Nurse Practitioner Preceptor Manual 2019-2020 - Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program and Post-Master NP ...

 
Nurse Practitioner Preceptor Manual 2019-2020 - Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program and Post-Master NP ...
Nurse Practitioner
Preceptor Manual 2019-2020

Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program
and Post-Master NP (PMNP) Diploma Program

                                         1                                   August 14, 2019
Nurse Practitioner Preceptor Manual 2019-2020 - Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program and Post-Master NP ...
Dear Respected Preceptor,

Thank you for agreeing to participate as a preceptor or NP Advisor for a student in the Nurse Practitioner program at the Lawrence S.
Bloomberg Faculty of Nursing. The preceptor role is fundamental to helping the student learn, experience, and practice in an environment that is
supportive and safe for both the student and the patients. We appreciate your time, your professional commitment, and your willingness to
share your knowledge. Please find included some useful information in assisting you to become familiar with our faculty and program.

The student for whom you are a preceptor or NP Advisor is enrolled either in the MN (NP Field) Degree Program or Post-Masters Nurse
Practitioner (PMNP) Diploma Program. Throughout the program, aspects of clinical reasoning will be investigated, critically reviewed and
applied to a broad range of clinical case studies as students develop advanced physical assessment skills, knowledge and skill in the
collection of data and diagnostic formulation. Practical elements of advanced client assessment, including physical and mental status,
psychosocial, family, and cultural and community factors, the implications of social determinants of health and risk appraisal will be
addressed in terms of their impact on the child/adolescent/adult/older adult client’s health status. Clinical, theoretical and scientific
knowledge will be synthesized in the identification and management of existing and potential client states of health and illness. Approaches
to effective written and verbal communication of findings to lay individuals and health professional colleagues as they relate to the client
and family will be addressed. Students will have opportunities to apply knowledge and develop advanced skills in assessment, clinical
reasoning, therapeutic management, and health promotion. They will also have opportunities to explore the full scope of the nurse
practitioner role by engaging in quality improvement, demonstrating leadership to improve client care and facilitating system change

The clinical component of the program includes a total of 800 practicum hours divided amongst 4 courses over 2 years. The clinical
practicums are designed to facilitate students’ development of advanced skills (interviewing, physical examination, diagnostic testing,
interpretation of findings, therapeutic planning and advanced practice/nurse practitioner role development) related to client/family,
community and system assessment. Application of the clinical reasoning process is integral to the students’ experiences. It is expected
that students will be competent in basic health and physical assessment (HPA) and the associated techniques prior to beginning the nurse
practitioner program. They will continue to build on these basic skills to develop an advanced level of assessment, planning and therapeutic
management.

Kind Regards,

Katherine Trip NP-Adult,
Coordinator, Nurse Practitioner Programs
Lawrence S. Bloomberg Faculty of Nursing
155 College Street, Suite 130
Toronto, ON, Canada, M5T 1P8

                                                                       2                                                         August 14, 2019
Nurse Practitioner Preceptor Manual 2019-2020 - Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program and Post-Master NP ...
Table of Contents
SECTION 1: FACULTY LIAISONS ________________________________________________________________________________ 4
SECTION 2: NP PROGRAM ____________________________________________________________________________________ 5
  Program Overview ________________________________________________________________________________________________ 5
  Summary of Clinical Practicum Course Competencies ______________________________________________________________ 7
  Detailed Clinical Practicum Course Competencies __________________________________________________________________ 8
SECTION 3: PRACTICUM ROLES & RESPONSIBILITIES ______________________________________________________________ 20
  Clinical Education Office _________________________________________________________________________________________ 20
  Students ________________________________________________________________________________________________________ 20
  NP and Physician Preceptors _____________________________________________________________________________________ 21
  NP Advisors ____________________________________________________________________________________________________ 22
SECTION 4: CHARACTERISTICS OF AN EFFECTIVE PRECEPTOR/NP ADVISOR ____________________________________________ 24
  Guiding Learners in Clinical Practice______________________________________________________________________________ 25
SECTION 5: ASSESSMENT AND EVALUATION OF STUDENTS_________________________________________________________ 27
  Competency Evaluation __________________________________________________________________________________________ 27
  Student Behavioural Evaluation __________________________________________________________________________________ 28
SECTION 6: POLICY AND PROCEDURES _________________________________________________________________________ 35
  Entry-to-Practice Competencies for Nurse Practitioners ____________________________________________________________ 35
  NP Student Conduct _____________________________________________________________________________________________ 35
  Accountabilities for Supporting Students _________________________________________________________________________ 36
  Student Preparedness Permit ____________________________________________________________________________________ 38
  Placement Process (Points of Contact / Escalating Issues) _________________________________________________________ 39
SECTION 8: PRECEPTOR BENEFITS _____________________________________________________________________________ 40
  Preceptor Honorarium ___________________________________________________________________________________________ 40
  Adjunct Appointments ___________________________________________________________________________________________ 41

                                                           3                                               August 14, 2019
Nurse Practitioner Preceptor Manual 2019-2020 - Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program and Post-Master NP ...
SECTION 1: FACULTY LIAISONS
Academic Inquiries

 Director, MN Program                                          Coordinator, NP Field of Study
 Martine Puts, RN, PhD                                         Katherine Trip, NP-Adult
 Telephone: 416-978-6059                                       Telephone: 416-946-7355
 Email: martine.puts@utoronto.ca                               Email: kathy.trip@utoronto.ca

Placement Inquiries

 Student Placement Coordinator                                 Student Placement Coordinator
 Sharon Lee                                                    Kong Ng
 Telephone: (416) 978-8475                                     Telephone: (416) 946-0279
 Email: nursingplacementoffice@utoronto.ca                     Email: Clinicalplacements.documents@utoronto.ca

Clinical Evaluation Inquiries
 Student Financial Awards, Stewardship & Project Officer       Graduate Program Assistant
 Angela Ho                                                     Star Yu
 Telephone: (416) 946-8165                                     Telephone: (416) 978-8318
 Email: npstudent@utoronto.ca                                  Email: academic.nursing@utoronto.ca

