Appendix 3: Competency framework for all levels
Core Competency 1: Clinical Practice- Specialist Knowledge
Level 5 |
Level 6 |
Level 7 |
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Develops basic knowledge on the aetiology and current leading theories on the causation of the condition Develops basic knowledge on the classification and staging of the condition Develops basic knowledge of anatomy/physiology and pathophysiology related to the condition Is aware of the general risk factors associated with the condition |
Understands the links between aetiology of the condition and symptoms/prognosis Can discuss the aetiology/classification/ staging/prognosis with the pwNC and their family member or carers Demonstrates a clear working knowledge of anatomy/physiology/ pathophysiology related to condition. Uses knowledge to formulate management plan |
Is able to educate HCPs on the aetiology and classification of the condition
Displays expert knowledge on the relevant anatomy, physiology, pathophysiology by the education of experienced health professionals |
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Awareness of typical and atypical symptoms of the condition Is aware of the need for holistic assessment including history taking, physical examination in conjunction with relevant scales and investigations |
Can take a history and physical examination. Uses knowledge to assess and identify both typical and atypical symptoms Can uses appropriate scales and order investigations which may enhance management Relates specific symptoms to appropriate management options and treatment pathways Explains and educates the pwNC/carer on how pathology relates to symptoms and discusses management options Can identify red flags symptoms and link to differential diagnoses Can assess and identify common risk factors associated with the condition When required, for certain conditions with increased genetic risks, may advise family of pwNC with regards to genetic screening |
Is able to educate experienced HCPs on the disease presentation, symptoms and management options Briefs HCPs on red flag symptoms which may be suggestive of alternative diagnoses Can interpret scales and investigation results and collaborate with MDT management planning Uses expert knowledge to develop specific pathways, risk management approaches, and local and national resources for specific neurological condition Is able to advise other experienced HCPs on the implications of genetic influences of specific neurological conditions |
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Develops knowledge and understanding on the potential pharmacological and non-pharmacological management options Develops knowledge of the pharmacokinetic and pharmacodynamic properties of the drugs specific to condition Develops awareness of appropriate treatment alternatives for specific patient groups |
Contributes and may lead on case management tasks, identifying the most suitable treatment option based on the specific needs of the pwNC Uses pharmacokinetic and pharmacodynamic knowledge of drugs to choose the best medical treatment Can explain risk and benefits of medications to pwNC/carer to enable informed decision making Applies knowledge to decision making in the formulation of treatment plans Informs pwNC/carers of pharmacological and non-pharmacological treatment options for their condition, to aid informed decision making |
Works with the local drug and therapeutics committees to develop protocols and shared care guidelines Advises and supports health professionals in medicine management of pwNC Develops and applies treatment pathways that make use of evidence based practice, using local and national guidelines |
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Can work under supervision with the aim of being autonomous Is aware of limitations. Recognises when to seek advice from line manager in relation to patient care Recognises when to raise concerns and/or serious incidents in accordance with local reporting procedures Keeps good records and documentation Acts to incorporate non-judgemental values-based care into practice Recognises and responds to health inequalities, respects diversity, and protects pwNC against discrimination in practice |
Able to manage own case load. Works autonomously. Is accountable for decisions Develops expertise through the development of knowledge and conjoining this with clinical reflection Recognises safe case load numbers Follows local and national guidelines when making decisions related to patient care Works according to code of professional conduct Identifies and uses technology and information systems to both support and inform practice |
Uses innovative leadership style to develop the skills of the nursing team, to enable the delivery of safe, patient centred care and the development of autonomy among the nursing team Educates and disseminates best practice in relation to code of professional conduct |
Core Competency 2: Clinical Practice- History Taking, Clinical Assessment and Investigation
Level 5 |
Level 6 |
Level 7 |
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Obtains consent from individuals before initiating assessment Understands the need for a person-centred approach. Promotes and delivers person-centred care during assessments as part of the MDT Develops skills to take an accurate history, taking into account age, gender and cultural background Understands and identifies factors (such as demographic details) that might highlight a need for adapted assessment Awareness of scales and assessment tools relevant to specific neurological condition |
Is able to undertake a comprehensive, person-centred assessment. Interprets information to formulate a tailored treatment plan Is able to adapt history to take into account the physiological, psychological, social, cultural, developmental, sexual and spiritual needs of the person Liaises with the MDT during the assessment process to ensure efficient care is given Is able to discuss findings of information gleaned from clinical history, along with investigations and physical examination, to pwNC/carer in a way that includes them in decision making Uses scales and assessment tools appropriate to specific neurological condition, to enhance information gathered during the clinical history |
