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Applying the Competencies
Required for Nurse Practitioners

in British Columbia
College of
Registered Nurses
of British Columbia
2855 Arbutus Street

Vancouver, BC
Canada V6J 3Y8
T: 604.736.7331
F: 604.738.2272
Toll-free: 1.800.565.6505
APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
TABLE OF CONTENTS
I n t r o d u c ti on
Ab o u t T h is D o c u me n t
T er m in ol ogy
A G u id in g Fr a m ew or k
1 . P r o f es s io n a l R o l e, R e sp on sib il i ty , a n d Ac c o u n ta b i li ty
2. H ea lt h A s se s s me n t a n d D ia gn o si s
18
3. T h er a p e u t ic M a n a g e m en t
22
4 . He a l th P r o m o ti on a n d P r e ve n t i on o f I lln e ss a n d I n j ur y
29
AP P EN D I X
32
Diseases, Disorders and Conditions Commonly Diagnosed and Managed by an Entry-Level

Family Nurse Practitioner
32

Adult Nurse Practitioner
38

Pediatric Nurse Practitioner
44
Resources
50
2855 Arbutus Street

Vancouver, B.C. V6J 3Y8
Tel. 604.736.7331 or
1.800.565.6505
www.crnbc.ca
Copyright CRNBC/March 2015
Pub. No. 440
College of Registered Nurses of British Columbia
Introduction
In January 2011, the College of Registered Nurses of British Columbia (CRNBC) introduced a new competencies
document entitled Competencies Required for Nurse Practitioners in British Columbia 1. This new document
replaced the previous competencies document, in use since 2003.
Also in 2011, CRNBC directed revisions to the Objective Structured Clinical Examination (OSCE) cases to
reflect the new competencies. This work was done in early 2012, with the June 2012 OSCE exam reflecting the
new competencies for NP practice. This revision required review and modification of the scoring and the
reporting of OSCE results.
Following the adoption of the new competencies, CRNBC continued to use two documents to support
assessment of nurse practitioner competencies:
Competencies Required for Nurse Practitioners in British Columbia

Applying the Competencies Required for Nurse Practitioners in British Columbia 2
About This Document

The Applying the Competencies Required for Nurse Practitioners in British Columbia document was revised in
2013 to reflect the approved new competencies. However, it continued to use the numbering and structure of
the old competencies. This created confusion for users trying to understand the performance expectations,
and for staff trying to guide potential nurse practitioner registrants and exam candidates.
This revised document is intended to combine the features of the two reference documents, listed above, into
one document. It aligns the specific objective criteria of the Applying the Competencies document with the
new competencies, and enhances understanding of the elements of expected performance for the
competencies. The document uses the existing approved competencies as the defining framework and the
statements from the previous Applying the Competencies as the basis for the performance indicators. The
indicators were refined by subsequent reviews.
The benefit for all users is that everything related to competencies is in one place using consistent terminology
and numbering. More specifically, potential registrants (including exam candidates) do not have to switch
between documents to gather the information they need to make informed decisions about preparation for
licensure or exams, or to understand exam performance reports. Consultants are all on the same page when
discussing issues. And CRNBC staff can use the document at the required level; higher levels for discussion of
overall competencies (e.g., in presentations to NP programs), and more detailed levels for discussions related
to preparation for licensure and exam performance.
It is important to remember that competencies cross boundaries of tasks and activities, and that a single
activity can incorporate multiple competencies. This is particularly applicable to the first category,
Professional Role, Responsibility and Accountability. (The Global Assessment Scale (GAS) in the OSCE exam
evaluates many of the competencies in this category, and the underlying knowledge, skills and abilities that
support many of the tasks and activities associated with nurse practitioner practice.)
1 College of Registered Nurses of British Columbia. (2010). Competencies Required for Nurse Practitioners in British Columbia. Pub. no. 416. Vancouver:
Author.
2 College of Registered Nurses of British Columbia. (2013). Applying the Competencies Required for Nurse Practitioners in British Columbia. Pub. no. 440.
Vancouver: Author.
Terminology
Several of the terms that are used in the competencies and indicators document have specific meanings:
Client(s): An individual, family, group, population or entire community who requires nursing expertise.
In some clinical settings, the client may be referred to as a patient or a resident. In research, the client
may be referred to as a participant.
Family: Two or more individuals who depend on one another for emotional, physical and/or economic
support. The members of the family are defined by the individual.
Support: A broad term that includes educating, coaching and/or counselling the client.
Cultural safety: A manner that affirms, respects and fosters the cultural expression of the client. This
usually requires nurses to have undertaken a process of reflection on their own cultural identity and to
have learned to practice in a way that affirms the culture of clients and nurses. Unsafe cultural
practice is any action which demeans, diminishes or disempowers the cultural identity and well-being
of people. Cultural safety addresses power relationships between the service provider and the people
who use the service.
A Guiding Framework3
Competence
Competencies
Indicators
Knowledge, Skills, and

Abilities (KSAs)
COMPETENCE
Competence is defined in the literature as:
the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning,
emotions, values, and reflection in daily practice for the benefit of the individual and community being
servedProfessional competence is developmental, impermanent, and context-dependent.4
There is no known way to measure competence. Competence can, however, be broken down into a series of
measureable competencies.
COMPETENCIES
Competence relies on competencies. Competencies can be thought of as facets of competence. They are
broad statements intended to define aspects of competence.
3 This framework is adapted from Cane, D. (2013). Competencies, Indicators and Assessments. Presentation to CNNAR, October 2013.
4 Epstein, RM and Hundert, DM. (2002). In Cane, D. (2013). Competencies, Indicators and Assessments. Presentation to CNNAR, October 2013.
The competency profile for nurse practitioners lists the competencies identified by CRNBC. CRNBC uses the
following definition of competencies in its publications:
Statements about the knowledge, skills, attitudes and judgments required to perform safely and
ethically within an individuals nursing practice or in a designated role or setting. 5
At their most basic, competencies are the ability to perform a job task with a specified level of proficiency. Job
tasks can be concrete skills (e.g., auscultation) or more complex skills (e.g., synthesis, decision-making). All
competencies are underpinned by their related knowledge, skills, and abilities.
Each competency includes multiple activities, and competencies may be used in a variety of contexts. Each
context will have specific nuances that will shape the knowledge and skills that are used to support the
achievement of a competency. Contexts can include the stream of practice, the work setting, the clientele or
population, and other factors. An NP who is competent in one stream of practice, work setting or population
may not be competent in a different environment.
ASSUMPTIONS RELATED TO NP COMPETENCIES
Nurse Practitioners work in multiple settings and may be primary care providers in many of these settings. The
assumptions used to develop the competencies are essential to understanding how they are applied to nurse
practitioner practice in any role and setting, not specific to a particular client population or practice
environment. The following assumptions were made in developing the competencies6:
The practice of nurse practitioners is grounded in the values, knowledge and theories of professional
nursing practice.
Nurse practitioner competencies build and expand upon the competencies required of a registered nurse.
Nurse Practitioner practice is advanced in the application of in-depth knowledge and theory from
nursing and other fields, including experiential knowledge gained from clinical practice experience as
registered nurses.
Nurse practitioners have achieved additional competencies at the graduate level of nursing
education, with a substantial clinical component.
Nurse practitioner core competencies are the foundation for all nurse practitioner practice and apply
across diverse practice settings and client populations. A common set of NP core competencies is
essential to all nurse practitioner education and practice regardless of practice stream (family, adult,
or pediatric). A description of each stream of practice demonstrates how the core competencies are
applied by family, adult or pediatric nurse practitioners.
Nurse practitioner core competencies are an essential element of nurse practitioner competence
assessment.
Nurse practitioner practice is grounded in the five World Health Organization (WHO) principles of
primary health care: accessibility, public participation, health promotion, appropriate technology and
intersectoral collaboration.
Nurse practitioners provide services relating to health promotion, illness/injury prevention,
rehabilitative care, curative and supportive care, and palliative/end-of-life care.
The identified competencies incorporate those of advanced nursing practice and specifically address
the activities that are included in the additional legislated scope of practice of nurse practitioners,
e.g., advanced health assessment, diagnosis of acute and chronic illnesses and their therapeutic
management.
5 CRNBC Glossary https://www.crnbc.ca/Glossary/Pages/Default.aspx Accessed September 5, 2014

6 College of Registered Nurses of British Columbia. (2010). Competencies Required for Nurse Practitioners in British Columbia. Pub. no. 416. Vancouver:
Author. (Page 7).
Nurse practitioners engage in interprofessional collaborative practice to provide safe, client-centered,

high quality health care services.
Newly graduated nurse practitioners gain proficiency in the breadth and depth of their practice over
time with support from employers, mentors and health-care team members.
(For a list of the NP competencies, please see Appendix.)

