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Competencies

For NP prescribing of controlled drugs and substances

Competencies are statements about the knowledge, skills and judgment required to perform safely within an individual’s nursing practice in a designated role or setting. The statement of competencies should be considered in conjunction with federal and provincial legislation and the standards in CRNBC’s Standards, Limits and Conditions for Nurse Practitioner Prescribing.

NP CDS prescribing competencies

Knowledge of legislation

The nurse practitioner establishes and maintains knowledge in federal and provincial legislation related to controlled drugs and substances. 

​Ethical practice

The nurse practitioner demonstrates ethical practice in prescribing controlled drugs and substances. 

​Assessment

The nurse practitioner performs and documents relevant and thorough baseline and ongoing assessments when initiating, modifying, continuing or discontinuing controlled drugs and substances. 

Identification and management of risk of aberrant drug-related behaviours and harms

The nurse practitioner identifies and manages the risk of aberrant drug related behaviours and harms associated with prescribing controlled drugs and substances. 

Diagnosis

The nurse practitioner demonstrates competence in diagnosis prior to prescribing controlled drugs and substances. 

Knowledge synthesis in therapeutic management

In making treatment decisions, the nurse practitioner synthesizes knowledge of a wide range of appropriate controlled, non-controlled and non-pharmacologic therapeutic options. 

Advanced communication, negotiation and facilitation skills in relation to controlled drugs and substances prescribing

The nurse practitioner demonstrates advanced skill in communication, negotiation, and facilitation of shared decision-making related to the initiation, utilization or discontinuation of controlled drugs and substances. 

Education

The nurse practitioner educates clients, and as appropriate families, regarding safe and appropriate use of controlled drugs and substances.  

Decision-making in prescribing

The nurse practitioner demonstrates competence in dosing, conversion, adjustment, titration, tapering, continuation and discontinuation when prescribing controlled drugs and substances

Documentation

The nurse practitioner documents all elements required for legal, safe and appropriate controlled drugs and substances provision in a timely and professional manner.​

About competencies
Competencies are statements about the knowledge, skills and judgment required to perform safely within an individual’s nursing practice in a designated role or setting. They provide the broad framework to develop outcomes relevant to nursing practice. They are also used for curricula building, teaching and professional development. CRNBC uses them to determine registration and examination requirements, in practice assessment and quality assurance. 

The assumptions used to develop competency statements specific to prescribing CDS and substances are presented below. They help define the NP role as unique but built upon RN level practice competencies. NP practice incorporates both national (CNA, 2010) and provincial level competencies (CRNBC, 2011). To strengthen the provincial level competencies for NPs, CRNBC developed a statement of competencies for NP CDS prescribing. For a full description of the process and analysis, see the report Analysis of the Proceedings of the Expert Panel: Development of Competencies for Nurse Practitioner Prescribing of Controlled Drugs and Substances, 2014. 

In brief, following a comprehensive literature review, CRNBC contracted with Washington State University to support its work. The principal investigator was an NP and nursing faculty member with recognized expertise in NP prescribing competencies. This investigator led an expert panel of NPs and other health professionals in the development of a statement of competencies for NP CDS prescribing. The process began with a review of assumptions presented in Competencies for Registered Nurse Practitioners in British Columbia (CRNBC, 2011). 

The panel then developed a set of additional assumptions specific to NP CDS prescribing. With this information and a preliminary draft of a statement of competencies prepared by the consultant, the panel created a statement of competencies. The statement of competencies should be considered in conjunction with federal and provincial legislation and the standards in CRNBC’s Standards, Limits and Conditions for Nurse Practitioner Prescribing (CRNBC, 2014).​​​​

Assumptions: NP competencies

The assumptions used to develop competencies are essential to understanding how they are applied to NP practice. They are not specific to a particular client population or practice environment. 

