The statistics below for the period July 2022 to June 2023 show the work handled by the Nursing and Midwifery Council during the year, including the number of complaints received - 934 (up on 863 the previous year).

There were 247 mandatory notifications (up from 161 reported in 2021/22), and complaints were mainly about clinical care, health impairment and offences.

The 2023/24 annual registration fee is set at $185 for NSW registered nurses and midwives. This is an increase of $5 on the previous year 2022/23 when the fee was $180.  This new fee will apply from 22 September 2023 and must be paid to the Australian Health Practitioner Regulation Agency (Ahpra).

The national registration fee for all NSW registered health professionals under the national scheme comprises of two components:

• a registration and accreditation component that is independently determined by Ahpra and the relevant National Board
• and a complaints component that is decided by the relevant NSW Council.

The complaints component for NSW health practitioners is subject to approval by the NSW Minister for Health under section 26A of the Health Practitioner Regulation National Law (NSW). 

The complaints component is a cost recovery model and is not subsidised by other health professions.

 For more information on the composition of the registration fees please refer to the Aphra website.

The Department of Health and Aged Care has published key documents entitled Medication management in the community - Guiding Principles  and Medication management in residential aged care facilities - Guiding Principles outlining the recommendations which  promote the quality use of medicines and medication management in these contexts. They also encourage a person-centred partnership and systems-based approach when support is being provided to people living at home or in residential aged care. Sound governance of medication management is fundamental.

Those involved in the prescription, dispensing, supply and support for a person’s medicines needs in these settings should ensure safe and quality medication management. This includes registered and enrolled nurses moving between the community, residential aged care and other healthcare settings.

These Guiding Principles are intended to: 

• Assist service providers in developing or evaluating policies, procedures and guidelines
• Support those involved in assisting people in their homes or in aged care settings
• Support people in either managing their own medicine(s) or in receiving care through the medication management process
• Guide healthcare professionals when applying and evaluating professional practice standards or guidelines.

Nurses and midwives in NSW must be registered with the Nursing and Midwifery Board of Australia (NMBA), and meet the NMBA's professional standards in order to practise in Australia.

Professional standards define the practice and behaviour of nurses and midwives and include:

• codes of conduct
• standards for practice
• codes of ethics.

Please click here for more information on professional codes and guidelines from Ahpra.

Examples are given of professional misconduct in the case studies below following complaints against practitioners and the outcomes of NCAT tribunals.

On 1 August 2023, a NSW registered nurse, employed as a clinical supervisor, was found guilty of professional misconduct under 139E of the National Law after proceedings were brought by the Health Care Complaints Commission (HCCC) before the NSW Civil and Administrative Tribunal (NCAT).

The HCCC alleged that during March 2021, the registered nurse attended an Emergency Department in the capacity of a Clinical Supervisor and misappropriated intravenous medications and a cannula.

The Tribunal found that not only did the practitioner remove the medications from the hospital, but they also failed to disclose to their supervisor they had removed these items, and instead stated they had taken “only saline solution and a cannula”, for the purpose of cleaning a nebuliser which had crystalised.

 The Tribunal heard evidence that the practitioner planned to treat a friend whose visa status did not permit access to Medicare and that the practitioner phoned a colleague and encouraged them to corroborate their version of the events.

Consequently, the Tribunal found the practitioners conduct was clearly wrong due to the following:

1)    The practitioner's conduct was clearly wrong and known by them to be wrongful. As an example it was unlawful to remove drugs and other items from the hospital.

Discussion: Health resources are paid for, owned, or controlled by health agencies. Employees have a responsibility to use them in an effective, efficient and honest manner. Misappropriation of employer assets may be considered theft and could be reported to NSW Police and lead to prosecution.

This decision serves as a reminder that taking resources from a workplace is unacceptable and may lead to professional criticism and regulatory action, as professional nurses and midwives should promote workplace cultures which ensure appropriate use of health resources.

2)    The practitioner conduct posed a risk of harm to his friend.

Discussion: The administration of a drug which has not been appropriately prescribed carries significant risk. Nurses need to be aware of pre-existing relationships and the potential boundary confusion that can result in harm.

The Nursing and Midwifery Board of Australia- Code of Professional Conduct for Nurses in Australia (2008), outlines the following:

• Nurses practice in a safe and competent manner.
• Nurses practice in accordance with the standards of the profession and broader health system.
• Nurses practice and conduct themselves in accordance with laws relevant to the profession and practice of nursing.
• Nurses should not be required to provide nursing care to persons with whom they have a pre-existing non-professional relationship.

3)    The practitioner’s conduct impacted the nursing profession and the hospital where they were employed.