Honorarium Payment Inquiries
 Financial & Payroll Administrator
 TBD
 E-mail: preceptor.nursing@utoronto.ca

                                                           4                                                     August 14, 2019
SECTION 2: NP PROGRAM
Program Overview
Approximately 100 NP students’ graduate per year from the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto
in one of three NP emphases: NP-Adult, NP-Paediatric and NP-Primary Health Care-Global Health. Students enter either a Master of
Nursing (MN) (Nurse Practitioner Field) Degree Program or a Post-Masters Nurse Practitioner (PMNP) Diploma Program. Our NP
programs prepare graduates to lead in the comprehensive care of patients through the application of Advanced Practice Nursing and
Nurse Practitioner competencies as described by the College of Nurses of Ontario (CNO, January 2018). Students are also
accountable for complying with relevant laws as outlined in the CNO Practice Standard (Revised 2017). Students gain population-
based experiences in caring for patients with health maintenance requirements, common health problems and/or acute and chronic
conditions within their chosen population of Adult (adolescents/adults/older adults) Paediatrics (infant/child/adolescent) or Primary
Health Care-Global Health (all ages).
Clinical placements may occur across the health care sector in primary care, long-term care, ambulatory care and acute care
settings. Students may choose to concentrate and specialize with a clinical focus through focused course work and targeted clinical
placement selection in the final year of the NP program.
Our NP programs are accessible to students across Canada. The student experience in this hybrid education delivery model
includes:
• Attendance at on-campus residencies,
• Simulation-based learning,
• Virtual classrooms, and
• Combined asynchronous and synchronous discussions.

Master of Nursing (MN) (Nurse Practitioner Field) Degree Program
The NP Field of the Master of Nursing Program is designed to provide students with the skills and competencies required to practice
as a Nurse Practitioner (Adult, Paediatric or PHC-GH). This innovative and accessible MN population-based program is completed
over 2 years (full time). The course-work is available entirely on-line and the practicums are emphasis focused. In addition to the
specialty NP courses outlined in Table 1, MN NP students are required to complete 4 foundation courses:

NUR 1094H:    Research Design, Appraisal, & Utilization
NUR 1095H:    Qualitative Research
NUR 1096H:    History of Ideas in Nursing
NUR 1097H:    Program Planning & Evaluation

More specific details on individual courses in the MN (NP Field) Degree Program is available on our website:
https://bloomberg.nursing.utoronto.ca/programs/post-masters-nurse-practitioner-diploma.

                                                                  5                                                    August 14, 2019
Post-Masters Nurse Practitioner (PMNP) Diploma Program
The Post-Master's NP Diploma is an innovative and highly competitive 2-year program (part time) available to students across
Canada. It is designed to afford students who have completed graduate education in nursing the opportunity to develop knowledge
and skills required to practice as a Nurse Practitioner. The Post-Master's NP Diploma consists of 5 courses (Table 1), completed
over a 2-year period. Students will focus their studies in the area of adult, paediatric, or primary health-global health care.

Table 1. MN Foundation (red font) and NP Specialty (black font) NP courses.

                                  Fall                                      Winter                                 Summer
                                               NUR 1100H:                                               NUR 1101H (Adult) or
                                 Pathophysiology and Pharmacotherapeutics                             NUR 1102H (Paediatric):
                                                                                                                  or
    Year 1                                                                                             NUR 1114H (PHC-GH)
                              NUR1094                               NUR1095                       Advanced Health Assessment and
                         (MN-NP students only)                 (MN-NP students only)                     Clinical Reasoning
                                                                                                          100 clinical hours
                                                                                                 (20h SimLab + 80h Practice Setting)
                         NUR 1115H (Adult)                     NUR 1215H (Adult)                  NUR 1221Y (Adult) or NUR1222Y
                                  or                                     or                     (Paediatric) or NUR1223Y (PHC-GH)
                       NUR1116H (Paediatric)                 NUR1216H (Paediatric)              Nurse Practitioners: Roles and Issues
                                  or                                     or                               200 clinical hours
                       NUR 1117H (PHC-GH)                     NUR 1217H (PHC-GH)
     Year 2        Advanced Health Assessment and        Advanced Health Assessment and
                      Therapeutic Management I              Therapeutic Management II
                        250 clinical hours Fall              250 clinical hours Winter

                   NUR1096 (MN-NP students only)          NUR1097 (MN-NP students only)

* please note that PMNPD students take only the NP Specialty courses and the MN NP students take both the MN Foundation and NP Specialty
courses.

                                                                    6                                                       August 14, 2019
Summary of Clinical Practicum Course Competencies
Clinical Course           Clinical Competencies
NUR 1101/1102/1114:       Following successful completion of 3 OSCE stations, students undertake this course with the goal of developing
NP Advanced Health        advanced practice skills in history taking and physical examination on clients/families with common health and illness
Assessment & Clinical     states. Learning to formulate differential diagnoses is also integral to this practice rotation. A focus on select
Reasoning                 competencies as outlined in the Entry-Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this
(20h simulation lab+80h   course: Competency I Client Care (Client Relationship Building and Communication, Assessment, and
in practice setting)      Diagnosis), Competency II: Quality Improvement and Research, Competency III: Leadership, and Competency
                          IV Education. Relevant controlled substances competencies are also integrated within relevant CNO Entry-Level
                          Competencies.
NUR 1115/1116/1117        Students undertake this course with the goal of continued development of clinical skills (advanced history taking and
Advanced Health           physical examination) with the integration of diagnostic testing and treatment planning. Students will continue to
Assessment and            develop advanced practice nursing judgment, skill and knowledge in patient/family care scenarios. . Students will also
Therapeutic               focus on educating clients, the community, and members of the healthcare team during this clinical practicum. Select
Management I              Entry-Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this course: Competency I Client Care
(250 hours)               (Client Relationship Building and Communication, Assessment, Diagnosis, and Management), Competency II:
                          Quality Improvement and Research, Competency III: Leadership, and Competency IV Education. Relevant
                          controlled substances competencies are also integrated within relevant CNO Entry-Level Competencies.

