February 2000 Newsletter | |||||||||||||||||||||||||||||||||
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News from the Council
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Strategic Direction On into the 21st Century the Nursing Council’s three-year strategic plan, 1 April 2000 to 31 March 2003 will set new directions. We have confirmed our purpose, governance role and operating principles and work is currently underway to develop specific objectives over the next few months. Purpose The Nursing Council exists in the public interest and is accountable to the public for establishing and maintaining standards that promote safe and competent practice by nurses and midwives. It has both a statutory role as set out in the Nurses Act 1977 and a leadership role for the nursing and midwifery professions. The Council’s role is to act in a proactive and responsive manner to relevant national and international trends that influence the practice of nurses and midwives. Principles The Nursing Council operates under the following principles:
Issues We have identified issues and strategies for moving forward in fulfilling our role. We want to influence legislation and achieve changes more appropriate for this new era. In particular the Nurses Act 1977 requires a full review and we will do what we can to encourage action. The Council has commissioned a review of undergraduate nursing education and this will shape the practice of the nurse of the future. This is an extremely important initiative for nursing and Council will be focusing a lot of energy on this review over the next 18 months or so. There will be wide consultation with the nursing sector during this review and we urge you all to ensure that your professional body or representatives are aware of your views so that they can be fed into the review and that you try to attend any advertised meetings in your area to feed in your ideas to the review. Our new policy on post-registration nursing education programmes is being implemented. At its December meeting, Council approved the first three programmes under the new policy and Council has received a further 10 applications from education providers for approval of their programmes. Council has commenced work on the development of a post-registration education framework for midwifery. We look forward to continuing our consultation as we work together to achieve our goals. Judy Kilpatrick
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Notes from the Chief Executive
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Annual Practising Certificates You will note that the renewal form for Annual Practising Certificates has been redesigned to make it clearer. The workforce questionaire has been expanded to incorporate information on qualifications, in line with other regulatory authorities, and also to elicit more detailed information on where nurses are working. We hope you will find it easier to complete. We would welcome any specific feedback on the redesign of the form and suggestions for improvement for next year. Please either write or email any comments to Suzette or Fergie at Nursing Council, (e- mail: suzette@nursingcouncil.org.nz or fergie@nursingcouncil.org.nz ) Do not write comments on the application form itself but send separately.There is no increase to the APC fee which remains at $32.00 for the 2000/01 year. We urge you to complete the form and send it with the money owing as soon as you receive it so that we can process all responses. Payments are due by 20 March to ensure that you receive your APC by 31 March 2000. The legislation change for competence-based practising certificates has not yet been enacted so there are no additional requirements to be met this 2000/2001 year.Pease let us know whenever you change your address so that our data-base is kept up to date. New Structure The restructure of the Nursing Council staffing has been completed. The New structure strengthens the role of nurse advisors and provides them with enhanced administrative support. It also formalises the creation of a role for a Midwifery Advisor to take responsibility for midwifery issues. I have decided to continue to combine the dual functions of Chief Executive and Registrar. Overall, the new structure increases the staff of the Council by two full-time staff members which will ease the workload of current staff and ensure a more effective service to Council. I look forward to welcoming three new administrative staff on 17 January and two new professional staff members in February. The expanded staffing is more closely aligned to our functions in education, registration, issuing of certificates, monitoring of practice and professional conduct, and our operational units. Changes in Staffing With the restructure we sadly farewell two
experienced professional staff members – Kathryn Wilson, Education
Officer, and Allison Chappell, Projects Co-ordinator. Donna Gordon, currently Duty Manager, Kenepuru Hospital at Capital Coast Health, will join the Nursing Council in February as Registrations Advisor and Deputy Registrar. This restructured role will have responsibility for both overseas and New Zealand registrations, including renewal of practising certificates, verifications, and professional assessment of competence of overseas graduates. She will also lead the implementation of competence-based practising certificates and the development of post-registration professional credentialling. We look forward to welcoming her onto the staff. An appointment to the Education Advisor position is pending but we expect to finalise a contract by February. In the meantime, education requirements will be covered by Marian McLauchlan and Teenah Handiside, who has provided invaluable support to the Council as temporary Registrations Officer since Pauline Climo left in September. Marcella Burke, Jo Pohatu and Charlotte Stapleton join the Nursing Council on 17 January. Their ranges and depth of experience significantly strengthens the administrative capability of the Council and should greatly increase our responsiveness to nurses and midwives and the Council members. Marion Clark
