Checklist for training 1

Professional development and recognition programme (PDRP) workbook Registered nurse Competent (RN2) Name: John Citizen Department: Ward Hospital: Auckland Manager’s name:Jane Doe Previous level attained/ date:N/A-NGRNSouthern Cross Hospitals National: Workbook RN 2 Page 1 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Definition of Competent Registered Nurse:The competent RN:  Develops partnerships with patients that implement Te Tiriti o Waitangi in a manner which the patient determines as culturally safe  Effectively applies knowledge and skills to practice  Has consolidated nursing knowledge in their practice setting  Has developed an holistic overview of the client  Is confident in familiar situations  Is able to manage and prioritise assigned patient care/ workload  Demonstrates increasing efficiency and effectiveness in practice  Is able to anticipate a likely outcome for the patient with predictable health needs  Is able to identify unpredictable situations, act appropriately and make appropriate referrals Ref: National framework for nursing professional development and recognition programmes (2004)Practice domains, competencies and indicatorsThese reflect the Nursing Council of New Zealand (NCNZ) Competencies for Registered Nurse Scope of Practice (December 2007).There are a number of indicators for each competency which provide further definition and clarity. These can be found in the NCNZ RNcompetency document at: http://www.nursingcouncil.org.nz/download/73/rn-comp.pdfEvidenceFor information about types and quality of evidence, refer to PDRP programme, section 7.0 (KB#10810)ConfidentialityFor information about confidentiality of portfolios and information, refer to PDRP programme, section 6.0 (KB#10810) Ensure this workbook remains a part of your portfolioSouthern Cross Hospitals National: Workbook RN 2 Page 2 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Portfolio requirements – checklist Registered nurse - competent (level 2)Use this checklist to ensure you have completed all portfolio requirements before submitting to your assessorState location of evidence in RN column to confirm item is included in portfolio. Assessor to confirm using assessor columnFor further information about each of the items, see PDRP processes 2010 (KB#10810) RN ITEM Assessor (state location Declaration completed, signed and dated (see next page) (assessor use /page number only) within portfolio) Copy of current APC (either photocopy both sides of card or print out of NCNZ website information)Page 4; Performance Review is current (within 12months)WorkbookSection B NCNZ Code of Conduct completed (evidence of)Section BSection B Self-review, with an actual example of your practice against each of the NCNZ competencies, is signed and dated bySection B applicant (may be part of performance review document) Senior nurse review which includes with an actual example of your practice against each of the NCNZ competenciesSection B (may be part of performance review document) Verification of practice hours within last 3 years (minimum 450 hours/ 3years) - may be part of performance reviewSection B document or confirmation from senior nurse/ manager Verified record of Professional Development / Education (minimum of 60 hours/ 3 years) with relevance to practiceSection C stated for each item 128.5 hours Reflection on 3 main professional development activities that have been undertaken within a 3 year time frameSection C 1. Pain and management +update 2. Liten up training+update 3. CatheterisationSection E Mandatory certifications are current (as per hospital/ area requirements)Section B CPR,  IV, Fire, Manual Handling, Infection Control, Health and Safety, Restraint, Others: Slips,trips falls, NMC, cultural competency, code of rights; Code of conduct: Direction and delegation Workbook pages 5-9 are complete with at least 2 pieces of evidence for each competency in portfolio – i.e. 1 x self-review (1st party); 1 x senior nurse/ peer review (3rd party).Southern Cross Hospitals National: Workbook RN 2 Page 3 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Portfolio DeclarationThe PDRP has been designed to enable participants to gather examples of participants’ everyday practice and their professional developmentactivities to demonstrate their on-going competence. This declaration records the participant’s representation that all material included in theirportfolio is a true reflection of their practice and that any information from other sources has been appropriately acknowledged. Participants should refer to the PDRP programme (KB#10810) for further clarification around confidentiality. DECLARATION Name: John Citizen  I declare that I have a current annual practising certificate and have placed a copy of this in my portfolio  I declare that I have completed the NCNZ Code of Conduct and evidence is included in my Portfolio - (on-line learning / NCNZ Roadshow / NZNO session / other)  I declare that I am not currently undergoing any performance management processes or investigations  I declare that this portfolio is a true and accurate representation of my practice. All sources of information other than my own work and experience have been appropriately acknowledged/ referenced. I have obtained the necessary consent from appropriate persons to disclose any confidential information contained in the portfolio  I understand and agree that the National Nurse Co-ordinator: PDRP and/ or Chief Nurse Advisor may seek further information relating to my portfolio from any sources and that my portfolio may be moderated or audited by another assessor Signed: _____________________________________ Date: ___23__/__8___/___201Southern Cross Hospitals National: Workbook RN 2 Page 4 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Competent RN Domain 1: Professional ResponsibilityThis domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety. These include being able to demonstrate knowledge and judgement and being accountable for own actions and decisions, while promoting an environment that maximises patients’ safety, independence and quality of life and health. RN to complete Assessor use only Evidence location i.e. state document or page number (minimum of one piece of each type 1st party 3rd party Supporting of evidence against each Outcome Competency competency) If not met - Use ‘reserved portfolio Self-review/ Senior nurse/ form to provide reflections peer review & Assessor √ evidence Evidence feedback to RN located location & other other supporting Met / Not met supporting evidence Met / Not met (3rd party) evidence Met / Not met (1st party)1.1 Accepts responsibility for ensuring own nursing PPR PPRpractice and conduct meet the standards of theprofessional, ethical and relevant legislatedrequirements1.2 Demonstrates the ability to apply the principles of PPR PPR the Treaty of Waitangi / Te Tiriti o Waitangi to nursing practice1.3 Demonstrates accountability for directing, PPR PPR monitoring and evaluating nursing care that is provided by nurse assistants, enrolled nurses and others1.4 Promotes an environment that enables patient PPR PPR safety, independence, quality of life and health. Met / Not met1.5 Practises nursing in a manner that the patient PPR PPR determines as being culturally safe. Met / Not metSouthern Cross Hospitals National: Workbook RN 2 Page 5 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Competent RN Domain 2: Management of Nursing CareThis domain contains competencies related to patient assessment and managing patient care, which is responsive to patients needs, and which is supported by nursing knowledge and evidence based research. RN to complete Assessor use only Evidence location i.e. state document or page number (minimum of one piece of each type 1st party 3rd party Supporting of evidence against each Outcome Competency competency) If not met - Use ‘reserved portfolio Self-review/ Senior nurse/ form to provide reflections peer review & Assessor √ evidence Evidence feedback to RN located location & other other supporting Met / Not met supporting evidence Met / Not met evidence (3rd party) Met / Not met (1st party) Met / Not met2.1 Provides planned nursing care to achieve identified PPR PPR;Preceptor Met / Not metoutcomes attestation2.2. Undertakes a comprehensive and accurate nursing PPR PPR;Preceptor assessment of the patient in a variety of settings attestation2.3 Ensures documentation is accurate and maintains PPR PPR;Preceptor confidentiality of information attestation2.4 Ensures the patient has adequate explanation of PPR PPR the effects, consequences and alternatives of proposed treatment options2.5 Acts appropriately to protect oneself and others PPR PPR;Preceptor when faced with unexpected patient responses, attestation confrontation, personal threat or other crisis situationsSouthern Cross Hospitals National: Workbook RN 2 Page 6 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