NUR1215/1216/1217         This course includes the goals of developing and refining clinical reasoning skills, and skills to critically appraise and
Advanced Health           synthesize relevant clinical data, research, theory and clinical practice guidelines related to geriatrics or paediatric
Assessment and            complex care, pain, end-of-life care and medical assistance in dying, mental health, diabetes, and skin
Therapeutic               disorders/dermatologic issues. The clinical practicum is focused on professional roles, responsibility and accountability
Management II             (clinical practice and collaboration, consultation and referral), therapeutic management, and health promotion and
(250 hours)               prevention of illness and injury. A focus on select competencies as outlined in the Entry-Level Competencies for Nurse
                          Practitioners (CNO, 2018) are integral to this course: Competency I Client Care (Client Relationship Building and
                          Communication, Management, Collaboration / Consultation/Referral, and Health Promotion), Competency II:
                          Quality Improvement and Research, Competency III: Leadership, and Competency IV Education. Relevant
                          controlled substances competencies are also integrated within CNO Entry-Level Competencies reflected in this course.

NUR 1221/1222/1223:       Students consolidate learning across the health-illness continuum. Practice settings offer opportunities for students to
Nurse Practitioners:      integrate all NP domains of practice into their advanced practice role with a focus on quality improvement . Select Entry-
Roles and Issues          Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this course: Competency I Client Care
(200 hours)               (Collaboration, Consultation, and Referral), Competency II Quality Improvement and Research, Competency III
                          Leadership, and Competency IV Education. Relevant controlled substances competencies are also integrated within
                          relevant CNO Entry-Level Competencies.

                                                                   7                                                         August 14, 2019
Detailed Clinical Practicum Course Competencies

Clinical Course            Clinical Competencies
NUR 1101/1102/1114:        I. Client Care
NP Advanced Health         A. Client Relationship Building and Communication
Assessment & Clinical      The competent, entry-level nurse practitioner uses appropriate communication strategies to create a safe and
Reasoning                  therapeutic environment for client care.
(20h simulation lab +           1. Clearly articulate the role of the nurse practitioner when interacting with the client.
80h in practice setting)        2. Use developmentally and culturally appropriate communication techniques and tools.
                                3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality
                                    are maintained.
                                4. Use relational strategies (e.g., open-ended questioning, fostering partnerships) to establish therapeutic
                                    relationships.
                                5. Provide culturally safe care, integrating clients’ cultural beliefs and values in all client interactions.
                                6. Identify personal beliefs and values and provide unbiased care.
                                7. Recognize moral and ethical dilemmas, and take appropriate action if necessary (e.g., consult with
                                    others, involve legal system).
                                8. Document relevant aspects of client care in client record.

                           B. Assessment
                           The competent, entry-level nurse practitioner integrates an evidence-informed knowledge base with advanced
                           assessment skills to obtain the necessary information to identify client diagnoses, strengths, and needs.
                               1. Establish the reason for the client encounter
                                     a. Review information relevant to the client encounter (e.g., referral information, information from
                                          other healthcare providers, triage notes) if available.
                                     b. Perform initial observational assessment of the client’s condition.
                                     c. Ask pertinent questions to establish the context for client encounter and chief presenting issue.
                                     d. Identify urgent, emergent, and life-threatening situations.
                                     e. Establish priorities of client encounter.
                               2. Complete relevant health history appropriate to the client’s presentation.
                                     a. Collect health history such as symptoms, history of presenting issue, past medical and mental
                                          health history, family health history, pre-natal history, growth and development history, sexual
                                          history, allergies, prescription and OTC medications, and complementary therapies.
                                     b. Collect relevant information specific to the client’s psychosocial, behavioral, cultural, ethnic,
                                          spiritual, developmental life stage, and social determinants of health. This includes unique
                                          considerations in vulnerable populations (children, older adults, indigenous populations, and
                                          clients with a history/risk of mental health conditions/addictions).
                                     c. Determine the client’s potential risk profile or actual risk profile behaviors (e.g., alcohol, illicit
                                          drugs and/or controlled substances, suicide or self-harm, abuse or neglect, falls, infections).
                                     d. Assess client’s strengths and health promotion, illness prevention, or risk reduction needs.

                                                                       8                                                          August 14, 2019
3. Perform assessment.
          a. Based on the client’s presenting condition and health history, identify level of assessment
             (focused or comprehensive) required, and perform review of relevant systems
          b. Select relevant assessment tools and techniques to examine the client, including specific
             assessment/history strategies to identify actual or potential risk of misuse, abuse, addiction and
             diversion.
          c. Perform a relevant physical examination based on assessment findings and specific client
             characteristics (e.g., age, culture, developmental level, functional ability). This includes unique
             considerations in vulnerable populations such as children, older adults, indigenous populations,
             and clients with a history or risk for mental health conditions and addictions.
          d. Assess mental health, cognitive status and vulnerability using relevant assessment tools.
             Highlight to potential role of screening/diagnostic investigations used in monitoring clients
             receiving controlled substances (for example, toxicology).
          e. Integrate laboratory and diagnostic results with history and physical assessment findings.

C. Diagnosis
The competent, entry-level nurse practitioner is engaged in the diagnostic process and develops differential
diagnoses through identification, analysis, and interpretation of findings from a variety of sources.
    1. Determine differential diagnosis for acute, chronic and life-threatening conditions and those related to
       common indications for the various classes of controlled substances.
           a. Analyze and interpret multiple sources of data, including results of diagnostic and screening
               tests, health history, and physical examination.
           b. Synthesize assessment findings with scientific knowledge, determinants of health, knowledge of
               normal and abnormal states of health/illness, patient and population-level characteristics,
               epidemiology, and health risks.
           c. Generate differential diagnoses.
           e. Determine most likely diagnoses based on clinical reasoning and available evidence.
    2. Explain assessment findings and communicate diagnosis to client.
           a. Explain results of clinical investigations to client.
           b. Communicate diagnosis to client, including implications for short- and long-term outcomes and
               prognosis.
           c. Ascertain client understanding of information related to findings and diagnoses.

