Running Head: NP COMPENTIENCES Nurse Practitioner Core Competencies (NONPF, 2012)

Scientific Foundation Competencies 1. Critically analyzes data and evidence for 1. Reviewed literature and guidelines and improving advanced nursing practice. interpreted a method to manage obesity. 2. Integrates knowledge from the humanities 2. When treating in the underserved and sciences within the context of nursing population social issues like food and shelter science. are part of the treatment plan as these are essential to meet their needs before they will participate in their health care. 3. Translates research and other forms of 3. Calculates stroke risk using Framingham knowledge to improve practice processes and Risk Score and advice patients on the outcomes. risk/benefit of Aspirin therapy. 4. Develops new practice approaches based on 4. Based on practice knowledge about barriers the integration of research, theory, and practice to treat obesity did a research analysis on knowledge. effective interventions for weight loss and applied the Transtheoretical Model to develop a new treatment plan for obese patients. Leadership Competencies 1. Assumes complex and advanced leadership roles to initiate and guide change. 1. Developed and advised nurse care managers at community health center how to incorporate evidenced-based practice to improve management of complex patients and improved documentation. 2. Encouraged policy makers to change practice and utilize Transtheoretical model for nurse care managers and integrated health care team to care for the complex patients in their community and use the resources in the area to improve health outcomes. 3. Assess the needs of the nurse care managers regarding their role and performance, evaluate their current practice, identify areas of practice needing improvement, met and shadowed them to discuss their roles at health center, discussed and observed areas for improvement, reviewed their documentation then developed and implemented changes to improve their care of complex patients. 4. Recommended LEAN changes that could be done at the community health center to promote patient flow and increase cost effective and quality care for their patients.

2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care.

3. Demonstrates leadership that uses critical and reflective thinking.

4. Advocates for improved access, quality and cost effective health care.

NP COMPETENCIES 5. Advances practice through the development and implementation of innovations incorporating principles of change. 6. Communicates practice knowledge effectively both orally and in writing. 7. Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus.

2 5. Encouraged preceptors and their practice to being using JNC-8 guidelines to treat patients with hypertension. 6. Discuss with patients the role of NP and wrote about the role; see writing samples: Nurse Practitioner role paper. 7. Active with the AENT scholars and Sigma Theta Tau Society and participate in growing and improving the health outcomes of the underserved population.

Quality Competencies 1. Uses best available evidence to continuously improve quality of clinical practice. 2. Evaluates the relationships among access, cost, quality, and safety and their influence on health care. 1. Changed practice to use JNC-8 guidelines to prevent hypotensive episodes in an 82 year patient. Evaluated the impact of cost of preventive screen tools like DEXA scan have on an underserved population female who needs monitoring and likely treatment for osteoporosis. 3. Understand how the low patient census during provider transition affects the financial stability of a company. 4. Applied knowledge of practice and leadership skills during team huddles to promote flow of patients during the office visits. 5. During measles outbreak in Orange, MA helped educate patients and staff on safety to ensure the disease wouldnt continue to spread.

3. Evaluates how organizational structure, care processes, financing, marketing and policy decisions impact the quality of health care. 4. Applies skills in peer review to promote a culture of excellence.

5. Anticipates variations in practice and is proactive in implementing interventions to ensure quality.

Practice Inquiry Competencies 1. Provides leadership in the translation of new knowledge into practice. 1. Encouraged use of PFTs and CAT score to manage patients who is suspected to have lung disease that had never completed these diagnostic and screening tools based on knowledge from guidelines. 2. Gained knowledge from routine follow up appointments to improve plans and outcomes of patients with hypertension, diabetes and hyperlipidemia. 3. Careful history and physical exam done to narrow down differentials to avoid over testing. 4. Asked why the use of ASA in all patient

2. Generates knowledge from clinical practice to improve practice and patient outcomes.

3. Applies clinical investigative skills to improve health outcomes. 4. Leads practice inquiry, individually or in

NP COMPETENCIES partnership with others.

3 versus using the Framingham risk score to ensure evidence based practice was being considered. 5. Presented to the Community Health Center staff about effective interventions for obesity management using handout of guidelines, PowerPoint presentation and poster. 6. Use USTPS guidelines for deciding what screen each patient needs at annual physical to prevent diseases and illnesses.

