Transforming nursing, midwifery and health professions roles: advance nursing practice

The second in a series of brief papers on the Transforming Roles programme outlines guidance for employers on developing advanced nursing practice in NHSScotland.

Annex 1: ANP competences

a) Comprehensive history-taking.

b) Clinical assessment – the ANP:

  • carries out comprehensive clinical examination of patients in their entirety, including physical examination of all systems and mental health assessment.

c) Differential diagnosis – the ANP:

  • applies high-level decision-making and assessment skills to formulate appropriate differential diagnoses based on synthesis of clinical findings; this takes account of managing clinical risk in dealing with undifferentiated client groups across the age spectrum.

d) Investigations – the ANP:

  • has the freedom and authority to request, where indicated and using judgement and clinical reasoning, appropriate diagnostic tests/investigations based on differential diagnoses
  • interprets and analyses previously ordered results of tests/investigations and works collaboratively with other healthcare professionals when needed
  • acts on the results to confirm diagnosis and thereby optimise treatment and management outcomes.

e) Treatment – the ANP:

  • formulates an action plan for the treatment of the patient, synthesising clinical information based on the patient’s presentation, history, clinical assessment and findings from relevant investigations, using appropriate evidence-based practice
  • is an independent non-medical prescriber
  • implements non-pharmacological interventions/therapies, dependent on the situation and technical requirements of care.

f) Admission, discharge and referral – the ANP:

  • has the freedom and authority to admit and discharge from identified clinical areas, dependent on patient need at the time of review: this includes the freedom and authority to refer to all appropriate healthcare professional groups and agencies, working collaboratively with them.


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