Competency II: Quality Improvement and Research
The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care
and health service delivery, and participates in research.
   1. Identify, appraise, and apply research, practice guidelines, and current best practice.

Competency III: Leadership
  5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care
     (e.g., by responding to clinical questions, sharing evidence).
  7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and
     change management.
                                          9                                                         August 14, 2019
IV. Education
                     The competent, entry-level nurse practitioner integrates formal and informal education into practice. This
                     includes but is not limited to educating self, clients, the community, and members of the healthcare team.

                     Continuing Competence
                        6. Engage in self-reflection to determine continuing education competence needs.
                        7. Engage in ongoing professional development.
                        8. Seek mentorship opportunities to support one’s professional development.

NUR 1115/1116/1117   I. Client Care
Advanced Health      A. Client Relationship Building and Communication
Assessment and       The competent, entry-level nurse practitioner uses appropriate communication strategies to create a safe and
Therapeutic          therapeutic environment for client care.
Management I (250
hours)                  1. Clearly articulate the role of the nurse practitioner when interacting with the client.
                        2. Use developmentally and culturally-appropriate communication techniques and tools.
                        3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality
                           are maintained.
                        4. Use relational strategies (e.g., open-ended questioning, fostering partnerships) to establish therapeutic
                           relationships.
                        5. Provide culturally safe care, integrating clients’ cultural beliefs and values in all client interactions.
                        6. Identify personal beliefs and values and provide unbiased care.
                        7. Recognize moral and ethical dilemmas, and take appropriate action if necessary (e.g., consult with
                           others, involve legal system).
                        8. Document relevant aspects of client care in client record.

                     B. Assessment
                     The competent, entry-level nurse practitioner integrates an evidence-informed knowledge base with advanced
                     assessment skills to obtain the necessary information to identify client diagnoses, strengths, and needs.
                         1. Establish the reason for the client encounter
                               a. Review information relevant to the client encounter (e.g., referral information, information from
                                    other healthcare providers, triage notes) if available.
                               b. Perform initial observational assessment of the client’s condition.
                               c. Ask pertinent questions to establish the context for client encounter and chief presenting issue.
                               d. Identify urgent, emergent, and life-threatening situations.
                               e. Establish priorities of client encounter.
                         2. Complete relevant health history appropriate to the client’s presentation.
                               a. Collect health history such as symptoms, history of presenting issue, past medical and mental
                                    health history, family health history, pre-natal history, growth and development history, sexual
                                    history, allergies, prescription and OTC medications, and complementary therapies.
                               b. Collect relevant information specific to the client’s psychosocial, behavioral, cultural, ethnic,
                                    spiritual, developmental life stage, and social determinants of health. This includes unique
                                                               10                                                        August 14, 2019
considerations in vulnerable populations (children, older adults, indigenous populations, and
              clients with a history/risk of mental health conditions/addictions).
           c. Determine the client’s potential risk profile or actual risk profile behaviors (e.g., alcohol, illicit
              drugs and/or controlled substances, suicide or self-harm, abuse or neglect, falls, infections).
           d. Assess client’s strengths and health promotion, illness prevention, or risk reduction needs.

   3. Perform assessment.
          a. Based on the client’s presenting condition and health history, identify level of assessment
             (focused or comprehensive) required, and perform review of relevant systems
          b. Select relevant assessment tools and techniques to examine the client, including specific
             assessment/history strategies to identify actual or potential risk of misuse, abuse, addiction and
             diversion.
          c. Perform a relevant physical examination based on assessment findings and specific client
             characteristics (e.g., age, culture, developmental level, functional ability). This includes unique
             considerations in vulnerable populations such as children, older adults, indigenous populations,
             and clients with a history or risk for mental health conditions and addictions.
          d. Assess mental health, cognitive status and vulnerability using relevant assessment tools.
             Highlight to potential role of screening/diagnostic investigations used in monitoring clients
             receiving controlled substances (for example, toxicology).
          e. Integrate laboratory and diagnostic results with history and physical assessment findings.

C. Diagnosis
The competent, entry-level nurse practitioner is engaged in the diagnostic process and develops differential
diagnoses through identification, analysis, and interpretation of findings from a variety of sources.
    1. Determine differential diagnosis for acute, chronic and life-threatening conditions and those related to
       common indications for the various classes of controlled substances.
           a. Analyze and interpret multiple sources of data, including results of diagnostic and screening
               tests, health history, and physical examination.
           b. Synthesize assessment findings with scientific knowledge, determinants of health, knowledge of
               normal and abnormal states of health/illness, patient and population-level characteristics,
               epidemiology, and health risks.
           c. Generate differential diagnoses.
           d. Inform the client of the rationale for ordering diagnostic tests.
           e. Determine most likely diagnoses based on clinical reasoning and available evidence.
           f. Order and/or perform screening and diagnostic investigations using best available evidence to
               support or rule out differential diagnoses.
           g. Assume responsibility for follow-up of test results.
           h. Interpret the results of screening and diagnostic investigations using evidence-informed clinical
               reasoning.
           i. Confirm most likely diagnoses.

                                            11                                                            August 14, 2019
2. Explain assessment findings and communicate diagnosis to client.
         a. Explain results of clinical investigations to client.
         b. Communicate diagnosis to client, including implications for short- and long-term outcomes and
              prognosis.
         c. Ascertain client understanding of information related to findings and diagnoses.

