The%20Register%20and%20Roll

1
The Register and Roll

• The 1999Act established a single register which
  records all persons that have met the entry to
  practice requirements for the registered nurse
• The roll records all persons who have met the
  entry practice requirements for the enrolled
  nurse.

2
The Enrolled nurse

• Is a second level nurse who works under the
  supervision of the registered nurse

3
National Standards

• Professional Nursing practice
• Topic 01

4
National Standards

• The Australian Nursing and Midwifery Council
  (ANMC) facilitates national standards for
  statutory nurse regulatory authorities. These
  define the minimum core competencies and expected
  standard of behavior/ conduct of all nurses

5
National Standards

• ANMC National Competency Standards for the
  Registered Nurse and Enrolled Nurse
• ANMC Codes of Professional Conduct for Nurses in
  Australia
• ANMC Codes of Ethics for Nurses in Australia

6
Board Endorsed Standards

• There are a number of standards that have been
  developed by national professional nursing/
  midwifery organizations.
• These can be endorsed by the Nurses Board

7
Board Standards

• The Board has developed standards which apply to
  the practice of nursing/midwifery and development
  of education programs leading to registration and
  enrolment
• Board standards reflect the Nurses Act,
  Regulations and contemporary regulatory practices

8
Board Standards

1. Standard for Medication Management
2. Standard for the Use of Restraint
3. Standard for Therapeutic Relationships and
   Professional Boundaries
4. Standards for Approval of Education Courses
5. Standards for approval as an Education Provider

9
Board Standards

• 6. Standards for Authorization for an Enrolled
  Nurse to practice without the supervision of a
  registered nurse
• 7. Professional standards statement for Nurse
  Practitioner Practice

10
Direct supervision

• Means that a registered nurse is present and
  works with the enrolled nurse observing and
  directing his or her activities.
• The proximity of this supervision is such that
  immediate intervention is possible if problems
  occur.
• The registered nurse is able to observe and
  monitor the execution of the enrolled nurses
  activities and retains accountability.

11
Indirect Supervision

• Means the registered nurse is not present and
  supervision is provided by other than direct
  observation, of an enrolled nurse by a registered
  nurse.
• The absence of proximity of the registered nurse
  requires processes being in place for the
  direction, guidance, support and monitoring of
  the enrolled nurse activities. The registered
  nurse retains accountability

12
Next week

• Need to have a copies of
• Code of Ethics
• Code of Conduct
• ANMC Competencies
• Activity - refer to them all three documents

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Title and Content Layout with List

• Add your first bullet point here
• Add your second bullet point here
• Add your third bullet point here

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Two Content Layout with Table

• First bullet point here
• Second bullet point here
• Third bullet point here

Group 1 Group 2
Class 1 82 95
Class 2 76 88
Class 3 84 90
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Professional Nursing practice

• Part I Professional Nursing bodies
• Part II- Scope of Practice
• Part II competency standards for EN and RN

16
Professional nursing bodies

• Part I

17
South Australia

• There are two professional bodies that guide
  nursing practice in South Australia
• The Nurses Board of South Australia (NBSA)
• The Australian Nursing Federation (ANF SA Branch)

18
NBSA

• Is the statutory body responsible for the
  administration of the Nurses Act and maintenance
  of registration records
• In administering the Nurses Act it fulfils a
  particular purpose by providing a set of
  standards that deal with qualifications, duties
  and responsibilities within the State.

19
NBSA

• Some of the activities of The Board includes
• Accountability The Board requires practicing
  nurses to maintain registration and enrolment
  annually with an emphasis on the importance of
  ensuring competence

20
NBSA

• Education
• The Board determines the educational preparation
  of nurses through approving courses that lead to
  registration and enrolment

21
NBSA

• Conduct and Competence
• The Board ensures that people applying for
  registration and enrolment have the competence,
  character, mental and physical capacity expected
  of the profession.

