Caring for

Emergency Care Association acutely

ill adults

National Curriculum and Competency Framework

Emergency
Emergency
planning andNursing (Level 2)
Caring for
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling
June 2017
Contents | Introduction | Level 2 competencies

Acknowledgements
This Royal College of Nursing (RCN) curriculum and competency framework for emergency
nursing was produced by a working party of emergency nursing representatives from across
the United Kingdom. Special thanks go to the individuals who gave their time and expertise to
make this possible.

Working party members

Janet Youd Chair, RCN Emergency Care Association (ECA), Emergency Nurse Consultant,
Calderdale and Huddersfield NHS Foundation Trust
Bruce Armstrong OBE Consultant Nurse in Emergency Care, Hampshire Hospitals NHS Foundation Trust,
Hampshire and Isle of Wight Air Ambulance
Jasmin Clark Advanced Nurse Practitioner, Royal Infirmary Edinburgh
Anna Crossley Royal College of Nursing (RCN) Professional Lead for Acute, Emergency and Critical
Care
Roisin Devlin ECA Committee Member, Lead Nurse for Emergency Departments, South Eastern
Health and Social Care Trust, Northern Ireland
Owen Hammett ECA Committee Member, Trainee Specialist Practitioner – Critical Care, South
Western Ambulance Service NHS Foundation Trust
Jacky Price ECA Committee Member, Principal Lecturer University of Hertfordshire
Kevin Randall Lead Nurse/ANP Emergency Department, Bridgend, Abertawe Bro Morgannwg
University Health Board
RCN Legal Disclaimer
Michelle Rudd Emergency Nurse Consultant, Lincolnshire Hospitals
Mandy Rumley-Bus ECA Committee Member, Consultant Nurse, Emergency Care Improvement This publication contains information, advice and guidance to help members of the RCN. It is intended for use
within the UK but readers are advised that practices may vary in each country and outside the UK.
Programme
Simon Standen ANP/Matron, University Hospitals Leicester/Paramedic Consultant, Yorkshire The information in this booklet has been compiled from professional sources, but its accuracy is not
Ambulance Service guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information
and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN
Dr Anne Welling Emergency Nurse Consultant, Portsmouth, Chair Wessex Emergency Care shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused
Collaboration directly or indirectly by what is contained in or left out of this website information and guidance.
Jill Windle RCN Fellow, Lecturer Practitioner, Salford University/Salford Royal NHS Published by the Royal College of Nursing, 20 Cavendish Square, London W1G 0RN
Foundation Trust
© 2017 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in
In addition to individual work, the development of this framework would not have been possible without the
a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying,
preceding work shared or published by various organisations; in particular the Wessex Emergency Care recording or otherwise, without prior permission of the Publishers. This publication may not be lent, resold,
Collaboration, the Faculty of Emergency Nursing and the Intercollegiate Board for Training in Pre-Hospital hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it
Emergency Medicine (IBTPHEM). is published, without the prior consent of the Publishers.

2 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) ACKNOWLEDGEMENTS
Contents | Introduction | Level 2 competencies

Foreword
Over 20 million patients access emergency and urgent care in the NHS each year in a range of
settings and services. Central to each of these services are the nursing teams working alongside
other professional colleagues to ensure that these patients and their families receive world-class
care. The increasing demands and challenges on the NHS emergency care system have seen it
evolve significantly in the last twenty years in the United Kingdom. Technological and clinical
advances, coupled with the introduction of integrated emergency care networks, involving major
trauma centres, and other centres of excellence, with emergency departments and urgent care
centres, ensure patients can expect to receive quality and compassionate care responsive to
their needs.

Alongside these clinical and service developments, emergency nursing has also progressed, both
in terms of its ability to improve outcomes for patients and their families, and to enrich the
profession of nursing itself, through evidence-base and role development. There is now an
increasing diversity of nursing roles required in emergency care settings, demanding specialist
and advanced skills and knowledge. Each brings a significant contribution to the multi-
professional team in the modern emergency care environment.

This framework, developed by leading emergency nursing experts, is founded on nursing

philosophy and details the depth and breadth of knowledge and skills required of emergency
nurses. It offers long overdue clarity on the nomenclature of nursing roles in emergency care
settings and provides a clear career structure for those wishing to advance in the specialism. It
will facilitate consistency and continuity of educational preparation of emergency nursing teams,
as well as future workforce planning, and will be an extremely valuable resource for both
individual nurses and organisations.

Ruth May
Executive Director of Nursing
NHS Improvement

3 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) FOREWORD
Contents | Introduction | Level 2 competencies

Contents
1 Introduction 5 Cross-cutting themes Level 2 24
Preceptorship and induction 5 CCT1 – Patient assessment 25

Glossary of nursing roles 6 CCT2 – Pain assessment and management 27

CCT3 – Medicines management 28
Emergency nurse development pathway 7
CCT4 – Moving and handling 30
Foundation practice – Working to Level 1 competencies 8
CCT5 – Infection prevention and control 31
Emergency nurses – Working to Level 2 competencies 8
CCT6 – Safeguarding children and adults 32
Emergency nurse development – Beyond Level 2 8 CCT7 – Documentation and record keeping 34
The competence framework 9 CCT8 – Preventing and controlling violence and aggression 35

Good nursing practice 10 Clinical domains Level 2 36
Cross-cutting themes 11
CD1 – Caring for acutely ill adults 36
Emergency care clinical domains 12
CD2 – Caring for adults requiring resuscitation 54
Competence assessment 13 CD3 – Caring for adults with minor illness or injury 67
The role of the clinical supervisor/assessor/mentor 14 CD4 – Caring for children and young people 75
2 Level 2 competencies: CD5 – Caring for people with mental health needs 90

Good nursing practice Level 2 15 CD6 – Caring for older people 95

GNP1 – Professional behaviour 16 CD7 – Emergency planning and disaster management 101

GNP2 – Team working 17

GNP3 – Communication 18
GNP4 – Leadership and management 19
GNP5 – Education 20
GNP6 – Evidence-based practice 21
GNP7 – Legal and ethical dilemmas and decision making 22

GNP8 – Service evaluation and improvement 23

4 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CONTENTS
Contents | Introduction | Level 2 competencies

1. Introduction
This framework was produced in response to a demand from RCN Emergency Care Association Preceptorship
members for clarity in the competencies expected of nurses working in emergency care settings
across the UK. Whilst its development focused on the needs of nurses working in emergency All nurses joining the NMC register have demonstrated their ability to undertake a wide range of
departments (EDs), the framework will also be applicable to nurses working in a wide range of core nursing skills with competence. This framework recognises the acquisition of these skills and
urgent and emergency care settings and also other health care professionals who are required to seeks to build specific competence in emergency nursing. The guidance provided in the
care for patients in emergency care settings. The aim is to encourage professional development, Preceptorship framework for newly registered nurses, midwives and allied health professions (DH,
leadership skills, and career progression in emergency nursing; promoting high quality patient 2009), should act as a useful resource.
care and a culture that supports recruitment and retention of emergency nurses. The framework
is designed to support nurses from newly qualified or new to the specialty (foundation staff
nurse) through to more experienced emergency nurses working with patients of all ages.
Induction
Nurses working in emergency care settings that receive trauma should also follow the trauma
competency framework developed by the National Major Trauma Nursing Group. These A period of structured support is vital for all nurses who are new to the emergency care
competencies can be found at: www.nmtng.co.uk/emergency-dept-1.html environment. For nurses who have clinical experience elsewhere, their transition into emergency
care may be less challenging, and their progress in achieving the competencies may be
Competencies for advanced clinical practitioners in emergency care have been developed by the accelerated in comparison to that of the newly qualified nurse.
Royal College of Emergency Medicine (RCEM) and Health Education England (HEE). These have
been endorsed by the RCN and are available at: www.rcem.ac.uk/RCEM/Exams_Training/ The emergency care environment is stressful and challenging and for emergency nurses to
Emergency_Care_ACP/RCEM/Exams_Training/Emergency_Care_ACP/Emergency_Care_ACP. develop and work effectively, they need to maintain personal wellbeing. To develop resilience,
aspx?hkey=8244ccaf-e85a-4b1e-8f8d-152484810137 emergency nurses should feel supported in exploring their experiences, to enable reflection and
learning. The need for emotional support at any stage in an emergency nurse’s career should
never be underestimated.

References
Department of Health (2009) Preceptorship framework for newly registered nurses, midwives and
allied health profession. London: DH.

5 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Glossary of nursing roles in the emergency Practice educator: This is an emergency nurse having completed Level 2 competencies who
facilitates educational opportunities in the emergency care setting. They provide supervision in
care setting practice, deliver training sessions and assessment of competencies. They often teach on nationally
recognised courses (for example, advanced life support). They should be working towards
Foundation staff nurse: A registered nurse who is either newly qualified or new to emergency education-specific competencies and/or qualifications. Typically, they are Band 6 or 7 depending
nursing; has not yet acquired the competencies of an emergency nurse. These nurses require on the leadership responsibilities of the role.
supervision in practice, ranging from direct supervision in their initial weeks, to indirect
supervision as they near the accomplishment of an emergency nurse. They should be working to Practice development lead: This is an emergency nurse having completed Level 2
complete the Level 1 competencies. Typically, they would be Band 5. competencies who leads the education strategy for the emergency care setting. They will provide
supervision in practice and deliver some training sessions, whilst establishing the training
Emergency nurse: A registered nurse who has completed preceptorship and has achieved requirements in the setting to ensure the necessary workforce skill mix. They will link the
the Level 1 competencies. They can work with individual patients or groups of patients without education strategy for the emergency care setting with the overall strategy for education in the
direct supervision in the emergency care setting. This includes initial assessment and the organisation. They will work closely with the lead nurse manager, the medical clinical director and
provision of treatment (but not diagnosis) for patients. In EDs, this is likely to include working with other education providers, including higher education institutes (HEIs). They will typically be Band
patients in the resuscitation room, those with major illness or injury and those with minor 7 or 8a.
presentations. They should be working to complete the Level 2 competencies. Typically, they
would be Band 5 or 6. Lead nurse manager: This is an emergency nurse having completed Level 2 competencies who
is responsible for the day-to-day operational management of the emergency care setting,
Emergency charge nurse: An emergency nurse who has completed level 2 competencies, is a including workforce management and implementation of local policy and clinical guidelines.
clinical expert and proactively develops themselves and others. They lead and supervise the Typically, Band 7 or 8a.
clinical work of others and can manage the emergency care setting as a whole; managing patient
flow and delegating care accordingly. In EDs they should work in close partnership with the Matron: This is an emergency nurse having completed Level 2 competencies who is responsible
emergency medicine consultant to ensure safety of patients and best use of resources. They for quality assurance and quality improvement in the emergency care setting; including
should focus on more in-depth leadership, educational and/or research competencies, which are responding to patient feedback and ensuring clinical incidents are investigated and any
beyond the scope of this framework. Typically, they would be senior Band 6 or 7. recommendations actioned. Typically, Band 8a.

Emergency nurse practitioner (ENP): A registered nurse who has undertaken specific Emergency nurse consultant: A clinical expert in emergency nursing with responsibility for
additional training in order to assess, diagnose and prescribe treatment for patients who present emergency care leadership; including strategic development of policy and practice, research,
with minor injuries and or illness. The role of emergency nurse practitioner is subject to local education and advanced clinical practice. Typically, Band 8b or 8c.
variation in education and practice provision, therefore this framework does not provide the
competencies required for this role. Typically, they would be Band 6 or 7.

Advanced clinical practitioner (ACP): An emergency nurse or other registered allied health
professional who has undergone masters level education in examination, diagnosis and treatment
and can provide a clinical consultation for any patient presenting to emergency care. They should
be working to the Royal College of Emergency Medicine/Health Education England emergency
care ACP competency standards. Typically, they would be Band 8a or 8b.

6 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Emergency nurse development pathway

A clearly defined development pathway enables nurses to identify their position on a career
journey, consider future options and plan the steps required to achieve their career aims.

Figure 1 maps the professional development pathways into management, education or clinical
specialist roles for emergency nurses. Defining stages within the pathway not only facilitates
career progression, but may also inform workforce development.

Figure 1: Career development pathway overview

Career development pathway overview

Advancing clinical practice pathway

Newly qualified nurse

(Foundation staff ENP ENP T-ACP ACP Emergency

nurse Band 5) Band 6 Band 7 Band 7 Band 8a nurse consultant
Band 8b+
Working to Level 1
Education pathway
Emergency nurse
Practice Senior practice Lead practice
(Band 5) educator educator development
Band 6 Band 7 Band 8a
(Working to Level 2)
New to specialty nurse Management pathway Senior nursing
(Foundation staff manager
nurse Band 5) Sister/charge Senior sister/lead (DHoN/HoN)
Matron Band 8b+
nurse nurse manager
Working to Level 1 Band 8a
Band 6 Band 7

7 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Foundation practice – Working to Level 1 Emergency nurses – Working to Level 2

competencies competencies
The newly qualified nurse requires at least 12 months to consolidate their nurse training in These nurses should form the largest nursing group in the emergency care setting. Provided they
addition to developing the competencies to be an emergency nurse. In total, it may take them up have had a structured foundation period, with appropriate education and supervision, they should
to two years to become an emergency nurse. be able to care for patients in all areas of the environment without direct supervision. These
nurses will have successfully completed the Foundation practice Level 1 competencies and be
Nurses new to the emergency care environment, but with previous nursing experience, should working to complete the Level 2 competencies.
aim to complete their Foundation Level 1 competencies within 12 months. They may achieve them
sooner if their previous experience is in an acute or critical care environment. Developmental milestones of emergency nurses are likely to include:
• ability to lead the provision of evidence-based holistic care for groups of patients, from initial
Developmental milestones of foundation staff nurse
assessment to discharge or admission
Three months
• teaching and supervising less experienced staff and students
• Be familiar with the environment and work as a member of the team caring for patients under
• developing in-depth knowledge about specific areas of interest and effectively communicating
supervision of an emergency nurse.
this to colleagues, for example, link nurse role
• Understand operational and patient processes in the various areas of the environment.
• advancing clinical skills and knowledge, developing teaching and assessing skills, and
• Start to develop good nursing practice and competencies of cross-cutting themes at Level 1. developing leadership qualities.
• Recognise own limitations, seeking help and advice when needed.

Six months
Emergency nurse development – Beyond
• Function as a member of the team in various areas of the setting, taking responsibility for Level 2
planning, implementing and evaluating individual patient care.

• Achieve further good nursing practice, cross-cutting themes and specific competencies of the It is important to recognise that developing competence as an emergency nurse is the
clinical practice domains at Level 1. fundamental platform on which all domains evolve. Depending on the aspirations and chosen
career direction, practice beyond that of an emergency nurse may follow a specific pathway or
12 months (up to two years for newly qualified) crossover between domains (see Figure 1):

• Manage allocated patients in various settings. In the emergency department, this is likely to • operational management (emergency sister/charge nurse/matron)
include majors, minors and resus.
• education specialist (practice educator/lead for practice development)
• Safely undertake the initial assessment of patients and triage appropriately.
• clinical specialist (emergency nurse practitioner/advanced nurse practitioner).
• Complete good nursing practice, cross-cutting themes and specific competencies of clinical
practice domains at Level 1. Competencies for these pathways are outside the scope of this document.

• Mentor student nurses and act as a guide to less experienced staff.

8 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

The competency framework Figure 2: The competency framework

The national curriculum and competency framework for emergency nursing is Caring for
demonstrated in Figure 2. acutely
ill adults
• Good nursing practice (GNP) – centre (core).

• Cross-cutting themes (CCT) – inner wheel.

• Clinical domains (CD) – outer wheel. Emergency

Caring for
planning and
These sections appear in both Level 1 and Level 2 competency sets. adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

9 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Good nursing practice Figure 3: Good nursing practice

Good nursing practice (GNP) forms the basis of all nursing care and is
central to the NMC Code. The behaviours outlined in GNP should be Caring for
applied when approaching the other competencies within the acutely
framework. The domains of GNP cover competencies in: ill adults

• GNP1 – Professional behaviour

• GNP2 – Team working Emergency

Caring for
• GNP3 – Communication planning and
adults requiring
disaster
• GNP4 – Leadership and management resuscitation
management Preventing
• GNP5 – Education and controlling Patient
violence and assessment
• GNP6 – Evidence-based practice aggression
• GNP7 – Legal and ethical dilemmas and decision making Pain
Documentation assessment
• GNP8 – Service evaluation and improvement. and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

10 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Cross-cutting themes Figure 4: Cross-cutting themes

These generic themes apply to patients in any emergency care setting
irrespective of their presenting complaint. The cross-cutting themes Caring for
(CCT) in Figure 4 are grouped into competencies relating to: acutely
ill adults
• CCT1 – Patient assessment

• CCT2 – Pain assessment and management

• CCT3 – Medicines management Emergency

Caring for
planning and
• CCT4 – Moving and handling adults requiring
disaster
resuscitation
• CCT5 – Infection prevention and control management Preventing
and controlling Patient
• CCT6 – Safeguarding children and adults violence and assessment
aggression
• CCT7 – Documentation and record keeping
Pain
• CCT8 – Preventing and controlling violence and aggression.
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

11 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Emergency care clinical domains Figure 5: Emergency care

The clinical domains (CD) in Figure 5 specify the competencies clinical domains
required to care for emergency patients across the lifespan. There are Caring for
seven clinical domains: acutely
ill adults
• CD1 – Caring for acutely ill adults

• CD2 – Caring for adults requiring resuscitation

• CD3 – Caring for adults with minor injury and illness Emergency
Caring for
planning and
• CD4 – Caring for children and young people adults requiring
disaster
resuscitation
• CD5 – Caring for people with mental health needs management Preventing
and controlling Patient
• CD6 – Caring for older people violence and assessment
aggression
• CD7 – Emergency planning and disaster management.
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

12 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies

Competence assessment Figure 6: Benner’s stages of clinical competence

Code Novice to expert Description

The competencies in this framework are presented in two levels. This publication covers continuum
competencies Level 2 and publication 005 883 covers competencies Level 1. N Novice or beginner No experience in the situation in which they are expected to perform and
depend on rules to guide their actions. Lacks confidence to demonstrate
• Level 1 competencies are intended for the foundation staff nurse to complete. safe practice and requires continual verbal and physical cues.

