anp role peraturan nursalam 11

7/26/2019 ANP Role Peraturan Nursalam 11

1/84

aduate Course Syllabus

DV NCED NURSING PR CTICE

: Paced/home-stdy!lectre! discssio"

: # c$

:

rse Coordi"ator : Nrsalam

dents review the characteristics and competencies of advanced nursing practice and examine issues related to theelopment of the role of an advanced practice nurse. Students build on their understanding of the competencies of advanced

sing practice to develop a vision of a future role in advanced nursing practice. As well, students develop a funding proposal

a project related to advanced nursing practice. Finally, students consider various futures scenarios that may shape theiranced nursing practice.

ter completing this course, students should be able to:

1. Discuss the characteristics and competencies of advanced nursing practice!. "valuate application of the competencies of advanced nursing practice in their own practice

#. Discuss issues related to implementation of advanced nursing practice roles, in particular the role of the nurse

practitioner

$. Develop awareness of how advanced nursing practice %particularly the role of the nurse practitioner& is regulated inhis'her province'territory

(. Analy)e current issues influencing advanced nursing practice, with particular reference to the role of the nurse

practitioner*. "xplore various future scenarios for advanced nursing practice

+. rovide evidence-based clinical services to well clients of all ages and to those presenting with acute and chronic health

concerns, at a level appropriate to a beginning practitioner, includinga. health history and physical examination

b. clinical decision ma/ing

c. ordering of laboratory and diagnostic tests

d. prescription of medications

e. therapeutic communication

f. collaborative relationships

0. efer, to other health professionals, clients with health concerns that exceed the scope of practice of a beginningpractitioner offering clinical services

2. Demonstrate integration of medical and nursing management of health concerns of clients

s course consists of the following units

it 1 - Competencies of Advanced Nursing Practice I

his unit students review the characteristics of advanced nursing practice as identified by the 5anadian 6urses Association

consider the extent to which they are able to evidence these. Students then study the competencies of advanced nursingctice, reflecting on how the Advanced 6ursing ractice program has prepared them in these areas. 4t should be focused on

evelop multiple advanced assessment and intervention strategies within a

nt-centered framewor/ for individual clients, communities and populations
http://www.athabascau.ca/html/calendar/glossary/gradonline.htmhttp://www.athabascau.ca/html/calendar/glossary/gradonline.htm


2/84

se 9ualitative and 9uantitative data from multiple sources, often in ambiguous and complex situations, when ma/ingnical decisions and initiating and

naging change

naly)e the complex interaction of sociological, psychological and physiological processes, determinants of health andnts: lived experience

cipate and explain the wide range of client responses to actual or potential health problems and recommend action

it 2 - Competencies of Advanced Nursing Practice 2

his unit students review the characteristics of advanced nursing practice as identified by the 5anadian 6urses Association

consider the extent to which they are able to evidence these. Students then study the competencies of advanced nursing

ctice, reflecting on how the Advanced 6ursing ractice program has prepared them in these areas. 4t should be focused onuide decision-ma/ing in complex clinical situations

ngage clients and other team members in resolving issues at the individual, organi)ational and health-care system levels

entify and assess trends or patterns that have health implications for individuals, families, groups or communities

it - Competencies of Advanced Nursing Practice

his unit students review the characteristics of advanced nursing practice as identified by the 5anadian 6urses Associationconsider the extent to which they are able to evidence these. Students then study the competencies of advanced nursing

ctice, reflecting on how the Advanced 6ursing ractice program has prepared them in these areas. 4t should be focused on

enerate and incorporate new nursing /nowledge and develop new standards of care, programs and policies

an, initiate, coordinate and conduct educational programs based on needs, priorities and organi)ational resources andanage a wide range of patient responses to actual and potential health problems.

it ! - Advanced Nursing Practice "ole Implementation 1

his unit students study issues related to implementation of advanced nursing practice, including phases of role development,ministrative support for advanced nursing practice, and evaluation of advanced nursing practice. 4ssues related to

repreneurial opportunities and regulation of practice are explored. 3he unit closes with a loo/ at issues that may influence

future of advanced nursing practice.

it # - Advanced Nursing Practice "ole Implementation 2

his unit students study issues related to legal practice certainty from the government. 4ssues related to Nursing $ill %raft

explored. 3he unit closes with a loo/ at issues that may influence the future of advanced nursing practice.

it & - "esearc' in Advanced Nursing Practicesearch s/ills are an integral competency of advanced nursing practice and advanced practice nurses will be expected toically review research and utili)e research findings. As well, it is li/ely that advanced practice nurses will be expected tontify the need for and facilitate the development of research-based projects in their wor/ settings.

it ( ) *ealt' "esearc' +et'ods

oduction to the scientific method, experimental, 9uasi-experimental, descriptive and epidemiological research.

asurement issues 9uestionnaire development, reliability and validity of data, issues of sampling and sample si)e. "thicsesearch. Descriptive statistics, estimation and confidence intervals, inferential statistical tests. 8se of SSS statistical

tware. "lements of critical appraisal.

it , - Clinical Practicum and Community Assessment Processes and "e.uirements

s unit reviews the re9uirements of the clinical practicum and community assessment. 3he focus of the clinical practicumcommunity assessment of this course is =closure.= Students end their student relationship with their preceptors and with

mbers of the community with whom they have developed relationships during your community assessment.

it / - Advanced Nursing Practice Compre'ensive 0amination

ring this course students are re9uired to complete a comprehensive examination. 3he examination evaluates /nowledge inh the clinical services and community health development components of advanced nursing practice. Students must pass the

mprehensive examination in order to graduate from the Advanced 6ursing ractice program. 3his unit provides information

ut the examination and suggestions to assist students in preparing for the examination.

it 1 ) Clinical 3eaders'ip


3/84

e unit consists of clinical leadership approaches'theories, decision ma/ing team building reflective practice, managingflict facilitating change and creating empowered wor/ environments. 3hese topics will be explored in the context of the

temporary healthcare environment and viewed from an ethico-legal stance. 4ncluded will be /nowledge of contemporary

ues in health care and trends in the development of effective clinical leadership in professional practice.

it 11 ) %evelopmental *ealt'

rrent research-based evidence on developmental and population health. 4nteraction of ecological, biological, psychological

social determinants. Developmental lifespan, including neurobiological, cognitive, social, emotional and moral

elopment. >io-psycho-social and cultural aspects utilising appropriate research findings and conceptual framewor/s to

ess, plan, implement and evaluate interventions targeting individuals, families and communities.

it 12 ) *ealt' Pro4ect Preparation

velopment of an investigation into an individual area of speciality. Development of a critical review of related literature,

dy design and methodology for the proposal in consultation with the project supervisor. reparation of a project'researchposal.

it 1 - Pro4ect %evelopment in Advanced Nursing Practice

his unit students learn how to develop project proposals.

it 1! - Preparation for Advanced Nursing Practice

his unit students consider possible futures of advanced nursing practice, including both components of extended healthvices and community health development.

ference

Affara F ? Schober lac/well

Association of egistered 6urses of 6ewfoundland and abrador. %!@@+&. Advanced practice-clinical nurse specialist

Bosition statementC. St. ohn:s Author.