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Survey
From Ministry of Health
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Summary The Nursing Council of New Zealand is the registration authority for nurses and midwives and draws its authority from the Nurses Act 1977 ("the Act") and subsequent amendments. The Council’s primary purpose is to ensure safe and competent care for all people in New Zealand by meeting the statutory provisions in the Act. The Act provides for direction and supervision of
enrolled nurses and registered obstetric nurses, and also for general
nurses in regard to obstetric nursing, but does not define
"direction and supervision". This position paper offers
guidelines to clarify the requirement. Where health service assistants are employed, or the client’s family are assisting with the care of the client/patient/resident/woman, and the registered nurse or midwife accepts responsibility for the supervision/and or delegation of that care, criteria for direction and supervision apply and accountability for nursing processes and outcomes remains. Background The Act provides primarily for the education, registration/enrolment, and discipline of nurses and midwives. In particular, the registration/enrolment process is designed to protect the public from unqualified practitioners and inadequate standards of nursing or midwifery practice. The Act defines and distinguishes between registered nurses/midwives and enrolled nurses. It does not refer to other categories such as health service assistants. In respect of employment of nurses [and midwives], section 57(1), as amended by the fourth schedule of the Health Reforms (Transitional Provisions) Act 1993, includes: Appointment of nurses -…(a) No person shall be appointed to the staff of any licensed hospital within the meaning of the Hospitals Act 1957 to carry out the duties of any class of persons whose registration is provided under this Act unless the person appointed is registered under this Act as a person of the appropriate class; and (b) No person shall be appointed to the staff of any licensed hospital within the meaning of the Hospitals Act 1957 to carry out the duties of any person of the class for whom enrolment is provided for under this Act unless the person appointed is registered or enrolled under this Act…. The Act does not refer to health service assistants or any category other than registered or enrolled nurses or registered midwives. The title of the respective classes of registered nurse or midwife or enrolled nurse are specifically defined in the interpretation section (s2) of the Act .Accordingly, the differences in "duties" must be clarified in accordance with the preparation for the particular "class " of registered nurse, or midwife, or enrolled nurse and the requirement that "no person shall be appointed…to carry out the duties of…" unless the person appointed is registered or enrolled as the case may be. Direction and Supervision of Enrolled Nurses The Nurses Act 1977 makes provision for direction and supervision of enrolled nurses. Section 53 A of the Act states:Offence relating to enrolled nurses - Every enrolled nurse commits an offence and is liable on summary conviction to a fine not exceeding $1,000 who, other than in an emergency, practises nursing other than under the direction and supervision of a registered nurse or medical practitioner.This requirement for enrolled nurses to practise nursing under direction and supervision means that the registered nurse or midwife must be clear about the respective roles and adequately prepared for providing appropriate direction and supervision. The Act does not define "direction and supervision". While the application may vary in different settings, direction and supervision refer to the active process of directing, guiding, monitoring and influencing the outcome of an individual’s performance of an activity related to assigned aspects of nursing practice or a delegated activity, and providing support in ways which enhance performance. Direct supervision is provided when the registered nurse or midwife is actually present, observes, works with and directs the person who is being supervised. Indirect supervision is provided when the registered nurse works in the same facility or organisation as the supervised person but does not constantly observe her/his activities. The registered nurse or midwife must be available for reasonable access. This includes ensuring that the enrolled nurse knows how, when and where to obtain assistance or further direction from the registered nurse or midwife. Direction and Supervision in Obstetric Nursing
Offences relating to obstetric nursing – (1) Every person commits an offence and is liable on summary conviction to a fine not exceeding $1,000 who carries out obstetric nursing in any case where a medical practitioner or registered midwife has not taken responsibility for the care of the patient.(2) Every person commits an offence and is liable on summary conviction to a fine not exceeding $1,000 who carries out obstetric nursing in any case where a medical practitioner or registered midwife has undertaken responsibility for the care of the patient, unless the person carrying out the obstetric nursing –
This s54 also includes: (6) For the purposes of this section, the expression "carries out obstetric nursing", in relation to any person, means that [s]he-