Undertakes appropriate specialist assessment relevant to specific neurological condition Expertly interprets all of the information available Assists other HCPs in interpreting findings from assessments Coordinates and formulates assessment and investigation pathways within the MDT that prioritises person-centred care Works nationally or internationally in partnership to develop and validate clinical rating scales that improve clinical assessment |
| Develops skills required for physical examination relevant to neurological condition | Uses skills to perform a comprehensive physical examination with the ability to differentiate symptoms which are relevant to specific neurological condition as opposed to co-morbidities | Educates HCPs to develop examination skills for comprehensive assessment of pwNC |
Core Competency 3: Clinical Practice- Analysing Data in the Diagnosis Process
Level 5 |
Level 6 |
Level 7 |
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Awareness of the need for thorough assessment of history, physical examination and investigations which may be used to assist the diagnostic procedure Awareness of existing diagnostic criteria and consider how that applies to pwNC Develops awareness of red flags which may lead to differential diagnoses/atypical forms of neurological condition Awareness of the ‘common’ symptoms and presentations of the condition and demographic contexts during the diagnostic stage |
Sound knowledge of neurological condition enabling critical analysis and evaluation of presenting signs and symptoms along with investigation findings to assist with diagnosis Apply findings to relevant diagnostic criteria Alert MDT to red flags which may lead to atypical/differential diagnosis Able to provide information in a way that is easy to understand for pwNC/carers about the diagnostic procedure and to explain findings. Provides emotional support during the diagnostic process |
Uses expertise to collaborate with MDT during the diagnostic process of the pwNC Collaborates with local MDT to produce protocols and guidelines for timely diagnosis of specific conditions related to recognised national and international criteria Educates HPCs on the diagnostic processes of specific neurological conditions, in relation to signs and symptoms and investigation findings Educate HPCs on red flags and differential diagnoses |
Core Competency 4: Clinical Practice- Treatment and Care
Level 5 |
Level 6 |
Level 7 |
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Develops knowledge of relevant guidance, policies and legislation that govern legal and ethical aspects of service provision, in relation to specific neurological condition
Uses and contributes to the development, implementation, and review of local policies, guidelines and protocols |
Able to communicate to pwNC/carers legal, moral, and ethical issues relating to care provision Critically evaluates and utilises the appropriate evidence-based interventions and guidelines that inform care for specific neurological condition |
Influences policy at local, organisational, and national level in response to some of the legal, moral, and ethical issues Provides leadership and expertise in the implementation of relevant guidelines, treatments and services through education of HCPs and colleagues Informs the strategic direction and leads on change to service delivery |
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Develops a knowledge base in the pharmacological and non-pharmacological treatment/ management for the pwNC |
Advances competence in the pharmacological management of treatment. This may include gaining supplementary or independent prescribing qualifications or the use of PGD to enable initiation of symptomatic treatment and managing side effects Informs the pwNC/carer on chosen therapies, to include expected effects and side effects. Advises on the importance of medicine management and drug concordance Includes non-pharmacological strategies in treatment plan and co-ordinates appropriate referrals to MDT where agreed with pwNC |
Independent prescriber qualification where neurological condition requires routine medication titrations. Ability to prescribe any licenced medicine within their area of competence Collaborates with GP, local pharmacists to advise on medication requirements for pwNC Collaborates with MDT to incorporate pharmacological and non-pharmacological approach to optimise treatment plan. |
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Awareness of the needs of developing an individual care plan, ensuring that the care plan follows the principles of person-centred care |
Uses holistic approach to develop a care plan with the person taking individual goals into consideration. Includes family and carers of pwNC in planning process, where consent is obtained |
Educates other HCPs on formulating a treatment plan and assists with any potential ethical issues Collaborates with services to develop and streamline pathways to ensure access to treatment/care is available at the point of need |
Core Competency 5: Clinical Practice- Co-ordination of Care
Level 5 |
Level 6 |
Level 7 |
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Understands, promotes and delivers care based on the principles of evidence-based medicine. |
Identifies as the key co-ordinator of care for the pwNC /carer across a range of health environments |
Leads and directs an integrated, responsive service for the pwNC/carer Develops specialist services for the pwNC to limit organisational barriers and ensure evidence-based care is implemented |
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Understands the importance of MDT working, has awareness of relevant local pathways, and establishes relationships with the MDT.
