AGACNP track competencies

1. Scientific Foundation
   1. Critically analyzes data and evidence for improving advanced nursing practice.
   2. Integrates knowledge from the humanities and sciences within the context of nursing science.
   3. Translates research and other forms of knowledge to improve practice processes and outcomes.
   4. Develops new practice approaches based on the integration of research, theory, and practice knowledge.
2. Leadership
   1. Assumes complex and advanced leadership roles to initiate and guide change.
   2. Provides leadership to foster collaboration with multiple stakeholders (e.g., patients, community, integrated healthcare teams, and policy makers) to improve health care.
   3. Demonstrates leadership that uses critical and reflective thinking.
   4. Advocates for improved access, quality, and cost-effective health care.
   5. Advances practice through the development and implementation of innovations incorporating principles of change.
   6. Communicates practice knowledge effectively, both orally and in writing.
   7. Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus.
3. Quality
   1. Uses best available evidence for continuous quality improvement of clinical practice.
   2. Evaluates the relationships among access, cost, quality, and safety and their influence on health care.
   3. Evaluates how organizational structure, care processes, financing, marketing, and policy decisions impact the quality of health care.
   4. Applies skills in peer review to promote a culture of excellence.
   5. Anticipates variations in practice and is proactive in implementing interventions to ensure quality.
4. Practice Inquiry
   1. Provides leadership in the translation of new knowledge into practice.
   2. Generates knowledge from clinical practice to improve practice and patient outcomes.
   3. Applies clinical investigative skills to improve health outcomes.
   4. Leads practice inquiry, individually or in partnership with others.
   5. Disseminates evidence from inquiry to diverse audiences using multiple modalities.
   6. Analyzes clinical guidelines for individualized application into practice.
5. Technology and Information Literacy
   1. Integrates appropriate technologies for knowledge management to improve health care.
   2. Translates technical and scientific health information appropriate for various users’ needs.
      1. Assesses the patient’s and caregiver’s educational needs to provide effective, personalized health care.
      2. Coaches the patient and caregiver for positive behavioral change.
   3. Demonstrates information literacy skills in complex decision-making.
   4. Contributes to the design of clinical information systems that promote safe, quality, and cost effective care.
   5. Uses technology systems that capture data on variables for the evaluation of nursing care.
6. Policy
   1. Demonstrates an understanding of the interdependence of policy and practice.
   2. Advocates for ethical policies that promote access, equity, quality, and cost.
   3. Analyzes ethical, legal, and social factors influencing policy development.
   4. Contributes in the development of health policy.
   5. Analyzes the implications of health policy across disciplines.
   6. Evaluates the impact of globalization on healthcare policy development.
   7. Advocates for policies for safe and healthy practice environments.
7. Health Delivery Systems
   1. Applies knowledge of organizational practices and complex systems to improve healthcare delivery.
   2. Effects healthcare change using broad-based skills including negotiating, consensus-building, and partnering.
   3. Minimizes risk to patients and providers at the individual and systems level.
   4. Facilitates the development of healthcare systems that address the needs of culturally diverse populations, providers, and other stakeholders.
   5. Evaluates the impact of healthcare delivery on patients, providers, other stakeholders, and the environment.
   6. Analyzes organizational structure, functions, and resources to improve the delivery of care.
   7. Collaborates in planning for transitions across the continuum of care.
8. Ethics
   1. Integrates ethical principles in decision-making.
   2. Evaluates the ethical consequences of decisions.
   3. Applies ethically sound solutions to complex issues related to individuals, populations, and systems of care.
9. Independent Practice
   1. Functions as a licensed independent practitioner.
   2. Demonstrates the highest level of accountability for professional practice.
   3. Practices independently managing previously diagnosed and undiagnosed patients.
      1. Provides the full spectrum of healthcare services to include health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end-of-life care.
      2. Uses advanced health assessment skills to differentiate between normal, variations of normal, and abnormal findings.
      3. Employs screening and diagnostic strategies in the development of diagnoses.
      4. Prescribes medications within scope of practice.
      5. Manages the health/illness status of patients and families over time.
   4. Provides patient-centered care recognizing cultural diversity and the patient or designee as a full partner in decision-making.
      1. Works to establish a relationship with the patient characterized by mutual respect, empathy, and collaboration.
      2. Creates a climate of patient-centered care to include confidentiality, privacy, comfort, emotional support, mutual trust, and respect.
      3. Incorporates the patient’s cultural and spiritual preferences, values, and beliefs into health care.
      4. Preserves the patient’s control over decision-making by negotiating a mutually acceptable plan of care.
      5. Develops strategies to prevent one’s own personal biases from interfering with delivery of quality care.
      6. Addresses cultural, spiritual, and ethnic influences that potentially create conflict among individuals, families, staff, and caregivers.
   5. Educates professional and lay caregivers to provide culturally and spiritually sensitive, appropriate care.
   6. Collaborates with both professional and other caregivers to achieve optimal care outcomes.
   7. Coordinates transitional care services in and across care settings.
   8. Participates in the development, use, and evaluation of professional standards and evidence-based care.