INDICATORS
Because competencies include multiple activities, there is a need to break them down further for assessment
purposes. Indicators are defined for many competencies in order to get to a level that is measurable through
performance.
An indicator is a task that can be performed in an assessment vehicle, demonstration of which
provides an indication of proficiency in a competency. 7
Indictors provide specific criteria that are used to measure the actual performance of an individual. The
varying number of indicators for each competency is related to the complexity of the task.
KNOWLEDGE, SKILLS AND ABILITIES (KSAS)8
KSAs are the foundation of NP practice. They overlap and support multiple competencies and multiple
indicators. KSAs include:
Knowledge of anatomy; physiology; developmental and life stages; determinants of health;

behavioural sciences; demographics; family process; diversity; cultural safety; pathophysiology;
psychopathology; epidemiology; environmental exposure; infectious diseases; clinical
manifestations of normal health events, acute illness/injuries, chronic diseases; emergency health
needs; comorbidities and the effects of multiple etiologies; pharmacotherapeutics; and evidenceinformed practice.
Skill in performing interviews, physical assessments and procedures, including the use of equipment
and assessment or treatment tools.
Abilities in generic areas such as communication, problem-solving, and decision-making.
A full mapping of KSAs to the related competencies is beyond the scope of this document.
There are parts of the NP assessment process (Post Encounter Probe [PEP] written OSCE stations, multiple
choice assessments) that specifically assess the knowledge that underpins NP practice, and this knowledge is
also assessed through assessment of higher level processes in clinical stations (application, synthesis,
evaluation).
RELATING KSAS, INDICATORS AND COMPETENCIES
It is assumed that if an individual demonstrates knowledge and skills and abilities (KSAs) at the required
standard for an entry level practitioner (beginning practice NP) on the indicator tasks and activities, he or she
possesses the competencies related to those indicators. Competencies therefore rely on KSAs, as well as on
the associated indicators.
7 Cane, D. (2013). Competencies, Indicators and Assessments. Presentation to CNNAR, October 2013.
8 http://www.abbreviations.com/term/92019 Accessed June 3, 2014
It is further assumed that if the candidate has demonstrated sufficient competencies across the spectrum of
those assessed on the OSCE, he or she is competent at that point in time.
This document combines the indicators for successful performance of each competency with the
competencies themselves. Some competencies are assessed in the examination process, through a written
examination9, the OSCE interactive checklist, the OSCE Global Assessment Scale (GAS)10 and /or the OSCE PEP
stations.
Competencies may not be assessed in the exam process because they are better suited to another type of
assessment or because they are acquired at a different stage of the nurse practitioners career. These
competencies are still important to nurse practitioner practice, and they are included here for completeness.
WHERE COMPETENCIES ARE ASSESSED
All competencies are assessed in the nurse practitioners interactions with clients and with other health care
providers throughout his or her career. That said, there are specific competencies that are highlighted for
assessment through different assessment tools, depending on the nature of the competencies involved.
The assessment vehicles identified are:
A written examination recognized by CRNBC13

The OSCE, which includes the interactive station checklists, the Global Assessment Scale (GAS), and
the post-encounter probe (PEP) questions
The Quality Assurance program, which may include self-assessment, portfolio assessment, and other
tools
Assessment of substantial equivalence/substantial difference related to credentialing of
internationally educated nurse practitioners
While a specific competency may be identified in this document as being assessed using one of these
assessment tools, it must be understood that each competency may be assessed in multiple ways over the
course of the nurse practitioners career. The notes on assessment provided are primarily for the use of exam
candidates, to know what might be covered on the written and/or OSCE exams.
9 CRNBC does not administer a written examination. Visit the CRNBC website for information about the recognized written examinations.
10 As of September 20, 2014, the GAS categories are: Professional Conduct; Client-centred Care; Communication; Organization and Approach; Skill; Decision
Making.
1. Professional Role, Responsibility, and Accountability

Professional role, responsibility and accountability encompass the core competencies for advanced
nursing practice as they apply to nurse practitioner practice in: clinical practice; leadership; research;
collaboration, consultation and referral (adapted from CNA, 2008). Nurse practitioner practice is
characterized by the simultaneous interaction and blending of competencies at a complexity that
reflects the nurse practitioners highly developed critical inquiry, clinical nursing experience and
advanced education with a substantial clinical component. The competencies listed below are
fundamental to advanced nursing practice and integrated in practice by nurse practitioners.
Therefore, the competencies listed in Category 1. Professional Role, Responsibility, and Accountability
apply to each of the three other competency categories in this document: Health Assessment and
Diagnosis; Therapeutic Management; and Health Promotion and Prevention of Illness and Injury.
Clinical Practice
Competency 1.1
Practises in accordance with federal and provincial/territorial legislation, professional and
ethical standards and policy relevant to nurse practitioner practice.
(May be assessed in exams)
Indicators:
1.1.1
1.1.2
1.1.3
1.1.4
Identifies relevant legislation and the implications for practice

Provides all aspects of client care (history, physical, investigations, analysis,
differential diagnosis, treatment planning, treatment implementation,
outcome monitoring) in accordance with legislated, professional and ethical
requirements
Documents practice and maintains records securely in accordance with
legislation on privacy and security of client record and with CRNBC Practice
Standards
This is about the security and confidentiality of records and other
client information; content of records is included in Competency 1.10.
Communicates with clients in accordance with privacy and protection laws
This refers to information in general; specific information about
assessments, investigations, treatments, drugs, and self-care is
included in the relevant sections.
Competency 1.2
Understands the changes in scope of practice from that of a registered nurse and how this
affects responsibilities and accountabilities when assuming the reserved title and scope of
practice of a nurse practitioner.
Indicators:
1.2.1
1.2.2
1.2.3
1.2.4
Meets CRNBC nurse practitioner Scope of Practice Standards, Limits and

Conditions for diagnosis and health care management (as found in documents
posted on website)
Makes decisions autonomously and accountably in keeping with the nurse
practitioner scope and stream of practice
Modifies practice to meet the needs of client populations and practice settings
This refers to the stream of practice and the practice setting. For
examination purposes, there are three possible streams of practice,
family, adult and paediatric.
Explains the role, responsibilities, limits and boundaries of the nurse
practitioner to the client, including defining accountability and responsibility
Competency 1.3
Incorporates knowledge of diversity, cultural safety and the determinants of health in
assessment, diagnosis and therapeutic management of the client and the evaluation of
outcomes.
Indicators:
There are no specific indicators for this competency. Indicators for other competencies
rely on this knowledge.
Competency 1.4
Incorporates knowledge of developmental and life stages, pathophysiology, psychopathology,
epidemiology, environmental exposure, infectious diseases, determinants of health,
behavioural sciences, demographics and family process when performing health assessment,
making diagnoses and providing overall therapeutic management.
Indicators:
10
Competency 1.5
Incorporates knowledge of the clinical manifestations of normal health events, acute
illness/injuries, chronic diseases, comorbidities and emergency health needs, including the
effects of multiple etiologies in assessment, diagnosis and therapeutic management of the
client and the evaluation of outcomes.
Indicators:
Competency 1.6
Integrates the principles of resource allocation and cost-effectiveness in clinical decisionmaking.
Indicators:
1.6.1
1.6.2
Makes decisions taking into account resource allocation

