Anyone using the protected titles of ‘registered nurse’ ‘enrolled nurse’ or ‘midwife’ in Australia can only do so if they are registered with the Nursing and Midwifery Board of Australia (NMBA).
Under the Health Practitioner Regulation National Law Act 2009 (the National Law) which governs this registration, there is no distinction made about your registration status depending on your work position or type of work.
In order to have gained registration, the individual must have successfully completed the educational preparation prescribed by the NMBA, demonstrated they have met the standards for practice in their area of registration, and gained the qualification required by the Board to practice as a registered nurse, an enrolled nurse or a midwife.
Having gained the status of a regulated health professional as either a nurse or midwife, all registrants must abide by the standards, codes and guidelines set by the NMBA, under the National Law.
Again, no distinction is made in complying with these requirements of regulation depending on your work position or type of work – all registered nurses, enrolled nurses and midwives are responsible and accountable for their practice, wherever that may occur. In addition registered nurses retain accountability for all care delegated to an enrolled nurse. The NMBA (2016) provides a very nice summary of the ‘wherever that may occur’ in the description to follow: Practice is not restricted to the provision of direct clinical care. Nursing/midwifery practice extends to any paid or unpaid role where the nurse/midwife uses their nursing/midwifery skills and knowledge. This practice includes working in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory, policy development roles or other roles that impact on safe, effective delivery of services in the professional and/or use of the nurse’s/midwife’s professional skills.
Some examples may help to reinforce the fact that, as regulated health professionals, our practice is governed by the same legal and professional practice requirements, whether clinical or non-clinical, as a nurse or midwife.
The first relates to what were originally known as ‘competency standards’. The NMBA has been progressively revising the standards by which all registered nurses and midwives practice. In order to remove any confusion with ‘competency based assessment’ as applied in the vocational education and training sector (VET) the NMBA has moved to the terminology of ‘standards for practice’. Thus, in 2016, after consultation with the profession and stakeholders, the NMBA published the newly revised Registered nurse standards for practice. The fact sheet accompanying these standards for practice emphasises that ‘the criteria are to be interpreted in the context of an individual RN’s practice’ and they ‘are for all RNs across all areas of practice’.
In early July 2017 the NMBA commenced public consultation on Midwife standards for practice, with the NMBA Chair, Associate Professor Lynette Cusack, saying in NMBA’s news publication that “The draft Midwife standards for practice have been thoroughly researched so they’re suitable for midwives in all contexts of practice”.
The second is the decision making framework (DMF) which facilitates a consistent approach for registered nurses and midwives to make decisions about their practice across all areas of practice.
The NMBA (2010) says the DMF is ‘most relevant for the clinical practice setting, but may be modified or adapted for decision making in other areas of nursing or midwifery practice such as education, research and management’.
Registered nurses and midwives are accountable for the decisions they make and the information or actions that follow, this applies whether in the context of deciding on appropriate care, delegation to subordinate workers, management of staff according to competence, or providing information on a policy submission. The DMF can be also used by staff in management positions to effectively negotiate with non-nursing/midwifery executives for appropriate staffing numbers and skills levels to provide safe, competent care.
The NMBA will be reviewing the DMF later this year and we will advise ANMF members so that you can participate in the consultation process of this important document for our professions.
While highlighting these features of the professional practice framework under which nurses and midwives practice, it should be noted that aspects of the National Law also apply equally to all regulated nurses and midwives regardless of where you work.
This includes: the common registration standards relating to criminal history, professional practice indemnity, continuing professional development, recency of practice, English language skills; and mandatory reporting and notifications of unprofessional conduct.
In a nutshell it’s a case of ‘One for all and all for one’. Whether clinical or non-clinical, the NMBA standards for practice, and in fact, the whole of the professional practice framework, applies!
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers