Problems began shortly after an RN commenced a 12-month new graduate programme at a public hospital. The nurse was involved in a number of incidents related to medication administration, patient assessment and planning care, documentation, privacy, dignity and communication.
During this time the nurse was placed on a number of Performance Improvement Plans and subsequent assessments to determine any improvement.
Despite being placed on four intensive plans over a 12-month period, the nurse was unable to demonstrate any improvement in practice or any insight in recognising that their practice was unsafe.
The RN’s employer made a mandatory notification, as they had assessed the nurse as practising in a way that was a significant departure from accepted professional standards, and which placed the public at significant risk of harm.
As hospitals have a responsibility for patient safety and the nurse was still practising below the expected standard of a nurse with similar years’ experience, the employer took further action based on the risk and imposed the following workplace practice restrictions:
- Direct supervision of practice whilst on duty
- Non-rotating roster working Monday - Friday AM shifts only
Whilst the employer took action to reduce harm to their patients through restricting the nurse’s practice, the Council took further action and imposed the following condition on the nurse’s registration:
- The practitioner must not work until reviewed by the Nursing & Midwifery Council of NSW
The nurse is now restricted from working as an RN on an interim basis; however, even before the Council took any action, this nurse declared her employer’s practice restrictions at registration renewal.
When renewing annual registration, declarations must be made around any workplace restrictions. If your employer has restricted you from any duties, placed you on restricted working hours or is supervising your practice, then you need to indicate ‘yes’ when answering your declaration when renewing your registration.
What happens next?
If you declare 'yes,' that you have restrictions on your practice, AHPRA who manage registrations on behalf of the Nurses and Midwives Board of Australia will seek further information including detail of the restrictions and the reason practice restrictions were imposed.
Remember it’s about your safety and competence to practise your profession whenever and wherever you may work.
In the above scenario, the practitioner has appropriately disclosed workplace restrictions on renewal. AHPRA then advised the Council about the nurse’s disclosure and provided the further information they had received.
The Council was already aware of the practice issues because these had been raised by the employer (mandatory notification). As an interim measure the nurse was restricted by the Council from practising nursing anywhere in Australia while arrangements were made for an independent performance assessment to be conducted against the RN practice standards. Thereby keeping the public safe while further evidence was obtained.
The performance assessment report provided evidence that the nurse’s practice did not meet the expected standards in a range of areas. The nurse subsequently attended a Performance Review Panel and a number of conditions were imposed on registration requiring: close supervision; regular reporting from the supervisor; further education in areas of deficit; and further performance assessment after the nurse has completed the education.
Should the reassessment show that the nurse’s practice has improved with further education and professional experience, the conditions on registration can be reviewed, relaxed or removed.