• Level 2 competencies are intended for the emergency nurse to complete. AB Advanced beginner Demonstrates marginally acceptable performance because the nurse has
had prior experience in actual situations. Often needs help setting
It is recognised that prior to the introduction of this framework, many nurses will have worked in priorities and cannot reliably sort out what is most important in complex
emergency care for many years. It would be reasonable for them to go straight to Level 2 situations and will require help to prioritise.

competencies rather than start with Level 1. For this reason, many of the Level 1 competencies are C Competent Demonstrates efficiency, is co-ordinated and has confidence in their
actions. Able to plan and determine which aspects of a situation are
duplicated in Level 2 where they are still required of a Level 2 emergency nurse. For those who
important and which can be ignored or delayed. This practitioner lacks
have completed level 1, some evidence will be transferable to the Level 2 framework, where the the speed and flexibility of a proficient practitioner but they show an
competencies remain the same. However, the majority will require demonstration of a higher level ability to cope with and manage contingencies of practice.
of achievement within the taxonomy as described opposite. P Proficient Someone who perceives the situation as a whole rather than in parts.
They have a holistic understanding of clinical situations which makes for
Competencies should be assessed using Benner’s stages of clinical competence (Figure 6). This quick and more accurate decision making. They consider fewer options
taxonomy is widely known and the definitions are easy to apply. and quickly hone in on accurate issues of the problem.
E Expert No longer relies on rules, guidelines, etc. to rapidly understand the
problem. With an extensive background of experience demonstrates an
intuitive grasp of complex situations. They focus on the accurate region
of the problem without first considering fruitless possibilities.
Benner P (1984) From novice to expert: Excellence and power in clinical nursing practice. Menlo
Park: Addison-Wesley.

Each competency starts with a self-assessment that helps to identify individual learning needs.

• Novice (N): I have some awareness but little knowledge or skill in this competency.

• Advanced beginner (AB): I have basic knowledge or skill in this competency and need
supervision.

• Competent (C): I have the knowledge and skills relevant for the competency and could
complete without supervision.

• Proficient (P): I am experienced in the knowledge and skills relevant for the competency and
could supervise or teach others.

• Expert (E): I am leading developments in this competency.

13 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents | Introduction | Level 2 competencies
For each competency, minimum achievement criteria are set for successful completion. However, • question and answer (Q&A)
this should be regarded as a minimum and not stifle those who wish to progress beyond this, for
• anonymised clinical case notes (CCN)
which they should be given recognition. Whilst some competencies will be unique to each level,
others have identical wording in Levels 1 and 2, but the minimum achievement criteria differ. For • feedback from colleagues and/or patients (F)
example, at Level 1 ‘Advanced beginner’ may be required, whilst at Level 2 ‘Proficiency’ may be
• nationally recognised courses (RC).
required.
It would be acceptable to put these abbreviated codes in the evidence column of the competency
framework to demonstrate the type of evidence that has been generated. Regular reviews are
essential to highlight and resolve any difficulties in achieving or maintaining competence. They
The role of the clinical supervisor/assessor/ also provide support for individuals, helping them to reach their potential without being restricted
mentor by traditional time-bound progression limits.

A foundation staff nurse should have an emergency nurse as a supervisor (having completed It would be overwhelming for anyone to try to address all the competencies simultaneously; it is
Level 1 as a minimum). The supervisor should have undergone specific training in supervision and recommended that realistic developmental goals are set at each one-to-one meeting and
assessment of others and, typically, would be a senior emergency nurse, emergency charge nurse reviewed in a timely manner. It may be helpful to put the date of the next meeting in the
or practice educator. For emergency nurses, a supervisor should be beyond Level 2. Typically, ‘expected achievement date’ column of those competencies which should be prioritised, leaving
they would be an emergency charge nurse or practice educator. blank those competencies which will be done at a future date.

It is recognised that when an emergency care setting starts to use this curriculum, there may During the first year of employment in the emergency care setting, it would be realistic to meet
be insufficient nurses that have achieved Level 1 and 2 competencies to supervise the with a mentor/assessor after the first month, then at three monthly intervals with an appraisal at
development of foundation staff nurses and emergency nurses. Until such a time, a pragmatic the end of the first year. In year two, it would be realistic to meet at six-monthly intervals, with
approach should be applied and senior nurses should be allowed to supervise others annual appraisals and development planning thereafter.
commensurate with their current role. At each meeting, there should be an agreement on which specific competencies have been
Whilst self-assessment helps to direct learning, support development and provides a baseline for achieved or maintained and which need to be progressed before the next meeting. It may be
subsequent assessment, objective formal assessment of competence should be undertaken for decided that some competencies are not applicable to the emergency care environment in which
quality assurance purposes and should include individual professional feedback. Assessment the individual is working. In this case ‘N/A’ should be marked against them. This will allow the
should be based on objective evidence. Due to the diverse nature of the competencies, no one individual to use their competency framework as a passport should they move to another
type of evidence can meet all the statements. It is important that a variety of evidence types are emergency care workplace and continue their development.
used to demonstrate the knowledge, skills and behaviours required. Evidence may include, but
would not be limited to:

• direct observation of practice (DOPS)

• case-based discussion (CBD)

• simulation (S)

• reflective report (RR)

14 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) INTRODUCTION
Contents

Level 2 competencies
Caring for
acutely
ill adults
Good nursing practice (GNP) Level 2
Emergency
Caring for
planning and
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

15 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
Contents

Core skills: Good nursing practice (GNP) – Level 2

GNP1 – Professional behaviour – Level 2
Demonstrate the knowledge, skills and behaviour to project a high standard of professional nursing
Knowledge Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 1.1.1 (L2) Understand the NMC Code and its N, AB, C, P, E Proficient
application within clinical practice
GNP1 1.1.2 (L2) Identify and interpret wider policy N, AB, C, P, E Competent
documents that guide professional
practice
Skills Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 1.2.1 (L2) Contribute to the process of personal N, AB, C, P, E Proficient
appraisal and the appraisal of others
GNP 1.2.2 (L2) Identify own developmental needs N, AB, C, P, E Proficient
and pursue activities to address them
GNP 1.2.3 (L2) Feedback to others about their N, AB, C, P, E Competent
professional behaviour
GNP 1.2.4 (L2) Alter pace of work according to N, AB, C, P, E Proficient
urgency of the clinical situation or
demands of the emergency care
setting
Behaviour Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 1.3.1 (L2) Acknowledge limitations in N, AB, C, P, E Competent
knowledge, skills and behaviour (as Level 1)
GNP 1.3.2 (L2) Demonstrate a positive attitude to N, AB, C, P, E Competent
learning and the development of self (as Level 1)
and others
GNP 1.3.3 (L2) Promote multi-professional team N, AB, C, P, E Proficient
working
GNP 1.3.4 (L2) Build a professional relationship with N, AB, C, P, E Competent
students and/or other professionals (as Level 1)
on attachment
GNP 1.3.5 (L2) Act as a role model to others, N, AB, C, P, E Competent
projecting a professional image at all (as Level 1)
times

16 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP2 – Team working – Level 2
Contribute to effective team working
Knowledge Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 2.1.1 (L2) Understand the concepts N, AB, C, P, E Proficient
relating to human factors and
team resource management,
situational awareness and error
theory
Skills Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 2.2.1 (L2) Identify stress and or stressful N, AB, C, P, E Competent
situations for self
GNP 2.2.2 (L2) Identify stress and or stressful N, AB, C, P, E Competent
situations for others
GNP 2.2.3 (L2) Identify individual coping N, AB, C, P, E Competent
mechanisms for dealing with
stress
GNP 2.2.4 (L2) Demonstrate the ability to work N, AB, C, P, E Proficient
effectively in a team
GNP 2.2.5 (L2) Demonstrate the ability to lead a N, AB, C, P, E Proficient
small team
GNP 2.2.6(L2) Demonstrate the ability to lead a N, AB, C, P, E Competent
departmental team on a shift
basis

17 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP3 – Communication – Level 2
Ensure effective communication
Knowledge Self-assessment (circle Minimum standard Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) for achievement achievement (print and sign)
GNP 3.1.1 (L2) Understand factors that influence N, AB, C, P, E Proficient
communication and common barriers to
effective communication
GNP 3.1.2 (L2) Discuss strategies available to aid N, AB, C, P, E Proficient
communication for individuals who have
sensory impairment
GNP 3.1.3 (L2) Discuss strategies available to aid N, AB, C, P, E Proficient
communication with individuals who
speak languages other than English
GNP 3.1.4 (L2) Describe and evaluate tools and strategies N, AB, C, P, E Competent
available to improve the quality of
communication between health
professionals
Skills Self-assessment (circle Minimum standard Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) for achievement achievement (print and sign)
GNP 3.2.1 (L2) Demonstrate effective communication N, AB, C, P, E Proficient
with colleagues both internal and external
to the emergency care setting
GNP 3.2.2 (L2) Demonstrate effective communication N, AB, C, P, E Competent
with partner agencies
GNP 3.2.3 (L2) Demonstrate effective communication N, AB, C, P, E Proficient
with patients of all ages and their families/
carers/significant others, including regular
updates on care plans
GNP 3.2.4 (L2) Facilitate use of interpreting services in N, AB, C, P, E Competent
line with local policy
GNP 3.4.5 (L2) Communicate effectively with individuals N, AB, C, P, E Competent
with audio and/or visual impairment
GNP 3.2.6(L2) Communicate effectively with individuals N, AB, C, P, E Competent
with learning disability such as autism or
attention deficit disorders

18 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP4 – Leadership and management – Level 2
Lead and manage the provision of emergency nursing care
Knowledge Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 4.1.1 (L2) Discuss the use of local and national N, AB, C, P, E Competent
quality indicators of emergency care
GNP 4.1.2 (L2) Discuss theories of leadership N, AB, C, P, E Competent
GNP 4.1.3 (L2) Articulate the difference between N, AB, C, P, E Competent
leadership and management
GNP 4.1.4 (L2) Understand the principles of N, AB, C, P, E Competent
effective change management
GNP 4.1.5 (L2) Describe principles of department N, AB, C, P, E Competent
management and patient flow
processes
GNP 4.1.6 (L2) Understand the local governance N, AB, C, P, E Competent
structure used to improve care
quality
Skills Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 4.2.1 (L2) Demonstrate skill in managing, N, AB, C, P, E Competent
supervising and supporting
colleagues on a shift basis
GNP 4.2.2 (L2) Manage patient flow and implement N, AB, C, P, E Competent
strategies to reduce delays
GNP 4.2.3 (L2) Respond appropriately to patient N, AB, C, P, E Proficient
satisfaction concerns and complaints
GNP 4.2.4 (L2) Identify and implement quality N, AB, C, P, E Competent
improvement initiatives within the
care setting
GNP 4.2.5 (L2) Identify and escalate concerns N, AB, C, P, E Competent
relating to patient safety according
to local policy

19 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP5 – Education – Level 2
Support the delivery of education, training and mentorship within the emergency care setting
Knowledge Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 5.1.1 (L2) Understand the theories that N, AB, C, P, E Competent
underpin clinical education and
mentorship, including learning
style theories
GNP 5.1.2 (L2) Discuss patient education N, AB, C, P, E Proficient
strategies
Skills Self-assessment (circle Minimum standard for Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement (print and sign)
GNP 5.2.1 (L2) Help others undertake a N, AB, C, P, E Competent
learning-needs analysis and
produce a development plan
GNP 5.2.2 (L2) Select and implement N, AB, C, P, E Proficient
appropriate strategies to
facilitate patient education
GNP 5.2.3 (L2) Demonstrate skill at teaching N, AB, C, P, E Competent
others, modifying approach in
response to group size and
learning styles
GNP 5.2.4 (L2) Demonstrate skill at assessing N, AB, C, P, E Competent
others and delivering feedback

20 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP6 – Evidence-based practice – Level 2
Ensure safe and effective care through application of evidence-based practice
Knowledge Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 6.1.1 (L2) Understand the theory of evidence-based N, AB, C, P, E Competent
practice
GNP 6.1.2 (L2) Describe how evidence can be identified N, AB, C, P, E Competent
and accessed
GNP 6.1.3 (L2) Describe how evidence should be N, AB, C, P, E Competent
reviewed and evaluated
GNP 6.1.4 (L2) Understand the local process for N, AB, C, P, E Competent
changing practice based on best evidence
GNP 6.1.5 (L2) Understand the principles to be N, AB, C, P, E Competent
considered when individual care requires
deviation from standard practice
guidelines
GNP 6.1.6 (L2) Understand the principles of the audit N, AB, C, P, E Competent
process
GNP 6.1.7 (L2) Discuss the local research governance N, AB, C, P, E Competent
structure and process
Skills Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 6.2.1 (L2) Demonstrate ability to critically appraise N, AB, C, P, E Competent
literature from professional and or
academic sources
GNP 6.2.2 (L2) Demonstrate ability to make a judgement N, AB, C, P, E Competent
about the applicability of a study to the
clinical environment
GNP 6.2.3 (L2) Contribute to developing evidence-based N, AB, C, P, E Competent
patient protocols and guidelines for the
local setting
GNP 6.2.4 (L2) Contribute to the audit process within the N, AB, C, P, E Competent
clinical setting
GNP 6.2.5 (L2) Identify topics for audit and/or research N, AB, C, P, E Competent

21 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP7 – Legal and ethical dilemmas and decision making – Level 2
Ensure practice is founded on legal frameworks and ethical principles
Knowledge Self-assessment (circle Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
as appropriate) for achievement of achievement completion achieved (print and sign)
GNP 7.1.1 (L2) Demonstrate understanding of the legal and ethical frameworks N, AB, C, P, E Competent
related to consent for all age groups (as Level 1)
GNP 7.1.2 (L2) Demonstrate understanding of the legal and ethical frameworks N, AB, C, P, E Competent
related to confidentiality for all age groups (as Level 1)
GNP 7.1.3 (L2) Describe the principles of the Equality Act (or equivalent in N, AB, C, P, E Competent
country of practice) and the implications for practice
GNP 7.1.4 (L2) Describe the principles of the Mental Capacity Act, including the N, AB, C, P, E Competent
Deprivation of Liberty Safeguards and the implications for
practice (or equivalent in country of practice)
GNP 7.1.5 (L2) Describe the principles of the Children Act relevant to country of N, AB, C, P, E Competent
practice and the implications for practice
GNP 7.1.6 (L2) Demonstrate understanding of the Mental Health Act relevant to N, AB, C, P, E Competent
the country of practice and the implications for practice
GNP 7.1.7 (L2) Reflect analytically on ethical, moral and legal dilemmas within N, AB, C, P, E Competent
clinical practice
Skills Self-assessment (circle Minimum standard Evidence submitted Date of Level Mentor sign-off
as appropriate) for achievement completion achieved (print and sign)
GNP 7.2.1 (L2) Demonstrate the ability to undertake and document an N, AB, C, P, E Competent
assessment of mental capacity
GNP 7.2.2 (L2) Demonstrate skill in applying the principles of the Mental N, AB, C, P, E Competent
Capacity Act (or equivalent)
GNP 7.2.3 (L2) Demonstrate ability to identify when there is a requirement to N, AB, C, P, E Competent
breach confidentiality
GNP 7.2.4 (L2) Demonstrate ability to gain lawful consent for treatment in the N, AB, C, P, E Competent
emergency care setting (as Level 1)
GNP 7.2.5 (L2) Recognise situations where it is necessary to provide treatment N, AB, C, P, E Competent
without consent and implement the process to ensure this is (as Level 1)
lawful
GNP 7.2.6 (L2) Demonstrate ability to initiate proceedings to establish N, AB, C, P, E Competent
Deprivation of Liberty Safeguards in country of practice
GNP 7.2.7 (L2) Demonstrate ability to seek legal advice as appropriate for N, AB, C, P, E Competent
complex situations

22 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Core skills: Good nursing practice (GNP) – Level 2

GNP8 – Service evaluation and improvement – Level 2
Contribute to service evaluation and improvement initiatives
Knowledge Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 8.1.1 (L2) Demonstrate an understanding N, AB, C, P, E Competent
of the policies which influence
cost-effective, high quality care
GNP 8.1.2 (L2) Understand how quality is N, AB, C, P, E Competent
measured in the care setting
GNP 8.1.3 (L2) Understand local processes for N, AB, C, P, E Competent
service evaluation
GNP 8.1.4 (L2) Understand local service N, AB, C, P, E Competent
improvement processes
Skills Self-assessment (circle Minimum standard for Expected date of Evidence submitted Date of completion Level achieved Mentor sign-off
as appropriate) achievement achievement (print and sign)
GNP 8.2.1 (L2) Engage with patients/carers to N, AB, C, P, E Proficient
inform service development
GNP 8.2.2 (L2) Communicate ideas for service N, AB, C, P, E Competent
improvement using local
governance frameworks
GNP 8.2.3 (L2) Lead service improvement N, AB, C, P, E Competent
projects

