2018/19 annual summary

Download the profession-specific data tables for 2018/19 (XLS)

Nursing

Snapshot of the profession

• 411,216 nurses
• Up 3.2% from 2017/18
• 55.2% of all registered health practitioners
• 27,707 also hold registration in midwifery
• The number of dual registered nurses and midwives in down 2.0% from last year
• 1.2% identified as Aboriginal and/or Torres Strait Islander
• Nurses including dual registered 88.7% female; 11.3% male
• Nurse-only registered: 88.0% female; 12.0% male

Age

Divisions, dual registrations and endorsements

Regulating the profession

• 1,751 notifications lodged with AHPRA¹
• Australia-wide, including Health Professional Councils Authority (HPCA) in NSW and Office of the Health Ombudsman (OHO) in Queensland data, 2,271 registered nurse – or 0.6% – had notifications made about them
• 1,912 notifications closed
  • 15.0% had conditions imposed on registration or an undertaking accepted
  • 9.0% received a caution or reprimand
  • 1.9% registration suspended or cancelled
  • 0.1% fined
  • 0.2% surrendered registration
  • 6.1% referred to another body or retained by a health complaints entity (HCE)
  • 67.7% no further action taken
• Immediate action taken 126 times
• 566 mandatory notifications received
  • 379 about professional standards
• 1,035 nurses monitored for health, performance and/or conduct during the year
• 1,203 cases were being monitored at 30 June
  • 75 on grounds of conduct
  • 249 for health reasons
  • 116 for performance
  • 164 prohibited practitioner/student
  • 599 for suitability/eligibility for registration
• 64 criminal offence complaints were made and 49 closed
  • 51 new matters related to title protection
  • 1 to practice protection
  • 10 to advertising breaches
• Matters decided by a tribunal: 61
• Matters decided by a panel: 13
• Decisions appealed: 15 by nurses, 2 by dual registered nurses and midwives

¹Unless stated otherwise, all notification data is AHPRA data.

Midwifery

Snapshot of the profession

• 33,434 midwives
• Down 0.2% from 2017/18
• 4.5% of all registered health practitioners
• 5,727 hold registration as midwife only
• The number of practitioners who are registered only as a midwife is up 9.9% from last year
• 1.2% of midwives and nurses identified as Aboriginal and/or Torres Strait Islander
• Midwives, including dual registered, 98.6% female; 1.4% male
• Midwife-only registered 99.7% female; 0.3% male

Age

Endorsements

Regulating the profession

• 75 notifications lodged with AHPRA¹
  • 3 notifications were made about students
• Australia-wide, including Health Professional Councils Authority (HPCA) in NSW and Office of the Health Ombudsman (OHO) in Queensland data, 99 midwives – or 0.3% – had notifications made about them
• 92 notifications closed
  • 13.0% had conditions imposed on registration or an undertaking accepted
  • 14.1% received a caution or reprimand
  • 1.1% registration suspended or cancelled
  • 1.1% fined
  • 8.7% referred to another body or retained by a health complaints entity (HCE)
  • 62.0% no further action taken
• Immediate action taken 3 times
• 12 mandatory notifications received
  • 8 about professional standards
• 24 midwives monitored for health, performance and/or conduct during the year
• 69 cases were being monitored at 30 June
  • 1 on the grounds of conduct
  • 4 for health reasons
  • 9 for performance
  • 1 prohibited practitioner/student
  • 54 for suitability/eligibility for registration
• 2 criminal offence complaints were made and 2 closed
  • both new matters related to title protection
• Matters decided by a tribunal: 3
• Matters decided by a panel: 0
• Board decisions appealed: 0 by midwives, 2 by dual registered nurses and midwives

¹Unless stated otherwise, all notification data is AHPRA data.

A report on the year from the Chair

Prescribing endorsement

On recommendation from the Health Workforce Principal Committee, the Nursing and Midwifery Board of Australia (the NMBA) worked with the Australian and New Zealand Council of Chief Nursing and Midwifery Officers (ANZCCNMO) to determine a model for an endorsement to enable registered nurses (RNs) to prescribe scheduled medicines.

The NMBA and ANZCCNMO consulted with governments, key nursing stakeholders, nurses and consumers to formulate the basis for the proposed new registration standard.

In July, the NMBA opened consultation on the proposed Registration standard: Endorsement for scheduled medicines for registered nurses prescribing in partnership and Guidelines: For registered nurses applying for and with the endorsement for scheduled medicines – prescribing in partnership.

