HPCA Health Practitioners’ Competence Assurance Act

In this area:

On this page

Introduction
Why the Act?
Changes to the registration processes
Dual registration
Professional Conduct Committee (PCC)
Health Practitioners Disciplinary Tribunal
Quality assurance activities
Competence and fitness to practise
Competence based practising certificates
What goes in a Portfolio?
Professional Development and Recognition Programmes (PDRPs)
Useful resources
Questions we have asked NCNZ
In conclusion

Introduction

The Health Practitioners’ Competence Assurance Act was passed in September 2003. The Act will be “phased in” with the most significant changes being law from September 2004.

From March 2005 Nurses will be expected to have a professional portfolio to demonstrate competence in order to obtain an Annual Practising Certificate.

A number of health professional groups are covered by the Act including Chiropractors, Dentists, Occupational Therapists, Physiotherapists and Optometrists.

NB. In the early stages the Bill was referred to as the Health Professionals (not Practitioners) Competence Assurance Bill so you may see it referred to as that.

Why the Act?

Mainly a response to recent very public examples of medical error
A response to demands from lobbyists to make health professionals more accountable and respect health care consumers’ rights
An attempt to streamline some of the bureaucratic processes by having main health professional groups under one piece of legislation
A need to update legislation like the 1977 Nurses’ Act

New Law Brings Major Changes by Teresa O'Connor Kai Tiaki Volume 9: No 10, page 11

Changes to registration processes

Nursing Council of New Zealand (NCNZ)

Members of NCNZ will be appointed by the Minister of Health not chosen by the profession.

Current NCNZ:

3 nurses
2 midwives
2 educators
4 others (1 maybe a nurse &1 a midwife)

HPCA NCNZ:

5-14 people
2 lay people if 8 or fewer members
3 lay people if over 9 members

NCNZ will still:

Maintain the roll of enrolled & registered nurses
Issue practising certificates
Receive initial complaints

But in addition NCNZ will be required to assess competence on an ongoing basis and maintain a Code of Ethics for the profession.

Midwifery Council of New Zealand

A separate Midwifery Council was established on 18 December, 2003, and will come into full effect on 14 September 2004. Work during this interim year will entail establishing premises and systems for the new Council processes and managing full separation from the Nursing Council of New Zealand.

The role of the Council covers standards, education, scope of practise and competency. Disciplinary processes will be managed through the Office of the Health and Disability Commissioner and heard by a separate Health Practitioners Disciplinary Tribunal.

Midwifery Council members are listed on the Ministry of Health website www.moh.govt.nz NZNO nominee Helen-Mary Walker is on the Council. The Council has six midwives and two lay people appointed by the Minister.

The Midwifery Council will have the same role and functions under the Act as the Nursing Council has for nurses.

Dual registration

Those holding both a nursing and midwifery qualification will need to consider what to do in relation to practising certificates. To maintain practising certificates in both disciplines, the requirements of both Councils for competence based practising certificates will need to be met.

Those who are practising nursing and not practising midwifery, will hold a practising certificate for nursing only. This does not mean that that person’s name is removed from the Register of Midwives. It does mean that she or he cannot practise as a midwife until he or she can meet the requirements of a competence based practising certificate for midwives.

Conversely those practising midwifery and not nursing will hold a practising certificate in midwifery but not in nursing. Their names will remain on the Register for Nurses but they will need to meet the requirements for a competence based practising certificate should they return to nursing.

A number with dual registration practise both nursing and midwifery. They will need to meet the requirements for practising certificates of both Councils. This may be difficult to achieve, depending on the requirements determined by the Councils and the employment setting. If it is a requirement of a particular employment position, for example, rural settings, then there is an obligation by an employer to assist in maintaining competence requirements in both disciplines. Discussions on how this may be achieved will occur in early 2004. NZNO will provide advice to members if there is any difficulty in reaching agreement.

A number with dual registration, work in specialised areas where they use both nursing skills and those from their midwifery practise, for example, neonatology and Plunket. It is important to determine the nature and scope of the practise in making a decision about holding a practising certificate for these roles. Competence requirements for practising certificates for midwives will be based on the standards for registration as a midwife, that is the continuum of midwifery practise. Neonatology and Plunket would fall under nursng and so a practising certificate from the NZNO will be required.

Those with dual Registration who will hold only one practising certificate in the future will need to be quite clear about their scope of practise and not practise the other discipline until they have competence based practising certificate.

Costs

There are significant costs involved in establishing a separate Midwifery Council and meeting the requirements of the HPCA. All Nurses $50, Registered Midwife (RM) $100, dual registration (All Nurses and RM) $150.