5. Disseminates evidence from inquiry to diverse audiences using multiple modalities.

6. Analyzes clinical guidelines for individualized application into practice.

Technology and Information Literacy Competencies

1. Integrates appropriate technologies for knowledge management to improve health care. 2. Translates technical and scientific health information appropriate for various users needs. 2a. Assesses the patients and caregivers educational needs to provide effective, personalized health care. 2b. Coaches the patient and caregiver for positive behavioral change. 1. Encouraged a diabetic patient to use smart phone app to track BS and insulin dosing and becoming active in care and improving health. 2. Translated the risk of heart disease and stroke using the cholesterol levels and interpreted results to patient so he would understand risk and need for treatment. 2a. Assessed a diabetic patient who is legally blind and developed hands on and verbal education and instruction about diabetes and using insulin. 2b. Coached an adolescent and mother about ways to develop positive behavior changes to improve restrictive eating disorder using a family stress theory. 3. Using guideline literature and algorithm for treatment of vasomotor symptoms associated with menopause to help patient decide best treatment plan for her. 4. Suggested ways to improve electronic medical record for diabetic tracking to make sure patients are receiving safe, quality and cost effective care. 5. Use electronic graph of growth chart for an obese school age child to demonstrate to parents and child the success of his healthy eating and exercise.

3. Demonstrates information literacy skills in complex decision making.

4. Contributes to the design of clinical information systems that promote safe, quality and cost effective care. 5. Uses technology systems that capture data on variables for the evaluation of nursing care.

Policy Competencies 1. Demonstrates an understanding of the interdependence of policy and practice. 1. Helped modify policy changes based on updated practice standards for cholesterol management.

NP COMPETENCIES 2. Advocates for ethical policies that promote access, equity, quality, and cost. 3. Analyzes ethical, legal, and social factors influencing policy development.

4 2. Encouraged staff to assist patients who are unable to read, speak English or blind with initial paper work. 3. When changing policy to incorporate offering HIV screen to adult patients during physical exam reviewed and prepared staff to address social stigmatism to practice change. 4. Helped monitor and screen patients at community health center for exposure to Measles and Mumps. 5. When changing health policies at the community health center took part in staff meeting to realize the importance to make sure all staff aware of practice standards and policies. 6. During meningitis outbreak at daycare realized how this affects those in the community and the importance of screening and treating.

4. Contributes in the development of health policy. 5. Analyzes the implications of health policy across disciplines.

6. Evaluates the impact of globalization on health care policy development.

Health Delivery System Competencies 1. Applies knowledge of organizational practices and complex systems to improve health care delivery. 1. Assisted elderly and mental challenged adult female navigate the health care system to obtain echo and dexa scan for part of her prevention and disease management. 2. Effects health care change using broad based 2. Participated in staff meeting at community skills including negotiating, consensushealth center and helped brainstorm effective building, and partnering. methods to monitor and control narcotic use. 3. Minimizes risk to patients and providers at 3. Encouraged use of hand-washing, staying the individual and systems level. away from public or wearing mask in public if has flu or other viruses. 4. Facilitates the development of health care 4. Encouraged and assisted in the use of systems that address the needs of culturally telephone interpretation system for patient who diverse populations, providers, and other spoke Spanish and on site interpreter stakeholders. unavailable. 5. Evaluates the impact of health care delivery 5. During the change to affordable health care, on patients, providers, other stakeholders, and assisted and directed patients on how to the environment. advocate for insurance benefits and referred them to assistance within the health care system. 6. Analyzes organizational structure, functions 6. Analyzed current methods of diabetes and resources to improve the delivery of care. insulin teaching, researched evidence based methods and implemented them into standards for community health center. 7. Collaborates in planning for transitions 7. Educated parents of children about expected

NP COMPETENCIES across the continuum of care. milestones and issues that may come arise during next growth phase. Ethics Competencies 1. Integrates ethical principles in decision making.

1. Adult female part of Native American ethnicities that prefers using complimentary treatments for her pain. Advised and supported her decision and plan for pain management. 2. Evaluates the ethical consequences of 2. Discussed with vegan the importance of decisions. obtaining protein in her diet as she complains about muscle atrophy and poor healing as this could be contributing to the lack of protein. 3. Applies ethically sound solutions to complex 3. Helped staff at early intervention make issues related to individuals, populations and home plans for 2 year old Asian child suffering systems of care. from complications of hypoxic encephalopathy that would incorporate her families culture beleifs. Independent Practice Competencies 1. Functions as a licensed independent practitioner. 2. Demonstrates the highest level of accountability for professional practice. 3. Practices independently managing previously diagnosed and undiagnosed patients. 3a). Provides the full spectrum of health care services to include health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end of life care. 3b). Uses advanced health assessment skills to differentiate between normal, variations of normal and abnormal findings. 1. At this time licensed not obtained, plan to have July 2014. 2. Preceptors evaluations provides evidence of professional practice; see preceptor evaluations. 3. At this time unable to practice independently, see #1. 3a). Review report created from Typhon to evaluate full spectrum of health care offered during clinical rotation; see clinical experience.

