Employers must support nurses who have competence issues: the competence review process, as required under law, has the potential to force some nurses out of the nursing workforce. Such an outcome is far from the original aims of the legislation.

The Health Practitioners Competence Assurance (HPCA) Act 2003 has changed nurses' employment and professional environment. The Act has made explicit the link between competence and safety to practise, through the introduction of competence-based annual practising certificates (APCs) and a competence review process. Under the Act, competence is mandatory and competency must be proven to show fitness to practise.

The competence review process is supposed to support nurses whose competence has been called into question to continue practising, while their competence issues are addressed. But employers of nurses have been stow to adapt to this new environment and have viewed negatively nurses who have competence conditions on their practice. This attitude has driven a number of nurses to seek work outside nursing. This negative employer attitude has to change. Nurses' employment can be sustained white they achieve the set competency goals/ conditions, if employers support these nurses.

Mandatory notification

Section 34 of the HPCA Act requires mandatory notification of a competency issue: firstly by the Health and Disability Commissioner (HDC) and/or Director of Proceedings (DOP), if there is an adverse finding against a nurse who has been the subject of a HDC inquiry; and secondly by the employer, if a nurse with an unresolved competence issue resigns or is dismissed. (1) There is also a voluntary requirement on other health practitioners to notify Nursing Council, if they are concerned a nurse's competence poses a risk to the public.

The Act requires each professional regulatory authority to set standards of clinical competence. These standards form the basis of competent practice. A nurse must show their practice meets all the standards, in order to show they do not pose a risk to public safety. Employers also use these standards as a basis for performance appraisal and the HDC uses them to gauge departure from the standard of care.

Standards of competence and competence conditions are an integral part of the HPCA Act and thus nurses' practice. They are here to stay and, in fact, will become more common. Therefore it behoves employers to respond in a supportive way to nurses who have competence conditions on their practice.

Aim is to support not punish

The purpose of such conditions, imposed by the Nursing Council, is to support the nurse in practice. They are meant to allow the nurse to continue to practise, white addressing identified areas of weakness in their practice. The HPCA Act separates competence issues from disciplinary processes, thus emphasising that the competence process is designed to support, not punish, nurses. The competency panel, which reviews a nurse's practice, also reinforces that the process is to support nurses, not to discipline them or lose nurses from the nursing workforce. The supportive nature of the process appears lost on employers.

Potential competence orders are set out in s38 of the HPCA Act and none are punitive. (1) It is only if a nurse fails to successfully complete a competence programme that s/he potentially faces toss of registration. So conditions on practice do not equate to incompetence or a risk of harm to the public. Such conditions are meant to enable the nurse to continue to practise--if the nurse can find a job. This is often complicated by the fact that whatever competence orders the review panel may impose are sent to an employer. While the panel considers the nurse safe to practise within certain parameters, ie the competence conditions, the conditions mean many potential employers see the nurse as a potential risk. Employers view competence conditions as a risk management issue. Risk management is important, but competence conditions are not meant to be seen as "risks", but as support tools to manage risk and ensure safe practice. But employers' attitudes to nurses with competence conditions act as a barrier to reemployment. If an employer has referred a nurse to the Nursing Council that employer will be unlikely to consider that nurse for re-employment until all competence conditions are fulfilled.

This restricts employment choices, especially if the nurse had been employed by a district health board that manages the majority of the health services for the area. This is compounded by the stress a nurse feels in revealing competence conditions to a new employer and often forces the nurse to consider employment outside the health sector. And it is virtually impossible for a nurses to fulfill some competence conditions within the aged-care sector. The severe staff shortages mean that those registered nurses in the sector cannot provide the necessary support and oversight of practice.

Once competence conditions are in place, it is even more important for a nurse to remain in clinical practice to cement new knowledge and gain confidence in their practice. Nurses will be unable to do this if, when they apply for a position, an employer reacts negatively to a nurse with competence conditions.

Such an attitude does not help sustain the nursing workforce. Employers need to more fully understand the rote of competence conditions and provide employment for nurses with such conditions on their practice. Employers need to move from a stance of risk management to one of support for the nurse with competency conditions. This will contribute to a supportive employment environment, which is needed to retain nursing staff.

Safe practice in the future will be shaped by both competence standards and competence conditions. Employers need to support nurses with competence conditions, understanding that these conditions ensure the nurse can continue to practise safety and competently. Only then, will the competence review process be meeting its original aims.

* This article was developed from a presentation Rebecca Keenan gave at the Workforce action: ready for the future conference in Wellington in June.

Reference

(1) Section 34 and Section 38. Part Three. Health Practitioners Competence Assurance Act.(2003) Wellington: New Zealand Government.

By NZNO legal adviser Rebecca Keenan