Scientific Foundations

1. Contributes to knowledge development and improved care of the adult–gerontology population.
2. Uses scientific knowledge and theoretical foundations to differentiate between normal and abnormal changes in physiological, psychological, and sociological development and aging.

Leadership

1. Describes the current and evolving adult–gerontology acute care NP role to other healthcare providers and the public.
2. Provides leadership to facilitate the complex coordination and planning required for the delivery of care to young adults (including late adolescents), adults, and older adults.
3. Demonstrates leadership in the practice and policy arenas to achieve optimal care outcomes and the adult–gerontology population.

Quality

1. Implements evidence-based practice interventions to promote safety and risk reduction for young adults, adults, and older adults.
2. Demonstrates continuous quality improvement of one's own practice.

Technology & Information Literacy

1. Synthesizes data from a variety of sources, including clinical decision support technology, to make clinical decisions regarding appropriate management, consultation, or referral for acutely and critically ill patients
2. Uses devices and technology to improve outcomes for acutely, critically, and chronically ill patients.
3. Analyzes strengths and barriers of technological and information systems with the goal of improving care delivery and coordination.
4. Applies ethical and legal standards regarding the use of technology in health care for the adult–gerontology population.
5. Analyzes the adequacy of data capture methods in clinical information systems to promote effective care for the adult–gerontology population.

Policy

1. Advocates for implementation of the full scope of the AG-ACNP role.
2. Advocates within acute healthcare systems for access to quality cost-effective care.
3. Participates in the design and/or implementation and evaluation of evidence-based, age-appropriate professional standards and guidelines for care impacting acute, critical, and complex chronically ill patients.
4. Develops strategies to reduce the impact of ageism, racism/ethnocentrism, and sexism on healthcare policies and systems.

Health Delivery System

1. Assesses the impact of internal and external healthcare delivery system factors on individual and population health status and quality of life during acute, critical, and complex chronic illness.
2. Determines the need for transition to a different level of acute care or care environment based on an assessment of an individual's acuity, frailty, stability, resources, and need for assistance, supervision, or monitoring.
3. Analyzes the cost effectiveness of high acuity practice initiatives accounting for risk and improvement of healthcare outcomes.
4. Facilitates the patient's transition within healthcare settings and across levels of acute care, including admitting, transferring, and discharging patients.
5. Evaluates risk–benefit ratio for adverse outcomes due to acute care treatment, including under- or over-treatment.
6. Applies advanced communication skills and processes to collaborate with caregivers and professionals to optimize healthcare outcomes for adults with acute, critical, or complex chronic illness.
7. Identifies processes, principles, and regulations related to payer systems used in the planning and delivery of complex healthcare services.
8. Describes challenges to optimal complex care created by the competing priorities of patients, payers, providers, and suppliers.
9. Promotes efficient use of resources in acute care and provision of safe, high quality care to achieve cost-effective outcomes.
10. Analyzes system barriers to acute care delivery and coordination.
11. Applies knowledge of the type and level of services provided across complex healthcare and residential settings.
12. Demonstrates sensitivity to diverse organizational cultures and populations.
13. Facilitates patient and family navigation of complex healthcare systems.

