*Name amended under Legislation Act, s 60
Authorised by the ACT Parliamentary Counsel—also accessible at www.legislation.act.gov.au
Australian Capital Territory
Health Professionals (ACT Nursing and
Midwifery Board Standards Statements)
Approval 2006 (No 1)*
Notifiable Instrument NI2006-216
made under the
Health Professionals Regulation 2004, section 134 ( Standards Statement )
1 Name of instrument
This instrument is the
Health Professionals (ACT Nursing and Midwifery Board
Standards Statements) Approval 2006 (No 1)
.
2 Commencement
This instrument commences on the day after notification.
3 Standard Statements
In accordance with Regulation 134 (3) of the Health Professionals Regulation 2004
the ACT Nursing and Midwifery Board has approved the following Standards
Statements.
Attachment 1: ANMC Code of Professional Conduct for Nurses in Australia
Attachment 2: ANMC Code of Ethics for Nurses in Australia
Attachment 3: ANMC National Competency Standards for the Registered Nurse
Attachment 4: ANMC National Competency Standards for the Enrolled Nurse
Attachment 5: ANMC National Competency Standards for the Nurse Practitioner
Attachment 6: ANMC National Competency Standards for the Midwife
Attachment 7: ACMI Code of Ethics
Attachment 8: ACMI Code of Practice for Midwives
Mary Kirk
President
20 June 2006
1
CODE OF PROFESSIONAL CONDUCT FOR NURSES IN AUSTRALIA
Introduction
The Code of Professional Conduct for Nurses in
Australia (the Code) is a set of expected national
standards of nursing conduct for Australian nurses.
The Code is not intended to give detailed professional
advice on specific issues and areas of practice, rather,
it identifies the minimum requirements for conduct in
the profession. A breach of the Code may constitute
professional misconduct or unprofessional conduct.
The nursing profession expects that nurses will conduct
themselves personally and professionally in a way
that will maintain public trust and confidence in the
profession. Nurses have a responsibility to the individual,
society, and the profession to provide safe and
competent nursing care which is responsive to individual,
group and community needs, and the profession.
Purpose
The purpose of the Code of Professional Conduct for
Nurses in Australia is to:
• set an expected national standard of conduct for the
nursing profession,
• inform the community of the standards for
professional conduct of nurses in Australia, and
• provide consumer, regulatory, employing and
professional bodies with a basis for decisions
regarding standards of professional conduct.
Nurse. Means a registered or enrolled nurse who is
authorised to practise in a state or territory of Australia.
Individual/s. Refers to a person/persons receiving
nursing care.
Adverse therapeutic outcome. Means a negative health
outcome for a person who has received services or care
from a nurse.
Significant other persons. Those persons of whatever
relationship to the person receiving nursing care, who
play an important role in the life of that individual.
Professional Boundaries. Means the limit of a
relationship between a nurse and an individual or
between a nurse and any significant other persons,
which facilitates safe and therapeutic practice and results
in safe and effective care.
A Sexual Relationship.
Means a relationship between
a nurse and an individual that includes a sexual element.
Professional Standards. Include:
• this Code,
• the Code of Ethics for Nurses in Australia,
• the ANMC Competency Standards for Registered and
Enrolled Nurses,
• other endorsed standards or guidelines published by
the state and territory nurse regulatory authorities,
and
• standards developed by professional nursing
organisations.
Interpretation of Terms
Introduction Purpose Interpretation of Terms Code of Professional Conduct Explanatory Statements Bibliography
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
2
3
A nurse must:
1. Practise in a safe and competent manner.
2. Practise in accordance with the agreed standards of
the profession.
3. Not bring discredit upon the reputation of the nursing
profession.
4. Practise in accordance with laws relevant to the
nurse’s area of practice.
5. Respect the dignity, culture, values and beliefs of an
individual and any significant other person.
6. Support the health, well being and informed decision-
making of an individual.
7. Promote and preserve the trust that is inherent in
the privileged relationship between a nurse and an
individual, and respect both the person and property
of that individual.
8. Treat personal information obtained in a professional
capacity as confidential.
9. Refrain from engaging in exploitation, misinformation
and misrepresentation in regard to health care
products and nursing services.
Code of Professional Conduct
7. A nurse must promote and preserve the trust that
is inherent in the privileged relationship between
a nurse and an individual and respect both the
person and property of that individual.
• Within a professional relationship between an
individual and a nurse, there exists a power
imbalance which makes the individual vulnerable and
open to exploitation.
• An individual trusts that a nurse will cause no
physical or psychological harm and will care for the
possessions and property of that individual.
• A nurse has a responsibility to maintain a professional
boundary between that nurse and an individual, and
between that nurse and any significant other person.
• A nurse fulfils roles outside of the professional role,
including family member, friend and community
member. A nurse must be aware that dual
relationships may compromise care outcomes and
always conduct professional relationships with the
primary intent of benefit to the individual.
•
A sexual relationship between a nurse and an individual
for whom they provide care is unacceptable. Consent
is not an acceptable defence in the case of sexual
or intimate behaviour within a relationship between a
nurse and an individual for whom they provide care.
4. A nurse must practise in accordance with laws
relevant to the nurse’s area of practice.
• Nurses must be familiar with relevant laws to ensure
that they do not engage in practices prohibited by
such laws or delegate to others activities prohibited by
those laws.
5. A nurse must respect the dignity, culture, values
and beliefs of an individual and any significant
other person.
• In planning and providing effective nursing care, a
nurse must consider and respect cultural values and
beliefs, personal wishes and decisions of individuals
and any significant other person.
• A nurse must promote and protect the interests of an
individual, irrespective of gender, age, race, sexuality,
lifestyle, or religious or cultural beliefs.
• In making professional judgements in relation to
individual’s interests and rights, a nurse must not
contravene any law or breach the human rights of any
individual.
6. A nurse must support the health, well being and
informed decision-making of an individual.
• A nurse must inform an individual and any significant
other person regarding the nature and purpose of that
individual’s care, and assist that individual to make an
informed decision.
• In situations where individuals are unable to decide
or speak independently, a nurse must endeavour
to ensure that the perspective of that individual is
represented by an appropriate advocate.
Explanatory Statements (Continued)
• When an aspect of care is delegated, a nurse must
ensure that delegation is appropriate and does not
compromise the safety of an individual.
• A nurse has an obligation to practise in a safe
and competent manner that is not compromised by
personal health limitations.
2. A nurse must practise in accordance with the agreed
standards of the profession.
• A nurse is responsible to ensure that the standard
of that nurse’s practice conforms with professional
standards with the object of enhancing the safety
of the individual, any significant other person and
colleagues.
• A nurse’s primary responsibility is to provide safe
and appropriate nursing services. Any circumstance
which may compromise professional standards, or
any observation of questionable or unethical practice,
will be made known to an appropriate person or
authority. If the concern is not resolved and continues
to compromise safe and appropriate care, a nurse
must intervene to safeguard the individual and notify
the appropriate authority.
3. A nurse must not bring discredit upon the reputation
of the nursing profession.
• The actions of a nurse in their personal life may
have an adverse impact on their reputation and on
the profession, and may have adverse therapeutic
outcomes.
• The conduct of a nurse must at all times maintain and
build public trust and confidence in the profession.
The explanatory statements form part of the Code
and may be used to clarify the meaning and scope of
operation of that provision.
1. A nurse must practise in a safe and competent
manner.
• A nurse is personally accountable for the provision
of safe and competent nursing care. Therefore it
is the responsibility of each nurse to maintain the
competence necessary for current practice.
• Maintenance of competence includes participation
in ongoing professional education to maintain and
upgrade knowledge and skills relevant to practice in
a clinical, management, education or research setting.
• A nurse must be aware that undertaking activities that
are not within their scope of practice may compromise
the safety of an individual. The scope of practice
is based on each nurse’s education, knowledge,
competency, extent of experience and lawful authority.
• Nurses will advise the appropriate authorities or
employers of their scope of practice including any
limitations.
Explanatory Statements
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
4
8. A nurse must treat personal information obtained
in a professional capacity as confidential.
This should be considered in conjunction with the
National Privacy Principles Guidelines which support the
Privacy Act 1994. (www.privacy.gov.au)
• A nurse has a moral duty and a legal obligation to
protect the privacy of an individual by restricting
information obtained in a professional capacity
to appropriate personnel and settings, and to
professional purposes.
• A nurse must, where relevant, inform an individual
that in order to provide competent care, it is
necessary for a nurse to disclose information that
may be important to the clinical decision making by
other members of a health care team.
• A nurse must, where practicable, seek consent from
the individual or a person entitled to act on behalf of
the individual before disclosing information. In the
absence of consent, the nurse uses professional
judgement regarding the necessity to disclose
particular details, giving due consideration to the
interests, well–being, health and safety of the
individual and recognising that the nurse is required
by law to disclose certain information.
9. A nurse must refrain from engaging in exploitation,
misinformation or misrepresentation in regard to
health care products and nursing services.
• When a nurse provides advice about any product or
service, the nurse must fully explain the advantages
and disadvantages of alternate products or services
so that an individual can make an informed choice.
Where a specific product or service is advised, a
nurse must ensure that advice is based on adequate
knowledge and not on commercial or other forms of
gain.
• A nurse must accurately represent the nature of their
services or care intended to be provided.
Explanatory Statements (continued)
American Nurses’ Association (1985) Code for Nurses with
Interpretive statements. American Nurses’ Association,
Kansas City.
An Bord Altranais (1988) The Code of Professional Conduct
for each Nurse and Midwife. An Bord Altranais, Dublin.
Australian Nursing Council Incorporated (1993) National
Competencies for the Registered and Enrolled Nurse.
Australian Nursing Council Inc., Canberra.
Australian Nursing Council Incorporated (1993) Code of
Ethics for Nurses in Australia. Australian Nursing Council Inc.,
Canberra.
Canadian Nurses Association (1991) Code of Ethics for
Nursing. Canadian Nurses Association, Ottawa.
International Council of Nurses (ICN) (2000) Code of Ethics
for Nurses. ICN, Geneva.
Nurses Board of Victoria (2001) Professional Boundaries
Guidelines for Registered Nurses in Victoria.
Nurses Registration Board of News South Wales (1999)
Guidelines for Registered Nurses and Enrolled Nurses
regarding the Boundaries of Professional Practice.
Peterson, M. (1992) At Personal Risk: Boundary violations in
professional-client relationships. New York: W. W. Norton and
Company.
The Nurses Board of Western Australia (2000) Nurses Code
of Practice.
The Queensland Nursing Council and Health Practitioner
Boards’ Statement on Sexual Relationships between Health
Practitioners and their Patients (2000).
United Kingdom Central Council for Nursing Midwifery and
Health Visiting (UKCC) (1992) Code of Professional Conduct.
UKCC, London.
Bibliography
Australian Nursing and Midwifery Council
PO Box 873, Dickson ACT 2602
Phone: (02) 6257 7960
Fax:(02) 6257 7955
Website:www.anmc.org.au
This work is copyright January 2003. Apart from any use as permitted
under the Copyright Act 1968, no part of this work may be reproduced
by any means electronic or otherwise without the written permission of
the copyright holders.
The Code of Professional Conduct for Nurses in Australia was first
published in 1990, revised in 2003 and reprinted February 2005.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
1
Background Introduction Interpretation of Terms Code of Ethics Bibliography
Developed under the auspices of Australian Nursing and Midwifery Council, Royal College of Nursing, Australia, Australian Nursing Federation
CODE OF ETHICS FOR NURSES IN AUSTRALIA
Background
The purpose of this Code of Ethics is to:
• identify the fundamental moral commitments of the
profession,
• provide nurses with a basis for professional and self
reflection on ethical conduct,
• act as a guide to ethical practice, and
• indicate to the community the moral values which nurses
can be expected to hold.
This Code of Ethics has been developed for nursing in
the Australian context and is relevant to all nurses in all
practice settings.
The impetus for its development came at the Australasian
Nurse Registering Authorities Conference (ANRAC)
of 1990, when the research arising from the ANRAC
Nursing Competencies Assessment Project indicated
that there was not a clear focus on the ethical standards
expected and required of nurses practising in the cultural
context of Australia.
The Code of Ethics for Nurses in Australia was first
developed in 1993 under the auspices of the then
Australian Nursing Council Inc., Royal College
of Nursing, Australia and the Australian Nursing
Federation. In 2000 these peak organisations agreed
to undertake a joint project to review the Code of
Ethics. It is recognised that the Code of Ethics could
not have been realised without the participation of
nurses and nursing organisations in Australia, whose
many submissions and comments are acknowledged
and appreciated.
The Code of Ethics outlines the nursing profession’s
intention to accept the rights of individuals and to
uphold these rights in practice. The Code of Ethics is
complementary to the International Council of Nurses
(ICN) Code of Ethics for Nurses (2000).
The nurse’s primary professional responsibility is to
people requiring nursing care. In fulfilling this
responsibility nurses provide care and support before
and during birth and throughout life, and alleviate pain
and suffering during the dying process. Nurses enable
individuals, families and groups to maintain, restore
or improve their health status, or to be cared for and
comforted when deterioration of health has become
irreversible.
A traditional ideal of nursing is the concern for the
care and nurture of human beings giving just and due
consideration to their ethnicity, culture, gender, spiritual
values, sexuality, disability, age, economic, social or
health status, or any other grounds. Nurses respect and
uphold the rights of Australian Indigenous peoples.
The profession also acknowledges the cultural diversity
in contemporary Australian society.
Nursing care is based on the development of a
therapeutic relationship and the implementation and
evaluation of therapeutic processes. Therapeutic
processes include health promotion and education,
counselling, nursing interventions and empowerment
of individuals, families or groups to exercise maximum
choice in relation to their health care.
Nursing practice is undertaken in a variety of settings.
Any particular setting will be affected to some degree
by processes which are not within a nurse’s control or
influence. The processes affecting nursing practice can
include government policies, laws, resource constraints,
institutional policies, management decisions, and the
practice of other health care providers. Nurses also
recognise the potential for conflict between one person’s
needs and those of another, or of a group or community.
Introduction
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
2
Introduction (continued)
Such factors may affect the degree to which nurses are
able to fulfil their moral obligations and/or the number and
type of ethical problems they may face.
The Code contains six broad value statement.
Nurses are encouraged to use these statements as a
guide in reflecting on the degree to which their practice
demonstrates those values. As a means of assisting in
interpretation of the six values, a number of explanatory
statements are provided.
These explanatory statements are not intended to cover
all the aspects a nurse should consider, but can be used
to assist further exploration and consideration of ethical
concerns in nursing practice.
Nurses are also encouraged to undertake discussion and
educational opportunities in ethics in order to clarify for
themselves issues related to the fulfilment of their moral
obligations. This Code of Ethics is not intended to provide
a formula for the resolution of ethical problems, nor can
it adequately address the definitions and exploration of
terms and concepts which are part of the study of ethics.
Nurses are autonomous moral agents and sometimes
may adopt a personal moral stance that would make
participation in certain procedures morally unacceptable
to them. Nurses have a right to refuse (conscientious
objection) to participate in procedures, which they judge
on strongly held moral beliefs to be unacceptable. In
exercising their conscientious objection nurses must take
all reasonable steps to ensure that quality of care and
patient safety is not compromised.
Nurses accepting employment positions where they
foresee they may be called on to be involved in situations
at variance with their sincerely held beliefs, have a
responsibility to acquaint their employer or prospective
employer with this fact within a reasonable time.
Nurses, however, should consider seriously whether it
is appropriate for them to accept employment positions
whe
re they see these situations may arise, particularly if
this is likely to be more than a rare occurrence.
Employers and colleagues have a responsibility to
ensure that such nurses are not overtly or covertly
discriminated against in their workplace.
The Code of Ethics is supported by the Code of
Professional Conduct for Nurses in Australia. While the
Code of Ethics focuses on the ethics and ideals of the
profession, the Code of Professional Conduct identifies
the minimum requirements for practice in the profession,
and focuses on the clarification of professional
misconduct and unprofessional conduct. The two Codes,
together with published practice standards, provide a
framework for nursing.
Interpretation of Terms
Accountability: the state of being answerable for one’s
decisions and actions. It cannot be delegated
(ANRAC 1990).
Individual/individuals: refers to a person/persons
receiving nursing care.
Moral Agent: a person who acts morally/ethically on his
or her own authority.
Responsibility: the obligation that an individual
assumes when undertaking to carry out planned/
delegated functions. The individual who authorises the
delegated function retains accountability (ANRAC 1990).
Ethics: the moral practices, beliefs, and standards of an
individual/s and/or a group.
Ethical problem: a situation that requires ethical
consideration or ethical decision making, or a conflict of
moral values.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
3
VALUE STATEMENT 1
Nurses respect individual’s needs, values, culture and
vulnerability in the provision of nursing care.
Explanatory Statements
1 Nurses acknowledge the diversity in contemporary
Australian society. Nursing care for any individual
or group should not be compromised because of
ethnicity, culture, aboriginality, gender, spiritual
values, sexuality, disability, age, economic, social
or health status, or any other ground.
2 Respect for an individual’s needs includes recognition
of the person’s place in a family and community.
Nurses should, therefore, facilitate the participation of
significant others in the care of the individual if, and
as, the person and the significant others wish.
3
Respect for individual needs, beliefs and values
includes culturally informed and appropriate care,
and the provision of as much comfort, dignity, privacy
and alleviation of pain and anxiety as possible.
4 Respect includes the development of confidence
and trust in the relationship between nurses and the
people for whom they care.