RN to complete Assessor use only Evidence location i.e. state document or page number (minimum of one piece of each type 1st party 3rd party Supporting of evidence against each Outcome Competency competency) If not met - Use ‘reserved portfolio2.6 Evaluates patient’s progress towards expected Self-review/ Senior nurse/ outcomes, in partnership with patient form to provide reflections peer review & Assessor √ evidence Evidence feedback to RN located location & other other supporting Met / Not met supporting evidence Met / Not met (3rd party) evidence Met / Not met (1st party) Met / Not met PPR PPR;Preceptor attestation2.7 Provides health education appropriate to the PPR PPR needs of the patient within a nursing framework2.8 Reflects upon, and evaluates with peers and PPR PPR experienced nurses, the effectiveness of nursing care2.9 Maintains professional development PPR PPRSouthern Cross Hospitals National: Workbook RN 2 Page 7 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Competent RN Domain 3: Interpersonal RelationshipsThis domain contains competencies related to interpersonal and therapeutic communication with patients, other nursing staff and inter- professional communication and documentation. RN to complete Assessor use only Evidence location i.e. state document or page number (minimum of one piece of each type 1st party 3rd party Supporting of evidence against each OutcomeCompetency competency) If not met - Use ‘reserved portfolio Self-review/ Senior nurse/ form to provide reflections peer review & Assessor √ evidence Evidence feedback to RN located location & other other supporting Met / Not met supporting evidence evidence (3rd party) (1st party)3.1 Establishes, maintains and concludes therapeutic PPR PPR;Preceptorinterpersonal relationships with patients attestation3.2 Practises nursing in a negotiated partnership with PPR PPR;Preceptor Met / Not met the patient where and when possible. attestation Met / Not met3.3 Communicates effectively with patients and members PPR PPR of the health care team.Southern Cross Hospitals National: Workbook RN 2 Page 8 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016

Competent RN Domain 4: Inter-professional Health Care & Quality ImprovementThis domain contains competencies to demonstrate that, as a member of the health care team the nurse evaluates the effectiveness of care and promotes a nursing perspective within the Inter-professional activities of the team. RN to complete Assessor use only Evidence location i.e. state document or page number (minimum of one piece of each type 1st party 3rd party Supporting of evidence against each OutcomeCompetency competency) If not met - Use ‘reserved portfolio Self-review/ Senior nurse/ form to provide reflections peer review & Assessor √ evidence Evidence feedback to RN located location & other other supporting Met / Not met supporting evidence evidence (3rd party) (1st party)4.1 Collaborate and participates with colleagues and PPR PPR;Preceptormembers of the healthcare team to facilitate and attestationco-ordinates care4.2 Recognises and values the roles and skills of all PPR PPR;Preceptor members of the health care team in the delivery of attestation care Met / Not met4.3 Participates in quality improvement activities to PPR PPR;Preceptor monitor and improve standards of nursing attestation Met / Not metNurses name: Workbook RN 2 Page 9 of 10 NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Southern Cross Hospitals National: July 2012, Date Reviewed: June 2016Approved by: Chief Nurse AdvisorDate Authorised:

Assessors overall summation of feedback:√ to confirm The competent RN:each aspect Develops partnerships with patients that implement Te Tiriti o Waitangi in a manner which the patient determines as culturally safehas been met Effectively applies knowledge and skills to practice Has consolidated nursing knowledge in their practice setting Has developed a holistic overview of the client Is confident in familiar situations Is able to manage and prioritise assigned patient care/ workload Demonstrates increasing efficiency and effectiveness in practice Is able to anticipate a likely outcome for the patient with predictable health needs Is able to identify unpredictable situations, act appropriately and make appropriate referralsAssessor comments re: meeting level of practice as per definition of competent RNThe evidence provided in this portfolio meets the requirements for the RN competent level of practice (RN2).□ Portfolio moderatedName of assessor: Signature: Date:Southern Cross Hospitals National: Workbook RN 2 Page 10 of 10Approved by: Chief Nurse Advisor NATIONAL DOCUMENT NOT FOR ALTERATION KB#10811Date Authorised: July 2012, Date Reviewed: June 2016