De;rasse, 5., ? 6ic/lin, E. %!@@1&. Advanced nursing practice ld hat, new design. 5anadian ournal of 6ursing

eadership, 1$%$&, +-1!.

Furlong, "., ? Smith, . %!@@(&. Advanced nursing practice olicy, education and role development. ournal o

5linical 6ursing, 1$, 1@(2-1@**.

Gamric, A., Spross, ., ? Ganson, 5. %!@@2&.Advanced nursing practice: An integrative approach%$th ed.&. St. ouis"lsevier Saunders.

>ryant-u/osius, D., ? Di5enso, A. %!@@$&. A framewor/ for the introduction and evaluation of advanced practice

nursing roles. ournal of Advanced 6ursing, $0%(&, (#@-($@.

>ryant-u/osius, D., Di5enso, A., >rowne, ;., ? inelli, . %!@@$&. Advanced practice nursing roles Development,

implementation and evaluation. ournal of Advanced 6ursing, $0%(&, (12-(!2.

3extboo/s and readings from other Advanced 6ursing ractice courses will be used as appropriate.


4/84

Advanced Nursing Practice

A National Framework

2008

www.cna-aiic .ca
http://www.cna/http://www.cna/


5/84

This document has been prepared by CNA in the pursuit of

CNAs mission, vision and goals. It has been approved by theCNA Board of Directors.

All rights reserved. ermission to photocopy or do!nload for individual use is granted.

"urther reproduction in any manner, including posting to a!ebsite, is prohibited !ithout prior !rittenpermission of the publisher. ermission may be obtainedby contacting CNA at permissions#cna$aiic.ca.

% Canadian Nurses Association

&' Drive!ay(tta!a, (N )* +*

Tel.- +/$*/0$*+// or +$1''$/+$12'2"a3- +/$*/0$/&*'!!!.cna$aiic.ca

"ebruary *''1

I4BN 501$+$&&++5$ *+*$/
http://www.cna-aiic.ca/http://www.cna-aiic.ca/


6/84

Contents

Introduction . . . +

volution of Advanced Nursing ractice &

De6nition and Characteristics . . . 5

De6nition . . . +'

Characteristics . . . +'

ducational reparation +/

7oles +&

7egulation +5

Competencies . . . *+

Clinical Competencies . . . **

7esearch Competencies */8eadership Competencies *2

Consultation and Collaboration Competencies . . . *

Impact of Advanced Nursing ractice *5

4upport for Advanced Nursing ractice . . . //

8oo9ing to the "uture . . . /0

:lossary 2'

Appendi3 A- A "rame!or9 2*

Appendi3 B- The Consultation rocess 2/

Appendi3 C- ;embers of the National


7/84

Advanced nursing practice

is an umbrella term describing an

advanced level of clinical nursing

practice that maximizes the use of

graduate educational preparation,

in-depth nursing knowledge and

expertise in meeting the health needs

of individuals, families, groups, commu-

nities and populations. t involves

anal!zing and s!nthesizing knowledge"

understanding, interpreting and appl!ing

nursing theor! and research" and devel-

oping and advancing nursing knowledge

and the profession as a whole.


8/84

ntroduction

4ociety and its health$care needs are al!ays

evolving. As a result, health care in Canada

today faces many challenges, including rising

costs, shortages of professionals, an aging

population, the introduction of ne! technology and

di=iculties !ith access to care. The

demand for collaborative, innovative clinical

practitioners to act as leaders in health care

has never been stronger.

Advanced Nursing Practice : A National Framework 1


9/84

4ociety and its health$care needs are al!ays evolving. As a result, health care in

Canada today faces many challenges, including rising costs,

shortages of professionals, an aging population, the introduction of

ne! technology and di=iculties !ith access to care. The demand

for collaborative, innovative clinical practitioners to act as

leaders in health care has never been stronger. Nurses in

advanced nursing practice are !ell positioned to respond to the

evolution of health care. In particular, advanced nursing practice

plays a 9ey role in meeting the health needs of Canadians, by

building nursing 9no!ledge, advancing the nursing profession

and contributing to a sustainable and e=ective health$care

system.

The Board of Directors of the Canadian Nurses Association >CNA?

approved the

9ey elements of a national frame!or9 for advanced nursing

practice in @une +555. The 6rst edition of Advanced Nursing

Practice# A National $ramework!as published in ;ay *'''. That

document de6ned advanced nursing practice, identi6ed its

characteristics and competencies,+ and described the necessary

educational preparation,

the various domains of practice and potential roles, and its

regulation. The frame$

!or9 !as deliberately broad, in part to allo! for variations among

urisdictions and in part to allo! for evolution of advanced

nursing practice roles. In ;arch *''*,

the CNA Board of Directors revised

one of

...advanced nursing practice

pla!s a ke! role in meeting the

health needs of Canadians ,

b! building nursing knowledge ,

advancing the nursing profession

and contributing to a sustainable

and e%ective health -care s!stem .


10/84

e 9ey elements of the frame!or9 by estab$

hing a graduate

greein nursing as the

nimum educational

uirement for advanced

rsing practice.

The overall obective of this national

frame$

!or9 is to promote a common

understanding

of advanced nursing practice in

Canada and

1 Terms defined in the glossary are resented in italics on first aearance in the te!t"

2 Advanced Nursing Practice : A NationalFramework


11/84

thereby to increase consistency in role de6nition,

curricula and competency development.

The frame!or9 has already been used

for a variety

of purposes, including developing

educational

courses, outlining concepts for

research, shaping

government position statements and

interpreting

advanced nursing practice for employers,

the public,

other health$care !or9ers and policy$

ma9ers.

In *''&, CNA organied the

Dialogue on

Advanced Nursing ractice to

bring together

n &arch ' ( ( ' , the CNA )oard of

*irectors revised one of the ke!

elements of the framework b!

establishing a graduate degree in

nursing as the minimum

educational re+uirement for

advanced nursing practice .

nursing sta9eholders $ including educators, policy$ma9ers, administrators and

representatives of nursing organiations $ to discuss !hat could

be learned from

the e3isting advanced nursing practice roles, to identify !hat

more could be done

to support the evolution of advanced nursing practice and to

identify principles

and strategies that !ould promote the introduction of other

advanced nursing

practice roles . articipants identi6ed the national frame!or9

for advanced

nursing practice as a useful guide in the continued

development of this form of

practice in Canada and recommended that it be updated


12/84

periodically to respond

to the needs of its users and to reect changes in health$care

system environments.

The Canadian Nurse ractitioner Initiative, launched in *''2, helped

in the development of a frame!or9 for the integration and

sustainability of the nurse practitioner role in Canadas health$care

system. 7ecommendations for practice, education, legislation and

regulation, and health human resources planning !ere considered

in the current revision of the advanced nursing practice

frame!or9.