5 Nurses acknowledge that there is a power imbalance
in the relationship between a person or group
receiving nursing care and a health care provider.
To promote a trusting and professional relationship,
and to prevent any exploitation of individuals, nurses
have an ethical responsibility always to maintain
appropriate professional boundaries between
themselves and persons to whom they provide
care.
Code of Ethics
VALUE STATEMENT 2
Nurses accept the rights of individuals to make informed
choices in relation to their care.
Explanatory Statements
1 Individuals have the right to make decisions related
to their own health care, based on accurate and
complete information given by health care providers.
Nurses must be satisfied that they have the person’s
consent for any care or treatment they are providing.
If individuals are not able to provide consent for
themselves, nurses have a role in ensuring that valid
consent is obtained from the appropriate substitute
decision-maker.
2 Nurses have a responsibility to inform people about
the nursing care that is available to them, and people
are entitled morally to accept or reject such care.
Nurses have a responsibility to respect the decisions
made by each individual.
3 Illness and/or other factors may compromise a
person’s capacity for self-determination. Where able,
nurses should ensure such persons continue to have
adequate and relevant information to enable them to
make informed choices about their care and treatment
and to maintain an optimum degree of self-direction
and self-determination.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
4
VALUE STATEMENT 3
Nurses promote and uphold the provision of quality
nursing care for all people.
Explanatory Statements
1 Quality nursing care includes competent care
provided by appropriately prepared nurses.
2 Promotion of quality nursing care includes valuing life
long learning and engaging in continuing education
as a means of maintaining and increasing knowledge
and skills. Continuing education refers to all formal
and informal opportunities for education.
3 Nurses research and evaluate nursing practice in
order to raise standards of care, and to ensure that
such standards are ethical.
4 Research should be conducted in a manner that is
ethically responsible and justified. Nurses should
not participate in any research or experimental
treatment on human subjects, which has not been
approved by an institutional ethics committee, and
which is not conducted in a manner consistent with
the requirements of the National Health and Medical
Research Council’s national statements relating to
ethical conduct in research involving humans.
5 Nurses contribute to the development and
implementation of policy to make the best use of
available resources and to promote quality care for
individuals.
VALUE STATEMENT 4
Nurses hold in confidence any information obtained in a
professional capacity, use professional judgement where
there is a need to share information for the therapeutic
benefit and safety of a person and ensure that privacy is
safeguarded.
Explanatory Statements
1 The nurse respects a person’s rights to determine
who will be provided with their personal information
and in what detail. Exceptions may be necessary in
circumstances where the life of the individual may be
placed in danger or where disclosure is required by
law.
Code of Ethics (continued)
2 When personal information is required for teaching,
research or quality assurance purposes, care must
be taken to protect the person’s autonomy, anonymity
and privacy. Consent must always be obtained from
the person or their lawful advocate.
3 Nurses protect persons in their care against breaches
of privacy by confining their verbal communications
to appropriate personnel and settings, and for
professional purposes.
4 Nurses have an obligation to adhere to legislative
guidelines limiting access to personal records
(whether paper or electronic).
VALUE STATEMENT 5
Nurses fulfil the accountability and responsibility
inherent in their roles.
Explanatory Statements
1 As morally autonomous professionals, nurses are
accountable for their clinical decision making and
have moral and legal obligations for the provision
of safe and competent nursing care.
2 Nurses contribute with other health care providers
in the provision of comprehensive health care,
recognising and respecting the perspective and
expertise of each team member.
3 Nurses have a right to refuse to participate in
procedures, which would violate their reasoned moral
conscience (ie. conscientious objection). In doing so,
they must take all reasonable steps to ensure that
quality of care and patient safetyis not compromised.
4 Nurses have an ethical responsibility to report
instances of unsafe and unethical practice. Nurses
should support colleagues who appropriately and
professionally notify instances of unsafe and unethical
practice.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
5
Bibliography
Code of Ethics (continued)
VALUE STATEMENT 6
Nurses value environmental ethics and a social,
economic and ecologically sustainable environment that
promotes health and well being.
Explanatory Statements
1 Nursing includes involvement in the detection of the
ill effects of the environment on the health of persons,
the ill effects of human activities on the natural
environment, and assisting communities in their
actions on envirnonmental health problems aimed at
minimising these effects.
2 Nurses value participation in the development,
implementation and monitoring of policies and
procedures, which promote safe and efficient use of
resources.
3 Nurses acknowledge that the social environment in
which a person resides has an impact on their health,
and in collaboration with other health professionals
and consumers, initiate and support action to meet
the health and social needs of the public.
American Nurses Association, 1985. (under review) Code for
Nurses. American Nurses Association, Kansas City.
Australian Nurse Registering Authorities Conference
(ANRAC), (now ceased), 1990, Report to the Australian Nurse
Registering Authorities Conference Vol 1 pp 91-94, Australian
Nursing Council Inc. (ANCI).
Beauchamp, T & Childress J, 1994. Principles of Biomedical
Ethics. 4th Edition Oxford University Press, New York.
Canadian Nurses Association, 1997. Code of Ethics for
Registered Nurses. Canadian Nurses Association, Ottawa.
Coady, M. and Bloch, S (Eds) 1996. Code of Ethics and the
Professions. Melbourne University Press, Melbourne.
Fry, S. and Johnstone, M-J, 2002. Ethics in Nursing Practice:
a guide to ethical decision making. 2nd edition. International
Council of Nurses, Geneva/Blackwell Publishing Oxford.
This work is copyright June 2002. Apart from any use as
permitted under the Copyright Act 1968, no part of this work
may be reproduced by any means electronic or otherwise
without the written permission of the copyright holders.
Published by ANMC July 1993, revised in 2002 reprinted
February 2005.
The Australian Nursing Council has officially changed its name
to the Australian Nursing and Midwifery Council.
Husted, G & Husted, J. 1981. Ethical Decision Making in
Nursing. Mosby, St Louis.
International Council of Nurses, 2000. Code of Ethics for
Nurses: International Council of Nurses, Geneva.
Johnstone, M J. 1999. Bioethics: A Nursing Perspective. 3rd
Edition Harcourt Australia, Sydney.
Johnstone, M. J. 1998. Determining and Responding
Effectively to Ethical Professional Misconduct in Nursing: A
Report to the Nurses Board of Victoria, Melbourne.
Kerridge, I. , Lowe, M. and McPhee, J. 1998. Ethics and Law
for the Health Professions. Social Science Press, Katoomba.
National Health and Medical Research Council, Australia.
http://www.nhmrc.health.gov.au
The New Zealand Nurses Association, 1995. Code of Ethics.
The New Zealand Nurses Association, Wellington.
Royal College of Nursing, Australia, 1998. Positions
Statement on Conscientious Objection. Royal College of
Nursing, Australia, Canberra.
Royal College of Nursing, Australia, 1996. Position
Statement Voluntary Euthanasia/Assisted Suicide. Royal
College of Nursing, Australia, Canberra.
Woodruff A, 1991: Discussion Paper: Code of Ethics and Code
of Conduct.
Woodruff A, (unpublished) Feedback from Code of Ethics
Think Tank 1992. Adelaide. Feedback from the Code of Ethics
Think Tank, 1992. Australian Nursing Council Inc. Canberra.
Australian Nursing and Midwifery Council
PO Box 873, Dickson ACT 2602
Phone: (02) 6257 7960
Fax: (02) 6257 7955
Website: www.anmc.org.au
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
1
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
National Competency Standards for the Registered Nurse
Introduction
The Australian Nursing and Midwifery Council Incorporated
(ANMC) is a peak national nursing and midwifery organisation
established in 1992 with the purpose of developing a national
approach to nursing and midwifery regulation. The ANMC works
in conjunction with the state and territory nursing and midwifery
regulatory authorities (NMRAs) to produce national standards
which are an integral component of the regulatory framework to
assist nurses and midwives to deliver safe and competent care.
The standards include the national competency standards
for registered nurses which were first adopted by the ANMC
in the early 1990s. These have been reviewed and revised
regularly since then. Other standards developed by the ANMC
for implementation by the NMRAs include the competency
standards for enrolled nurses, midwives and nurse practitioners,
codes of professional conduct and ethics, and a range of
position statements and guidelines. The full list of standards,
position papers and guidelines produced by the ANMC can be
viewed on the website.
In 2004/2005 the ANMC undertook a review of the national
competency standards for the registered nurse
to ensure that they remain contemporary and congruent with
the legislative requirements of the NMRAs.
This review, which was undertaken by a team of expert nursing
consultants, included extensive consultation with nurses
around Australia. The resulting standards, whilst different in
some areas from the previous competency standards, remain
broad and principle based so that they are sufficiently dynamic
for practicing nurses and the NMRAs to use as a benchmark to
assess competence to practice in a range of settings.
What are the standards used for?
T
he national competency standards for the registered nurse are
the core competency standards by which your performance
is assessed to obtain and retain your license to practice as a
registered nurse in Australia.
As a registered nurse, these core competency standards
provide you with the framework for assessing your competence,
and are used by your state/territory NMRA to assess
competence as part of the annual renewal of license process, to
assess nurses educated overseas seeking to work in Australia,
and to assess nurses returning to work after breaks in service.
They are also used to assess nurses involved in professional
conduct matters. The NMRAs may also apply the competency
standards in order to communicate to consumers the standards
that they can expect from nurses.
Universities also use the standards when developing
nursing curricula, and to assess student and new graduate
performance.
These are YOUR standards — developed using the best possible
evidence, and using information and feedback provided by
nurses in a variety of settings. Included also are the principles
of assessment which will assist you in understanding how these
standards may be used to assess performance. We believe you
will find them easy to understand, and user friendly.
ANMC would like to thank nurses throughout Australia for their
willing input to the development of these standards.
Description of the registered nurse
on entry to practice
The registered nurse demonstrates competence in the
provision of nursing care as specified by the registering
authority’s licence to practice, educational preparation,
relevant legislation, standards and codes, and context of
care. The registered nurse practices independently and
interdependently assuming accountability and responsibility
for their own actions and delegation of care to enrolled nurses
and health care workers. Delegation takes into consideration
the education and training of enrolled nurses and health care
workers and the context of care.
The registered nurse provides evidence–based nursing care
to people of all ages and cultural groups, including individuals,
families and communities. The role of the registered nurse
includes promotion and maintenance of health and prevention
of illness for individual/s with physical or mental illness,
disabilities and/or rehabilitation needs, as well as alleviation of
pain and suffering at the end stage of life.
The registered nurse assesses, plans, implements and
evaluates nursing care in collaboration with individual/s
and the multidisciplinary health care team so as to achieve
goals and health outcomes. The registered nurse recognises
INTRODUCTION DESCRIPTION OF
REGISTERED NURSE
DOMAINS NATIONAL COMPETENCY
STANDARDS
GLOSSARY
OF TERMS
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
2
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
that
ethnicity, culture, gender, spiritual values, sexuality, age,
disability and economic and social factors have an impact on
an individual’s responses to, and beliefs about, health and
illness, and plans and modifies nursing care appropriately.
The registered nurse provides care in a range of settings that
may include acute, community, residential and extended care
settings, homes, educational institutions or other work settings
and modifies practice according to the model/s of care delivery.
The registered nurse takes a leadership role in the coordination
of nursing and health care within and across different care
contexts to facilitate optimal health outcomes. This includes
appropriate referral to, and consultation with, other relevant
health professionals, service providers, and community and
support services.
The registered nurse contributes to quality health care
through lifelong learning and professional development of
herself/himself and others, research data generation, clinical
supervision and development of policy and clinical practice
guidelines. The registered nurse develops their professional
practice in accordance with the health needs of the population/
society and changing patterns of disease and illness.
Domains
The competencies which make up the ANMC National
Competency Standards for the Registered Nurses are organised
into domains.
Professional Practice
This relates to the professional, legal and ethical responsibilities
which require demonstration of a satisfactory knowledge base,
accountability for practice, functioning in accordance with
legislation affecting nursing and health care, and the protection
of individual and group rights.
Critical Thinking and Analysis
This relates to self – appraisal, professional development, and
the value of evidence and research for practice. Reflecting on
practice, feelings and beliefs and the consequences of these for
individuals/groups is an important professional benchmark.
Provision and Coordination of Care
This domain relates to the coordination, organisation and
provision of nursing care that includes the assessment of
individuals /groups, planning, implementation and evaluation of
care.
Collaborative and Therapeutic Practice
This relates to establishing, sustaining and concluding
professional relationships with individuals/groups. This
also contains those competencies that relate to the nurse
understanding their contribution to the interdisciplinary health
care team.
National Competency Standards
for the Registered Nurse
PROFESSIONAL PRACTICE
Relates to the professional, legal and ethical responsibilities
which require demonstration of a satisfactory knowledge
base, accountability for practice, functioning in accordance
with legislation affecting nursing and health care, and the
protection of individual and group rights.
1. Practises in accordance with legislation affecting
nursing practice and health care
1.1 Complies with relevant legislation and common law
● identifies legislation governing nursing practice
● describes nursing practice within the requirements of
common law
● describes and adheres to legal requirements for
medications
● identifies legal implications of nursing interventions
● actions demonstrate awareness of legal implications of
nursing practice
● identifies and explains effects of legislation on the care of
individuals/groups
● identifies and explains effects of legislation in the area of
health
● identifies unprofessional practice as it relates to
confidentiality and privacy legislation
1.2 Fulfils the duty of care
● performs nursing interventions in accordance with
recognised standards of practice
● clarifies responsibility for aspects of care with other
members of the health team
● recognises the responsibility to prevent harm
● performs nursing interventions following comprehensive
and accurate assessments
1.3 Recognises and responds appropriately to unsafe or
unprofessional practice
● identifies interventions which prevent care being
compromised and/or law contravened
● identifies appropriate action to be taken in specified
circumstances
● identifies and explains alternative strategies for
intervention and their likely outcomes
● identifies behaviour that is detrimental to achieving optimal
care
● follows up incidents of unsafe practice to prevent re–
occurrence
2. Practises within a professional and ethical nursing
framework
2.1 Practices in accordance with the nursing profession’s codes
of ethics and conduct
● accepts individuals/groups regardless of race, culture,
religion, age, gender, sexual preference, physical or mental
state
● ensures that personal values and attitudes are not
imposed on others
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
3
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
● conducts assessments that are sensitive to the needs of
individuals/groups
● recognises and accepts the rights of others
● maintains an effective process of care when confronted by
differing values, beliefs and biases
● seeks assistance to resolve situations involving moral
conflict
● identifies and attempts to overcome factors which may
constrain ethical decisions in consultation with the health
care team
2.2 Integrates organisational policies and guidelines with
professional standards
● maintains current knowledge of and incorporates relevant
professional standards into practice
● maintains current knowledge of and incorporates
organisational policies and guidelines into practice
● reviews and provides feedback on the relevance of
organisational policies and professional standards
procedures to practice
● demonstrates awareness and understanding of
developments in nursing that have an impact on the
individual’s capacity to practice nursing
● considers individual health and wellbeing in relation to
being fit for practice
2.3 Practises in a way that acknowledges the dignity, culture,
values, beliefs and rights of individuals/groups
● demonstrates respect for individual/group common and
legal rights in relation to health care
● identifies and adheres to strategies to promote and protect
individual/group rights
● considers individual/group preferences when providing care
● clarifies individual/group requests to change and/or refuse
care with relevant members of the health care team
● advocates for individuals/groups when rights are
overlooked and/or compromised
● accepts individuals/groups to whom care is provided
regardless of race, culture, religion, age, gender, sexual
preference, physical or mental state
● ensures that personal values and attitudes are not imposed
on others
● undertakes assessments which are sensitive to the needs
of individuals/groups
● recognises and accepts the rights of others
● maintains an effective process of care when confronted by
differing values, beliefs and biases
● provides appropriate information within the nurse’s scope
of practice to individuals/groups
● consults relevant members of the health care team when
required
● questions and/or clarifies orders and decisions that are
unclear, not understood or questionable
● questions and/or clarifies interventions that appear
inappropriate with relevant members of the health care
team
2.4 Advocates for individuals/groups and their rights for nursing
and health care within organisational and management
structures
● identifies when resources are insufficient to meet care
needs of individuals/groups
● communicates skill mix requirements to meet care needs of
individuals/groups to management
● protects the rights of individuals and groups and facilitates
informed decisions
● identifies and explains policies/practices which infringe on
the rights of individuals or groups
● clarifies policies, procedures and guidelines when rights of
individuals or groups are compromised
● recommends changes to policies, procedures and
guidelines when rights are compromised
2.5 Understands and practises within own scope of practice
● seeks clarification when questions, directions and
decisions are unclear or not understood
● undertakes decisions about care that are within scope of
competence without consulting senior staff
● raises concerns about inappropriate delegation with the
appropriate registered nurse
● demonstrates accountability and responsibility for own
actions within nursing practice
● assesses consequences of various outcomes of decision
making
● consults relevant members of the health care team when
required
● questions and/or clarifies interventions which appear
inappropriate with relevant members of the health care
team
2.6 Integrates nursing and health care knowledge, skills and
attitudes to provide safe and effective nursing care
● maintains a current knowledge base
● considers ethical responsibilities in all aspects of practice
● ensures privacy and confidentiality when providing care
● questions and/or clarifies interventions which appear
inappropriate with relevant members of the health care
team
2.7 Recognises the differences in accountability and
responsibility between Registered Nurses, Enrolled Nurses
and unlicensed care workers
● understands requirements of statutory and professionally
regulated practice
● understands requirements for delegation and supervision
of practice
● raises concerns about inappropriate delegation with
relevant organisational or regulatory personnel
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
4
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
CRITICAL THINKING AND ANALYSIS
Relates to self-appraisal, professional development and
the value of evidence and research for practice. Reflecting
on practice, feelings and beliefs and the consequences of
these for individuals/groups is an important professional
benchmark.
