Ahpra has issued warnings over concerns unproven IV infusion treatments may be being marketed inappropriately across Australia. Click here to read the Ahpra media release.

Do you need to self notify Ahpra about certain events?  Make sure you tell Ahpra if you have undergone a "notifiable event" - under section 130 of the National Law it is your responsibility as a registered health practitioner to tell Ahpra if they occur. You can do this by either writing to Ahpra or completing a form titled  Notice of Certain Events – NOCE 00 . Ahpra will refer this information to the Health Care Complaints Commission (HCCC) and the Nursing and Midwifery Council. Check below to see when you should notify. 

Form CHPD-00 must be used for requesting a change of personal details including change of name, address, contact details and gender. (You can also change your contact information online by logging in to your Ahpra account at www.ahpra.gov.au/login) 

The Nursing and Midwifery Board (NMBA) is responsible for developing standards, codes and guidelines for the nursing and midwifery professions.  Please read here for more information on professional standards from the NMBA. 

Professional standards define the practice and behaviour of nurses and midwives.  Please ensure you update yourself on the professional boundaries expectations by reading the Ahpra fact sheet .

Recently attention has been drawn to practitioners subscribing to the OnlyFans online content service, where  "content creators" can earn money from users (the 'fans') who subscribe to their content. Creators can upload photos and video and send mass digital content to their followers. If a practitioner is the content creator, then being recognised  or publishing photographs in uniform, they could be reported for their conduct - deemed by the complainant  as unprofessional, or as one said, a distraction for patients. As nudity is permitted on OnlyFans, the content posted can be typically intimate.  Learn more about the risks associated with using online content subscription services such as OnlyFans.

The Social Media guidance is clear on the obligations of nurses and midwives to maintain professional boundaries, and where relevant, the Nursing and Midwifery Board may consider social media use in your private life (even where there is no identifiable link to you as a registered health practitioner) if it raises concerns about your fitness to hold registration.

See below examples of Onlyfans scenarios for discussion with your colleagues.

• A patient recognises a nurse from her Onlyfans page and advises other patients and her colleagues of the nurse's Onlyfans content. This creates a difficult situation in the workplace. A colleague reports her to the regulator as she believes her conduct is below the expected standards of a registered nurse and that her behaviour has brought the profession into disrepute.

• A senior manager recognises a junior from her Onlyfans page and gives her preferential rostering.  He later sends her messages on her Onlyfans account asking for the favour to be returned.The nurse reports him to the regulator.

• A nurse is promoting her Onlyfans page at work to patients and colleagues. This creates conflict within the workplace. Colleagues report her to the regulator.

Have a discussion amongst your team members and talk through the above scenarios. Read the professional code of conduct  and decide:

• What do you think of these situations?
• How do you think the code of conduct impacts upon your behaviour at work and outside work?
• What do you think the regulator should do?
• What do you think the regulator can do?

Watch this space to learn the outcomes and to see if your team came to the same conclusions.

Continuing professional development (CPD) is the means by which nurses and midwives maintain, improve and broaden their knowledge, competence and expertise whilst developing the professional and personal qualities throughout their professional lives.  CPD requirements for all registered nurses and midwives are outlined in the NMBA Registration Standard: Continuing Professional Development.

The Nursing and Midwifery Board of Australia recommends that you keep evidence of CPD, including self-directed learning, for a period of five years of completion of the CPD and notes records will be required when a nurse or midwife is subject to audit or if they are subject to notification/complaint.

So, each nurse and midwife is obligated to record their CPD and produce evidence of this when requested by a regulator. Some nurses and midwives report challenges accessing their employer’s (or previous employer’s) records when they are asked by the Council to provide their CPD records. Therefore, it is important that you do not rely on your employer's education system or online records alone. Please ensure that you keep your own CPD records and that they are up to date. 

Further information about CPD requirements and record keeping including a  template on how to appropriately record your CPD is provided by NMBA and here.

Were you aware that immunisation courses completed from 1 December 2021, must conform to the National Immunisation Education Framework for Health Professionals? The courses need to be approved by Health Education Services Australia (HESA) and be published on the list of approved courses on the HESA website.

In NSW only an RN or RM who have successfully completed one of these courses can work as an independent Authorised Nurse or Authorised Midwife Immuniser.

It is not uncommon for a notification about practitioners to be made where childhood vaccinations are administered for the wrong age group or sequence. Refer to the National Immunisation Schedule for further information.

Recently, a notification alleging a patient at a general practice had been handed a form to give to the nurse to administer a Diphtheria, Tetanus and Pertussis (DTP) vaccine. The nurse took the form, did not verify the patient's name, date of birth, allergy status or verify the vaccine required. The vaccine was administered, and the patient left immediately. The next day after reviewing the Medicare App, the patient realised that he was given the Influenza vaccine which he had received four weeks prior.

