Mr. Daniels leaves home and arrives at the regional hospital with shortness of breath, dehydration, fever and productive cough. Mr. Daniels tells the staff, “I just don’t have any energy this week, not even to eat”.
Michael, a nurse practitioner at the regional hospital assesses Mr. Daniels and writes orders to include: oxygen, chest x-ray, blood work and intravenous fluids.
Shelley, a registered nurse who is new to this practice setting has never worked on a team with a nurse practitioner. She is caring for Mr. Daniels and has reviewed his chart and notes the NP’s orders. Shelley wonders if she can implement the orders that Michael, the NP has written. She determines it would be best to ask the charge nurse for confirmation.
The charge nurse replies, “yes, we are able to implement orders that have been written by NPs. On this unit we work with two NPs, Michael and Andrea. I don’t believe you have met them yet? Why don’t I introduce you to Michael right now and then he can provide you with information about his scope of practice.”
When Shelly meets Michael she asks, “I have never worked with a nurse practitioner before and would like to better understand your role. Can you tell me how the NP role is different from the RN role?” Michael provides the following overview of his scope of practice.
What does he say?
Nurse practitioners are essential health professionals with advanced education, who provide a full range of comprehensive health services to the public. The nurse practitioner role is distinct from that of the registered nurse. The nurse practitioner role requires advanced knowledge and decision-making skills gained through further clinical practice, education and experience that enable nurse practitioners to perform additional activities that are not considered part of the registered nurse scope of practice (CNA, 2004). The professional role, responsibilities and accountability of the nurse practitioner includes clinical practice, collaboration, consultation and referral, research and leadership.
Nurse practitioners have the competencies to:
Conduct comprehensive health assessment.
To diagnose health/illness conditions.
Treat and manage acute and chronic illness within a holistic model of care.
Nurse practitioners order and interpret screening and diagnostic tests, perform procedures and prescribe medications and therapeutic interventions, while integrating the principles of resource allocation and cost-effectiveness, in accordance with federal, provincial and territorial legislation and policy.
Shelley wonders how the NP role differs from the physician role and asks Michael, “how does your role differ from the attending physician’s on the unit?”
The nurse practitioner role is a nursing role that complements, rather than replaces other health-care providers. Nurse practitioners, as autonomous and independent health professionals, provide essential health services grounded in the registered nurse profession’s values, knowledge, theories and practice. They are health professional members of interprofessional health-care teams, and consult with, refer to, and are consulted by physicians and other health-care providers.
Michael tells Shelley that the CARNA document, Scope of Practice for Nurse Practitioners as well as the Entry-Level Competencies for Nurse Practitioners in Canada provides more information regarding the necessary skills, knowledge and competence required to engage in restricted activities that NPs are authorized to perform. Michael also mentions to Shelley that he can tell her more about his role over coffee break.
After their brief conversation, Shelley thanks her colleague for the information regarding nurse practitioner practice and proceeds to Mr. Daniels room to implement the orders. Prior to starting Mr. Daniels’ IV line, Mr. Daniels asks Shelley if the doctor will be coming in to see him. Shelley recognizes that Mr. Daniel’s question is an opportunity to provide some patient teaching around role clarity of the various health-care providers that are part of his health-care team. Shelley spends time with Mr. Daniels discussing her role, the role of the NP and how they differ from and complement other members of the health-care team.