23 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) GOOD NURSING PRACTICE (GNP) LEVEL 2
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Level 2 competencies
Caring for
acutely
ill adults
Cross-cutting themes (CCT) Level 2
Emergency
Caring for
planning and
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

24 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT1 – Patient assessment – Level 2
Holistically and systematically, assess patients
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 1.1.1 (L2) Understand the importance of pre-hospital care information N, AB, C, P, E Competent
CCT 1.1.2 (L2) Understand the factors that affect communication or act as a N, AB, C, P, E Proficient
communication barrier and strategies that may be used to
overcome them (see GNP3)
CCT 1.1.3 (L2) Understand the importance of obtaining a comprehensive clinical N, AB, C, P, E Competent
and social history to plan appropriate person-centred care
CCT 1.1.4 (L2) Understand the elements underpinning the structured approach N, AB, C, P, E Proficient
to patient assessment
CCT 1.1.5 (L2) Discuss the use of clinical assessment tools N, AB, C, P, E Competent
CCT 1.1.6 (L2) Understand the system in place to prioritise patients according to N, AB, C, P, E Proficient
clinical need
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 1.2.1 (L2) Effectively receive handover from pre-hospital personnel and N, AB, C, P, E Proficient
document appropriately
CCT 1.2.2 (L2) Use a structured approach to gather and document the clinical N, AB, C, P, E Proficient
history
CCT 1.2.3 (L2) Effectively determine patient priority based on assessment N, AB, C, P, E Proficient
(triage)
CCT 1.2.4 (L2) Direct/move patients to appropriate areas, teams and services N, AB, C, P, E Proficient
CCT 1.2.5 (L2) Use a structured A-E approach to undertake patient assessment N, AB, C, P, E Proficient
CCT 1.2.6 (L2) Safely and accurately record clinical observations including: N, AB, C, P, E Proficient
• respiration
• oxygen saturations
• heart rate (manual)
• blood pressure
• temperature
• Peak expiratory flow rate
CCT 1.2.7 (L2) Use the National Early Warning Score (or local variant) and act as N, AB, C, P, E Proficient
per guidelines depending on score

25 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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CCT 1.2.8 (L2) Safely and accurately conduct the following investigations: N, AB, C, P, E Proficient
• ECG monitoring
• capillary blood glucose
• urinalysis
• pregnancy testing
CCT 1.2.9 (L2) Safely and effectively conduct cannulation and venipuncture in N, AB, C, P, E Competent
accordance with local guidelines

26 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT2 – Pain assessment and management – Level 2
Provide holistic care for patients with pain
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 2.1.1 (L2) Understand the physiology of pain N, AB, C, P, E Competent
CCT 2.1.2 (L2) Understand the principles of pain management N, AB, C, P, E Proficient
CCT 2.1.3 (L1) Discuss the tools available to assess and objectively measure pain N, AB, C, P, E Proficient
CCT 2.1.4 (L2) Discuss how pain assessment relates to triage priority N, AB, C, P, E Proficient
CCT 2.1.5 (L2) Discuss the pharmacological and non-pharmacological strategies N, AB, C, P, E Proficient
for managing pain
CCT 2.1.6 (L2) Understand locally agreed PGDs for nurse-led analgesia (where N, AB, C, P, E Proficient
relevant)
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 2.2.1 (L2) Select and use pain assessment tools to objectively assess pain N, AB, C, P, E Proficient
CCT 2.2.2 (L2) Apply appropriate non-pharmacologic strategies for the N, AB, C, P, E Proficient
management of pain (i.e. splinting, positioning, dressings)
CCT 2.2.3 (L2) Administer prescribed analgesia via a variety of routes N, AB, C, P, E Proficient
CCT 2.2.4 (L2) If using PGDs, select appropriate drug and route for effective pain N, AB, C, P, E Proficient
management using systematic and step-wise approach
CCT 2.2.5 (L2) Evaluate the effectiveness of analgesia at appropriate times N, AB, C, P, E Proficient
following administration and respond appropriately
CCT 2.2.6 (L2) Use Entonox safely and appropriately N, AB, C, P, E Proficient

27 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT3 – Medicines management – Level 2
Store, administer and dispose of medications safely and effectively in line with NMC standards and local policy
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 3.1.1 (L2) Understand the NMC standards for medicines management and N, AB, C, P, E Proficient
their application locally
CCT 3.1.2 (L2) Understand locally agreed policies, procedures and guidelines N, AB, C, P, E Proficient
relating to the storage, administration, disposal and recording of
medicines
CCT 3.1.3 (L2) Understand how to use additional information about medicines N, AB, C, P, E Proficient
(e.g. British National Formulary)
CCT 3.1.4 (L2) Understand the immunisation schedule and its importance N, AB, C, P, E Competent
CCT 3.1.5 (L2) Understand drug error or near miss reporting N, AB, C, P, E Proficient
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 3.2.1 (L2) Follow local policies on drug administration and the NMC N, AB, C, P, E Proficient
guidelines for the administration of medicines
CCT 3.2.2 (L2) Store medication safely N, AB, C, P, E Proficient
CCT 3.2.3 (L2) Select appropriate equipment and safely administer medications N, AB, C, P, E Proficient
as prescribed via:
• oral
• intravenous
• intramuscular
• subcutaneous
• inhaled
• rectal
• buccal
• topical
• ophthalmic
• aural
CCT 3.2.4 (L2) Administer medications using PGDs as per local policy N, AB, C, P, E Proficient
CCT 3.2.5 (L2) Administer controlled drugs as per local policy N, AB, C, P, E Proficient
CCT 3.2.6 (L2) Recognise and take appropriate action when a patient N, AB, C, P, E Competent
experiences early signs of adverse drug reactions, allergic
reactions or anaphylaxis

28 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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CCT 3.2.7 (L2) Document and communicate appropriately when patients refuse N, AB, C, P, E Competent
medications
CCT 3.2.8 (L2) Report medicine-related adverse incidents or ‘near-miss’ events N, AB, C, P, E Competent
CCT 3.2.9 (L2) Ensure adequate information for patients about medication prior N, AB, C, P, E Proficient
to discharge

29 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT4 – Moving and handling – Level 2
Ensure safe moving and handling of patients and equipment in the emergency care setting
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 4.1.1 (L2) Understand of the principles of safe moving and handling N, AB, C, P, E Proficient
CCT 4.1.2 (L2) Discuss the tools available to aid the assessment of moving and N, AB, C, P, E Proficient
handling tasks
CCT 4.1.3 (L2) Understand the equipment available within the local organisation, N, AB, C, P, E Proficient
including its benefits and limitations
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 4.2.1 (L2) Adhere to local health and safety guidance when moving N, AB, C, P, E Competent
equipment and resources
CCT 4.2.2 (L2) Assess and plan patient moving and handling needs N, AB, C, P, E Proficient
CCT 4.2.3 (L2) Safely use locally available moving and handling aids N, AB, C, P, E Proficient
CCT 4.2.4 (L2) Lead a team undertaking patient handling activities N, AB, C, P, E Competent

30 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT5 – Infection prevention and control – Level 2
Care for patients with due regard to infection prevention and control principles
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 5.1.1 (L2) Understand the role of the infection prevention and control (IPC) N, AB, C, P, E Competent
team
CCT 5.1.2 (L2) Discuss the local IPC policies and identify IPC resources N, AB, C, P, E Proficient
CCT 5.1.3 (L2) Understand the importance of the hand hygiene policy and the N, AB, C, P, E Competent
correct use of Personal Protective Equipment (PPE)
CCT 5.1.4 (L2) Explain national, regional and local initiatives/targets/data in N, AB, C, P, E Competent
relation to infection prevention and control (IPC)
CCT 5.1.5 (L2) Describe the chain of infection and give examples of how it can be N, AB, C, P, E Competent
broken
CCT 5.1.6 (L2) Understand antimicrobial resistance and the nurse role in N, AB, C, P, E Competent
antibiotic safeguarding
CCT 5.1.7 (L2) Have awareness of communicable diseases N, AB, C, P, E Competent
CCT 5.1.8 (L2) Discuss the local pandemic infection plan and major incident plan N, AB, C, P, E Competent
related to infection control (see CD7.1)
CCT 5.1.9 (L2) Understand implementation of the department isolation plan and N, AB, C, P, E Competent
associated implications
CCT 5.1.10 (L2) Understand when and how to decontaminate equipment and N, AB, C, P, E Competent
department areas
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 5.2.1 (L2) Apply the isolation, waste, linen, standard precautions and sharps N, AB, C, P, E Proficient
policies, promote best practice and challenge bad behaviour
CCT 5.2.2 (L2) Apply and remove Personal Protective Equipment (PPE) N, AB, C, P, E Proficient
appropriately
CCT 5.2.3 (L2) Decontaminate hands effectively N, AB, C, P, E Proficient
CCT 5.2.4 (L2) Demonstrate the aseptic technique i.e. Aseptic Non-Touch N, AB, C, P, E Proficient
Technique (ANTT)
CCT 5.2.5 (L2) Effectively communicate with other health care providers the N, AB, C, P, E Competent
infection status of patients

31 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT6 – Safeguarding children and adults – Level 2
Protect the safety of children and adults
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 6.1.1 (L2) Understand local guidelines and policies on safeguarding adults N, AB, C, P, E Proficient
and children and how to access support
CCT 6.1.2 (L2) Identify the named nurse for safeguarding adults and children and N, AB, C, P, E Competent
understand their role
CCT 6.1.3 (L2) Understand the needs of persons who are susceptible to abuse, N, AB, C, P, E Proficient
either through mental disability, physical disability or at risk from
self or carer
CCT 6.1.4 (L2) Understand the principles of the Mental Capacity Act (or N, AB, C, P, E Proficient
equivalent in country of practice) and its implementation (see
GNP7)
CCT 6.1.5 (L2) Understand the principles and legal implications for Deprivation of N, AB, C, P, E Proficient
Liberty Safeguards (DOLS) or capacity legislation in country of
practice (see GNP7)
CCT 6.1.6 (L2) Discuss the signs and symptoms of abuse: N, AB, C, P, E Proficient
• physical
• emotional
• sexual (including exploitation)
• female genital mutilation
• neglect
• domestic abuse
• honour-based violence
CCT 6.1.7 (L2) Discuss information sharing in order to adequately safeguard N, AB, C, P, E Competent
children or adults
CCT 6.1.8 (L2) Understand the role of safeguarding a patient’s dependents N, AB, C, P, E Proficient
CCT 6.1.9 (L2) Discuss the challenges of caring for persons/family suffering from N, AB, C, P, E Competent
domestic abuse
CCT 6.1.10 (L2) Recognise local processes for referral to external agencies N, AB, C, P, E Competent

32 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 6.2.1 (L2) Identify children or parents in need of social support and initiate N, AB, C, P, E Proficient
appropriate action
CCT 6.2.2 (L2) Respond appropriately to situations which necessitate immediate N, AB, C, P, E Proficient
action to safeguard children or adults
CCT 6.2.3 (L2) Access and implement the local policy for safeguarding children N, AB, C, P, E Proficient
and adults
CCT 6.2.4 (L2) Provide support and advice to others in conducting safeguarding N, AB, C, P, E Competent
interventions
CCT 6.2.5 (L2) Undertake a risk assessment and initiate a local multi-agency N, AB, C, P, E Competent
domestic abuse referral
CCT 6.2.6 (L2) Identify appropriate resources available for persons who are at risk N, AB, C, P, E Competent
of abuse
CCT 6.2.7 (L2) Complete safeguarding training level commensurate with local N, AB, C, P, E Competent
policy
CCT 6.2.8 (L2) Engage in safeguarding supervision N, AB, C, P, E Competent

33 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT7 – Documentation and record keeping – Level 2
Effectively document care in line with NMC standards for record keeping
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 7.1.1 (L2) Understand the NMC standards and local policy for documentation N, AB, C, P, E Competent
and record keeping
CCT 7.1.2 (L2) Discuss patient confidentiality and the safekeeping of patient- N, AB, C, P, E Proficient
identifiable data (see GNP7 Legal and ethical practice)
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 7.2.1 (L2) Complete all documentation accurately and legibly in accordance N, AB, C, P, E Competent
with local guidelines
CCT 7.2.2 (L2) Ensure that patient-identifiable records remain secure N, AB, C, P, E Competent

34 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Cross-cutting themes (CCT) Level 2

CCT8 – Preventing and controlling violence and aggression – Level 2
Ensure safety of staff and patients when individuals display violent and/or aggressive behaviour
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CCT 8.1.1 (L2) Demonstrate an understanding of clinical conditions that increase N, AB, C, P, E Competent
the risk of violence and aggression
CCT 8.1.2 (L2) Understand organic (physical) causes of violent or aggressive N, AB, C, P, E Competent
behaviour and the importance of early senior medical assessment
CCT 8.1.3 (L2) Understand the potential triggers for violent and aggressive N, AB, C, P, E Competent
behaviour
CCT 8.1.4 (L2) Understand the local policy on restraint, both physical and N, AB, C, P, E Competent
chemical
CCT 8.1.5 (L2) Understand the local policy for involvement of security and police N, AB, C, P, E Competent
services
CCT 8.1.6 (L2) Describe the use of safe breakaway techniques N, AB, C, P, E Competent
Skills Self-assessment Minimum standard Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement completion achieved (print and sign)
CCT 8.2.1 (L2) Recognise signs of increasing emotion or agitation and use N, AB, C, P, E Proficient
appropriate de-escalation techniques in the management of
violence and aggression
CCT 8.2.2 (L2) Use safe breakaway techniques to maintain own safety N, AB, C, P, E Proficient
CCT 8.2.3 (L2) Ensure any restrictive practice procedures are implemented safely, N, AB, C, P, E Proficient
effectively and based on an appropriate assessment of risk, with
minimum force necessary and appropriate monitoring during the
restraint
CCT 8.2.4 (L2) Contact support services to assist with episodes of violence and N, AB, C, P, E Proficient
aggression as per local policy
CCT 8.2.5 (L2) Safely and effectively assist with rapid tranquilisation and N, AB, C, P, E Proficient
undertake appropriate nursing care of the sedated patient
CCT 8.2.6 (L2) Use local risk management system to report episodes of violence N, AB, C, P, E Proficient
and aggression
CCT 8.2.7 (L2) Recognise the implications for the mental wellbeing of all people N, AB, C, P, E Proficient
involved following an episode of violence or aggression and seek
appropriate support

35 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CROSS-CUTTING THEMES (CCT) LEVEL 2
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Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Caring for acutely ill adults
Emergency
Caring for
planning and
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

36 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.1 – Adults with problems affecting the respiratory system – Level 2
Care for patients with airway and respiratory system problems (also see the National Major Trauma Nursing Group competencies for trauma-specific respiratory competences)
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 1.1.1 (L2) Understand the normal anatomy and physiology of the respiratory N, AB, C, P, E Competent
system
CD1 1.1.2 (L2) Understand the principles (and tools used) of respiratory function N, AB, C, P, E Proficient
assessment
CD1 1.1.3 (L2) Understand the conditions associated with actual or potential N, AB, C, P, E Proficient
obstruction of the upper airway and the associated signs and
airway noises
CD1 1.1.4 (L2) Discuss the features and clinical presentation of patients with: N, AB, C, P, E Proficient
• acute breathlessness
• type 1 respiratory failure
• type 2 respiratory failure
CD1 1.1.5 (L2) Understand the pathophysiology associated with the illnesses of: N, AB, C, P, E Proficient
• pulmonary embolism (PE)
• respiratory tract infection and pneumonia
• asthma
• COPD
CD1 1.1.6 (L2) Understand the local and national guidelines for oxygen therapy N, AB, C, P, E Proficient
CD1 1.1.7 (L2) Discuss methods of delivering oxygen therapy for supporting N, AB, C, P, E Proficient
ventilation
CD1 1.1.8 (L2) Describe the pathophysiology of a pneumothorax and tension N, AB, C, P, E Competent
pneumothorax, and describe the principles and possible
complications of treatment
CD1 1.1.9 (L2) Understand the signs and symptoms of respiratory distress and N, AB, C, P, E Proficient
the local escalation processes to ensure appropriate clinical
support

37 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 1.2.1 (L2) As part of a structured A-E assessment, demonstrate assessment N, AB, C, P, E Proficient
and recording of:
• actual or potential airway obstruction
• respiratory rate, depth and pattern
• oxygen saturations, having awareness of situations which affect
reliability of readings
• peak expiratory flow rate
CD1 1.2.2 (L2) Recognise and respond appropriately to: N, AB, C, P, E Proficient
• stridor
• expiratory wheeze
CD1 1.2.3 (L2) Deliver oxygen therapy using a range of devices, including: N, AB, C, P, E Proficient
• nasal cannulae
• variable flow masks
• high-concentration masks
• tracheostomy masks
CD1 1.2.4 (L2) Deliver inhaled medication via: N, AB, C, P, E Proficient
• metered dose inhaler (with and without spacer device)
• nebuliser device
CD1 1.2.5 (L2) Prepare equipment and support a patient undergoing chest N, AB, C, P, E Competent
aspiration or chest drain insertion for a pneumothorax

