Clinical Governance for Nurse Practitioners in Queensland

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1 Office of the Chief Nursing Officer Clinical Governance for Nurse Practitioners in Queensland A guide

2 Clinical Governance for Nurse Practitioners in Queensland: A guide Queensland Health Office of the Chief Nursing Officer Clinical Governance for Nurse Practitioners in Queensland: A Guide ISBN The State of Queensland Copyright protects this publication. However, the Queensland Government has no objection to this material being reproduced with acknowledgement, except for commercial purposes. Permission to reproduce for commercial purposes should be sought from: Senior Administrative Officer Policy Branch Queensland Health PO Box 48 Brisbane 4001 Preferred citation: Queensland Government 2011 Clinical Governance for Nurse Practitioners in Queensland: A guide Queensland Government, Brisbane An electronic version of this document is available at

3 Foreword At this exciting time in the history of nursing in this country, national health reform has provided opportunities for nurse practitioners to lead the way in specialist nursing care delivery. Nurse practitioners are acknowledged as essential to the health care system not only for the responsive care they are able to deliver to patients, but also the benefits that patients can now access under Medicare Australia. Nurse practitioners are highly specialised, skilled and competent clinicians. However, their full potential is yet to be realised. I am confident this will occur as increasingly they take their place in a broader range of health care settings. Members of the nursing profession are responsible now more than ever for advancing the role of the nurse practitioner and ensuring professional standards are maintained. The benefits of the nurse practitioner role need to be supported by research and evidence to more effectively inform health care policy and service development at the local, state and national level. This document Clinical Governance for Nurse Practitioners: A guide supports nurse practitioners to practise in the capacity at which they are authorised, legislated and competent. The document can be used in any setting where nurse practitioners may be employed, including the public and private sectors. The revised Drug Therapy Protocol for Nurse Practitioners and condition for an approved Practice Scope is more relevant to contemporary nurse practitioner practice. It recognises that the nurse practitioner role is dynamic and responsive to the needs of clients and employers. This change represents new opportunities for nurse practitioners to expand their role in the current health care environment. Clinical Governance for Nurse Practitioners in Queensland: A guide Pauline Ross Chief Nursing Officer Queensland Health 1 1

4 Contents Introduction 4 1. Overview 4 2. Purpose 5 3. Application 5 4. How to use this guide 5 5. Conflict with legislation 6 6. Updates 6 1. Understanding the role 8 1. Overview 9 2. Guideline Definitions 9 3. What is a nurse practitioner? First and foremost a nurse Extended practice National nurse practitioner competency framework Working autonomously and collaboratively Is a practice nurse the same as a nurse practitioner? Professional regulation Protection of title Eligibility Developing a model of care Overview Guideline The model of care Consultation Clarifying the service need Clarifying the clinical nursing role Defining the practice scope of the nurse practitioner Describing the practice environment, clinical service and clinical service measures Practice scope approval Publication Review Right person, right skills, safe practice environment Overview Guideline Nurse practitioner candidates Definition Employment as a nurse practitioner candidate Clinical internship or supported clinical practice Clinical supervision and mentoring Nurse practitioner endorsement Credentialing and defining the scope of clinical practice Definition Credentialing principles Adopting Queensland Health s policy s Extended clinical practice Overview Guideline Continuing professional development Prescription of medicines Statutory authority Drug Therapy Protocol for Nurse Practitioners 33 2

5 4.3 Components of prescribing Prescribing competency framework List of personal or preferred drugs (P-drugs) Supplementary prescribing Quality use of medicines (QUM) Use of blood and blood components Regulation Prescribing blood and blood components (blood transfusion) Diagnostic services Pathology Pathology services Quality use of pathology AUSLAB Pathology Management System Private pathology Diagnostic services Diagnostic imaging Diagnostic imaging Requests Diagnostic Radiography Protocol Diagnostic interpretation Medicare and the Pharmaceutical Benefits Scheme National health care system Medicare Benefits Schedule (MBS) Pharmaceutical Benefits Scheme (PBS) Repatriation Pharmaceutical Benefits Scheme (RPBS) Eligible nurse practitioner Delegation, referral and clinical handover Issuing certificates General principles Workers Compensation Certificates Centrelink Fair Work Act 2009 (Commonwealth) Reportable deaths Cause of death certificate Healthcare-related deaths 51 Contents 5. Clinical audit and review Overview Guideline Quality assessment framework s 54 Summary 55 Governance checklist 56 References 57 Appendices 58 Appendix A: Templates Practice Scope of the Nurse Practitioner 58 Appendix B: Audit tools 64 Contact details 67 Figures Figure 1: Principles of governance 7 Figure 2: Critical success factors for the nurse practitioner role 9 Figure 3: Comparison across nursing roles 18 Figure 4: Practice scope of the nurse practitioner (example) 20 Figure 5: Four components to prescribing 34 Figure 6: SBAR tool