Can explain to pwNC/carer different roles within MDT and wider support networks and benefits of referrals |
Is able to communicate effectively to the MDT to ensure that the pwNC’s needs are met Offers appropriate and timely referral services to the MDT both in primary and secondary settings Communicates and liaises with other health and social care professionals and services to help inform admission and discharge planning Communicates the role of the specialist nurse as a pivotal member of the MDT |
Works as an independent practitioner within the MDT and acts as an expert link between the patient and the MDT, ensuring full engagement from the pwNC/carer in shared decision making |
Core Competency 6: Clinical Practice- Expert Specialist Resource
Level 5 |
Level 6 |
Level 7 |
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Evidence reflection on own and others experiences in the workplace Makes use of networking and engages with experienced professionals to improve their own competence Identifies and participates in educational programmes and recognised CPD programmes that relate to the management of the disease/condition to support own development Can identify their own individual learning needs and personal development planning |
Demonstrates evidence of their own CPD through evaluation and reflection and participation in clinical networks |
Maintenance of advanced professional development through frequent reviews of the literature, use of self-directed study, networking and regular reflection Develops leadership skills of others through training and mentorship |
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Develops advanced communication skills and understands the need to apply these to individual communication styles Develops the therapeutic relationship with the pwNC Translates evidence and recent research and disseminates additional evidence-based resources to the pwNC and their family members and/or carers |
Acts as a knowledgeable, accessible and responsive source of information Provides and shares complex information effectively and concisely for a range of situations and contexts to ensure safety and continuity of care Tailors the communication strategy and employs advanced communication skills to discuss potentially challenging and emotive topics Acts as an emotional support for the families and carers and is able to assist with potential conflict between the patient and their family/carers Sources a range of educational materials to support the development of pwNC, their carers and/or family members |
Expertly shares complex information to ensure patient safety and continuity of care Is able to support other HCPs in the development of their own communication skills Offers a critical appraisal of information available to the pwNC and is able to provide further educational materials through liaison with community organisations and third sector organisations |
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Demonstrates facilitation of teaching skills and behaviours including supervision and teaching Evidences use of a wide range of skills to motivate, stimulate and encourage others to facilitate the learning process
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Ability to act as a clinical advisor to non-specialist and junior staff on patient management Provides expertise and advice to colleagues across a range of different clinical settings. This may include provision of training and the sharing of information Identifies and supports the learning needs of the team in response to service need and personal development planning Provides education to voluntary and non-professional groups Undertakes teaching at higher education institutions and on undergraduate and graduate training programmes |
Acts as an expert clinical advisor and resource to educate and inform colleagues, HCPs, and other members of the MDT to ensure that care remains evidence-based Teaches and advises colleagues and members of the MDT and external professions on the best method to educate patient groups Role model exemplary facilitation, leadership, communication and teaching skills and develop those skills in others |
Core Competency 7: Facilitation of Learning
Level 5 |
Level 6 |
Level 7 |
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Engages in the development of patient education programmes and resources Assists in the development of a positive learning environment Engages in learning theories to improve practice and engage with learning in the local environment Demonstrates knowledge and use of a range of information to review/evaluate and enhance the learning environment May think about the need to develop therapeutic education programmes for the pwNC and for the HCPs
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Creates a reflective environment that allows learning through experience, education, research, and learning with others Contribute to and participate in clinical supervision, Practice Supervision and facilitation of learning and support others to participate. This may also include those in undergraduate/pre-registration Competently uses learning theories to plan, implement and evaluate learning in the local environment Creates an effective learning environment that ensures learning opportunities for staff and students Participation in learning needs analysis, educational audits and evaluation of educational interventions Apply and continue to develop specialist knowledge of andragogy appropriate to specific role |
Develops educational pathways and materials for carers and family members Lead on strategies that enable effective reflective practice Demonstrates and understands the key theories of adult learning and apply a wide range of facilitation, teaching, and assessment skills to practice Review data collected from educational audits and sources of other feedback to plan and lead at a local level to enable a positive learning environment Apply advanced knowledge of andragogy appropriate to specific role Leads on the development and delivery of regional higher education institutions and ensures appropriate training and curriculum development in undergraduate programmes Leads the development of local and regional education initiatives for pwNC, healthcare workers and members of the MDT to promote high level practice |
Core Competency 8: Leadership
Level 5 |
Level 6 |
Level 7 |
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Uses national leadership frameworks to assess and develop self-leadership Engages in a supportive culture and makes use of constructive feedback Understands how leadership can be used to improve people’s wellbeing and experiences of healthcare Apply and continue to develop, leadership skills and behaviours appropriate to specific role Demonstrates leadership qualities and behaviours including skills in motivating, influencing and negotiation |