38 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.2 – Adults with problems affecting the cardiovascular system – Level 2
Effectively care for patients with cardiovascular problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 2.1.1 (L2) Understand the normal anatomy and physiology of the N, AB, C, P, E Competent
cardiovascular system
CD1 2.1.2 (L2) Understand cardiac conduction, the cardiac cycle and the features N, AB, C, P, E Competent
of the normal ECG
CD1 2.1.3 (L2) Discuss the advanced life support (ALS) algorithms for managing N, AB, C, P, E Competent
abnormal cardiac rhythms associated with significant patient
cardiovascular compromise
CD1 2.1.4 (L2) Describe the ECG changes associated with acute coronary N, AB, C, P, E Proficient
syndrome (ACS) and myocardial infarction (MI) and appropriate
escalation pathways
CD1 2.1.5 (L2) Understand the emergency treatment for ACS and MI N, AB, C, P, E Competent
CD1 2.1.6 (L2) Discuss the pathophysiology of: N, AB, C, P, E Competent
• pericarditis
• pulmonary embolism
• pneumothorax
• pleuritic pain
• musculoskeletal chest pain
• ischaemic limb pain
CD1 2.1.7 (L2) Understand the pathophysiology of sickle cell anaemia and N, AB, C, P, E Competent
treatment for sickle cell crisis in relation to cardiovascular
problems
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 2.2.1 (L2) Undertake a structured approach to the assessment of patients N, AB, C, P, E Proficient
presenting with chest pain and determine priority of care
CD1 2.2.2 (L2) Correctly perform 12 lead ECG and troubleshoot where recordings N, AB, C, P, E Proficient
are of poor quality (such as artefact, wandering baseline etc.)
CD1 2.2.3 (L2) Demonstrate a systematic approach to ECG interpretation and N, AB, C, P, E Competent
recognition of life-threatening arrhythmias

39 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 2.2.4 (L2) Effectively prepare patients and equipment and assist in the N, AB, C, P, E Competent
procedure for:
• synchronised cardioversion
• transcutaneous pacing
CD1 2.2.5 (L2) Initiate effective immediate management of ACS following local N, AB, C, P, E Competent
policy and guidelines
CD1 2.2.6 (L2) Provide effective care to patients in acute heart failure, including N, AB, C, P, E Proficient
administration of prescribed medication, monitoring of clinical
condition and provision of psychological support
CD1 2.2.7 (L2) Ensure timely emergency care for patients with sickle cell crisis N, AB, C, P, E Competent
and support provision of prescribed treatment

40 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.3 Neurological system – Level 2
Effectively care for patients with neurological problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 3.1.1 (L2) Understand basic anatomy and physiology of the central nervous N, AB, C, P, E Competent
system including:
• principal brain areas and their function
• sensory and motor pathways
CD1 3.1.2 (L2) Understand the pathophysiology associated with the following N, AB, C, P, E Competent
medical conditions:
• stroke
• intracranial haemorrhage (subarachnoid haemorrhage,
extradural haemorrhage, subdural haemorrhage)
• epilepsy
• Parkinson’s disease
• Guillain–Barré syndrome
• Myasthenia gravis
CD1 3.1.3 (L2) Understand national guidelines for: N, AB, C, P, E Competent
• stroke
• head injury
• Parkinson’s disease
• back pain
CD1 3.1.4 (L2) Discuss the signs of conditions requiring emergency intervention: N, AB, C, P, E Competent
• raised intracranial pressure
• cauda-equina
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 3.2.1 (L2) Recognise and act appropriately when mechanism of injury or N, AB, C, P, E Competent
history of presenting complaint may suggest acute neurological
insult

41 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 3.2.2 (L2) Undertake a neurological assessment to include: N, AB, C, P, E Proficient

• assessment of conscious level using ‘alert, voice, pain,
unresponsive’ scale (AVPU)
• basic assessment of sensation, motor power and tone
• Glasgow Coma Score
• assessment of pupillary size and reaction
CD1 3.2.3 (L2) Identify patients with red flag symptoms and/or signs and escalate N, AB, C, P, E Competent
concerns to appropriate clinician
CD1 3.2.4 (L2) Apply local and national clinical guidelines in the care of N, AB, C, P, E Competent
• stroke
• intracranial haemorrhage
• seizures
• altered levels of consciousness
CD1 3.2.5 (L2) Provide safe and effective care of the agitated and/or combative N, AB, C, P, E Competent
patient

42 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.4 - Gastrointestinal system – Level 2
Effectively care for patients with abdominal pain and/or gastrointestinal problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 4.1.1 (L2) Understand the anatomy and physiology of the gastrointestinal N, AB, C, P, E Competent
(GI) system
CD1 4.1.2 (L2) Understand the pathophysiology associated with the following N, AB, C, P, E Competent
emergency presentations:
• GI bleeding
• intra-abdominal sepsis, including pancreatitis
• acute gastroenteritis
• abdominal aortic aneurism
• ischaemic bowel
CD1 4.1.3 (L2) Discuss specific information required when assessing patients with N, AB, C, P, E Proficient
acute gastrointestinal symptoms and/or abdominal pain in order
to determine clinical priority
CD1 4.1.4 (L2) Understand local clinical guidelines pertaining to common N, AB, C, P, E Competent
gastrointestinal emergency presentations (e.g. GI bleeding)
CD1 4.1.5 (L2) Understand the investigations commonly undertaken in patients N, AB, C, P, E Competent
with abdominal pain or gastrointestinal presentations
CD1 4.1.6 (L2) Understand the rationale for insertion of nasogastric tube in this N, AB, C, P, E Competent
group of patients and local guidelines/policy for tube placement
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 4.2.1 (L2) Demonstrate initial assessment and prioritisation of patients N, AB, C, P, E Proficient
presenting with abdominal pain, initiating appropriate pain relief
and investigations to aid further clinical assessment
CD1 4.2.2 (L2) Recognise and report ‘red flag’ signs and symptoms of: N, AB, C, P, E Competent
• vomiting and/or per rectum loss of frank or occult blood
• faecal vomiting
• rigid/distended abdomen
• abdominal bruising
CD1 4.2.3 (L2) Provide care with respect to dignity and privacy for patients with N, AB, C, P, E Proficient
diarrhoea and or vomiting; having awareness of skin integrity
problems in patients with diarrhoea

43 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 4.2.4 (L2) Demonstrate the ability to safely and effectively insert a wide bore N, AB, C, P, E Competent
nasogastric tube
CD1 4.2.5 (L2) Recognise and locate the equipment used to control variceal N, AB, C, P, E Competent
bleeding and instigate massive haemorrhage protocol where
needed
CD1 4.2.6 (L2) Recognise patients who may pose an infection control risk and N, AB, C, P, E Competent
implement isolation procedures (e.g. those with diarrhoea and or
vomiting)
CD1 4.2.7 (L2) Undertake collection of stool samples and send for appropriate N, AB, C, P, E Competent
investigations

44 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.5 – Renal system – Level 2
Effectively care for patients with renal problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 5.1.1 (L2) Understand the anatomy and physiology of the kidneys and renal N, AB, C, P, E Competent
tract
CD1 5.1.2 (L2) Understand the pathophysiology associated with the common N, AB, C, P, E Competent
renal presentations:
• Pyelonephritis
• renal colic
• urine retention and haematuria
• trauma to the kidney and/or renal tract
CD1 5.1.3 (L2) Discuss the pathophysiology associated with the following N, AB, C, P, E Competent
presentations and their relationship to the renal system:
• hyper/hypokalemia
• hyper/hyponatremia
• hypomagnesemia
CD1 5.1.4 (L2) Understand the presenting signs and symptoms and N, AB, C, P, E Competent
pathophysiology associated with:
• AKI – acute kidney injury
• CKD – chronic kidney disease
CD1 5.1.5 (L2) Recognise the normal values for urea and electrolytes and N, AB, C, P, E Competent
understand the significance of derangement
CD1 5.1.6 (L2) Understand the local and national guidelines (including NICE N, AB, C, P, E Competent
guidelines) in relation to AKI and CKD
CD1 5.1.7 (L2) Understand the principles of haemofiltration and the emergency N, AB, C, P, E Competent
indications for dialysis
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 5.2.1 (L2) Identify patients with abnormal renal function tests and escalate N, AB, C, P, E Competent
appropriately
CD1 5.2.2 (L2) Implement safe and effective care in patients with: N, AB, C, P, E Competent
• acute kidney injury
• chronic kidney disease

45 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 5.2.3 (L2) Insert urethral catheters in female patients in line with locally N, AB, C, P, E Competent
agreed policies and procedures
CD1 5.2.4 (L2) Insert urethral catheters in male patients in line with locally agreed N, AB, C, P, E Competent
policies and procedures
CD1 5.2.5 (L2) Monitor urine output and fluid intake and escalate concerns N, AB, C, P, E Proficient
appropriately

46 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.6 – Endocrine system – Level 2
Effectively care for patients with endocrine problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 6.1.1 (L2) Understand the anatomy and physiology associated with the N, AB, C, P, E Competent
endocrine system
CD1 6.1.2 (L2) Understand the pathophysiology associated with conditions N, AB, C, P, E Competent
affecting the endocrine system, in particular:
• pancreas – diabetes and glycaemic emergencies
• thyroid – thyrotoxicosis and hypothyroidism
• pituitary – diabetes insipidus
• adrenal – Addison’s disease
CD1 6.1.3 (L2) Describe the signs and symptoms of the following presentations: N, AB, C, P, E Competent
• hyperglycaemia
• diabetic ketoacidosis (DKA)
• hypoglycaemia
• Addisonian Crisis
CD1 6.1.4 (L2) Understand the local guidelines to manage endocrine emergency N, AB, C, P, E Competent
presentations
CD1 6.1.5 (L2) Understand the normal reference ranges for blood glucose, blood N, AB, C, P, E Competent
pH, lactate and blood gases
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 6.2.1 (L2) Recognise ‘red flag’ endocrine presentations and escalate N, AB, C, P, E Competent
concerns to an appropriate clinician
CD1 6.2.2 (L2) Provide safe and effective assessment of patients presenting with N, AB, C, P, E Competent
actual or potential problems affecting the endocrine system,
including the ability to undertake the following investigations:
• capillary blood glucose monitoring
• capillary blood ketone monitoring
• urinalysis

47 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 6.2.3 (L2) Instigate the blood tests necessary to investigate and manage N, AB, C, P, E Competent
endocrine emergencies
CD1 6.2.4 (L2) Provide safe and effective care to patients with endocrine N, AB, C, P, E Competent
emergencies, in particular the management of:
• hyperglycaemia
• DKA
• hypoglycaemia
• Addison’s Crisis

48 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.7 – Reproductive system – Level 2
Effectively care for patients with reproductive system problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 7.1.1 (L2) Understand the normal anatomy and physiology of the male and N, AB, C, P, E Competent
female reproductive system
CD1 7.1.2 (L2) Understand the assessment and management of vaginal and rectal N, AB, C, P, E Competent
foreign bodies
CD1 7.1.3 (L2) Understand the emotional and physical care of women and men N, AB, C, P, E Competent
who present with injuries as a result of sexual assault or rape
CD1 7.1.4 (L2) Discuss the signs, symptoms and presentation of sexually N, AB, C, P, E Competent
transmitted infections (STIs), their management and the
information and referral resources available
CD1 7.1.5 (L2) Describe the health promotion and screening available for N, AB, C, P, E Competent
reproductive health surveillance for men and women including:
• breast and testicular self-examination
• vulval health
• cervical smears
• human papilloma virus (HPV) vaccination
• mammography
• prostate assessment and examination
Female-specific competency knowledge
CD1 7.1.6 (L2) Understand reproductive development and maturity, the N, AB, C, P, E Competent
menstrual cycle and the features of normal menopausal changes
CD1 7.1.7 (L2) Describe the primary symptoms of potential cancer diagnosis N, AB, C, P, E Competent
CD1 7.1.8 (L2) Discuss the specific assessment related to female reproductive N, AB, C, P, E Proficient
system presentations to determine clinical priority
CD1 7.1.9 (L2) Understand the assessment, treatment options, health advice and N, AB, C, P, E Competent
sexual health promotion for women requesting emergency
contraception
CD1 7.1.10 (L2) Discuss the legal and professional responsibilities of the N, AB, C, P, E Competent
emergency nurse in relation to female genital mutilation (FGM)

49 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Pregnancy-specific competency knowledge

CD1 7.1.11 (L2) Understand the significance of establishing pregnancy in the N, AB, C, P, E Competent
emergency care setting and the potential for false negatives based
on hormonal irregularities
CD1 7.1.12 (L2) Describe the development of the foetus within the first 16 weeks N, AB, C, P, E Competent
and the related health guidance in early pregnancy
CD1 7.1.13 (L2) Understand the signs and symptoms and management of N, AB, C, P, E Competent
hyperemesis
CD1 7.1.14 (L2) Understand the local guidance relating to: N, AB, C, P, E Competent
• miscarriage
• ectopic pregnancy
• emergency delivery
CD1 7.1.15 (L2) Describe local policy for investigating and/or disposing of N, AB, C, P, E Competent
products of conception in the emergency care setting
CD1 7.1.16 (L2) Understand the physical and emotional impact of early N, AB, C, P, E Competent
miscarriage and ectopic pregnancy and the importance of
empathy, support and specific services and counselling available
CD1 7.1.17 (L2) Understand the assessment and management of women N, AB, C, P, E Competent
presenting with complications post termination of pregnancy
CD1 7.1.18 (L2) Understand common complications which arise in the third N, AB, C, P, E Competent
trimester of pregnancy (e.g. pre-eclampsia, gestational diabetes)
Gynaecological conditions
CD1 7.1.19 (L2) Understand the features and management of: N, AB, C, P, E Competent
• torsion or rupture of ovarian cysts
• salpingitis
• pelvic inflammatory disorders
• dysmenorrhoea
• IVF associated conditions (ovarian hyperstimulation)
CD1 7.1.20 (L2) Understand the features and management of abnormal vaginal N, AB, C, P, E Competent
bleeding from:
• trauma
• post-coital
• post-menopausal

50 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Male-specific competency knowledge

CD1 7.1.21 (L2) Understand reproductive development and sexual maturity N, AB, C, P, E Competent
CD1 7.1.22 (L2) Describe the specific assessment related to the male reproductive N, AB, C, P, E Competent
system to determine clinical priority
CD1 7.1.23 (L2) Understand the signs and symptoms and management of: N, AB, C, P, E Competent
• torsion of the testes
• hydrocele
• epididymo-orchitis
• penile trauma
• penile fracture
• balanitis
• paraphymosis
• priaprism
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 7.2.1 (L2) Undertake a structured approach to the initial assessment of N, AB, C, P, E Proficient
women presenting with problems associated with pregnancy and
prioritise appropriately (triage)
CD1 7.2.2 (L2) Undertake a structured approach to the initial assessment of N, AB, C, P, E Proficient
women presenting with gynaecological symptoms and prioritise
appropriately
CD1 7.2.3 (L2) Prepare equipment and support women undergoing vaginal N, AB, C, P, E Competent
examination and ensure the presence of a female chaperone
CD1 7.2.4 (L2) Identify location and prepare equipment required in the event of N, AB, C, P, E Competent
haemorrhagic shock resulting from vaginal bleeding
CD1 7.2.5 (L2) Undertake a structured approach to the initial assessment of men N, AB, C, P, E Proficient
presenting with reproductive/genital associated symptoms and
prioritise appropriately
CD1 7.2.6 (L2) Prepare equipment and support men undergoing examination of N, AB, C, P, E Competent
the reproductive system, and ensure the presence of a male
chaperone
CD1 7.2.7 (L2) Demonstrate compassion and empathy when communicating with N, AB, C, P, E Proficient
patients, and those important to them, who may be experiencing
the loss of a pregnancy or news of an unexpected pregnancy
CD1 7.2.8 (L2) Demonstrate a non-judgemental approach to issues of sexual N, AB, C, P, E Proficient
harm, including FGM, assault, rape and sexually transmitted
infection

51 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD1 – Caring for acutely ill adults – Level 2

CD1.8 – Illness affecting the musculoskeletal system – Level 2
(also see the National Major Trauma Nursing Group competencies Level 2, which can be found at: www.nmtng.co.uk/emergency-dept-1.html)
Effectively care for patients with major musculoskeletal problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 8.1.1 (L2) Understand the anatomy and physiology of the musculoskeletal N, AB, C, P, E Competent
system
CD1 8.1.2 (L2) Understand the immediate management of catastrophic N, AB, C, P, E Proficient
haemorrhage associated with musculoskeletal injuries
CD1 8.1.3 (L2) Describe the signs and symptoms of life or limb-threatening N, AB, C, P, E Competent
musculoskeletal injuries
CD1 8.1.4 (L2) Describe the initial assessment of major musculoskeletal problems, N, AB, C, P, E Competent
including the relevance of mechanism of injury
CD1 8.1.5 (L2) Understand the pathophysiology of major musculoskeletal N, AB, C, P, E Competent
problems including:
• major fractures – pelvis, hip and long bones
• spinal injury
• cauda-equina
• major joint dislocation
CD1 8.1.6 (L2) Understand the local and national guidelines for the assessment N, AB, C, P, E Competent
and management of major musculoskeletal problems (e.g. local
trauma network guidelines)
CD1 8.1.7 (L2) Understand the assessment and treatment of venous N, AB, C, P, E Competent
thromboembolism (VTE)
CD1 8.1.8 (L2) Describe local policy on VTE prevention in patients with N, AB, C, P, E Competent
immobilised limbs
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD1 8.2.1 (L2) Undertake a structured initial assessment of patients with N, AB, C, P, E Proficient
musculoskeletal problems and prioritise care appropriately (triage)

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CD1 8.2.2 (L2) Provide safe and effective care for patients with: N, AB, C, P, E Proficient
• major pelvic injury
• fractured neck of femur
• fractured femoral shaft
• major joint dislocation
• spinal injury
CD1 8.2.3 (L2) Identify the need for emergency manipulations of fractures and N, AB, C, P, E Competent
dislocations that pose a threat to neurovascular supply or skin
integrity, and escalate appropriately
CD1 8.2.4 (L2) Apply a range of splints to support major fractures N, AB, C, P, E Competent
CD1 8.2.5 (L2) Apply femoral traction splints N, AB, C, P, E Competent
CD1 8.2.6 (L2) Apply a pelvic splint N, AB, C, P, E Competent
CD1 8.2.7 (L2) Identify the need for, and demonstrate safe spinal immobilisation N, AB, C, P, E Competent
of patients and lead procedures to move patients who require
spinal immobilisation