3 Practises within an evidence-based framework
3.1 Identifies the relevance of research to improving individual/
group health outcomes
● identifies problems/issues in nursing practice which may
be investigated through research
● considers potential for improvement in reviewing the
outcomes of nursing activities and individual/group care
● discusses implications of research with colleagues
● participates in research
● demonstrates awareness of current research in own field of
practice
3.2 Uses best available evidence, nursing expertise and respect
for the values and beliefs of individuals/groups in the
provision of nursing care
● uses relevant literature and research findings to improve
current practice
● participates in review of policies, procedures and guidelines
based on relevant research
● identifies and disseminates relevant changes in practice or
new information to colleagues
● recognises that judgements and decisions are aspects of
nursing care
● recognises that nursing expertise varies with education,
experience and context of practice
3.3 Demonstrates analytical skills in accessing and evaluating
health information and research evidence
● demonstrates understanding of the registered nurse role in
contributing to nursing research
● undertakes critical analysis of research findings in
considering their application to practice
● maintains accurate documentation of information which
could be used in nursing research
● clarifies when resources are not understood or their
application is questionable
3.4 Supports and contributes to nursing and health care
research
● participates in research
● identifies problems suitable for research
3.5 Participates in quality improvement activities
● recognises that quality improvement involves ongoing
consideration, use and review of practice in relation to
practice outcomes, standards and guidelines and new
developments
● seeks feedback from a wide range of sources to improve
the quality of nursing care
● participates in case review activities
● participates in clinical audits
4. Participates in ongoing professional development of self
and others
4.1 Uses best available evidence, standards and guidelines to
evaluate nursing performance
● undertakes regular self-evaluation of own nursing practice
● seeks and considers feedback from colleagues about, and
critically reflects on, own nursing practice
● participates actively in performance review processes
4.2 Participates in professional development to enhance nursing
practice
● reflects on own practice to identify professional
development needs
● seeks additional knowledge and/or information when
presented with unfamiliar situations
● seeks support from colleagues in identifying learning needs
● participates actively in ongoing professional development
● maintains records of involvement in professional
development which includes both formal and informal
activities
4.3 Contributes to the professional development of others
● demonstrates an increasing responsibility to share
knowledge with colleagues
● supports health care students to meet their learning
objectives in cooperation with other members of the health
care team
● facilitates mutual sharing of knowledge and experience with
colleagues relating to individual/group/unit problems
● contributes to orientation and ongoing education programs
● acts as a role model to other members of the health care
team
● participates where possible in preceptorship, coaching and
mentoring to assist and develop colleagues
● participates where appropriate in teaching others including
students of nursing and other health disciplines, and
inexperienced nurses
● contributes to formal and informal professional
development
4.4 Uses appropriate strategies to manage own responses to the
professional work environment
● identifies and uses support networks
● shares experiences related to professional issues mutually
with colleagues
● uses reflective practice to identify personal needs and seek
appropriate support
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
5
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
PROVISION AND COORDINATION OF CARE
Relates to the coordination, organisation and provision of
nursing care that includes the assessment of individuals/
groups, planning, implementation and evaluation of care.
5. Conducts a comprehensive and systematic nursing
assessment
5.1 Uses a relevant evidence-based assessment framework to
collect data about the physical socio-cultural and mental
health of the individual/group
● approaches and organises assessment in a structured way
● uses all available evidence sources, including individuals/
groups/significant others, health care team, records,
reports, and own knowledge and experience
● collects data that relates to physiological, psychological,
spiritual, socio-economic and cultural variables on an
ongoing basis
● understands the role of research-based, and other forms of
evidence
● confirms data with the individual/group and members of
the health care team
● uses appropriate assessment tools and strategies to assist
the collection of data
● frames questions in ways that indicate the use of a
theoretical framework/structured approach
● ensures practice is sensitive and supportive to cultural
issues
5.2 Uses a range of assessment techniques to collect relevant
and accurate data
● uses a range of data gathering techniques, including
observation, interview, physical examination and
measurement in obtaining a nursing history and
assessment
● collaboratively identifies actual and potential health
problems through accurate interpretation of data
● accurately uses health care technologies in accordance
with manufacturer’s specification and organisational policy
● identifies deviations from normal, or improvements in the
individual’s/group’s, health status
● identifies and incorporates the needs and preferences of
individuals/group into a plan of care
5.3 Analyses and interprets assessment data accurately
● recognises that clinical judgements involve consideration of
conflicting information and evidence
● identifies types and sources of supplementary information
for nursing assessment
● describes the role of supplementary information in nursing
assessment
● demonstrates knowledge of quantitative and qualitative
data to assess individual/group
needs
6. Plans nursing care in consultation with individuals/
groups, significant others and the interdisciplinary health
care team
6.1 Determines agreed priorities for resolving health needs of
individuals/groups
● incorporates relevant assessment data in developing a plan
for care
● determines priorities for care, based on nursing
assessment of an individual’s/group’s needs for
intervention, current nursing knowledge and research
● considers individual/group preferences when determining
priorities for care
6.2 Identifies expected and agreed individual/group health
outcomes including a time frame for achievement
● establishes realistic short- and long-term goals that identify
individual/group health outcomes and specify condition for
achievement
● identifies goals that are measurable, achievable, and
congruent with values and beliefs of the individual/group
and/or significant others
● uses resources to support the achievement of outcomes
● identifies criteria for evaluation of expected outcomes
6.3 Documents a plan of care to achieve expected outcomes
● ensures that plans of care are based on an ongoing
analysis of assessment data
● plans care that is consistent with current nursing
knowledge and research
● documents plans of care clearly
6.4 Plans for continuity of care to achieve expected outcomes
● collaboratively supports the therapeutic interventions of
other health team members
● information necessary for continuity of the plan of care is
maintained and documented
● responds to individual/group or carer’s educational needs
● provides or facilitates an individual/group or carer’s
resources and aids as required
● identifies and recommends appropriate agency,
government and community resources to ensure continuity
of care
● initiates necessary contacts and referrals to external
agencies
● forwards all information needed for continuity of care when
an individual/group is transferred to another facility or
discharged
7. Provides comprehensive, safe and effective evidence–
based nursing care to achieve identified individual/group
health outcomes
7.1 Effectively manages the nursing care of individuals/groups
● uses resources effectively and efficiently in providing care
● performs actions in a manner consistent with relevant
nursing principles
● performs procedures confidently and safely
● monitors responses of individuals/groups throughout each
intervention and adjusts care accordingly
● provides education and support to assist development and
maintenance of independent living skills
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
6
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
7.2 Provides nursing care according to the documented care or
treatment plan
● acts consistently with the predetermined plan of care
● uses a range of appropriate strategies to facilitate the
individual/group’s achievement of short and long term
expected goals
7.3 Prioritises workload based on the individual’s/group’s
needs, acuity and optimal time for intervention
● determines priorities for care, based on nursing
assessment of an individual/group’s needs for intervention,
current nursing knowledge and research
● considers the individual/group’s preferences when
determining priorities for care
7.4 Responds effectively to unexpected or rapidly changing
situations
● responds effectively to emergencies
● maintains self-control in the clinical setting and under
stress conditions
● implements crisis interventions and emergency routines as
necessary
● maintains current knowledge of emergency plans and
procedures to maximise effectiveness in crisis situations
● participates in emergency management practices and drills
according to agency policy
7.5 Delegates aspects of care to others according to their
competence and scope of practice
● delegates aspects of care according to role, functions,
capabilities and learning needs
● monitors aspects of care delegated to others and provides
clarification/assistance as required
● recognises own accountabilities and responsibilities when
delegating aspects of care to others
● delegates to and supervises others consistent with
legislation and organisational policy
7.6 Provides effective and timely direction and supervision to
ensure that delegated care is provided safely and accurately
● supervises and evaluates nursing care provided by others
● uses a range of direct and indirect techniques such as
instructing, coaching, mentoring, and collaborating in the
supervision and support of others
● provides support with documentation to nurses being
supervised or to whom care has been delegated
● delegates activities consistent with scope of practice/
competence
7.7 Educates individuals/groups to promote independence and
control over their health
● identifies and documents specific educational requirements
and requests of individuals/groups
● undertakes formal and informal education sessions with
individuals/groups as necessary
● identifies appropriate educational resources, including
other health professionals
7.8 Uses health care resources effectively and efficiently to
promote optimal nursing and health care
● recognises when nursing resources are insufficient to meet
an individual’s/group’s needs
● demonstrates flexibility in providing care where resources
are limited
● recognises the responsibility to report to relevant persons
when level of resources risks compromising the quality of
care
8. Evaluates progress towards expected individual/group
health outcomes in consultation with individuals/groups,
significant others and interdisciplinary health care team
8.1 Determines progress of individuals/groups toward planned
outcomes
● recognises when individual’s/group’s progress and
expected progress differ and modifies plans and actions
accordingly
● discusses progress with the individual/group
● evaluates individual/group responses to interventions
● assesses the effectiveness of the plan of care in achieving
planned outcomes
8.2 Revises the plan of care and determines further outcomes in
accordance with evaluation data
● revises expected outcomes, nursing interventions and
priorities with any change in an individual’s/group’s
condition, needs or situational variations
● communicates new information and revisions to members
of the health care team as required
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
7
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
COLLABORATIVE AND THERAPEUTIC PRACTICE
Relates to establishing, sustaining and concluding
professional relationships with individuals/groups. This
also contains those competencies that relate to the nurse
understanding their contribution to the interdisciplinary health
care team.
9. Establishes, maintains and appropriately concludes
therapeutic relationships
9.1 Establishes therapeutic relationships that are goal directed
and recognises professional boundaries
● demonstrates empathy, trust and respect for the dignity
and potential of the individual/group
● interacts with individuals/groups in a supportive manner
● effectively initiates, maintains and concludes interpersonal
interactions
● establishes rapport with individuals/groups that enhances
their ability to express feelings, and fosters an appropriate
context for expression of feeling
● understands the potential benefits of partnership
approaches on nurse individual/group relationships
● demonstrates an understanding of standards and practices
of professional boundaries and therapeutic relationships
9.2 Communicates effectively with individuals/groups to
facilitate provision of care
● uses a range of effective communication techniques
● uses language appropriate to the context
● uses written and spoken communication skills appropriate
to the needs of individuals/groups
● uses an interpreter where appropriate
● provides adequate time for discussion
● establishes, where possible, alternative communication
methods for individuals/groups who are unable to verbalise
● uses open/closed questions appropriately
9.3 Uses appropriate strategies to promote an individual’s/
group’s self-esteem, dignity, integrity and comfort
● identifies and uses strategies which encourage
independence
● identifies and uses strategies which affirm individuality
● uses strategies which involve the family/significant others
in care
● identifies and recommends appropriate support networks
to individuals/groups
● identifies situations which may threaten the dignity/
integrity of an individual/group
● implements measures to maintain dignity of individuals/
groups during periods of self-care deficit
● implements measures to support individuals/groups
experiencing emotional distress
● information is provided to individuals/groups to enhance
their control over their own health care
9.4 Assists and supports individuals/groups to make informed
health care decisions
● facilitates and encourages individual/group decision-
making
● maintains and supports respect for an individual/group’s
decision through communication with other members of the
interdisciplinary health care team
● arranges consultation to support individuals/groups to
make informed decisions regarding health care
9.5 Facilitates a physical, psychosocial, cultural and spiritual
environment that promotes individual/group safety and
security
● demonstrates sensitivity, awareness and respect
for cultural identity as part of an individual’s/group’s
perceptions of security
● demonstrates sensitivity, awareness and respect in regard
to an individual’s/group’s spiritual needs
● involves family and others in ensuring that cultural and
spiritual needs are met
● identifies, eliminates or prevents environmental hazards
where possible
● applies relevant principles to ensure the safe
administration of therapeutic substances
● maintains standards for infection control
● applies ergonomic principles to prevent injury to individual/
group and self
● prioritises safety problems
● adheres to occupational health and safety legislation
● modifies environmental factors to meet an individual’s/
group’s comfort needs where possible
● promotes individual/group comfort throughout
interventions
● uses ergonomic principles and appropriate aids to promote
the individual/group’s comfort
10. Collaborates with the interdisciplinary health care
team to provide comprehensive nursing care
10.1 Recognises that the membership and roles of health care
teams and service providers will vary depending on an
individual’s/group’s needs and health care setting
● recognises the impact and role of population, primary
health and partnership health care models
● recognises when to negotiate with, or refer to, other health
care or service providers
● establishes positive and productive working relationships
with colleagues
● recognises and understands the separate and
interdependent roles and functions of health care team
members
10.2 Communicates nursing assessments and decisions to the
interdisciplinary health care team and other relevant service
providers
● explains the nursing role to the interdisciplinary team and
service providers
● maintains confidentiality in discussions about an individual/
group’s needs and progress
● discusses individual/group care requirements with relevant
members of the health care team
● collaborates with members of the health care team in
decision making about care of individuals/groups
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
8
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
Glossary of Terms
ANMC: Australian Nursing and Midwifery Council
Appropriate: Matching the circumstances, meeting needs of
the individual, groups or situation
Attributes: Characteristics which underpin competent
performance
Core Competency Standards: Essential competency
standards for Standards registration or licensure.
Competence: The combination of skills, knowledge, attitudes,
values and abilities that underpin effective and/or superior
performance in a profession/occupational area.
Competent: The person has competence across all the
domains of competencies applicable to the nurse, at a
standard that is judged to be appropriate for the level of nurse
being assessed.
Competency Unit: Represents a major function/functional
area in the total competencies of a Registered Nurse in a
nursing context representing a stand-alone function which
can be performed by the individual.
Competency Element: Represents a sub-function of the
competency unit.
Competency Standards: Consists of competency units and
competency elements.
Contexts: The setting/environment where competence can
be demonstrated or applied.
Cues: Key generic examples of competent performance. They
are neither comprehensive nor exhaustive.
They assist the assessor when using their professional
judgement in assessing nursing practice. They further assist
curriculum development.
Domain: An organised cluster of competencies in nursing
practice.
Enrolled Nurse: A person licensed under an Australian State
or Territory Nurses Act or Health Professionals Act to provide
nursing care under the supervision of a Registered Nurse.
Referred to as a Registered Nurse Division II in Victoria.
Exemplars: Concrete, key examples chosen to be typical of
competence. They are not the standard but are indicative of
the standard
Registered Nurse: A person licensed to practice nursing
under an Australian State or Territory Nurses Act or Health
Professionals Act. Referred to as a Registered Nurse Division
1 in Victoria.
● demonstrates skills in written, verbal and electronic
communication
● documents, as soon possible, forms of communication,
nursing interventions and individual/group responses
10.3 Facilitates coordination of care to achieve agreed health
outcomes
● adopts and implements a collaborative approach to
practice
● participates in health care team activities
● demonstrates the necessary communication skills to
manage avoidance, confusion and confrontation
● demonstrates the necessary communication skills to
enable negotiation
● demonstrates an understanding of how collaboration
has an impact on the safe and effective provision of
comprehensive care
● establishes and maintains effective and collaborative
working relationships with other members of the health
care team
● consults with relevant health care professionals and
service providers to facilitate continuity of care
● recognises the contribution of, and liaises with, relevant
community and support services
● records information systematically in an accessible and
retrievable form
● ensures that written communication is comprehensive,
logical, legible, clear and concise, spelling is accurate and
only acceptable abbreviations are used
● establishes and maintains documentation according to
organisational guidelines and procedures
10.4 Collaborates with the health care team to inform policy and
guideline development
● regularly consults policies and guidelines
● demonstrates awareness of changes to policies and
guidelines
● attends meetings and participates in practice reviews and
audits
● demonstrates understanding of the implications of national
health strategies for nursing and health care practice
The ANMC acknowledges that the methods and processes in
assessment of competencies will be further developed, and
that the content of this document will be reviewed in three
years. Comments should be addressed to:
The Chief Executive Officer
Australian Nursing and Midwifery Council
PO Box 873
DICKSON ACT 2602
This work is copyright December 2005. Apart from any use as
permitted under the Copyright Act 1968, no part of this work
may be reproduced by any means electronic or otherwise
without the written permission of the copyright holders.
Requests and enquiries concerning reproduction rights
should be addressed to the Chief Executive Officer, Australian
Nursing and Midwifery Council.
ANMC NATIONAL COMPETENCY STANDARDS FOR THE REGISTERED NURSE
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
1
ANMC NATIONAL COMPETENCY STANDARDS FOR THE ENROLLED NURSE
Introduction to the ANMC National
Nursing Competency Standards
National Competency Standards
for the Registered Nurse
Domains
Purposes of the ANMC National Nursing
Competency Standards
The ANMC Competency Standards for Registered
Nurses and Enrolled Nurses are core competency
standards and have the following specific purposes:
• to provide a means of communicating to consumers
the expected competency standards of nurses;
• to determine the eligibility for initial registration or
enrolment of persons who have undertaken nursing
courses in Australia;
• to determine the eligibility of nurses who have
undertaken nursing courses outside Australia, and
who wish to practice in this country;
• to provide the basis for assessing nurses who wish
to re-enter the workforce after a period of absence
defined by the registering authority; and
• to assess qualified nurses who are required to show
that they can demonstrate the minimum level of
competence for continuing practice.