Will use national frameworks to assist and develop leadership skills in others Actively promotes a supportive culture, where constructive feedback is received positively and regarded as a learning opportunity Provide leadership for quality improvement and service development to enhance people's wellbeing and experiences of healthcare Contributes to workforce development through personal and professional development of individuals and team aligned to organisational priorities May develop own leadership skills through recognised courses Engages in professional networking within the locality, such as within the MDT, local clinical networks, and networking across social and health care boundaries |
Provides strong and effective leadership across professional and organisational teams/boundaries Demonstrates how feedback is used by the organisation to positively improve services Applies advanced leadership skills and behaviours appropriate to specific role Demonstrate and support others to manage people effectively using organisational policies and exemplary leadership qualities Develops leadership skills of others through training and mentorship Aims to actively contribute to a variety of organisational (and international if available) professional networks to share best practice |
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Is able to communicate complex information to the nursing and multi-disciplinary team Identifies and analyses problems and recommends solutions Demonstrates the ability to work well within a team and in collaboration with others |
Is able to communicate complex information at an appropriate level to a range of audiences and contexts Display creativity and innovation in exploring and implementing possible solutions to problems and evaluating their effectiveness Support others to take responsibility for ensuring concerns are addressed in a timely manner, applying relevant policies such as whistleblowing and complaints Responds in a transparent and structured way to any complaints from staff about the unacceptable or unfair behaviours of other members of the team Advocates for the pwNC among the MDT to prevent barriers to care and ensure their wishes are being met |
Role model highly developed verbal, nonverbal and written communication skills Use creative and innovative solutions to address complex problems, leading innovation and quality improvement and promoting the involvement of others Promotes a culture of empowerment to enable concerns to be raised, addressed and /or appropriately Advocates for the pwNC at a local (across the MDT), organisational, and national level and throughout their care pathway |
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Understands the need for recognised workload assessment Contributes to effective management of resources including workforce resources within own area of practice |
Demonstrates the ability to use workload assessment and skill mix tools to manage resources and budgetary demands including workforce resources Demonstrates leadership behaviours when managing people, making use of human resource policies and processes, and recognising early signs of poor performance |
Build and lead teams, engage stakeholders and work in collaboration with others Demonstrate effective financial and workforce planning, delivery and reporting, progressing workforce development plans aligned to organisational qualities Manages and develops an MDT appropriate to service need and availability |
Core Competency 9: Evidence, Research and Development
Level 5 |
Level 6 |
Level 7 |
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Uses a range of research approaches to assess how evidence is being used, by self and others, to inform and develop practice Share with others good practice from audits, and quality improvement activity May identify the need for, and engage with, audits within local services Ability to critically identify, define, and analyse complex professional problems and issues |
Demonstrate the ability to search and critically appraise evidence (such as patient outcome measures, assessment tools, and treatments) that can be used to enhance patient care Makes use of a range of tools and methodologies (such as audits) to analyse patient satisfaction and implement findings Disseminates recent findings from relevant literature to pwNC and their family members and/or carers Critically analyses the integration of new policy and changes to local practice |
Share good practice and the lessons learned from audit, research and quality improvement activity locally and nationally through professional and peer reviewed processes to improve local practice Acts as a role model for the wider team by promoting a positive research culture Applies the critical analysis of the literature to help with service development, using specialist knowledge to contribute to the development of evidence-based policies and procedures Contributes to and leads the design of local and national/multi-centre audits, and then subsequently reviews and implements the findings of the audits |
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Critically analyses and evaluates information and has the ability to search and appraise evidence Applies and continue to develop specialist knowledge of research appropriate to role Has understanding of research governance including GCP, ethics, data protection and confidentiality Is able to explain the principles of clinical trials and the contribution of the specialist nurse |
Critically reviews the evidence base for nursing management of the disease/condition Has awareness and understanding on the various research projects (both nationally and internationally) available for pwNC. Supports, contributes, and actively recruits to potential research studies Enables and informs patients on the realistic expectations and concepts of clinical trials and participating in research Involvement in nursing research projects, scientific societies, and conferences Critically analyses and interprets the results of research and clinical trials |
Utilises appropriate policies to ensure support for clinical research activity and adherence to research governance, including GCP, ethics, data protection and confidentiality Applies advanced knowledge of research and development appropriate to role, and leads in the development, managing, analysis and dissemination of research projects Identifies research questions relevant to daily practice (which can include the identification of gaps in service or areas for improvement) and with supervision may design, implement and report on research projects May engage in other research projects that can relate to the care and management of the pwNC Engages with knowledge dissemination at regional, national, and international levels that may involve speaking at conferences and writing for publication |