Registered Nurse Entry-Level Competencies

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CompetenciesSASKATCHEWANASSOCIATIONRegistered NurseEntry-LevelCompetenciesEffective: October 30, 20191Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

Registered NurseEntry-LevelCompetenciesEffective: October 30, 20191Registered Nurse Practice Standards 2019 Saskatchewan Registered Nurses Association

SRNA’s Mandate and PurposeThe Saskatchewan Registered Nurses Association (SRNA) is a profession-ledregulatory body and association established in 1917 by the provincial legislature. TheSRNA is accountable through The Registered Nurses Act, 1988 for public protectionby ensuring members are safe, competent and ethical practitioners. One of theways SRNA does this is by establishing and maintaining standards for registerednurse (RN) practice. Standards are developed in collaboration with members,the public and stakeholders and when examined alongside the RN entry-levelcompetencies outline the basic expectations for RN practice in Saskatchewan.Throughout this document, the term registered nurse refers to graduate nurse,GN; registered nurse, RN; graduate nurse practitioner, GNP; registered nursewith Additional Authorized Practice, RN(AAP); and nurse practitioner, NP.2Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

Entry-Level CompetenciesBackgroundIn 2017, the Canadian Council of Registered Nurse Regulators (CCRNR)initiated the revisions of the Entry-Level Competencies of Registered Nursesin Canada (the “ELCs”). This initiative was led by a working group comprisedof 11 jurisdictions representing registered nurse regulators in Canada. TheELCs are revised every five years to ensure inter-jurisdictional consistency andpractice relevance. Consistency between jurisdictions supports the workforcemobility requirements of the Canadian Free Trade Agreement. Revisions arebased on the results of an environmental scan, literature reviews and stakeholderconsultation. The regulatory body in each jurisdiction validates and approves theELCs and confirms they are consistent with provincial/territorial legislation.Each ELC in this context is considered to be an observable ability of aregistered nurse at entry-level that integrates the knowledge, skills, abilitiesand judgment required to practice nursing safely and ethically.ELCs are used by regulatory bodies for a number of purposes including, butnot limited to: Academic program approval/recognition Assessment of internationally-educated applicants Assessment of applicants for the purpose of re-entry into the profession Input into the content and scope of entry-to-practice exams Practice advice/guidance to clinicians Public and employer awareness of the practice expectations of registered nursesThe Context of Entry-Level Registered Nursing PracticeThe design and application of the listed competencies is at entry-to-practice. Entrylevel RNs are at the point of initial registration or licensure, following graduationfrom an approved nursing education program. Their beginning practice draws ona theoretical and experiential knowledge-base that has been shaped by specificexperiences during their education program. They are health care team members whoare expected to accept responsibility and demonstrate accountability for their practice.They will recognize their limitations, ask questions, exercise professional judgment anddetermine when they require consultation. Entry-level RNs realize the importance ofidentifying what they know and do not know, what their learning gaps may be, and howand where to access available resources. They display initiative, a beginning confidence,and self-awareness in taking responsibility for their decisions in the care they provide.RN practice is dynamic and evolving; the ELCs establish the foundationfor nursing practice. Entry-to-practice represents the time when learnersbecome clinicians. Further development of RN practice is facilitatedthrough education, collaboration and mentorship. All groups involved in theprovision of health care have a shared responsibility to create and maintainpractice environments that support RNs in providing safe, ethical andquality health care. The practice environment influences the transition andconsolidation of RN practice and the development of further competence.3Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

Overarching PrinciplesThese competencies are expected not only of entry-level RNs; all RNs are ultimatelyaccountable to meet these competencies throughout their careers relative totheir specific context and/or patient population. The following overarchingprinciples apply to the education and practice of entry-level registered nurses:1. The entry-level RN is a beginning practitioner. It is unrealistic to expect anentry-level RN to function at the level of practice of an experienced RN.2. The entry-level RN works within the registered nursing scope of practice, andappropriately seeks guidance when they encounter situations outside of their ability.3. The entry-level RN must have the requisite skills and abilities to attainthe entry-level competencies.4. The entry-level RN is prepared as a generalist to practice safely, competently,compassionately and ethically: in situations of health and illness; with all people across the lifespan; with all recipients of care: individuals, families,groups, communities and populations; across diverse practice settings; and, using evidence-informed practice.5. The entry-level RN has a strong foundation in nursing theory,concepts and knowledge, health and sciences, humanities, research,and ethics from education at the baccalaureate level.6. The entry-level RN practices autonomously within legislation, practicestandards, ethics and scope of practice in their jurisdiction.7. The entry-level RN applies the critical thinking process throughoutall aspects of practice.The client is the central focus of RN practice and leads the process of decisionmaking related to care. In the context of this document, “client” refers to a personwho benefits from registered nursing care and, where the context requires,includes a substitute decision-maker for the recipient of nursing services. A clientmay be an individual, a family, group, community or population. Client-centredcare reflects that people are at the centre of decisions about their health and areseen as experts, working alongside RNs to achieve optimal health outcomes.4Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