6 Introduction 1. Overview Queensland is the fastest-growing State in Australia, with population growth nearly double the national average. Our health system is contending with a growing and ageing population, high birth rates, increasing cases of mental illness and preventable disease, and an unacceptable gap in Indigenous life expectancy. Nurse practitioners are one of a number of roles introduced in Queensland to deliver innovative and flexible health care solutions to meet the needs of individuals, families and communities. The nurse practitioner role was formally introduced in Queensland in 2006, following a successful trial of practice conducted in 2005 in a number of Queensland Health facilities. Nurse practitioners are now well integrated statewide across public and private sectors in a range of metropolitan, regional, rural and remote health services. This document reflects the contemporary health care landscape and legislative change underpinning the role of the nurse practitioner. It also reflects the recognition of the importance of the role in improving access, and delivering quality, dependable health care for all Queenslanders. 2. Purpose This guide has been developed as a practical tool to provide clear and concise information about the implementation and governance of the nurse practitioner role in Queensland. The goal is to assist health administrators, nurse practitioners and their employers to understand the critical success factors necessary to realise the full potential of the nurse practitioner role. This guide outlines fundamental good practice for the governance of the nurse practitioner role and makes explicit the standards to which all nurse practitioners and their employers should aspire. The intent is to: assist the growth and development of a flexible and responsive nurse practitioner workforce based on a culture of innovation, learning and continual improvement support health service planning and integration of new models of care resolve the recurrent and persistent barriers that prevent nurse practitioners from realising their full potential protect patient safety through clinical governance provide a framework for continuous quality improvement, which supports evaluation of health services provided by nurse practitioners. 4

7 3. Application The principles within this document apply to all nurse practitioners in Queensland, irrespective of the context and health service setting in which they practise. They are relevant for public and private sector health services, as well as private practice settings. Introduction Nurse practitioners and their employers have a professional and regulatory responsibility to apply these underlying principles. The Clinical Governance for Nurse Practitioners in Queensland: A guide may also be used to assist regulators, such as the Nursing Midwifery Board of Australia (NMBA), the Chief Health Officer and any other statutory bodies, such as the State Coroner, Health Quality and Complaints Commission and the Courts, in reviewing the decisions and actions of nurse practitioners and their managers. 4. How to use this guide This guide is presented in five sections, that deal with the key concepts of nurse practitioner models of care (see also figure 1 on page 7). 1: Understanding the role Lack of understanding about nurse practitioners is a recurrent theme and a persistent barrier to full implementation of the role. The purpose of this section is to clarify the nurse practitioner role and identify the critical success factors that are essential to realising the full potential of nurse practitioner models of care. 2: Developing a model of care Each model of care must be defined and clearly articulated to inform health consumers (patients/clients), nurses, medical practitioners, pharmacists, health care administrators and other health professionals about the nurse practitioner s role. This section provides guidance on developing innovative health care solutions based on health service planning principles, defining the scope of clinical practice of each position, and identifying the service capability of the health service setting in which a nurse practitioner is engaged (the practice scope). 3: Right person, right skills, safe practice environment The scope of clinical practice of each nurse practitioner is specific to the context of practice and is determined by the clinical specialty in which the nurse practitioner is educated, competent and authorised to practise. This section provides guidance on clinical supervision and mentoring for nurse practitioner candidates, endorsement as a nurse practitioner, and an overview of credentialing and defining the scope of clinical practice of the individual nurse practitioner. 4: Extended clinical practice A nurse practitioner is educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. This includes 5

8 Introduction undertaking roles and responsibilities not ordinarily associated with nursing, including prescribing medication, ordering and interpreting diagnostics. This section provides guidance on the extended practice privileges that are available to nurse practitioners. 5: Clinical audit and review Clinical audit is an important tool for continuous quality improvement for all clinicians. Safety and quality of nurse practitioner service must be evaluated against indicators that are relevant to the clinical service and patient outcomes. This section provides guidance for auditing a nurse practitioner model of care. 5. Conflict with legislation For completeness, this guide must be read and understood with the laws, codes and regulations that apply to nurse practitioners at both a state and federal level, and with the nationally accepted clinical practice standards that are relevant to each nurse practitioner s specialist area of clinical practice. In the event of conflict or overlap between these principles and the requirements of relevant Commonwealth and State legislation, the requirements of the legislation prevail over the principles, to the extent of the conflict or overlap. 6. Updates The contents of this document will be updated over time. Individuals looking for guidance and support about nurse practitioner governance should ensure that they refer to the most recent edition of this publication, plus any other national guidance, legislation and directives that may have been subsequently produced. More information is available from the following sites: Office of the Chief Nursing Officer Nursing and Midwifery Board of Australia Australian Nursing and Midwifery Accreditation Council Australian College of Nurse Practitioners Clinical Guidelines Portal Medicare Australia Workers Compensation Regulatory Authority National Prescribing Service Royal College of Nursing Australia Health Quality and Complaints Commission

9 Figure 1: Principles of governance 1 1. Understanding the role Respect and recognition Innovation Collaboration Introduction Autonomy Role clarity Safety and quality Supportive clinical environment which values nurse practitioners 2 2. Developing a model of care Health service need Clinical nursing scope Service capability Defined practice scope for nurse practitioner solution 3 3. Right person, right skills, safe practice environment Nurse practitioner candidate Endorsed nurse practitioner Competent nurse practitioners provide quality care in safe service environments 4 4. Extended clinical practice Prescribing Diagnostics Radiography Pathology Extended practice privileges are appropriate and necessary to practise nursing within the regulatory framework 5 5. Clinical audit and review Continuous quality improvement in nurse practitioner models of care 7

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