Makes decisions taking into account cost-effectiveness
Competency 1.7
Provides client diagnostic information and education that is relevant, theory-based and
evidence-informed using appropriate teaching/learning strategies.
Indicators:
1.7.1
Provides information that is current, relevant and evidence-informed
Information provided takes into account new evidence, and the
relevance of the information to the clients circumstances.
Competency 1.8
Promotes safe client care by mitigating harm and addressing immediate risks for clients and
others affected by adverse events and near misses.
Indicators:
1.8.1
Takes appropriate action to mitigate harm and address immediate risks
Competency 1.9
Discloses the facts of an adverse event to the client, and reports adverse events to appropriate
authorities, in keeping with relevant legislation and organizational policies, e.g., the Canadian
Adverse Drug Reporting system.
Indicators:
1.9.1
1.9.2
Reports adverse events related to medications to client and others

Reviews critical incidents with colleagues
11
Competency 1.10
Documents clinical data, assessment findings, diagnoses, plan of care, therapeutic
intervention, clients response and clinical rationale in a timely and accurate manner.
Indicators:
1.10.1
1.10.2
Documents in a timely, clear, accurate and complete manner in accordance

with relevant CRNBC Practice Standards
Documents recommendations (including those declined by client), orders,
treatment plans, clinical rationale, all therapeutic interventions provided,
ongoing monitoring of clients response to the plan of care, evaluation of
outcomes, and revisions to the plan of care in the documentation
Competency 1.11
Adheres to federal and provincial legislation, policies and standards related to privacy,
documentation and information management (this applies to verbal, written or electronic
records).
Indicators:
1.11.1
1.11.2
1.11.3
Documents practice in accordance with CRNBC Practice Standards and all

legislation on privacy and security of client record
Maintains privacy of client records
Manages information in accordance with CRNBC Practice Standards and
relevant legislation
Competency 1.12
Meets the CRNBC Standards of Practice including Professional Standards, Practice Standards
and Scope of Practice Standards.
Indicators:
1.12.1
1.12.2
Practices in accordance with ethical and professional standards

Obtains consent for the agreed-upon plan of care, in accordance with CRNBC
Practice Standard Consent, before implementing plan
Competency 1.13
Engages in ongoing professional development and accepts personal responsibility for
maintaining nurse practitioner competence.
Indicators:
1.13.1
1.13.2
1.13.3
1.13.4
1.13.5
1.13.6
Bases self-assessment on reflective practice

Evaluates and identifies own learning style and needs
Adapts practice to meet new patterns of health needs, trends, evolving
practice guidelines, and evidence
Identifies, interprets and applies current research to improve practice
Identifies methods and strategies used to maintain competence
Identifies methods and strategies used to ensure quality improvement in
practice
12
Collaboration, Consultation and Referral

Competency 1.14
Consults and/or refers clients to other health-care providers at any point in the care continuum
when the clients condition is not within nurse practitioner scope of practice or the individual
nurse practitioners competence.
Indicators:
1.14.1
1.14.2
1.14.3
Uses consultation and collaboration as appropriate to confirm a diagnosis,

identify a health need, or establish/confirm treatment recommendations
Makes referrals to other health professionals that are concise, succinct,
accurate, timely, and appropriate to the needs of the client in an effective
manner
This includes identifying the essential information to be
communicated to the consultant, either verbally or in writing.
Coordinates and facilitates connections with other health care providers,
agencies and community resources, as appropriate to the clients health care
needs, interests and decisions
In the exam setting, this is limited to making recommendations for
referral to a type of provider; a name and contact information are not
required, and the NP is not expected to initiate contact with the
provider.
Competency 1.15
Acts as a consultant and/or refers and accepts referrals from health-care providers, community
agencies and allied non-health-care professionals.
Indicators:
1.15.1
1.15.2
Makes timely, effective and appropriate consultations and referrals relative to

the needs of the client
Accepts referrals from and/or provides consultation to other health-care
providers, community agencies and allied non-health-care professionals
Competency 1.16
Advocates for clients in relation to therapeutic intervention, health-care access, the health-care
system and policy decisions that affect health and quality of life.
Indicators:
1.16.1
Discusses client care and access with relevant personnel to facilitate client
health care and quality of life
13
Competency 1.17
Collaborates with members of the health-care team to provide and promote interprofessional
client-centered care at the individual, organizational and systems levels.
Indicators:
1.17.1
Facilitates interactions with other health team members to maximize client

participation and decision-making
Competency 1.18
Collaborates with members of the health-care team to promote and guide continuous quality
improvement initiatives at the individual, organizational and systems levels.
Indicators:
1.18.1
Facilitates interactions with other health team members to identify and

address quality improvement needs
Competency 1.19
Applies advanced knowledge and skills in communication, negotiation, coalition building,
change management, and conflict-resolution including the ability to analyze, manage and
negotiate conflict.
Indicators:
1.19.1
1.19.2
1.19.3
1.19.4
Forms coalitions and effective partnerships to initiate or manage change

Initiates change to reflect evidence-informed practice at the individual,
organizational and systems level
Facilitates and manages change effectively and with respect
Resolves conflicts respectfully and through collaborative problem-solving
Research
Competency 1.20
Engages in evidence-informed practice by critically appraising and applying relevant research,
best practice guidelines and theory when providing health-care services.
Indicators:
1.20.1
1.20.2
1.20.3
Identifies research, practice guidelines and theory relevant to the practice

setting and clients.
Applies relevant research, practice guidelines and theory to practice
Encourages others in the health care setting to apply relevant research,
practice guidelines and theory
14
Competency 1.21
Develops, utilizes and evaluates processes within the practice setting to ensure that clients
receive coordinated health services that identify client outcomes and contribute to knowledge
development.
Indicators:
1.21.1
1.21.2
Uses follow-up and quality improvement strategies

Uses logical and appropriate follow-up and information systems
Competency 1.22
Identifies and implements research-based innovations for improving client care at the
individual, organizational and systems levels.
Indicators:
1.22.1
Assumes a leadership role, when there is opportunity, to initiate or guide

policy related activities that will influence practice, health services and public
policy
Competency 1.23
Identifies, collects data on, and evaluates the outcomes of, nurse practitioner practice for
clients and the health-care system.
Indicators:
1.23.1
1.23.2
1.23.3
Selects outcome measures proactively

Captures anticipated evidence-informed client outcomes including those
identified in relevant practice guidelines
Evaluates outcome measures in follow-up of clients and data information
systems
Competency 1.24
Collaborates with other members of the health-care team or community to identify research
opportunities, to conduct and/or support research.
Indicators:
1.24.1
1.24.2
Identifies research opportunities relevant to practice setting and/or clients

Conducts or supports research as appropriate
15
Competency 1.25
Acts as a change agent through knowledge translation and dissemination of new knowledge
that may include formal presentations, publication, informal discussions and the development
of best practice guidelines and policies.
Indicators:
1.25.1
Bases changes in practice on the evaluation of health promotion and

prevention strategies.
Leadership
Competency 1.26
Provides leadership in clinical care and is a resource person, educator and role model.
Indicators:
1.26.1
1.26.2
Communicates clearly and appropriately to the communication styles of

others
Make decisions collaboratively
Competency 1.27
Precepts, mentors and coaches nursing colleagues, other members of the health-care team
and students.
Indicators:
1.27.1
1.27.2
Mentors and supports others to develop their skill and knowledge