The following assumptions, present in Competencies for Registered Nurse Practitioners in British Columbia (CRNBC, 2011), were adopted as context for the development of NP CDS prescribing competencies: 

  • The practice of nurse practitioners is grounded in the values, knowledge and theories of professional nursing practice.  
  • Nurse practitioner competencies build and expand upon the competencies required of a registered nurse.  
  • Nurse practitioner practice is advanced in the application of in-depth knowledge and theory from nursing and other fields, including experiential knowledge gained from clinical practice experience as registered nurses.  
  • Nurse practitioners have achieved additional competencies at the graduate level of nursing education, with a substantial clinical component.  
  • Nurse practitioner core competencies are the foundation for all nurse practitioner practice and apply across diverse practice settings and client populations. 

A common set of NP core competencies is essential to all nurse practitioner education and practice regardless of practice stream (family, adult, or pediatric). A description of each stream of practice demonstrates how the core competencies are applied by family, adult or pediatric nurse practitioners.  

Nurse practitioner core competencies are an essential element of nurse practitioner competence assessment. Nurse practitioner practice is grounded in the five World Health Organization (WHO) principles of primary health care: 

  • accessibility
  • public participation
  • health promotion
  • appropriate technology
  • intersectoral collaboration.  

Nurse practitioners provide services relating to health promotion, illness/injury prevention, rehabilitative care, curative and supportive care, and palliative/end-of-life care.  

The identified competencies incorporate those of advanced nursing practice and specifically address the activities that are included in the additional legislated scope of practice of Nurse Practitioners, e.g., advanced health assessment, diagnosis of acute and chronic illnesses and their therapeutic management.  Nurse practitioners engage in inter-professional collaborative practice to provide safe, client-centered, high quality health care services.  Newly graduated nurses practitioners gain proficiency in the breadth and depth of their practice over time with support from employers, mentors and health-care team members.

Assumptions: CDS prescribing competencies

The additional assumptions used to develop controlled drugs and substances competencies are essential to understanding how they are applied to nurse practitioner practice in any role and setting that includes responsibilities for prescribing. The following additional assumptions were made:

  • Nurse practitioners develop and implement a plan of care that includes appropriate controlled and non-controlled medications as well as non-pharmacologic therapeutic options.
  • There are a unique set of competencies for nurse practitioner prescribing, management and dispensing specific to controlled drugs and substances.
  • Nurse practitioners practice within the CRNBC Standards, Limits and Conditions for Nurse Practitioner Prescribing.
  • The identified competencies for prescribing controlled drugs and substances may be integrated into advanced pharmacotherapeutic education obtained during  or after initial nurse practitioner education and practice. 
  • Nurse practitioners are responsible to obtain and maintain competence in controlled drugs and substances prescribing congruent with their scope of practice, stream in which they are registered, role, populations served, and practice setting-specific standards.
  • Nurse practitioners engage in evidence informed prescribing of controlled drugs and substances.
  • Nurse practitioners communicate, as appropriate, with inter-professional colleagues involved in a client’s care both before and after prescribing controlled drugs and substances.​
Bibliography

Canadian Nurses Association (CNA). (2010). Canadian Nurse Practitioner Core Competency Framework. Ottawa, ON: Author. 

College of Registered Nurses of British Columbia (CRNBC). (2011). Competencies Required for Nurse Practitioners in British Columbia. Vancouver, BC: Author. 

College of Registered Nurses of British Columbia (CRNBC). (2012). Narcotics and Controlled Substances Literature Review. Vancouver, BC: Author. 

College of Registered Nurses of British​ Columbia (CRNBC). (May, 2013). Nurse Practitioner Controlled Substance Post Survey Analysis. Vancouver, BC: Author.

College of Registered Nurses of British Columbia (CRNBC). (March, 2014). Expert Panel Analysis: Development of Competencies for Nurse Practitioner Prescribing of Controlled Drugs and Substances. Vancouver, BC: Author. 

College of Registered Nurses of British Columbia (CRNBC). (May, 2014). Standards, Limits and Conditions for Nurse Practitioner Prescribing. Vancouver, BC: Author. 

Government of Canada. (2014). Controlled Drugs and Substances Act​ (S.C. 1996, c. 19). ​

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