Advanced Nursing Practice : A National Framework #


13/84

The advanced nursing practice frame!or9 contains the follo!ing 9ey elements-

E evolution of advanced nursing practice

E de6nition and characteristics

E educational preparation

E roles

E regulation

E competencies

E impact of advanced nursing practice

E support for advanced nursing practice

$ Advanced Nursing Practice : A NationalFramework


14/84

volution of Advanced

Nursing Practice

Advanced nursing practice has emerged

over the past decades as health$care systems

and governments around the !orld have come

to recognie Fthat optimiing the nursing

contribution to health care through e3panding

their role is an e=ective strategy for improving

health servicesG >4chober H A=ara, *'', p. *?.

Advanced Nursing Practice : A National Framework %


15/84

Nurses can choose from

a variet! of diverse and

e+uall! valuable practice

opportunities , of which

advanced nursing practice

is one .

Advanced nursing practice* has emerged over the past

decades as health$care systems and

governments around

the !orld have come to recognie Fthat

optimiing the

nursing contribution to health care through

e3panding

their role is an e=ective strategy for

improving health

servicesG >4chober H A=ara, *'', p. *?.

Despite the

common development of this realm of

nursing practice,

the understanding of !hat constitutes advanced nursing practice

varies from one country to another and even !ithin countries.

Advanced practice nurses are vie!ed as e3perts in their respective

domains, engaged in activities that e3tend beyond the narro!

application of technically comple3 procedures. In particular, advanced

nursing practice involves the sophisticated use of 9no!ledge and s9ills

>Daly H Carn!ell, *''/, p. +/?.

T!o advanced nursing practice roles are recognied in Canada today- the clinicalnurse

specialistand the nurse practitioner. These t!o roles evolved from

di=erent roots. Clinical nurse specialists 6rst emerged in the +50's

as client care gre! more comple3. Their role !as to provide clinical

guidance and leadership to nursing sta= managing comple3 care, to

improve the uality of care and to promote evidence$based practice.

Cutbac9s in the +51's and +55's led to the elimination of many of

these positions, but as concern over the uality of care builds in the

early *+st century, there is reason to believe that the clinical nurse

specialist role !ill regain prominence.


16/84

In Canada, the origin of the nurse practitioner lies in the !or9 of

nurses !ho, decades ago,

provided care that !as other!ise unavailable in rural and remote areas.

Nurse practitioners

gained formal recognition in the +50's, !hen this role !as

recommended by policy$ma9ers

as a !ay of providing health care to isolated populations. ducation

programs !ere started,

2 Advanced nursing ractice is used &y 'NA as the um&rella term for the advanced level of clinicalractice descri&ed inthis framework( individuals in advanced nursing ractice roles are referred to in this document asadvanced ractice nurses"Nurses refers to registered nurses"

) Advanced Nursing Practice : A NationalFramework


17/84

Canadian advanced practice nurses have

but a perceived oversupplyof

physicians, a lac9 of

enabling

legislation and problems

related

to remuneration caused

interest

to !ane. Interest !as

re9indled

in the +55's by health$

care

the education , clinical expertise , leadership

skills and understanding of organizations , health

polic! and decision -making to pla! an important

role in client and health -care s!stem outcomes now

and in the future .

reform, an increased demand for access to primary health care and

the need for integrated care. The Canadian Nurse ractitioner

Initiative !as launched in *''2 to develop a panCanadian frame!or9

to encourage full integration of nurse practitioners into Canadian

health care.

As demand, technology and 9no!ledge change the !ays in !hich

health care is delivered,

interest in advanced nursing practice is on the rise. Trends in the

delivery of health care

are providing opportunities for nurses to e3pand current roles and

create ne! ones. Nurses

can choose from a variety of diverse and eually valuable practice

opportunities, of !hich

advanced nursing practice is one. As nurses move along the continuum

of e3perience and

education, they acuire additional competencies that become

incorporated into their

practice. This evolution enables nurses to contribute to the health$care system in ne!

!ays.


18/84

Although all nurses contribute to the health$care system through their !or9 in

clinical practice, education, administration, research and policy, advancednursing

practice focuses on the clinical domain in a !ide array of practice settings.Clinical

practice not only incorporates direct client care but also involves a supportiveand

consultative role. Canadian advanced practice nurses have the education, clinical

e3pertise, leadership s9ills and understanding of organiations, health

policy and decisionma9ing to play an important role in client and

health$care system outcomes no! and

in the future.

Advanced Nursing Practice : A National Framework *


19/84



20/84

*enition and

Characteristics

*enition

Advanced nursing practiceis an umbrella term

describing an advanced level of clinical nursing

practice that ma3imies the use of graduate educational

preparation, in$depth nursing 9no!ledge and e3pertise in

meeting the health needs of individuals, families, groups,

communities and populations.

Advanced Nursing Practice : A National Framework +


21/84

*enition

Advanced nursing practice is an umbrella term describing an

advanced level of clinical nursing practice that ma3imies the use

of graduate educational preparation, in$depth nursing 9no!ledge

and e3pertise in meeting the health needs of individuals, families,

groups, communities and populations. It involves-

E analying and synthesiing 9no!ledge

E understanding, interpreting and applying nursing theory and research and

E developing and advancing nursing 9no!ledge and the profession as a !hole.

Characteristics

In advanced nursing practice, nurses build on their e3pertise in

a specialty area,

integrating and consistently displaying the follo!ing featuresand characteristics-

E provision of e=ective and e=icient care, delivered !ith

a high degree of autonomy, to an identi6ed population

E demonstration of leadership and initiation of change to

improve client, organiation and system outcomes

E deliberate, purposeful and integrated use of in$depthnursing 9no!ledge, research and clinical e3pertise, as

!ell as integration of 9no!ledge from other disciplines

E depth and breadth of 9no!ledge that dra!s on a !ide

range of strategies

to meet the needs of clientsand to improve access to and

uality of care

E ability to e3plain and apply the theoretical, empirical,

ethical and e3periential foundations of nursing practice


22/84



23/84

E understanding, development and dissemination of

evidence$based nursing 9no!ledge

E ability to initiate or participate in planning,

coordinating, implementing

and evaluating programs to meet client needs and

support nursing practice

E use of 9no!ledge$transfer techniues to put research$

based 9no!ledge into practice

E demonstration of advanced udgment and decision$ma9ing s9ills and

E critical analysis of and inuence on health policy.


24/84



25/84



26/84

ducational Preparation

The minimum educational preparation for

advanced nursing practice is a graduate degree in

nursing. A nurse !ith this type of graduate

preparation has a thorough grounding in the

theoretical foundation of nursing and can

promote nursing research, generate ne!

9no!ledge and use academic preparation,

synthesis and 9no!ledge$transfer s9ills to

interpret and incorporate ne! 9no!ledge

into clinical practice.

