Nurses must know laws governing practice: nurses need to be aware of all the legislation that governs their practice and understand how it impacts on their practice.
Why do nurses' minds go blank and their eyes glaze over when the word legislation is mentioned? In my role as competency review adviser for NZNO, I frequently see nurses who have a poor understanding of the legislation that guides their practice and how that legislation impacts on their practice.
Every year, all nurses sign their application for an annual practising certificate (APC) and make a declaration that they meet the competencies for their scope of practice. All nurses are expected to reflect on whether they meet these competencies when they are making the annual declaration which accompanies the APC application. This declaration provides the Nursing Council and the public with assurance that nurses are meeting the continuing competence requirements. (1)
Nurses are professionally accountable for meeting these competencies and it is important they complete their declaration honestly. One of these competencies is: Competency 1.1 Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical and relevant legislated requirements. (1)
The indicator for the enrolled nurse scope of practice states: Demonstrates knowledge of relevant legislation pertaining to the delivery of health consumer care. (2)
The indicator for the registered nurse scope of practice states: Practises nursing in accord with relevant legislation/code/policies and upholds client rights derived from that legislation. (3)
The indicator for the nurse practitioner scope of practice (relates to nurse practitioner prescribers) states: Understands the regulatory and legislative frameworks, contractual environment, subsidies, professional ethics and roles of key government agencies associated with prescribing. (4)
So nurses need to ask themselves: Are you being honest when you make your declaration on your application for your APC? Do you really know about the relevant legislation and does your nursing practice meet the requirements?
Here are some pointers to help nurses either confirm their declarations in previous years have been honest, or help them update their knowledge of legislation under which nurses practise, so next time they apply for an APC, the declaration they sign will be honest.
Nurses know they need to hold an APC and what is required to get one. They have to meet the requirements of their scope of practice and make a declaration they are fit to practise. But how many know the authority to issue APCs, along with all the other regulatory authority responsibilities, comes from the Health Practitioner's Competence Assurance Act 2003?
This Act requires regulatory authorities (such as Nursing Council) to set the scopes of practice, register practitioners within the scopes, issue practising certificates, review competence, fitness to practise and quality assurance, to investigate complaints and to discipline health practitioners, as well as a number of other administrative functions.
Nurses working in hospitals, aged-care facilities or disability services know about the Health and Disability Standards each provider must meet in order to obtain certification of the service. But do they know these standards are requirements under the Health and Disability Services (Safety) Act 2001? All these requirements are embedded in legislation.
Nurses also know of the requirements for the storage and administration of medicines. The requirements for medicines are in the Medicines Act 1981, Medicines Regulations 1984, the Misuse of Drugs Act 1975, and Medicines (Standing Orders) Regulations 2002.
Most nurses will be familiar with the maroon poster, Your Rights When Receiving a Health or Disability Service, that is on the walls of most hospitals and health care facilities. They know about the 10 rights in the Health and Disability Commissioners Code of Consumer Rights. This code comes from The Health and Disability Commissioner Act 1994. The rights in the code, for those using health and disability services, are the right to:
* freedom from discrimination;
* dignity and independence;
* reasonable care and skill;
* information you need to make a decision, and to refuse services;
* informed choice and informed consent;
* a support person;
* support teaching and research; and
* make a complaint.
Nurses working in mental health are familiar with the Mental Health (Compulsory Assessment and Treatment) Act 1992.
There is a multitude of New Zealand legislation that governs nurses' practice. (5) Other Acts that affect the provision of health services are (to name a few): the Privacy Act 1993; the Human Rights Act 1993; the Health Act 1956; the New Zealand Public Health and Disability Act 2000; and the Health and Safety in Employment Act 1992.
There are a number of websites where nurses can find out about the laws that affect their practice, including: www.statutes.govt.nz (which covers all legislation); www.moh.govt. nz; www.nursingcouncil.org.nz; www.hdc.org. nz; and www.nzno.org.nz.
Policies, procedures and guidelines sit underneath the legislation to ensure nurses are all working to the same standards.
Nurses aware of the above legislation and how it applies to their nursing practice can confidently declare they meet that first competency. For those who are not, it is time to become familiar with the legislation.
Most nurses do know about legislation, it's just that sometimes they find it difficult to link what they do in practice and why, to its foundation in New Zealand legislation.
(1) Nursing Council of New Zealand. (2008) Continuing Competence Requirements. www.nursingcouncilorg.nz. Retrieved 15/11/11.
(2) Nursing Council of New Zealand. (2010) Competencies for enrolled nurses, www.nursingcouncilorg.nz. Retrieved 15/11/11.
(3) Nursing Council of New Zealand. (2007) Competencies for registered nurses, www.nursingcouncilorg.nz. Retrieved 15/11/11.
(4) Nursing Council of New Zealand. (2010) Competencies for nurse practitioners, www.nursingcouncilorg.nz. Retrieved 15/11/11.
(5) Keenan, R. (2010) Health Care and the law. Wellington: Brookers Ltd.
By competency review adviser Pauline Cook