Mentors and supports other nurse practitioners and registered nurses in their
learning
Competency 1.28
Articulates and promotes the role of the nurse practitioner to clients, other health-care
providers, social and public service sectors, the public, legislators and policy-makers.
Indicators:
1.28.1
Explains the role and responsibilities of the nurse practitioner to clients, other
health care providers, social and public service sectors, the public, legislators,
and policy-makers
16
Competency 1.29
Provides leadership in the development and integration of the nurse practitioner role within the
health-care system.
Indicators:
1.29.1
Establishes networks with other colleagues to enhance, support and/or

develop knowledge, solve problems and set policy
Competency 1.30
Advocates for, and participates in, creating an organizational environment that supports safe
client care, collaborative practice and professional growth.
Indicators:
1.30.1
1.30.2
Develops systems to promote safe client care and demonstrate effective

outcomes
Uses risk management strategies to promote safe practice
Competency 1.31
Guides, initiates and provides leadership in the development and implementation of
standards, practice guidelines, quality assurance, and education and research initiatives.
Indicators:
1.31.1
1.31.2
Communicates or disseminates outcomes, when appropriate, to contribute to

nursing and other scientific knowledge
the development of evidence-informed practice guidelines
Competency 1.32
Guides, initiates and provides leadership in policy-related activities to influence practice,
health services and public policy.
Indicators:
1.32.1

the development of evidence-informed policies
17
2. Health Assessment and Diagnosis

The nurse practitioner integrates a current, scientific knowledge base and critical appraisal to obtain
the required information for determining diagnoses and client needs. Throughout the process, the
nurse practitioner works collaboratively with the client to identify and mitigate health risks, promote
understanding of health issues and support healthy behaviour.
Competency 2.1
Performs a focused health assessment and/or an advanced comprehensive health
assessment, using and adapting assessment tools and techniques based on client needs and
relevance to client stage of life.
Indicators:
There are no specific indicators for this competency. The following two competencies
break down the health assessment and provide indicators for each component.
Competency 2.2
Performs a complete or focused health history appropriate to client situation including
physical, psychosocial, emotional, ethnic, cultural and spiritual dimensions of health.
Indicators:
2.2.1
Uses a method of either focused or comprehensive history taking that is

appropriate to the clients presenting concern
The candidate instructions usually say to take a brief focused health
history. A more comprehensive history might be required in some
circumstances.
2.2.2
Includes in history as appropriate the reason for seeking care, present health
or history of present illness, review of systems, past health, family health
history, personal and social history (psychosocial, emotional, ethnic, cultural
and spiritual), identification of support network, functional assessment, and
the clients perception of his or her health and well being
Gathers information in a standard, systematic and organized manner
Uses information gathering tools and techniques that are appropriate to client
needs and age and/or developmental stage
Uses assessment tools and techniques that are appropriate to client needs
and age and/or developmental stage
Gathers information respectfully and sensitively, and appropriately maintains
confidentiality within a family interview
In the exam setting, this includes interviews of family members with
the client present or not present, e.g. small children.
2.2.3
2.2.4
2.2.5
2.2.6
2.2.7
2.2.8
Seeks clarification when necessary to enhance understanding and improve

ongoing differential diagnosis
Uses interpreter services when necessary to enhance understanding and
communication
18
Competency 2.3
Performs a complete or focused physical examination, and identifies and interprets normal and
abnormal findings as appropriate to client presentation.
Indicators:
2.3.1
2.3.2
2.3.3
2.3.4
2.3.5
2.3.6
2.3.7
Performs physical examinations in keeping with standardized and accepted

practice
Performs physical examinations that are congruent with the history and
assessment findings and are comprehensive and appropriate to differential
diagnosis
This incorporates decision-making about what physical examination
techniques are appropriate or not required in specific situations.
Exam candidates are expected to set priorities for physical
examinations on the basis of the history and other information
provided at the start of the station or provided during the station.
Uses techniques and strategies to gain focused or comprehensive data that is
appropriate to the client presentation and in consideration of client age and
developmental stage
Respects the clients privacy and dignity and ensures client safety during
physical examination
Performs examination in a systematic and organized manner with minimal
discomfort to the client
Provides clear instruction to the client about the examination
Maintains the client relationship through appropriate verbal communication
during the examination
This could include reassurance, report of findings, or other verbal
communication appropriate to the circumstances.
Competency 2.4
Synthesizes health assessment information using critical inquiry, clinical and diagnostic
reasoning to diagnose health risks and states of health/illness. (May be assessed in exams)
Indicators:
2.4.1
Analyzes and interprets information from appropriate sources

In the OSCE setting, information may be obtained from posted
instructions prior to (or in) the interactive station, from the client in
the interactive station, from the examiner in the interactive station, or
from the information provided for the PEP station.
2.4.2
Identifies and accurately interprets both normal and abnormal findings, as

appropriate to client presentation
In the OSCE setting, the examiner may be instructed to confirm
findings as either normal or abnormal, when there is a possibility of
misinterpretation.
2.4.3
Integrates information from the history, including the presenting symptoms,

response to illness, physical and mental/cognitive examination, and
19
2.4.4
diagnostic and screening investigations to develop differential diagnoses and

determine the most likely diagnosis
Notes indications of potential health concerns
Competency 2.5
Formulates differential diagnoses through the integration of client information, nursing and
medical knowledge, and evidence-informed practice. (May be assessed in exams)
Indicators:
2.5.1
2.5.2
2.5.3
2.5.4
Formulates differential diagnoses that are congruent with the findings from
the history, physical assessment, and other relevant information
Formulates differential diagnoses that are based on critical inquiry
Formulates differential diagnoses that are accurate and comprehensive
Formulates differential diagnoses that reflect sound clinical reasoning
Competency 2.6
Anticipates and diagnoses urgent, emergent and life-threatening situations. (May be assessed
in exams)
Indicators:
2.6.1
2.6.2
Asks questions and/or performs physical examinations to identify urgent,

emergent and life threatening situations
Recognizes signs and symptoms of urgent, emergent and life threatening
situations
In the OSCE, this is highlighted in the cases with defined safety flags.
Competency 2.7
Orders and/or performs screening and diagnostic investigations, interprets results using
evidence-informed clinical reasoning and critical inquiry, and assumes responsibility for followup. (May be assessed in exams)
Indicators:
2.7.1
2.7.2
Performs or orders investigations appropriately, safely and in keeping with

evidence-informed practice for screening, monitoring and diagnostic purposes
Interprets diagnostic investigations accurately and with sound clinical
reasoning
20
Competency 2.8
Diagnoses diseases, disorders, injuries, conditions and identifies health needs while
considering the client response to the health/illness experience. (May be assessed in exams)
Indicators:
2.8.1
Makes comprehensive and accurate diagnosis(es)

This includes diagnosing urgent, emergent and life threatening
conditions.
2.8.2
2.8.3
Bases diagnosis(es) on sound scientific evidence and clinical reasoning

Considers culture and determinants of health as appropriate in making
diagnosis(es)
Competency 2.9
Communicates with clients about health assessment findings and/or diagnosis, including
outcomes and prognosis. (May be assessed in exams)
Indicators:
2.9.1
Communicates health assessment findings, diagnosis, outcomes and

prognosis appropriately
This includes communication both during and following the
assessment.
2.9.2
Communicates findings directly to the client

In the examination context, the candidate is expected to
communicate with the individual presenting in the station. In some
situations, this is not the client.
2.9.3
Communicates findings, diagnosis(es), outcomes and prognosis at a level and

in a manner that maximizes client understanding
Encourages the client to ask questions and raise concerns
This refers to questions and concerns about the diagnosis; in the
examination context, this indicator may be limited by available time.
2.9.4
2.9.5
2.9.6
Responds to clients questions and concerns

Communicates need for consultations with, or referrals to, other health care
professionals effectively
21
3. Therapeutic Management
Nurse practitioners collaborate and share decision-making with clients to set priorities for the
provision and overall coordination of care along the health/illness continuum. The nurse practitioner
selects appropriate interventions from a range of non-pharmacological and pharmacological
interventions to assist clients in promoting, restoring or maintaining functional, physiological,
emotional and mental stability to achieve optimal client health.
Competency 3.1
Creates an environment in which effective communication of diagnostic and therapeutic
intervention can take place. (May be assessed in exams)
Indicators:
3.1.1
3.1.2
3.1.3
Welcomes the client and encourages the client to feel at ease