Nurses in Australia are regulated and accountable to the
community for providing high quality care through safe
and effective work practice.To assist in achieving this,
the state and territory nursing and midwifery regulatory
authorities set standards of competence that describe
the behaviour of nurses.
The state and territory nursing and midwifery regulatory
authorities establish and maintain standards and
processes for regulation within Australia.
The ANMC develops national standards that provide
a framework for professional nursing practice. These
standards are:
• The ANMC National Competency Standards for
Registered and Enrolled Nurses
• The Code of Ethics for Nurses in Australia
• The Code of Professional Conduct for Nurses in
Australia
The competency standards take account of the
various roles and functions nurses fulfil and identify a
combination of the attributes a competent nurse must
have.
Introduction to the ANMC National
Nursing Competency Standards
Purposes
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
2
The enrolled nurse is an associate to the registered
nurse who demonstrates competence in the provision
of patient-centred care as specified by the registering
authority’s licence to practise, educational preparation
and context of care.
Core as opposed to minimum enrolled nursing practice
requires the enrolled nurse to work under the direction
and supervision of the registered nurse as stipulated by
the relevant nursing and midwifery registering authority.
At all times, the enrolled nurse retains responsibility for
his/her actions and remains accountable in providing
delegated nursing care.
Core enrolled nurse responsibilities in the provision
of patient-centred nursing care include recognition of
normal and abnormal in assessment, intervention and
evaluation of individual health and functional status.
The enrolled nurse monitors the impact of nursing
care and maintains ongoing communication with the
registered nurse regarding the health and functional
status of individuals. Core enrolled nurse responsibilities
also include providing support and comfort, assisting
with activities of daily living to achieve an optimal level
of independence, and providing for emotional needs of
individuals. Where state law and organisational policy
allows, enrolled nurses may administer prescribed
medicines or maintain intravenous fluids, in accordance
with their educational preparation.
Enrolled nurses are required to be information
technology literate with specific skills in the application
of health care technology. Enrolled nurses demonstrate
critical and reflective thinking skills in contributing to
decision making which includes reporting changes in
health and functional status and individual responses to
health care interventions. Enrolled nurses work as a part
of the health care team to advocate for and facilitate the
involvement of individuals, their families and significant
others in planning and evaluating care and progress
toward health outcomes.
These responsibilities are illustrative of the types of core
activities that an enrolled nurse would be expected to
undertake on entry to practice.
All enrolled nurses have a responsibility for ongoing
self-development to maintain their knowledge base to
carry out their role.
Description of the Enrolled Nurse
on Entry to Practice
The significance of the competency standards.
For the public, employers and others.
These core competency standards are designed
to encourage understanding of their purpose in the
community as well as by others involved in providing
health and related services.
They contribute to positive health outcomes because
enrolled nurses are equipped to provide safe and
effective nursing care.
Nurses who are enrolled are required to demonstrate
competence and have a professional responsibility to
maintain the standards in order to renew their licence.
Education courses leading to registration are
accredited by nurse regulatory authorities. These
programs require graduates to demonstrate the
competency standards. This assists in ensuring that
enrolled nurses are fit to provide safe, competent care
in a variety of settings.
For Nursing & Midwifery Regulatory Authorities
Nurse and midwifery regulatory authorities apply the
competency standards in order to:
• communicate to consumers the competency
standards that they can expect of nurses;
• determine the eligibility for registration of people who
have undertaken nursing courses in Australia;
• determine the eligibility for registration of nurses who
wish to practise in Australia but have undertaken
courses elsewhere;
• assess nurses who wish to return to work after being
out of the work force for a defined period; and,
• assess qualified nurses who are required to show
they are fit to continue working.
For nurses
The standards take account of the contemporary role
of the enrolled nurse which covers professional and
ethical clinical practice, management of care, and
communication. They provide a benchmark for nurses
in daily practice.
Introduction to the ANMC
National Competency Standards
for the Enrolled Nurse
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
3
Competency Unit 1
Functions in accordance with legislation, policies
and procedures affecting nursing practice.
Element 1.1
Demonstrates knowledge of legislation and common law
pertinent to enrolled nursing practice.
Element 1.2
Demonstrates knowledge of organisational policies and
procedures pertinent to enrolled nursing practice.
Element 1.3
Fulfils the duty of care in the course of enrolled nursing
practice.
Element 1.4
Acts to ensure safe outcomes for individuals and groups
by recognising and reporting the potential for harm.
Element 1.5
Reports practices that may breach legislation, policies
and procedures relating to nursing practice to the
appropriate person.
Competency Unit 2
Conducts nursing practice in a way that can be
ethically justified.
Element 2.1
Acts in accordance with the nursing profession's codes.
Element 2.2
Demonstrates an understanding of the implications of
these codes for enrolled nursing practice.
Domain: Professional and Ethical Practice
They may be used for academic assessment,
workplace performance review and for measuring
continuing fitness to practice.
The competency standards reflect the unique
characteristics of nursing as well as broader
attributes nurses have in common with other
professions and occupations. In addition, they identify
the knowledge, skills and attitudes required by nurses
and reflect the complex nature of nursing activities.
Domains
The competencies which make up the ANMC
National Competency Standards for the Enrolled
Nurse are organised into domains.
Professional and Ethical Practice
This contains the competencies that relate to legal
and ethical responsibilities, including being able to
demonstrate a satisfactory knowledge base, being
accountable for practice, functioning in accordance
with legislation affecting nursing, and the protection
of individuals and group rights.
Critical Thinking and Analysis
This contains those competencies relating to
self-appraisal, and professional development.
Management of Care
This contains the competencies that relate to
the assessment of patients/clients, planning,
implementation and the evaluation of care.
Enabling
This contains those competencies essential for
establishing and sustaining the nurse/patient
relationship. It integrates interpersonal and
communication skills to ensure the provision of
care. It also includes the ability to interact with other
members of the health care team.
Introduction to the ANMC
National Competency Standards
for the Enrolled Nurse
(continued)
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
4
Competency Unit 5
Demonstrates critical thinking in the conduct of
enrolled nursing practice.
Element 5.1
Uses nursing standards to assess own performance.
Element 5.2
Recognises the need for and participates in continuing
self/professional development.
Element 5.3
Recognises the need for care of self.
Competency Unit 3
Conducts nursing practice in a way that respects the
rights of individuals and groups.
Element 3.1
Practises in accordance with organisational policies rel-
evant to individual/group rights in the health care context.
Element 3.2
Demonstrates an understanding of the rights of
individuals/groups in the health care setting.
Element 3.3
Liaises with others to ensure that the rights of individuals/
groups are maintained.
Element 3.4
Demonstrates respect for the values, customs, spiritual
beliefs and practices of individuals and groups.
Element 3.5
Liaises with others to ensure that the spiritual, emotional
and cultural needs of individuals/groups are met.
Element 3.6
Contributes to the provision of relevant health care
information to individuals and groups.
Competency Unit 4
Accepts accountability and responsibility for own
actions within enrolled nursing practice
Element 4.1
Recognises own level of competence.
Element 4.2
Recognises the differences in accountability and
responsibility between registered nurses, enrolled nurses
and unregulated care workers.
Element 4.3
Differentiates the responsibility and accountability of the
registered nurse and enrolled nurse in the delegation of
nursing care.
Domain: Professional and Ethical Practice Domain: Critical Thinking and Analysis
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
5
Competency Unit 6
Contributes to the formulation of care plans in col-
laboration with the registered nurse, individuals and
groups.
Element 6.1
Accurately collects and reports data regarding the health
and functional status of individuals and groups.
Element 6.2
Participates with the registered nurse and individuals and
groups in identifying expected health care outcomes.
Element 6.3
Participates with the registered nurse in evaluation of
progress of individuals and groups toward expected
outcomes and reformulation of care plans.
Competency Unit 7
Manages nursing care of individuals and groups
within the scope of enrolled nursing practice.
Element 7.1
Implements planned nursing care to achieve identified
outcomes.
Element 7.2
Recognises and reports changes in the health and
functional status of individuals/groups to the registered
nurse.
Element 7.3
Ensures communication, reporting and documentation
are timely and accurate.
Element 7.4
Organises workload to facilitate planned nursing care for
individuals and groups.
Competency Unit 8
Contributes to the promotion of safety, security and
personal integrity of individuals and groups within
the scope of enrolled nursing practice.
Element 8.1
Acts appropriately to enhance the safety of individuals
and groups at all times.
Element 8.2
Establishes, maintains and concludes effective
interpersonal communication.
Element 8.3
Applies appropriate strategies to promote the self esteem
of individuals and groups.
Element 8.4
Acts appropriately to maintain the dignity and integrity of
individuals and groups.
Competency Unit 9
Provides support and care to individuals and groups
within the scope of enrolled nursing practice.
Element 9.1
Provides for the comfort needs of individuals and groups
experiencing illness or dependence.
Element 9.2
Collaborates with the registered nurse and members of the
health care team in the provision of nursing care to individuals
and groups experiencing illness or dependence.
Element 9.3
Contributes to the health education of individuals or groups to
maintain and promote health.
Element 9.4
Communicates with individuals and groups to enable
therapeutic outcomes.
Domain: Management of Care Domain: Enabling
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
6
Competency Unit 10
Collaborates with members of the health care team to
achieve effective health care outcomes.
Element 10.1
Demonstrates an understanding of the role of the enrolled
nurse as a member of the health care team.
Element 10.2
Demonstrates an understanding of the role of members of the
health care team in achieving health care outcomes.
Element 10.3
Establishes and maintains collaborative relationships with
members of the health care team.
Element 10.4
Contributes to decision-making by members of the health care
team.
This work is copyright October 2000. Apart from any use
as permitted under the Copyright Act 1968, no part of
this work may be reproduced by any means electronic or
otherwise without the written permission of the copyright
holders. Requests and enquiries concerning reproduction
rights should be addressed to the Chief Executive
Officer, Australian Nursing and Midwifery Council.
Domain: Enabling
Australian Nursing and Midwifery Council
PO Box 873, Dickson ACT 2602
Phone: (02) 6257 7960
Fax:(02) 6257 7955
Website:www.anmc.org.au
Additional Information
Additional information in relation to the ANMC
competency standards and registration and enrolment,
can be obtained from the nurses' board or council in your
state or territory.
A complete copy of the competency standards with
domains, cues and glossary can be purchased from the
Australian Nursing and Midwifery Council.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
1
National Competency Standards for the Nurse Practitioner
Introduction
The Australian Nursing and Midwifery Council Incorporated
(ANMC) is a peak national nursing and midwifery organisation
established in 1992 with the purpose of developing a national
approach to nursing and midwifery regulation. The ANMC
works in conjunction with the state and territory nursing and
midwifery regulatory authorities (NMRAs) to produce national
standards which are an integral component of the regulatory
framework to assist nurses and midwives to deliver safe and
competent care.
The standards include the national competency standards for
the registered nurse, which were first adopted by the ANMC
in the early 1990s, and have been reviewed and revised
regularly since then. Other standards developed by the ANMC
for implementation by NMRAs include competency standards
for enrolled nurses and midwives, codes of professional
conduct and ethics, and a range of position statements and
guidelines. The full list of standards, position papers and
guidelines produced by the ANMC can be viewed on the
website.
In 2004 the ANMC, with contributions from the Nursing
Council of New Zealand, commissioned a project to
investigate the scope and role of nurse practitioners and
develop national standards for practice. The resulting
standards are reproduced in this booklet together with the
supporting performance indicators.
What are the standards used for?
The national competency standards for the nurse practitioner
build on the core competency standards for registered nurses
and midwives, and the advanced nursing practice competency
standards. The competency standards, which have been
endorsed by all NMRAs are those by which your performance
is assessed to obtain and retain your license to practice as a
nurse practitioner in Australia.
As a nurse practitioner, these competency standards provide
you with the framework for assessing your competence, and
are used by your state/territory NMRA to assess competence
as part of the annual renewal of license process and to
assess nurse practitioners educated overseas seeking
to work in Australia. They are also used to assess nurse
practitioners involved in professional conduct matters. The
NMRAs may also apply the competency standards in order
to communicate to consumers the standards that they can
expect from nurse practitioners.
Universities also use the standards when developing nursing
curricula, and to assess student performance.
These are YOUR standards — developed using the best
possible evidence, and using information and feedback
provided by nurse practitioners in a variety of settings.
Included also are the principles of assessment which will
assist you in understanding how these standards may be
used to assess performance. We believe you will find them
easy to understand, and user friendly.
ANMC would like to thank nurse practitioners around Australia
and New Zealand for their willing input to the development of
these standards.
Definition of the
Nurse Practitioner
A nurse practitioner is a registered nurse educated and
authorised to function autonomously and collaboratively in an
advanced and extended clinical role. The nurse practitioner
role includes assessment and management of clients
using nursing knowledge and skills and may include but is
not limited to the direct referral of patients to other health
care professionals, prescribing medications and ordering
diagnostic investigations. The nurse practitioner role is
grounded in the nursing profession’s values, knowledge,
theories and practise and provides innovative and flexible
health care delivery that complements other health care
providers. The scope of practice of the nurse practitioner is
determined by the context in which the nurse practitioner is
authorised to practise.
INTRODUCTION DEFINITION OF
NURSE PRACTITIONER
NURSE PRACTITIONER
FRAMEWORK
GLOSSARY
OF TERMS
COMPETENCY STANDARDS
FOR NURSE PRACTITIONER
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
2
ANMC NATIONAL COMPETENCY STANDARDS FOR THE NURSE PRACTITIONER
Three generic standards that define the parameters of nurse
practitioner practice have been identified. These standards are
defined by nine competencies each with specific performance
indicators.
The three standards are:
STANDARD 1
Dynamic practice that incorporates application of high-
level knowledge and skills in extended practice across
stable, unpredictable and complex situations
Dynamic practice has several core components, at the core of
which are highly developed clinical practice skills focused on
a particular population group or area of specialty practice. Key
elements of dynamic practice are comprehensive assessment
ability including advanced physical assessment and an
analysis of the person context. This is based on advanced
knowledge of pathophysiology and the range of human
sciences integral to nursing. Dynamic practice incorporates
the ability to prescribe and to order investigative procedures
according to health assessment information in addressing
need. Finally, dynamic practice includes the need to address
currency of practice as a continuous process.
STANDARD 2
Professional efficacy whereby practice is structured
in a nursing model and enhanced by autonomy and
accountability
Professional efficacy describes the level of knowledge and
skill, and the approach to using that knowledge. It captures
the sense of professional identity and authority which
supports delivering extended skills based in patient/client
need and delivering them from a sound base of nursing. The
nurse practitioner identifies as first and foremost a nurse
and this identity determines the nature of practice. The nurse
practitioner applies critical reasoning to negotiate evidence
and adapt care to the lived realities of clients in vastly
different contexts and achieves this by establishing a climate
of mutual trust and partnership with patients and clients, and
whole communities where relevant. The critical component
of professional efficacy is the ability to respect the right of
people to determine their own journey through a health/
illness episode while ensuring that people have accurate and
appropriately interpreted information on which to base their
decisions.
Professional efficacy also means that the nurse practitioner
participates as a senior member of any multidisciplinary
team, recognising nursing autonomy and giving and accepting
referrals as appropriate. To do this they implicitly understand
their own accountability but also work collaboratively with
other clinicians to secure the best care of each patient or
client.
Nurse Practitioner
Competency Standards
STANDARD 3
Clinical leadership that influences and progresses clinical
care, policy and collaboration through all levels of health
service
The nurse practitioner is a leader in all dimensions of nursing
practice. This is not only the most senior clinical role, but a
nurse practitioner also provides health service leadership
from the perspective of a senior clinician. Key elements of
clinical leadership are the need to guide and influence care
delivery systems through engagement in policy development
either directly at local organisation and local government
level or though active engagement in the policy work of
their professional organisation. The nurse practitioner leads
through any of a number of roles including researcher, clinical
teacher, case co-ordinator, and spokesperson, and in this
capacity may take responsibility for assisting the public, policy
makers and other health care professionals to understand
the nurse practitioner role. In so doing they draw from the
relevant evidence base to influence the quality and nature of
services provided.
ASSUMPTIONS
The following assumptions underpin use of the competency
framework:
1. The nurse practitioner is a registered nurse whose
practice must first meet the following regulatory and
professional requirements for Australia and New Zealand and
then demonstrate the additional requirements of the nurse
practitioner:
● National Competency Standards for the Registered Nurse
● Code of Ethics for Nurses
● Code of Professional Conduct for Nurses
These assumed requirements serve as the foundation for
the nurse practitioner competency framework and are not
repeated in the nurse practitioner framework.
2. The nurse practitioner standards build upon the existing
Advanced Nursing Practice Competency Standards used
respectively in New Zealand and Australia. These standards are
not repeated in the nurse practitioner framework.
3. The nurse practitioner standards are based on the findings
from the Nurse Practitioner Standards Research Project. They
are developed to ensure safe nurse practitioner practice that
relates to a specific field of health care.
4. The nurse practitioner standards are core standards that
are common to all models of nurse practitioner practice. They
can accommodate specialty competencies that are designed
to meet the unique health care needs of specific client/patient
populations.
5. The nurse practitioner standards will be used by nurse
practitioner education providers to develop the content and
process requirements for a nurse practitioner education
program.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
3
ANMC NATIONAL COMPETENCY STANDARDS FOR THE NURSE PRACTITIONER
6. The nurse practitioner standards will be used by regulatory
authorities to determine the eligibility of nurse practitioners
seeking authorisation as nurse practitioner in Australia and New
Zealand
.
Nurse Practitioner
Competency Framework
● Is knowledgeable and creative in selection and integration
of both pharmacological and non-pharmacological
treatment interventions into the management plan in
consultation with the patient/client
● Rapidly and continuously evaluates the patient/client/’s
condition and response to therapy and modifies the
management plan when necessary to achieve desired
patient/client outcomes
● Is an expert clinician in the use of therapeutic interventions
specific to, and based upon, their expert knowledge of
specialty practice
● Collaborates effectively with other health professionals and
agencies and makes and accepts referrals as appropriate
to specific model of practice
● Evaluates treatment/intervention regimes on completion
of the episode of care, in accordance with patient/client-
determined outcomes
Competency 1.3 Has the capacity to use the knowledge
and skills of extended practice
competencies in complex and
unfamiliar environments
Performance indicators
● Actively engages community/public health assessment
information to inform interventions, referrals and
coordination of care
● Demonstrates confidence and self-efficacy in
accommodating uncertainty and managing risk in complex
patient care situations
● Demonstrates professional integrity, probity and ethical
conduct in response to industry marketing strategies when
prescribing drugs and other product.
● Uses critical judgment to vary practice according to
contextual and cultural influences
● Confidently integrates scientific knowledge and expert
judgment to assess and intervene to assist the person in
complex and unpredictable situations
Competency 1.4 Demonstrates skills in accessing
established and evolving knowledge
in clinical and social sciences, and the
application of this knowledge to
patient care and the education of
others
Performance indicators
● Critically appraises and integrates relevant research
findings in decision making about health care management
and patient interventions
● Demonstrates the capacity to conduct research/quality
audits as deemed necessary in the practice environment
● Demonstrates an open-minded and analytical approach to
acquiring new knowledge
● Demonstrates the skills and values of lifelong learning and
relates this to the demands of extended clinical practice
STANDARD 1
Dynamic practice that incorporates application of high-
level knowledge and skills in extended practice across
stable, unpredictable and complex situations
Competency 1.1 Conducts advanced, comprehensive
and holistic health assessment
relevant to a specialist field of
nursing practice
Performance indicators
● Demonstrates advanced knowledge of human sciences and
extended skills in diagnostic reasoning
● Differentiates between normal, variation of normal and
abnormal findings in clinical assessment
● Rapidly assesses a patient’s unstable and complex health
care problem through synthesis and prioritisation of
historical and available data
● Makes decisions about use of investigative options that are
judicious, patient focused and informed by clinical findings
● Demonstrates confidence in own ability to synthesise and
interpret assessment information including client/patient
history, physical findings and diagnostic data to identify
normal and abnormal states of health and differential
diagnoses
● Makes informed and autonomous decisions about
preventive, diagnostic and therapeutic responses and
interventions that are based on clinical judgment, scientific
evidence, and patient determined outcomes
Competency 1.2 Demonstrates a high level of
confidence and clinical proficiency in
carrying out a range of procedures,
treatments and interventions that
are evidence based and informed by
specialist knowledge
Performance indicators
● Consistently demonstrates a thoughtful and innovative
approach to effective clinical management planning in
collaboration with the patient/client
● Exhibits a comprehensive knowledge of pharmacology
and pharmacokinetics related to a specific field of clinical
practice
● Selects/prescribes appropriate medication, including
dosage, routes and frequency pattern, based upon
accurate knowledge of patient characteristics and
concurrent therapies
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
4
ANMC NATIONAL COMPETENCY STANDARDS FOR THE NURSE PRACTITIONER
STANDARD 2
Professional efficacy whereby practice is structured
in a nursing model and enhanced by autonomy and
accountability
Competency 2.1 Applies extended practice
competencies within a nursing model
of practice
Performance indicators
● Readily identifies the values intrinsic to nursing that inform
nurse practitioner practice and an holistic approach to
patient/client/community care
● Communicates a calm, confident and knowing approach to
patient care that brings comfort and emotional support to
the client and their family
● Demonstrates the ability and confidence to apply extended
practice competencies within a scope of practice that is
autonomous and collaborative
● Creates a climate that supports mutual engagement and
establishes partnerships with patients/carer/family
● Readily articulates a coherent and clearly defined nurse
practitioner scope of practice that is characterised by
extensions and parameters
Competency 2.2 Establishes therapeutic links with
the patient/client/community that
recognise and respect cultural identity
and lifestyle choices
Performance indicators
● Demonstrates respect for the rights of people to determine
their own journey through a health/illness episode while
ensuring access to accurate and appropriately interpreted
information on which to base decisions
● Demonstrates cultural competence by incorporating
cultural beliefs and practices into all interactions and plans
for direct and referred care
● Demonstrates respect for differences in cultural and social
responses to health and illness and incorporates health
beliefs of the individual/community into treatment and
management modalities
Competency 2.3 Is proactive in conducting clinical
service that is enhanced and
extended by autonomous and
accountable practice
Performance indicators
● Establishes effective, collegial relationships with other
health professionals that reflect confidence in the
contribution that nursing makes to client outcomes
● Readily uses creative solutions and processes to meet
patient/client /community defined health care outcomes
within a frame of autonomous practice
● Demonstrates accountability in considering access, clinical
efficacy and quality when making patient-care decisions
● Incorporates the impact of the nurse practitioner service
within local and national jurisdictions into the scope of
practice
● Advocates for expansion to the nurse practitioner model of
service that will improve access to quality, cost-effective
health care for specific populations
STANDARD 3
Clinical leadership that influences and progresses clinical
care, policy and collaboration through all levels of health
service
Competency 3.1 Engages in and leads clinical
collaboration that optimise outcomes
for patients/clients/communities
Performance indicators
● Actively participates as a senior member and/or leader of
relevant multidisciplinary teams
● Establishes effective communication strategies that
promote positive multidisciplinary clinical partnerships
● Articulates and promotes the nurse practitioner role in
clinical, political and professional contexts
● Monitors their own practice as well as participating in
intra- and inter-disciplinary peer supervision and review
Competency 3.2 Engages in and leads informed critique and
influence at the systems level of health care
Performance indicators
● Critiques the implication of emerging health policy on the
nurse practitioner role and the client population
● Evaluates the impact of social factors (such as literacy,
poverty, domestic violence and racial attitudes) on
the health of individuals and communities and acts to
moderate the influence of these factors on the specific
population/individual
● Maintains current knowledge of financing of the health care
system as it affects delivery of care
● Influences health care policy and practice through
leadership and active participation in workplace and
professional organisations and at state and national
government levels
● Actively contributes to and advocates for the development
of specialist, local and national, health service policy that
enhances nurse practitioner practice and the health of the
community
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
5
ANMC NATIONAL COMPETENCY STANDARDS FOR THE NURSE PRACTITIONER
Advanced practice: Advanced practice nursing defines a
level of nursing practice that utilises extended and expanded
skills, experience and knowledge in assessment, planning,
implementation, diagnosis and evaluation of the care
required. Nurses practising at this level are educationally
prepared at postgraduate level and may work in a specialist or
generalist capacity. However, the basis of advanced practice
is the high degree of knowledge, skill and experience that is
applied within the nurse-patient/client relationship to achieve
optimal outcomes through critical analysis, problem solving
and accurate decision making.
Advanced practice nursing forms the basis for the role of
nurse practitioner. The nurse practitioner role is an expanded
form of advanced practice nursing which is specifically
regulated by legislation and by professional regulation.
Legislation may allow prescribing and referral, in addition to
admitting privileges to health care facilities. (RCNA Position
Statement 2000. Under review).
Authorisation: The process through which the NMRA
sanctions the practice of nurse practitioners within their
jurisdiction. The authorisation process invests legal authority
and responsibilities on the person so authorised. Once an
applicant is authorised, he or she will be registered, that
is, have his or her details entered on a written record, and
the NMRA will endorse, that is, openly approve, of his or her
practice as a nurse practitioner.
Autonomy: Having a sense of one’s own identity and an
ability to act independently and to exert control over one’s
environment, including a sense of task mastery, internal locus
of control, and self-efficacy.
Client: A person or persons who engage(s) or is/are served
by the professional advice or services of another. May refer to
an individual, family or community. Use acknowledges that a
significant part of nursing’s services are delivered to people
who are well and proactively engaging in health care, however
in this study, ‘client’ and ‘patient’ are used synonymously to
acknowledge that the same services may be used for both
clients and patients.
Extended practice: Defines the level of nursing that draws
upon advanced nursing practice knowledge and skill in
conjunction with legislative provisions that enable the nurse
to deliver a health service that encompasses a complete
episode of care to clients/patients. This nursing care is
autonomous and collaborative and determined by the health-
service needs of clients in specific populations.
Jurisdiction: The limits within which a power or control can be
exercised.
NP: Nurse practitioner
Nursing and midwifery regulatory authority (NMRA):
The legally constituted body in each jurisdiction charged with
the regulation of nursing and midwifery professional practice.
The primary role of the NMRAs is to protect the public through
ensuring nurses and midwives demonstrate an acceptable
standard of practice.
Patient: See ‘client’. Use acknowledges that nursing provides
some of its services to people who are sick and, in the true
Latin meaning, are ‘suffering’. ‘Patient’ and ‘client’ are used
synonymously to acknowledge that the same services may, at
times, be delivered for both clients and patients.
Program: A collection of courses/papers/units of study that
lead to an academic qualification.
Glossary of Terms
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
1
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
National Competency Standards for the Midwife
Introduction
The Australian Nursing and Midwifery Council Incorporated
(ANMC) is a peak national nursing and midwifery organisation
established in 1992 with the purpose of developing a national
approach to nursing and midwifery regulation. The ANMC
works in conjunction with the state and territory nursing and
midwifery regulatory authorities (NMRAs) to produce national
standards which are an integral component of the regulatory
framework to assist nurses and midwives to deliver safe and
competent care.
The standards include national competency standards for
registered nurses, enrolled nurses, midwives and nurse
practitioners, codes of professional conduct and ethics, and
a range of position statements and guidelines. The full list of
standards, position papers and guidelines produced by the
ANMC can be viewed on the website.
In 2004, the ANMC commissioned research to develop and
validate national competency standards for midwives, the
scope of practice of midwives, and a generic description
of the midwife on entry to practice. This research, which
was undertaken by a team of expert midwifery consultants,
included extensive consultation with midwives around
Australia. The resulting standards are broad and principle
based so that they are sufficiently dynamic for practising
midwives and the NMRAs to use as a benchmark to assess
competence to practice in a range of settings.
What are the standards used for?
The national competency standards for the midwife are the
core competency standards by which your performance is
assessed to obtain and retain your license to practice as a
midwife in Australia.
As a midwife, these core competency standards provide you
with the framework for assessing your competence, and are
used by your state/territory NMRA to assess competence
as part of the annual renewal of license process, to assess
midwives educated overseas seeking to work in Australia,
and to assess midwives returning to work after breaks in
service. They are also used to assess midwives involved in
professional conduct matters. The NMRAs may also apply the
competency standards in order to communicate to consumers
the standards that they can expect from midwives.
Universities also use the standards when developing
midwifery curricula, and to assess student and new graduate
performance.
These are YOUR standards — developed using the best
possible evidence, and using information and feedback
provided by midwives in a variety of settings. Included
also are the principles of assessment which will assist you
in understanding how these standards may be used to
assess performance. We believe you will find them easy to
understand, and user friendly.
ANMC would like to thank midwives throughout Australia for
their willing input to the development of these standards.
Description of the midwife on
entry to practice
On entry to practice, a midwife is a person who:
… having been regularly admitted to a midwifery educational program,
duly recognised in the country in which it is located, has successfully
completed the prescribed course of studies in midwifery and has
acquired the requisite qualifications to be registered and/or legally
licensed to practise midwifery.
The midwife is recognised as a responsible and accountable
professional who works in partnership with women to give the
necessary support, care and advice during pregnancy, labour and the
postpartum period, to conduct births on the midwife’s own responsibility
and to provide care for the newborn and the infant. This care includes
preventative measures, the promotion of normal birth, the detection
of complications in mother and child, the accessing of medical care
or other appropriate assistance and the carrying out of emergency
measures.
The midwife has an important task in health counselling and education,
not only for the woman, but also within the family and the community.
This work should involve antenatal education and preparation for
parenthood and may extend to women’s health, sexual or reproductive
health and child care.
A midwife may practise in any setting including the home, community,
hospitals, clinics or health units. (ICM 2005)
INTRODUCTION DESCRIPTION OF
THE MIDWIFE
DOMAINS NATIONAL COMPETENCY
STANDARDS
GLOSSARY
OF TERMS
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
2
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
The midwife will be able to demonstrate competence in
the provision of midwifery care as specified in the ANMC’s
National Competency Standards for the Midwife.
The four domains in the provision of woman–centred
midwifery care include legal and professional practice;
midwifery knowledge and practice; midwifery as primary
health care and ethical and reflective practice.
Legal and professional practice
The graduate midwife has a sound knowledge of the
Australian health care system, relevant legislation and the role
of the midwifery profession both locally and internationally.
She practises within legislation and common law. Thus
she complies with policies and guidelines that have legal
implications and fulfil the duty of care. The graduate midwive
is able to identify unsafe practice and act appropriately. She
works in partnership with women and collaborates with other
members of the health care team. The ability to reason, whilst
being able to justify practice within legal, professional, ethical
and reflective frameworks are characteristic of the graduate
midwife. She accepts accountability and responsibility for
her actions, whilst recognising her own knowledge base
and scope of practice. She is able to identify complications
with appropriate and timely consultation and referral as
needed. She delegates when necessary, always providing the
appropriate supervision.
The graduate midwife documents practice according to
legal and professional guidelines and procedures. She
demonstrates competence in oral and written communication
and technological literacy. She understands and values the
imperative to base practice on evidence; is able to access
relevant and appropriate evidence; recognise when evidence
is less than adequate to fully inform care and identify areas of
practice that require further evidence.
Midwifery knowledge and practice
The graduate midwife appreciates the centrality of the
relationship with women to the practice of midwifery, which
she can demonstrate through working in partnership and
communicating effectively. She works with women to plan
and evaluate care whilst providing learning opportunities that
facilitate decision-making by the woman.
The graduate midwife has the knowledge, skills and attitudes
to practise midwifery according to the international definition
of the role and scope of practice of the midwife. This is
informed by other disciplines such as biological, physical,
social and behavioural sciences; nursing; primary health
care; ethics and law. The graduate midwife will be able to
provide safe and effective care across the interface between
hospital and community; in any setting, including the home,
the community, hospitals, or in any other maternity service.
She is able to comprehensively and accurately assess the
needs of women and their babies and to plan, implement and
evaluate midwifery care. This includes the antenatal period,
during labour and birth and in the postnatal period. She
supports, and may practise in, continuity of care models.
The graduate midwife is versatile, adaptable and able to
respond in a range of situations including emergencies.
When women or babies have complex needs and require
referral, the graduate midwife will provide midwifery care in
collaboration with other health professionals. The graduate
midwife protects, promotes and supports breastfeeding while
respecting each woman’s choice in infant feeding. She is able
to initiate, supply and administer relevant pharmacological
substances in a safe and effective manner within legislation.
Midwifery as primary health care
The graduate midwife practises within a woman centred,
primary health care framework and is committed to seeing
midwifery as a public heath strategy that encompasses a
broad social context. The graduate midwife understands
that health is a dynamic state, influenced by particular
sociocultural, spiritual and politico-economic environments.
The graduate midwife has an important advocacy role in
protecting the rights of women, families and communities
whilst respecting and supporting their right to self
determination. A graduate midwife has a commitment to
cultural safety within all aspects of her practice and acts in
ways that enhance the dignity and integrity of others.
Midwifery practice involves informing and preparing the
woman and her family for pregnancy, birth, breastfeeding and
parenthood and includes certain aspects of women’s health,
family planning and infant well-being. The graduate midwife
has a role in public health that includes wellness promotion
for the woman, her family and the community.
Whilst the graduate midwife has the skills “to do” they also
have an ability to develop relationships with the women
for whom they care as well as others with whom they
interact in their professional lives. The graduate midwife
works collaboratively with health care providers and other
professionals referring women to appropriate community
agencies and support networks.
Reflective and ethical practice
The graduate midwife practises in accordance with the
endorsed code of ethics, professional standards and
relevant state and commonwealth privacy obligations.
Through reflective processes developed during the program,
the graduate midwife respects diverse values, beliefs and
sociocultural structures. Integral to this process is the ability
to understand and identify the impact of her own culture,
values and beliefs on the provision of midwifery care, whilst
recognising the power relations that exist within the health
system and the community.
The graduate midwife has the ability and skills to analyse and
reflect in, on, and about practice. She maintains competence
through continual professional development. The graduate
midwife is able to assess the effectiveness of her work and
regards lifelong learning as a key to continuing professional
and personal development. The graduate midwife
demonstrates a lively, questioning perspective that enables
her to actively contribute to the development of midwifery
as a discipline. She also demonstrates both computer and
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
3
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
National Competency Standards
for the Midwife
information literacy which is reflected in her capacity to
derive information from multiple sources. The graduate
midwife has the capacity to transform this into meaningful
information that impacts on practice and interactions with
women and the health care system as a whole. The graduate
midwife has developed both a capacity and a desire to
learn from experiences in the workplace and through more
formal educational opportunities. She is able to contribute
to, and evaluate, the learning experiences and professional
development of others, particularly through mentoring.