In March, the NMBA reviewed a final draft, which incorporated public consultation feedback, in preparation for a submission to the Ministerial Council. The final proposal is an Endorsement for scheduled medicines designated registered nurse prescriber, terminology that better reflects the intention of this model of prescribing as set out in the Health Professionals Prescribing Pathway. The NMBA and ANZCCNMO also held a final consultation session with stakeholders. If approved, the endorsement will be released and will come into effect in 2020.

New midwife standards for practice  

On 1 October, new standards for practice came into effect for all midwives in Australia. The Midwife standards for practice replaced the previous National competency standards for the midwife and provide a framework for midwifery practice in all contexts. The Midwife standards for practice are seven interrelated standards which are framed within a woman-centred approach and contain criteria that specify how the standard can be demonstrated.

These evidence-based standards were widely consulted on in 2017.

New assessment model for IQNMs 

In 2014, the NMBA introduced an interim assessment model for internationally qualified nurses and midwives (IQNMs) and committed to the establishment of a permanent model that meets international best practice. Since 2014, the NMBA has been researching an evidence base for the permanent model of assessment. In 2018, the NMBA announced that, based on the recommendations of this research, it would transition to an outcomes-based assessment model for some IQNMs.

From 2020, IQNMs who hold relevant but not substantially equivalent qualifications (and who meet the mandatory registration standards) will undertake an outcomes-based assessment model, replacing the current need for bridging programs.

During 2018/19, the NMBA has been developing the assessment model, which will include:

• a cognitive component consisting of a multiple-choice exam, which must be passed first, and
• a behavioural component in the form of an objective structured clinical examination (OSCE). The OSCE has been developed to assess the behavioural skills of an IQNM that reflect the knowledge and skills of an entry-level Australian nurse or midwife.

The new assessment model will also include a program to orientate all IQNMs to working in the Australian healthcare context.

As part of the new model, in early 2019 the NMBA also replaced the eight qualification assessment criteria for IQNMs with three revised criteria. The new criteria have streamlined the qualification assessment process without altering the outcomes from assessments.

English language skills

1 March, the NMBA English language skills registration standard (2019) took effect. All applicants for general registration as a nurse or midwife in Australia need to meet this standard.

This standard amends the Extended Education Pathway to clarify the existing requirement to complete at least five years (full-time equivalent) education as continuous education. The requirement for education to be continuous over five years aligns with the approach across all professions in the National Scheme.

Revised re-entry to practice

The NMBA’s revised Re-entry to practice for nurses and midwives policy took effect on 11 February. This policy enables a consistent approach to decisions about people who have previously held registration in Australia as a nurse and/ or a midwife and are seeking to re-enter the professions.

The revised policy reflects the findings from an evidence-based review in 2018, which aimed to improve the approach to re-entry by making the process clearer for applicants and employers while ensuring public safety.

Decision-making framework

In 2018, the NMBA undertook an evidence-based review of the current National framework for the development of decision-making tools for nursing and midwifery practice (the national framework).

From this review, the NMBA developed the proposed Decision-making framework for nurses and midwives (DMF). It provides a guide to decision-making about scope of practice and delegation. It promotes consistent, safe, person-centred and evidence-based decision-making across the nursing and midwifery professions.

Changes to the national framework in the proposed DMF include:

• clearer, simpler content
• strengthening the involvement of the person receiving care in decision-making, and
• clearer guidance for registered nurses and midwives on delegating to enrolled nurses and other health workers.

April, the NMBA opened consultation on the proposed DMF and expects the final framework to take effect in 2020.

Advanced practice definition

In March, the NMBA consulted on proposed changes to its definitions about advanced practice.

The NMBA currently has definitions of ‘advanced nursing practice’ and ‘advanced practice nurse’. These definitions are set out within the NMBA Nurse practitioner standards for practice and the Registration standard: Endorsement as a nurse practitioner. The definitions are also found in the Nurse practitioner accreditation standards.

The NMBA worked closely with the Chief Nursing and Midwifery Officers (CNMOs) to develop the proposed definitions of ‘advanced practice’ and ‘nurse practitioner’.

The NMBA considered the feedback received in the public consultation and agreed the revised definitions at its June meeting. Revised standards, with the proposed new definitions, will progress to Ministerial Council for approval.

Statement on cultural safety

August, the joint statement Cultural safety: Nurses and midwives leading the way for safer healthcare reached 30 signatures of support from leading nursing and midwifery organisations.

The joint statement outlines why the principles of cultural safety are included in the NMBA’s codes of conduct. The NMBA worked closely with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) to develop the requirements for cultural safety in the codes.

Associate Professor Lynette Cusack, Chair