D. Management
The competent, entry-level nurse practitioner, on the basis of assessment and diagnosis, formulates the most
appropriate plan of care for the client, implementing evidence-informed therapeutic interventions in partnership
with the client to optimize health.
    1. Initiate interventions for the purpose of stabilizing the client in, urgent, emergent, and life-threatening
        situations (e.g., establish and maintain airway, breathing and circulation; suicidal ideation).
    2. Formulate plan of care based on diagnosis and evidence-informed practice.
             a. Determine and discuss options for managing the client’s diagnosis, incorporating client
                 considerations (e.g., socioeconomic factors, geography, developmental stage).
             b. Select appropriate interventions, synthesizing information including determinants of health,
                 evidence-informed practice and client preferences.
             c. Initiate appropriate plan of care (e.g. non-pharmacological, pharmacological, diagnostic tests,
                 referral) and discuss the rationale for selecting controlled substances over other treatments.
             d. Consider resource implications of therapeutic choices (e.g. cost, availability).
    3. Provide pharmacological interventions, treatment, or therapy. Summarize pharmacotherapeutics for
        various controlled substances (e.g., benzodiazepines) and discuss poly-pharmacy risks, including
        common high-risk drug combinations.
             a. Select pharmacotherapeutic options as indicated by diagnosis based on determinants of health,
                 evidence-informed practice, and client preference. Summarize considerations associated with
                 individual client needs, including dosing, various formulations of controlled substances (e.g.,
                 long versus short acting, tamper resistant formulations), and quantity prescribed.
             b. Counsel client on pharmacotherapeutics, including rationale, cost, potential adverse effects,
                 interactions, contraindications and precautions as well as reasons to adhere to the prescribed
                 regimen and required monitoring and follow up. Ensure the establishment and documentation of
                 a clear treatment plan when prescribing controlled substances.
             c. Complete accurate prescription(s) in accordance with applicable jurisdictional and institutional
                 requirements. Use specific evidence-based practice resources and clinical practice guidelines.
             d. Establish a plan to monitor client’s responses to medication therapy and continue, adjust or
                 discontinue a medication based on assessment of the client’s response.
             e. Apply strategies to reduce risk of harm involving controlled substances, including medication
                 abuse, addiction, and diversion.
    4. Provide non-pharmacological interventions, treatments, or therapies.
             a. Select therapeutic options (including complementary and alternative approaches) as indicated
                 by diagnosis based on determinants of health, evidence-informed practice, and client
                 preference.
             b. Counsel client on therapeutic option(s), including rationale, potential risks and benefits, adverse
                 effects, required after care, and follow-up. This includes a standardized approach for monitoring
                                           12                                                         August 14, 2019
of controlled substances, including frequent assessments, treatment agreements, functional
               improvement, and achievement of treatment goals.
          c. Order required treatments (e.g., wound care, phlebotomy).
          d. Discuss and arrange follow-up.
   5. Perform invasive and non-invasive procedures.
          a. Inform client about the procedure, including rationale, potential risks and benefits, adverse
               effects, and anticipated aftercare and follow-up.
          b. Obtain and document informed consent from the client, including risk for addiction and overdose
               with clients. Highlight considerations for client education in relation to controlled substances,
               including: common side-effects, risk factors, rationale for type and frequency of monitoring, safe
               storage at home, disposal, adherence to treatment plan (e.g., no crushing, chewing, cutting).
          c. Perform procedures using evidence-informed techniques.
          d. Review clinical findings, aftercare, and follow-up.
   6. Provide oversight of care across the continuum for clients with complex and/or chronic conditions.
   7. Follow up and provide ongoing management. Discuss common universal strategies for assessing,
      managing and monitoring potential or actual misuse, abuse, addiction, diversion or aberrant behaviors
      (e.g., standardized assessment tools, treatment contracts, standardized monitoring protocols).
          a. Develop a systematic and timely process for monitoring client progress.
          b. Evaluate response to plan of care in collaboration with the client. Discuss possible, or expected,
               consequences that may include dependence, tolerance, pseudo addiction, and non-adherence.
               Highlight strategies to address consequences including discontinuing treatment if therapeutic
               goals are not met.
          c. Revise plan of care based on client’s response and preferences.

Competency II: Quality Improvement and Research
The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care
and health service delivery, and participates in research.
   1. Identify, appraise, and apply research, practice guidelines, and current best practice.

Competency III: Leadership
  5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care
     (e.g., by responding to clinical questions, sharing evidence).
  7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and
     change management.

IV. Education
The competent, entry-level nurse practitioner integrates formal and informal education into practice. This
includes but is not limited to educating self, clients, the community, and members of the healthcare team.
Client, Community, and Healthcare Team Education
    1. Assess and prioritize learning needs of intended recipients.
    2. Apply relevant, theory-based, and evidence-informed content when providing education.
    3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods,
        considering available resources (e.g., human, material, financial).
                                          13                                                        August 14, 2019
4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations,
                           publications).
                        5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre-
                           and post-surveys).
                     Continuing Competence
                        6. Engage in self-reflection to determine continuing education competence needs.
                        7. Engage in ongoing professional development.
                        8. Seek mentorship opportunities to support one’s professional development.

NUR1215/1216/1217    I. Client Care
Advanced Health      A. Client Relationship Building and Communication
Assessment and       The competent, entry-level nurse practitioner uses appropriate communication strategies to create a safe and
Therapeutic          therapeutic environment for client care.
Management II (250        1. Clearly articulate the role of the nurse practitioner when interacting with the client.
hours)                    2. Use developmentally and culturally appropriate communication techniques and tools.
                          3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality
                             are maintained.
                          4. Use relational strategies (e.g., open-ended questioning, fostering partnerships) to establish therapeutic
                             relationships.
                          5. Provide culturally safe care, integrating clients’ cultural beliefs and values in all client interactions.
                          6. Identify personal beliefs and values and provide unbiased care.
                          7. Recognize moral and ethical dilemmas, and take appropriate action if necessary (e.g., consult with
                             others, involve legal system).
                          8. Document relevant aspects of client care in client record.