StructureThe document is organized thematically using a roles-based format. There area total of 101 competencies grouped thematically under nine headings:1. Clinician2. Professional3. Communicator4. Collaborator5. Coordinator6. Leader7. Advocate8. Educator9. ScholarCopyright 2015 The Royal College of Physicians and Surgeons of anmeds-framework-e. Adapted with permission.Integration of all nine roles enables the entry-level RN to provide safe,competent, ethical, compassionate and evidence-informed nursing care in anypractice setting. Some concepts are relevant to multiple roles. For the sake ofclarity and to avoid unnecessary repetition, certain key concepts (e.g. clientcentred) are mentioned once and assumed to apply to all competencies.5Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

Competencies1. ClinicianRegistered nurses are clinicians who provide safe, competent, ethical,compassionate and evidence-informed care across the lifespan in responseto client needs. Registered nurses integrate knowledge, skills, judgment andprofessional values from nursing and other diverse sources into their practice.1.1Provides safe, ethical, competent, compassionate, client-centred and evidenceinformed nursing care across the lifespan in response to client needs.1.2Conducts a holistic nursing assessment to collect comprehensiveinformation on client health status.1.3Uses principles of trauma-informed care which places priority on traumasurvivors’ safety, choice and control.Trauma-InformedCare is aCarestrengths-basedframeworkthat is groundedTrauma-Informedis a strengths-basedframeworkthat is groundedin an understandingof and responsivenessto the impacttrauma,that thatin an understandingof and responsivenessto the ofimpactof trauma,emphasizesphysical,psychologicaland emotionalsafety land emotionalsafetyboth providersand survivors,and thatandcreatesopportunitiesfor survivorsto rebuilda sense a senseand survivors,that createsopportunitiesfor survivorsto rebuildof .133)of control and empowerment. (Hopper, Bassuk & Olivet, 2009, p. 133)1.4Analyses and interprets data obtained in client assessment to inform ongoingdecision-making about client health status.1.5Develops plans of care using critical inquiry to support professional judgment andreasoned decision-making. . . processof purposefuland reflectivereasoningwhereCriticalinquiry is thinkinga: . . . processof purposefulthinkingand inciples,conclusions,reasoning where practitioners examine ideas, assumptions, principles,beliefs andactions inbeliefsthe contextof nursingthisconclusions,and actionsin thepractice.contextInof addition,nursing practice.Inprocessaddition,is associateda spiritof inquiry,discrimination,logicaldiscrimination,this withprocessis associatedwitha spirit of inquiry,reasoningand applicationof standards. . of. (Brunt,2005,61) 2005, p. 61)logicalreasoning andapplicationstandards. . .p.(Brunt,1.6Evaluates effectiveness of plan of care and modifies accordingly.1.7Anticipates actual and potential health risks and possible unintended outcomes.1.8Recognizes and responds immediately when client safety is affected.1.9Recognizes and responds immediately when client’s condition is deteriorating.1.10 Prepares clients for and performs procedures, treatments and follow-up care.1.11 Applies knowledge of pharmacology and principles of safe medication practice.1.12 Implements evidence-informed practices of pain prevention, managesclient’s pain and provides comfort through pharmacological and nonpharmacological interventions.1.13 Implements therapeutic nursing interventions that contribute to the care andneeds of the client.1.14 Provides nursing care to meet palliative and end-of-life care needs.1.15 Incorporates knowledge about ethical, legal, and regulatory implicationsof medical assistance in dying (MAiD) when providing nursing care.6Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

