1. Competency development and revalidation
for advanced nursing practice
Linda Nazarko
MSc, PgDip, PgCert, BSc(Hons), RN, NIP, OBE, FRCN
London 11th
March 2016
,

2. Aims
 To enable those managing nurses practicing
at specialist and advanced level to understand
the components of advanced practice and how
they can support nurses
 To enable nurses who are developing into
advanced practitioners to understand what
skills, knowledge and support they will require.
 To enable nurses practicing at specialist and
advanced levels to maintain and develop their
skills
 To enable nurses practicing at specialist and
advanced levels to prepare for re-validation

3. Learning objectives
To be aware of how to :
 Develop competence and confidence in accurate
assessment & diagnoses
 Provide nurses with suitable education and training
 Enable to develop competency
 Maintain competency in assessment, diagnosis &
prescribing
 Move beyond competency to capability
 Enable setting up & development of nurse led services
 Develop protocols & guidelines
 Prepare for appraisal & revalidation

4. What is competency?
“Nurses and nursing staff have up-to-
date knowledge and skills, and use
these with intelligence, insight and
understanding in line with the
needs of each individual in their
care”.
RCN (2012)

5. What does competency
mean?
 The ability to
combine technical
skills with
humanistic care
 Combining the art &
the science of
nursing

6. Defining advanced nursing practice
“A registered nurse who has command of an
expert knowledge base and clinical
competence, is able to make complex clinical
decisions using expert clinical judgement, is
an essential member of an interdependent
health care team and whose role is
determined by the context in which s/he
practices”
NMC 2007

7. Components of advanced
practice

8. Core competencies advanced practice
 Practicing autonomously
 Making decisions and being accountable
 Admitting and discharging patients
 Ability to take a clinical history
 Ability to physically examine patient
 Ability to determine diagnosis
 Ability to determine when onward referral is
required
 Ability to prescribe

9. Generic clinical competencies
 Practicing autonomously
 Making decisions and being accountable
 Admitting and discharging patients
 Ability to take a clinical history
 Ability to physically examine patient
 Ability to determine diagnosis
 Ability to determine when onward referral is required
 Ability to prescribe

10. Narrow or broad specialisms
 Competencies should be related to the area of
practice.
 Specialism may be narrow and deep, e.g. diabetes,
cardiology
 Specialism may be broad such as gerontology, nurse
practitioners.

11. Specific clinical competencies
 Competencies specific to your service
 Competencies related to where your service
is delivered
 Competencies specific to the client group

12. Combining theory and practice

13. Education and training

14. Building on assessment & diagnostic
skills
 Practice!
 Working with more experienced practitioners
 Reading
 Using “You Tube” and other media.
 Visiting, shadowing
Aim to look back at where you are now
and see how far you have come.

15. Non medical prescribers

16. Where do nurse NMPs work?

17. Supporting new prescribers
 Remember writing your first prescription
is scary
 Grow nurture and support staff
 Help staff to develop, gain skills and
confidence
None of us are born experts

18. Becoming a confident & competent prescriber
 Prescribe
 Check everything three times
 Find a an experienced prescriber
“buddy”
 If possible get your buddy to check your
prescribing until you gain confidence

19. Maintaining & enhancing skills
 Find a mentor
 Work with others to audit prescribing
 Find out what you don’t know
 Fill the gaps
 Join or form an NMP group
 Read
 Attend conferences
 Organise your own conference
 Speak at conferences

20. Ways to use an NMP group
 To audit practice
 To develop skills- learn from experts
 To keep up to date with new medicines
 To keep up to date with alerts
 To share skills and knowledge
 To support each other
 To educate and enable

22. Moving beyond competencies

23. Setting up nurse led services
 Proposals
 Working up business case
 Showing benefits
 Winning hearts, minds and funding
 Minimising KPIs
 Maximising improvement

24. Protocols and guidelines
 You may not be the
first to explore this
territory
 Find out what exists,
adapt and develop
 Share new work by
publishing and at
conferences

25. What protocols and guidelines
 Admission/entry criteria
 Exclusion criteria
 Referral forms/protocols
 Escalation criteria
 Referral to other services
 Pathways, how often to see patient
 Follow up
 Discharge
 KPIs and reporting

26. Capability expert practice
“the combination of skills, knowledge,
values and self-esteem which enables
individuals to manage change, be
flexible and move beyond competency”
(O’Connell et al, 2014)

27. Appraisal of nurses practicing at advanced level
 Job description should spell out what the nurse actually
does
 If prescribing this should be in JD
 Appraiser should if possible have expertise in nurse’s
area of practice
 Nurse consultants currently under-utilised in management
of specialist nurses

28. Questions to ask when appraising
 How are you using
your advanced skills?
 How are you
maintaining?
 What barriers are you
facing?
 What do you most
enjoy?
 What can we do to
support?

29. Advanced Practitioner Role
 A new type of nurse
 Not a nurse at all
 An evolution of the nursing role
 Remains unregulated

30. Revalidation
 Aim to demonstrate how you meet all four
domains
 Use your hours log
 Use your CPD ensure relevant to scope of
practice
 Use your reflections ensure relevant and
demonstrate learning.
 Use the process to drive your
practice forward

31. Précis of a reflection
Mrs Baker, 93, is px Sertaline and suffers
severe postural hypotension. Efforts to
address not successful and changed to
Citalopram with effect.
Unable to ascertain if sertraline caused or
merely worsened existing postural
hypotension

32. Précis reflection (2)
 Nurse led unit did not routinely check
L/S BP in those who had not fallen
 Change in practice – all patients have
L/S BP checked x 48 hours and not just
those who have fallen
Nazarko (2016). Pain, sadness and ageing
http://www.magonlinelibrary.com/doi/10.12968/
npre.2016.14.2.94

33. Fundamental nursing
"Nursing is rooted from the needs of humanity
and is founded on the ideal of service. And
that, “the nurse is temporarily the
consciousness of the unconscious, the
love of life for the suicidal, the leg of the
amputee, the eyes of the newly blind, a
means of locomotion for the infant,
knowledge and confidence for the mother
and the mouthpiece for those too weak or
withdrawn to speak”

34. The fundamentals of nursing
The unique function of the nurse is to assist the
individual, sick or well, in the performance of
those activities contributing to health or its
recovery (or to peaceful death) that he would
perform unaided if he had the necessary
strength, will, or knowledge. And to do this in
such a way as to help him gain independence
as rapidly as possible.”
Henderson V. (1966), The Nature of Nursing: 15: Macmillan Publishing, New York.

35. The value of nursing
 Goes beyond the medical model
 Nurse with the hands, the heart and the head
 Develop a partnership a with the unique
human being
 Value the person’s perspective, hopes and
aspirations
 Enables us to provide humanistic care and
support

36. All is changed
 Advanced practice changes every aspect of nursing
 If we get this right then nursing and patient care
moves forward and we provide compassionate life
enhancing care

37. The art and science
Art – trusting relationships. We meet people in
their darkest hours and they share their
hopes, fears and aspirations
Science – working out what can be done to aid
recovery or come to terms with changes
Art is in working with the person through these
times
The art and science combine to provide kind,
compassionate humane care.

38. Advanced nursing practice
 Contributes to
developing nursing
 Enables us to nurse
with the hands, the
heart and the head
 Enriches the lives of
those we care for
and our lives

39. Thank you for listening
Any questions?