What are the NP Core Competencies?
What is every nurse practitioner (NP) required to know once he or she graduates from NP school? These requirements are defined and agreed upon by the National Organization of Nurse Practitioner Faculties (NONPF). The NONPF created the first set of competencies in 1990; the most recent updates were incorporated in 2012.
These core competencies apply to all nurse practitioners, regardless their medical specialty or patient population focus. Nurse practitioner core competencies were created by experts in clinical practice and education. The task force behind the 2012 update included various nurse practitioner organization and certification boards, and they created sub-groups of experts for each population focus.
NONPF has defined nine broad areas of core competence:
- Scientific foundations
- Practice inquiry
- Technology and information literacy
- Health delivery system
- Independent practice
Each of these is subdivided into specific objectives that every nurse practitioner must demonstrate in order to graduate NP school. Furthermore, NP schools use the core competencies to design their curricula to ensure that students gain the knowledge, skills, and abilities to practice as licensed independent practitioners. The NONPF asserts that achievement of these competencies is of greater value than the total number of clinical hours a student performs.
Scientific Foundation Competencies
These competencies ensure that nurse practitioners graduate with a comprehensive background in medical sciences. All nurse practitioner students are required to take foundational pathophysiology and pharmacology, but depending on their specialty, they may take additional courses. Psychiatric nurse practitioners often take courses in neuroscience whereas neonatal nurse practitioners take courses in neonatology. Scientific core competencies also include knowledge and understanding of clinical practice guidelines, evidence-based practice, translational research, and treatment of vulnerable and diverse patient populations.
The scientific foundation core competencies defined by the NONPF include the following:
- Thinks critically about data and applies this evidence to improving practice.
- Allows knowledge from the humanities and other disciplines to inform one’s work in nursing.
- Incorporates research findings to enhance practice methods and patient outcomes.
- Creates fresh evidence-based approaches and techniques, paying thought to research findings, core theory, and experience from practice.
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Leadership competencies focus on professional accountability, scholarship, and advocacy. These skills ensure that nurse practitioner students understand their scope and standards of practice and that they are prepared to lead healthcare teams. The leadership competencies also encompass cultural sensitivity, engagement in professional organizations, and communication skills.
The leadership core competencies include the following:
- Embraces high leadership opportunities to facilitate change.
- Liaises effectively between various parties (e.g., healthcare teams, patients, community, policy advocates) in efforts to improve healthcare.
- Applies critical and reflective thinking to one’s leadership.
- Acts as an advocate for resource-efficient, cost-effective, and quality care.
- Elevates practice by incorporating innovations.
- Has excellent oral and written communication skills.
- Joins professional associations, advocacy groups, and other activities to improve healthcare.
Quality care, as defined by the NONPF, refers to the degree to which health services increase the desired health outcomes consistent with professional knowledge and standards. Quality competencies focus on understanding how to access and use information databases and how to critically evaluate research findings.
The quality core competencies include the following:
- Applies the best and most contemporary research findings to clinical practice.
- Considers the complex relationships between cost, safety, access, and quality in healthcare delivery.
- Assesses the effects of organizational structures, financial management, policy, and other factors on healthcare.
- Offers feedback in peer reviews to “promote a culture of excellence.”
- Tailors care to each practice situation and uses interventions as necessary.
Practice Inquiry Competencies
Practice inquiry competencies focus on translational research, i.e., taking academic research and applying it to the clinical setting. These competencies ensure that nurse practitioner students understand how to apply research to improve their patients’ health outcomes.
The practice inquiry core competencies include the following:
- Translates new knowledge into practice through leadership.
- Uses clinical experiences to inform practice and improve patient outcomes.
- Applies investigative abilities in a clinical setting to improve healthcare.
- Facilitates practice inquiry, both individually and in partnerships.
- Transmits knowledge from inquiry to others.
- Thinks critically about the individual applications of clinical guidelines.
Technology and Information Literacy Competencies
Information literacy, as defined by the NONPF, refers to the use of digital technology, communications tools, and/or networks to access, manage, integrate, evaluate, create, and effectively communicate information. The goal of these competencies is to teach nurse practitioner students how to use available technology to enhance the safety and health outcomes of their patients. To achieve these objectives, NP schools may require students to take an informatics course.
The technology and information literacy core competencies include the following:
- Uses appropriate technology to manage information.
- Translates health information for various users.
- Helps patients and caregivers understand conditions and treatments.
- Motivates patients and caregivers to make positive changes.
- Excels at complex decision-making.
- Informs the design of effective clinical information systems.
