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.

AMA’s Position Statement on nurses in general practice

Earlier this week the Australian Medical Association (AMA) published a position statement on nurses in general practice – General Practice Nurse Position Statement 2005. Revised 2015 (see here). This document is a revision of the original statement which was published 10 years ago.

This position statement came as a surprise to APNA, and as the peak professional body representing nurses working in primary health care including general practice it is disappointing we were not consulted in this process. Karen Booth, our President, has now written to the AMA’s President to express our concern around this.

While there are some positive statements about nurses contained in the position statement, it also contains a number of inaccuracies, such as outdated nurse data and a misunderstanding around nurse scope of practice. We have provided this feedback to the AMA and we hope the position statement will be amended.

It is important the role of the primary health care nurse working in general practice is clearly understood by fellow health professionals. Your experience, unfortunately, tells us that this is not the case – in the last APNA salary and conditions survey you told us that only 23% of GPs had a full understanding of nurse scope of practice in general practice and, more worryingly, 4% of GPs had no understanding of scope whatsoever. This lack of understanding is one of the many barriers faced by nurses working in the general practice setting.

Does the AMA’s position statement just add to this lack of understanding? What does the profession need in order to change attitudes and perceptions? Let us know your thoughts.

Removal of healthy kids check from MBS

From 1 November 2015, Medicare benefits for the pre-school healthy kids check (including the nurse item #10986) will no longer be available. See here for the MBS notification.

The Australian Government has cited a lack of evidence around the current system providing a higher quality service and the increased annual cost of delivering pre-school health checks as factors behind its decision to remove the healthy kids check MBS items.

The four year old health check remains a recommended child health assessment, which can still be undertaken in general practice settings using time and complexity based MBS items #23, #36, #44 (and the Aboriginal and Torres Strait Islander health assessment item #715). The health checks can also be undertaken by State and Territory funded infant health clinics, where available.

With these changes in mind there is debate around whether the rebates for these consults accurately reflect the work required to undertake a comprehensive childhood health assessment or support the non face-to-face work undertaken outside of the consultation.

  • Do you believe there will be a change in your health assessment rates for children in your area as a result of the Government’s decision?

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16 September 2013

The Federal Election is over and Australia has a new Coalition led Federal Government. Those of us who, at the end of the day are grass roots primary health care (PHC) nurses delivering care as best we can, fighting the chronic disease that is devastating our communities. We may wonder – what will really change? Our patients keep coming, their needs keep increasing and we are getting older and increasingly becoming consumers of healthcare too.

As mentioned previously, APNA has called for the recognition and ongoing support, of the Australian PHC nursing workforce. Nurses are the largest health workforce and in PHC – a perfectly placed and essential army. This nurse army is ready willing and able to participate in, coordinate and lead multidisciplinary team care provision, education and support to our communities essential in the fight against the Tsunami of chronic disease. A Tsunami that will very soon overwhelm our health system if urgent action is not taken.

As APNA president I look forward to speaking with our new Federal health minister to share APNAs experience, the experience of our membership and our proposals for building a well integrated, person-centred primary health care system with full engagement of all relevant health professions – medical, nursing, allied health, pharmacy, and most importantly with consumers at the centre.

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