                     D. Management
                     The competent, entry-level nurse practitioner, on the basis of assessment and diagnosis, formulates the most
                     appropriate plan of care for the client, implementing evidence-informed therapeutic interventions in partnership
                     with the client to optimize health.
                         1. Initiate interventions for the purpose of stabilizing the client in, urgent, emergent, and life-threatening
                             situations (e.g., establish and maintain airway, breathing and circulation; suicidal ideation).
                         2. Formulate plan of care based on diagnosis and evidence-informed practice.
                                  a. Determine and discuss options for managing the client’s diagnosis, incorporating client
                                      considerations (e.g., socioeconomic factors, geography, developmental stage).
                                  b. Select appropriate interventions, synthesizing information including determinants of health,
                                      evidence-informed practice and client preferences.
                                  c. Initiate appropriate plan of care (e.g. non-pharmacological, pharmacological, diagnostic tests,
                                      referral) and discuss the rationale for selecting controlled substances over other treatments.
                                  d. Consider resource implications of therapeutic choices (e.g. cost, availability).

                                                                14                                                         August 14, 2019
3. Provide pharmacological interventions, treatment, or therapy. Summarize pharmacotherapeutics for
   various controlled substances (e.g., benzodiazepines) and discuss poly-pharmacy risks, including
   common high-risk drug combinations.
       a. Select pharmacotherapeutic options as indicated by diagnosis based on determinants of health,
            evidence-informed practice, and client preference. Summarize considerations associated with
            individual client needs, including dosing, various formulations of controlled substances (e.g.,
            long versus short acting, tamper resistant formulations), and quantity prescribed.
       b. Counsel client on pharmacotherapeutics, including rationale, cost, potential adverse effects,
            interactions, contraindications and precautions as well as reasons to adhere to the prescribed
            regimen and required monitoring and follow up. Ensure the establishment and documentation of
            a clear treatment plan when prescribing controlled substances.
       c. Complete accurate prescription(s) in accordance with applicable jurisdictional and institutional
            requirements. Use specific evidence-based practice resources and clinical practice guidelines.
       d. Establish a plan to monitor client’s responses to medication therapy and continue, adjust or
            discontinue a medication based on assessment of the client’s response.
       e. Apply strategies to reduce risk of harm involving controlled substances, including medication
            abuse, addiction, and diversion.
4. Provide non-pharmacological interventions, treatments, or therapies.
       a. Select therapeutic options (including complementary and alternative approaches) as indicated
            by diagnosis based on determinants of health, evidence-informed practice, and client
            preference.
       b. Counsel client on therapeutic option(s), including rationale, potential risks and benefits, adverse
            effects, required after care, and follow-up. This includes a standardized approach for monitoring
            of controlled substances, including frequent assessments, treatment agreements, functional
            improvement, and achievement of treatment goals.
       c. Order required treatments (e.g., wound care, phlebotomy).
       d. Discuss and arrange follow-up.
5. Perform invasive and non-invasive procedures.
       a. Inform client about the procedure, including rationale, potential risks and benefits, adverse
            effects, and anticipated aftercare and follow-up.
       b. Obtain and document informed consent from the client, including risk for addiction and overdose
            with clients. Highlight considerations for client education in relation to controlled substances,
            including: common side-effects, risk factors, rationale for type and frequency of monitoring, safe
            storage at home, disposal, adherence to treatment plan (e.g., no crushing, chewing, cutting).
       c. Perform procedures using evidence-informed techniques.
       d. Review clinical findings, aftercare, and follow-up.
6. Provide oversight of care across the continuum for clients with complex and/or chronic conditions.
7. Follow up and provide ongoing management. Discuss common universal strategies for assessing,
   managing and monitoring potential or actual misuse, abuse, addiction, diversion or aberrant behaviors
   (e.g., standardized assessment tools, treatment contracts, standardized monitoring protocols).
       a. Develop a systematic and timely process for monitoring client progress.
       b. Evaluate response to plan of care in collaboration with the client. Discuss possible, or expected,
            consequences that may include dependence, tolerance, pseudo addiction, and non-adherence.
                                       15                                                        August 14, 2019
Highlight strategies to address consequences including discontinuing treatment if therapeutic
               goals are not met.
            c. Revise plan of care based on client’s response and preferences.

E. Collaboration, Consultation, and Referral
The competent, entry-level nurse practitioner identifies when collaboration, consultation, and referral are
necessary for safe, competent, and comprehensive client care.
    1. Establish collaborative relationships with healthcare providers and community-based services,
        rehabilitation, home care.
    2. Provide recommendations or relevant treatment in response to consultation requests or incoming
        referrals.
    3. Identify need for consultation and/or referral (e.g., to confirm a diagnosis, to augment a plan of care, to
        assume care when a client’s health condition is beyond the nurse practitioner’s individual competence
        or legal scope of practice).
    4. Initiate a consultation and/or referral, specifying relevant information (e.g., client history, assessment
        findings, diagnosis) and expectations. Discuss strategies for identifying client-populations, or findings
        that may require specialized services.
    5. Review consultation and/or referral recommendations with the client and integrate into plan of care as
        appropriate.

F. Health Promotion
The competent, entry-level nurse practitioner uses evidence and collaborates with community partners and
other healthcare providers to optimize the health of individuals, families, communities, and populations.
    1. Identify individual, family, community and/or population strengths and health needs to collaboratively
        develop strategies to address issues.
    2. Analyze information from a variety of sources to determine population trends that have health
        implications.
    3. Select and implement evidence-informed strategies for health promotion and primary, secondary, and
        tertiary prevention.
    4. Evaluate outcomes of selected health promotion strategies and revise the plan accordingly.

Competency II: Quality Improvement and Research
The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care
and health service delivery, and participates in research.
   1. Identify, appraise, and apply research, practice guidelines, and current best practice.

Competency III: Leadership
  5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care
     (e.g., by responding to clinical questions, sharing evidence).
  7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and
     change management.