Communicates clearly and appropriately to the communication styles of the
client
Encourages the client to describe his/her situation, feelings, concerns and
attitudes
In the examination setting, this indicator is limited by available time.
3.1.4
Encourages the client to describe the meaning of his/her health/illness

experience and how his/her daily living is affected
In the examination setting, this indicator expected to the extent
possible in the time available
3.1.5
3.1.6
3.1.7
Treats the client respectfully and in accordance with his/her cultural beliefs
Acknowledges the clients health status and concerns
Provides information and makes recommendations in a manner that
encourages participation, understanding and learning
Supports the client to voice and address concerns
This refers to general support around concerns, encouraging the client
to ask questions and raise concerns and assisting the client to
address concerns.
3.1.8
22
Competency 3.2
Explores therapeutic options with clients considering implications for the clients by integrating
client information and evidence-informed practice. (May be assessed in exams)
Indicators:
3.2.1
3.2.2
3.2.3
3.2.4
3.2.5
3.2.6
3.2.7
Negotiates priorities and decisions with the client

Takes into account clients acute and chronic diseases, disorders, conditions,
health risks and circumstances in setting priorities and making
recommendations
Includes consideration of relevant information provided by other health care
providers and family where appropriate in setting priorities and making
recommendations
Recognizes and responds appropriately to urgent and emergent health needs
in setting priorities and making recommendations
Reflects realistic health outcomes and relevant evidence in setting priorities
and making recommendations
Explains the purpose, benefits and risks of the interventions to the client as
appropriate
Communicates and explores anticipated clinical outcomes and negotiates a
plan in the event that outcomes cannot be met
Competency 3.3
Determines care options and initiates therapeutic interventions in negotiation with clients
while considering client perspectives, feasibility and best outcomes. (May be assessed in
exams)
Indicators:
3.3.1
3.3.2
Reflects evidence-based practice in orders or treatment plan

Obtains informed consent as appropriate
In the examination setting, consent is assumed except in cases where
a lack of consent is explicitly stated, or in cases where consent is
explicitly withdrawn.
Competency 3.4
Initiates interventions for the purpose of stabilizing clients in urgent, emergent and life
threatening situations. (May be assessed in exams)
Indicators:
3.4.1
3.4.2
Performs necessary interventions for the health and well-being of the client
Explains the purpose, benefits and risks of the interventions as appropriate
In an urgent, emergent or life-threatening situation, the immediate
need for intervention may outweigh the need for explanation of
interventions.
3.4.3
3.4.4
Reflects current technology in therapeutic interventions

Reflects evidence-based practice in interventions
23
Competency 3.5
Supports, educates, coaches and counsels clients regarding diagnoses, prognoses, and selfmanagement including their personal responses to diseases, disorders, conditions, injuries,
risk factors, lifestyle changes and therapeutic interventions.
In the examination setting, time constraints may limit the candidates ability to provide
the desired extent of support, or to encourage the client to express difficulties in
managing care, but there should be some indication of an intent to provide support and
elicit client feedback.
Indicators:
3.5.1
3.5.2
3.5.3
3.5.4
3.5.5
3.5.6
3.5.7
3.5.8
3.5.9
3.5.10
3.5.11
Provides helpful support to the client

Offers counselling/coaching to enhance clients ability to meet his/her health
and quality of life goals
Supports the client regarding diagnoses, prognoses, and self-management
including personal responses to diseases, disorders, conditions, injuries, risk
factors, lifestyle changes and therapeutic interventions
Supports the client to follow the recommended and accepted drug therapy,
including frequency and duration, and all other recommended treatments and
therapeutic interventions
Supports the client to identify and take action to address his/her own health
care needs and decisions including those related to living with chronic
disease
Supports the client to identify health promotion/prevention strategies and
take appropriate action
Supports the client to identify trends and patterns affecting his/her health and
well-being
Encourages the client to manage his/her own plan of care, to report difficulties
in implementing the plan of care, and to work with the provider to resolve
situations of conflict or to address barriers to implementation
Reflects current technology in interventions
Reflects evidence-based practice in interventions
Takes opportunities for health promotion and disease and injury prevention
In the examination context, these opportunities are limited by the
time available; the expectation is that candidates will address
aspects of health promotion or disease and injury prevention that
pertain to the presenting concern.
Competency 3.6
Promotes client self-efficacy in navigating the health-care system and in identifying and
accessing the necessary resources.
Indicators:
3.6.1
Supports clients to access resources and navigate the health care system
24
Competency 3.7
Coordinates and facilitates client care with other health-care providers, agencies and
community resources.
Indicators:
3.7.1
3.7.2
3.7.3
Identifies services gaps

Makes contributions to enhance communication strategies among health
providers and others to address service gaps and maximize continuity of care
Facilitates problem-solving to enable communities to address problems
Competency 3.8
Performs procedures (invasive/non-invasive) for the clinical management/prevention of
disease, injuries, disorders or conditions.
Indicators:
3.8.1
3.8.2
3.8.3
3.8.4
Performs interventions that are necessary for the health and well-being of the
client
Explains the purpose, benefits and risks of the interventions to the client as
appropriate
Obtains informed consent as appropriate
Reflects current technology in interventions
Competency 3.9
Prescribes pharmacotherapy based on the clients health history, disease, disorder, condition
and stage of life and individual client circumstances. Uses information from PharmaNet when
possible.
Indicators:
3.9.1
3.9.2
3.9.3
3.9.4
Prescribes appropriately to the needs and acceptance of the client

Prescribes based on the clients ability to understand and follow the treatment
regime
Writes prescriptions that are evidence-informed, accurate and complete
Prescriptions take into account all contraindications, potential drug
interactions, clients health history, current health status, lifestyle, gender,
circumstances, and clients perspective
25
Competency 3.10
Applies knowledge of pharmacotherapeutics and evidence-informed practice in prescribing,
monitoring and dispensing drugs.
Indicators:
Competency 3.11
Considers the active participation of clients, cost-effectiveness and affordability when
prescribing drug therapy.
Active participation is covered under Competency 3.5 for all aspects of care.
Indicators:
3.11.1
3.11.2
Prescriptions take into account affordability

Prescriptions take into account cost-effectiveness
Cost-effectiveness is not included in the OSCE.
Competency 3.12
Counsels clients on medication therapy, benefits, potential side effects, interactions,
importance of adherence and recommended follow-up.
Indicators:
3.12.1
Provides drug information that is current, relevant and evidence-based

Indicator 3.12.1 is the same as indicator 1.7.1. It is repeated here
because of the importance attached to providing drug information.
Competency 3.13
Demonstrates awareness of health products, medical devices, medications, alternative
therapies and health programs, and is mindful of the power dynamics and marketing strategies
used to promote them.
Indicators:
3.13.1
3.13.2
Advises clients about health products, medical devices, medications,

alternative therapies and health programs
Considers the power dynamics and marketing strategies used to promote
health products, medical devices, medications, alternative therapies and
health programs
26
Competency 3.14
Intervenes as appropriate when potential or actual problematic substance use and/or misuse
of drugs, including complementary and alternative therapies, is identified.
Indicators:
3.14.1
Identifies and manages potential or actual problematic substance use and/or

misuse of drugs, including complementary and alternative therapies
Competency 3.15
Prescribes and/or dispenses drugs in accordance with CRNBC standards and provincial or
federal legislative requirements.
Indicators:
There are no indicators associated with this competency. Performance is covered under
indicators in Competency 1.1.
Competency 3.16
Uses an evidence-informed approach in the selection or consideration of complementary and
alternative therapies and considers the benefits and risks to clients health and safety.
Indicators:
3.16.1
3.16.2
Includes possible alternative approaches in recommendations

Explains possible alternative approaches to the client
Competency 3.17
Negotiates ongoing contact with clients to monitor their response to therapeutic intervention(s)
and adjust interventions as needed.
Indicators:
3.17.1
3.17.2
Negotiates follow-up as needed or as requested

Encourages the client to report signs, symptoms, side-effects or potential
adverse reactions
27
Competency 3.18
Monitors, evaluates and revises the plan of care and therapeutic intervention with clients,
based on current evidence-informed practice, client goals, preferences, health status and
outcomes.
Indicators:
3.18.1
3.18.2
3.18.3
3.18.4
3.18.5
3.18.6
Provides ongoing monitoring and evaluation of the plan of care

