Health Practitioners Competence Assurance Act 2003

The Health Practitioners Competence Assurance Act 2003 ('the Act') came into effect on 18 September 2004 and replaced the Nurses Act 1977.

Its principal purpose is to protect the health and safety of the public by ensuring that health practitioners are fit and competent to practise.

The main points under the Act include:

  1. A consistent framework for all health practitioners.

  2. A separate Midwifery Council to regulate midwives.

  3. Scopes of Practice (instead of registers) and conditions to further define an individual nurse's scope of practice.

  4. Changes to requirements of registration under the Health Practitioners Competence Assurance Act 2003.

  5. Restrictions on issuing of annual practising certificates.

  6. The introduction of competence provisions.

  7. Ongoing Fitness to Practise (Health).

  8. Professional Conduct.

  9. The introduction of an independent Health Practitioners Disciplinary Tribunal to hear disciplinary matters.

  10. Quality Assurance provisions.

The Act continues the core functions that the Council had under the Nurses Act 1977 of setting and maintaining standards for nursing education programmes; registration and mainating the register; investigation of nurses; and health and disability monitoring.

This means the Council will continue to set standards for nursing education programmes, and to audit and approve educational institutions and their programmes for the education of nurses in New Zealand.

The Council continues to be the registration body for nurses in New Zealand. This means keeping a register and issuing annual practising certificates.

The Council continues to receive complaints about professional misconduct and refers them to the Health and Disability Commissioner to investigate them and to prosecute where necessary.

It also continues to receive notifications of health and disability issues that prevent a nurse from being able to carry out nursing functions.

In addition, under the Act, the Council will also receive notifications about nurses who may pose a risk of harm to the public by practising below the required standard of competence.

1. A Consistent Framework for all Health Practitioners

The Act applies to all registered health practitioners including chiropractors, dentists, dieticians, medical laboratory technologists and scientists, medical practitioners (doctors, surgeons and other specialists), medical radiation technologists, midwives, nurses, occupational therapists, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists and psychologists.

Each practitioner is registered with the relevant authority. That authority holds a register of all the practitioners registered with it. These registers are available to the public.

The Council has an online register available to the public that provides details of nurses who hold current practising certificates. Click here to access the online register.

2. A Separate Midwifery Council to Regulate Midwives

The Act established a separate Midwifery Council that has jurisdiction over the education, registration, discipline and competence of all midwives in New Zealand. The midwifery register was transferred from the Nursing Council to the Midwifery Council on 18 September 2004. The Nursing Council has worked with the Midwifery Council in its separation by providing information and ongoing assistance.

The Midwifery Council and the Nursing Council will issue practising certificates separately for each profession.

  • If you are practising nursing, you must have a nursing practising certificate from the Nursing Council.

  • If you are practising midwifery, you must have a midwifery practising certificate from the Midwifery Council.

  • If you hold dual registration as both a nurse and a midwife but are practising nursing, you must have a nursing practising certificate. You can choose whether to apply to the Midwifery Council for a midwifery practising certificate as well.

  • If you hold dual registration as both a nurse and a midwife but are practising midwifery, you must have a midwifery practising certificate. You can choose whether to apply to the Nursing Council for a nursing practising certificate as well.

  • If you hold dual registration and consider you are practising both nursing and midwifery, you must have two practising certificates - one for nursing and one for midwifery.

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Please note that under Section 8 Act 2003, it is illegal to practise as a health professional without a current practising certificate issued by the responsible authority for the profession in which you are practising.

3. Scopes of Practice

Under Sections 11 and 12 of the Act, the Council must describe the contents of the profession in terms of one or more scopes. Scope may be defined however the body sees fit.

The Council must also prescribe qualification(s) for every scope of practice, including a degree or diploma, the successful completion of a programme, a pass in an examination, registration with an overseas equivalent authority, and/or experience.

It must monitor every New Zealand institution and may monitor overseas institutions which provide a degree or diploma designated for a scope of practice.

Under Section 22(3), the Council may place conditions on a nurse's scope of practice. Conditions must be of a kind that the Council considers are required to ensure the competent practice of the applicant and may include:

  • practise under supervision or oversight

  • restrictions on tasks performed

  • practise only under certain conditions

  • practise for a specified period

  • attain further qualifications

and/or any other conditions the Council believes necessary (on reasonable grounds) for protection of public safety.

The Council can decline a practising certificate if the applicant has failed to comply with a condition included on a scope of practice.

Nurses can also be prosecuted before the Health Practitioners Disciplinary Tribunal if they practise outside the scopes, or breach conditions.

Under the Act, the previous registers are replaced by four scopes of practice. These are: Registered Nurse, Nurse Practitioner, Nurse Assistant and Enrolled Nurse.

This means there is a title change for most nurses. The legal titles of registered comprehensive nurse, registered general and obstetric nurse, registered general nurse, registered obstetric nurse, registered psychiatric nurse and registered psychopaedic nurse has been replaced with Registered Nurse (RN).

Enrolled nurses who graduated before 2000 keep their previous title but enrolled nurses educated after 2000 will have the title Nurse Assistant.

Some scopes have conditions attached according to the nurse's qualification and experience to further define the specific area of practice.

For a description of the new scopes of practice and qualifications and a table showing how nurses will be transferred into the new scopes of practice, click here.

Please note that all nurses had their current registrations transferred into the new scopes automatically. New scopes of practice and conditions have been noted on all practising certificates since 18 September 2003 . As nurses apply for their practising certificates, their new scopes of practice and conditions will be indicated on the application forms.

4. Requirements and Fitness for Registration under the Health Practitioners Competence Assurance Act 2003

The Act lists requirements that have to be met before applicants can be registered as nurses (Sections 15 & 16).