                                           16                                                         August 14, 2019
IV. Education
                       The competent, entry-level nurse practitioner integrates formal and informal education into practice. This
                       includes but is not limited to educating self, clients, the community, and members of the healthcare team.
                       Client, Community, and Healthcare Team Education
                           1. Assess and prioritize learning needs of intended recipients
                           2. Apply relevant, theory-based, and evidence-informed content when providing education
                           3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods,
                               considering available resources (e.g., human, material, financial)
                           4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations,
                               publications)
                           5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre-
                               and post-surveys)
                       Continuing Competence
                           6. Engage in self-reflection to determine continuing education competence needs.
                           7. Engage in ongoing professional development.
                           8. Seek mentorship opportunities to support one’s professional development

NUR 1221/1222/1223:    I. Client Care
Nurse Practitioners:   A. Client Relationship Building and Communication
Roles and Issues       The competent, entry-level nurse practitioner integrates formal and informal education into practice. This
200 hours              includes but is not limited to educating self, clients, the community, and members of the healthcare team.
                            1. Clearly articulate the role of the nurse practitioner when interacting with the client.

                       E. Collaboration, Consultation, and Referral
                       The competent, entry-level nurse practitioner identifies when collaboration, consultation, and referral are
                       necessary for safe, competent, and comprehensive client care.
                           2. Establish collaborative relationships with healthcare providers and community-based services,
                               rehabilitation, home care).
                           3. Provide recommendations or relevant treatment in response to consultation requests or incoming
                               referrals.
                           4. Identify need for consultation and/or referral (e.g., to confirm a diagnosis, to augment a plan of care, to
                               assume care when a client’s health condition is beyond the nurse practitioner’s individual competence
                               or legal scope of practice).
                           5. Initiate a consultation and/or referral, specifying relevant information (e.g., client history, assessment
                               findings, diagnosis) and expectations. Discuss strategies for identifying client-populations, or findings
                               that may require specialized services.
                           6. Review consultation and/or referral recommendations with the client and integrate into plan of care as
                               appropriate.

                                                                  17                                                         August 14, 2019
II: Quality Improvement and Research
The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize
client care and health service delivery, and participates in research.
     1. Identify, appraise, and apply research, practice guidelines, and current best practice.
     2. Identify the need for improvements in health service delivery.
     3. Analyze the implications (e.g., opportunity costs, unintended consequences) for the client and/or the
         system of implementing changes in practice.
     4. Implement planned improvements in healthcare and delivery structures and processes.
     5. Participate in quality improvement and evaluation of client care outcomes and health service delivery.
     6. Identify and manage risks to individual, families, populations, and the healthcare system to support
         quality improvement.
     7. Report adverse events to clients and/or appropriate authorities, in keeping with relevant legislation and
         organizational policies.
     8. Analyze factors that contribute to the occurrence of adverse events and near misses and develop
         strategies to mitigate risks. This includes identifying misuse, abuse, addiction, overdose and diversion
         as risks when using controlled substances.
     9. Participate in research.
     10. Contribute to the evaluation of the impact of nurse practitioner practice on client outcomes and
         healthcare delivery.

III. Leadership
The competent entry-level nurse practitioner demonstrates leadership by using the nurse practitioner role to
improve client care and facilitate system change.
      1. Promote the benefits of the nurse practitioner role in client care to other healthcare providers and
         stakeholders (e.g., employers, social and public service sectors, the public, legislators, policy-makers).
      2. Implement strategies to integrate and optimize the nurse practitioner role within healthcare teams and
         systems to improve client care.
      3. Coordinate interprofessional teams in the provision of client care.
      4. Create opportunities to learn with, from, and about other healthcare providers to optimize client care.
      5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care
         (e.g., by responding to clinical questions, sharing evidence).
      6. Identify gaps and/or opportunities to improve processes and practices, and provide evidence informed
      1. recommendations for change.
      7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and
         change management. Reinforce the leadership necessary to ensure clients receive appropriate
         treatment, while also managing expectations and dealing with the pressure to prescribe.
      8. Identify the need and advocate for policy development to enhance client care.
      9. Participate in program planning and development to optimize client care.

                                           18                                                          August 14, 2019
IV. Education
The competent, entry-level nurse practitioner integrates formal and informal education into practice. This
includes but is not limited to educating self, clients, the community, and members of the healthcare team.
Client, Community, and Healthcare Team Education
    1. Assess and prioritize learning needs of intended recipients
    2. Apply relevant, theory-based, and evidence-informed content when providing education
    3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods,
        considering available resources (e.g., human, material, financial)
    4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations,
        publications)
    5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre-
        and post-surveys)
Continuing Competence
    6. Engage in self-reflection to determine continuing education competence needs.
    7. Engage in ongoing professional development.
    8. Seek mentorship opportunities to support one’s professional development.

                                         19                                                     August 14, 2019
SECTION 3: PRACTICUM ROLES & RESPONSIBILITIES
Individual NP students are placed in a clinical practicum to work with either an NP or a physician (Preceptor Model). The student
works under the guidance and direction of the preceptor and is expected to take on a portion of the workload. Student supervision is
integrated within the role of the NP or physician preceptor and supported by the course instructor and the NP program coordinator.

The preceptor's roles include those of a coach, teacher, facilitator, resource person, and clinical evaluator. In most cases, the
preceptor is a NP (with at least one year of clinical NP experience). In some situations, students may have a physician preceptor. In
this case, students are also assigned a NP Advisor. Students may complete no more than 50% of program practicum hours (400
hours maximum) with physician preceptors. Students generally have one placement and preceptor for each practicum course. This is
to ensure each student has adequate time to develop in the role of a NP and to allow the preceptor adequate time to assess the
student and provide a reliable and valid student and clinical experience evaluation.

Clinical Education Office
The staff in the Faculty’s Clinical Education Office identify potential NP placements, in collaboration with the student and the NP
program faculty. They recruit suitable preceptors and use a placement matching system to coordinate placements. The staff in the
Clinical Education Office are normally the initial point of contact for students and agencies related to placements. The staff are also
responsible for formally notifying agencies when students have been matched to preceptors and informing students of necessary
agency orientation requirements.