3c). Employs screening and diagnostic strategies in the development of diagnoses.

3b). Female adolescent complains of knee pain, used advance health assessment skills and signs to determine these symptoms are related to the growth changes and are benign and will resolve as she grows. 3c). Middle age male patient complains of pain and weakness of bilateral arms after confirmation with physical exam xray ordered to determine structure changes, then based on findings ordered MRI and neurosurgeon referral.

NP COMPETENCIES 3d). Prescribes medications within scope of practice.

6 3d). Elderly female patient with severe COPD transferred as new patient and was found to be treated with theophylline, realized she should be seen by pulmonologist for management of this therapy and educated and referred her. 3e). Followed and treated a female with anorexia restrictive type from October 2013 until May 2014, during this time she gained weight, established normal weight and was able to change behaviors. 4. Female patient with hypertension, not controlled on current regimen, when creating a treatment plan involved her decisions to establish patient-centered care. 4a). Preceptors have provided feedback explaining my success of creating rapport with patients; see preceptor evaluations. 4b). During comprehensive physical exam of elderly male patient ensure curtain was pulled, room temperature adjusted, provided a chaperone, using a sheet kept him draped only exposing area of assessment, encouraged his involvement with developing plan to help with weight loss. 4c). Incorporated a diabetic patients preference to practice a vegan diet to develop a meal plan that will also promote her diabetes management. 4d). Elderly gentleman with history of multiple prostate biopsies, discussed risk/benefit for future testing and biopsies allowing him to make educated decision about his health care.

3e). Manages the health/illness status of patients and families over time.

4. Provides patient-centered care recognizing cultural diversity and the patient or designee as a full partner in decision-making. 4a). Works to establish a relationship with the patient characterized by mutual respect, empathy, and collaboration. 4b). Creates a climate of patient-centered care to include confidentiality, privacy, comfort, emotional support, mutual trust, and respect.

4c). Incorporates the patients cultural and spiritual preferences, values, and beliefs into health care. 4d). Preserves the patients control over decision making by negotiating a mutually acceptable plan of care.

Across the Life Span/Family NP Competencies (NONPF, 2012) Leadership Competencies for the FNP 1. Works with individuals of other professions to maintain a climate of mutual respect and shared values. 2. Engages diverse health professionals who complement ones own professional expertise, as well as associated resources, to develop 1. Work with other providers, nutritionist, nursing staff, medical assistance and secretaries with respect and shared values. 2. Asked Dr. Jackson, well studied in psychological treatment about use of antidepressant in young female who had side

NP COMPETENCIES strategies to meet specific patient care needs.

7 effects of the more commonly used antidepressants and treated according to her recommendations. 3. Every Thursday at CHCFC participates in a lunch and learn session with the team to learn about new guidelines, research, or pharmaceuticals to improve our treatment plans for patients. 4. Discussed and supported first year medical residents with their transition to rounding and providing care to patients in a hospital setting.

3. Engages in continuous professional and interprofessional development to enhance team performance.

4. Assumes leadership in interprofessional groups to facilitate the development, implementation and evaluation of care provided in complex systems.

Independent Practice Competencies for the FNP 1. Obtains and accurately documents a relevant health history for patients of all ages and in all stages of the individual and family life cycle using collateral information as needed. 2. Performs and accurately documents appropriate comprehensive or symptom focused physical examinations on patients of all ages (including developmental behavioral screening, physical exam and mental health evaluations). 3. Identifies health and psychosocial risk factors of patients of all ages and families in all stages of the family life cycle. 4. Identifies and plans interventions to promote health with families at risk. 1. Thoroughly inquires about relevant health history for 40yr who is a new patient to the practice including reviewing his old records and updating the information into his electronic medical record. 2. Completed physical exams for ages 2mo94 years and documented findings including PHQ2/9, CRAFT questionnaire, and minimental examinations; see clinical experience.

5. Assesses the impact of an acute and/or common illness or common injuries on the family as a whole. 6. Distinguishes between normal and abnormal change across the lifespan.