Before registration, each applicant is required to demonstrate that she or he:

  • has the prescribed qualifications

  • is competent to practise

  • is able to communicate effectively

  • is able to communicate in and comprehend English

  • does not have a mental or physical condition which may mean she or he is not able to perform the functions required

  • has not been convicted of an offence punishable by three months imprisonment or more that reflects adversely on her or his practice

  • is not under investigation or the subject of disciplinary proceedings in New Zealand or overseas that reflects adversely on her or his practice

  • has not had a disciplinary order made which reflects adversely on her or his practice.

The authority may also refuse to register an applicant if it has reason to believe that the applicant may endanger the health and safety of members of the public.

5. Restrictions on Issue of Annual Practising Certificates

Once a nurse is registered, she/he must apply for a practising certificate every year. It is illegal to work as a nurse without a current one.

In order to protect the public's health and safety by ensuring that health practitioners are fit and competent to practise, Section 29 provides for the Council to consider whether to issue a practising certificate to any nurse if it has reasonable grounds to believe the applicant:

  • has failed to maintain the required standard of competence

  • has failed to fulfill or comply with a condition on the applicant’s scope of practice

  • has not satisfactorily completed the requirements of any competence programme

  • has not held a practising certificate for three years

  • is unable to perform the functions required for nursing because of some mental or physical condition

  • has not, within the three years immediately preceding the date of application, lawfully practised nursing.

6. Competence Provisions

Information booklets on the process for competence are being developed.

Reporting Provisions

Under Section 34, the Health and Disability Commissioner must notify the responsible authority when she or he has reason to believe a health practitioner may pose a risk of harm to the public by practising below the required standard of competence.

An employer must notify the authority if any employee is dismissed or resigns for reasons related to competency.

In addition, any health practitioner may notify the authority if they have reason to believe that another health practitioner may pose a risk of harm to the public by practising below the required standard of competence. No civil or disciplinary procedeings lie against any person in respect of a notice given under this Section by that person, unless the person has acted in bad faith.

Whenever an authority has reason to believe that there may be a risk of harm to the public from practice a health practitioner registered with that authority, it must promptly advise the Accident Compensation Corporation, the Director-General Of Health, the Health and Disability Commissioner and any known employer of that authority.

7. Ongoing Fitness to Practise (Health)

Under Section 45 any person who:

  • is in charge of an organisation that provides health services; oris an employer of health practitioners; or

  • is a medical officer of health

must notify the authority if they have reason to believe that a health practitioner is unable to perform the function required for nursing because of some mental or physical condition. Thisincludes an impairment caused by alcohol or drug abuse.

An authority may order interim suspension of practice before ordering a medical examination and before the Health Committee hears the practitioner. The authority may carry our further further inquiries or may order a competence review.

An authority may suspend a practitioner or place conditions on her or his practice if it believes that the health practitioner is unable to perform the functions required for the practise of her or his profession. The authority may not make any such orders until it has informed the practitioner of its intentions and given her/him a resaonable opportunity to make written submissions and be heard.

There is also a mandatory reporting requirement on persons in charge of education programmes to notify the Council if they have reason to believe that a student would be unable to perform the functions required for nursing because of a mental or physical condition.

8. Professional Conduct

Anyone may complain about the conduct of a practitioner.

Complaints alleging that the practice or conduct of a health practitioner has affected a health consumer should be made to the Health and Disability Commissioner in the first instance.

The Commissioner may refer a complaint to an authority for appropriate action.

The Council may suspend the practice of a practitioner during an investigation when there are good grounds to do so.

If the Council decides that a complaint should be investigated, it appoints a Professional Conduct Committee ('PCC') to investigate. The Council has called for nominations and maintains a panel of appropriately experienced nurses and laypersons from which to assemble a PCC (which consists of three individuals).

A PCC may recommend that the authority review the practitioner’s competence, fitness to practise, or scope of practice. A PCCmay recommend that an Council refer the matter to the police or counsel the practitioner.

A PCC also may may decide that no further action will be taken, or bring a charge against a practitioner before the Health Practitioners Disciplinary Tribunal (see below) alleging professional misconduct, or refer the complaint to conciliation.

 

9. Health Practitioners Disciplinary Tribunal

The Health Practitioners Disciplinary Tribunal ('HDPT') is an independent tribunal that will hear charges of professional misconduct instead of the Council. The Tribunal will consist of a chairperson or deputy chairperson who is a lawyer and four panel members. Three must be professional peers of the health practitioner who is the subject of the hearing and the other must be a layperson.

The Chairperson of the HDPT is Dr David Collins, QC and the Deputy Chairpersons are: Ms Kate Davenport, Ms Belinda Greer and Dr Fiona McCrimmon. The nurse members of the tribunal are Christine Alavi, Marian Bland, Taima Campbell, Andrea Corbett, Judy Kilpatrick, Orana Harris, Katie Bolton and Alan Thomson.

10. Quality Assurance Provisions

Quality Assurance Activities (‘QAA’) describe the way practitioners review, assess and monitor their work. The aim is to identify ways in which practice and competence can be improved. Health practitioners who are involved in QAA can apply to the Minister of Health to have their QAA protected. This provides a mechanism to protect the confidentiality of the information gathered, to ensure that QAA takes place without fear of reprisal and achieves its overall goal of improving practice and systems.

Further information is contained in the New Zealand Ministry of Health: Protected Quality Assurance Activities under the Health Practitioners Competence Assurance Act 2003, available on the Ministry's website.

Disclaimer: This web page provides summary information only. The Nursing Council is able to clarify the statutory framework but it is not able to provide advice to individual nurses. That is the role of the professional organisations such as the College of Nurses and New Zealand Nurses Organisation.

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