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Once upon a time people could get qualifications in nursing or midwifery, go and do something else, and then come back to nursing or midwifery at any time they wished.
But not now.
If a person applies for registration or enrolment after an absence from practice, the person may be required to satisfy the Board that she or he has the knowledge and skill for current practice. Depending on the duration of the absence and any activities undertaken to maintain knowledge and skill in nursing and/or midwifery, a person may now be refused registration or enrolment.
In order to be registered again, some people will need to undertake a three-year university bachelor degree recognised by the Board. Some people seeking to be enrolled again will need to undertake an enrolled nurse course recognised by the Board.
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Some years ago it used to be possible for persons, who had previously been registered or enrolled, to obtain registration or enrolment again quite easily. Until 2004 it was necessary only to pay a small fee. Since 2004 legislation has provided that restoration to a Register or the Roll cannot now be presumed.
Amendment to the Nurses and Midwives Act 1991 in 2004 inserted section 2A which states the objects of the legislation. The effect of the changes is that the Board must exercise its functions consistent with protection of the health and safety of the public. While the Board had previously functioned on this basis, it became an explicit requirement in legislation. Further amendments to the Act in 2004 provided that the Board is no longer required to restore a person's name to the Register or Roll and instead may scrutinise the application in the same way that it would deal with an application from a person who had never previously been registered or enrolled.
The Board may permit registration or enrolment with certain conditions, if it is considered that these conditions would be adequate to protect the public. In some instances there may be serious doubt that a person could practise safely after many years away from professional practice; in such instances the Board may refer the application to an inquiry which is conducted in accord with Schedule 1B to the Act. Even where a person satisfies all other requirements, section 29A provides circumstances in which the Board may refuse regisration or impose conditions. The legislated definition of competence may be found in section 4B.
Schedule 1B inquiry is similar to an inquiry by the Nurses and Midwives Tribunal except that the Tribunal determines if a person who is already registered or enrolled should be permitted to stay on a Register or the Roll, while a Schedule 1B inquiry makes decisions about persons who are not yet registered or enrolled. Inquiries are formal, with evidence being taken under oath and with the Director-General of the NSW Health Department and the Health Care Complaints Commission able to make submissions if they choose. Reasons for Decision documents are not usually published. However in one instance an applicant who had been refused registration by a schedule 1B inquiry lodged an appeal with the Nurses and Midwives Tribunal and the schedule 1B inquiry's decision document has been published as an appendix to the Tribunal's decision; see Annexure B in Nesbit v Nurses and Midwives Board [2009] NSWNMT 10 (19 March 2009).
Nurses and midwives who have been away from practice for relatively short periods of time are usually able to be restored to a Register or the Roll promptly.
In some instances, as noted above, registration or enrolment is granted with conditions if this is considered adequate to protect the public. Conditions frequently limit practice to a setting where a nurse manager or midwife manager is prepared to provide the Board with a report on the nurse or midwife's practice within three months of the nurse or midwife commencing practice. Depending on the report, the conditions may then be lifted or varied.
Many of the persons registered with conditions have been unable to obtain employment in appropriate settings and some have decided not to renew registration after one or two years. In some instances, it has been possible to remove conditions where a nurse manager or midwife manager has written a report which has satisfied the Board that the nurse or midwife is able to practise safely without the need for conditions.
Where a person has been away from practice for an extended period, the application may be referred for an inquiry and it is not uncommon for applications to be refused after the inquiry has considered the information before it.
There have been many former nurses and midwives wanting to obtain registration or enrolment again and there have been delays in convening inquiries to deal with all the applications. The Board is looking at alternative strategies for dealing with applications while mindful of the requirement to protect the health and safety of the public.
The issue for people who were educated many years ago and who have not practised for some years is whether they have the knowledge and skill for current practice. Few applicants seem able to provide any evidence of their knowledge and skill and so it becomes inevitable that many applications are refused.
An assessment program has been developed by the College of Nursing and is approved by the Board but it is available only to persons who are referred by the Board. This program is suitable for persons whose education and prior practice was not too distant. However some persons, who were educated many years ago and have not practised in recent years, may need to undertake education at university (to be registered as a nurse or midwife) or recognised organisation (such as TAFE NSW) in order to be enrolled. |
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The knowledge and skills required for current practice are those which have been identified by the Nurses and Midwives Board as requirements in courses which are approved by the Board.
For persons applying for registration as nurses, these are:
For persons applying for registration as midwives, these are:
For persons applying for enrolment as nurses, these are:
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I wish to pursue my application
You must be able to satisfy the Board's officers that you are the person who was previously registered or enrolled.
There is an application for restoration form which may be submitted, the required fee must be paid and current address provided. You may be requested to provide further information, possibly extensive information. You may be registered or enrolled with conditions. It may take some time for your application to be processed. Your application may be referred to an inquiry in accord with Schedule 1B and may ultimately be refused.
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Case Studies
Where persons are aggrieved by the Board's decision in regard to their applications, they may appeal to the Nurses and Midwives Tribunal. The following cases are persons whose applications were refused, following an inquiry, and who lodged appeals with the Nurses and Midwives Tribunal. Applicants who are considering lodging appeals are advised to refer to Appeals against decisions of the Board.