1.16 Incorporates principles of harm reduction with respect to substance use andmisuse into plans of care.Harm reductionis consideredto be “policies,programmesand practicesHarm reductionis consideredto be “policies,programmesand practicesthat aimthatto primarilyreduce theadversehealth, socialeconomicaim to primarilyreducethe adversehealth,andsocialand economicconsequencesof the useof legalandillegaldrugs withoutconsequencesof theuse oflegalandpsychoactiveillegal psychoactivedrugs 017a,p.15).necessarily reducing drug consumption” (CNA, 2017a, p. 15).1.17 Incorporates knowledge of epidemiological principles into plans of care.1.18 Provides recovery-oriented nursing care in partnership with clients whoexperience a mental health condition and/or sincludessix dimensions:1. Creatinga CultureandRecovery-orientedsix dimensions:1. Creatinga CultureandLanguageof Hope;of2.Hope;Recoveryis Personal;3. RecoveryOccurs inthe ContextofLanguage2. Recoveryis Personal;3. RecoveryOccursin the ContextofOne’s inCanada;5.One’s Life; 4. Responding to the Diverse Needs of Everyone Living in Canada; 5.WorkingWorkingwith FirstNations,Inuit andMetis;6. Recoveris aboutisTransformingwithFirst Nations,InuitandandMétis;and 6. Recoverabout TransformingServicesServicesand -17)and Systems. (Mental Health Commission of Canada, 2015,pp. 15-17)1.19 Incorporates mental health promotion when providing nursing care.1.20 Incorporates suicide prevention approaches when providing nursing care.1.21 Incorporates knowledge from the health sciences, including anatomy,physiology, pathophysiology, psychopathology, pharmacology,microbiology, epidemiology, genetics, immunology and nutrition.1.22 Incorporates knowledge from nursing science, social sciences,humanities and health-related research into plans of care.1.23 Uses knowledge of the impact of evidence-informed registerednursing practice on client health outcomes.1.24 Uses effective strategies to prevent, de-escalate and managedisruptive, aggressive or violent behaviour.1.25 Uses strategies to promote wellness, to prevent illness, and tominimize disease and injury in clients, self and others.1.26 Adapts practice in response to the spiritual beliefs and cultural practices of clients.1.27 Implements evidence-informed practices for infection prevention and control.7Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

2. ProfessionalRegistered nurses are professionals who are committed to the health andwell-being of clients. Registered nurses uphold the profession’s practicestandards and ethics and are accountable to the public and the profession.Registered nurses demonstrate accountability, accepts responsibility and seeksassistance as necessary for decisions and actions within the legislated scope of practice.2.1Demonstrates accountability, accepts responsibility, and seeks assistance asnecessary for decisions and actions within the legislated scope of practice.2.2 Demonstrates a professional presence, and confidence, honesty, integrity andrespect in all interactions.Professionalpresenceis the demonstrationof s the demonstrationof onand empathyin accordancewith professionalstandards,optimism,and empathyin accordancewith professionalstandards,guidelinesand codesethics.includesa nurse’sa verbalnonverbalguidelinesandofcodesofItethics.It includesnurse’sandverbaland nonverbalcommunicationsand the andabilityarticulatea positiverole androleprofessionalcommunicationsthetoabilityto articulatea positiveand professionalimage, includingthe use theof fulltitle.Thedemonstrationof professionalimage, includingusenameof fullandnameandtitle.The demonstrationof professionalpresenceleads toleadstrustingrelationshipswith clients,families,families,communitiespresenceto trustingrelationshipswith clients,communities andand 018,1)otherhealthteammembers.(Collegeof NursesNovap.Scotia,2018, p. 2)2.3 Exercises professional judgment when using agency policies and procedures,or when practicing in their absence.2.4 Maintains client privacy, confidentiality and security by complying withlegislation, practice standards, ethics and organizational policies.2.5 Identifies the influence of personal values, beliefs and positional power onclients and the health care team and acts to reduce bias and influences.2.6 Establishes and maintains professional boundaries with clients andthe health care team.2.7 Identifies and addresses ethical (moral) issues using ethical reasoning, seekingsupport when necessary.2.8 Demonstrates professional judgment to ensure social media and information andcommunication technologies (ICTs) are used in a way that maintains public trustin the profession.Informationand communicationtechnologies“Encompassesall thosealldigitalInformationand communicationtechnologies“Encompassesthose digitaland analoguetechnologiesthat facilitatethe capturing,processing,storage,storage,and analoguetechnologiesthat facilitatethe capturing,processing,and exchangeof informationvia electroniccommunication”(Canadianand exchangeof informationvia electroniccommunication”(CanadianAssociationof Schoolsof Nursing,Canada CanadaHealth Infoway,2012, p. 2012,13). p. 13).Associationof Schoolsof Nursing,Health Infoway,2.9 Adheres to the self-regulatory requirements of jurisdictional legislation toprotect the public by: assessing own practice and individual competence to identify learning needs; developing a learning plan using a variety of sources; seeking and using new knowledge that may enhance,support or influence competence in practice; and, implementing and evaluating the effectiveness of the learningplan and developing future learning plans to maintainand enhance competence as a registered nurse.2.10 Demonstrates fitness to practice.Fitness Fitnessto practiceare “all thequalitiesand capabilitiesof an individualrelevantrelevantto practiceare “allthe qualitiesand capabilitiesof an individualto their topracticeas a nurse,but not butlimitedto the freedomfrom anytheir practiceas aincludingnurse, includingnot limitedto the freedomfrom itionanddependencefromcognitive, physical, psychological or emotional condition and dependence fromalcohol alcoholor drugsorthatimpairstheir abilitypracticenursing”(CNA, 2017b,drugsthat impairstheirtoabilityto practicenursing”(CNA,p.22).2017b, p.22).8Registered Nurse Entry-Level Competencies 2019 Saskatchewan Registered Nurses Association

