Enrolled Nurse Supervision and Standards of Practice Changes

APNA often gets a number of enquiries around supervision (specifically for Enrolled Nurses) and standards of practice. Below is a brief update around Standards of Practice and supervision.
As you may know, the Nursing and Midwifery Board of Australia (NMBA) recently updated Registered and Enrolled Nurses standards of practice. To practice in Australia, you must meet the NMBA’s professional standards. The revised standards can be found here.
They focused strongly on supervision of Enrolled Nurses. Below is a summary of supervision requirements for Enrolled Nurses.

Supervision of Enrolled Nurses by a Registered Nurse is a requirement of the Enrolled Nurse Standards for Practice.

  • Supervision by a person other than a Registered Nurse is not consistent with the professional standards of the profession and may contravene requirements. Professional supervision relates to the quality and safety of care and is provided by a member of the same profession.
  • A general practitioner or other Doctor, may have management responsibilities, but a member of the nursing profession, namely a Registered Nurse, must undertake professional supervision of an Enrolled Nurse. It is the obligation of the employing general practice to ensure that appropriate supervisory arrangements are in place.
  • Supervision and delegation of work to an Enrolled Nurse can be direct or indirect, and will vary depending on the abilities, education, qualifications, scope of practice, experience of the Enrolled Nurse, and contextual factors such as the geographical setting and size of the practice. Click here to read more around context of practice.

What does supervision of enrolled nurses mean?

Supervision of enrolled nurses by registered nurses can be direct or indirect depending on: the competence of the enrolled nurse for the scope of nursing practice; the condition of the person receiving nursing care; and the context in which the care is given. At all times, the enrolled nurse remains accountable for their own actions and is responsible to the registered nurse for all delegated functions

Direct and Indirect Supervision

Direct Supervision is when the supervisor is actually present and personally observes, works with, guides and directs the person who is being supervised.

Indirect Supervision is when the supervisor works in the same facility or organisation as the supervised person, but does not constantly observe their activities. The supervisor must be available for reasonable access. What is reasonable will depend on the context, the needs of the person receiving care and the needs of the person who is being supervised.

The employer must ensure that supervisory arrangements are in place. Registered Nurses should be aware of their legal responsibility in regard to supervision of Enrolled Nurses.

Another arrangement for indirect supervision of an Enrolled Nurse may occur in a general practice that has multiple sites. The Registered Nurse provides indirect supervision for Enrolled Nurses employed in that practice. In this type of situation the Registered Nurse may move between clinics giving supervision to an Enrolled Nurse/s. This model is particularly applicable to practices located in rural or remote settings, or multiple sites where geographical distances make direct supervision impractical. Registered Nurses should be aware of their legal responsibility in regard to supervision of Enrolled Nurses.

Some of the nurse regulatory authorities have produced policy statements and guidelines for delegation to and supervision of enrolled nurses and these must be considered by employers of enrolled nurses. The Australian Nursing and Midwifery Council has guidelines on delegation and supervision.

There are also decision making frameworks to assist registered nurses and enrolled nurses make decisions about the way that nursing work is delegated to enrolled nurses. Click here to view these and read more.

9 December 2013

The run down to the end of the year is always a busy time for us all. For APNA it is very busy in house as we progress our very exciting APNA and AML Alliance NiGP Program activities. For APNA externally, representation is required at many national forums, requiring stakeholder input and sign-off to progress national health programs. In the last fortnight I have attended various meetings of which I will give you a snapshot.

Members of two NPS Medicinewise program committees met for discussions around future program development. NPS Medicinewise are a valued and vital source of information and education for clinicians and consumers around quality use of medicine if you haven’t before then I would suggest you have a look at their resources.

RACGP National Standing Committee for Standards in General Practice, of which APNA has been a member for the development of the 3rd and 4th edition of the standards. Work continues on further refinement and development of these standards and others important to nurses working in general practice, and in particular nurses leading and participating in quality assurance within their workplace. See RACGP Standards for more. The General Practice Roundtable Taskforce (GPRT) continues to provide a forum for discussion with key general practice clinicians around disaster and pandemic planning and is chaired by the Chief Medical Officer. Vital national Information is shared through the GPRT. APNA then feed to our members and stakeholders through the fortnightly eNews and when more urgent through email.

APNA attended the Cancer Australia health professionals forum where strategic planning directions for the next five years was discussed. Cancer Australia was established by the Australian Government in 2006 to benefit all Australians affected by cancer, and their families and carers. Cancer Australia works to reduce the impact of cancer and improve the wellbeing of those diagnosed by ensuring that evidence informs cancer prevention, screening, diagnosis, treatment and supportive care. As the lead national cancer control agency, Cancer Australia also makes recommendations to the Australian Government about cancer policy and priorities. APNA has been actively involved with Cancer Australia since 2006 at the national level and most recently with their Lung Cancer program. I would recommend you revisit the Investigating symptoms of lung cancer, an excellent resource for all primary health care nurses.

Your thoughts are very welcome at president@apna.asn.au.