ISSUES
AHPRA
AHPRA – Notifications, investigations, processes and outcomes By Jayr Teng Nursing is often referred to as a science and an art. A science in the sense that the nursing profession is based on research and an art because nursing is a profession grounded in caring for others. When things go wrong however, nurses are held accountable as professionals. This article examines the notification and investigative processes by which registered nurses can be held to account under the Health Practitioner Regulation National Law (National Law) as in force in each state and territory.
AHPRA and the Nursing and Midwifery Board of Australia The Nursing and Midwifery Board of Australia (NMBA) is one of 14 national boards established under section 31 of the National Law. The NMBA replaced the former, state and territory nursing and midwifery boards. The Australian Health Practitioner Regulation Agency (AHPRA) receives notifications and complaints about nurses and midwives on behalf of the NMBA. In 2014, AHPRA received 2,010 notifications in relation to registered nurses and midwives. This accounted for 20% of the total notifications (10,047) made in that year. The types of issues notifications were made about included, adequacy of clinical care, communication, confidentiality, documentation and informed consent.
Types of notifications A notification can either be a voluntary notification or mandatory notification. Anyone can make a voluntary notification under the National Law about a registered nurse or registered midwife (practitioner) or nursing/midwifery student. The grounds for making a voluntary notification against practitioners include that (among others): a. The practitioner’s professional conduct is or may be of a lesser standard than which might be expected; b. The practitioner’s knowledge, skill or judgment may be below the standard reasonably expected of the practitioner; c. The practitioner is not a fit and proper person. Mandatory notifications are required to be made by a registered health practitioner (eg. nurse, doctor, physiotherapist, or pharmacist) where, in the course of practising their health profession they form a reasonable belief that another registered health practitioner (eg. nurse, doctor, physiotherapist, or pharmacist) has behaved in a way that constitutes notifiable conduct. For the purposes of mandatory 24 February 2016 Volume 23, No. 7
notifications, notifiable conduct means: a. practicing while intoxicated by alcohol or drugs; b. engaging in sexual misconduct in connection with the practitioner’s practice; c. placing the public at risk of harm because of an impairment; d. placing the public at risk of harm through practicing the profession in a way which is a significant departure from accepted professional standards. It is important to note that mandatory notification provisions apply to nurses individually and the NMBA may take action against a nurse who fails to notify it of notifiable conduct. Each state and territory Health Services Commission may also refer matters to the NMBA.
IT IS IMPORTANT TO SEEK ADVICE EARLY AND ENSURE THAT YOU PROVIDE THE NMBA WITH CLEAR, INSIGHTFUL AND HONEST RESPONSES TO THE MATTERS ON WHICH SUBMISSIONS HAVE BEEN SOUGHT. Investigation process Once notification has been received by AHPRA, the NMBA has 60 days to conduct a preliminary assessment of the notification and decide what further action may be required. The NMBA on assessment of a notification may decide: a. to take no further action; or b. conduct an investigation in respect of the notification received; or c. take immediate action to cancel, suspend or impose a condition/ undertaking on the Practitioner’s registration. The NMBA may take no further action where a notification is frivolous, vexatious, misconceived or lacking in substance. Conversely, immediate action is taken where the NMBA believes that immediate action is necessary to protect public health or safety. Investigations are commenced where the NMBA considers that a Practitioner’s practice or conduct may be unsatisfactory.
An investigator from AHPRA is appointed by the NMBA to conduct the investigation in a timely manner. On conclusion of the investigation, the investigator appointed by AHPRA provides their report to the NMBA who then determines what further action may be required. The NMBA may, after considering the investigators report: a. take no further action; or b. caution the practitioner; or c. impose conditions/require undertakings (including for further education or supervision);or d. refer the matter to a performance and professional standards panel; or e. refer the matter to a Tribunal. At various points, a practitioner may be asked to provide a written submission to assist the NMBA make an appropriate decision in respect of the notification. It is important to seek advice early and ensure that you provide the NMBA with clear, insightful and honest responses to the matters on which submissions have been sought. Examples of conduct/practice which have resulted in disciplinary consequences for the registered include lack of clinical competence, breaches of confidentiality and lack of documentation.
What should nurses do when faced with a notification? A notification to AHPRA and the subsequent investigation process is stressful. This process involves preparing statements and may also involve having to appear personally before a panel or Tribunal. All notifications made to AHPRA should be taken seriously, even if you personally think that the allegations that have been made are baseless or without merit. Even if you consider that the allegations are baseless, they may in fact still result in you being cautioned by the NMBA. If you are the subject of a notification, at first instance you should seek professional assistance for advice on the most appropriate next steps to deal with the notification/complaint made against you. Jayr Teng, LLB (Monash), LLM (Melb), BNurs (Deakin), BAppSc (HealthProm) (Deakin), GDLP, GCMgmt (VU), FTI, Solicitor, works for Meridian Lawyers. This article is based on the views and research of the author(s) and has not been peer reviewed. anmf.org.au