Expanded Practice
Supplementary Competencies
To be completed in conjunction with RN level 4 documentation
(SHADED AREA TO BE COMPLETED BY NURSE VALIDATING PRACTICE)
Name:
Date:
Position:
Department & Service:
The purpose of the review
PDRP level
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




Annual
Signature:
Level 4 completed/attached
PDRP
Maintenance
Challenging
N/A
Name:
Name and position of nurse validating self-review
(This is usually filled out by the nurse that completed your annual appraisal)
Date:
Signature:
Designation:
Position:
Department & Service
Contact Number
Expanded Practice Competencies
Provides evidence that describes how the nurse meets each of the following.
Competency
1. Demonstrates initial and ongoing knowledge and skills for specific expanded practice role/activities through
postgraduate education, clinical training and competence assessment
Competency
2. Participates in the evaluation of the outcomes of expanded practice e.g. case review, clinical audit,
multidisciplinary peer review
Competency
3. Integrates and evaluates knowledge and resources from different disciplines and health care teams to effectively
meet the health care needs of individuals and groups
NORTHLAND DISTRICT HEALTH BOARD
TITLE: Expanded Practice Supplementary Competencies
Page 1 of 1
Date of first Issue:
Revision Date:
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Initials of nurse completing form:
.