53 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Caring for adults requiring
Emergency
resuscitation planning and
Caring for
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
For nurses caring for trauma patients please also see the National mental health young people
Major Trauma Nursing Group competencies, available at: needs
www.nmtng.co.uk/emergency-dept-1.html

54 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.1 – Anaphylaxis – Level 2
Care appropriately for patients suffering anaphylaxis
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 1.1.1 (L2) Understand the pathophysiology of anaphylaxis N, AB, C, P, E Competent
CD2 1.1.2 (L2) Understand the clinical signs and symptoms, differentiating N, AB, C, P, E Proficient
between allergic reaction and anaphylaxis
CD2 1.1.3 (L2) Discuss the common causes of anaphylaxis N, AB, C, P, E Competent
CD2 1.1.4 (L2) Describe how to summon emergency assistance to support N, AB, C, P, E Proficient
immediate emergency care
CD2 1.1.5 (L2) Understand the national and local guidelines for the emergency N, AB, C, P, E Competent
management of anaphylaxis
CD2 1.1.6 (L2) Understand the importance of investigations in patients with N, AB, C, P, E Competent
anaphylaxis (e.g. venous blood gas, lactate, mast cell tryptase)
CD2 1.1.7 (L2) Understand the follow-up pathways following treatment for N, AB, C, P, E Competent
anaphylaxis
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 1.2.1 (L2) Recognise signs of anaphylaxis (bronchospasm, hypotension, N, AB, C, P, E Proficient
angio-oedema) and summon appropriate clinical support
CD2 1.2.2 (L2) Initiate emergency resuscitation – oxygen and IM adrenaline N, AB, C, P, E Competent
CD2 1.2.3 (L2) Ensure timely IV access, IV fluids, antihistamine and steroids (in N, AB, C, P, E Competent
accordance with national guidance and locally agreed procedures)
CD2 1.2.4 (L2) Establish appropriate physiological monitoring N, AB, C, P, E Competent
CD2 1.2.5 (L2) Ensure the patient is placed in an appropriate clinical area, capable N, AB, C, P, E Proficient
of supporting their physiological needs and level of observation
CD2 1.2.6 (L2) Order appropriate investigations (e.g. venous blood gas, lactate, N, AB, C, P, E Competent
mast cell tryptase)

55 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.2 – Cardiorespiratory arrest – Level 2
Identify patients in respiratory or cardiorespiratory arrest and instigate life support procedures in accordance with the UK Resuscitation Council guidelines (2015), available at:
www.resus.org.uk/resuscitation-guidelines
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 2.1.1 (L2) Understand the causes of cardiac arrest, including special situations N, AB, C, P, E Proficient
(e.g. overdose, hypothermia)
CD2 2.1.2 (L2) Understand the UK Resuscitation Council guidelines for in-hospital N, AB, C, P, E Proficient
resuscitation
CD2 2.1.3 (L2) Understand the indications and delivery methods of drugs used N, AB, C, P, E Proficient
within the advanced life support (ALS) algorithm
CD2 2.1.4 (L2) Describe the safe use of emergency resuscitation equipment (e.g. N, AB, C, P, E Proficient
suction, oxygen, defibrillator, automated compression device)
CD2 2.1.5 (L2) Discuss the major reversible causes of cardiorespiratory arrest and N, AB, C, P, E Proficient
their treatment
CD2 2.1.6 (L2) Understand the decision-making process relating to continuation or N, AB, C, P, E Proficient
termination of resuscitation, and the actions to be taken in the event
of unsuccessful resuscitation
CD2 2.1.7 (L2) Understand procedures relating to organ and tissue donation N, AB, C, P, E Proficient
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 2.2.1 (L2) Rapidly assess the collapsed patient, adopting a structured approach N, AB, C, P, E Proficient
CD2 2.2.2 (L2) Recognise critical illness and summon appropriate clinical support to N, AB, C, P, E Proficient
instigate early management (prevention of cardiorespiratory arrest)
CD2 2.2.3 (L2) Perform basic life support in accordance with the Resuscitation N, AB, C, P, E Proficient
Council UK guidelines. For example, effective chest compressions,
basic airway management and bag-valve-mask ventilation
CD2 2.2.4 (L2) Advanced Life Support (ALS) (or equivalent) provider status N, AB, C, P, E Competent
CD2 2.2.5 (L2) Identify shockable cardiac arrest rhythms (VF, VT) and safely perform N, AB, C, P, E Competent
DC defibrillation when indicated
CD2 2.2.6 (L2) Anticipate and prepare drugs as per ALS guidelines N, AB, C, P, E Competent
CD2 2.2.7 (L2) Provide clinical care as part of the ALS approach; IV/IO access, IV/IO N, AB, C, P, E Competent
drug administration and where indicated, assist with emergency
endotracheal intubation. Assist in the management of reversible
causes of arrest

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CD2 2.2.8 (L2) Undertake lead nurse role as part of the clinical team N, AB, C, P, E Competent
CD2 2.2.9 (L2) Instigate appropriate monitoring and investigations following return N, AB, C, P, E Competent
of spontaneous cardiac output
CD2 2.2.10 (L2) Provide appropriate emotional support during the process of N, AB, C, P, E Proficient
breaking bad news. For example, demonstrate sensitivity and
empathy
CD2 2.2.11 (L2) Care for the deceased patient in accordance with local guidelines N, AB, C, P, E Competent

57 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.3 – Managing sepsis – Level 2
Provide appropriate care for patients with sepsis
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 3.1.1 (L2) Understand the potential causes of sepsis N, AB, C, P, E Competent
CD2 3.1.2 (L2) Understand the pathophysiology of sepsis, including its identifying N, AB, C, P, E Competent
clinical features
CD2 3.1.3 (L2) Describe the significance of patient investigations such as: lactate N, AB, C, P, E Competent
levels and white cell count
CD2 3.1.4 (L2) Articulate the features associated with high risk criteria for sepsis N, AB, C, P, E Competent
and the circumstances in which patients may require senior clinical
input and/or review by intensive care experts
CD2 3.1.5 (L2) Understand locally agreed guidelines and documentation relating N, AB, C, P, E Competent
to sepsis
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 3.2.1 (L2) Identify patients with signs or symptoms of sepsis and ensure N, AB, C, P, E Competent
initiation of early treatment as per local guidelines
CD2 3.2.2 (L2) Instigate physiological monitoring, record baseline observations N, AB, C, P, E Proficient
and accurately calculate early warning score and assign patient
priority (triage)
CD2 3.2.3 (L2) Initiate oxygen therapy titrated to oxygen saturations and in N, AB, C, P, E Proficient
accordance with agreed guidelines
CD2 3.2.4 (L2) Establish IV access and obtain appropriate blood samples, N, AB, C, P, E Proficient
including venous blood cultures – in line with locally agreed
procedures
CD2 3.2.5 (L2) Evaluate results of near patient tests and report abnormal results N, AB, C, P, E Competent
to an appropriate clinician
CD2 3.2.6 (L2) Administer intravenous fluid and antibiotics as prescribed and in N, AB, C, P, E Competent
accordance with guidelines and local policy
CD2 3.2.7 (L2) Maintain accurate fluid balance monitoring N, AB, C, P, E Proficient
CD2 3.2.8 (L2) Maintain close observation of patient’s condition, liaising with N, AB, C, P, E Competent
critical care support as required in line with local guidelines and
procedures

58 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.4 – The shocked patient – Level 2
Provide appropriate care for patients with ‘shock’ states. Also see CD2.1 Anaphylaxis, CD2.3 Sepsis and the National Major Trauma Group competencies
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 4.1.1 (L2) Define ‘shock’ and discuss the pathophysiology and presenting signs N, AB, C, P, E Competent
and symptoms resulting from:
• hypovolemic shock
• cardiogenic shock
• septic shock
• anaphylactic shock
• neurogenic shock
CD2 4.1.2 (L2) Understand the progression of shock and the resulting manifestation N, AB, C, P, E Competent
of signs, symptoms and blood values
CD2 4.1.3 (L2) Understand the management of the different forms of shock listed N, AB, C, P, E Competent
above
CD2 4.1.4 (L2) Describe methods to minimise external bleeding N, AB, C, P, E Competent
CD2 4.1.5 (L2) Understand the local guidelines relating to activation of the massive N, AB, C, P, E Competent
haemorrhage protocol
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 4.2.1 (L2) Identify and report evidence of catastrophic haemorrhage N, AB, C, P, E Competent
CD2 4.2.2 (L2) Establish physiological monitoring, record baseline observations and N, AB, C, P, E Proficient
accurately calculate early warning score and assign triage category
CD2 4.2.3 (L2) Initiate oxygen therapy in accordance with local and national guidance N, AB, C, P, E Competent
CD2 4.2.4 (L2) Establish IV access and obtain appropriate blood samples, in line with N, AB, C, P, E Competent
locally agreed procedures
CD2 4.2.5 (L2) Evaluate blood results and communicate abnormal results N, AB, C, P, E Competent
appropriately
CD2 4.2.6 (L2) Initiate intravenous fluids and/or transfusion of blood products as N, AB, C, P, E Competent
prescribed and in accordance with guidelines and local policy
CD2 4.2.7 (L2) Maintain accurate fluid balance monitoring N, AB, C, P, E Proficient
CD2 4.2.8 (L2) Evaluate effect of interventions, communicate to responsible clinician N, AB, C, P, E Competent
and facilitate critical care support in line with local guidelines and
procedures

59 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.5 – The unconscious patient – Level 2
Provide holistic care for patients presenting with reduced level of consciousness
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 5.1.1 (L2) Discuss the potential causes of unconsciousness N, AB, C, P, E Competent
CD2 5.1.2 (L2) Describe the systematic assessment of patients with altered levels N, AB, C, P, E Proficient
of consciousness
CD2 5.1.3 (L2) Understand the terms ‘AVPU’ and describe the Glasgow Coma N, AB, C, P, E Proficient
Score (GCS)
CD2 5.1.4 (L2) Describe the investigations required to establish cause and N, AB, C, P, E Competent
possible treatment for patients with altered levels of
consciousness
CD2 5.1.5 (L2) Describe methods of obtaining information on relevant medical N, AB, C, P, E Competent
history in unconscious patients (e.g. medic alerts, telephone)
CD2 5.1.6 (L2) Understand the local pathways to specialist services for patients N, AB, C, P, E Competent
with brain injury (e.g. cerebral haemorrhage or stroke)
CD2 5.1.7 (L2) Understand the need for comprehensive nursing care to meet N, AB, C, P, E Proficient
hydration, hygiene (oral, eye and general), mobility and
communication needs in patients unable to do so themselves
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 5.2.1 (L2) Recognise patients who are unable to maintain their own airway N, AB, C, P, E Competent
and implement the following basic airway skills:
• positioning – chin lift/head tilt and/or jaw thrust
• use of oropharyngeal airways (OPA)
• use of nasopharyngeal airway (NPA)
• suctioning of the oropharynx
CD2 5.2.2 (L2) Escalate, promptly and effectively, concerns about any patient N, AB, C, P, E Proficient
with the inability to protect or maintain their airway or where
there is derangement or deterioration of physiological parameters
CD2 5.2.3 (L2) Demonstrate the ability to undertake a structured initial N, AB, C, P, E Proficient
assessment of a patient with altered conscious level, and prioritise
care appropriately (triage)
CD2 5.2.4 (L2) Establish appropriate physiological monitoring N, AB, C, P, E Proficient

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CD2 5.2.5 (L2) Demonstrate effective patient positioning, having due regard for N, AB, C, P, E Proficient
pressure area care
CD2 5.2.6 (L2) Ensure hygiene needs are met with due regard for privacy and N, AB, C, P, E Competent
dignity
CD2 5.2.7 (L2) Conduct eye and mouth care once initial assessment and N, AB, C, P, E Competent
evaluation has been completed
CD2 5.2.8 (L2) Take steps to establish identity of patients and contact significant N, AB, C, P, E Competent
others

61 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.6 – Emergency airway and ventilation management – Level 2
Provide holistic care for patients requiring emergency airway intervention and/or ventilation
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 6.1.1 (L2) Understand the principles of bag-valve-mask ventilation N, AB, C, P, E Proficient
CD2 6.1.2 (L2) Describe emergency airway management and the concepts of N, AB, C, P, E Competent
rapid sequence induction (RSI)
CD2 6.1.3 (L2) Understand the guidelines for minimum standards of monitoring N, AB, C, P, E Competent
of physiological parameters for ventilated patients and the local
equipment required
CD2 6.1.4 (L2) Understand the drugs commonly used for: N, AB, C, P, E Competent
• emergency anaesthesia and RSI
• on-going anaesthesia
CD2 6.1.5 (L2) Describe the standard operating procedures and guidelines N, AB, C, P, E Competent
relating to emergency airway management and the roles of each
team member
CD2 6.1.6 (L2) Understand end-tidal CO2 monitoring (ETCO2) and the normal N, AB, C, P, E Competent
values
CD2 6.1.7 (L2) Understand normal blood gas values N, AB, C, P, E Competent
CD2 6.1.8 (L2) Understand how blood gas values change due to inadequate N, AB, C, P, E Competent
ventilation and/or inadequate perfusion
CD2 6.1.9 (L2) Discuss use of mechanical ventilator – identifying location, N, AB, C, P, E Competent
associated equipment (e.g. tubing, filters) and principles of
functioning
CD2 6.1.10 (L2) Understand the signs of a patient who is under-sedated and/or N, AB, C, P, E Competent
requires further paralysis
CD2 6.1.11 (L2) Discuss the process of endotracheal suctioning and associated N, AB, C, P, E Competent
complications
CD2 6.1.12 (L2) Understand the features of patients who may be predicted to be N, AB, C, P, E Competent
difficult to intubate and or bag-valve-mask ventilate
CD2 6.1.13 (L2) Describe the location and components of difficult airway N, AB, C, P, E Competent
equipment
CD2 6.1.14 (L2) Describe the location and components of surgical airway N, AB, C, P, E Competent
equipment

62 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 6.2.1 (L2) Establish physiological monitoring and prepare ETC02 equipment N, AB, C, P, E Competent
CD2 6.2.2 (L2) Prepare the drugs prescribed for RSI in accordance with local N, AB, C, P, E Competent
guidelines and procedures
CD2 6.2.3 (L2) Prepare equipment for intubation in discussion with the clinician N, AB, C, P, E Competent
who will intubate the patient
CD2 6.2.4 (L2) Prepare the ventilator for use and effectively undertake a N, AB, C, P, E Competent
functional check following agreed procedures
CD2 6.2.5 (L2) Correctly discuss pre-determined ventilator settings and set up N, AB, C, P, E Competent
the transport ventilator effectively
CD2 6.2.6 (L2) Safely and effectively undertake the role of airway assistant during N, AB, C, P, E Competent
RSI and intubation
CD2 6.2.7 (L2) Correctly assemble the equipment necessary to suction through N, AB, C, P, E Competent
the endotracheal tube and demonstrate safe technique for
endotracheal suctioning
CD2 6.2.8 (L2) Effectively monitor the patient’s physiological parameters N, AB, C, P, E Competent
post-intubation and ventilation and escalate concerns
appropriately
CD2 6.2.9 (L2) Demonstrate the correct procedure for the preparation of N, AB, C, P, E Competent
prescribed maintenance drugs for on-going anaesthesia and
paralysis

63 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.6a – The patient requiring non-Invasive ventilation (NIV) – Level 2
Provide holistic care for patients requiring non-invasive ventilation (NIV)
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 6a.1.1 (L2) Understand the anxieties experienced by patients needing NIV N, AB, C, P, E Competent
(and their families)
CD2 6a.1.2 (L2) Understand the indications, contraindications and potential N, AB, C, P, E Competent
complications with NIV
CD2 6a.1.2 (L2) Understand the difference in the two primary modes of NIV – N, AB, C, P, E Competent
CPAP and BiPAP
CD2 6a.1.3 (L2) Understand the British Thoracic Society guidelines and the local N, AB, C, P, E Competent
standard operating procedures for the use of NIV
CD2 6a.1.4 (L2) Describe the term positive end-expiratory pressure (PEEP) and N, AB, C, P, E Competent
discuss its advantages and disadvantages
CD2 6a.1.5 (L2) Understand the importance of oxygen saturation and arterial N, AB, C, P, E Competent
blood gas monitoring and interpretation in the contexts of
managing NIV
CD2 6a.1.6 (L2) Describe the systems available within the care setting to deliver N, AB, C, P, E Competent
NIV
CD2 6a.1.7 (L2) Understand when NIV may no longer be appropriate and the N, AB, C, P, E Competent
threshold at which invasive ventilation may be required
CD2 6a.1.8 (L2) Discuss the equipment required when transferring patients on NIV, N, AB, C, P, E Competent
both within the hospital and externally
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 6a.2.1 (L2) Provide adequate advice, instruction, reassurance and support to N, AB, C, P, E Competent
the patient prior to commencing NIV
CD2 6a.2.2 (L2) Identify the correct mask for the system being used and size the N, AB, C, P, E Competent
mask appropriately
CD2 6a.2.3 (L2) Instigate the correct standard of physiological monitoring prior to N, AB, C, P, E Competent
the implementation of NIV and monitor these parameters once
NIV has started
CD2 6a.2.4 (L2) Demonstrate the ability to effectively adjust NIV settings following N, AB, C, P, E Competent
prescribed limits and/or medically defined physiological
parameters
CD2 6a.2.5 (L2) Accurately document the care of patients undergoing NIV N, AB, C, P, E Competent