Ms H. was educated as a nurse in another state and registered as a nurse in New South Wales in 1985. She had not practised as a nurse since 1989. In recent years she had been employed in day care for elderly people with cognitive difficulties including dementia. In 2008, she applied to be registered again.
The application was referred to an inquiry.
The inquiry members explored Ms H.'s knowledge and skills in nursing. On the information before it, the inquiry considered that there were gaps in Ms H.'s nursing knowledge and in areas including physiology, pharmacology and her ability to manage such issues as co-morbidities and polypharmacy.
The inquiry struggled to understand Ms H.'s employment in aged care. On the evidence provided by her manager, it appeared that, although unregistered, Ms H. had been employed as a registered nurse but did not appear to understand her employment conditions at the time and did not appear to understand the responsibilities expected of someone who was supposed to be practising as a registered nurse.
The inquiry was not satisfied that Ms H was competent to practise at the time of the inquiry but it considered there was sufficient basis for her to be permitted to undertake an assessment program, which was approved by the Board and be eligible for registration if she was successful in that program.
Ms H. lodged an appeal against this decision. Ms H. wrote that she needed to work and that she had difficulty in managing the cost of the assessment program ($10,000) and the time to undertake the program. She also expressed concern about the cost associated with pursuing an appeal before the Tribunal and decided to withdraw the appeal.
On Ms H's request and with the consent of the Nurses and Midwives Board, the Tribunal dismissed Ms H.'s appeal.
Ms C. had completed education as an enrolled nurse in 1979 and practised as an enrolled nurse until 1991. She continued to pay the annual practising fees for some years and, although not practising, commenced a course to upgrade her qualification to Certificate IV level. Although she did the theory at that time, she did not complete clinical requirements. Subsequently she did not pay an annual practising fee and her enrolment was cancelled.
When Ms C. applied for enrolment in 2008, her application was referred to an inquiry. Ms C. indicated that she wished to undertake a refresher course but the inquiry considered that this would not be adequate for her to be able to practise safely after her long period of absence from practice during which there had been significant changes in the education and practice of enrolled nurses. The inquiry determined that Ms C.'s application was refused.
Ms C. lodged an appeal with the Nurses and Midwives Tribunal but just prior to the hearing, advised that she wished to withdraw. With the consent of the Nurses and Midwives Board, the Tribunal formally dismissed the appeal. Ms C. indicated that she intended to undertake a TAFE course in order to qualify as an enrolled nurse at current standards.
Ms D. completed her education in 1975 and was registered at that time and had not practised since 1977. In the intervening years she had undertaken some other study including a Bachelor of Social Science degree and had worked in a rural enterprise. With changes in the rural business, she wised to return to nursing. Her application for registration as a nurse in 2007 was referred to an inquiry.
Inquiry members asked Ms D questions about nursing and she had difficulty in providing answers which could satisfy inquiry members. For example Ms D. had indicated she wished to seek employment in a medical practice and the inquiry members offered her a scenario regarding a diabetic patient. When asked about assessing blood glucose levels, Ms D. indicated that a 'blood sample' would be required for 'pathology'. She indicated knowledge of 'sticks' which may be used, stating that she hasn't used these since completing her training.
In one part of the inquiry, members sought Ms D's understanding of contemporary nursing practice using a number of examples. In general, Ms D's responses indicated limited understanding of contemporary nursing practice, treatment options, and the responsibility of the registered nurse to plan, manage, supervise and delegate appropriate nursing care based on current evidence.
The inquiry was not satisfied that, on the information before it, Ms D was currently competent to practise nursing and registration as a nurse was refused.
Ms D lodged an appeal with the Nurses and Midwives Tribunal.
The Tribunal had difficulty in communicating with Ms D. She did not attend the directions hearing and did not respond to messages left on her mobile and home telephones and she did not respond to letters sent to both her home and her post office box address. The Tribunal arranged for a process server to deliver a letter to her home. The process server advised her that he had documents for her from the Nurses and Midwives Tribunal. She stated she would not accept them so the process server placed them at her feet and stated, "you have been served". She then picked up the documents, proceeded to tear them up and told the process server to get off her property. Subsequently an officer of the Tribunal was able to make telephone contact with Ms D and she told him to stop harassing her and asked that he not call her again.
The Tribunal subsequently ordered that Ms D's appeal was dismissed.
Ms R completed a course at a New South Wales hospital in 1981 and was registered at that time. She participated in a one-year midwifery course but was unable to pass the Board's registration examination, which was required at that time. Her practice as a registered nurse consisted of approximately nine months at one hospital and a much shorter period at a second hospital. Her most recent practice as a registered nurse was more than 25 years ago.
When Ms R applied for registration in 2007, her application was referred to an inquiry.
Ms R had not undertaken any further education in nursing or related areas in the period of absence from practice. Ms R. stated she wished to undertake a refresher course and the inquiry was not satisfied that she understood the need to undertake a program of study of sufficient content and rigour that would enable her to enter contemporary nursing practice safely.
On the information before it, the inquiry considered that Ms R was not competent to practise nursing and refused her application.
Ms R lodged an appeal with the Nurses and Midwives Tribunal. The Tribunal dismissed the appeal. The reasons for the Tribunal's decision may be accessed at Richardson v Nurses and Midwives Board [2009] NSWNMT 9 (13 March 2009).
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