Ethics

1. Participates in interprofessional teams to address issues related to triage, quality of life, and utilization of resources.
2. Advocates for the patient's and family's rights regarding healthcare decision-making, taking into account ethical and legal standards.
3. Facilitates patient and family decision-making regarding complex acute, critical, and chronic illness treatment decisions.

Independent Practice

1. Independently manages complex acute, critical, and chronically ill adult and older adult patients at risk for urgent and emergent conditions, using both physiologically and technologically derived data, to manage physiologic instability and risk for potential life-threatening conditions.
2. Promotes health and protection from disease and environmental factors by assessing risks associated with care of acute, critical, and complex chronically ill patients.
3. Identifies the presence of co-morbidities and the potential for rapid physiologic and mental health deterioration or life-threatening instability and the risk for iatrogenesis.
4. Diagnoses common behavioral and mental health and substance use or addictive disorder/disease, in the context of complex acute, critical, and chronic illness.
5. Prioritizes diagnoses during rapid physiologic and mental health deterioration or life-threatening instability.
6. Collaborates with intraprofessional and interprofessional team and informal caregivers to achieve optimal patient outcomes during acute, critical, and/or complex chronic illness.
7. Employs interventions to support the patient to regain and maintain age-specific physiologic and psychological stability consistent with the patient's goals of care.
8. Performs diagnostic and therapeutic interventions including, but not limited to:
   1. Interpretation of EKG and imaging studies
   2. Respiratory support
   3. Hemodynamic monitoring, line, and tube insertion
   4. Lumbar puncture
   5. Wound debridement and closure.
9. Assesses the individual's and family's ability to cope with and manage developmental (life stage) transitions.
10. Manages geriatric syndromes and changing conditions using evidence-based guidelines.
11. Collaborates with the individual, family, and caregivers in the development of educational interventions appropriate to the complex acute, critical, and chronically ill patient's needs, values, developmental and cognitive level, and health literacy.
12. Educates individuals, families, caregivers, and groups regarding strategies to manage the interaction among normal development, aging, and mental and physical disorders.
13. Employs treatments and therapeutic devices as indicated, including, but not limited to:
    1. Oxygen
    2. Noninvasive and invasive mechnical ventilation
    3. Prosthetics
    4. Splints
    5. Pacers
    6. Circulatory support
    7. Adaptive equipment
14. Evaluates the effect of therapies including but not limited to:
    1. Physical therapy
    2. Occupational therapy
    3. Speech therapy
    4. Home health care
    5. Palliative care
    6. Nutritional therapy
15. Implements interventions to support the patient with a rapidly deteriorating physiologic condition based on Advanced Cardiac Life Support and Fundamentals of Critical Care Support.
16. Conducts a pharmacologic assessment addressing pharmacogenetic risks, complex medical regimens, drug interations, and other adverse events.
17. Prescribes medications maintaining awareness of and monitoring for adverse drug outcome and complex medical regimens, especially in high-risk and vulnerable populations.
18. Uses pharmacologic and non-pharmacologic management strategies to ameliorate physical and behavioral symptoms in individuals who have mental health and substance misuse disorders.
19. Initiates discussion of sensitive issues, such as advanced directives and end-of-life decisions, with the individual, family, and other caregivers.
20. Applies principles of crisis and stress management in assisting the patient and family experiencing complex acute, critical, and chronic physical and mental illness during changes in status.
21. Coordinates comprehensive care in and across care settings for patients who have acute and chronic illness needs.
22. Promotes the delivery of evidence-based care for patients with complex acute, critical, and chronic physical and mental illness.
23. Practices within the national, state, and institutional credentialing and scope of practice