Advanced Nursing Practice : A National Framework 1#


27/84

The minimum educational preparation for advanced nursing practice is a graduate

degree in nursing. A nurse !ith this type of graduate preparation has a thorough

grounding in the theoretical foundation of nursing and can promote

nursing research,

generate ne! 9no!ledge and use academic preparation, synthesis

and 9no!ledge$

transfer s9ills to interpret and incorporate ne! 9no!ledge into

clinical practice.

Although a graduate degree is essential for advanced nursing

practice, nurses !ho have completed one or more graduate degrees

cannot assume that their practice is at an advanced level on the

basis of these educational credentialsalone. It is the combination of

graduate education and clinical e3perience that allo!s nurses to

develop the competencies reuired in advanced nursing practice.

8i9e all nurses, advanced practice nurses are committed to lifelong

learning. In addition to pursuing such learning for themselves, they

are committed to promoting, leading and contributing to the lifelong

learning of others.


28/84

1$ Advanced Nursing Practice : A NationalFramework


29/84

oles

Advanced nursing practice focuses on clinical

practice, !hether through a direct relationship

!ith clients or through a supportive and

consultative role. Nurse educators, researchers

and administrators must demonstrate compe$

tencies in advanced nursing practice and

must have clinical practice as a signi6cant part

of their role if they are to be considered as

functioning !ithin advanced nursing practice.

Advanced Nursing Practice : A National Framework 1%


30/84

Advanced nursing practice focuses on clinical practice, !hether

through a direct relationship !ith clients or through a supportive

and consultative role. Nurse educators, researchers and

administrators must demonstrate competencies in advanced

nursing practice and must have clinical practice as a signi6cant

part of their role if they are to be considered as functioning !ithin

advanced nursing practice.

(nly t!o advanced nursing practice roles are recognied in Canada

today- the clinical nurse specialist and the nurse practitioner. These

t!o roles are fundamentally di=erent. Clinical nurse specialists

provide e3pert nursing care for specialied client populations. They

play a leading role in the development of clinical guidelines and

protocols,

promote the use of evidence, provide e3pert support and

consultation, and facilitate system change >Association of

7egistered Nurses of Ne!foundland and 8abrador,

*''0?. In contrast, nurse practitioners provide direct care

focusing on health promotion and the treatment and management

of health conditions. They are Fregistered

nurses !ith additional educational preparation and e3perience

!ho possess and

demonstrate the competencies to autonomously diagnose, order

and interpret

diagnostic tests, prescribe pharmaceuticals and perform speci6c

procedures !ithin

their legislated scope of practiceG >CNA, *''a?.

/ith a focus on health promotion and disease

prevention , both the clinical nurse specialist and the

nurse practitioner 0enhance the provision of timel! ,


31/84

accessible , cost -e%ective and +ualit! health care for all

Canadians 1

2CNA , ' ( ( 3 b , p . 4 5 .

1) Advanced Nursing Practice : A NationalFramework


32/84

06he clinical nurse specialist pla!s

Clinical nurse specialists and nursepractitioners

spend di=erent amounts of time providingdirect

clinical care, but both roles incorporateeducation,

research, consultation and leadershipcomponents.

Client, organiation and system needs !illhelp to

shape and determine the role of individualclinical

nurse specialists and nurse practitioners.

CNA, *''b, p. /?. It

is

anticipated that ne! advanced nursingpractice

roles !ill develop to meet the e3isting andemerging

health$care needs of Canadians. "or e3ample,several

urisdictions are e3ploring an advancednursing

practice role !ithin anesthesia care.

Advanced Nursing Practice : ANational Framework


33/84

pivotal role in the provision of

afe , e%ective , evidence -based care , supporting nurses to ensure that

e! maximize their skills

nd abilities . 1

, -ernadine .allis/ clinical nurse secialist

.innieg/ 0anito&a

nurse practitioner complements

ther than replaces other health -

are providers , bridges the gap

service deliver! for patients , expands care options , and supports a shift

wellness -based care . 1

, 0ary Nugent/ nurse ractitioner

Ta&er/ Al&erta

1*


34/84



35/84

egulation

A frame!or9 describing advanced nursing

practice allo!s for a coordinated national

approach, permits e3ibility among provinces

and territories, and allo!s ne! roles to develop.

4uch a coordinated approach is necessary to

ensure that the public has access to consistent,

high$uality nursing services across the country.

It !ill also facilitate labour mobility for

advanced practice nurses !ho are subect to

speci6c provincial or territorial legislation.

Advanced Nursing Practice : A National Framework 1+


36/84

A frame!or9 describing advanced nursing practice allo!s for a

coordinated national

approach, permits e3ibility among provinces and territories, and

allo!s ne! roles to develop. 4uch a coordinated approach is

necessary to ensure that the public has access to consistent, high$

uality nursing services across the country. It !ill also facilitate

labour mobility for advanced practice nurses !ho are subect to

speci6c provincial or territorial legislation.

Advanced practice nurses are registered nurses !ho are licensed by

and accountable to

the registered nursing regulatory body established by legislation in

each province and

territory. "or many advanced practice nurses, additional regulation

and standards are not

reuired because they practise !ithin the scope of registered nursing

in their respective

urisdictions. In some cases, the scope of practiceincludes

additional responsibilities,

such as prescriptive authority, that may reuire additional regulatory

authority, but these

additional authorities are all !ithin the scope of practice of nursing.

The regulation of nursing practice is intended to safeguard the

public by ensuring that nurses meet standard levels of 9no!ledge

and education. In Canada, regulatory titles, including Fregistered

nurseG and F7N,G are protected, but other titles, such as Fnurse,G

Fnurse practitionerG and FN,G may or may not be protected according

to the legislation of speci6c urisdictions.

Currently, the only advanced nursing practice

A framework describing advanced

nursing practice allows for a

coordinated national approach , permits

7exibilit! among provinces and territories , and allows

new


37/84

roles to develop .

20

role !ith additional regulation and title protection

in Canada is the nurse practitioner,

although the speci6c title used varies

among the provinces and territories. As

ne! roles in advanced nursing

practice emerge, they may or may not reuire

additional legislation and regulation.

Advanced Nursing Practice : A NationalFramework


38/84

Competencies

Competencies are the speci6c 9no!ledge, s9ills,

udgment and personal attributes reuired for a

registered nurse to practise safely and ethically in

a designated role and setting >CNA, *''&?. Core

competencies for advanced nursing practice are

based on an appropriate depth, breadth and range of nursing

9no!ledge, theory and research, enhanced by clinical

e3perience.



39/84

Competencies are the speci6c 9no!ledge, s9ills, udgment and personal

attributes reuired

for a registered nurse to practise safely and ethically in a designated

role and setting

>CNA, *''&?. Core competencies for advanced nursing practice are

based on an appropriate

depth, breadth and range of nursing 9no!ledge, theory and research,

enhanced by clinical

e3perience./ They cut across specialty lines and are e3hibited by all

advanced practice nurses.

