NZNO support for nurses facing competence reviews: the Health Practitioners Competence Assurance Act introduced a number of changes for the profession. One is the competence review process. NZNO offers members support through this process.

The Health Practitioners' Competence Assessment Act (HPCA) came into effect in September last year and the impact of the changes it heralded for nursing are beginning to be felt. One such change is the competence review process. Under the HPCA (section 34) an employer must notify the Nursing Council when a nurse has resigned or been dismissed for reasons relating to competence. Chief executive of the Nursing Council Marion Clark reports the Council has received 30 competency referrals so far. NZNO staff are handling around four cases a month.

Lack of understanding of process

NZNO lawyer Nicola Bush, who has dealt with a number of competence reviews over the last few months, said nurses often didn't understand employers' legal requirement to report competence issues to the Council "Sometimes a nurse facing a competencey issue decides to 'get out', to resign, without understanding there will be implications down the track because the Council has to be informed," she said.

Other bodies required by law to notify the Nursing Council of concerns over a nurse's competence are the Office of the Health and Disability Commissioner (HDC) and the Accident Compensation Corporation (ACC).

The person making the notification must include why that person believes the nurse may pose a risk to the public by practising below the required standard of competence. The Council then assesses the notification. If it decides to proceed, the Council informs the nurse by letter of the notification and asks if s/he has any information to put to the Council It is at this point the nurse should contact NZNO. "We really want nurses facing a competence review to contact us before they send any response or information to Nursing Council We can help the nurse develop a response to the Council's initial letter. It is much better if we are involved from the beginning of the process, not part way through or right at the end," Bush said.

An emerging trend

NZNO has dealt with over ten cases so far and Bush said a trend was emerging. "Where a nurse has had a 'one-off incident referred to the Council by the HDC or ACC, and the nurse could establish s/he has had reasonable performance appraisals and is involved in some professional development, we are finding in most of these cases no further action is taken and there is no competence review hearing. We've had five or six cases in that category."

If the Council decides to proceed with a review, the Registrar will write to the nurse informing her/him that a panel will carry out a competence review, the reasons for the review and who will be on the review panel. The three-member panel assesses whether a nurse meets the required level of competence. The panel must include a practitioner from the nurse's area of practice, a lay person and another nurse, who is often an educator. The panel gives the nurse all the relevant information it has and the nurse has the opportunity to respond at a meeting with the panel. The nurse is entitled to formal representation or to have a support person present at the meeting. If NZNO is involved, it will also receive all relevant information. The timeframe from initial letter to the final recommendations can be some months.

Improving competence

The aim of the meeting with the panel is to assess the nurse's competence and what, if anything, needs to be put in place to improve his/ her competence. The meeting takes place in the town or city closest to the nurse's home. If the nurse is a member, NZNO pays for the costs of travelling to the meeting.

"At the meeting the focus is very much on the nurse and whether they are competent. The nurse is asked to explain the circumstances which led to the referral The panel asks questions to elicit the nurse's current level of competence, eg drug calculations or scenario-type questions to gauge a nurse's assessment skills. There can be oral questions and/or a short written test. It is quite a gruelling experience, although the panel tries to make it as supportive as possible. But in the cases we have been involved with, the nurses have found it pretty difficult constantly answering questions and explaining," Bush said. The NZNO adviser's role during the meeting was one of support and guidance.

At the end of the day the panel tells the nurse its recommendations. The panel writes its recommendations to the Council, which makes the final decision. Its recommendations can include no further action or a pathway to enable the nurse to demonstrate competence. If the panel decides there is a competence issue, it can recommend one of the following: the nurse complete a competence programme; one or more conditions be included in the nurse's scope of practice; the nurse sit an examination or undertake a specified assessment; or one or more nominated persons assist or counsel the nurse. The Council must make orders to institute the panel's recommendations and a copy of any such orders is sent to the nurse, the nurse's employer, and any person who works in partnership or association with the nurse.

Suspension order

Where the panel considers the nurse poses a risk of serious harm to the public, it may suspend the nurse from practice. The nurse must be given a reasonable opportunity to make submissions and be heard before a suspension order is made. Bush said because a nurse could potentially have her/his practising certificate suspended, it was important NZNO was involved right from the start. "Because the process is a new one, it is not very well understood and most nurses are not aware of it or its implications. Suspension of an annual practising certificate is extremely serious."

In the competence reviews Bush had been involved in, the panel had recommended education or mentoring and/or clinical supervision, rather than suspension. Bush stressed the competence review process was entirely separate from any disciplinary processes.

Employment extended

Nurse and lawyer Rebecca Keenan, has been working for NZNO, supporting nurses facing competency reviews under the HPCA. Keenan has been working out of the Christchurch office on a part-time basis. She has had her employment extended until the end of the financial year.

* More information on the Nursing Council's competence review process is available at: www.nursing.council.org.nz.