Section 54 (a) and (b) of the Act excludes registered psychiatric or psychopaedic nurses from obstetric nursing practice. Preparation for Direction and Supervision The Nursing Council Competencies for Entry to the Register of Nurses and the Competencies for Entry to the Register of Midwives now include criteria about this direction and supervision. In practice, there needs to be clarity around what type of direction and supervision is provided and when this direction and supervision is required, as well as understanding about the roles/scope of practice and respective responsibilities. Scope of Practice Each individual nurse and midwife has professional
responsibility to practise within their scope of practice. Registered nurses and midwives must, therefore, exercise professional judgement regarding the degree of direction and supervision, in the delegation of responsibilities to enrolled nurses. The same applies to registered obstetric nurses and registered general nurses practising obstetric nursing. The extent of the direct or indirect supervision depends on the complexity of nursing skills and judgement involved. Enrolled nurses, obstetric nurses, and general nurses (in the maternity setting) must be aware of the limitations of their role and be willing to accept the direction and supervision and to know when and whom to contact while remaining accountable for their own actions or inactions. Accountability Each registered nurse, midwife and enrolled nurse is individually accountable for their practice. Being accountable means being answerable, chargeable, culpable, liable and responsible. Maintaining professional standards is expected of all registered nurses, midwives and enrolled nurses. The Nursing Council ‘Code of Conduct for Nurses and Midwives’ (1995) contains four principles, each with criteria, as guidelines related to the legal and ethical requirements of professional nursing or midwifery practice. The disciplinary provisions of the Act include reference to "…any registered or enrolled nurse..." as written in section 40 ‘Complaints against nurses’ and section 42 ‘Disciplinary powers of Council’ which includes "(a) Is convicted of…any offence against section 53 A or section 54 of this Act". Professional misconduct is defined in section 2 ("Interpretation") of the Act:Professional misconduct, in relation to a nurse, means conduct which, in the judgement of the Council,- (a) Amounts to malpractice or negligence by that nurse in relation to the class of nursing in respect of which he is registered or enrolled; or (b) Brings or is likely to bring discredit on the nursing profession. In the context of section 53 A and section 54 of the Act the registered nurse and the registered midwife have accountability for the direction and supervision provided. This includes that the enrolled nurse or obstetric nurse (or general nurse in obstetric settings) is not placed in a position of being accountable for clients/patients/residents/women whose nursing care requires knowledge and skill outside the parameters of their preparation.Responsibilities Direction and supervision from the registered nurse or midwife is about appropriate activities or aspects of care in relation to the stable and predictable needs of the assigned patient/client/resident/woman and the education and skill of the enrolled nurse, or obstetric nurse (or general nurse in obstetric nursing settings). In accepting assigned nursing care, the enrolled nurse or obstetric nurse (or general nurse in obstetric nursing settings) has a responsibility to ensure that she/he:
The enrolled nurse must not delegate her/his nursing care to a health service assistant. The responsibility for carrying out the assigned nursing care remains with the enrolled nurse. The registered nurse or midwife retains responsibility for direction and supervision. Increasingly, health service assistants are employed to perform tasks or the client’s family are assisting with the care of the client/patient/resident/woman. Where the registered nurse or midwife accepts responsibility for the supervision/and or delegation of that care, the registered nurse or midwife must demonstrate competencies in direction and supervision along with delegation of activities while retaining accountability for nursing processes and outcomes. The paper, The Health Service Assistant and the Registered Nurse, (April 1999) published by the Ministry of Health for the College of Nurses Aotearoa (NZ) Inc, Nurse Educators in the Tertiary Sector (NETS) and Nurse Executives of New Zealand (NENZ) provides guidelines for successful and safe working relationships with health service assistants. The Nursing Council recommends this paper as a position statement concerning principles in supervision of, or delegation to, the unregulated assistant to the registered nurse or midwife. The safety of the client/patient/resident/woman is the primary factor in the assessment of their needs, circumstances, the context of care, and decisions about direction and supervision and/or delegation made by the registered nurse or midwife. Conclusion The Nurses Act 1977 provides for direction and supervision of enrolled nurses practising nursing in any setting, and also for registered obstetric nurses and registered general nurses in carrying out obstetric nursing. Acting within the legislated requirements and scope of practice parameters, enrolled nurses, registered obstetric nurses and (registered general nurses in obstetric settings) retain their responsibilities and individual accountabilities for their actions, while practising under direction and supervision. In providing appropriate direction and supervision
each registered nurse or midwife must meet the Nursing Council