On receiving the notification, the practitioner was identified as an Enrolled Nurse and on seeking further information from the practitioner, it was evident the EN was in breach of her professional obligations under the EN Standards for practice, working without supervision of an RN. The Decision-making framework for nursing and midwifery is a guide to practice decisions on scope of practice, delegation and supervision for nurses, RNs, RMs and ENs. This is also a useful document for all nurses and midwives to be aware of regarding their professional obligations.

Further information is available via the following links:

• HESA approved immunisation courses

• RN Standards for practice

• RM Standards for practice

• EN Standards for practice

• Decision making framework for nursing and midwifery

Professional Boundaries - what does that really mean?

The Code of Conduct for Nurses and Midwives notes the words Professional Boundaries under "act with professional integrity" and lists a number of points to consider such as:

• recognising the inherent power imbalance that exists between nurse and people under their care
• actively managing the persons expectations - as the professional
• avoiding conflict of interest when you care for someone you know outside of work
• avoiding sexual relationships with persons whom they have currently or had previously entered into a professional relationship 
• recognising over-involvement.

Let us look at the section d. sexual relationships. This further states: "These relationships are inappropriate in most circumstances and could be considered unprofessional conduct or professional misconduct".

A recent Professional Standards Committee made such a finding:

"The Committee made findings of unsatisfactory professional conduct and determined to reprimand (the professional) and impose conditions upon their registration".

The nurse made a match on a dating application prior to that person's hospital admission but they had not at any stage met in person or on video, and they had only exchanged some messages.

The person was subsequently admitted to the nurse's place of work. The nurse did not handle the conflict-of-interest part listed in the Code of Conduct; they didn’t inform their manager of the matter and began caring for the person as a nurse. The relationship moved from more than nurse/patient and continued after discharge, when they started to live together.

The decision has words in it such as “unethical”, “improper” and references the Code of Conduct noting that it states: 

• that nurses are to act with professional integrity (Principle 4), specifically (at 4.1.d) a nurse is to...
• ...avoid sexual relationships with persons with whom they have currently or had previously entered into a professional relationship. These relationships are inappropriate in most circumstances and could be considered unprofessional conduct or professional misconduct.

Further the decision references the Nurse Standards for Practice:

Standard 2, ‘The RN... [2.1] establishes, sustains and concludes relationships in a way that differentiates the boundaries between professional and personal relationships.’

The nurse admitted her conduct was unsatisfactory and the committee spent some time exploring her understanding of professional boundaries, therapeutic relationships, integrity and why they were important.

The committee acknowledged the nurse was a relatively new graduate, had reflected on and acknowledged her behaviour. They reprimanded her, placed conditions for her to complete an ethics course and to establish a reflective clinical supervision arrangement (a mentor).

The reprimand and conditions are placed upon the public register and are monitored.

Failure to comply can led to further action.

So, why is this important?

Trust and integrity:

Nurses and Midwives are expected to act in the best interests of patients/clients and to respect their dignity and privacy. This means abstaining from attaining personal gain at the patients/clients’ expense and refraining from endangering the therapeutic relationship.

We do this by maintaining that trust by practicing with integrity, knowing the standards and codes and working within them.

We should be knowledgeable regarding professional boundaries and work to establish and maintain those boundaries.

Professional boundaries are the spaces between the nurse’s power and the patient’s vulnerability. The power comes from the professional position and access to sensitive personal information. Professionals must make every effort to respect the power imbalance and ensure a person-centred relationship.

Resources:

The Standards for practice for Nurses and Midwives

The Codes of Conduct for Nurses and Midwives

https://www.ncsbn.org/nursing-regulation/practice/professional-boundaries.page

Welcome to 2023. The role of the Nursing and Midwifery Council is to protect the public in NSW, and address matters in the public interest. Council Members are statutory appointments by the NSW Governor, as recommended by the Minister for Health.

The Council comprises of 11 registered nurses and midwives, including two enrolled nurses and four community representative members, and manages complaints and notifications about nurses and midwives in NSW, in consultation with the Health Care Complaints Commission (HCCC).

In this newsletter, you will find an overview of practitioner complaints, which highlights the number and types of notifications in 2021/2022, with approximately 860 notifications or 70 per month the Council has managed. You can read more about our work in the Annual Report for 2021/22 through this link.

The Council's current Strategic Priorities 2023-2024 include the Cultural Safety Strategy panels and Family Violence notifications. The Cultural Safety action plan is in the implementation stage, which will ensure Council members are training in cultural safety and working towards having representation of First Nations people on our panels. Family Violence will review and identify regulatory implications of family violence involving nurse and midwives.

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