There are financial implications for nurses, midwives and employers in the introduction of competence based practising certificates. This is particularly so where employment of midwives in maternity services is by “subspecialty”, that is, delivery suite, postnatal, antenatal. Depending on the final competence requirements, employment patterns of midwives in these settings may require some change to maintain competence across the continuum. Also, employers paying the costs of practising certificates will have to budget for the higher costs.

Scope of practise

NCNZ will define our Scope of practise (from 18 Sept 2004) at present NCNZ say they will have 3 scopes of practise:

Registered Nurses
Enrolled Nurses
Nurse Practitioners (TM)

There will be wide spread consultation in early 2004 about the scope of practise.

You must not practise outside your scope of practise apart from emergency, training, assessment
Employers must be aware of your scope of practise and may be liable if you work outside of your scope
NCNZ may place variations on your scope of practise related to your competence to practise
Nurses must still be qualified and competent to undertake tasks even if those tasks are within their scope of practise

Restricted activities

There may be some activities that are restricted to a particular professional group. At present we do not know if there will be a list of restricted activities for nurses.

Professional Conduct Committee (PCC)

NCNZ may appoint a PCC in relation to a particular case. The PCC will consist of two health practitioners and one layperson. If the PCC wishes to lay a charge it must refer to the Health Practitioners Disciplinary Tribunal.

Health Practitioners Disciplinary Tribunal

Complaints or issues of competence will be referred by the director of proceedings or the PCC to the Health Practitioners Disciplinary Tribunal. This Committee will cover all professional groups. It will be chaired by a barrister, with one lay person and two professionals.

Quality assurance activities

This part of the Act is already in place. Certain information can be protected. Organisations can apply to the Minister of Health to have an activity such as a clinical review, mortality & morbidity meeting “protected” this means that information obtained only from the protected activity can not be recorded, disclosed or used in court. Some organisations may apply for their Professional Development and Recognition Programme to be a quality assurance activity so that information in nurses’ portfolios is protected.

Competence and fitness to practise

Employers must inform NCNZ if a nurse resigns or is dismissed for reasons relating to competence (it is a good idea for organisations to have a protocol on this to guide team leaders etc.)
If there is reason to believe a nurse may pose a risk of harm to the public by practising below the required standard of competence she may be reported by colleagues to NCNZ
If NCNZ has concerns about competence they must inform:
ACC, Director General of Health, Health & Disability Commissioner, the employer
and may inform those working in partnership or association with the nurse
Employers must report to NCNZ if a nurse cannot practise because of mental/physical condition
The Health & Disability Services Commissioner’s Office must report to NCNZ any concerns about a nurses competence arising from investigations.

Competence based practising certificates

From March 2005 Registered Nurses will be required to maintain a portfolio which can be submitted to NCNZ on request (NCNZ plan to maker a random selection of 5%)

Nursing Council has not yet produced guidelines for Enrolled Nurses & Registered Obstetric Nurses

Remember that NCNZ’s role is to protect public safety by ensuring nurses are competent and so your portfolio will only have to meet that standard which may be different from the requirements of your employer or for your PDRP.

Some of the likely requirements from NCNZ that will need demonstrated in your portfolio: NCNZ, (2001). Guidelines for Competence-Based Practising Certificates for Registered Nurses

750 hours practise in the last 5 years
75 hours professional development in last 5 years
Evidence of reflection (may or may not be included)
Back to nursing programme if you have been out of nursing for 3 years
A curriculum vitae
Peer review/performance review
Consumer feedback
Examples that you meet the 11 competencies of NCNZ

NCNZ Competencies for Registered Nurses: NCNZ, (2002). Competencies for Entry on to the Register of Comprehensive

Communication
Cultural Safety
Professional Judgement
Health Education
Management of nursing care
Professional Development
Management of environment
Legal responsibility
Ethical accountability
Interprofessional health care
Quality improvement

(There are other competencies for Enrolled Nurses, specialty practise and Nurse Practitioner.)

What goes in a Portfolio?

