cooper, M. (2011). The evolution of the role of the Emergency Nurse Practitioner in Scotland: a longitudinal study. Journal of Clinical Nursing, 20(19-20), 2958-2967. doi: 10.1111/j.1365-2702.2011.03747.x

Gardner, A., & Gardner, G. (2005). A trial of nurse practitioner scope of practice. [Research Support, Non-U.S. Gov't]. Journal of Advanced Nursing, 49(2), 135-145.

Popay, J., Roberts, H., Sowden, A., Petticrew, M., Britten, N., Arai, L., . . . Rodgers, M. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. Lancaster: Institute for Health Research: Lancaster University. Information sheet 17/07/12

Review Team:

Professor Andrew Cashin, Discipline Lead, Professor of Nursing, Southern Cross University, Adjunct Professor Charles Darwin University and University of Technology, Sydney.

Dr ThomasBuckley, Senior Lecturer/ Co-ordinator Master of Nursing Nurse Practitioner, University of Sydney/ Southern Cross University

ProfessorSandra Dunn, Professor in Health and Clinical Practice, School of Health, Charles Darwin University.

Dr Marie Heartfield, Senior Lecturer Chronic Condition Management, Flinders Human Behaviour and Health Research Unit, Flinders University.

Associate Professor Donna Waters, Associate Dean (Research), Sydney Nursing School, University of Sydney.

Ms Julianne Bryce, Senior Federal Professional Officer, Australian Nursing Federation.

Ms Helen Gosby, Nurse Practitioner, Emergency Department, The Children’s Hospital, Westmead, NSW.

Adjunct Professor John Kelly, Chief Executive Officer of Aged and Community Services, Australia.

Ms Darlene Cox, Executive Director of the Health Care Consumers Association, ACT.

Dr Helen Stasa, Post Doctoral Research Fellow in Collaborative Research Network Project University of Sydney/ Southern Cross University.

Emeritus Professor Judith Donoghue, Senior Research Fellow, Collaborative Research Network Project University of Sydney/ Southern Cross

Information sheet 17/07/12