22
Investigation and adjudication

• The Board investigates reports about nurses
  conduct, competence or incapacity and hears
  matters determining the outcomes to protect the
  public interest

23
The ANF

• Is the largest industrial body representing the
  interests of nurses in Australia.
• The South Australian branch of this organisation
  is a State Registered Union which represents
  nurses industrially and professionally just and
  the ANF does in other states

24
ANF

• The ANF has a dual role, which combines
  professional and industrial responsibilities
• The ANF has had a major impact on the development
  of nursing as a profession

25
ANF

• Has provided nurses with guidelines and
  contribute to the development of the Australian
  Nursing Council (ANMC) standards for the
  Registered and Enrolled Nurse
• It has also developed standards for self
  appraisal and the relevant documentation for
  nursing care to be measured

26
Legal Context

• The creation of a set of standards within nursing
  has had a major impact on the degree of
  accountability and responsibility of both
  registered and enrolled nurses and has helped
  define their roles
• With these guidelines in place, the legal system
  is then provided with parameters within which
  nursing is performed

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You as an Enrolled Nurse

• As an enrolled nurse, your role and function are
  defined by the Nurses Board, ANF, your job
  description and the health units policies and
  procedures.
• How you practice these guidelines is influenced
  by your level of responsibility and
  accountability.

28
Nurses contract with society

• Nursing exists to satisfy a fundamental need of
  humanity.
• Nurses are in a position to be aware of
  injustices in the health care system and the
  political arena therefore, they have a duty to
  set an example and become involved.

29
Nurses professional role

• Nurses want the rights and privileges that
  accompany their professional role, but they do
  not always want the responsibilities that
  accompany these rights.
• It is not enough for nurses to simply care for
  patients they must advocate, educate and set and
  example to the public

30
Nurses professional role

• Many nurses do not want theses rights of
  responsibilities preferring instead to focus on
  clinical tasks only.
• What is wrong with this?????

31
Nurses professional role

• This mentality is dangerous for nursing
• It will prevent nursing from progressing to a
  higher professional level.
• If the main focus of the profession is
  task-orientated rather than visionary, nursing
  will lose the battle for patient orientated
  health care and greater respect for the nursing
  profession

32
Leadership

• Having visionary nursing leaders in strategic
  positions in health care facilities, professional
  organisations, and in local and national offices,
  increases the influence of nurses and therefore,
  their objective in the health care political
  arena

33
Ethical obligations

• On community and national levels nurses have an
  ethical obligation to promote human rights
  awareness and influence health care policies.

34
Benchmarks

• Rules of guidelines we work under, standards we
  meet.
• Nursing is regulated by many legislative acts and
  regulations ( as listed on NBSA website)
• All nurses must be particularly well aware of the
  implications of The Nurses Act 1999 and the
  Consent to Medical Treatment and Palliative Care
  Act 1995.

35
Nurses Board

• What is its function under the Nurses Act 1999
• To nurses
• To the public

36
Key Terms and what do they mean to your practice

• Supervision
• Accountability
• Responsibility

37
What are national standards

• ANMC standards for ENs
• ANMC Code of Professional Conduct
• ANMC Code of Ethics for Nurses

38
Board Endorsed Standards

• Reflect the Nurses Act, Regulations and
  contemporary regulatory practices

39
Policies and Procedures

• Organizational policy and procedures are
  essential to guide nursing practice within that
  particular organisation.
• They protect your practice within the workforce.

40
Policy and Procedure Statements How important
are they?

• Take these seriously
• Often failure to follow protocol that gives the
  court cause to review nursing practice
• Take care reading them responsibility for
  failing to do so will lie with the practitioner
• Linda Saunders 7/12/04

41
Impact on Enrolled Nursing Practice

• Regulates the profession. Currently not all
  health professionals are regulated.
• Only registered or enrolled nurses are entitled
  to be called nurse
• Nurses must function in accordance with Nurses
  Act and legislation.
• Nurses must have an understanding of the legal
  implication which effect their practice

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Impact on Enrolled Nursing Practice

• Be aware of standards for restraint
• False imprisonment
• Tort of negligence
• Duty of Care
• Vicarious Liability

43
Impact on Enrolled Nursing Practice

• Conduct nursing in a way that can be ethically
  justified according to code of ethics and
  professional code
• Respect the rights of individuals
• Accepts accountability and responsibility for own
  actions within practice
• Assess their own practice

44
Impact on Enrolled Nursing Practice

• Maintain own professional development
• Practice in a safe manner
• Maintain professional confidentiality
• Ensures informed decision making
• Verifies consent for procedures
• Aware what constitutes assault/ battery
• Understands advocacy
• Can identify the moral commitments of the
  profession.

45
Review of the Nurses Act

• The Nurses Act is currently under review
• Consultation is underway with all colleges of
  nursing and general nurses and midwives

46
Key Issues for inclusion of amendment

• A separate midwifery register
• Regulation of students of nursing
• Definition of nurse practitioner
• Authority for prescribing of medication for nurse
  practitioners and midwives
• Definitions of delegation, direct and indirect
  supervision

47
Key Issues for inclusion of amendment

• Evidence for continuing competence and scope of
  practice
• Review of the composition of the Board
• Review of authorization of enrolled nurses
  without supervision
• Review of investigation and formal proceedings
  and processes

48
Why change?

• The Minister for Health has requested a review of
  professional registration Acts.
• The Medical Practice Bill 2004 and Podiatry
  Practice Bill 2004 have both been tabled in the
  House of Assembly in 2004.
• It is likely the new Act will be changed to the
  Nurses and Midwives Act

49
Hot topics

• Taken from a talk by Linda Saunders 7/12/04

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We now work in an environment

• That has alternative models of care from
  traditional hospital focus
• What are they?
• Linda Saunders 7/12/04

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Alternative care models

• Impact of day surgery. Less time to access
  patients
• Primary health care.
• Linda Saunders 7/12/04

52
Advances in Technology

• The Internet
• Research legal implications
• Linda Saunders 7/12/04

53
Fear of litigation

• Most health professionals fear being sued
• Personally and professionally devastating
• No more at risk than other members of the
  community
• All have a responsibility to avoid causing
  personal and property damage
• Most litigation in health care settings
  attributed to unsafe practice, negligent
  delegations or supervision of staff.
• Linda Saunders 7/12/04

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Medical Litigation Explosion or Media
Sensationalism

• 555 million Medicare services a year
• 1.1 million hospital admissions
• At any one time 450 claims for all kinds of
  medical negligence in Australian courts collected
  over 2-3 years
• Obstetric litigation expensive and protracted due
  to the extent of time a claim can be made and the
  need to investigate time from conception to birth
• 4 get to court
• 1 get to hearing
• Linda Saunders 7/12/04

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Case of Sophie Heatcote

• Registered nurse on night duty at Wilcannia
  Hospital
• Death in custody of Mark Anthony Quayle
• Follow policy
• Document clearly
• Maintain a professional demenour
• Activity read the case
• http//books.google.lk/books?idga0PYFkdAV4CpgPA
  4dqCaseofSophieHeathcotehlensaXei3TxRUZ
  71KourrAevtYHACwved0CCsQ6AEwAAvonepageqffal
  se

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Go through a day at work

• Go through the tasks you will perform in a single
  working day
• Eg take handover
• Perform ADLs
• Administer medications
• Document
• Speak to relatives
• Admit and discharge patients
• Patient education

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What legal and ethical parameters impact on your
day to day practice?
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Ethics

• Topic 03 Ethics
• Theories
• Principles
• Resolving ethical dilemmas models of decision
  making
• Discontinuing treatment
• Not for resuscitations

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Principle Based Ethics

1. Autonomy
2. Beneficence
3. Non-malificence
4. Justice

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1. Principle of Autonomy

• Humans have the right to non interference when
  making decisions about themselves
• Free will , without any pressure ???
• Health information asymmetry
• Forms the basis of ideas about privacy,
  confidentiality, veracity, fidelity and consent

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a. Confidentiality

• Not reveling information collected from the
  patient
• Verbally
• Examination
• Records
• Complicated process
• Educate staff
• Security of Medical documents

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b. Privacy

• Areas where patient does not want to reveal
• History
• Examinations
• Complicated process
• Social harm
• Social benefit
• Use your common sense

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c.Veracity

• Revealing truthful information to the patient
• As a professional
• Cultural /social /Medical
• harm
• Benefit

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d. Fidelity

• Practicing within the boundaries of Nursing
• Scope of practice
• Professional standards

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e. Consent

• Intervention
• Wiliness to agree to undergo any intervention
• Implied
• Verbal
• Written

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2. Principle of Beneficence

• I will use treatment for the benefit of the
  sick, according to my ability and judgment
• Hippocratic Oath
• Conduct is aimed at the good and well being of
  others
• Principle requires that practitioners provide
  both appropriate treatment and an assurance that
  the treatment will not produce more harm than good

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3. Principle of Non-malificence

• Above all do no harm -Hippocratic Oath
• In health care the ethical issues of
  non-malificence and beneficence are particularly
  apparent in decisions regarding the institution
  of dangerous therapy or withdrawal of therapy
  that is no longer thought to be beneficial.