This frame!or9 separates competencies into four categories- clinical,

research, leadership,

and consultation and collaboration. Jo!ever, it is the e=ective and

simultaneous interaction,

blending and e3ecution of 9no!ledge, s9ills, udgment and personal

attributes in a !ide

variety of practice environments that characteries advanced nursing

practice.

Clinical Competencies

The cornerstone of advanced nursing practice is e3pertise in a specialized area ofnursing.

Through a holistic and integrated approach, the nurse !or9s in

partnership !ith the client and other members of the health$care team

in the provision of comprehensive care.

An advanced practice nurse integrates e3tensive clinical e3perience

!ith theory, research and in$depth nursing and related 9no!ledge to-

E develop multiple advanced assessment and intervention

strategies !ithin a

client$centred frame!or9 for individual clients,communities and populations


40/84

E use ualitative and uantitative data from multiple sources,

often in ambiguous and comple3 situations, !hen ma9ing

clinical decisions and initiating and

managing change

E analye the comple3 interaction of sociological, psychological

and physiological processes, determinants of health and clients

lived e3perience

# 'ometencies secific to the nurse ractitioner role and resonsi&ilities are identified in 'anadian Nurse Practitioner:'ore 'ometency Framework 1'NA/ 200%"



41/84

E anticipate and e3plain the !ide range of client

responses to actual or potential health problems and

recommend action

E guide decision$ma9ing in comple3 clinical situations

E engage clients and other team members in resolving issues

at the individual, organiational and health$care system

levels

E identify and assess trends or patterns that have health

implications for individuals, families, groups or

communities

E generate and incorporate ne! nursing 9no!ledge and

develop ne! standards of care, programs and policies

E plan, initiate, coordinate and conduct educational

programs based on needs, priorities and organiational

resources and

E manage a !ide range of patient responses to actual and

potential health problems.

esearch Competencies

:enerating, synthesiing and using research evidence is

central to advanced nursing practice.

An advanced practice nurse is able to-

E identify and implement research$based innovations for

improving client care, organiations or systems

E as either primary investigator or collaborator !ith other

members of the health$care team or community, identify,

conduct and support research that enhances or bene6ts

nursing practice


42/84

Advanced Nursing Practice : A National Framework 2#


43/84

Advanced practice

nurses are leaders in

the organizations and

communities where the!

work .

E evaluate current practice at individual and system levels in

light of research 6ndings

E collect data on, and evaluate the outcomes of,

advancednursing practice for clients, the nursing

profession and the

health$care system

E critiue, interpret, apply and disseminate evidence$based 6ndings and

E contribute to nursing and the health$care system by disseminating ne!

9no!ledge through formal and informal channels,

including presentationand publication at the local, regional, national and

international levels.

8eadership Competencies

Advanced practice nurses are leaders in the organiations and

communities !here they !or9. They are agents of change,

consistently see9ing e=ective ne! !ays to practise, to improve the

delivery of care, to shape their organiations, to bene6t the public

and to inuence health policy.

An advanced practice nurse demonstrates leadership by-

E advocating for individuals, families, groups and

communities in relation to treatment, the health$care systemand policy decisions that a=ect health and uality of life

E identifying the learning needs of nurses and other members

of the health$care

team and 6nding or developing programs and resources to

meet those needs

Ementoringand coaching nursing colleagues, other

members of the healthcare team, and students


44/84

E advocating for and promoting the importance of health$

care access and advanced nursing practice to nurses and

other health professionals, the public, legislators and

policy$ma9ers

2$ Advanced Nursing Practice : A NationalFramework


45/84

E contributing to and advocating for an organiational

culture that supports

professional gro!th, continuous learning and collaborative

practice

E evaluating programs in the organiation and the

community and developing

innovative approaches to comple3 issues

E understanding and integrating the principles of

resource allocation and

cost$e=ectiveness in organiational and system$level

decision$ma9ing

E identifying gaps in the health$care system and developing partnerships to

facilitate and manage change

E developing and clearly articulating a vision for nursing

practice, inuencing

and contributing to the organiations and the health$care

systems vision

and implementing approaches to realie that vision

E advising clients, colleagues, the community, health$care institutions and

policy$ma9ers on issues related to nursing, health and

health care

E identifying problems and initiating change to

address challenges at the

individual, organiational or system level and

E understanding legislative and socio$political issuesthat inuence health

policy, and building strategies to improve health, health$

care access and

healthy public policy.


46/84

Advanced Nursing Practice : A National Framework 2%


47/84

Consultation and Collaboration Competencies

=ective collaboration and communication !ith clients and others on

the health$care team represent important aspects of any nursing

practice. The ability to consult and collaborate !ith colleagues

across sectors and at the organiational, provincial, national and

international level is a characteristic of nurses in advanced practice.

A nurse in advanced practice is able to-

E initiate timely and appropriate consultation, referrals and

collaboration !ith other health$care providers

E consult and collaborate !ith members of the health$care

team to develop uality$improvement and ris9$

management strategies

E !or9 !ith others to gather and synthesie ualitative

and uantitative information on determinants of health

from a variety of sources

E practise collaboratively and build e=ective coalitions

E apply theories related to group dynamics, roles and organiations

0Collaboration is a complex process re+uiring knowledge sharing

and 9oint responsibilit! for patient care ,

management and outcomes . 1

, 3andra 4uke/ nurse

ractitioner

5alifa!/ Nova

3cotia


48/84

2) Advanced Nursing Practice : A NationalFramework


49/84

E demonstrate 9no!ledge and s9ill in communication,

negotiation and conict

resolution, including the ability to analye, manage and

negotiate conict

E clearly articulate the contribution of advanced nursing

practice !ithin the interprofessional health$care team

E participate in collaborative proects !ith academic

institutions and maintain cross$appointments and

E advocate for changes in health policy by participating on

regional, provincialK territorial, and federal committees that

inuence decision$ma9ing at

those levels.


50/84

Advanced Nursing Practice : A National Framework 2*


51/84



52/84

mpact of Advanced

Nursing Practice

Advanced nursing practice has evolved to meet the

demands of modern health care through

increasingly advanced 9no!ledge and s9ills.

It is not merely technical and educational

progress that has driven the development of

advanced nursing practice the health needs

of clients and the gro!ing comple3ity of care

have also contributed.

