Employers Adding New Emerging Competency

As knowledge and technology advance and health care environments change, nursing practice continually evolves. Increasingly, RNs, NPs, and RPNs face decisions about performing procedures, competencies, or activities that are new, or were previously the responsibility of other health care professionals. There may be circumstances within the health care system, employment setting, or in a specific practice setting where new and/or emerging competencies are required to be added to the scope of RNs, NPs and RPNs.¹

Decision-Making Framework

The Provincial Health Authorities (PHA) and Employers/Organizations are granted authority, by the College, to incorporate new and/or emerging competencies into the scope of practice of RNs/NPs/RPNs within their employment setting, provided key principles are met. The College has developed a Decision-Making Framework that can be used to inform the employer’s process for advancing nursing scope of practice. The College’s decision-making framework incorporates a principle-based approach to stimulate critical evaluation of proposed scope of practice changes.

• The College’s Decision-Making Framework is underpinned by the following assumptions:
• The College is responsible to set the parameters for scope of practice decision making to promote safe, competent, and ethical nursing practice.
• The Nurses Act and Regulations identifies requirements for authorization of RN, NP, and RPN Practice.
• RNs, NPs, and RPNs hold professional accountability for their own practice.
• The PHA/employer is responsible to provide quality health care services in response to client needs.
• The PHA/employer has available resources and internal quality initiatives to facilitate advancing nursing scope of practice.

The Decision-Making Framework is designed to ensure public safety and competent nursing practice by requiring input be sought from all relevant professionals, contextual issues to be thoroughly explored, and the necessary safeguards, including nursing education and policy, to be established. To promote consistency, the PHA is encouraged to use this information as a template to develop their own process.

Further, the PHA/employers are strongly encouraged to develop or adopt a standard review process for their organization that reflects adherence to the College’s foundational principles to ensure a consistent, comprehensive, and professional review of all scope of nursing practice requests. This includes the identification of the employer’s authority and procedures whereby scope of practice requests are submitted, reviewed, and approved. The PHA/employer process should be established before any new decisions about performance of new or emerging nursing competencies are reviewed. The established process should be supported through nursing policy and readily available within all applicable practice settings. Additionally, the PHA/employer should provide the RN, NP, and RPN with the required education and practice experience to gain and maintain competency of the new/emerging competency and implement the necessary supports to support the practice. Reciprocally, the RN, NP, and RPN is accountable to engage in the education and practice to build their capacity to perform the competency safely and competently.

Self-employed RNs, NPs, and RPNs seeking to incorporate new/emerging competencies into their practice are required to consult with the College for a determination of whether the competency is considered within the practice of an RN, NP, or RPN in NL. Please refer to the most current version of the applicable College’s Self-Employment document.

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