Australian Capital Territory
Health (Nurse Practitioner Positions) Approval 2009 (No 1)
Notifiable instrument NI2009-26
made under the
Health Regulation 2004 - section 8 (approval of Nurse practitioner positions) 

1	Name of instrument

This instrument is the Health (Nurse Practitioner Positions) Approval 2009 (No 1)

2	Commencement

This instrument commences on the day after notification.

3	Scope of Practice for nurse practitioner positions

Under section 8, approval of nurse practitioner positions, I have approved the establishment of an Intensive Care Liaison Nurse Practitioner position for Calvary Health Care ACT .  

The scope of practice for the nurse practitioner position is attached.
As this position is ‘new’, the clinical practice guidelines and medication formularies are a work in progress and may change. These will be finalised within the first three months of the position being established after they have received the endorsement of the ACT Nurse Practitioner Clinical Practice Guideline Development Standing Committee.

Mark Cormack 
Chief Executive
19 January 2009

Scope of Practice Statement
Position details
Local Title	Nurse Practitioner (Intensive Care Liaison)	
Classification	Registered Nurse Level 4.2	
Department/ Ward	Intensive Care / Coronary Care Unit	
Position number(s)		Type		Fortnightly hours	76	
		Ins. No.	99/99	Cost Centre		
Reporting details
Supervises		Line responsibility / authority / 
accountability	Operational:

Professional

Clinical

Regulatory:	Director of Clinical Operations
Director of Intensive Care

Manager, Innovation and Clinical Quality 

Director of Intensive Care 

ACT Nursing and Midwifery Board 
Calvary Health Care ACT
Health Professionals Act (2004); Nurse Practitioner Legislation Amendment Act (2004)	
Nurse Practitioner (Intensive Care Liaison)
Role	•	A Nurse Practitioner (NP) is a Registered Nurse with advanced knowledge, skills and recognised clinical competence, authorised by the ACT Nursing and Midwifery Board 
•	The NP is a recognised specialist nurse in intensive care and has specific knowledge and expertise in the specialty. This includes advanced physical assessment, advanced life support and mechanical ventilation.
•	The NP will practice professionally, working within a multidisciplinary team and functioning autonomously, within the scope of practice. 
•	The NP will initiate and utilise research findings in the provision of clinical services, contribution to the development and delivery of speciality related education programs and policies.  
•	The NP participates in the strategic and operational planning processes within the Intensive Care Unit 
•	The NP is active in the education of other nursing staff.
•	The NP displays a commitment to the professional development of both themselves and their colleagues.
•	The NP provides acute health care services to the community within a framework guided by professional guidelines of practice through assessment, diagnosis and management of health issues in a complex and unpredictable environment.
•	The NP is authorised to provide an expert level of coordinated clinical care, health assessment and management for adult patients within the critical care units, inpatient units and outpatient services at Calvary Health Care ACT; within a framework guided by professional guidelines of practice through assessment, diagnosis and management of complex health issues.  The adult patient is defined as persons above the age of 18 years.	
Aim
	•	To provide appropriate timely care to adults requiring episodic critical care health care and services by appropriate members of a multidisciplinary health professional team. 
•	Develop the advanced nursing practice role, working autonomously, within a scope of practice, with measurable quality outcomes as outlined in the key performance indicators for the role.	

Environment
	•	The NP will be based in the Intensive Care Unit
•	The NP practices autonomously within the acute health care areas of Calvary Health Care ACT and within a multidisciplinary framework.
•	The NP has the knowledge, expertise and authorisation to support referral to other health care professionals.
•	The NP works both as a colleague and in a collaborative practice with departmental, unit and ward nursing staff.  	
Formulary
	•	The NP is authorised to prescribe medications from the formulary approved and endorsed as part of the clinical practice guidelines.  This formulary will be prescribed within a framework of clinical guidelines both specific to clinical practice within the critical care areas and those established and accepted as best practice such as the therapeutic guidelines. 	
Ordering Diagnostic Tests	•	The Intensive Care Liaison NP is authorised to order the following diagnostic tests
•	Haematology – FBC, Coagulation studies
•	Biochemistry – UEC, CMP, TnI, CK, TFT, LFT, BGL
•	Arterial blood gases and lactate
•	Sputum, blood, urine, throat, wound and skin culture 
•	Chest X-ray 	
Process of Care

	The NP responds to referrals for adult patient assessment made by medical, nursing and allied health staff throughout the hospital and cares for these patients throughout the acute phase of their physiological instability and/or as a bridge to transfer to the Intensive Care Unit.
The NP will undertake the following process of care
Assessment of health status including;
•	Advanced physical assessment
•	Health history attainment
•	Identification of health risks
•	Identification of increased risk of deterioration
•	Application of emergency intervention when indicated

If significant signs of deterioration, as defined by the Medical Emergency Team (MET) criteria or a Modified Early Warning Score (MEWS) of greater than or equal to 6 is identified on assessment of health status, then the NP will directly refer the patient to the appropriate medical team/officer as outlined in the MET and MEWS policies at Calvary Health Care ACT (CHC MET clinical policy Jan 2007; CHC MEWS clinical policy Nov 2007).

Diagnosis
•	Formulates appropriate differential diagnosis based on clinical findings
•	Identifies individual requirements to access health data from relevant persons
•	Identifies individual requirements to access health care services to support the implementation of acute/critical care

Development of a Treatment Plan
•	Priorities are established and a plan of care is devised to maximise the health potential of the individual.  This includes:
•	Ordering appropriate diagnostic tests;
•	Prescribing appropriate pharmacological agents;
•	Analysing patient/family education needs;
•	Establishing treatment plans based on evidence-based best practice standards

Implementation of Treatment Plan
•	Interventions are based upon priorities and clinical guidelines
•	Treatment is individual and specific to the patient.
•	Treatment is based on scientific principles, theoretical knowledge and clinical expertise

Intervention Actions
•	Within the acute care setting, providing episodic health care including:
•	Accurately conducting and interpreting diagnostic tests;
•	Prescribing pharmacological agents;
•	Prescribing non-pharmacological therapies;
•	Making appropriate referrals to other health care professionals;
•	Providing relevant patient and/or family health promotion/restoration education.
Follow Up
•	Follow up and evaluation of outcome of episodic health care 	
Categories of Care
	The NP will provide advanced physical assessment and care for adult patients who are referred under the referral criteria and in accordance with the Clinical Practice Guidelines.	
Role Evaluation
	Regular Nurse Practitioner role effectiveness in terms of health outcome measures will be assessed by the professional Nurse Supervisor through annual performance appraisal as measured against the key performance indicators for the role.	

Approved Service Director:		
		
Approved HR Department