- Facilitates health information technologies which allow for care evaluation.
Health policy, as defined by the NONPF, refers to the set of decisions pertaining to health, which influence health resource allocation. These can be made at organizational, local, state, national, and global levels. These competencies teach nurse practitioner students how to influence legislation to improve health issues and social problems like poverty, literacy, and violence. Students may be required to take a specific health policy or healthcare economics course in order to achieve these competencies.
The policy core competencies include the following:
- Understands the interdependence of clinical practice and policy.
- Promotes ethical approaches to improving access, cost, and quality.
- Pays thought to policy’s context (e.g., legal, social, etc).
- Assists in creating health policy.
- Examines cross-disciplinary impact of policy.
- Analyzes influence of globalization on healthcare policy.
Health Delivery System Competencies
The health delivery system competencies refer to the planning, development, and implementation of public and community health programs. These competencies also educate students on healthcare reform and organizational decision-making.
The health delivery system core competencies include the following:
- Incorporates knowledge of organizations and systems to improve healthcare.
- Utilizes negotiation and relationship-building to positively affect healthcare.
- Minimizes patient and provider risks.
- Develops culturally competent care.
- Analyzes impact of healthcare system on all stakeholders.
- Thinks critically about organizational structures and resource allocation.
- Works with others to improve the continuum of healthcare.
These competencies encompass understanding the ethical implications of scientific advances and learning to negotiate ethical dilemmas specific to that student’s patient population.
The ethical core competencies include the following:
- Uses ethics in decision-making.
- Analyzes ethical impact of all decisions.
- Understands ethical complexities in healthcare delivery to individuals and populations.
Independent Practice Competencies
The independent practice competencies ensure that a nurse practitioner can function as a licensed independent practitioner. The NONPF defines a licensed independent practitioner as an individual with a recognized scientific knowledge base, who is permitted by law to provide care and services without direction or supervision. These competencies encompass the assessment, diagnosis, and treatment of patients within the student’s population focus. For example, a psychiatric nurse practitioner would learn to diagnosis and treat mental illness and addiction.
The independent practice core competencies include the following:
1.Works effectively as an autonomous practitioner.
2. Operates professionally under highest level of accountability.
3. Manages both diagnosed and undiagnosed patients as an independent practitioner:
a. Offers health promotion and protection; preventative care; counseling; treatment planning and implementation; and palliative or end-of-life care.
b. Can distinguish between normal and abnormal health findings.
c. Knows screening and diagnostic protocols.
d. Prescribes medications in accordance with regional laws.
e. Provides healthcare over the lifespan of individuals and families.
4. Respects patient’s wishes and offers culturally competent care:
a. Fosters collaborative and empathetic patient relationships.
b. Cultivates patient-centeredness with respect to confidentiality, mutual trust, and support.
c. Takes into consideration patient’s spiritual and cultural influences (or other beliefs).
d. Reassures patients that they have control over decisions and offers expertise in creating a viable healthcare plan.
The NONPF taskforce used their expertise along with the following resources to develop the most recent nurse practitioner core competencies.
- The Future of Nursing: Leading Change, Advancing Health (IOM, 2011)
- Core Competencies for Interprofessional Collaborative Practice (2011)
- Quality and Safety Education for Nurses (QSEN) Graduate Competency KSAs (2012)
- Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (2012)
- The Essentials of Master’s Education in Nursing (AACN, 2011)
- The Essentials of Doctoral Education for Advanced Practice Nursing (AACN, 2006)
- Oral Health Core Clinical Competencies for non-Dental Providers (2013)
Dr. Melissa DeCapua, DNP, PMHNP-BC
Melissa DeCapua is a board-certified psychiatric nurse practitioner who graduated from Vanderbilt University. She has a background in child and adolescent psychiatry as well as psychosomatic medicine. Uniquely, she also possesses a bachelor’s degree in studio arts, which she uses to enhance patient care, promote the nursing profession, and solve complex problems. Melissa currently works as the Healthcare Strategist at a Seattle-based health information technology company where she guides product development by combining her clinical background and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Melissa, check out her blog www.melissadecapua.com and follow her on Twitter @melissadecapua.
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Given the overwhelming evidence that NPs provide cost-effective, safe healthcare for their patients, it’s time for Oklahoma to disabuse itself of unnecessary practice restrictions so that NPs can help alleviate the looming primary care provider shortage.
As a shortage of primary care providers looms on our collective horizon, lack of access to primary care has the potential to get much worse. And, unfortunately, the South is going to be the most heavily impacted.
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