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CD2 6a.2.6 (L2) Demonstrate the ability to safely transfer patients undergoing NIV, N, AB, C, P, E Competent
ensure that all essential equipment accompanies the patient
during transfer

65 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD2 – Caring for adults requiring resuscitation – Level 2

CD2.7 – The patient requiring invasive monitoring (central venous access and arterial lines) – Level 2
Provide holistic care for patients requiring invasive monitoring using central venous access and/or arterial lines
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 7.1.1 (L2) Demonstrate understanding of the indications and rationale for N, AB, C, P, E Competent
the placement of central venous catheters or arterial catheters,
and the potential risks and complications of insertion
CD2 7.1.2 (L2) Understand local policies and guidelines for the placement and N, AB, C, P, E Competent
use of central venous access and arterial lines
CD2 7.1.3 (L2) Demonstrate an understanding of the equipment necessary for the N, AB, C, P, E Competent
insertion of central venous and arterial catheters, and the types of
lines commonly inserted
CD2 7.1.4 (L2) Demonstrate an understanding of the common sites for insertion N, AB, C, P, E Competent
and the procedure for insertion of central venous and arterial
catheters
CD2 7.1.5 (L2) Demonstrate an understanding of pressure transducer equipment N, AB, C, P, E Competent
and the configuration of the multi-modality monitor to facilitate
recording, and monitoring of CVP and arterial pressures
CD2 7.1.6 (L2) Demonstrate an understanding of the risks and complications N, AB, C, P, E Competent
associated with central venous access and arterial lines, and their
insertion
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD2 7.2.1 (L2) Correctly assemble the equipment necessary for central venous or N, AB, C, P, E Competent
arterial catheter insertion and prepare the procedure trolley whilst
maintaining aseptic technique
CD2 7.2.2 (L2) Where possible, ensure the patient is fully informed of the N, AB, C, P, E Competent
proposed procedure and provide psychological support
CD2 7.2.3 (L2) Correctly assist with the insertion procedure and assemble N, AB, C, P, E Competent
transducer equipment, ensuring lines are labelled correctly
CD2 7.2.4 (L2) Demonstrate correct connection to patient and configuration of N, AB, C, P, E Competent
CVP monitoring, including configuration of the multi-modality
monitor and ability to ‘zero’ the line
CD2 7.2.5 (L2) Correctly document care relating to central venous access and/or N, AB, C, P, E Competent
arterial lines
CD2 7.2.6 (L2) Escalate appropriately in response to line complications or N, AB, C, P, E Competent
emergencies – take appropriate immediate action

66 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Caring for adults with minor injury
Emergency
or illness planning and
Caring for
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

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CD3 – Caring for adults with minor injury or illness – Level 2

CD3.1 – Limb injuries – Level 2
Provide holistic care for patients presenting with upper and lower limb injuries
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 1.1.1 (L2) Describe of the basic anatomy of the upper and lower limb N, AB, C, P, E Competent
CD3 1.1.2 (L2) Describe the term mechanism of injury and the significance of this N, AB, C, P, E Proficient
in patient assessment
CD3 1.1.3 (L2) Describe the red flag signs and symptoms associated with injuries N, AB, C, P, E Proficient
that represent a risk to life or limb
CD3 1.1.4 (L2) Describe the signs and symptoms of common limb fractures and N, AB, C, P, E Competent
dislocations
CD3 1.1.5 (L2) Describe the local guidelines relating to the assessment and N, AB, C, P, E Competent
radiological imaging of upper and lower limb injuries
CD3 1.1.6 (L2) Understand ionising radiation for medical exposure regulations N, AB, C, P, E Competent
(IRMER)
CD3 1.1.7 (L2) Describe venous thromoboembolism (VTE) risk assessment and N, AB, C, P, E Competent
when this is indicated
CD3 1.1.8 (L2) Describe the risks and complications associated with limb N, AB, C, P, E Competent
immobilisation
CD3 1.1.9 (L2) Describe treatments available for managing upper limb and hand N, AB, C, P, E Competent
injuries, including their indications and complications
CD3 1.1.10 (L2) Understand how significant systemic illness may present as an N, AB, C, P, E Proficient
apparent minor injury
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 1.2.1 (L2) Assess patients with upper and lower limb injuries and prioritise N, AB, C, P, E Proficient
care appropriately (triage)
CD3 1.2.2 (L2) Demonstrate ability to carry out and document neurovascular N, AB, C, P, E Proficient
observations on limbs distal to injury site
CD3 1.2.3 (L2) Use correct technique for removal of rings N, AB, C, P, E Competent
CD3 1.2.4 (L2) Recognise patients who require more detailed systemic medical N, AB, C, P, E Proficient
assessment beyond assessment of the injury
CD3 1.2.5 (L2) Recognise patients with signs and symptoms of fracture to the N, AB, C, P, E Proficient
neck or femur (NOF)

68 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD3 1.2.6 (L2) Demonstrate the correct application and provision of appropriate N, AB, C, P, E Proficient
advice following:
• broad arm sling
• high arm sling
• collar and cuff
• neighbour strapping
• mallet/zimmer splints
• thumb spica
• application of wrist splints (with and without thumb extension)
CD3 1.2.7 (L2) Apply to lower limbs: N, AB, C, P, E Proficient
• wool and crepe bandage
• knee splint
• ankle splint
CD3 1.2.8 (L2) Apply upper and lower limb casts (Plaster of Paris or locally used N, AB, C, P, E Proficient
equivalent), following locally agreed procedures and adopting
national best practice
CD3 1.2.9 (L2) Give appropriate advice following application of a cast N, AB, C, P, E Competent
CD3 1.2.10 (L2) Undertake a VTE risk assessment and ensure that appropriate N, AB, C, P, E Competent
management/prophylaxis is implemented
CD3 1.2.11 (L2) Provide patients with correctly sized, appropriate walking aids N, AB, C, P, E Proficient
(e.g. crutches, Zimmer frame, walking stick) and instructions,
ensuring they can use the device safely
CD3 1.2.12 (L2) Support the care of patients undergoing manipulation under: N, AB, C, P, E Competent
• regional anaesthesia (regional block)
• sedation
CD3 1.2.13 (L2) Provide appropriate discharge advice to patients following lower N, AB, C, P, E Competent
limb injuries. For example:
• sprains to knee and ankle
• fractures to tibia/fibula and bones of the ankle and foot
CD3 1.2.14 (L2) Ensure outpatient follow up (in accordance with locally agreed N, AB, C, P, E Competent
guidelines and procedures)
CD3 1.2.15 (L2) Recognise and refer patients for additional therapy (physio/OT) N, AB, C, P, E Competent
following locally agreed guidelines and procedures

69 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD3 – Caring for adults with minor injury or illness – Level 2

CD3.2 – Head and neck – Level 2
Provide holistic care for patients presenting with ophthalmic, maxillofacial, or ear, nose and throat (ENT) problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 2.1.1 (L2) Describe the normal anatomy and physiology of the eye N, AB, C, P, E Competent
CD3 2.1.2 (L2) Describe the normal anatomy and physiology of the ear, nose and N, AB, C, P, E Competent
throat
CD3 2.1.3 (L2) Describe the mechanism of injury associated with: N, AB, C, P, E Competent
• foreign body to the eye
• abrasion to cornea
• blunt trauma to the eye
• penetrating trauma to the eye
• chemical eye injury
CD3 2.1.4 (L2) Describe the mechanism of injury associated with: N, AB, C, P, E Competent
• perforated tympanic membrane (traumatic)
• foreign body to the ear
• nasal fractures and septal haematoma
• trauma to the face and ears, including lacerations and fractures
CD3 2.1.5 (L2) Describe the red flag signs or symptoms and immediate treatment N, AB, C, P, E Competent
of an eye-threatening emergency
CD3 2.1.6 (L2) Describe the red flag signs or symptoms of an ENT emergency N, AB, C, P, E Competent
and the immediate actions required
CD3 2.1.7 (L2) Describe the assessment process for patients with ophthalmic N, AB, C, P, E Proficient
presentations, including:
• assessing visual acuity
• rationale for measuring eye pH
CD3 2.1.8 (L2) Describe the assessment process for patients with ENT N, AB, C, P, E Proficient
presentations
CD3 2.1.9 (L2) Understand how systemic illnesses may manifest in eye or ENT N, AB, C, P, E Competent
symptoms
CD3 2.1.10 (L2) Describe local processes for obtaining ophthalmic, ENT and N, AB, C, P, E Competent
maxillofacial specialist referral

70 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD3 2.1.11 (L2) Describe common eye medication used within the emergency N, AB, C, P, E Competent
department. For example:
• local anaesthetic
• antibiotics
• corneal stains
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 2.2.1 (L2) Assess and prioritise patients presenting with an eye problem N, AB, C, P, E Proficient
CD3 2.2.2 (L2) Assess and prioritise patients presenting with an ENT problem N, AB, C, P, E Proficient
CD3 2.2.3 (L2) Accurately measure and record visual acuity: N, AB, C, P, E Competent
• unaided
• with glasses
• with pinhole
CD3 2.2.4 (L2) Measure and record eye pH N, AB, C, P, E Competent
CD3 2.2.5 (L2) Recognise when patients with eye or ENT symptoms may require N, AB, C, P, E Competent
more detailed examination of other body systems and refer to
appropriate clinician
CD3 2.2.6 (L2) Effectively undertake eye irrigation N, AB, C, P, E Proficient
CD3 2.2.7 (L2) Effectively administer eye medications N, AB, C, P, E Competent
CD3 2.2.8 (L2) Provide first aid steps to manage an epistaxis N, AB, C, P, E Competent
CD3 2.2.9 (L2) Effectively prepare the patient and equipment for nasal packing N, AB, C, P, E Competent
by a trained clinician
CD3 2.2.10 (L2) Make an appropriate referral to other specialties or health N, AB, C, P, E Competent
professionals in line with locally agreed pathways

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CD3 – Caring for adults with minor injury or illness – Level 2

CD3.3 – Back problems – Level 2
Provide holistic care to patients presenting with back problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 3.1.1 (L2) Describe the normal anatomy and physiology of the back and N, AB, C, P, E Competent
spine
CD3 3.1.2 (L2) Describe the red flags indicating spinal pathology N, AB, C, P, E Competent
CD3 3.1.3 (L2) Describe the local guidelines for spine immobilisation N, AB, C, P, E Competent
CD3 3.1.4 (L2) Describe mechanisms of injury and how this influences injury to N, AB, C, P, E Competent
the back/spine
CD3 3.1.5 (L2) Understand the psychological and social implication for patients N, AB, C, P, E Competent
with acute and chronic back pain
CD3 3.1.6 (L2) Understand how pathology of other systems may result in the N, AB, C, P, E Competent
experience of back pain (e.g. pneumonia, abdominal aortic
aneurysm)
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 3.2.1 (L2) Assess patients presenting with acute back problems and N, AB, C, P, E Proficient
prioritise appropriately
CD3 3.2.2 (L2) Identify any new neurological deficit and report concerns N, AB, C, P, E Competent
appropriately
CD3 3.2.3 (L2) Identify patients with back pain symptoms who may require N, AB, C, P, E Competent
urgent clinical assessment of other body systems and report
concerns appropriately
CD3 3.2.4 (L2) Facilitate appropriate pain management (see CCT2) N, AB, C, P, E Proficient
CD3 3.2.5 (L2) Provide appropriate discharge advice to patients with N, AB, C, P, E Competent
musculoskeletal back pain

72 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD3 – Caring for adults with minor injury or illness – Level 2

CD3.4 – Wounds and burns – Level 2
Provide holistic care to patients presenting with minor wounds and burns (for major burns refer to the National Major Trauma Nursing Group competencies)
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 4.1.1 (L2) Describe the normal anatomy of the skin N, AB, C, P, E Competent
CD3 4.1.2 (L2) Describe mechanisms of injury that may result in wounds and/or N, AB, C, P, E Competent
burns
CD3 4.1.3 (L2) Understand the terminology associated with wounds and burns N, AB, C, P, E Competent
including:
• laceration
• incision
• graze
• scald
• full thickness
• partial thickness
• superficial
CD3 4.1.4 (L2) Describe wound and burn assessment including red flags N, AB, C, P, E Proficient
CD3 4.1.5 (L2) Understand how seemingly small wounds or burns may have N, AB, C, P, E Competent
serious consequences due to anatomical site
CD3 4.1.6 (L2) Understand the normal wound and burn healing processes and the N, AB, C, P, E Competent
factors that may affect this
CD3 4.1.7 (L2) Describe the properties of dressings used to facilitate wound and N, AB, C, P, E Competent
burn healing
CD3 4.1.8 (L2) Describe recognised immediate and delayed complications arising N, AB, C, P, E Competent
from wounds and burns
CD3 4.1.9 (L2) Describe the local guidelines relating to wound and burn N, AB, C, P, E Competent
management
CD3 4.1.10 (L2) Understand how the presence of wounds, burns or other minor N, AB, C, P, E Proficient
injuries may give rise to safeguarding concerns (see CTT6)
CD3 4.1.11 (L2) Describe the criteria for wound and burn referral to specialised N, AB, C, P, E Competent
services and the locally agreed guidelines and processes for
referral

73 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD3 4.2.1 (L2) Demonstrate the initial assessment of patients with wounds and N, AB, C, P, E Competent
burns and prioritise appropriately (triage)
CD3 4.2.2 (L2) Initiate first aid treatment of wounds and burns N, AB, C, P, E Proficient
CD3 4.2.3 (L2) Undertake wound cleaning following local guidelines N, AB, C, P, E Competent
CD3 4.2.4 (L2) Following local policy, clean and close an uncomplicated N, AB, C, P, E Proficient
wound with:
• tissue adhesive
• steri strips
• staples
• sutures
CD3 4.2.5 (L2) Demonstrate ability to de-roof blisters according to local N, AB, C, P, E Competent
guidelines
CD3 4.2.6 (L2) Select and apply dressings to wounds and burns (as per local N, AB, C, P, E Proficient
guidelines)
CD3 4.2.7 (L2) Recognise when a wound or burn requires more detailed clinical N, AB, C, P, E Competent
exploration/assessment and report concerns appropriately
CD3 4.2.8 (L2) Provide appropriate wound care advice, including when to seek N, AB, C, P, E Competent
urgent clinical attention

74 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Caring for children and young people
Emergency
Caring for
planning and
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
The Good Nursing Practice and Cross-Cutting Theme control handling
competencies apply equally to nurses caring for adults and
children. However, nurses caring for children and young people
must prioritise completion of CCT6 competencies on safeguarding
children and adults.
Caring for Caring for
people with children and
For nurses caring for children following major trauma, please also mental health young people
see the National Major Trauma Nursing Group Competencies needs
available at: www.nmtng.co.uk/emergency-dept-1.html

75 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD4 – Caring for children and young people – Level 2

CD4.1 – Assessing children and young people – Level 2
Holistically and systematically assess children and young people through the age spectrum
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 1.1.1 (L2) Describe how anatomy and physiology changes from infancy N, AB, C, P, E Competent
through to adulthood
CD4 1.1.2 (L2) Understand how anatomical and physiological differences impact N, AB, C, P, E Proficient
on illness and injury manifestations
CD4 1.1.3 (L2) Describe how anatomical, physiological and psychological N, AB, C, P, E Proficient
differences impact on nursing assessment
CD4 1.1.4 (L2) Discuss normal parameters of weight in children of various ages N, AB, C, P, E Proficient
and the use of formulae to estimate this
CD4 1.1.5 (L2) Explain how normal values of heart rate, respiratory rate, blood N, AB, C, P, E Proficient
pressure and urine output vary with age
CD4 1.1.6 (L2) Describe normal child development from infancy to adulthood N, AB, C, P, E Proficient
CD4 1.1.7 (L2) Describe why children may present with abnormal development N, AB, C, P, E Competent
CD4 1.1.8 (L2) Discuss how developmental stage impacts on injury and illness N, AB, C, P, E Competent
presentations
CD4 1.1.9 (L2) Describe the role of centile charts in monitoring child growth N, AB, C, P, E Competent
CD4 1.1.10 (L2) Describe the normal nutritional and fluid requirements of children N, AB, C, P, E Competent
at different ages
CD4 1.1.11 (L2) Discuss dietary requirements of children, including feeding N, AB, C, P, E Competent
regimes
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 1.2.1 (L2) Demonstrate a systematic method of assessment of children and N, AB, C, P, E Proficient
young people following a structured A-E approach

76 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD4 1.2.2 (L2) For children of all ages, appropriately measure and record the N, AB, C, P, E Proficient
following physiological observations:
• evaluation of respiration to include:
• rate and work of breathing
• oxygen saturations
• heart rate
• blood pressure
• capillary refill time (CRT)
• conscious level – AVPU and Glasgow Coma Score (GCS)
• blood glucose measurement (BM)
• temperature
CD4 1.2.3 (L2) Correctly calculate and document the locally used paediatric early N, AB, C, P, E Proficient
warning score
CD4 1.2.4 (L2) Demonstrate appropriate urine collection techniques in all ages of N, AB, C, P, E Proficient
children and interpret urinalysis
CD4 1.2.5 (L2) Identify children who are acutely unwell or seriously injured, move N, AB, C, P, E Competent
to an appropriate environment, commence immediate treatment
and summon help
CD4 1.2.6 (L2) Triage children accurately and modify priority management based N, AB, C, P, E Competent
on issues other than acuity (e.g. learning disability)
CD4 1.2.7 (L2) Assess children in a calm and age-appropriate manner N, AB, C, P, E Proficient
CD4 1.2.8 (L2) Modify communication and interaction strategies to facilitate N, AB, C, P, E Proficient
appropriate assessment
CD4 1.2.9 (L2) Engage with parents and carers in order to gather pertinent N, AB, C, P, E Proficient
information to enhance assessment
CD4 1.2.10 (L2) Calculate maintenance fluid requirements for children according to N, AB, C, P, E Competent
weight
CD4 1.2.11 (L2) Identify the deteriorating child and respond appropriately N, AB, C, P, E Proficient

77 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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CD4 – Caring for children and young people – Level 2

CD4.2 – Assessment and management of pain in children (including medicines management) – Level 2
Safely assess and manage pain in children
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 2.1.1 (L2) Describe the principles of pain theory and assessment in children N, AB, C, P, E Competent
CD4 2.1.2 (L2) Has working knowledge of local pain management guidelines for N, AB, C, P, E Proficient
children
CD4 2.1.3 (L2) Compare and contrast pain assessment tools for children of N, AB, C, P, E Competent
different developmental stages
CD4 2.1.4 (L2) Discuss how pain assessment influences triage priority N, AB, C, P, E Proficient
CD4 2.1.5 (L2) Describe pharmacological differences between children and adults N, AB, C, P, E Competent
and the implications this has for practice
CD4 2.1.6 (L2) Discuss the factors affecting administration of medicines to N, AB, C, P, E Proficient
children and young people and describe strategies for facilitating
administration
CD4 2.1.7 (L2) Understand how to use the BNF(c) N, AB, C, P, E Competent
CD4 2.1.8 (L2) Describe non-pharmacological pain management strategies N, AB, C, P, E Proficient
suitable for children at different ages
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 2.2.1 (L2) Demonstrate a systematic method of pain assessment of children N, AB, C, P, E Proficient
and young people using appropriate tools
CD4 2.2.2 (L2) Demonstrate non-pharmacological methods of pain management N, AB, C, P, E Proficient
for children
CD4 2.2.3 (L2) Demonstrate weight-based drug calculations for children N, AB, C, P, E Proficient
CD4 2.2.4 (L2) Where locally available, use PGDs appropriately to administer N, AB, C, P, E Competent
timely analgesia to children. (If a non-medical prescriber, prescribe
appropriate analgesia for children safely.)