A number of different items could go in a portfolio to demonstrate competence including:

A CV: Name address, qualifications, work history, voluntary work, other roles e.g. delegate
Evaluation/Appraisal
Continuing education (certificates) & magazine subscriptions
Evidence of teaching
Feedback from colleagues, patients, families
Exemplars/stories
Protocols, submissions
Assignments

Tips on setting up a Portfolio

You do not have to follow a set format - personalise your portfolio
If you are using a template you don’t have to use each section
It is a good idea to use plastic pockets to protect your documents
You could include an introduction and table of contents as a guide
Make sure your portfolio is in a logical order and is professional in it’s presentation
Ask someone to check it for you
Work on you portfolio over time, it does take a while to do it properly
Use copies of documents if sending your portfolio away not originals (unless specifically requested)

Other good reasons to have a portfolio

Transforms practise in to something tangible
A useful resource
Helps direct our learning
Distinguishes us from other professionals
Builds professional esteem
Useful for job applications
Part of a PDRP

Professional Development and Recognition Programmes (PDRPs)

NCNZ (2003). Framework for the approval of Professional Recognition Programmes to meet the requirements of competence-based practising certificates)

If your organisation has a PDRP (e.g. a CCP, PDP etc. ) the organisation can apply to NCNZ to have the programme approved. If the programme does gain NCNZ approval then nurses on that programme will automatically be considered as meeting NCNZ requirements of demonstrating competence for their Annual Practising Certificates and will not have to submit their portfolios to NCNZ for audit.

Useful resources

www.moh.govt.nz/hpca - HPCA update
www.moh.govt.nz - publications - article on HPCA
www.nursingcouncil.org.nz for the following documents:
- Guidelines for Competence-Based Practising Certificates for Registered Nurses (2001)
- Competencies for Entry on to the Register of Comprehensive Nurses (2002)
- Framework for the approval of Professional Recognition Programmes to meet the requirements of competence-based practising certificates
- Copy of the HPCA - $15 (plus p+p) from Bennetts Bookshops (usually located in university towns). Or Whitcoulls in large towns. Or phone Bennetts in Wellington 04-499-3433 Alternatively try online at: http://www.webstorefront.co.nz/bennetts/default.asp?cookie%5Ftest=1 download for free from http://www.legislation.govt.nz and click on 'statutes' and then on 'H' for HPCA and then click on HPCA.

Questions we have asked NCNZ

Nurses have raised a number of questions with NZNO and we have taken these to NCNZ. As NCNZ respond to these question we will publish the responses here:

Q. When will the definition of clinical practise be available?

A. There will be consultation in early 2004.

Q. How will continuing education be demonstrated, will you require certificates or a list, or what?
Q. How will clinical practise hours be demonstrated? Will someone need to validate it? if so whom?

A. Send certified copies of orignal documents. "Documents can be certified by another registered nurse, a registered midwife, a Justice of the Peace. a Kaumatua or a lawyer." Nursing Council of New Zealand (2001). Guidelines for competence-based practising certificates for registered nurses. Wellington. p.11.

Q Will you require authentication of photocopies, if so by whom?

Q. How much detail will you require in demonstrating one of the competencies – will each criterion (in your booklet Competencies for Entry on to the Register of Comprehensive Nurses (2002)) have to be demonstrated?
Q. How many pieces of evidenced will you require to demonstrate each competency?
Q. If nurses are on an approved PDRP does that exempt them from their portfolio being in the 5% or portfolios that are randomly selected by NCZN?

A. Yes

Q. If a nurse is required to submit her portfolio to NCNZ is there a chance she will be called again in later years?
Q. Are there going to be any guidelines on the requirement of employers to report nurses to NCNZ? Questions have been raised about how you determine if someone resigns for reasons relating to competence and whether a temporary mental or physical condition affecting a nurse’s practise should be reported to NCNZ.
Q. If I have been out of nursing for 6 years having children and I start work sometime later in 2004. I will not be able to meet the requirements of 750 hours of practise and 75 hours in the last 5 years so how will I get a Practising Certificate next March?

A. Nursing Council has not yet finalised the system for this kind of situation but it is likely to be one of two options:

1) They will have a criteria of fewer hours of practise and professional development over a shorter period of time (this system is used in Canada) or
2) On your declaration form you will put that you do not meet the requirements and they will review each case like this individually.

If you have any questions to add please contact Suzanne Rolls suzanne.rolls@nzno.org.nz.

In conclusion

“Invest your time and effort in a planned process that starts now rather than responding with urgency when the requirement is forced on you” Kelly, J. (1996). The really useful guide to portfolios and profiles. Nursing Standard. 10(36): Supplement.
Keep your portfolio up to date
Check out Kai Tiaki: Nursing New Zealand or this website for ongoing updates

This article was prepared by Faith Roberts, Professional Nursing Advisor. Faith has now moved on from this role. If you believe anything is inaccurate, unclear of have any other comments please email Suzanne Rolls suzanne.rolls@nzno.org.nz.