competencies and exercise judgement in the particular situation with
regard to the assessed needs and the planned care of the
patient/client/resident/woman. |
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The re-designed application form for renewal of the annual practising certificate for the year 1 April 2000 to 31 March 2001 is sent to all nurses and midwives holding a current APC as of the last week in January 2000. Any nurse or midwife requiring a practising certificate who does not automatically receive a renewal form by the end of February 2000 can telephone the Annual Practising Certificate department on (04) 385 6921, to make sure the Nursing Council has the most recent address on file. It is important that you complete all sections of your own personalised application form sent to you including all the data requested and return it, with a cheque for $32.00, to the Nursing Council by 20 March to ensure that you receive your practising certificate by 31 March 2000. Please note that it is illegal to practise as a nurse or midwife without a current practising certificate. As in previous years, payment must accompany the application form. We regret that we can only accept cheques or cash for payment. Please do not attempt to directly credit payments as we often cannot track who these payments are from. Following some complaints last year, we have investigated the use of credit cards but have not implemented any changes for this year’s round. The need for recouping the extra costs of use of credit cards by increases in fees, and the implications of management of credit card payments needs further consideration. The application forms that are automatically sent all have a bar-coding printed at the bottom. Any application form requested and dispatched after the first week of February will not have this coding. If you are renewing your certificate through your employer who is making a bulk payment, it is important that you advise them if you have an application form without a bar-coding. The annual practising certificate for the 2000/2001 year utilises a built-in self-lamination feature. The laminate layer allows us to personalise the card and prevents any forgery or tampering. Please read and carefully follow the illustrated instructions
provided on the back of your certificate. Sign the card first and then
bend it slightly and peel out the card so it is separated from the backing. Flip
the card over and carefully place it face down on the same space from which it
is removed. Press it thoroughly to ensure that the laminate firmly adheres to
the card all over. After this, detach the card from the backing slip. Your
laminated practising certificate will then be ready for use. |
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During April to December 1999, the Council conducted nine disciplinary hearings. Of these hearings, four were following court conviction notifications and five were convened to consider allegations of professional misconduct. Court Convictions Of the four cases heard, three were convictions under the Crimes Act 1961: One person convicted had conditions imposed on practice and ordered to pay 50% of the costs incurred by Council. An enrolled nurse convicted of using a document for pecuniary advantage, had his name removed from the roll with the ability to apply in 12 months time for re-instatement to the roll. The Council also ordered the nurse to pay $1, 043, being 50% of the costs incurred, and publication of the effect of the orders but not the nurse’s name. The nurse had brought the nursing profession into disrepute in that honesty is an integral part of the professional behaviour of a nurse. Two cases are still in process. Allegations of Professional Misconduct In respect the five hearings of alleged professional misconduct: A nurse was found guilty of professional misconduct for carrying a concealed knife while on duty. The Council accepted the difficulty of working with some clients but determined that carrying a concealed weapon has potential harm to clients and the public and is never acceptable, and that this conduct had brought discredit on the nursing profession. The nurse was censured and ordered to pay $5,480, being 50% of the costs incurred by the Council, investigation by the Commissioner and prosecution by the Director of Proceedings. A registered comprehensive nurse was found guilty of professional misconduct for intentionally hitting a patient on the head. Council considered it unethical for a nurse to assault a patient in that the nurse is charged with the duty to provide care and ensure the safety of clients. The nurse’s behaviour fell below that expected of a registered nurse and brought discredit on the nursing profession. The Council censured the nurse, recommended that she developed and implemented strategies for improving and maintaining her professional practice, and ordered that the nurse pay $6,010, being 50% of the costs incurred by the Council, investigation by the Commissioner and prosecution by the Director of Proceedings, and publication. One case is subject to appeal. Two other cases are still in progress. |
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Kathryn Wilson has been Education Officer with the Nursing Council for 4 years and left in January to take up a position as Nursing Programme Manager, at Northland Polytechnic. Kathryn is a highly experienced nurse educator and Council has appreciated her assistance and advice. We look forward to working with Kathryn in her new role at Northland Polytechnic.
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11 February
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Registration
- Annual Practising Certificates | |||||||||||||||||||||||||||||||||