She is able to support students to meet their learning needs
and objectives in collaboration with others, and contributes to
orientation and ongoing education programs.
The graduate midwife uses research to inform midwifery
practice. This includes interpreting evidence as a basis to
inform practice, policy, guidelines and decision-making.
This implies an understanding about the way that knowledge
and evidence are continuously created, applied and
recreated. The development of a critical self-awareness
is essential to this reflective process and is a defining
characteristic of a graduate.
The National Competency Standards for the Midwife provide
the detail of the skills, knowledge and attitudes expected
of a midwife to work within the midwifery scope of practice.
The definition and scope of practice provides the broad
boundaries of midwifery practice, whereas competency
standards provide the detail of how a midwife is expected
to practise and his/her capacity to practice. These will be
minimum competency standards required of all midwives
who seek authority to practise as a midwife in Australia. It is
expected that all midwives should be able to demonstrate
that they are able to meet the competency standards relevant
to the position they hold.
Overarching framework
The competency standards have an overarching framework
– woman centred care. Woman-centred care is a concept that
implies that midwifery care:
● is focused on the woman’s individual, unique needs,
expectations and aspirations, rather than the needs of
institutions or professions
● recognises the woman’s right to self determination in terms
of choice, control, and continuity of care
● encompasses the needs of the baby, the woman’s family,
significant others and community, as identified and
negotiated by the woman herself
● follows the woman between institutions and the community,
through all phases of pregnancy, birth and the post natal
period
● is ‘holistic’ – addresses the woman’s social, emotional,
physical, psychological, spiritual and cultural needs and
expectations
Domains
The competency standards are underpinned by primary
health care principles. These principles encompass equity,
access, the provision of services based on need, community
participation, collaboration and community based care.
Primary health care involves using approaches that are
affordable, appropriate to local needs and sustainable. These
principles are outlined in the Ottawa Charter (1986).
Organisation of the National Competency Standards for the
Midwife
The competency standards include domains, competencies,
competency elements and cues. A domain is as an organised
cluster of competencies that characterise a central aspect
of midwifery practice. Within each of the domains are
competencies. A competency represents a stand-alone
function or functional area underlying some aspect of
professional performance. Within each competency are
elements. An element is a sub-section of the competency unit.
The elements contain examples of competent performance
known as cues. The cues are examples and prompts.
These are neither comprehensive nor exhaustive and assist in
assessment, self reflection and curriculum development.
The competencies which make up the National Competency
Standards for the Midwife are organised in four domains.
The order of the domains does not reflect their diminishing
order of importance.
Legal and professional practice
This domain contains the competencies that relate to legal
and professional responsibilities including accountability,
functioning in accordance with legislation affecting midwifery
and demonstration of leadership.
Midwifery knowledge and practice
This domain contains the competencies that relate to the
performance of midwifery practice including assessment,
planning, implementation and evaluation. Partnership with the
woman is included in this domain.
Midwifery as primary health care
This domain contains the competencies that relate to
midwifery as a public health strategy. Included are the notions
of self determination and the protection of individual and
group rights.
Reflective and ethical practice
This final domain contains the competencies relating to
self appraisal, professional development and the value of
research. The competencies, elements and cues are outlined
in the following pages.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
4
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
LEGAL AND PROFESSIONAL PRACTICE
COMPETENCY 1
Functions in accordance with legislation and common law
affecting midwifery practice
Element 1.1 Demonstrates and acts upon knowledge of legislation
and common law pertinent to midwifery practice.
Cues ● Practises midwifery within the requirements of
legislation and common law.
● Identifies and interprets laws in relation to
midwifery practice, including the administration
of drugs; negligence; consent; report writing;
confidentiality; and vicarious liability.
● Recognises and acts upon breaches of law
relating to midwifery practice.
Element 1.2 Complies with policies and guidelines that have legal
and professional implications for practice.
Cues ● Complies with legal policies and guidelines, for
example, occupational Health and safety, child
protection, Family violence.
Element 1.3 Formulates documentation according to legal and
professional guidelines.
Cues ● Adheres to legal requirements in all aspects of
documentation.
● Documentation is contemporaneous,
comprehensive, logical, legible, clear, concise
and accurate.
● Documentation identifies the author
and designation.
Element 1.4 Fulfils the duty of care in the course of
midwifery practice.
Cues ● Undertakes midwifery practice in accordance with
professional Australian standards for midwives.
COMPETENCY 2
Accepts accountability and responsibility for own actions
within midwifery practice.
Element 2.1 Recognises and acts within own knowledge
base and scope of practice.
Cues ● Recognises the midwife’s role and responsibility
for understanding, supporting, and facilitating
pregnancy, labour, birth and the postnatal period.
● Analyses strengths and limitations in own skill,
knowledge and experience and addresses
limitations.
● Accepts professional responsibility and
personal accountability for own practice.
● Collaborates with other health care providers
when care is outside the scope of practice.
Element 2.2 Identifies unsafe practice and takes
appropriate action.
Cues ● Identifies practices that compromise safe and
effective care, or contravenes legislation, and
takes appropriate action.
● Utilises risk management and/or open disclosure
policies in the follow-up of unsafe practice.
● Promotes and engages in ongoing development of
the safety and quality improvement agenda to
optimise health outcomes of women and their
families.
● Supports other midwives or health care providers
who report unsafe practice.
Element 2.3 Consults with, and refers to, another
midwife or appropriate health care provider
when the needs of the woman and her baby
fall outside own scope of practice or
competence.
Cues ● Applies relevant guidelines or policies to ensure
timely consultation and referral.
● Develops and maintains collegial networks with
midwifery colleagues and others to optimise
outcomes for the woman.
Element 2.4 Delegates, when necessary, activities
matching abilities and scope of practice
and provides appropriate supervision.
Cues ● Underpins delegation and supervision with
knowledge of legal requirements and
organisational policies.
● Is accountable for actions in relation to the
decision to educate, delegate and supervise
other health care workers.
● Uses a range of supportive strategies when
supervising aspects of care delegated to others.
● Ensures delegation does not compromise safety.
Element 2.5 Assumes responsibility for professional
midwifery leadership functions.
Cues ● Integrates leadership skills into practice.
● Acts as a role model for other colleagues by
exemplifying best practice in midwifery.
● Provides advice and guidance in problem solving
and decision making to midwifery colleagues and
others as appropriate.
MIDWIFERY KNOWLEDGE AND PRACTICE
COMPETENCY 3
Communicates information to facilitate decision-making by
the woman.
Element 3.1 Communicates effectively with the
woman, her family and friends.
Cues ● Actively listens to the woman and responds
appropriately.
● Assists the woman to identify her knowledge,
feelings and thoughts about her pregnancy,
labour, birth and the postnatal period.
● Uses language that is readily understood.
● Allows adequate time to meet the
needs of the woman for information,
advice and support.
● Engages the assistance of a
professional interpreter where
appropriate.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
5
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
Element 3.2 Provides learning opportunities
appropriate to the woman’s needs.
Cues ● Uses adult learning principles in the
provision of information.
● Incorporates learning opportunities into every
facet of midwifery practice.
Element 3.3 Plans and evaluates care in partnership
with the woman.
Cues ● Listens to the woman to identify her needs.
Involves the woman in decision making.
● Obtains informed consent for midwifery
interventions.
● Documents decisions, actions and outcomes
including the woman’s response to care.
COMPETENCY 4
Promotes safe and effective midwifery care.
Element 4.1 Applies knowledge, skills and attitudes to
enable woman centred care.
Cues ● Participates in respectful partnerships with the
woman and other members of the health care
team.
● Practises in ways that respects each woman’s
emotional, social, cultural and lifestyle needs.
● Facilitates the involvement of family and friends
as defined by the woman.
Element 4.2 Provides or supports midwifery continuity
of care.
Cues ● Demonstrates an understanding of continuity of
care and carer.
● Supports models that provide continuity of carer.
Element 4.3 Manages the midwifery care of women and
their babies.
Cues ● Organises workload to facilitate midwifery care for
women and their babies.
● Demonstrates appropriate time management and
priority setting skills.
● Ensures the effective use of resources
including personnel.
COMPETENCY 5
Assesses, plans, provides and evaluates safe and effective
midwifery care.
Element 5.1 Utilises midwifery knowledge and skills to
facilitate an optimal experience for the
woman.
Cues ● Promotes the understanding that childbirth is a
normal, physiological process and a significant life
event for most women.
Element 5.2 Assesses the health and well being of the
woman and her baby.
Cues ● Carries out a comprehensive assessment of the
woman and her baby.
● Interprets and acts upon information from the
assessment.
Element 5.3 Plans, provides, and is responsible for, safe
and effective midwifery care.
Cues ● Assists the woman to identify and plan her
preferred pathway of care.
● Orders (within relevant legislation) and interprets
relevant investigative and diagnostic tests and
screening procedures.
● Attends and supports the woman and her baby
and ensures appropriate, timely midwifery
interventions are undertaken.
● Assists with the transition to parenthood.
Element 5.4 Protects, promotes and supports
breastfeeding.
Cues ● Proactively protects, promotes and supports
breastfeeding, reflecting the WHO/UNICEF Ten
Steps to Successful Breastfeeding.
● Provides information to the woman, colleagues
and community regarding breast feeding.
● Respects and facilitates the woman’s choice
regarding infant feeding.
● Assists the woman with her mode of infant
feeding.
Element 5.5 Demonstrates the ability to initiate,
supply and administer relevant pharmacological
substances in a safe and effective manner within
relevant state or territory legislation.
Cues ● Maintains up to date knowledge about
pharmacological substances commonly used in
midwifery practice.
● Provides information to the woman.
● Demonstrates safe administration including drug
calculations, correct route of administration, side
effects and documentation.
● Demonstrates knowledge of pharmacological
substances which are safe during pregnancy,
birth and breastfeeding.
Element 5.6 Evaluates the midwifery care provided to
the woman and her baby.
Cues ● Invites and acts upon constructive feedback on
midwifery practice from the woman.
● Demonstrates knowledge of the different ways in
which midwifery practice can be evaluated.
COMPETENCY 6
Assesses, plans, provides and evaluates safe and effective
midwifery care for the woman and/ or baby with complex
needs.
Element 6.1 Utilises a range of midwifery knowledge and skills to
provide midwifery care for the woman and/or her
baby with complex needs as part of a collaborative
team.
Cues ● Demonstrates a sound knowledge base
of relevant disease processes and
health complexities.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
6
● Demonstrates an understanding of the
particular psychosocial needs of the
woman and her family where there are
complexities.
● Continues to provide midwifery care
when collaboration with a medical
practitioner or other health care
provider is required.
● Uses, justifies and interprets
appropriate technology to achieve best
health outcomes for the woman and
her baby.
Element 6.2 Recognises and responds effectively in
emergencies or urgent situations.
Cues ● Recognises and responds to any urgent or
emergency situations with timely and appropriate
intervention, consultation and/or referral.
● Maintains up to date skills and knowledge
concerning emergency plans and protocols.
MIDWIFERY AS PRIMARY HEALTH CARE
COMPETENCY 7
Advocates to protect the rights of women, families and
communities in relation to maternity care.
Element 7.1 Respects and supports women and their
families to be self-determining in promoting
their own health and well–being.
Cues ● Articulates primary health care principles and
acts accordingly.
● Works with the woman to identify and develop
appropriate sources of social and community
support and health care.
● Concludes the midwifery relationship in a timely
and appropriate manner.
● Involves women and communities in maternity
service development, improvement and
evaluation.
Element 7.2 Acts to ensure that the rights of women
receiving maternity care are respected.
Cues ● Acknowledges, respects and advocates for the
rights of the woman to be involved as an active
participant in her care including her right to make
informed decisions and maintain dignity and
privacy.
● Takes into account the woman’s individual
preferences and cultural needs.
COMPETENCY 8
Develops effective strategies to implement and support
collaborative midwifery practice.
Element 8.1 Demonstrates effective communication
with midwives, health care providers and
other professionals.
Cues ● Adapts styles and methods of communication
to maximise effectiveness.
● Uses a range of communication methods
including written and oral.
● Liaises and negotiates with colleagues at all
levels to build systems an processes to optimise
outcomes for the woman.
● Discusses and clarifies with relevant health care
providers interventions that
appear inappropriate or unnecessary and
negotiates a collaborative plan.
● Demonstrates effective communication during
consultation, referral and handover.
Element 8.2 Establishes, maintains and evaluates
professional relationships with other health
care providers.
Cues ● Recognises the role of other members of the
health care team in the provision of maternity
care.
● Identifies and responds to factors that facilitate
or hinder professional relationships.
● Invites, acts upon, and offers, constructive
feedback on midwifery practice from peers and
colleagues.
COMPETENCY 9
Actively supports midwifery as a public health strategy.
Element 9.1 Advocates for, and promotes midwifery
practice, within the context of public health
policy.
Cues ● Acknowledges the impact of social, economic and
psychological factors on women’s lives.
● Acts to address public health issues, including
the promotion of breastfeeding, smoking
cessation, and responding appropriately in
situations where there is domestic violence,
drugs or alcohol use.
● Plans, provides and evaluates care to ensure
equity of access for women from marginalised
communities.
Element 9.2 Collaborates with, and refers women to,
appropriate community agencies and
support networks.
Cues ● Collaborates with, and refers to, other health care
providers, community groups and agencies.
● Provides women with clear information about
accessing community support agencies during
pregnancy and following birth.
COMPETENCY 10
Ensures midwifery practice is culturally safe.
Element 10.1 Plans, implements and evaluates
strategies for providing culturally safe
practice for women, their families and
colleagues.
Cues ● Incorporates knowledge of cross cultural and
historical factors into practice.
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
7
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
● Demonstrates respect for differences in cultural
meanings and responses to health and maternity
care.
● Recognises the specific needs of Aboriginal and
Torres Strait Islander women and their
communities.
● Recognises and respects customary law.
REFLECTIVE AND ETHICAL PRACTICE.
COMPETENCY 11
Bases midwifery practice on ethical decision making.
Element 11.1 Practises in accordance with the endorsed
Code of Ethics and relevant state/
territories and commonwealth privacy
obligations under law.
Cues ● Demonstrates knowledge of contemporary ethical
issues in midwifery.
● Demonstrates ethical behaviour towards women,
colleagues and communities.
● Develops and assesses strategies to address
ethical issues and breaches of confidentiality and
privacy in collaboration with others.
COMPETENCY 12
Identifies personal beliefs and develops these in ways that
enhance midwifery practice.
Element 12.1 Addresses the impact of personal beliefs
and experiences on the provision of
midwifery care.
Cues ● Recognises own attitudes, biases and values and
their potential impact on practice.
● Evaluates own practice and its effect on women
and others.
Element 12.2 Appraises and addresses the impact of
power relations on midwifery practice.
Cues ● Demonstrates an awareness of the impact of
gender, race and social policies on women and
maternity services.
● Works towards addressing power imbalances
between health care providers, childbearing
women and others in the community.
● Acts to eliminate harassment, victimisation and
bullying in the work place.
● Demonstrates a commitment to, and respect for,
co-workers.
COMPETENCY 13
Acts to enhance the professional development of self and
others.
Element 13.1 Assesses and acts upon own professional
development needs.
Cues ● Identifies own learning needs through reflective
practice and self evaluation.
● Contributes to self appraisal and peer review
activities as appropriate.
● Prepares and actions annual professional
development plans using continuing professional
development frameworks.
● Seeks and engages in opportunities to maintain
or update skills, knowledge, attitudes and
experience.
● Demonstrates and documents own professional
development.
Element 13.2 Contributes to, and evaluates, the learning
experiences and professional
development of others.
Cues ● Supports students to meet their learning needs
and objectives.
● Contributes to orientation and ongoing education
programs.
● Undertakes and critiques mutual sharing of
experiences and knowledge with multidisciplinary
colleagues.
● Contributes to mentoring, peer support and/or
clinical supervision.
● Seeks and engages in opportunities to maintain
or update skills, knowledge, attitudes and
experience.
● Demonstrates and documents own professional
development.
COMPETENCY 14
Uses research to inform midwifery practice.
Element 14.1 Ensures research evidence is incorporated
into practice.
Cues ● Values and acknowledges the importance of
research and evidence.
● Maintains current knowledge about relevant
research.
● Demonstrates skills in retrieving and
understanding research evidence including levels
of enquiry and forms of evidence.
● Discusses the implications of evidence with the
woman and colleagues.
● Participates in reviews of practice and policies.
● Supports research in midwifery and maternity
care.
Element 14.2 Interprets evidence as a basis to inform
practice and decision making
Cues ● Underpins midwifery practice with current
knowledge and best evidence.
● Accesses evidence, shares and utilises
to inform policy and practice.
● Explains options while recognising the
woman’s right to choose.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
8
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
Glossary of Terms
ANMC: Australian Nursing and Midwifery Council.
Appropriate: Matching the circumstances, meeting needs of
the individual, groups or situation.
Attributes: Characteristics which underpin competent
performance.
Core Competency Standards: Essential competency
standards for registration or licensure.
Competence: The combination of skills, knowledge, attitudes,
values and abilities that underpin effective and/or superior
performance in a profession/occupational area.
Competent: The person has competence across all the
domains of competencies applicable to the midwife, at a
standard that is judged to be appropriate for the level of
midwife being assessed.
