Nurse education in Australia: Part 10

National Law (2009) and mandatory registration standards

In 2005, the Council of Australian Governments [COAG] published the findings of a report by the Productivity Commission which detailed the challenges faced by Australia’s health system (Katsikitis et al. 2013). It highlighted the pressures arising from Australia’s ageing population, increased community expectation and complex co-morbidity which, through offset by technological advancements and adaptive care models, resulted in significant nursing workforce shortages and reduced access to safe, high-quality health care (Katsikitis et al. 2013).

By way of addressing these challenges, COAG enacted the National Registration and Accreditation Scheme (‘National Scheme’) which came into effect on 1 July 2010 (Department of Health, 2019). The Australian Health Practitioner Regulation Agency [AHPRA] was established to support 15 National Boards representing a diverse range of health professions- including nurses and midwives- to implement the Scheme (AHPRA 2020). The National Scheme was enforced in accordance with the Health Practitioner National Law (‘National Law’) (AHPRA, 2020).

The National Scheme had two main objectives: firstly, to keep the public safe by ensuring that only suitably qualified and ethical practitioners were registered, and secondly, to facilitate workforce mobility and development. The National Scheme ensured that registration standards were transparent, holding practitioners to account for their clinical competence and capability to practice (Department of Health, 2019). The principles guiding the administration of the National Scheme, related to equity and fairness. These efficiencies helped maintain registration fees at reasonable levels and provided practitioners with the flexibility to practice anywhere in Australia.

The Nursing and Midwifery Board of Australia [NMBA] was responsible for: 1) developing the standards, codes and guidelines governing practice; 2) approving accreditation standards for courses of study leading to nursing and midwifery qualifications in partnership with the Australian Nursing and Midwifery Accreditation Council (ANMAC); 3) assessing the qualifications of overseas trained practitioners seeking registration in Australia, and; 4) adjudicating notifications, complaints, investigations and disciplinary hearings referred by the Nursing and Midwifery Council (NMC). The NMBA continue to provide vigilant oversight of nursing and midwifery policy and professional standards, while the state and territory boards make decisions about jurisdictional concerns relating to 1) registration; 2) endorsements; 3) notations, and; 4) compliance (NMBA, 2020).

In 2016, the NMBA introduced a revised set of registration standards which reflected a more contemporary regulatory framework. This transition from Competency standards to RN standards for practice (NMBA 2017) was profound, as the amended nomenclature and level of accountability contained in the new standards heralded a new era in nursing and midwifery governance and professionalism. The seven standards were designed to interconnect, with standards one, two and three relating to each other, as well as to each dimension of practice contained in standards four, five, six and seven. These standards set a new benchmark for registered nursing and midwifery practice and a means of empowering consumers by informing their expectations. They also provided a framework for assessing capability prior to obtaining, or retaining, registration. The RN Standards for practice (NMBA, 2017) and Midwife standards for practice (NMBA, 2018) continue to be periodically reviewed by the NMBA, who take responsibility for their maintenance.

In order to remain applicable to all practitioners- regardless of experience level or clinical speciality- the standards had to be broad and principle-based. This breadth recognised the requirement for autonomous, person-centred and evidence-based practice along with the need for critical thinking and respectful engagement. The development and maintenance of therapeutic relationships and the accountability for supervision and delegation of nursing activities to other health professionals- such as enrolled nurses (ENs) and assistants in nursing- was also captured (NMBA, 2017).

As stated in last month’s article, nurses and midwives were by now employed in a range of clinical, non- clinical and advanced practice roles within universities, government departments, hospitals and the community. Therefore, it was essential to expand definitions of the word “practice” to include both direct and indirect care (NMBA, 2019). Reference to “practice” now encompasses, “any role, whether remunerated or not, in which the individual uses their skills and knowledge as a health practitioner in their profession” … and is not “restricted to the provision of direct clinical care”. The term also includes “using professional knowledge (working) in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on the safe, effective delivery of services in the profession”. (NMBA, 2010, p. 1).

Under this revised regulatory framework, nurses and midwives were required to demonstrate compliance with five mandatory registration standards relating to 1) recency of practice; 2) continuing professional development; 3) criminal history; 4) English language skills, and; 5) professional indemnity insurance, prior to their annual registration renewal. The Criminal history, English language and Professional indemnity insurance standards applied to only some nurses and midwives by virtue of their history, first language, or current role, whereas ongoing adherence with the Recency of practice and Continuing professional development standards was (and remains) mandatory for all practitioners. The Recency of practice registration standard outlined the types of experience nurses and midwives required to ensure professional currency such as 1) the provision of 450 practice hours within the preceding 5 years; 2) completion of an NMBA approved program or assessment process or 3) completion of a supervised practice experience.

Registered nurses and midwives were also required to complete at least 20 hours of CPD during each registration year. The NMBA defined Continuing professional development (CPD) as any activity which “enabled nurses and midwives to maintain, improve, and broaden their professional knowledge, expertise and competence to meet their obligation to provide ethical, effective, safe and competent practice… resulting in positive learning outcomes and evidence-based changes to practice” (NMBA 2016, p. 1).

The inclusion of words such as “improve”, “broaden”, “professional knowledge”, “expertise”, and “competence” reinforced that CPD activities were designed to support the learning needs and professional growth of individual practitioners, with the benefits of these activities documented and reinforced by subsequent reflection. However, authors such as Katsikitis et al. (2013) and Ross et al. (2013) initially challenged the notion of mandatory professional development by suggesting that that further research into the most effective means of delivering high-quality, relevant CPD was required and that any barriers to completion- such as financial or work-related impediments- must be identified and removed.

In 2014, the NMBA highlighted the need to regulate Australia’s ever-increasing number of nursing sub-specialties. Following research and consultation, the NMBA concluded that the professional organisations representing these emerging speciality areas had put adequate processes in place (such as the speciality practice standards used for benchmarking and credentialing) to differentiate between specialities and protect the public. However, these professional developments will be expanded upon in next month’s article.