Gathers data to determine the appropriateness of the plan
Monitors and manages clients responses to drugs, treatments or other
therapeutic interventions
Evaluates the plan of care using established outcome criteria, appropriate
practice guidelines and relevant evidence
Identifies changes in health status and health concerns
Modifies plan of care to reflect changes, circumstances, goals and preferences
of the client
28
4. Health Promotion and Prevention of Illness and Injury

Nurse practitioners in all practice settings focus on promoting, improving and restoring health. The
nurse practitioner may lead or collaborate with other health-care team members, other sectors and/or
the community by participating in initiatives that promote health and reduce the risk of
complications, illness and injury for their individual clients, client groups and/or the population as a
whole.
Competency 4.1
Assesses, identifies, and critically analyzes information from a variety of sources to determine
client and/or population trends and patterns that have health implications.
Indicators:
4.1.1
4.1.2
Anticipates health promotions and injury prevention needs based on evidence

informed guidelines
Gathers information to elicit health promotion and injury prevention needs of
clients and/or communities where applicable
In the examination setting, this data is provided in the instructions, or
by the examiner or client in the station.
4.1.3
Establishes health care goals collaboratively to respond to trends, patterns or

identified risks
This is closely related to Competency 3.2, but reflects knowledge of
the underlying trends or patterns associated with specific segments
of the population.
4.1.4
Sets goals based on information and data that have been critically analyzed
and interpreted correctly
Competency 4.2
Initiates or participates in the development of strategies to address identified client and/or
population health implications. e.g., implementing evidence-informed screening for
populations at risk and harm reduction strategies that are population based.
Indicators:
4.2.1
4.2.2
Uses evidence-informed health promotion/prevention strategies

Implements health promotion/prevention strategies to reflect the clients
unique attributes with attention to cultural safety
29
Competency 4.3
Initiates or participates in the design of services/interventions for health promotion, health
protection and the prevention of injury, illness, disease and complications.
Indicators:
4.3.1
4.3.2
Uses advocacy strategies to support the introduction or the development of

health promotion/prevention strategies including screening populations at
risk and population based harm reduction
Encourages community support for policies and programs that promote health
and well-being
Competency 4.4
Participates in the implementation, monitoring and evaluation of health promotion and
illness/injury prevention strategies in partnership with other health care providers,
communities, social and public service sectors.
Indicators:
4.4.1
4.4.2
4.4.3
Conducts and monitors evaluation activities in collaboration with others

Minimizes barriers to community participation and decision-making
Facilitates interactions with community members to maximize participation
and decision-making
Competency 4.5
Collaborates with other health care providers and other sectors to use knowledge of
determinants of health and principles of community development to help groups or entire
communities obtain the services they need to meet their health goals.
Indicators:
4.5.1
4.5.2
4.5.3
4.5.4
4.5.5
4.5.6
4.5.7
4.5.8
4.5.9
4.5.10
Uses a community development approach

Identifies health trends and risks that affect the well-being of clients
Identifies service gaps
Facilitates problem-solving to enable communities to address problems
Encourages clients to advocate for positive community change to address
health concerns
Makes contributions to policies that protect the health of clients, support
diversity and promote community well-being
Encourages community support for policies and programs that promote health
and well-being
Makes contributions to enhance communication strategies among health
providers and others to address service gaps and maximize continuity of care
Facilitates communication within the community to create or promote change
Makes contributions to the development and maintenance of appropriate
programs and services
30
Competency 4.6
Advocates for and creates an environment that facilitates learning and maximizes client
participation and control of their own health, including living with chronic disease and meeting
their own health needs.
Indicators:
4.6.1
4.6.2
4.6.3
4.6.4
Creates environments to encourage participation and learning

Fosters problem-solving and decision-making within available resources
Provides information and achievable options to enable decision-making
Minimizes barriers to community participation and decision-making
Competency 4.7
Provides culturally safe and competent care with people from diverse backgrounds by tailoring
services to unique client attributes.
Indicators:
4.7.1
Identifies and addresses the particular needs of diverse populations in

collaboration with the community
31
APPENDIX
DISEASES, DISORDERS AND CONDITIONS COMMONLY DIAGNOSED AND
MANAGED BY AN ENTRY -LEVEL FAMILY NURSE PRACTITIONER
Code:
D
The nurse practitioner diagnoses and manages independently or refers as appropriate. Will refer
to physician at any point as deemed necessary or at some stage as per accepted guidelines.
Referrals are in accordance with CRNBCs standards for nurse practitioner- physician
consultation.
The nurse practitioner establishes or strongly suspects the diagnosis and consults with a
physician for the management plan or consults with a physician to confirm the diagnosis, and as
a result of the consultation:
i)
the nurse practitioner receives an opinion and recommendation, and assumes ongoing
primary responsibility and authority for the plan of care;
ii)
the physician assumes concurrent responsibility for some aspects of the plan of care; or
iii)
the care is transferred to the physician or emergency medicine as appropriate.
1. Infectious and Parasitic Diseases

D Chickenpox
D Coxsackie viral infection
D German measles (Rubella)
D Measles (Rubeola)
D Infectious mononucleosis
D Mumps
D Pertussis
D Strep throat
D Syphilis
D Hepatitis A
C Hepatitis B
C Hepatitis C
C HIV
C Tuberculosis
D Fifth disease
D Roseola
2. Endocrine, Nutritional and Metabolic Diseases
C Diabetes type I in adults
D Diabetes type II
32
D Hypothyroidism in adults
D Obesity
C Cushings syndrome in adults
D Gout
C Hyperthyroidism
3. Mental and Behavioural Disorders
D Anxiety disorders in adults
D Depression in adults
C Attention deficit disorder
D Obsessive compulsive disorder in adults
D Substance abuse
D Substance dependence
C Post traumatic stress disorder
C Autistic spectrum disorder
C Fetal alcohol spectrum disorder
4. Diseases of the Nervous System
D Headaches-primary headaches without structural or systemic pathology
D Bells palsy-with any eye symptoms refer immediately to ophthalmologist
D Simple febrile seizure disorder in children
C Chronic seizure disorders in adults
C Meningitis
D Benign essential tremors
D Delirium
D Herpes zoster-immediate referral if ophthalmic involvement
D Restless leg syndrome in adults
C Trigeminal neuralgia
C Parkinsons disease
C Multiple sclerosis
C Cerebral vascular disorder/transient ischemic attacks
D Peripheral neuropathies
C Alzheimers disease and related dementias
5. Diseases of the Eyes, Ears, Nose and Throat
Eyes
D Blepharitis
D Chalazion
D Conjunctivitis
D Simple corneal abrasion
D Nasolacrimal duct obstruction
33
D Simple foreign body

D Hordeolum
C Cataracts
C Glaucoma
C Periorbital cellulitis
C Uveitis
Ears
D Otitis media
D Otitis externa
D Cerumen impaction
D Benign positional paroxysmal vertigo
D Foreign body
D Labyrinthitis
C Mnires disease in adults
Nose and Throat
D Rhinitis
D Cervical adenitis
D Anterior epistaxis
D Gingivitis
D Sinusitis
D Tonsillitis
D Pharyngitis
D Stomatitis
D Temporomandibular joint dysfunction
6. Diseases of the Circulatory System
D Hypertension in adults
D Peripheral vascular disease
D Stasis ulcers
D Superficial thrombophlebitis
D Varicose veins
C Heart failure
C Arrhythmias
D Stable coronary artery disease
D Chronic stable angina pectoris
D Dyslipidemia
7. Diseases of the Respiratory System
D Asthma
D Bronchitis
34
D Bronchiolitis
D Influenza
D Nicotine dependence
C Tuberculosis
C Epiglotittis
D Chronic obstructive pulmonary disease, mild to moderate
C Interstitial lung disease
D Croup
D Upper respiratory infection
D Community acquired pneumonia
D Pertussis
8. Diseases of the Digestive System
D Anal fissures
D Constipation
D Gastroesophogeal reflux disease
D Irritable bowel syndrome
D Parasitic infections-roundworm, pinworm
D Peptic ulcer in adults
D Dysphagia in adults
C Hernia-inguinal, hiatal, umbilical
D Diverticular disease in adults
D Hemorrhoids in adults
C Cholecystitis in adults
C Chronic inflammatory bowel disease in adults
C Pancreatitis
D Gastroenteritis
D Encopresis
D Hyperbilirubinemia
D Colic
9. Diseases of the Skin and Subcutaneous Tissue
D Parasitic-scabies, pediculosis
D Fungal-candidiasis, dermatophytoses tinea, onychomycosis
D Bacterial-impetigo, folliculitis, furuncles, carbuncles, cellulitis
D Viral-warts and herpes simplex
D Psoriasis in adults
D Pityriasis rosea
D Non-malignant skin lesions
C Malignant skin lesions
D Acne vulgaris
D Dermatitis-atopic (eczema), contact and seborrheic
35
D Sunburn
D Lyme disease
D Bacterial-cellulitis
10. Diseases of the Musculoskeletal System and Connective Tissue
D Bursitis
D Cervicalgia
D Costochondritis
D Plantar fasciitis
D Tendinitis/tenosynovitis
C Meniscus and ligament tears
D Carpal tunnel syndrome
D Fibromyalgia
D Impingement syndromes
D Osteoarthritis
D Osteoporosis
D Herniated disc
D Subluxation of the radial head
D Repetitive motion syndrome
11. Diseases of the Genitourinary System
D Lower urinary tract infections
D Pyelonephritis
D Primary nocturnal enuresis
D Urinary incontinence
D Nephrolithiasis
D Chronic kidney disease
C Acute renal failure
12. Pregnancy
C Gestational hypertension
D Post partum depression
D Hyperemesis gravidarum
C Gestational diabetes
13. Injury, Poisoning, and other Consequences of External Causes
(All within the nurse practitioners scope and competence depending on the severity. Referral
would be indicated when beyond scope and competence.)
D Wounds and lacerations
D Burns
D Animal and human bites
D Arthropod bites and stings
D Poisoning
D Mild traumatic brain injury/concussion
36
D Fractures-not requiring reduction or casting

D Foreign body obstructions
14. Diseases and Conditions of the Reproductive System
Male
D Balanitis
D Epididymitis in adults
D Epididymitis in children after puberty
D Sexually transmitted infections
D Benign prostatic hyperplasia
D impotence/erectile dysfunction
D Prostatitis in adults
D Hydrocele in adults
C Varicocele
D Phimosis
Female
C Primary amenorrhea
D Dysmenorrhea
D Pelvic inflammatory disease
D Vulovaginal infections
D Family planning and contraception
D Premenstrual syndrome
D Simple ovarian cyst
D Mastitis
D Menopause
C Polycystic ovary syndrome
C Endometriosis
15. Hematological and Immune Diseases
Hematologic
D Anemia
C Sickle cell anemia
Immune
D Allergic reactions
D Chronic fatigue syndrome
C Rheumatoid arthritis
C Sjgrens syndrome
C Systemic lupus erythematosus
37

MANAGED BY AN ENTRY-LEVEL ADULT NURSE PRACTITIONER
Code:
D The nurse practitioner diagnoses and manages independently or refers as appropriate. Will refer
Referrals are in accordance with CRNBCs standards for nurse practitioner-physician consultation.
C
i)
ii)
iii)
1. Infectious and Parasitic Diseases

D Chickenpox
D Measles (Rubeola)
D Mumps
D Pertussis
D Strep throat
D Syphilis
D Hepatitis A
C Hepatitis B
C Hepatitis C
C HIV
C Tuberculosis
D Giardiasis
C Diabetes type I
D Diabetes type II
C Diabetes insipidus
D Primary hypothyroidism
D Obesity
C Cushings syndrome
D Gout
C Hyperthyroidism
38

D Anxiety disorders-panic attacks, generalized anxiety disorders, adjustment disorders
D Depression
C Attention deficit disorder
D Obsessive compulsive disorder
D Substance abuse
D Substance dependence
D Post traumatic stress disorder
D Hypochondriasis
D Alcohol abuse
D Alcohol dependence
C Eating disorders
C Personality disorders
D Bells palsy
C Chronic Seizure disorder
C Meningitis
D Benign essential tremors
D Delirium
D Herpes Zoster-immediate referral if ophthalmic involvement
D Restless leg syndrome
D Trigeminal neuralgia-immediate referral if ophthalmic involvement
C Parkinsons disease
C Multiple sclerosis
C Cerebral vascular disease/transient ischemic attacks
C Alzheimers and related dementias
Eyes
D Blepharitis
D Chalazion
D Conjunctivitis
D Simple corneal abrasion
C Cataracts
C Glaucoma
C Periorbital cellulitis
C Uveitis
39
Ears
D Otitis media
D Otitis externa
D Cerumen impaction
D Benign positional paroxysmal vertigo
D Labyrinthitis
C Menieres syndrome
D Mastoiditis
D Perforated eardrum
Nose/Throat
D Rhinitis
D Cervical adenitis
D Gingivitis
D Sinusitis
D Tonsillitis
D Pharyngitis
D Stomatitis
D Temporomandibular joint dysfunction

D Hypertension
D Peripheral vascular disease
D Stasis ulcers
D Superficial thrombophlebitis
D Varicose veins
C Heart Failure
C Arrhythmias
D Stable coronary artery disease
D Raynauds disease
C Beurgers disease
D Asthma
D Bronchitis
D Bronchiolitis
D Influenza
C Tuberculosis
40
C Epiglottitis
D Chronic obstructive lung disease, mild to moderate
C Interstitial lung disease
C Sleep apnea
C Bronchiectasis
D Anal fissures
D Constipation
D Gastroesophageal reflux disease
D Peptic ulcer disease
C Dysphagia
D Hernia-hiatal, inguinal, umbilical
D Diverticular disease
D Hemorrhoids
C Cholecystitis
C Chronic inflammatory bowel disease-ulcerative colitis, Crohns disease
C Pancreatitis
C Celiac disease
D Parasitic-scabies, pediculosis
D Fungal-candidiasis, dermaphytoses tinea, oncyhomycosis
D Bacterial-impetigo, folliculitis, furuncles, carbuncles, cellulitis
D Viral-warts, molluscum cantagiosum, herpes simplex
D Psoriasis
D Pityriasis rosea
D Non malignant skin lesions
C Malignant skin lesions
D Lichen planus
D Bursitis
D Cervicalgia
D Costochondritis
D Plantar fasciitis
D Tendonitis/tendosynovitis
D Carpal tunnel syndrome
D Fibromyalgia
41
D Impingement syndromes
D Osteoarthritis
D Osteoporosis
D Herniated disk
D Low back pain
11. Diseases of the Genitourinary Systems
D Lower urinary tract infections
D Pyelonephritis
D Urinary incontinence
D Nephrolithiasis
D Chronic kidney disease
C Acute renal failure
D Interstitial cystitis
12. Pregnancy not in scope of practice for NP (Adult)
13. Injury, Poisoning and other Consequences of External Causes
D Burns
D Arthropod stings and bites
D Poisoning
D Fractures-not requiring reduction or casting
14. Diseases of the Reproductive System
Male
D Balantitis
D Epididymitis
D Benign prostatic hypertrophy
D Impotence/erectile dysfunction
D Prostatitis
D Hydrocele
C Varicocele
Female
D Primary Amenorrhea
D Dysmenorrhea
D Vulvovaginal infections
D Family planning and contraception
42
D Premenstrual symptoms
D Mastitis
D Menopause
C Polycystic ovary syndrome
D Abnormal uterine bleeding
D Atrophic vaginitis
C Post menopausal bleeding
Hematologic
D Anaemia
C Sickle cell anaemia
C Chronic lymphocytic leukemia
C Disseminated intravascular coagulation
C Non-Hodgkins lymphoma
C Polycythemia vera
Immunological
D Chronic fatigue syndrome
C Rheumatoid arthritis
C Sjogrens syndrome
C Systemic lupus erythematosus
43