Competency Unit: Represents a major function/functional
area in the total competencies of a Registered Midwife in a
midwifery context representing a stand-alone function which
can be performed by the individual.
Competency Element: Represents a sub-function of the
competency unit.
Competency Standards: Consists of competency units and
competency elements.
Contexts: The setting/environment where competence can
be demonstrated or applied.
Cues: Key generic examples of competent performance.
They are neither comprehensive nor exhaustive. They assist
the assessor when using their professional judgement in
assessing midwifery practice. They further assist curriculum
development.
Domain: An organised cluster of competencies in midwifery
practice.
Exemplars: Concrete, key examples chosen to be typical of
competence. They are not the standard but are indicative of
the standard
Midwife: is a person who …’ has successfully completed the
prescribed course of studies in midwifery and has acquired
the requisite qualifications to be registered and/or legally
licensed to practice midwifery’ (ICM 2005).
The ANMC acknowledges that the methods and processes in
assessment of competencies will be further developed, and
that the content of this document will be reviewed in three
years. Comments should be addressed to:
The Chief Executive Officer
Australian Nursing and Midwifery Council
PO Box 873
DICKSON ACT 2602
Australia
This work is copyright January 2006. Apart from any use as
permitted under the Copyright Act 1968, no part of this work
may be reproduced by any means electronic or otherwise
without the written permission of the copyright holders.
Requests and enquiries concerning reproduction rights
should be addressed to the Chief Executive Officer, Australian
Nursing and Midwifery Council.
ANMC NATIONAL COMPETENCY STANDARDS FOR THE MIDWIFE
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
Revised 2001 - to be Revised 2004
- 1 -
Australian College of Midwives Incorporated
CODE OF ETHICS
September 2001
This Australian Code of Ethics
has been adapted from the
International Confederation of Midwives (ICM)
Code of Ethics, September 1995
Australian College of Midwives Incorporated
GPO Box 666
CANBERRA ACT 2601
Email: acm[email protected]
www.acmi.org.au
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
Revised 2001 - to be Revised 2004
- 2 -
CODE OF ETHICS
INTRODUCTION
The aim of the Australian College of Midwives Incorporated (ACMI) is to maintain
and improve the standard of care provided to women, babies and families throughout
Australia through development, education and utilisation of appropriate knowledge
and skills of the professional midwife. In keeping with its aims of women’s health
and focus on the midwife, this code acknowledges women as persons, seeks justice
for all people, equity in access to health care, and is based on mutual relationships of
respect, trust, and the dignity of all members of society.
THE CODE
I. THE PROFESSIONAL RESPONSIBILITIES OF MIDWIVES
A. Midwives in their professional capacity should at all times maintain standards
of personal conduct which reflect credit upon the profession.
B. Midwives respect and maintain confidentiality of client information in order to
protect the client’s right to privacy, and use professional judgement when
sharing information necessary to achieve health care goals.
C. Midwives are accountable for their decisions and actions related to outcomes
of their care of women.
D. Midwives may refuse to participate in activities for which they hold deep
moral opposition: however the emphasis on individual conscience should not
deprive women of essential health services or respect for her culture.
E. Midwives participate in the development and implementation of health
policies that promote the health of women and childbearing families.
F. Midwives are accountable for the dissemination of unbiased, current
information to promote informed choice by women.
II. PRACTICE OF MIDWIFERY
A. Midwives provide care in partnership for women and childbearing families
with respect for cultural diversity.
B. Midwives encourage realistic expectations of childbirth by women within their
own society.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
Revised 2001 - to be Revised 2004
- 3 -
C. Midwives use their professional knowledge in collaboration with women
ensuring that women are not harmed by conception, childbearing or birthing
practises in all environments and cultures.
D. Midwives respond to the psychological, physical, emotional and spiritual
needs of women seeking health care, whatever their circumstances.
E. Midwives actively seek spiritual, intellectual and professional growth
throughout their midwifery career, integrating this growth into their practice.
III. MIDWIFERY RELATIONSHIPS
A. Midwives respect a woman’s right to make an informed choice and
acknowledge her choice and support her in that choice.
B. Midwives encourage and support women in their right to participate actively
in decisions about their care. Midwives empower women to speak for
themselves on issues affecting the health and welfare of women and their
families in their culture/society.
C. Midwives, in partnership with women, work with policy and funding agencies
to define women’s needs for health services and to ensure that resources are
allocated equitably considering priorities and availability.
D. Midwives support and sustain each other in their professional roles, and
actively nurture their own and others’ sense of self worth.
E. Midwives liaise with other health professionals as necessary to ensure that
women’s needs for care are met.
F. Midwives recognise the human interdependence within their field of practice
and actively promote co-operation and mutual understanding.
IV. ADVANCEMENT OF MIDWIFERY KNOWLEDGE AND PRACTICE
A. Professional development encompasses a range of activities related to
advancement of midwifery knowledge, is based on skills, evidence based
practice and inquiry that protects the rights of women.
B. Midwives are responsible for maintaining a core of professional knowledge,
through reflection on current practices and the initiation of new research.
C. Midwives implement quality standards of practice through processes such as
peer review, continuous quality improvement and research.
D. Midwives support and actively participate in the education of midwifery
students and each other.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
Revised 2001 - to be Revised 2004
- 4 -
ETHICAL ANALYSIS OF THE CODE OF ETHICS FOR MIDWIVES
Introduction: Ethics codes are often a mix of universal principles and strongly held
values specific to the “professional” group and its culture. The following is a brief
analysis of the principles and concepts that form the basis for each of the statements
of the ACMI Code of Ethics for Midwives:
I The Professional Responsibilities of Midwives
A. Professional responsibility and accountability
B. Confidentiality
C. Midwife accountability
D. Midwife conscience clause, autonomy of midwife, compassion for
women
E. Health policy development; to ensure justice and equity
F. Promotes informed choice
II Practice of Midwifery
A. Respect for others; promote best practice and equity
B. Truth-telling, autonomy
C. Safety, not harming, doing good
D. Respect for human dignity, working in partnership with women,
respecting cultural activities
E. Health promotion; attain/maintain autonomy, doing good not harming,
allocation of resources, professional development
III Midwifery Relationships
A. Autonomy, acceptance and compassion for women
B. Accountability, advocacy, autonomy
C. Justice, equity
D. Respect for human dignity and culture
E. Competence, interdependence, safety not harming
F. Respect for one another
IV Advancement of Midwifery Knowledge and Practice
A. Protecting rights of women
B. Accountability, safety, competence
C. Accountability, competence
D. Professional responsibility; enhancing competence of all professionals,
doing good not harming
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
Revised 2001 - to be Revised 2004
- 5 -
GLOSSARY OF TERMS FOR CODE OF ETHICS
Equity in access to Health Care (Introduction):
This implies fairness in the allocation of limited resources according to need. For
example, vulnerable populations/groups could receive more attention to their health
needs and availability of services than those who can access such services elsewhere.
Human interdependence (III.F.):
Since midwives work in relationships with women and others, and may not always
agree, it is imperative that midwives seek to understand the reasons for the
disagreements with clients or colleagues and work to resolve those conflicts that need
to be resolved with mutual respect in order for ethical care to continue.
Individual conscience (I.D):
Thoughtful reflection and analysis of deeply held moral positions; in this context, the
midwife can refuse to provide care only if someone else appropriate is available to
provide the needed care.
Informed right of choice (III.A.):
“Informed” implies that complete information is given and understood by the woman,
regarding the risks, benefits and probable outcomes of each choice available to her.
“Partnership”: The relationship between the woman and midwife in which there is
mutual recognition of the individual and shared responsibilities, open interactive
communication, and sharing of all relevant information.
Professional (Introduction):
This term is used to recognise the concept that to be ethical is to be professional, to be
unethical is to be unprofessional.
Professional knowledge (II.C):
This implies midwifery knowledge gained from research and formal and informal
educational opportunities for competence of practice.
Professional responsibilities (I):
This refers to the broad ethical duties/obligations of the midwife that are not practice,
education or research specific.
Related outcomes (I.C):
Midwives are responsible for the results of their own decisions and actions; they
cannot be held responsible for outcomes over which they have no control (e.g.
genetics). There may be situations in which the midwife is ordered by someone in
power to practice in an unethical manner. The difficulty of this is appreciated, but the
action remains unethical if the midwife chooses to follow such an order. The midwife
must be aware of the risks in choosing not to follow such an order.
Rights of women (IV.A):
Human rights related to any research involvement includes privacy, respect, truth-
telling, doing good and not harming, autonomy and informed consent.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
Revised 2001 - to be Revised 2004
- 6 -
Women as persons (Introduction):
This concept implies that women will be treated with respect for human dignity (not
as objects), and that the ethical principles of truth-telling, privacy, autonomy and
informed consent, doing good and not harming will direct any interaction between
women and midwives.
Australian College of Midwives Incorporated
GPO Box 666
CANBERRA ACT 2601
Email: [email protected]
www.acmi.org.au
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 1 -
CODE OF PRACTICE FOR MIDWIVES
CODE OF PRACTICE FOR MIDWIVES
Introduction……….……………………………………………………… ……. 2
Definition of a Midwife………………………………………………………… 2
Midwifery Practice.…………………………………………………………….. 2
A Midwife’s Accountabilities………………………………………………….. 3
Glossary of Terms……………………………………………………………… 5
Consumer Resources…………………………………………………………… 6
Appendix……………………………………………………………………….. 7
Acknowledgements…………………………………………………………….. 8
GUIDELINES FOR MIDWIFERY PRACTICE
Introduction……………………………………………………………………. 9
Midwifery Care……….……………………………………………………..… 9
Developing the Midwifery Care Relationship/Partnership…………………….. 9
Consent………………………………………………………..……………….. 10
Scenarios………..……………………………………………………………… 13
Conclusion……………………………………………………………………… 22
Acknowledgements…………………………………………………………….. 22
Bibliography……………………………………………………………………. 22
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 2 -
CODE OF PRACTICE FOR MIDWIVES
1. INTRODUCTION
This Code has been developed by the Queensland Nursing Council in
collaboration with consumers and the Australian College of Midwives
Incorporated (ACMI) after extensive consultation with stakeholders. The Code of
Practice for Midwives
1
provides guidance to midwives in any setting for their
professional practice and informs consumers of expected standards for that
practice.
Each midwives as a professional practitioner is accountable for their practice, and
works within relevant legislation (see Appendix). The midwife’s practice is also
guided by the ACMI Code of Ethics and Competency Standards for Midwives.
2. DEFINITION OF A MIDWIFE
The formal definition of a midwife accepted internationally is as follows:
‘A midwife is a person who, having been regularly admitted to a midwifery
education program, duly recognised in the country in which it is located, has
successfully completed the prescribed course of studies in midwifery and has
acquired the requisite qualifications to be registered and/or legally licensed to
practise midwifery’
2
The second part of the formal definition relating to care for which the midwife is
educated and competent to provide is expanded in the section on Midwifery
Practice.
To practise in Australia, a midwife must have a current licence/certificate.
3. MIDWIFERY PRACTICE
Midwifery care is woman centred, and occurs in an open and interactive
environment in which the woman and the midwife negotiate a partnership to
achieve the best possible health outcomes.
Midwifery practice enhances and promotes the normal process of childbirth while
being flexible and responsive to change.
The midwife must recognise and respect the uniqueness and dignity of each
woman, and respond to her need for care, irrespective of the woman’s
childbearing beliefs, values and expectations, life experiences, ethnic origin,
religious beliefs, the nature of her health problem or any other factor.
1
A copy of the Code of Practice for Midwives is available on the Internet: www.acmi.org.au
2
As adopted by the International Confederation of Midwives, the International Federation of
Gynaecologists and Obstetricians, in 1972 & 1973 respectively, and the World Health Organisation, in
1992
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 3 -
The scope of midwifery practice is that which a midwife is educated, authorised
and competent to perform. The actual scope of practice of individual midwives is
influenced by the settings in which they practise, the care needs of the woman and
infant, the level of competence of the midwife and the policy requirements of the
service provider. The midwife may practise in the home, hospital, birth centre,
community or other care settings.
The midwife has the educational preparation and competence to:
! give necessary advice, care and support to the woman preconceptually, and
during pregnancy, labour, birth and the postpartum period;
! assist the birthing woman, conduct deliveries and care for the infant;
! recognise the signs of deviations from normal in the woman or infant
which necessitate referral, and to initiate the necessary emergency
measures;
! care for the woman and infant and provide support and guidance in the
postnatal period;
! provide health education and counselling for the woman, her family and
the community;
! participate in health promotion and education which could include
childbirth and parenthood classes;
! provide comprehensive family planning information and advice;
! participate in data collection and documentation of care, and maintenance
of records; and
! undertake and participate in research for the development of midwifery
practice.
All these activities are of equal importance in midwifery practice.
4. A MIDWIFE’S ACCOUNTABILITIES
As a midwife, you are professionally accountable to the Regulatory Board in the
State/Territory in which you are registered, as well as having accountability at law
to the birthing woman and your employer in the areas of negligence, contract and
the law of defamation.
You much always act to promote and safeguard the interest and wellbeing of the
woman and her infant and their needs much be the primary focus of your practice.
In practising as a midwife and to meet your duty of care you must:
4.1 inform the woman of her rights and responsibilities in the planning,
provision, and evaluation of care and document these decisions;
4.2 obtain informed consent from the woman by providing her with all
necessary information, and by discussing this with her in a way that enables
her to make informed decisions about her care;
4.3 acknowledge spiritual and cultural diversity, and respect those of the woman
with whom you have a professional relationship; also facilitate opportunities
for discussion of her spiritual and cultural needs;
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 4 -
4.4 clearly state when your professional judgement is in conflict with the
decisions or plans of the woman and discuss appropriate options; consult
with colleagues in an effort to find mutually satisfying solutions, negotiate a
referral strategy with the woman and health professional or agency, and
document decisions and actions;
4.5 ensure that no action or omission on your part, or within your sphere of
responsibility, is detrimental to the interests of the woman or her infant;
4.6 act within the scope of midwifery practice and ensure your level of
competence meets the professional standard; this will be achieved by
ongoing education, critical evaluation of your practice, and incorporation of
current research evidence into your practice;
4.7 work in a collaborative and cooperative way with colleagues, health care
professionals and those involved in providing care, and recognise and
respect their particular contributions within the care team;
4.8 respect the privileged relationship with the woman including access allowed
to her person, property, residence or workplace;
4.9 protect all confidential information concerning the woman obtained in the
course of professional practice and make disclosures only with consent of
the woman, or only when legally required to;
4.10 report to a relevant person or authority any circumstances in the environment
of care which could jeopardise standards of practice or where appropriate
care cannot be provided;
4.11 assist midwifery students and colleagues in the care team to develop their
professional competence, and to practise to a standard appropriate to their
roles;
4.12 maintain adequate, accurate, and contemporary records of practice, to
include that documentation required under legislation, documentation of care
given, response to care and evaluation of care;
4.13 ensure that adequate strategies are in the place for referral to a relevant
health professional or agency as part of providing midwifery care, and in the
event of potential or actual problems for the woman and her infant;
4.14 ensure that you have adequate professional indemnity insurance; and
4.15 be familiar with, understand, and adhere to current legislation and common
law duties relevant to your practice.
5. GLOSSARY OF TERMS
Accountability
Midwives must be prepared to answer to others for decisions about their practice,
including delegation decisions.
Common Law Duties
These are duties imposed upon a midwife by the Court system and include:
! a duty to use reasonable care and skill in your professional practice;
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 5 -
! a duty of confidentiality;
! a duty to act with good faith in dealing with your employer; and
! a duty to act in the best interest of your employer.
Duty of Care
Generally, members of society have a duty to take reasonable care not to injure
fellow members of society. To fulfil this duty of care, a midwife must consistently
demonstrate competent practice consistent with the standards acceptable to the
whole profession. The midwife also has a professional duty of care to apply the
knowledge and skills acquired through education and experience to provide safe
and competent midwifery care.
Informed Consent
Decisions in health care ultimately rest with capable informed individuals in a
context of shared decision-making with clinicians and family members. In the
midwifery context, ‘informed consent’ should be understood as a process
involving an ongoing exchange of information in which knowledge and clinical
reasoning are shared between the midwife and the woman. An ethically valid
consent process has four necessary conditions: a woman who is capable of giving
consent; disclosure of information by the midwife in easily understood language;
comprehension of the information by the woman; and voluntary consent freely
given by the woman.
Partnership
Refers to a relationship between the woman and the midwife in which there is
mutual recognition of individual and shared responsibilities, open interactive
communication, and sharing of all relevant information.
Woman
Refers to the primary recipient of care and includes, where appropriate, the
woman’s infant (born or unborn), and those she considers family.