Advanced Nursing Practice : A National Framework 2+


53/84

Advanced practice nurses

have used their experienceAdvanced nursing practice has evolved to meet the

and education to take nurs -demands of modern health care through increasingly

ing practice to new levels ,

as the! have moved from a

supportive to a leading role in

client care .

advanced 9no!ledge and s9ills. It is not merely technical

and educational progress that has driven the

development

of advanced nursing practice the health

needs of

clients and the gro!ing comple3ity of care

have also

contributed. Advanced practice nurses have

used their

e3perience and education to ta9e nursing practice to ne! levels,

as they have moved from a supportive to a leading role in client

care.

vidence about the bene6ts of advanced nursing practice is no!

building. Cunningham

>*''2, p. *+5? has stated that nurses in advanced nursing practice

FenrichG health care by

adding value to the delivery of health$care services. Bryant$8u9osius,

DiCenso, Bro!ne

and inelli >*''2, p. &*? found that advanced practice nurses may

improve client and

health$care system outcomes related to health status, functional

status, uality of life,

satisfaction !ith care and cost e=iciency. De:rasse and Nic9lin

>*''+, p. 1? reported

that the use of advanced practice nurses decreased

the number of hospital admissions and emergency

0Clinical nurse specialists , with

their focus on patient care from a

nursing perspective , can advance

nursing practice through education,

research and the development of

s!stems that meet patient and


54/84

famil! needs . 1

, 6rlene 3ea&orne/ clinical nurse secialist

5amilton/ 7ntario

#0

department visits, shortened lengths of stay and

resulted in cost savings for the institutions

!here they !ere employed. (ther

outcomes that improved !ith advanced

nursing practice included fe!er

readmissions for heart failure, shorter

lengths ofstay !hen patients !ere readmitted and

lo!er rates

of urinary tract infections, s9in

brea9do!n and

pneumonia >)leinpell, *''0, p. *'?.

)leinpell also reported that advanced

nursing practice helped

promote evidence$based care, improved patients



55/84

0Clinical nurse specialists support and

teach other health -care providers and

adherence to health promotion and builtthe

evidence base of nursing. Advanced

nursing practice is an innovative and

e3citing develop$

ment that provides nurses !ith an

opportunity to !or9 at an advanced

level of clinical practice >"urlong H

4mith, *''&, p. +'*?.

can in7uence and improve health care

at the individual and the s!stem level . 1

, 8inda 9ead Paul/ clinical nurse

secialist'algary/ Al&erta

The role of the nurse practitioner has been studied for many years. In a literature

revie! commissioned by the College of 7egistered Nurses of Nova

4cotia and released in @une *''0, 4angster$:ormley reported that

client satisfaction and education are the most commonly researched

outcomes of nurse practitioner care. Jo!ever, the author !ent on to

describe solid evidence for many other bene6ts to care- nurse

practitioners are more li9ely to follo! practice guidelines, and their

patients have shorter stays, fe!er readmissions and other

successful outcomes.

The body of research on advanced nursing practice is smaller than

is the case for many

other topics in nursing. In another revie! of recent research,

(erman and "loyd

>*''*, p. +2'? identi6ed and described this lac9 of evidence. They

found that researchon outcomes has focused too much on cost savings, ignoring

important aspects of the

!or9 of advanced practice nurses such as resolution of symptoms,

enhancement of

clients uality of life and improvements in 9no!ledge among

patients and families.

They called for advanced practice nurses to lead more research on theresults of speci6c


56/84

nursing interventions.

"or their annotated bibliography, published in *''2, "ulton and

Bald!in revie!ed

0' research papers that had been !ritten by nurses or had

e3amined the impact of

clinical nurse specialists. "ulton and Bald!in identi6ed many

!ays in !hich clinical

nurse specialists improved care, such as reducing the number of

visits to emergency

departments by clients !ith asthma and improving prenatal care

of and generating

Advanced Nursing Practice : A National Framework #1


57/84

better outcomes for very lo! birth !eight babies they also found that cancer

patients !hose care team included a clinical nurse specialist had

fe!er complications. erhaps the most important aspect of the

article !as the scope of information it

covered- in addition to the research pieces, the authors revie!ed /+

publications about

program development and evaluation and *& anecdotal accounts.

These numbers are

a sign that the 9no!ledge base for advanced nursing practice is

building, but "ulton

and Bald!in >*''2, p. **? !arned that Falthough the number of

articles had drastically

increased, the scope of everyday Lclinical nurse specialistM

accomplishments is not

completely captured in published !or9. LClinical nurse specialistsM

improve care

practice on a daily basis.G


58/84

#2 Advanced Nursing Practice : A NationalFramework


59/84

:upport for Advanced

Nursing Practice

Advanced nursing practice must be supported at many

levels if it is to operate e=ectively and provide a full

range of bene6ts to clients, other members of the

health team, organiations and the community as a

!hole.

Advanced Nursing Practice : A National Framework ##


60/84

Advanced nursing practice must be supported at many levels if it is to

operate e=ectively

and provide a full range of bene6ts to clients, other members of the

health team, organiations and the community as a !hole. The

;niversit! ;icevs9i et al., *''2, p. &/?.

To ourish, advanced nursing practice needs-

E leadership by CNA, other nursing organiations and

governments to encourage creation of positions for nurses in

this type of practice

E leadership by CNA and other nursing organiations to

identify opportunities for the introduction of future advanced

nursing practice roles that align !ith current and emerging

population health and system needs

E health human resources planning that ta9es a pan$

Canadian, interprofessional approach and that is based on a

conceptual frame!or9

E organiational and administrative support and resources to

implement, develop and sustain various aspects of advanced

nursing practice

E communication and education tools to inform the public, policy$

ma9ers, adminis$

trators and other professions about the contributions of advanced

nursing practice

E human resources policies that allo! nurses to pursue graduate education


61/84

E specially designed graduate curricula based on the

characteristics and competencies of advanced nursing

practice

E e3ible path!ays to graduate nursing education

#$ Advanced Nursing Practice : A NationalFramework


62/84

E support for professional development and lifelong learning

E funding for research about and by nurses in advanced nursing practice

E interprofessional education and organiations that foster team !or9

E resources to put in place the positions, technology,

administrative infrastructure and culture for advanced practice

nurses to !or9 most e=ectively and

E policy processes that promote advanced nursing practice and

are shaped by the e3pertise of advanced practice nurses.

Advanced Nursing Practice : A National Framework #%


63/84

#) Advanced Nursing Practice : A NationalFramework


64/84

8ooking to the $uture

Canadas health$care needs are gro!ing

!ith the aging of the population, continued

shortages in the supply of health human

resources, increasing comple3ity of the health$

care system and mounting pressure to contain

costs. Advanced nursing practice is helping

to meet these gro!ing needs. To have a far$

reaching impact, ho!ever, advanced nursing

practice must be promoted and sustained.

Advanced Nursing Practice : A National Framework #*


65/84

Canadas health$care needs are gro!ing !ith the aging of the population, continued

shortages in the supply of health human resources, increasing

comple3ity of the health$care system and mounting pressure to

contain costs. Advanced nursing practice is helping to meet these

gro!ing needs. To have a far$reaching impact, ho!ever, advanced

nursing practice must be promoted and sustained.