7. Assesses decision making ability and consults and refers appropriately.

3. Assessed and advised a new mother about the toddler stage, the importance of patients, time alone to stay calm, and safety. 4. Assisting a family who has a sister with an eating disorder on plans for eating health and coping mechanisms to deal with the stress after their father leaving. 5. Assessed how two sisters of a patient were so worried about their fathers diagnosis of cancer it caused them to have frequent arguments about his care. 6. A 55year gentleman was complaining of short term memory loss and decided this was too early in life to not have cause found his hormones were imbalanced after sending him to endocrinologist for treatment his memory returned. 7. Assessed and treated a 23 year old female with deciding about birth control initiated oral contraception while waiting for referral to ob-

NP COMPETENCIES

gyn for discussion of IUD placement. 8. Synthesizes data from a variety of sources to 8. Based on evidence based research and make clinical decisions regarding appropriate guidelines advised male obese child and management, consultation or referral. parents on recommended management and referred to dietician and exercise for health program. 9. Plans diagnostic strategies and makes 9. Refers to guidelines for when necessary to appropriate use of diagnostic tools for perform rapid strep or urinalysis in the office to screening and prevention, with consideration of avoid false positives/negative. the costs, risks and benefits to individuals. 10. Formulates comprehensive differential 10. For each encounter establishes at least diagnoses. three differential diagnoses for presenting symptoms and findings. 11. Manages common acute and chronic 11. Gentleman was having asthma flare related physical and mental illnesses, including acute to seasonal allergies, prescribed antihistamine exacerbations and injuries across the lifespan and short steroid burst with a follow up in one to minimize the development of complications, week to determine effect. and promote function and quality of living. 12. Prescribes medications with knowledge of 12. During a physical examination, realized altered pharmacodynamics and this 80 year female didnt require three pharmacokinetics with special populations, antihypertensive drugs any longer and in a such as infants and children, pregnant and month was able to stop two of the three with lactating women, and older adults. continue control of her blood pressure. 13. Prescribes therapeutic devices. 13. Prescribed compression stocking for diabetic patient suffering from peripheral edema related to venous insufficiency. 14. Adapts interventions to meet the complex 14. Elderly couple who live together but their needs of individuals and families arising from needs of more care has increased; both had aging, developmental/life transitions, comultiple falls brought family in for discussion morbidities, psychosocial and financial issues. of best care options and involved social worker to help address financial concerns. 15. Assesses and promotes self-care for 15. Female suffering from hypoxic individuals with disabilities. encephalopathy evaluated for self-care deficits and order appropriate medical equipment and services to ensure self-care. 16. Plans and orders palliative and end-of-life 16. Established plan for 67yo female with care as appropriate. terminal breast cancer and referred to hospice for care of her and her family to ensure her wishes were respected. 17. Performs primary care procedures. 17. Performed cryotherapy, pap, breast, prostate and rectal examinations accurately, see clinical experience. 18. Uses knowledge of family and family 18. Applied and evaluated the impact of a theories and development stages to teenager with eating disorder and her mother individualize care provided to individuals and still trying to give her freedom and families. responsibility using the family social science

NP COMPETENCIES

9 theory: family life cycle. 19. Had a family meeting with patient and his two daughters to educate about treatment options for brain tumors and assisted and advised them on how to develop a plan that best met his health needs. 20. During a follow up with a diabetic patient realized his short-term memory loss impacted how I explained to use two different insulin types. The next time I wrote the information down and had him repeat it back to me, then called him later that day and discussed once more the changes. 21. Explained to patients and referred those suffering from mental health conditions to a psychologist for medication management and to psychiatrist for counseling needs.

19. Facilitates family decision-making about health.

20. Analyzes the impact of aging and age-anddisease-related changes in sensory/perceptual function, cognition, confidence with technology, and health literacy and numeracy on the ability and readiness to learn and tailor interventions accordingly. 21. Demonstrates knowledge of the similarities and differences in roles of various health professionals providing mental health services, e.g. psychotherapists, psychologist, psychiatric social worker, psychiatrist, and advance practice psychiatric nurse. 22. Evaluates the impact of life transitions on the health/illness status of patients and the impact of health and illness on patients (individuals, families and communities). 23. Applies principles of selfefficacy/empowerment in promoting behavior change.

22. Evaluated the impact of a patient losing her mother and helped treat her increased depression and lack of self-care.

23. Explained the lab results to patient after he modified his diet and exercise habits to decrease his cholesterol, encouraged him to keep up the efforts. 24. Develops patient-appropriate educational 24. Developed a handout for patient to assists materials that address the language and cultural diabetic patients to titrate their Lantus dosing beliefs of the patient. at home based on fasting blood sugars. 25. Monitors specialized care coordination to 25. Hispanic family struggling with obesity, enhance effectiveness of outcomes for routine follow ups to monitor their success and individuals and families. discuss new treatment plans.