Students
The primary objective of practicum experience is to gain knowledge and expertise from working with the preceptor and within the
practice setting in preparation for a career as a knowledgeable, competent nurse practitioner. Professional demeanor as would
normally be expected of one working in the role of an RN is expected to continue in all practicum experience situations. Respect,
collegiality and privacy of information will be upheld at all times by the student. Any breach in conduct should be reported by the
preceptor to the instructor immediately.

           Before Beginning a Clinical Rotation
           • Analyze and determine what they want to gain from the experience (please reflect on course competencies and
              individual learning needs)
           • Complete online practicum information form
           • Ensure that all required documentation for student preparedness permit is valid and complete (immunization, CNO or
              comparable registration, mask fit testing results, vulnerable sector police record check)
           • Complete any agency-specific orientation and/or documentation requirements (e.g. agency ID, secure system access,
              etc.)
           • Develop a draft learning plan; consider the self-reflection piece of the clinical portfolio and the specific course
              competencies when formulating the learning plan

                                                                   20                                                      August 14, 2019
At the Outset of every Clinical Rotation
           • Discuss your consolidated clinical portfolio and draft learning plan with the preceptor/submit to course instructor as
               required
           • Discuss with the preceptor reciprocal expectations and devise a schedule of activities to meet learning competencies

           During the Clinical Rotation
           • Maintain an updated clinical portfolio and learning plan
           • Seek supervision and feedback from the preceptor on a weekly basis
           • Perform within the administrative framework of the practice facility
           • Progress toward achievement of all course competencies for a successful clinical evaluation
           • Abide by PHIPPA requirements; students will not view any records that they are not authorized to see and will not
              copy, scan or remove any patient documents from the clinical setting
           • Communicate with course instructor if issues arise during practicum placement (e.g. challenges with meeting course
              competencies, issues with preceptor access or availability, concerns re: clinical supervision, etc.)

           After Completion of every Clinical Rotation
           • Review the clinical portfolio and learning plan with the preceptor to determine if competencies have been successfully
              achieved
           • Discuss student self-evaluation with the preceptor
           • Submit a preceptor approved clinical portfolio to instructor verifying hours of on site clinical practice experience
           • Submit a completed learning plan as directed to instructor
           • Keep a copy of the clinical portfolio for submission to the instructor in the next clinical course (i.e. keep 1101 [or 1102
              or 1114] for submission at beginning of 1115 [or 1116 or 1117]), etc.
           • Complete online preceptor and placement evaluations

NP and Physician Preceptors
The preceptor role is fundamental to helping the student learn, experience, and practice in an environment that is supportive and
safe for both the student and the patients. All NP preceptors and NP Advisors must be entitled to practice as an RN (EC) in Ontario
(or in their province where placement occurs) with no restrictions. All physician preceptors must be in good standing with the College
of Physicians and Surgeons of the province where placement occurs. All NP students must have valid RN registration in their
province.

           Prior to the Beginning of the Clinical Rotation
           • Communicate with the student in order to discuss the clinical environment
           • Information such as start times, dress code, reporting of sick time etc. should be communicated prior to the beginning
              of the practicum experience
           • Additional learning opportunities such as rounds, journal clubs etc. can be suggested at this time as well

                                                                  21                                                       August 14, 2019
At the Outset of the Clinical Rotation
           • Review the learning plan, clinical portfolio, and practicum competencies with the student
           • Assist the student to identify strategies for achieving competencies
           • Communicate with the course instructor to establish initial contact (the course instructor typically initiates this contact
               via email within the first 2 – 3 weeks of the course.)
           • Complete the honorarium request sent via email by the Financial & Payroll Administrator
           Note: Honoraria requests will be processed once the practicum evaluation has been completed, and final grades have
               been submitted by the course instructor and approved by Committee on Standing. Honorarium payments are issued
               September, January, and May each year for the previous term. For more details, visit
               https://bloomberg.nursing.utoronto.ca/nppreceptor.

           During the Clinical Rotation
           • Facilitate student's introduction to the clinical setting
           • Act as a clinical expert and role model sharing experiences and knowledge
           • Provide clinical supervision and consultation to the student during their practicum experience
           • Meet with the student regularly to discuss progress towards achievement of learning competencies (as outlined in the
              student’s learning plan)
           • Inform the course instructor of any problems arising from the student placement as soon as these are suspected or
              identified (Early intervention and faculty support helps to ensure student success and decrease preceptor burden in
              difficult situations)
           • Complete all required evaluations* via the online evaluation tool - Linking Health Professionals (watch for an email link
              from account.management@linkinghealthprofessionals.com), and discuss the evaluation with course instructor if
              unsatisfactory. If you have not received an email, please notify the course instructor.

           After Completion of the Clinical Rotation
           • Review the course competencies with the student to determine if successfully achieved. Meet and discuss evaluation
              of performance with the student. Complete the required final evaluation* online via Linking Health Professionals,
              (watch for an email link from account.management@linkinghealthprofessionals.com), and discuss the evaluation with
              course instructor if unsatisfactory.
           • Review the clinical portfolio for accuracy
           *If you are a physician preceptor, please discuss evaluation of performance with the NP Advisor prior to completing the online form.

NP Advisors
All students with a physician preceptor in any semester must also have a NP Advisor. A NP Advisor will provide feedback via on line
evaluation to the course instructor about a NP student’s progress towards their clinical competencies as they relate to NP practice.
The NP Advisor will work together with the student and their physician preceptor to ensure the student has the opportunity to learn
and be assessed by an Advanced Practice Nurse with NP competencies. NP Advisors may participate in the students learning
through direct observation in the clinical setting, or via indirect methods including face-to-face meetings, video room chats, telephone
calls or email correspondence.

                                                                       22                                                          August 14, 2019
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