Registed Nurses' Association of Ontario

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Choosing a Care Provider - NP Competencies

The Hospital Based Nurse Practitioner

The purpose of this document is to expand on the specific competencies of Nurse Practitioners (NPs) in the hospital environment. This document can support hospital administrators in understanding the unique contributions and outcomes that NPs can facilitate in advancing access, flow, patient experience/outcomes, quality and cost-effectiveness.

NPs are clinicians that provide essential health services to patients within a framework of advanced nursing practice (specialty knowledge and skills). NP practice is authorized by a legislated scope of practice that includes assessment, diagnosis and therapeutic/treatment planning. NPs treat and manage acute and chronic illnesses in hospitals and are completely accountable for the autonomous care that they provide. NPs consult and collaborate with physicians and other inter-professional team members as needed to optimize care. NPs also provide leadership within teams including the development, implementation and evaluation of strategies to promote health and prevent secondary and tertiary illness and injury.

NPs as Advanced Practitioners

NPs have an expert knowledge base, complex decision making skills and clinical competencies (DiCenza et al., 2012). NPs can analyze and synthesize knowledge, understand, interpret and apply nursing theory and research and assist in developing and advancing nursing staff, contributing to nursing knowledge and to the profession as a whole (CNA, 2008).

Confirmed Outcomes for NP Practice include:

patient satisfaction (1,2,3)

improved clinical outcomes (3,4)

decreased length of stay (5,6)

improved patient flow and clinical outcomes by reducing patient complication, morbidity and mortality rates (7,8,9)

decreased care costs (10)

prevention of ER visits11

NP Competencies (CNA, 2010)

Advanced Health Assessment/Diagnosis/Therapeutic Planning

The NP:

  • Performs comprehensive health assessments (focused or comprehensive).
  • Diagnoses diseases, disorders, injuries and conditions.
  • Prevents, anticipates, diagnoses and intervenes to manage emergent, urgent and life-threatening situations.
  • Orders and or performs diagnostic investigations, interprets results using evidence-informed clinical reasoning and critical inquiry, and assumes responsibility for follow-up.
  • Communicates with patients and families diagnosis, including outcomes and prognosis.
  • Develops therapeutic plans with patients, families and inter-professional team using evidence-informed practice.
  • Supports, educates, coaches and counsels clients regarding diagnoses, prognoses and self- management.
  • Prescribes pharmacotherapy, applying evidence-informed practice in prescribing, monitoring and dispensing drugs,
  • Counsels clients on medication therapy, benefits, potential side effects, interactions, importance of compliance and recommended follow-up.

Health Promotion and Prevention of Illness

The NP:

  • Develops, implements and evaluates strategies to improve/restore health.
  • Identifies clinical and system issues and trends.
  • Prevents and manages nosocomial complications.
  • Optimizes management of acute and chronic illness.
  • Implements evidence-based best practices, for example:
    • DVT prophyaxis
    • Antimicrobial stewardship
    • Delirium prevention
    • Falls prevention
    • Prevention of urinary-tract infections
    • Prevention of pneumonia
    • Pressure ulcer prevention
    • Prevention of hospital-association deconditioning
    • Restraint-use minimization

Professional Role and Responsibility

The NP:

  • Provides leadership in the management of clinical care, is a resource person, educator and role model.
  • Acts as a preceptor, mentor and coach.
  • Collaborates with members of the health-care team to provide and promote inter-professional client-centred care
  • Applies advanced knowledge and skills in communication, negotiation, coalition building, change management and conflict-resolution.
  • Acts as a change agent.
  • Advocates for an organizational environment that supports safe client care, collaborative practice and professional growth.
  • Provides leadership in the development and implementation of standards, policies, practice guidelines, quality assurance, and education and research initiatives.
  • Integrates the principles of resource allocation and cost-effectiveness into clinical decision-making.
  • Promotes safe client care
  • Consults with other health-care providers when the client’s condition is not within NP scope of practice or competence.


  1. Cooper,M. A. Lindsay,G. M. Kinn,S. Swann,I. J. Evaluating Emergency Nurse Practitioner services: a randomized controlled trial Journal of advanced nursing, Dec 2002:40(6) p721-730
  2. Dinh,Michael Walker,Andrew Parameswaran,Ahilan Enright,Nicholas Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors Australasian Emergency Nursing Journal, 11 2012:15(4) p188-194
  3. Sawatzky, JA Christie, S Singal, RK. Exploring outcomes of a nurse practitioner-managed cardiac surgery follow-up intervention: a randomized trial. Journal of advanced nursing, 2013:p1-12
  4. van Zuilen,A. D. Blankestijn,P. J. van Buren,M. ten Dam,M. A. Kaasjager,K. A. Ligtenberg,G. Sijpkens,Y. W. Sluiter,H. E. van de Ven,P. J. Vervoort,G. Vleming,L. Bots,M. L. Wetzels,J. F. Nurse practitioners improve quality of care in chronic kidney disease: two-year results of a randomised
    study. Netherlands Journal of Medicine, Nov-Dec 2011:69(11) p517-526
  5. Gross,P. A. Aho,L. Ashtyani,H. Levine,J. McGee,M. Moran,S. Anton,T. Feldman,J. Kuyumjian,A. Skurnick,J. Extending the nurse practitioner concurrent intervention model to community-acquired pneumonia and chronic obstructive pulmonary disease. Joint Commission Journal on Quality and Safety, Jul 2004:30(7) p377-386
  6. Medeiros, R. NeSmith, E. Heath, J. Hawkins, M. Hawkins, D. Bias, R. Midlevel Health Providers Impact on ICU Length of Stay, Patient Satisfaction, Mortality, and Resource Utilization Journal of Trauma Nursing, 2011 2011:18(3) p149-154
  7. Fry, M. Literature review of the impact of nurse practitioners in critical care services Nursing in critical care, 2011 2011:16(2) p58-66
  8. Broers,C. J. M. Sinclair,N. Van Der Ploeg,T. J. Jaarsma,T. Van Veldhuisen,D. J. Umans,V. A. W. M. The post-infarction nurse practitioner project - A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population. Netherlands Heart Journal, February 2009:17(2) p61-67
  9. Broers,C. J. M. Sinclair,N. Van Der Ploeg,T. J. Jaarsma,T. Van Veldhuisen,D. J. Umans,V. A. W. M. The post-infarction nurse practitioner project - A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population. Netherlands Heart Journal, February 2009:17(2) p61-67
  10. Chen,C. McNeese-Smith,D. Cowan,M. Upenieks,V. Afifi,A. Evaluation of a nurse practitioner-led care management model in reducing inpatient drug utilization and cost. Nursing Economics, May-Jun 2009:27(3) p160-168
  11. Robles,Lourdes Slogoff,Michele Ladwig-Scott,Eva Zank,Dan Larson,Mary Kay Aranha,Gerard Shoup,Margo The addition of a nurse practitioner to an inpatient surgical team results in improved use of resources Surgery, OCT 2011:150(4) p711-716