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You may not be a real nurse

The ‘recency of practice’ standard requires you to make sure you are, in fact, practising to keep your registrations current. 

Each nurse and midwife has ‘recency of practice’ obligations to ensure that their recent experience entails practising their profession and that their nursing or midwifery skills are current and up to date. The National Board has defined ‘practice’ broadly as:

“... any role, whether remunerated or not, in which the individual uses their skills and knowledge as a nurse or midwife ... Practice is not restricted to the provision of direct clinical care. It also includes 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 safe, effective delivery of services in the profession and/or use of their professional skills.”

Two recent examples where purported nurses have failed their recency of practice requirements are illustrative.

In the first case, the Tribunal’s refusal related to a woman who had been working as a co-ordinator of a water-based exercise program in a job-share capacity since 2004. Nothing in the position description required the holder to engage in specific nursing functions. However, on this point, the tribunal indicated that ‘practice’ is broad enough in scope to include a co-coordinator role carried out in a healthcare context, so long as the individual was exercising nursing skills and knowledge when fulfilling their role.

The Tribunal was not satisfied that the woman used her knowledge and skills to a sufficient extent when carrying out the functions of the position. Her own evidence demonstrated that her knowledge of nursing basics had deteriorated and was “limited and tentative”, that the observations nurses usually make – such as blood pressure or pulse taking – were not embedded in the program, and that there was an absence of equipment to measure and undertake such nursing tasks. When the ‘nurse’ was asked hypothetical poolside scenarios, her answers/responses were neither as accurate nor as thorough as one would expect. Lastly, there was minimal evidence of records consistent with maintaining standard nursing practice. Whilst the ‘nurse’ did conduct falls assessments on new clients, she did not undertake or develop any care or treatment plans, which was interpreted as further evidence of not meeting the recency standard.

In the second case, an appellant commenced employment in 2006 as a manager in her husband’s anaesthetist practice. Her registrations as a nurse and midwife were renewed from 2006 to 2011, (despite non-compliance with some imposed conditions). In 2012, her application to renew her registrations was denied, as she had not satisfied the recency of practice registration standard of completing 456 hours, or three months’ full-time equivalent, of practice. She appealed the decision concerning her nursing registration.

On appeal, the interpretation of the standard was examined, along with the question of whether the appellant had satisfied the requirement of undertaking sufficient practice to demonstrate competency as a nurse in the preceding five years. The appellant again argued that her employment as a practice manager should be considered practice as a nurse for the purpose of the standard. The appellant’s evidence was that since 2006 she had been working 20 hours a week and as the practice manager was involved in liaising with patients, health funds, Medicare and surgeons’ secretaries, and creating accounts and billings. Whilst conceding the role was not directly clinical, it nevertheless fell within the broad definition of the standard, she argued. The appellant relied heavily on her role of ‘telephone liaison with patients’ in supporting her submissions.

The practice’s medical practitioner gave evidence on this point and said it was very useful to have someone with experience in nursing to screen calls, that the appellant’s experience working in the nursing field enabled her to recognise a problem that required direct discussion between the doctor and patient. “I think having nursing experience allows her to prioritise when she needs to call me,” the practitioner said. “If the patient calls her and discusses an issue, she will either call me straightaway and say, ‘Look, there’s this patient needs something sorted out’ or it can wait.”

Tellingly he also made it plain to the appellant that she should not give advice to patients, and that any patient who had a medical or clinical problem was to be referred to him, and he would deal with it directly with the patient. After assessing the evidence, the tribunal was not satisfied that the appellant’s employment as a practice manager, or any part of it, constituted the relevant number of hours of the practice of nursing the standard requires.

Nurses and midwives need to take heed and reflect on whether the role of their employment truly does involve the practice of nursing/midwifery. This may very much mean itemising the tasks and responsibilities of the role and then examining whether they require using or applying nursing/midwifery knowledge and skills to a sufficient extent.

Saying you work as a nurse or midwife does not mean interpretations of the standard will determine that you work as a nurse or midwife.

Scott Trueman is a lecturer in the school of nursing, midwifery and nutrition at James Cook University.

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