CC Advanced Nursing Practice


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The Canadian Nurses Association’s (CNA) Advanced Nursing Practice National Framework (2008) identifies the demand for collaborative, innovative clinical practitioners who can serve as leaders in healthcare. Nurses in advanced nursing practice (ANP) roles are well positioned to respond to the changing needs of healthcare, and as such, the Canadian Association of Critical Care Nurses (CACCN) believes that a national definition of ANP in critical care (ANP-cc) is crucial to the continued development of these roles in Canada. CACCN’s first position statement was published in 2002. The purpose of this revised statement is to continue to promote a common understanding of ANP-cc and to enhance role definition and implementation, specifically the clinical nurse specialist in critical care (CNS-cc) and nurse practitioner in critical care (NP-cc). Therefore, CACCN has continued to build on the landmark papers from CNA (2000, 2002, and 2008).

ANP-cc is an umbrella term. It describes an advanced level of nursing practice that maximizes the use of in-depth nursing knowledge and skill in meeting the complex healthcare needs of patients (individuals, families, groups, and communities) requiring critical care nursing. ANP-cc may occur in such settings as neonatal, pediatric, adult, medical, surgical, trauma, cardiac, and neurologic critical care units located within secondary, tertiary or quaternary level facilities. 

CACCN endorses that all nurses in an ANP-cc role hold a masters or doctorate degree in nursing and have demonstrated clinical expertise in their critical care specialty. Therefore, nurses in an ANP-cc role have expertise in critical care practice such that they are able to analyze, synthesize and apply an advanced level of knowledge that is grounded in nursing theory and other theoretical foundations, as well as research, and the individual’s unique experience.

Nurses in ANP-cc function both autonomously and in collaboration with patients, families and other health professionals to comprehensively manage the healthcare needs of a specific critical care population. The focus of ANP-cc is to manage complex situations and/or the complex needs of patients with episodes of actual or potential acute and/or life-threatening illnesses, minimize complications, restore maximal health potential, and provide holistic nursing care. Healthcare interventions in this setting may be restorative, rehabilitative, maintenance or palliative in nature.

Competencies related to clinical, consultation and collaboration, leadership, and research are woven into ANP-cc practice. These competencies incorporate the previously identified five interrelated domains of practice: clinical, education, research, consultation, and leadership (CACCN, 2002). The proportion of time dedicated to each competency will continuously vary depending on the setting in which nurses in ANP-cc roles are employed, the needs of the patients cared for in that setting, and the expertise of the nurse in the role. Although there are variations in the implementation of the competencies, ANP-cc practice always includes a clinical practice component. Integrated within the practice of each competency are expert skills related to communication, collaboration, and ethical decision-making, as well as effectively moving through the transition of change. Nurses in ANP-cc roles apply these competencies across three spheres of influence: the patient (and family); nursing, both the individual and the profession; and organizational systems. 

Approved by the CACCN Board of Directors
Date January 19, 2011



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