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CD4 2.2.5 (L2) Demonstrate effective strategies for safe administration of N, AB, C, P, E Proficient
analgesia to children via a variety of routes:
• oral
• rectal
• intranasal
• inhaled
• intravenous
• topical
CD4 2.2.6 (L2) Demonstrate evaluation of pain after interventions and respond N, AB, C, P, E Proficient
appropriately

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CD4 – Caring for children and young people – Level 2

CD4.3 – Children requiring resuscitation – Level 2
Care holistically for children requiring resuscitation
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 3.1.1 (L2) Describe the pathophysiology and the emergency treatment for: N, AB, C, P, E Competent
• airway obstruction
• anaphylaxis
• respiratory failure
• circulatory compromise including hypovolaemic shock
• sepsis
• the fitting child
• diabetic ketoacidosis
• poisoning
CD4 3.1.2 (L2) Describe the sequence of progression of signs and symptoms from N, AB, C, P, E Competent
respiratory distress or circulatory compromise to cardiopulmonary
arrest
CD4 3.1.3 (L2) Describe the basic life support guidelines for neonates, infants and N, AB, C, P, E Proficient
children
CD4 3.1.4 (L2) Understand advanced life support guidelines and algorithms for N, AB, C, P, E Proficient
infants and children. Possess APLS provider status or equivalent
CD4 3.1.5 (L2) Understand the roles of the paediatric resuscitation team and N, AB, C, P, E Competent
describe the human factors necessary for effective team working
CD4 3.1.6 (L2) Describe signs of possible emotional distress in self and/or N, AB, C, P, E Competent
colleagues when caring for a critically ill or injured child and know
what support is available and appropriate
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 3.2.1 (L2) Identify respiratory failure in children and respond appropriately N, AB, C, P, E Proficient
CD4 3.2.2 (L2) Identify circulatory compromise in children and respond N, AB, C, P, E Proficient
appropriately
CD4 3.2.3 (L2) Identify cardiac arrest in children and respond appropriately N, AB, C, P, E Proficient
CD4 3.2.4 (L2) Demonstrate advanced life support skills in infants and children N, AB, C, P, E Competent
including safe defibrillation
CD4 3.2.5 (L2) Recognise the seizing child and initiate immediate interventions N, AB, C, P, E Proficient
CD4 3.2.6 (L2) Function as lead nurse in the paediatric resuscitation team N, AB, C, P, E Competent

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CD4 3.2.7 (L2) Locate equipment and, safely and effectively, implement N, AB, C, P, E Proficient
emergency airway and breathing management to include the
following:
• manual airway maneuvers
• insertion of oropharyngeal airway
• insertion of nasopharyngeal airway
• use of suctioning
• initiation of oxygen therapy
• set up and administration of prescribed nebuliser therapy
• pulse oximetry
• two person technique, bag-valve-mask ventilation
• set up of intubation equipment
• set up of ETCO2 monitoring
• set up and assist with chest drain insertion
• set up of transport ventilator equipment
CD4 3.2.8 (L2) Locate equipment and, safely and effectively, implement N, AB, C, P, E Proficient
emergency circulatory support, to include the following:
• use of equipment for venepuncture and intravenous or
intraosseous cannulation
• application of NIBP and ECG monitoring
• calculate, prepare and administer prescribed weight-based fluid
boluses
• set up of prescribed intravenous medications, including fluid
therapy
• set up of invasive pressure monitoring (arterial lines)
CD4 3.2.9 (L2) Interpret blood gas results N, AB, C, P, E Competent
CD4 3.2.10 (L2) Safely insert a urinary catheter and monitor urine output N, AB, C, P, E Competent
CD4 3.2.11 (L2) Safely insert a nasogastric tube N, AB, C, P, E Competent
CD4 3.2.12 (L2) Recognise the child with reduced level of consciousness and N, AB, C, P, E Competent
respond appropriately
CD4 3.2.13 (L2) Demonstrate the ability to arrange and co-ordinate the emergency N, AB, C, P, E Competent
transfer of children using established referral pathways and
regional retrieval and transfer services
CD4 3.2.14 (L2) Implement local guidelines for the management of sudden death N, AB, C, P, E Competent
in infants and children
CD4 3.2.15 (L2) Demonstrate awareness of emotions of self and others when N, AB, C, P, E Proficient
caring for children and families and seek/offer appropriate support

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CD4 – Caring for children and young people – Level 2

CD4.4 – Caring for acutely ill children – Level 2
Care holistically for children and young people presenting with acute illness
Knowledge Self-assessment Minimum standard Expected date Evidence Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement submitted completion achieved (print and sign)
CD4 4.1.1 (L2) Demonstrate an understanding of the pathophysiology and N, AB, C, P, E Proficient
associated signs and symptoms of common respiratory illnesses in
children. For example:
• bronchiolitis
• croup
• asthma
• pneumonia
CD4 4.1.2 (L2) Demonstrate an understanding of the pathophysiology and N, AB, C, P, E Proficient
associated signs and symptoms of common gastrointestinal
presentations in children:
• gastroenteritis
• constipation
• swallowed foreign body
• appendicitis
• pyloric stenosis
• intussusception
CD4 4.1.3 (L2) Demonstrate an understanding of the pathophysiology and N, AB, C, P, E Proficient
associated signs and symptoms of common ENT presentations in
children:
• otitis media
• ENT foreign body
• tonsillitis
• peri-tonsillar abscess
CD4 4.1.4 (L2) Demonstrate an understanding of the pathophysiology and N, AB, C, P, E Proficient
associated signs and symptoms of common neurological
presentations in children:
• head Injury
• febrile convulsions
• epilepsy
• headache
• collapse

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CD4 4.1.5 (L2) Demonstrate an understanding of the pathophysiology and N, AB, C, P, E Proficient
associated signs and symptoms of common endocrine presentations
in children:
• diabetes
• diabetic ketoacidosis
• hypoglycaemia
• Addison’s disease and Addisonian Crisis
CD4 4.1.6 (L2) Demonstrate an understanding of the pathophysiology and N, AB, C, P, E Competent
associated signs and symptoms of common childhood infectious
disease presentations in children. For example:
• chicken pox
• rubella
• mumps
• measles
• scarlet fever
• fifth disease
• hand, foot and mouth disease
CD4 4.1.7 (L2) Describe the assessment and care of a child with fever of unknown N, AB, C, P, E Proficient
origin with reference to national and local guidelines
CD4 4.1.8 (L2) Describe when a child may need nursing in an environment away N, AB, C, P, E Proficient
from other patients due to reduced immunity
CD4 4.1.9 (L2) Describe when a child may need nursing in an environment away N, AB, C, P, E Proficient
from other patients to prevent spread of infection
Skills Self-assessment Minimum standard Expected date Evidence Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement submitted completion achieved (print and sign)
CD4 4.2.1 (L2) Implement clinical care following local and/or national guidance for N, AB, C, P, E Proficient
infants, children and adolescents presenting with:
• respiratory problems
• gastrointestinal problems
• ENT problems
• neurological problems
• endocrine problems
• infectious diseases

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CD4 4.2.2 (L2) Demonstrate ability to assess and care for children with fever of N, AB, C, P, E Proficient
unknown origin. Including:
• regular recording of vital signs and early warning score
calculations with appropriate escalation of concerns
• assessment for signs of meningism, dehydration or sepsis
• conducting urinalysis with interpretation of results
• ensuring adequate fluid intake
• adherence to local anti-pyretic interventions
CD4 4.2.3 (L2) Demonstrate effective strategies for safe administration of medicines N, AB, C, P, E Proficient
to children via a variety of routes
CD4 4.2.4 (L2) Contribute to evidence review and introduction/update of clinical N, AB, C, P, E Competent
guidance
CD4 4.2.5 (L2) Give appropriate discharge advice to carers of children who have N, AB, C, P, E Proficient
presented with illness, including safety-netting of when to return

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CD4 – Caring for children and young people – Level 2

CD4.5 – Children with minor injuries and limb problems – Level 2
Care holistically for children and young people presenting with minor injuries and limb problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 5.1.1 (L2) Describe how mechanism of injury relates to actual injury pattern N, AB, C, P, E Competent
CD4 5.1.2 (L2) Demonstrate an understanding of the signs, symptoms and N, AB, C, P, E Proficient
pathophysiology of common upper limb presentations in children.
For example:
• pulled elbow
• upper limb fractures (including the clavicle)
• upper limb sprain
• injuries to the hand and digits
CD4 5.1.3 (L2) Demonstrate an understanding of the signs, symptoms and N, AB, C, P, E Proficient
pathophysiology of common lower limb presentations in children.
For example:
• lower limb fractures
• lower limb sprains
• injuries to the foot and toes
• hip problems:
idiopathic synovitis (irritable hip)
septic arthritis
slipped upper femoral epiphysis
Legg-Perthes Disease
• knee problems:
patella dislocation
Osgood-Schlatter Disease
CD4 5.1.4 (L2) Demonstrate an understanding of the pathophysiology of wounds N, AB, C, P, E Proficient
and burns in children, specifically in relation to area and depth of
injury and the involvement of associated structures
CD4 5.1.5 (L2) Understand the principles of wound and burn assessment and N, AB, C, P, E Proficient
describe red flag or priority features requiring immediate
escalation and intervention
CD4 5.1.6 (L2) Describe the wound and burn healing processes and the factors N, AB, C, P, E Proficient
that may affect these in children

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CD4 5.1.7 (L2) Describe local, regional and national guidelines relating to wound N, AB, C, P, E Proficient
and burn assessment and management in children
CD4 5.1.8 (L2) Demonstrate an understanding of the criteria for wound and burn N, AB, C, P, E Proficient
referral to specialised services, and the locally agreed guidelines
and processes for referral of children
CD4 5.1.9 (L2) Understand Ionising Radiation for Medical Exposure Regulations N, AB, C, P, E Competent
(IRMER)
CD4 5.1.10 (L2) Understand how the presence of minor injuries may give rise to N, AB, C, P, E Competent
safeguarding concerns (see CCT6)
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 5.2.1 (L2) Demonstrate ability to carry out and document a musculoskeletal N, AB, C, P, E Competent
assessment on the limb of a child, making notes of:
• time of injury
• mechanism of injury
• wounds/bruising/swelling/deformity
• bony tenderness
• ability to move the limb
• ability to weight-bear if lower limb
• neurovascular status
CD4 5.2.2 (L2) Initiate immediate first aid to wounds/burns N, AB, C, P, E Proficient
CD4 5.2.3 (L2) Demonstrate ability to splint upper and lower limbs in children, N, AB, C, P, E
selecting appropriate equipment for anatomical area and size of
child, including use of Plaster of Paris casts
CD4 5.2.4 (L2) Request X-rays as per local protocols (e.g. use of Ottowa ankle N, AB, C, P, E Proficient
rules)
CD4 5.2.5 (L2) Demonstrate ability to accurately assess the size of a burn or N, AB, C, P, E Competent
wound in a child
CD4 5.2.6 (L2) Demonstrate ability to select and apply appropriate dressings for N, AB, C, P, E Proficient
wounds and burns in children following local guidelines and
policies
CD4 5.2.7 (L2) Select and demonstrate ability of appropriate wound closure N, AB, C, P, E Proficient
techniques
CD4 5.2.8 (L2) Provide appropriate discharge advice to children and their families N, AB, C, P, E Proficient
following treatment for a wound or burn, including when to seek
urgent medical attention

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CD4 5.2.9 (L2) Provide appropriate discharge advice to children and their families N, AB, C, P, E Proficient
following treatment for a limb injury, including when to seek
urgent medical attention
CD4 5.2.10 (L2) Provide appropriate discharge advice to children and their families N, AB, C, P, E Proficient
following treatment for a head injury, including when to seek
urgent medical attention
CD4 5.2.11 (L2) Communicate appropriate safety/health promotional advice to N, AB, C, P, E Proficient
children and their families

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CD4 – Caring for children and young people – Level 2

CD4.6 – Psychological and mental health aspects of care of children – Level 2 (also see CD5.1)
Provide safe psychological and mental health care for children and young people
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 6.1.1 (L2) Discuss the role of play in relation to development N, AB, C, P, E Proficient
CD4 6.1.2 (L2) Discuss the role of play in the assessment and management of N, AB, C, P, E Proficient
children presenting to hospital
CD4 6.1.3 (L2) Describe factors that may contribute to fear in children and N, AB, C, P, E Proficient
strategies that may be used to mitigate them
CD4 6.1.4 (L2) Discuss the implications of risk-taking behaviour in young people N, AB, C, P, E Competent
CD4 6.1.5 (L2) Understand the roles of other professionals (e.g. play therapists) in N, AB, C, P, E Competent
the care of acutely ill or injured children
CD4 6.1.6 (L2) Identify the possible psychological effects of hospitalisation on N, AB, C, P, E Competent
children and families, and the coping strategies that may be used
CD4 6.1.7 (L2) Understand the behavioural and psychological symptoms that N, AB, C, P, E Competent
may be experienced by children with mental health issues and the
impact this has on families
CD4 6.1.8 (L2) Understand the common mental health problems of children and N, AB, C, P, E Competent
young people including:
• depression
• anxiety
• suicide ideation
• self-harm
• eating disorders
• psychosis
CD4 6.1.9 (L2) Understand the principles of a suicide/self-harm risk assessment N, AB, C, P, E Competent
with a young person
CD4 6.1.10 (L2) Describe local child and adolescent mental health services N, AB, C, P, E Competent
(CAMHS) and referral pathways for young people
CD4 6.1.11 (L2) Discuss the use of the Mental Health Act or equivalent in country N, AB, C, P, E Competent
of practice
CD4 6.1.12 (L2) Describe local alcohol and substance misuse services for children N, AB, C, P, E Competent
and young people

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Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD4 6.2.1 (L2) Demonstrate the appropriate use of distraction methods in N, AB, C, P, E Proficient
children of various developmental stages
CD4 6.2.2 (L2) Demonstrate the use of play as part of the assessment and N, AB, C, P, E Proficient
management of children presenting with illness or injury
CD4 6.2.3 (L2) Demonstrate effective communication and interaction strategies N, AB, C, P, E Proficient
with both children and their families
CD4 6.2.4 (L2) Demonstrate ability to conduct a suicide/self-harm risk N, AB, C, P, E Competent
assessment with a young person
CD4 6.2.5 (L2) Demonstrate compassion and empathy for young people and their N, AB, C, P, E Proficient
families who present with mental health concerns
CD4 6.2.6 (L2) Make appropriate referrals to local alcohol and substance misuse N, AB, C, P, E Competent
service
CD4 6.2.7 (L2) Liaise with local CAMHS as per local guidelines when appropriate N, AB, C, P, E Competent
CD4 6.2.8 (L2) Instigate safeguarding interventions as per local policy for children N, AB, C, P, E Proficient
with mental health and/or substance misuse problems

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Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Caring for people with mental
Emergency
health needs planning and
Caring for
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

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CD5 – Caring for people with mental health needs – Level 2