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4. Principle of Justice

• Justice as fairness
• Comparative Justice
• Distributive Justice

69
Identify the ethical problem

• Is it ethically reasonable to allow a person to
  stop eating and drinking
• This situation was complicated by the fact that
  JD was unable to communicate and may or may not
  be confused, or in fact mentally competent

70
Mental competence

• We cannot proceed further with solving this
  ethical question until we decide if JD is
  mentally competent.
• If after examination Mr. D is considered
  mentally competent and able to communicate then
  continuing to drip feed him is an unbearable
  assault on his person and the decision to forgo
  treatment is straight forward

71
If JD is not competent

• Can we ethically refrain from providing food and
  fluid to a mentally incompetent individual who
  appears to have a poor quality of life but will
  need to be restrained by force to feed him

72
What facts are available?

• Will he be likely to suffer more from not feeding
  him or restraining him and forcing food upon him?

73
Consider the four principles

• In JDs case we cannot negotiate fully with him
  as he is not mentally competent. So in order to
  respect his autonomy, we must fallback on other
  ways of dealing with him, such as involving
  family or close friends, ascertaining whether he
  has left instructions about what do in this
  circumstance (advance directives)

74
Consider the four principles

• Although we wish to do our best to help him, we
  are still unsure as to whether he will be best
  served by being allowed to die or by being forced
  to live.
• Which option will entail the greater burdens?
• Which option will afford him and his family the
  most justice?

75
There is no single answer

• A solution will only be obtained from
  collaboration within the health team and with
  others who are close to the patient
• Issues of justice, most commonly resource
  allocation may become important

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Identifying ethical conflicts

• There is a conflict between the principle of
  beneficence and non-malificence.
• We wish to help this man, but we are unsure if
  our help will actually harm him

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Consider the Law

• We need to enquire of relatives whether JD had
  expressed views about treatment he would have
  declined.
• In this case his wishes should be considered when
  deciding treatment.
• None of the proposed courses of conduct would
  appear to be deliberating intended to end JDs
  life (which would be illegal)

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Consider the Law

• A court if asked to consider this issue would
  probably not consider the withdrawal of treatment
  (artificial nutrition and hydration) to be the
  primary cause of JDs death.
• In this instance the approach that a legal
  enquiry would follow would be the similar to that
  of ethics.

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Making the Clinical Decision

• Gather all the relevant information and
  communicate between health professionals,
  patients, families and between members of the
  health team.
• The decision should be discussed with all
  concerned and documented clearly in the notes,
  specifying who was involved in making the
  decision and why the decision was made.

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Making the clinical decision

• The decision should be reviewed at intervals as
  determined by the clinical context.
• The decision may be reviewed after the patient
  has died, by a clinical audit, the coroner, and
  the legal system
• It is important that individual practitioners
  evaluate their own moral decisions

81
Clinical Ethics

• Since the 1970s clinical ethics has developed.
• Clinical ethics committees have emerged within
  all institutions
• They can assist with promoting and enhancing
  shared decision making.

82
Ethics and Nursing

• Ethics when applied to nursing is the standard of
  behaviour which nurses are expected to follow in
  the interest of the public good
• A nursing code of ethics provides nurses with
  guidelines which the standards of practice for
  the profession are conceived, preserved and
  refined.

83
Code of Ethics for Nurses in Australia

• Has been developed for nursing in the Australian
  context and is relevant to all nurses in all
  practice settings
• The code of ethics outlines the nursing
  professions intention to accept the rights of
  individuals and to uphold these rights in
  practice.