Ne! advanced nursing practice roles should be introduced only in response to the health$

care needs of Canadians and must be based on solid evidence of those

needs. CNAs position statement National Planning for Bryant$8u9osius H DiCenso, *''2, p. &/+

*''2, p. &/*? presented

the A

frame!or9, a Fparticipatory, evidence$based,

patient$centred

process for Ladvanced nursing practiceM role

development,

implementation and evaluation,G !hich set out

nine steps for

determining !hether a ne! advanced nursing

practice role is

needed and !hether it !ill be e=ective. These steps include de6ning


66/84

the patient population, de6ning ne! models of care and the place of

the advanced practice nurse !ithin them, implementing the ne!

models of care and long$term monitoring.

The Canadian Nurse ractitioner Initiative includes an

implementation and evaluation

tool9it, !hich serves as a practical guide to assessing the need and

readiness for the nurse

practitioner role. In addition, the tool9it identi6es 9ey steps and

factors to support the

implementation of this role and ongoing monitoring of its

e=ectiveness through a

#8 Advanced Nursing Practice : A NationalFramework


67/84

structured, for!ard$loo9ing evaluative approach. In particular, the tool9it

o=ers guidance on

tailoring the planning, implementation and evaluation of the nurse

practitioner role to the

uniue reuirements of speci6c practice settings. The design of the tool9it

!as based on the

A frame!or9, e3tensive literature revie! and e3perimental research,

9ey sta9eholder con$

sultation and a revie! of best practices >CNA, *''d?. In addition, a

needs$based simulation

model for health human resources planning !as developed in conunction

!ith the Canadian

Nurse ractitioner Initiative this model is applicable to primary health

care nurse practitioners

across all urisdictions in Canada. It goes beyond the traditional planning

models, !hich are

based on supply and proected population$to$provider ratios, to consider

population health

needs and the level of services reuired to meet those needs >CNA,

*''e?.

Coordination of the preparation and roles for advanced nursing practice is

another necessary step. The development of educational and e3periential

goals and programs for advanced practice nurses should be aligned

across the provinces and territories, to reinforce their place in health care

overall and to permit labour mobility. The goal must be to ensure that all

Canadians have access to similar types of e3pertise.

To e=ectively develop and sustain the health$care system, the roles of health$care providers,

including advanced practice nurses, must be optimied. Canadians can

anticipate many ne! chal$

lenges to their health$care system, including increases in chronic diseases

such as diabetes mellitus


68/84

and arthritis. Nonetheless, a shift in focus from illness to health is e3pected,

!hereby clients !ill

become more educated and more strongly engaged and !ill participate more

actively in developing

and maintaining their o!n health >illeneuve H ;acDonald, *''?.

Advanced practice nurses

must be part of the solution to these health$care challenges and the changes

that lie ahead.

Ne! approaches to health care, based on strategies that !ill enhance

access to service delivery !hile improving the health of the population,

must be developed collaboratively.


69/84

=lossar!

Advanced nursing practice

Ombrella term for an advanced level of clinical nursing

practice that ma3imies the use of

graduate educational preparation, in$depth nursing

9no!ledge and e3pertise in meeting the

health needs of individuals, families, groups, communities

and populations. It involves-

E analying and synthesiing 9no!ledge

E understanding, interpreting and applying nursing theory and researchand

E developing and advancing nursing 9no!ledge and the profession as a!hole.

Client The bene6ciary of care may be an individual, family, group,population or entire

community

Client-centred care

FNurses achieve client$centred care by actively includingthe client and signi6cant others

as partners in the care, Land byM identifying the clients

goals, !ishes and preferences

and ma9ing these the basis of the plan of care...G

>College of Nurses of (ntario, *''?

Clinical nurse specialistA registered nurse !ho holds a masters or doctoral

degree in nursing !ith e3pertise in a clinical nursing

specialty uses in$depth 9no!ledge and s9ills, advancedudgment and

clinical e3perience in a nursing specialty to assist in

providing solutions for comple3

health$care issues

Competencies

Credentials


70/84

$0Integrated 9no!ledge, s9ills, udgment and personal attributes reuiredof a registered

nurse to practise safely and ethically in a designated role and setting>CNA, *''&?

;ar9s or FstampsG of uality and achievement

communicating to employers, payers and

consumers !hat to e3pect from a FcredentialedG nurse,

specialist course or program ofstudy, institution of higher education, hospital or health

service, or health$care product,

technology or device



71/84

=raduate education

ducation beyond the baccalaureate level, including

masters, doctoral and postdoctoral levels >"ield, 4tinson

H Thibaudeau, +55*?

&entoring A voluntary, mutually bene6cial, long$term relationship in !hich ane3perienced and

9no!ledgeable leader >the mentor? supports the

maturation of a less e3perienced nurse !ith leadership

potential >the FmenteeG?

Nurse practitioner

A registered nurse !ith additional educational

preparation and e3perience !ho possesses and

demonstrates the competencies to autonomously

diagnose, order and interpret diagnostic tests,

prescribe pharmaceuticals and perform speci6c

procedures !ithin the legislated scope of practice

>CNA, *''a?

egulation All of those legitimate and appropriate means $ governmental,professional, private and

individual $ !hereby order, identity, consistency and

control are brought to the profession through regulation,

the profession and its members are de6ned, the scope of

practice is determined, standards of education and of

ethical and competent practice are set and systems of

accountability are established >4tyles H A=ara, +550?

:cope of nursing practice

The activities that nurses are educated and authoried to

perform, as established through legislated de6nitions of

nursing practice, complemented by standards,

guidelines and policy positions issued by professional

nursing bodies >CNA, *''&?

:pecialized practice

ractice that concentrates on a particular aspect of nursing, related tothe clients age

>e.g., pediatrics, gerontology?, the clients problem >e.g.,pain management, bereavement?,


72/84

the diagnostic group >e.g., orthopedics, vascular

surgery?, the practice setting >e.g., home

care, emergency? or the type of care >e.g., primary

health care, palliative care, critical care?

Advanced Nursing Practice : A National Framework $1


73/84

Appendix A

PPPA $ramework

Participator!, evidence-based, patient-centred process for advanced practice nurse >APN?

role development, implementation and evaluation

From: -ryant,ukosius/ 4"/ 4i'enso/ A" 1200$" A framework for the introduction of an evaluation ofadvanced racticenursing roles" ;ournal of Advanced Nursing/ $8 1%/ %#0,%$0" 9erinted with the ermission of -lackwellPu&lishing"

$2 Advanced Nursing Practice : A National


74/84

Framework


75/84

Appendix )

6he Consultation Process

The Board of Directors of the Canadian Nurses Association >CNA?

approved the 9ey elements of a national frame!or9 for advanced

nursing practice in @une +555. The frame!or9 !as 6rst published

in ;ay *''' in Advanced Nursing Practice# A National $ramework.

In ;arch *''*, the CNA Board of Directors revised one of the 9ey

elements of the frame!or9 by establishing a graduate degree in

nursing as the minimum educational reuirement for advanced

nursing practice

Changes in practice that emerged during CNAs *''& Dialogue on

Advanced Nursing ractice and the Canadian Nurse ractitioner

Initiative >*''2$'? signalled the need to update CNAs frame!or9

on advanced nursing practice.