CD5.1 – Assessing adults with mental health problems – Level 2 (for children and young people see CD4.6)
Holistically and systematically assess adults with mental health problems
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD5 1.1.1 (L2) Discuss factors that influence mental health and psychological N, AB, C, P, E Proficient
wellbeing
CD5 1.1.2 (L2) Understand the behavioural and psychological symptoms that N, AB, C, P, E Proficient
may be experienced by patients with mental health issues
CD5 1.1.3 (L2) Discuss how mental health problems may impact on the N, AB, C, P, E Competent
individual’s ability to communicate effectively and how this may
impair mental capacity
CD5 1.1.4 (L2) Describe assessment frameworks and tools used to support N, AB, C, P, E Proficient
emergency mental health assessment
CD5 1.1.5 (L2) Describe the signs and symptoms of the following common N, AB, C, P, E Competent
mental illnesses:
• depression
• anxiety
• eating disorders
• bi-polar disorder
• schizophrenia
CD5 1.1.6 (L2) Discuss the signs or symptoms of mental illness that require N, AB, C, P, E Proficient
immediate or urgent intervention
CD5 1.1.7 (L2) Discuss the correlation between mental health conditions and N, AB, C, P, E Competent
physiological conditions, appreciating how one may manifest as
the other
CD5 1.1.8 (L2) Understand the use of the Mental Health Act (or equivalent in N, AB, C, P, E Competent
country of practice) in the emergency care setting
CD5 1.1.9 (L2) Understand how emotional distress may result in verbal and/or N, AB, C, P, E Proficient
physical violence. Describe principles of de-escalation and safety
CD5 1.1.10 (L2) Understand how mental illness may impair a patient’s ability to N, AB, C, P, E Competent
safeguard themselves
CD5 1.1.11 (L2) Understand how acute mental illness may impair ability of the N, AB, C, P, E Competent
patient to care adequately for dependents
CD5 1.1.12 (L2) Describe local policy for reporting and escalating concerns of a N, AB, C, P, E Competent
missing/absconded patient

91 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD5 1.2.1 (L2) Use a structured approach to assess patients presenting with N, AB, C, P, E Proficient
acute mental health problems and prioritise appropriately
CD5 1.2.2 (L2) Evaluate patient behaviour in relationship to actual and/or N, AB, C, P, E Competent
potential risk of harm to self or others
CD5 1.2.3 (L2) Recognise when a patient presenting with a physical illness may N, AB, C, P, E Proficient
be experiencing symptoms of a mental illness and report
appropriately
CD5 1.2.4 (L2) Recognise when a patient presenting with a mental health N, AB, C, P, E Proficient
problem may be experiencing symptoms of a physical illness and
report appropriately
CD5 1.2.5 (L2) Use effective strategies, including the inclusion or withdrawal of N, AB, C, P, E Competent
significant others, to calm highly emotional situations
CD5 1.2.6 (L2) Act in line with local policy to safeguard patients with mental N, AB, C, P, E Competent
illness
CD5 1.2.7 (L2) Act in line with local policy to safeguard dependents of patients N, AB, C, P, E Competent
with impaired ability to do so themselves

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CD5 – Caring for people with mental health needs – Level 2

CD5.2 – Self-harm – Level 2
Care holistically for patients presenting with self-harm
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD5 2.1.1 (L2) Discuss national guidance on management of self-harm patients N, AB, C, P, E Competent
and implications for local practice
CD5 2.1.2 (L2) Understand the physical management of self-poisoning and N, AB, C, P, E Proficient
self-injury
CD5 2.1.3 (L2) Discuss the issues surrounding repeated attendance for self-harm N, AB, C, P, E Proficient
CD5 2.1.4 (L2) Understand the nursing care required for a patient with drug N, AB, C, P, E Proficient
toxicity
CD5 2.1.5 (L2) Discuss the need for a timely mental health assessment N, AB, C, P, E Competent
CD5 2.1.6 (L2) Understand local processes and pathways for ensuring patients N, AB, C, P, E Competent
with self-harm receive formal psycho-social assessment
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD5 2.2.1 (L2) Engage with patients who have self-harmed (and their families) N, AB, C, P, E Competent
with empathy and dignity
CD5 2.2.2 (L2) Use a structured approach to assess patients who present N, AB, C, P, E Competent
following intentional self-harm and assign appropriate priority
using a locally approved system
CD5 2.2.3 (L2) Instigate first aid for significant injuries N, AB, C, P, E Competent
CD5 2.2.4 (L2) Ensure patients receive any timely treatment for self-injury or N, AB, C, P, E Proficient
self-poisoning
CD5 2.2.5 (L2) Use locally approved pathways and guidelines when caring for N, AB, C, P, E Proficient
patients with self-harm, including local missing person guidance

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CD5 – Caring for people with mental health needs – Level 2

CD5.3 – Patients with alcohol problems – Level 2
Care holistically for patients presenting with problems relating to alcohol or substance misuse
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD5 3.1.1 (L2) Understand the impact of alcohol or substance misuse on both N, AB, C, P, E Proficient
physical and mental health
CD5 3.1.2 (L2) Understand the medical conditions that may manifest as N, AB, C, P, E Competent
intoxication
CD5 3.1.3 (L2) Understand how alcohol or substance misuse may affect mental N, AB, C, P, E Competent
capacity and the implications on nursing care
CD5 3.1.4 (L2) Describe the signs and symptoms of acute alcohol withdrawal and N, AB, C, P, E Competent
understand the emergency management
CD5 3.1.5 (L2) Describe local alcohol and substance misuse services and their N, AB, C, P, E Proficient
referral processes
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD5 3.2.1 (L2) Use a structured approach to assess and manage patients N, AB, C, P, E Proficient
presenting with alcohol or substance withdrawal symptoms
CD5 3.2.2 (L2) Use a structured approach to assess and manage patients N, AB, C, P, E Proficient
presenting with acute alcohol or substance intoxication
CD5 3.2.3 (L2) Use locally approved assessment tools and pathways for alcohol N, AB, C, P, E Competent
dependence, alcohol intoxication and alcohol withdrawal
CD5 3.2.4 (L2) Provide effective clinical care to patients with alcohol or substance N, AB, C, P, E Proficient
dependence, intoxication or withdrawal
CD5 3.2.5 (L2) Make appropriate referrals to local alcohol and substance misuse N, AB, C, P, E Competent
services

94 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
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Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Caring for older people
Emergency
Caring for
planning and
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

95 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD6 – Caring for older people – Level 2

CD6.1 – Assessing older people – Level 2
Holistically and systematically assess the needs of the older person
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 1.1.1 (L2) Understand the anatomical and physiological changes in the older N, AB, C, P, E Proficient
adult
CD6 1.1.2 (L2) Understand frailty and its impact on older adults N, AB, C, P, E Proficient
CD6 1.1.3 (L2) Understand the impact of psychological and/or social influences N, AB, C, P, E Proficient
on older adults
CD6 1.1.4 (L2) Understand how the ageing process impacts on the body’s ability N, AB, C, P, E Proficient
to compensate for illness and injury
CD6 1.1.5 (L2) Understand how the ageing process influences pharmacology in N, AB, C, P, E Proficient
older adults
CD6 1.1.6 (L2) Understand the impact of polypharmacy in older adults N, AB, C, P, E Proficient
CD6 1.1.7 (L2) Discuss quality standards to be followed when caring for older N, AB, C, P, E Proficient
people in the emergency care setting (e.g. Silver Book)
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 1.2.1 (L2) Conduct a systematic initial assessment of the older person and N, AB, C, P, E Proficient
prioritise care appropriately (triage)
CD6 1.2.2 (L2) Recognise and respond appropriately to the following common N, AB, C, P, E Proficient
conditions in an older adult:
• sepsis
• delirium
• postural hypotension
• dehydration
CD6 1.2.3 (L2) Conduct a falls risk assessment and document subsequent nursing N, AB, C, P, E Proficient
care plan
CD6 1.2.4 (L2) Conduct a pressure area risk assessment and document a N, AB, C, P, E Proficient
subsequent nursing care plan
CD6 1.2.5 (L2) Assess continence in the older person and plan appropriate care N, AB, C, P, E Proficient
CD6 1.2.6 (L2) Assess nutritional and fluid requirements in older people and N, AB, C, P, E Proficient
provide appropriate assistance where needed
CD6 1.2.7 (L2) Demonstrate ability to assess the older adult for frailty and N, AB, C, P, E Proficient
commence referral to appropriate health and social services

96 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD6 – Caring for older people – Level 2

CD6.2 – Psychological and social care of older adults – Level 2
Ensure the provision of holistic psychological and social care for older people
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 2.1.1 (L2) Understand the application of the Mental Capacity Act, including N, AB, C, P, E Proficient
the role of the Independent Mental Capacity Advocate (or
equivalent in country of practice) (also see GNP7)
CD6 2.1.2 (L2) Understand the Principles of Deprivation of Liberty Safeguards N, AB, C, P, E Proficient
(DoLS) or the equivalent in country of practice (also see GNP7)
CD6 2.1.3 (L2) Understand safeguarding principles of adults specific to the older N, AB, C, P, E Proficient
person (also see CCT6)
CD6 2.1.4 (L2) Understand how dementia affects physiological, psychological and N, AB, C, P, E Proficient
social wellbeing in patients and their families
CD6 2.1.5 (L2) Describe local support services for people with dementia and N, AB, C, P, E Proficient
those important to them
CD6 2.1.6 (L2) Understand the legal principles when someone has a Lasting N, AB, C, P, E Proficient
Power of Attorney (or country equivalent)
CD6 2.1.7 (L2) Discuss why it is important to have discussions which may be N, AB, C, P, E Proficient
distressing and/or life-changing. For example:
• end of life care
• DNA CPR
• ability to live independently
• neglect and abuse
• ability to drive
CD6 2.1.8 (L2) Describe the possible causes of acute confusion in the older N, AB, C, P, E Proficient
person
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 2.2.1 (L2) Ensure services meet the requirements of the Equality Act (Or N, AB, C, P, E Competent
equivalent in country of practice) to protect the needs of older
adults
CD6 2.2.2 (L2) Conduct and document a mental capacity assessment N, AB, C, P, E Proficient
CD6 2.2.3 (L2) Promote dignity when caring for older adults N, AB, C, P, E Proficient

97 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD6 2.2.4 (L2) Identify signs and symptoms of potential undiagnosed dementia N, AB, C, P, E Proficient
and escalate within own health care setting and/or partner
agencies
CD6 2.2.5 (L2) Identify when existing support services (including unpaid carers) N, AB, C, P, E Competent
are unable to meet the needs of an older person and initiate
multi-professional assessment
CD6 2.2.6 (L2) Identify the need for, and instigate, a social services referral for an N, AB, C, P, E Competent
older person as appropriate
CD6 2.2.7 (L2) Assess the older person for neglect and/or self-harm and report as N, AB, C, P, E Competent
per local policy
CD6 2.2.8 (L2) Select and use appropriate distraction techniques for older people N, AB, C, P, E Proficient
who may be agitated or distressed
CD6 2.2.9 (L2) Communicate effectively with patients who have sensory N, AB, C, P, E Proficient
impairment.

98 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD6 – Caring for older people – Level 2

CD6.3 – Critically ill older people – Level 2
Care holistically for critically ill older people (also see CD1 and CD2 in addition to the National Major Trauma Nursing Group competencies)
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 3.1.1 (L2) Understand how altered physiology may mask critical illness in the N, AB, C, P, E Competent
older person
CD6 3.1.2 (L2) Describe how mechanism of injury and frailty relate to actual or N, AB, C, P, E Competent
potential injury patterns in the older adult
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 3.2.1 (L2) Recognise the signs of deterioration in the older person and N, AB, C, P, E Proficient
respond appropriately
CD6 3.2.2 (L2) Evaluate physiological data with reference to medication and N, AB, C, P, E Competent
co-morbidities

99 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD6 – Caring for older people – Level 2

CD6.4 – End of life care – Level 2
Provide dignified holistic end of life care for patients and those important to them
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 4.1.1 (L2) Describe the principles of decision making in end of life care N, AB, C, P, E Competent
planning
CD6 4.1.2 (L2) Discuss the challenges of providing both anticipated end of life N, AB, C, P, E Competent
care and unexpected/traumatic end of life care
CD6 4.1.3 (L2) Understand local, regional and national guidelines and procedures N, AB, C, P, E Competent
relating to end of life care
CD6 4.1.4 (L2) Describe the legal framework around advanced directives in the N, AB, C, P, E Competent
country of practice
CD6 4.1.5 (L2) Understand the need to consider the person’s wishes around N, AB, C, P, E Competent
organ donation
CD6 4.1.6 (L2) Discuss the policies and procedures relating to transfer of the N, AB, C, P, E Competent
deceased person to the mortuary and meeting cultural and
religious beliefs
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD6 4.2.1 (L2) Respect the wishes of people and those important to them N, AB, C, P, E Proficient
regarding end of life where possible
CD6 4.2.2 (L2) Support carers and families of patients who are at the end of their N, AB, C, P, E Proficient
life and signpost to relevant bereavement services
CD6 4.2.3 (L2) Ensure contemporaneous documentation of discussions and N, AB, C, P, E Proficient
information is provided to the person (and those important to
them)
CD6 4.2.4 (L2) Provide an appropriate environment for the person at the end of N, AB, C, P, E Competent
life, maintaining privacy, dignity and meeting spiritual and cultural
needs
CD6 4.2.5 (L2) Discuss with people important to the person, their wishes N, AB, C, P, E Competent
regarding organ donation and contact relevant persons to
facilitate this
CD6 4.2.6 (L2) Follow local procedures for safe transfer of the deceased person N, AB, C, P, E Competent
to the mortuary

100 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

Level 2 competencies
Caring for
acutely
ill adults
Clinical domains (CD) Level 2
Emergency planning and disaster
Emergency
management planning and
Caring for
adults requiring
disaster
resuscitation
management Preventing
and controlling Patient
violence and assessment
aggression
Pain
Documentation assessment
and record and
keeping Good management
nursing
Safeguarding practice Medicines Caring for
children management
Caring for adults with
and adults
older people minor injury
Infection
and illness
prevention Moving
and and
control handling

Caring for Caring for

people with children and
mental health young people
needs

101 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD7 – Emergency planning and disaster management – Level 2

CD7.1 – Emergency planning and disaster management – Level 2
Contribute effectively to the implementation of the organisational plan in the event of a major incident
Knowledge Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD7 1.1.1 (L2) Define the term major incident N, AB, C, P, E Competent
CD7 1.1.2 (L2) Understand the local major incident plan and how to access it N, AB, C, P, E Competent
CD7 1.1.3 (L2) Understand triage in the context of a major incident N, AB, C, P, E Competent
CD7 1.1.4 (L2) Understand the purpose and location of local survivor reception N, AB, C, P, E Competent
centres
CD7 1.1.5 (L2) Understand the role of other emergency services as part of the N, AB, C, P, E Competent
major incident plan
CD7 1.1.6 (L2) Understand communication strategies used during a major N, AB, C, P, E Competent
incident
CD7 1.1.7 (L2) Understand the use of equipment specific to major incident N, AB, C, P, E Competent
management and how to access it
CD7 1.1.8 (L2) Understand how to access and use major incident documentation N, AB, C, P, E Competent
CD7 1.1.9 (L2) Understand the principles of a CBRN (chemical, biological, N, AB, C, P, E Competent
radiological, nuclear) incident and specific management of these
events
CD7 1.1.10 (L2) Understand the principles and indications for decontamination, N, AB, C, P, E Competent
including use of equipment and personnel
CD7 1.1.11 (L2) Understand strategies to brief the press and contact relatives/ N, AB, C, P, E Competent
significant others of those involved in the incident
CD7 1.1.12 (L2) Discuss the importance of a post-incident debrief N, AB, C, P, E Competent
Skills Self-assessment Minimum standard Expected date Evidence submitted Date of Level Mentor sign-off
(circle as appropriate) for achievement of achievement completion achieved (print and sign)
CD7 1.2.1 (L2) Recognise situations which constitute a major incident and N, AB, C, P, E Competent
instigate activation of the local plan including the call cascade to
notify additional personnel to attend
CD7 1.2.2 (L2) Demonstrate ability to safely apply and remove personal N, AB, C, P, E Competent
protective equipment required in response to the specific incident

102 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
Contents

CD7 1.2.3 (L2) Effectively assume (or respond to instructions to undertake) N, AB, C, P, E Competent
specific roles as part of the major incident team for the duration of
the incident, including but not limited to:
• lead nurse role
• resuscitation lead nurse
• triage nurse
• minor injury lead nurse
• relative liaison nurse
CD7 1.2.4 (L2) Liaise effectively with other health professionals contributing to N, AB, C, P, E Competent
the major incident response team and key individuals from other
emergency services
CD7 1.2.5 (L2) Identify and report situations which may indicate serious risk to N, AB, C, P, E Competent
safety of staff or patients
CD7 1.2.6 (L2) Undertake major incident training as per local policy N, AB, C, P, E Competent
CD7 1.2.7 (L2) Provide effective support to the team at post-incident debrief N, AB, C, P, E Competent

103 COMPETENCIES: NATIONAL CURRICULUM AND COMPETENCY FRAMEWORK FOR EMERGENCY NURSING (LEVEL 2) CLINICAL DOMAINS (CD) LEVEL 2
 Caring for
acutely
ill adults

Emergency
The RCN represents nurses and nursing, promotes Caring for
excellence in practice and shapes health policies planning and
adults requir
June 2017 disaster
resuscitatio
Review date: June 2019
management Preventing
RCN Online and controlling Patient
www.rcn.org.uk
violence and assessment
RCN Direct aggression
www.rcn.org.uk/direct

0345 772 6100 Pain

Documentation assessment
and record and
Published by the Royal College of Nursing
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Infection
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Publication code: 005 923

The Royal College of Nursing would like to thank NHS

Improvement for its support in the production of this publication.

Caring for