84
Code of Ethics for Nurses in Australia

• Its purpose is to
• Identify the fundamental moral commitments of the
  profession
• Provide nurses with a basis for professional and
  self reflection on ethical conduct

85
Purpose

• Act as a guide to ethical practice
• Indicate to the community the moral values which
  nurses can be expected to hold.
• The code contains six broad value statements with
  explanatory notes

86
Personal Moral Stance

• Nurses may adopt a personal moral stance that
  would make participation in certain procedures
  morally unacceptable to them.
• Nurses have a right to refuse to participate in
  procedures which they judge on strongly held
  moral beliefs to be unacceptable, however they
  must ensure the quality of care and patient
  safety are not compromised.

87
A framework for nursing ( 02)

• The Code of Ethics is supported by the Code of
  Professional Conduct for Nurses in Australia. The
  Code of Ethics focuses on the ethics and ideals
  of the profession.

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Code of Ethics
89
Code of EthicsValue statement 1

• Nurses respect individual needs, values, culture
  and vulnerability in the provision of nursing care

90
Code of EthicsValue statement 2

• Nurses accept the rights of individuals to make
  informed choices in relation to their care

91
Code of EthicsValue Statement 3

• Nurses promote and uphold the provision of
  quality nursing care for all people

92
Code of EthicsValue Statement 4

• Nurses hold in confidence any information
  obtained in a professional capacity, use
  professional judgment where there is a need to
  share information for the therapeutic benefit and
  safety of a person and ensure that privacy is
  safeguarded

93
Code of EthicsValue Statement 5

• Nurses fulfill the accountability and
  responsibility inherent in their roles

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Accountability and Responsibility

• Accountability the state of being answerable for
  ones decisions and actions. It cannot be
  delegated.
• Responsibility the obligation that an individual
  assumes when undertaking to carry out planned/
  delegated functions. The individual who
  authorizes the delegated function retains
  accountability

95
Code of EthicsValue Statement 6

• Nurses value environmental ethics and a social,
  economic and ecologically sustainable environment
  that promotes health and well being

96
Code of Professional Conduct
97
Code of Professional Conduct

• Identifies the minimum requirements for practice
  in the profession, and focuses on the
  clarification of professional misconduct and
  unprofessional conduct.
• The two Codes, together with published practice
  standards, provide a framework for nursing.

98
The Code of Professional Conduct

• The purpose of the Code of Professional Conduct
  for nurses in Australia is to
• Set an expected national standard of conduct for
  the nursing profession
• Inform the community of the standards
• Provide consumer, regulatory, employing and
  professional bodies with a basis for decisions
  regarding standards of professional conduct

99
Code of Professional Conduct

• A nurse must
• Practice in a safe and competent manner
• Practice in accordance with the agreed standards
  of the profession
• Not bring discredit upon the reputation of the
  nursing profession
• Respect the dignity, culture, values and beliefs
  of an individual and any significant other person

100
Code of Professional Conduct

• Support the health, well being and informed
  decision making of an individual
• Promote and preserve the trust that is inherent
  in the privileged relationship between a nurse
  and an individual, and respect both the person
  and property of that individual

101
Code of Professional Conduct

• Treat personal information obtained in a
  professional capacity as confidential
• Refrain from engaging in exploitation,
  misinformation and misrepresentation in regard to
  health care products and nursing services

102
Competencies

• There are professional and ethical competency
  units within the ANMC Enrolled Nurse Competencies
  which are endorsed by the Nurses Board.
• Enrolled nurses are expected to function in
  accordance with legislation, policies and
  procedures affecting nursing practice
• They are expected to conduct nursing practice in
  a way that can be ethically justified

103
Professional Competence

• Professionals are expected to internalise the
  standards of the profession that guide their day-
  to- day work

104
Is it lawful to disguise medication in the
patients food?

• Ethical issues breach of trust?????
• Legal issues duty of care?????
• Does it matter if it is medication for a physical
  or psychological ailment?
• Linda Saunders 7/12/04

105
Unclear..

• Should not be a practice adopted to meet time
  issues associated with inadequate staff levels
• Ultimately may meet duty of care
• Should be open and transparent
• Discuss with next of kin/care team
• Formalize as part of the care plan,
• Sets a standard of care for that person
• Linda Saunders 7/12/04

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Case scenarios

• A law student left arm was amputated after 03 of
  applying POP plaster .

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