Freed to care
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Supporting Health Professionals
through a Career Crisis
Opportunities or Threats ?
Pauline Cook RN, BN. ADN
Competency Review Advisor
New Zealand Nurses Organisation
www.nzno.org.nz
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Outline for this session
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Information about NZ legislative
framework
Competence issues or concerns
A practise crisis
Pathways to recovery
Tools to help nurses maintain their
competence
www.nzno.org.nz
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Legislative framework for safety
in health services in NZ
Applies to all health services
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Legislation
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Accident Compensation Act 2001
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Health and Disability
Commissioner Act 1994
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Health Practitioners Competence
Assurance Act 2003
www.nzno.org.nz
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Accident Compensation Act 2001
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Comprehensive, no-fault personal injury
cover for all New Zealand residents and
visitors to New Zealand
This can include a wide range of
services, from:
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payment towards treatment
help around the home during recovery
income support to cover the period off
work because of injury
 Develop and Promote injury prevention
programmes and strategies
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Health and Disability Commissioner
Act 1994
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Code of Consumer Rights when receiving a
health or disability service
Provides an independent advocacy service
Investigates complaints and possible
breaches of the Code
Refers to other agencies i.e.
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Human Rights Commission
Ministry of Health
Regulatory Bodies such as Medical Council/
Nursing Council
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Health Practitioners Competence
Assurance Act 2003 (HPCA)
To protect the health and safety of members of
the public by providing for mechanisms to
ensure that health practitioners are competent
and fit to practise their professions
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Registration and practising certificates
for health practitioners
Competence, fitness to practise and
quality assurance
Complaints and discipline
www.nzno.org.nz
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Competence issues and
concerns
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Section 36: When authority may review
health practitioners competence
Authority to undertake a Competence Review
(4) The responsible authority may at any time
review the competency of a practitioner who
holds a current practising certificate, whether
or not –
(a)
(b)
there is reason to believe that the
practitioner’s competence may be deficient,
or
the authority receives a notice of the kind
described in subsection (2).
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Section 34 Notification that practice below
required standard of competence
If a health practitioner has reason to believe
that another heath practitioner may pose a
risk of harm to the public by practising
below the required standard of competence,
the health practitioner may give the
Registrar of the authority that the health
practitioner is registered with written notice
of the reasons on which that belief is based.
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Nursing Council’s responsibility
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The Council is not wanting to establish
who was right or wrong related to the
concerns raised, but:
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They need to determine whether the
nurse is safe to practise and/or
whether they pose a risk of harm to the
public under Section 39 (HPCA)
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A career crisis
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Competence review
This is the nurses’ opportunity to prove to
Nursing Council that they are safe to
practice.
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The career crisis
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To have your practise examined
To have to answer about the reported
practise concerns or issues
Possible loss of position or employment
Feeling
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Embarrassed
Threatened
Confused
Anxious
Hyper vigilant
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Competence review of nurses
Full day of:
 Questioning
 Scenarios
 Role plays
 Testing
Can be asked anything that is in the nurse’s
scope of practice.
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Outcome of a competence review
The nurse may:
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No further action
Be required to undertake a course of
education
Be required to meet with a
mentor/supervisor for a period of time
Be required to undertake a competence
assessment in the workplace, once
other requirements are met.
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Have conditions placed on the
practising certificate
Such as:
 May not be the sole registered nurse on
duty
 Must have a Nursing Council approved
employer
 Must practise under the supervision of a
Council approved registered nurse
May propose to suspend the practising
certificate
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Information about NZNO
members
Who went through
competence review
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Nurses/midwives supported by
NZNO for competency
Year
NZNO Members
2004/05
17
2006
14
2007
13
2008
53
2009
61
2010
57
NZNO members
215
Nursing Council reported 346 cases for the
same period
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Qualifications
% Nurse
assistants
% Registered
nurses
% midwives
% Enrolled
nurses
% Other health
professional
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Age groups
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Age of nurses in competence review
2010
40%
35%
30%
25%
20%
15%
10%
5%
0%
Group 2 (20-29) Group 3 (30-39) Group 4 (40-49) Group 5 (50-59) Group 6 (60-69) Group 7 (70above)
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Length of career
25%
20%
15%
10%
5%
0%
<5 years
6-10
years
11-15
years
16-20
years
21-25
years
26-30
years
>30
years
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Specialty breakdown
Rest Home Mental Surgical, 5%
Care, 11% health, 0%
Midwifery, 2%
Medical, 32%
Aged Care in
Hospital, 34%
Primary
health care,
14%
Paediatric,
2%
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Outcomes
Of the 36 reviews attended in 2010
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No further action
Suspended
Requirements
5
2
29
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Pathways to recovery
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Pathways to recovery
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Remediation of practice issues
Following the Nursing Council
requirements
Seeking supervision/mentorship – even
if it is not a requirement
Finding ways to reward yourself for your
achievements
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Once all the requirements are met
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The nurse returns to normal practice
The conditions are removed from the
practising certificate
There has been lots of learning from
the studies
The nurse regains confidence
The nurse knows that they are
competent to practice.
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With crisis comes opportunity
and new beginnings
Decision making time
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A fresh start to their career
Resolve the issues and advance nursing
career to a higher level
New nursing pathways
Career versus developing other interests
New career pathways
Retirement from nursing
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Tools for the maintenance of your
competence
and... avoid a career crisis
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If you make mistakes
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Accept responsibility
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Reflect on ways you would avoid this situation
recurring and what you would do differently
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Immediately seek training or education on the
issue
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Engage in performance management process if
you are offered it
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Get peer support
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Seek professional support
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Show that you are competent by:
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Maintaining your own self respect
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Building alliances
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Learning to negotiate well
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Support respectful behaviour
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Reduce negativity over past events
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Don’t let any lack of confidence be perceived
as incompetence
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Focus on the basics of trust
respect and common sense
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Be responsible for your contribution in the team
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Manage stress with humour
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Support your peers
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Share your knowledge with others
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Be helpful and responsive to each other
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Praise success stories
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Encourage your colleagues to try new things, to be
autonomous and innovative in their practice
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Ways to maintain your competency
Take responsibility for your career by:
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Keeping up to date with changes in practice
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Using evidenced based practice
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Actively seeking professional development
opportunities beyond what employers provide
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Find a supervisor/mentor to help you reflect on your
practice and keep you on track
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Keep on learning
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References
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Freed to care
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Accident Compensation Act 2001
Cook, P. (2009) Facing a Competence Review, Kai
Tiaki: Nursing New Zealand, (Vol. 15, Issue 8, Page
26 (1))
Keenan, R. (2010) Health Care and the Law (4th
Ed), Wellington, Brookers.
Health and Disability Commissioner Act 1994
Health Practitioners Competence Assurance Act
2003
The competence review process, (2008) Nursing
Council of New Zealand
www.nzno.org.nz
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It’s an opportunity to improve
practice but can be a threat to the
health professional’s career
Pauline Cook
Competency Review Advisor
Paulinec@nzno.org.nz
04 494 6393
www.nzno.org.nz