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Trials upon re-entry

Officials sound off after regulator requests feedback on refresher courses for nurses and midwives.

The Nursing and Midwifery Board of Australia (National Board) has called for public consultation on its guidelines for re-entry to practice.

In a media statement, the board has announced proposed pathways to widen options for formerly registered nurses and midwives seeking to return to the professions after an absence. Its aim is to encourage workforce flexibility whilst ensuring public safety and competent practice, the regulator states.

Australian nurses and midwives wanting to return to work after a long break continue to face challenges. Existing rules have been described by some as a deterrent to nurses wanting to return after infant-rearing or long service leave. Guidelines introduced in 2010 may impose obstacles, including the need to repeat basic training and sometimes costly re-entry courses.

Australian College of Nursing CEO Debra Thoms says: “Present consultation by the Nurses and Midwives Board of Australia [through AHPRA] provides an opportunity to address some of the concerns that have been raised.”

The National Board call out also coincides with what many see as a downwards trend in nurse numbers, especially at nurse or midwife’s prime-of-life age. NSW president for the Australian College of Midwives, Joanne Gray, says the regulator’s latest move looks likely to be welcomed by nurses and midwives and may encourage practitioners to seek more support in returning to wards or other clinical practice.

The proposed pathways “aim to encourage workforce flexibility, while ensuring public safety and competent practice”, the regulator’s statement reads. The AHPRA also states that the proposed supervision guidelines for nursing and midwifery set out principles for effective management in a range of circumstances. Provisional registrants would receive different levels of monitoring depending on their skills, experience and time away from work.

In NSW, Chief Nursing and Midwifery Officer Susan Pearce says since March 2011 the NSW Health nursing and midwifery workforce has increased by more than 4100, by headcount, and 2800 full-time equivalent nurses and midwives.

Pearce says scholarships exist in NSW for nurses and midwives and focus on supporting rural and remote practitioners who help local nurses undertaking their midwifery training. Scholarships of up to $10,000 are available in the state for nurses undertaking re-entry training provided by the Australian College of Nursing or other online courses.

“In accepting the scholarship, the recipient agrees to work in the public health system for a period of two years post successful completion of the program,” Pearce says. “We are also in our third year of the rollout of the NSW Government’s commitment to employ 275 clinical nurse educators in its first term.” Such expert staff provide advice and guidance to less-experienced nurses and midwives, she explains, describing the program as very successful. Pearce pointed to a recently introduced additional 40 clinical nurse specialist positions scheduled to be filled by June 30 next year. Work is also under way to establish a re-entry course in NSW for midwives. At present, midwives in NSW must complete re-entry training in the ACT.

Research by the Australian Bureau of Statistics (ABS) shows the age distribution of nurses has changed over the past decade. By 2011, nurses aged 50–54 made up the largest group, at 16 per cent, followed by those aged under 30 years, at 15 percent. “There were also considerable increases amongst those aged over 55 years,” with the proportion nearly doubling from 2001 to 2011, the researchers said. By contrast, the bureau’s 2001 estimates found 19 per cent of nurses were aged 40–44 years, making this the largest age group, followed by those aged 45 to 49.

The researchers say federal initiatives to support nurses returning to work who may otherwise have left the profession, along with increasing the number of education and training places, may have helped boost the overall numbers of nurses.

A variety of refresher courses

Ask almost any trainer and you will be told the nurse refresher course system has critical relevance at present, as a number of re-entry programs for registered nurses across Australia continue to offer a combination of online and practical programs for RNs, sometimes for registered nurses in aged care.

In Western Australia, recruitment is online and centrally coordinated by the Nursing and Midwifery Office through a Refresher Pathway Connect program. A WA Health spokesperson says applicants are able to apply for a fixed-term refresher post at their preferred participating health site.

“Country applicants are no longer disadvantaged, and nurses are now able to apply for a refresher position in a regional hospital close to home,” the spokesperson said. “The program participant is allocated a minimum of five days supernumary time at start of their fixed-term employment contract.

“During this time, the participant receives full hospital and ward-based orientation. A preceptor is allocated to provide ongoing support, education, supervision and assistance to the participant to assist their transition back into the workforce. With the preceptor, a staff development nurse also provides education and support in the clinical area.”

Hunter New England Health nurse manager Susan Brazil paid tribute to the nurses who have completed the state government’s scholarship program. The course covers four weeks of theory and four weeks of supervised clinical placement duties, Brazil says. “This has seen a number of practitioners complete the Re-entry to Nursing Program,” she says. It includes supervised clinical practice at facilities such as John Hunter Hospital in Newcastle.

“We would support any return to nursing for a nurse with between five and 10 years of lapsed ward practice,” Brazil says. She says costs vary and can range up to $10,000 and include four weeks of theory and competencies in an approved college such as Australian College of Nursing or other available online courses. “NSW Government scholarships are also available,” she says.

Brazil says she has received no complaints after a nurse has returned to the clinical environment. “Everyone has fit in quite well, with positive feedback from co-workers following orientation and induction into an allocated ward or unit,” she says. This is partly because the nurses always have a clinical nurse educator on clinical practice rounds. Employment is also guaranteed for suitable applicants, Brazil says. Many registered nurse re-entry candidates show a preference for working in coastal areas and “we have vacancies right now in the Hunter Region”, she says.

ACN’s Thoms pointed out the recency of professional practice guidelines the Nursing and Midwifery Board of Australia adopted three years ago – professionals who have been non-practising for at least five years but not more than 10 must participate in a re-entry program to maintain competence. She says ACN’s board-accredited re-entry programs are designed specifically to re-orient nurses to the workforce.

Currency a necessary hurdle

Some high-level nurses are not averse to speaking out about the discomfort and frustrations for nurses under the present re-entry rules. In Queensland, the state’s chief nurse, Dr Frances Hughes, says: “I can appreciate that re-entering the nursing and midwifery workforce after an extended period away can be a daunting and confusing process.” However, Hughes describes the re-entry process as very important. “This is because it ensures our nurses feel confident in their practice capabilities, and that our patients receive the best quality care,” she says.

The 5500-member Australian College of Midwives’ NSW president, Joanne Gray points out that the workforce of nurses and midwives is predominantly female and is, therefore, affected by long-term absences as a result of child bearing. Gray says the move to national registration in 2010 affected women who had taken leave from the workforce for child bearing and other carer activities. She describes existing currency of practice rules as “essential, but also a real challenge for those nurses and midwives who wish to return to practice after a period of absence”.

She praises the regulator as supportive, describing feedback from members about difficulties finding refresher programs as “sporadic”. Even so, “It has been distressing because the options for midwives are limited,” Gray says. Whilst “there are some courses available, returning midwives find access to supervised practice the most challenging. There are very limited options for returning midwives to find a suitable placement within the health system and this adds to the frustrations of these midwives.”

The Australian Nursing Federation position statement on re-entry for nurses and midwives expresses support for the new re-entry programs. Nurses and midwives re-entering the workforce must have access to experienced colleagues to provide support during the transition to practice, through models such as preceptor-ship, team-based care, supervision and mentoring, the federation argues. Programs combining theory and clinical experience must be widely available in a variety of learning modes, the federation states, to allow previously educated professionals to demonstrate the competence required for re-entry to the register. Also, re-entry programs must be available and accessible.

The employee organisation also called for the NMBA to provide national standards that ensure clear criteria for acceptance into re-entry programs and/or supervised practice arrangements. It says educational providers or agencies offering re-entry programs or supervised practice arrangements must ensure that the NMBA requirements for supervision are met and also that people undertaking the re-entry program are not included in staff establishment numbers until their licence to practice is fully restored.

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