MANAGED BY AN ENTRY-LEVEL PEDIATRIC NURSE PRACTITIONER
Code:
D
The nurse practitioner diagnoses and manages independently or refers as appropriate. Will refer
Referrals are in accordance with CRNBCs standards for nurse practitioner- physician
consultation.
i)
ii)
iii)
1. Infectious and Parasitic Diseases in Children

D Chickenpox
D Measles (Rubeola)
D Mumps
D Pertussis
D Strep throat
D Fifth disease
D Roseola
C Diabetes type I
C Diabetes type II
C Juvenile hypothyroidism
D Obesity
C Phenylketonuria
D Anxiety Disorders-separation, generalized, panic disorders and school phobias
D Dysthymia
C Depression
C Attention deficit hyperactivity disorder
44
C Anorexia/bulimia
C Autistic spectrum disorders
C Fetal alcohol spectrum disorders
D Bells Palsy-with any eye symptoms refer immediately to ophthalmologist
D Simple febrile seizures
C Seizure disorder
C Meningitis
Eyes
D Blepharitis
D Chalazion
D Conjunctivitis
C Simple corneal abrasion
D Hordeolum
C Periorbital cellulitus
C Strabismus
Ears
D Otitis media
D Otitis externa
D Cerumen impaction
D Foreign body
D Perforated tympanic membrane
Nose/Throat
D Rhinitis
C Cervical adenitis
D Gingivitis
D Sinusitis
D Tonsillitis
D Pharyngitis
D Stomatitis
D Nasal foreign body
C Peritonsillar abscess
45

C Hypertension
D Innocent heart murmur
D Presyncope/syncope
C Rheumatic fever
C Congenital heart disease
C Dyslipidemia
D Asthma
D Bronchitis
D Bronchiolitis
D Influenza
C Tuberculosis
C Epiglottis
D Croup
D Upper respiratory infection
D Pneumonia
D Anal fissures
D Constipation
D Gastroesophageal reflux disease
D Hepatitis A viral
D Peptic ulcer disease
C Dysphagia
D Hernia-inguinal, hiatal, umbilical
D Gastroenteritis
D Encoporesis
D Hyperbilirubinemia
D Colic
C Celiac disease
D Failure to thrive (inorganic)
D Feeding disorders
D Lactose intolerance
D Malabsorption syndrome
D Obesity
46

D Parasitic-scabies and pediculosis
D Fungal-candidiasis; dermatophytosese tinea, onychomycosis
D Bacterial-impetigo, follculitis, furuncles, carbuncles, paronychia, cellulitis
D Viral-warts, molluscum contagiosum, herpes simplex and herpes zoster
D Psoriasis
D Pityriasis rosea
D Non-malignant skin lesions
C Malignant skin lesion
D Acne vulgaris
D Dermatitis-atopic (eczema), contact, seborrheic and diaper
D Sunburn
D Drug eruptions, urticaria and erythema multiforme (minor)

D Bursitis
D Cervicalgia
D Costochondritis
D Plantar fasciitis
D Tendonitis/tendosynovitis
D Subluxation of the radial head
D Lumbar lordosis
D Osgood-Schlatter disease
D Scoliosis
C Brachial plexus injury
C Clavicle fracture
C Septic arthritis
C Osteomyelitis
C Transient synovitis
11. Diseases of the Genitourinary System
D Lower urinary tract infection (female)
C Lower urinary tract infection (male)
D Pyelonephritis
D Primary nocturnal enuresis
C Vesicoureteral reflux
12. Pregnancy not in scope of practice for NP (Pediatric)
47
13. Injury, Poisoning and other Consequences of External Causes

D Burns
D Arthropod bites and stings
D Poisoning
D Foreign bodies
D Contusions and hematomas
14. Diseases of the Reproductive System

Male
D Balanitis
D Epididymitis in children after puberty
D Phimosis and Paraphimosis
D Gynecomastia
D Undescended testes
C Hypospadias
Female
C Primary amenorrhea
D Dysmennorrhea
D Vulvovaginal infections
D Contraception
D Premenstrual syndrome
C Dysfunction uterine bleeding
D Precocious puberty

Hematologic
D Anemia
C Sickle cell anemia
C Thalassemia minor (trait)
C Idiopathic thrombocytopenia purpura
C Hemophilia
C G6PD deficiency
48
Immune
C Chronic fatigue syndrome
C Juvenile rheumatoid arthritis
49
RESOURCES
CRNBC Resources
Practice Support: General Enquiries: practice@crnbc.ca 604.736.7331 ext. 332 or toll-free
1.800.565.6505, ext. 332 (see CRNBC website for more information www.crnbc.ca)
Quality Assurance and Continuing Competence for Nurse Practitioners
Competencies Required for Nurse Practitioners in British Columbia
CRNBC Glossary
Legislation Relevant to Nurses Practice
Overview of: Health Professions Act; Nurses (Registered) and Nurse Practitioners Regulation; and
CRNBC Bylaws
CRNBC Standards of Practice
See the complete list on the CRNBC website: www.crnbc.ca. Nurse practitioners are expected to
review all CRNBC Practice Standards to determine relevance to their practice. Standards referenced in
this publication are:
Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions
Professional Standards for Registered Nurses and Nurse Practitioners
Communicable Diseases: Preventing Nurse-to-Client Transmission (includes information related to
treating members of a nurse practitioners family or friends)
Conflict of Interest Practice Standard (includes information related to communicating with
pharmaceutical companies)
Consent Practice Standard
Dispensing Medications Practice Standard
Documentation Practice Standard
50
Other Resources
Canadian Patient Safety Institute (www.patientsafetyinstitute.ca)
Canadian Adverse Drug Reporting Program (available on the Health Canada web site, see Drugs and
Health Products "medeffect adverse reporting" www.hc-sc.gc.ca)
Public Health Agency of Canada (available on web site: www.publichealth.gc.ca)
51

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Applying the Competencies

Required for Nurse Practitioners

2855 Arbutus Street

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Diseases, Disorders and Conditions Commonly Diagnosed and Managed by an Entry-Level

Diseases, Disorders and Conditions Commonly Diagnosed and Managed by an Entry-Level

Diseases, Disorders and Conditions Commonly Diagnosed and Managed by an Entry-Level

2855 Arbutus Street

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Competencies Required for Nurse Practitioners in British Columbia

About This Document

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Knowledge, Skills, and

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

5 CRNBC Glossary https://www.crnbc.ca/Glossary/Pages/Default.aspx Accessed September 5, 2014

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Nurse practitioners engage in interprofessional collaborative practice to provide safe, client-centered,

(For a list of the NP competencies, please see Appendix.)

Knowledge of anatomy; physiology; developmental and life stages; determinants of health;

Abilities in generic areas such as communication, problem-solving, and decision-making.

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

A written examination recognized by CRNBC13

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

1. Professional Role, Responsibility, and Accountability

Identifies relevant legislation and the implications for practice

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Meets CRNBC nurse practitioner Scope of Practice Standards, Limits and

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Makes decisions taking into account resource allocation

Takes appropriate action to mitigate harm and address immediate risks

Reports adverse events related to medications to client and others

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Documents in a timely, clear, accurate and complete manner in accordance

Documents practice in accordance with CRNBC Practice Standards and all

Practices in accordance with ethical and professional standards

Bases self-assessment on reflective practice

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Collaboration, Consultation and Referral

Uses consultation and collaboration as appropriate to confirm a diagnosis,

Makes timely, effective and appropriate consultations and referrals relative to

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Facilitates interactions with other health team members to maximize client

Facilitates interactions with other health team members to identify and

Forms coalitions and effective partnerships to initiate or manage change

Identifies research, practice guidelines and theory relevant to the practice

College of Registered Nurses of British Columbia

APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA

Uses follow-up and quality improvement strategies

Assumes a leadership role, when there is opportunity, to initiate or guide