In *'', the CNA Board of Directors created a national !or9ing

group to guide revision

of the frame!or9. Its consultations involved one face$to$face

meeting, numerous tele$

conferences and circulation of several draft documents among

member urisdictions

and national nursing and other health$care organiations. In

addition, a discussion of

the draft frame!or9 by the CNA Board of Directors helped to guide

the 6nal version.

"eedbac9 from the consultation process !as e3tensive. Jundreds of responses !ere

received from associations, organiations and individual nurses.


76/84

Although vie!s on speci6c

aspects of the frame!or9 di=ered, there !as strong consensus on the

9ey concepts for

advanced nursing practice. Ta9ing into consideration the feedbac9

received and the con$

sensus recommendations from the national !or9ing group, the CNA

Board of Directors

approved the updated frame!or9 for advanced nursing practice in

November *''0.

Advanced Nursing Practice : A National Framework $#


77/84

Appendix C

&embers of the National /orking =roup

Co-Chairs

Christine ieck )uckle! Canadian Nurses Association

*ebbie PhilipchukCollege @ Association of egistered Nurses of Alberta

&embers

aren Antoni Canadian Association of Advanced Practice Nurses

=ail )eatt! egistered NursesB Association of ntario

&ichDle )rennanCollege of egistered Nurses of Nova :cotia

:uzanne *urand rdre des inrmiDres et inrmiers du EuFbec

:tephen 8eck egistered Nurses Association of Northwest 6erritories and

Nunavut

$rancis 8oos :askatchewan egistered NursesB Association

)ett! 8undriganAssociation of egistered Nurses of Newfoundland and 8abrador

Patricia &c=arr Gukon egistered Nurses Association

)lake Parkin Association of egistered Nurses of Prince dward sland

Cheri Higar College of Nurses of ntario

)arb /aters Nurse Practitioner Council of Canada

Io /earing College of egistered Nurses of )ritish Columbia

*oug /heeler Nurses Association of New )runswick

Ioanne /insor College of egistered Nurses of &anitoba

$$ Advanced Nursing Practice : A NationalFramework


78/84

eferences

Association of 7egistered Nurses of Ne!foundland and 8abrador.

>*''0?. Advanced practice-clinical nurse specialist Losition

statementM. 4t. @ohns- Author.

Bryant$8u9osius, D., H DiCenso, A. >*''2?. A frame!or9 for

the introduction and evaluation of advanced practice nursing

roles.Iournal of Advanced Nursing, JK>&?, &/'$&2'.

Bryant$8u9osius, D., DiCenso, A., Bro!ne, :., H inelli, @. >*''2?.

Advanced practice nursing roles- Development, implementation

and evaluation.Iournal of Advanced Nursing, JK>&?, &+5$&*5.

Canadian Nurses Association. >*''&?. Canadian nurse

practitioner# Core competenc! framework. (tta!a-

Author.

Canadian Nurses Association. >*''a?. Practice framework for

nurse practitioners in Canada. (tta!a- Author.

Canadian Nurses Association. >*''b?. eport of '((L dialogue on

advanced nursing practice.(tta!a- Author.

Canadian Nurses Association. >*''c?. National planning forhuman resources in the health sector Losition statementM.(tta!a- Author.

Canadian Nurses Association. >*''d?. Canadian nurse

practitioner initiative# mplementation and evaluation

toolkit for nurse practitioners in Canada. (tta!a- Author.

Canadian Nurses Association. >*''e?. Jealth human resources

chapter. In- Canadian nurse practitioner technical report. (tta!a-

Author.

College of Nurses of (ntario. >*''?. 8earning module-

6herapeutic communication and client-centred

care. 6herapeutic Nurse-Client elationship, evised '((3,

practice standard# 6herapeutic Communication

and Client-Centred Care, slide 1. 7etrieved "ebruary 0, *''1,

from http-KK!!!.cno.orgKpracKlearnK

modulesKtncrKpdfKTNC7$Chapter/.pdf

Cunningham, 7. 4. >*''2?. Advanced practice nursing outcomes-

A revie! of selected empirical literature. ncolog! Nursing

$orum, 4M>*?, *+5$*/'.
http://www.cno.org/prac/learn/http://www.cno.org/prac/learn/


79/84

Daly, *''/?. Nursing roles and levels of

practice- A frame!or9 for di=erentiating

bet!een elementary, specialist and advancing nursing practice.

Iournal of Clinical Nursing, M',+&1$+0.

De:rasse, C., H Nic9lin, *''+?. Advanced nursing practice-

(ld hat, ne! design. Canadian Iournal of Nursing 8eadership,

MJ>2?, 0$+*.

Advanced Nursing Practice : A National Framework $%


80/84

"ield, . A., 4tinson, 4., H Thibaudeau, ;$". >+55*?. :raduate

education in nursing in Canada. In A. @. Baumgart H @. 8arsen

>ds.?, Canadian nursing faces the future. Toronto- C ;osby,

+551.

"ulton, @., H Bald!in, ). >*''2?. An annotated bibliography

reecting CN4 practice and outcomes. Clinical Nurse :pecialist,MK>+?, *+$/5.

"urlong, ., H 4mith, 7. >*''&?. Advanced nursing practice-

olicy, education and role development. Iournal of Clinical

Nursing, MJ, +'&5$+'.

)leinpell, 7. ;. >*''0?. ANs- Invisible championsP Nursing &anagement, 4K>&?,+1$**.

;icevs9i, ., )or9ola, 8., 4ar9issian, 4., ;ulcahy, ., 4hobbroo9, C., Belford, 8., et al.>*''2?. The

Oniversity Jealth Net!or9 frame!or9 for advanced nursing practice. Nursing8eadership, M>/?, &*$2.

(erman, ;. J., H "loyd, @. >*''*?. (utcomes research- An essential

component of the advanced practice nurse role. Clinical Nurse

:pecialist, M3>/?, +2'$+22.

4angster$:ormley, . >*''0?. Nurse practitioner-sensitive

outcomes. Jalifa3- College of 7egistered Nurses of Nova

4cotia.

4chober, ;., H A=ara, ". >*''?. Advanced nursing practice. :eneva- International

Council of Nurses.

4tyles, ;. ;., H A=ara, ". A. >+550?. CN on regulation#6owards a 'Mst centur! model. :eneva- InternationalCouncil of Nurses.

illeneuve, ;., H ;acDonald, @. >*''?. 6oward '('(# Hisions

for nursing. (tta!a- Canadian Nurses Association.

*''&?.A guide to the

implementation of the nurse practitioner role in !our health

setting.


81/84

$) Advanced Nursing Practice : A NationalFramework


82/84


83/84

www.cna-aiic .ca
http://www.cna/http://www.cna/


84/84

anp role peraturan nursalam 11

Documents