2.11 Adheres to the duty to report.2.12 Distinguishes between the mandates of regulatory bodies, professionalassociations and unions.2.13 Recognizes, acts on and reports harmful incidences, near misses and noharm incidences.Patientincidentsafety incidentis consideredtoeventbe: Anor circumstancePatient safetyis consideredto be: Anoreventcircumstancewhichhavecouldhave resulted,or didinresult,in unnecessarywhich couldresulted,or did result,unnecessaryharm toharm to apatient.are typesthree oftypesof patientincidents:a patient.ThereThereare threepatientsafety safetyincidents:harmfulaincident:a patientsafetyincidentthat harmful incident:patient safetyincidentthatresultedinresultedharm in harmto thepatient.“preventableReplaces “preventableadverse event”;to the patient.Replacesadverse event”; nearmiss:safetya patientsafetyincidentdidthenot reach the near miss:a patientincidentthatdid notthatreachandnothereforeno harmandresulted; and,patient andpatientthereforeharm resulted;no-harmaincident:a patientsafetyincidentthatreachedbut no no-harm incident:patient harm(Canadianresulted. (CanadianPatientSafety2015,Institute,2015, Glossary)discernablediscernableharm resulted.Patient SafetyInstitute,Glossary)2.14 Recognizes, acts on and reports actual and potential workplace andoccupational safety risks.3. CommunicatorRegistered nurses are communicators who use a variety of strategies andrelevant technologies to create and maintain professional relationships,share information and foster therapeutic environments.3.1Introduces self to clients and health care team members by firstand last name and professional designation (protected title).3.2 Engages in active listening to understand and respond to theclient’s experience, preferences and health goals.3.3 Uses evidence-informed communication skills to build trusting,compassionate and therapeutic relationships with clients.3.4 Uses conflict transformation strategies to promote healthyrelationships and optimal client outcomes.3.5 Incorporates the process of relational practice to adapt communication skills.Relationalpracticepracticeis consideredto be “atorespectfuland reflexiveapproachtoRelationalis consideredbe “a respectfuland reflexiveapproachtoinquire inquireinto patients’lived experiencesand healthneeds”p.2016,1). p. 1).into patients’lived experiencesandcarehealthcare (Zou,needs”2016,(Zou,3.6 Uses ICTs to su

entry-level RN to function at the level of practice of an experienced RN. 2. The entry-level RN works within the registered nursing scope of practice, and appropriately seeks guidance when they encounter situations outside of their ability. 3. The entry-level RN must have the requisite skills and abilities to attain the entry-level competencies. 4.

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