Discussion: The unlawful and unethical actions of nurses can adversely affect how the profession is positively perceived by the public and potentially damaging to the reputation of the employing organisation.  

 In this case, the practitioner failed to re- register as a nurse, however the Tribunal advised if still registered, it would have suspended their registration for nine months. Although, this was the practitioner's first offence, they had dishonestly breached the fundamental tenets of the nursing profession.

The full decision can be found on NSW Caselaw.

In March 2023, the Health Care Complaints Commission (HCCC) published its findings against six nursing practitioners - five registered nurses and one enrolled nurse  - following a complaint alleging various failures relating to the treatment of a man who was found deceased in his cell  at the Parklea Correctional Centre on 7 December 2017. The original hearing  in September 2021 was delayed due to the COVID-19 restrictions, and eventually took place in May 2022.

The six nurses all consented to the matters being heard together and complaints against them included findings of unsatisfactory professional conduct and professional misconduct. Allegations included a variety of issues, depending on the practitioner, but included failure to:

• Read the clinical notes and health records of the patient
• Implement the treatment plan ordered by the treating Medical Officer
• Respond to the patient's requests to see a nurse following a complaint of abdominal pain
• Ensure that clinical information regarding the patient’s clinical management details were recorded in the written handover or patient notes
• Ensure that the following shift nursing staff were provided with a clinical handover of the patient as a patient of concern
• Accurately document the administration of medication that was administered to the patient

The Tribunal imposed a variety of  decisions on practitioners who were found guilty of unsatisfactory professional conduct and professional misconduct. Depending on the severity of the offence, these ranged from a cancellation of registration with a non-review period of six months; cancellation of registration for three months; a caution with conditions on registration including further education; professional mentoring and a reprimand. All respondents had to pay a share of the costs incurred by the HCCC in bring the complaint to the Tribunal.

For further information, please check NSW Caselaw for the following decisions:

• HCCC v Nuevo (No 2) [2023] NSWCATOD 24
• HCCC v Stratten [2022} NSWCATOD 126
• HCCC v Balagtas [2022] NSWCATOD 125
• HCCC v Day [2022] NSWCATOD 134
• HCCC v Nguyen (No 2) [2023] NSWCATOD 28
• HCCC v Gallagher (No 2) [2023] NSWCATOD 25

Recently the Nursing and Midwifery Board of Australia (NMBA)  and the Australian Health Practitioner Regulation Agency (Ahpra) developed resources for registered health practitioners and consumers which captures the NMBA's position on nurses working in the area of cosmetic medical procedures. The position statement can be found here.

The International Congress of Nurses recently held their annual Congress in Montreal and we were delighted to have our abstract submissions accepted.  Here is one submission on cosmetic nursing which we hope you find interesting. Click the image for a larger version.

In June 2023, the NSW Professional Councils and the Health Professional Councils Authority (HPCA) launched its joint Aboriginal Cultural Safety Strategy.  The joint Strategy aims to improve the experiences of Aboriginal people who interact with the NSW healthcare and regulatory system.

Our Strategy aligns with existing state and national initiatives to improve health outcomes for Aboriginal people.

The Councils, HPCA and regulatory system exist for the benefit and protection of the NSW community and we acknowledge that Aboriginal people have, and continue to suffer, disproportionate levels of disadvantage, including in health outcomes.

Our Strategy aims to strengthen cultural safety within the NSW regulatory system through increased participation of Aboriginal people and collaboration with stakeholders.

To read more about the Strategy and its launch, visit the HPCA website.

At the same time, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and the Nursing and Midwifery Board of Australia (NMBA) have launched a Partnership Investment Agreement to improve the quality and safety for contemporary nursing and midwifery for Aboriginal and Torrres Strait Islander People.

Click here to read more on this.

Welcome to the September edition of the Nursing and Midwifery Council of NSW's Newsletter.

This edition we have brought you articles on medication management in the community and aged care facilities, an updated position statement on nurses and cosmetic medical procedures, news of the launch of the NSW Professional Councils and the Health Professional Councils Authority (HPCA) joint Aboriginal Cultural Safety Strategy in June 2023 and two thought-provoking and challenging case studies on professional misconduct and unsatisfactory professional conduct.

As you will be aware, the Council’s principal role is to protect the health and safety of the public.  We do this by managing complaints about the conduct, performance and health of registered nurses, midwives and students in NSW.  The Council will take regulatory action only where it is necessary to protect the public or where it is in the public interest to do so. 

We hope you enjoy reading this edition of the newsletter and do let us know at the link below if you have any particular comment or suggestion about this edition.

Regards,

Adjunct Professor Greg Rickard OAM FACN