Woman Centred
The woman is the focus of midwifery care, and with the midwife, it is she who
identifies the priorities for care.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 6 -
6. CONSUMER RESOURCES
Consumers’ Health Forum of Australia
PO Box 170, Curtin, ACT, 2605
Tel……….……….……………………….…………………... 02 6281 0811
Fax……….……….……………………….…………………... 02 6281 0959
www.chf.org.au
Publications include: Australian Health Consumer
Australian Breastfeeding Association
National Office …..……………………….…………………... 07 3839 0088
State Breastfeeding Help Lines
ACT/Southern NSW ..………….………….…………... 02 6258 8928
NSW ...…….…….……………………………………... 02 9639 8686
QLD …….……….……………………………………... 07 3844 8977
SA & NT ……….………………………..……..…….… 08 8411 0050
TAS ...….……….…………………………………….… 03 6223 2609
VIC ...……….……………………….………………….. 03 9885 0653
WA ……….……………………….………………….. 08 9340 1200
www.breastfeeding.asn.au
Publications include: Breastfeeding Review Journal
SANDS (Stillbirth and Neonatal Death Support) Australia National Council
Inc – (including miscarriage)
ACT Office .…………………...….……………………….... 02 6287 4255
NSW Office ……………………………………...….…….... 02 9721 0124
QLD Office ….……………….……...….…………………... 07 3254 3422
SA Office …….……………...….…………………………... 08 8277 0304
TAS Office …………………...….………………..………... 03 9517 4470
VIC Office …………………...….………………………...... 03 9899 0217
WA Office …………………...….………………………...... 08 9474 3544
http://www.sands.org.au/
Publications include: Saying goodbye before you’ve said hello
Association for Improvement in the Maternity Services (AIMS)
www.aims.org.uk
Publications include: AIMS Journal
National Health and Medical Research Council (NHMRC)
GPO Box 9484, Canberra ACT 2601
Tel.…………………….……………………………….……... 02 6289 9184
Fax.…………………….……………………………….……... 02 6289 9197
www.health.gov.au/nhmrc
Publications include: Homebirth guidelines for parents
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 7 -
The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists (RANZCOG)
College House, 254-260 Albert St, East Melbourne Victoria 3002
Tel.…………………….……………………………….……... 03 9417 1699
Fax.…………………….……………………………….……... 03 9419 0672
www.ranzcog.edu.au/
Publications include: ANZJOG (Australia and New Zealand Journal of Obstetrics
and Gynaecology)
Maternity Coalition
The Maternity Coalition, PO Box 1190, Blackburn North Vic 3130
Tel & Fax..…………….……………………………….……... 03 8802 4491
www.maternitycoalition.org.au/
Publications include: Birth Matters Journal
7. APPENDIX
The Acts listed below are available on the Internet: www.legislation.qld.au
Adoption of Children Act 1964
Adoption of Children Regulation 1999
Anti Discrimination Act 1991
Child Protection Act 1999
Coroners Act 1958
Coroners Regulations 1998
Domestic Violence (Family Protection) Act 1989
Domestic Violence (Family Protection) Regulation 1993
Drugs Misuse Act 1986
Drugs Misuse Regulation 1987
Freedom of Information Act 1992
Health Act 1937
Health Regulation 1996
Health (Drugs and Poisons) Regulation 1996
Health Rights Commission Act 1991
Health Services Act 1991
Mental Health Act 1974
Mental Health Regulation 1985
Nursing Act 1992
Nursing By-law 1993
Registration of Births, Deaths and Marriages Act 1962
Registration of Births, Deaths and Marriages Regulation 1995
Workplace Health and Safety Act 1995
Workplace Health and Safety Regulation 1997
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 8 -
ACKNOWLEDGEMENT
Australian College of Midwives Incorporated (1998)
Competency Standards for Midwives. Melbourne: ACMI
Nurses’ Board of Victoria (1998)
Code of Practice for Midwives in Victoria. Melbourne: NBV
Nursing Council of New Zealand (1998)
Code of Practice for Nurses and Midwives. Reprint February. Wellington: NCNZ
New Zealand College of Midwives (1993)
Midwives Handbook for Practice. Christchurch: NZCM
Queensland Nursing Council (1998)
Scope of Nursing Practice Decision Making Framework. Brisbane: QNC
United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992)
Code of Professional Conduct. London: UKCC
United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1998)
Midwives rules and code of practice. London: UKCC
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 9 -
GUIDELINES FOR MIDWIFERY
PRACTICE
INTRODUCTION
The Code of Practice for Midwives, and the Guidelines for Midwifery Practice
have been developed by the Queensland Nursing Council in collaboration with
consumers and the Australian College Midwives Incorporated (ACMI), after
extensive consultation with stakeholders.
The Code of Practice for Midwives sets out the minimum expected level of
performance for midwifery practice and a midwife’s accountabilities. The
Guidelines for Midwifery Practice, to be read in conjunction with the Code,
provides the additional information and practical scenarios.
The Guidelines document expands on the areas of: developing the care
relationship, consent, confidentiality, referral and professional development.
Included in the Guidelines are fictional case scenarios that could occur in practice.
Midwifery strategies are outlined in the case scenarios. They are not intended to
be all-inclusive, as the environment will influence individual decision-making.
The case scenarios are designed to be educational, to assist professional
judgement and to encourage reflection on practice.
Where appropriate, the relevant ‘accountability’ (A) from the Code of Practice for
Midwives is identified (A) for cross-reference purposes with the Code.
MIDWIFERY CARE
Midwifery care is woman centred, and occurs in an open and interactive
environment in which the woman and the midwife negotiate a partnership to
achieve the best possible outcomes. It includes awareness of, and sensitivity to,
the cultural needs of the woman. (A: 4.2; 4.3.)
Woman centred care involves:
! building a relationship of trust;
! ensuring the woman is a partner in the planning and provision of care; and
! creating an environment that is respectful of the woman’s needs.
DEVELOPING THE MIDWIFERY CARE
RELATIONSHIP/PARTNERSHIP
The first step in developing the care relationship is to facilitate open, interactive
communication.
Good communication has three parts:
(1) the ability to listen. When you actively listen to another person you are
providing the opportunity for them to openly communicate;
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 10 -
(2) how you respond to the person. Responding in easily understood language
with information that is timely and useful, and presented clearly and
honestly, enables informed decisions. Ensuring that the person has time to
consider the information is important; and
(3) create an environment with privacy. Interruption-free discussion and the
appropriate physical surroundings enhance open communication.
The next step in the midwifery care relationship is to recognise the woman as a
partner in the care experience. A partnership can be initiated at any time, but it
will take time to develop and will need to respond to changing circumstances. A
partnership implies an informed woman and an informed midwife.
(A 4.1; 4.2; 4.3; 4.4; 4.5; 4.6; 4.8; 4.14.)
In a partnership there are individual and shared responsibilities. The focus is
informed, shared decision-making in which the woman and midwife work
together for the best possible health outcomes.
Shared decision-making involves:
! identifying the ideas and information that the woman has in relation to her
individual care needs;
! responding to the woman’s ideas, concerns, and expectations with the
appropriate level of information, advice and support; and
! developing and agreeing on a plan of care and involving others (partner,
family, and other health care professionals) as appropriate.
(A: 4.1; 4.2; 4.3; 4.5; 4.6; 4.7.)
CONSENT
Throughout the care relationship consent should be considered as an ongoing
exchange of information in which clinical reasoning is shared with the woman.
This continual exchange of information not only enhances trust and confidence
but also upholds the legal principles underpinning health care interventions. (A:
4.1; 4.2; 4.4; 4.6.)
It is a legal requirement and the right of each woman to give consent prior to
any midwifery procedure/intervention.
3
Therefore, you must:
! obtain consent of the woman before you perform any
procedure/intervention; and
! provide sufficient information for the woman to make an informed
decision.
The midwife should confirm and take the necessary action so that the woman has
the knowledge to make informed decisions.
In order for consent to be valid, four conditions must be met. These are:
1. Informed disclosure that includes:
3
Procedures/intervention encompasses a range of midwifery care actions including body touch,
assessment technique, test, treatment and therapy for the woman and her infant
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 11 -
! the nature and purpose of the intervention in the context of the plan of
care;
! intended effects and side effects, risks, harms and anticipated benefits
of the intervention;
! reasonable alternative to the intervention including risks, harms and
benefits; and
! likely outcomes if the intervention is not given.
2. Comprehension of the information requiring:
! information in language that is understood by the woman: this may
involve the services of interpreters and/or leaflets; and
! adequate time for the woman to consider the information.
3. Consent needs to be voluntary, made without coercion, threat, fraud,
bribe or misrepresentation of the nature or necessity of the
intervention.
4. The woman has the capacity to give consent if she can:
! communicate her decisions;
! understand relevant information; and
! appreciate the situation and its consequences. (A 4.2; 4.15.)
If the woman has been given a drug that may affect her judgement, valid consent
for a procedure/intervention may not be possible. In this situation, if possible:
! wait until the woman is able to make the competent judgement; and
! where possible, discuss the likelihood of a procedure/intervention at a
relevant time (eg. end of antenatal period or early labour).
At anytime in the relationship the woman has the right to refuse or withdraw
consent, and/or change her mind. Midwives need to respect such decisions.
In a situation where the woman’s decision is in conflict with your professional
judgement, as a midwife you should:
! clarify the situation with the woman;
! ensure the woman is fully informed;
! negotiate referral if appropriate;
! with the consent of the woman, consult with colleagues and/or other
members of the health team; and
! document the discussion and decisions, and ask the woman to sign and
date the entry and include your signature.
(A: 4.1; 4.2; 4.4; 4.5; 4.8; 4.13; 4.15.)
In emergency situations, where a procedure/intervention is necessary to preserve
life and the woman cannot make a decision (eg. she is unconscious), the law
allows you to provide treatment without the woman’s consent, if you are acting in
her best interests. Consult with colleagues and document all decisions.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 12 -
SCENARIO
A woman attends a midwives’ clinic for a regular antenatal visit at 36 weeks
gestation. The midwife’s clinical assessment confirms that the woman is
hypertensive. In discussion, the midwife advises a visit to the consultant, and test.
The woman insist she feels well and refuses all treatment. She believes this is an
over-reaction and decides to make other arrangements.
How could the midwife respond?
Strategies:
! listen to the woman’s ‘story’, draw her out on her feelings concerning
care;
! discuss the care guidelines for women in the midwives’ clinic;
! provide specific information on risks, harms and benefits of the
procedure/intervention and negotiate options;
! discuss the woman’s support system and together, identify appropriate
options;
! inform other members of the team of the discussions;
! provide appropriate information leaflets or other resources and ensure
there is time for the woman to consider the information;
! document all discussion and outcomes; and
! if the woman still chooses to leave the midwives’ clinic and make
alternative arrangements, provide information on how she may contact the
clinic or facility should she reconsider her decision or want to discuss the
issues later: keep communication lines open for her.
(A: 4.1; 4.2; 4.4; 4.5; 4.6; 4.7; 4.8; 4.12; 4.13)
CONFIDENTIALITY
To trust another person with private and personal information is significant. A
woman has the right to believe that information given to a midwife will only be
used for the purposes for which it was given, and that it will not be released to
others without her permission. The obligation to maintain this confidentiality does
not cease when the professional relationship ends, nor with the death of the
woman or infant. (A: 4.8; 4.9.)
It is impractical to obtain consent from the woman every time information is
needs to be shared with staff involved in the woman’s care. What is important is
that the woman understands the information may be made available to others
involved in the provision of her care. However, the woman must know with whom
the information will be shared, and should the woman request that certain
information not be shared with others, she must know that her rights will be
respected.
Maintaining confidentiality of information received as part of midwifery care
extends to all written and oral communication. The principles of confidentiality
applies to resources for education and training, research, audit and the handling
and storing of records.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 13 -
Educators are responsible for ensuring that students understand the importance of
confidentiality and the need to follow local protocols for handling and storing
records. Debriefing and case discussion should occur in a way that does not
identify personal information.
As a midwife, if you breach your duty of confidentiality you may be liable
for:
! a civil legal action for breach of contract, by the woman or your employer;
! charges of professional misconduct will be referred to the appropriate State
Professional Conduct Committee;
! a civil legal action in negligence brought by the woman if harm is caused;
! a civil legal action in defamation brought by the woman or others, if the
disclosure is defamatory; and
! disciplinary action by your employer
Your obligation to keep information confidential can be set aside in certain
exceptional circumstances. These circumstances could include:
! with the consent of the woman;
! disclosure to other health professionals in the interest of the woman or
infant;
! when disclosure is required by the court or legal proceedings without the
consent of the woman; and
! disclosure with statutory justification such as:
! notification of registration of birth or stillbirth;
! infectious disease regulations; and
! requirements under the Child Protection Act 1999
(A: 4.2; 4.7; 4.8; 4.9; 4.14; 4.15)
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 14 -
SCENARIO
A woman attends an antenatal clinic at a rural hospital. This is her third
pregnancy. She has two girls aged 5 and 7 years. The midwife suspects that the
partner is abusing the woman.
What could the midwife do?
Strategies:
! in a conversational manner ask the woman about her home
situation/environment;
! if appropriate, offer general information about a range of resources and
include the availability of a referral to appropriate person/agencies;
! respect the woman’s right to decline assistance;
! maintain confidentiality of discussions and disclose information only with
consent or when legally necessary; and
! discuss with colleagues the need for specific skills or other learning
strategies to enhance knowledge and expertise of team members.
(A: 4.1; 4.2; 4.6; 4.7; 4.8; 4.9; 4.11; 4.13; 4.15.)
WORKING TOGETHER – COLLABORATIVE AND PROFESSIONAL
RESPONSIBILITIES
Health care is complex and occurs within an interdisciplinary team framework in
which team members are valued for their knowledge and contribution. To be
effective, care must be based on mutual understanding, trust, respect and
cooperation.
Good teamwork is where members:
! question and challenge;
! nurture self confidence;
! engender confidence in others, enhancing their contribution;
! promote respect for, and trust in, other team members;
! promote effective communication; and
! operate in a positive and blame-free way. (A: 4.6; 4.7; 4.10; 4.11)
Good teamwork is hindered by:
! individual members of the team having their own specific and separate
objectives;
! one member attempting to dominate without considering the opinions,
knowledge and skills of other members; and
! inappropriate use of, or response to, hierarchical power.
In the collaborative care model there is no place for discrimination or harassment
based on gender, age, race, disability, sexuality, culture or religious beliefs. Such
conduct is unlawful. (A: 4.6; 4.7; 4.10; 4.11; 4.14)
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 15 -
SCENARIO
A midwife is caring for a woman in a busy birthing unit. In conversation the
woman shares her feeling about childbirth, and how keen she is to have a normal
vaginal birth. The woman has been in second stage labour for just over 2 hours.
The midwife’s assessment is that maternal and fetal parameters are within normal
limits but progress is slow. The midwife requests a review by the midwife leading
the team. The team leader than advises the woman that a doctor’s assessment is
required, a caesarean section is highly likely and they should not wait any longer.
What care strategies are important in this situation?
Strategies:
! maintain accurate and detailed clinical documentation throughout labour;
! give continuous support to the woman;
! undertake regular maternal and fetal monitoring and assessment of
progress;
! share information with the woman and the health care team at regular
intervals;
! consult with the team leader midwife and the doctor as required by local
protocols;
! in collaboration with the woman, initiate clinical measures to encourage
progress;
! discuss other clinical options with the woman to enable informed decision-
making;
! support the woman’s right to disagree with advice and attempt to negotiate
a compromise;
! if the woman is to be transferred, remain with her for as long as possible;
! ensure adequate and appropriate referral documentation is completed and
available; and
! review care protocols and collaborative strategies at an appropriate time.
(A: 4.1; 4.2; 4.4; 4.5; 4.6; 4.7; 4.11; 4.12; 4.13.)
REFERRAL
In midwifery practice, referral for an opinion and/or action may be required.
Irrespective of the choice of health service, midwife or birth place, each midwife
has the responsibility to set in place and utilise strategies for consultation and
collaboration. On initial contact with the woman, the midwife should provide
details of collaborative network and referral strategies and discuss the woman’s
views and expectations. (A: 4.1; 4.2; 4.3; 4.4; 4.5; 4.6; 4.7; 4.12; 4.13; 4.14.)
Referral may be made:
! at the woman’s request;
! in the midwife’s professional judgement; and/or
! by mutual agreement.
Referral may be made to:
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 16 -
! other midwives;
! medical practitioners;
! allied health professionals;
! hospitals and health services;
! consumer and voluntary groups; and
! social services.
If the need for a referral arises:
! discuss with the woman options for her care;
! facilitate opportunities for the woman to make an informed decision;
! document outcomes or negotiations;
! collaborate with the appropriate health professional or agency;
! ensure adequate and appropriate referral documentation is completed and
available; and
! facilitate access to the chosen option.
For the woman, referral from the primary health carer to another health
professional or facility may be a time of considerable anxiety. Consequently,
every effort must be make to facilitate this transfer and settling-in process. Open
discussion by all involved and provision of proper documentation will ensure
continuing optimum care. (A: 4.1; 4.2; 4.3; 4.4; 4.5; 4.6; 4.7; 4.12; 4.13.)
Midwives with admitting and/or clinical privileges at the referral facility should
follow the contractual arrangement in place.
The appropriate staff member at the referral facility should advise the referring
midwife about the outcome or ongoing care of the woman.
If the woman does not accept your advice, continue to give the best care you can.
With the consent of the woman, communicate with and, as necessary, seek
support from other health professionals and maintain accurate contemporaneous
documentation of events and actions. (A: 4.5; 4.7; 4.12; 4.14; 4.15.)
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 17 -
SCENARIO
A woman arranges for a midwife-attended home birth for her second child and
elects not to book into a hospital. The labour progresses well and the woman calls
the midwife in first stage. The midwife and the woman’s partner and support
person are then present. Following the birth, the infant requires resuscitation
(suction and oxygen), responds, and the mother cuddles her newborn baby. The
midwife then notices heavy maternal blood loss and has difficulty removing the
placenta. The blood loss continues and there are signs of maternal shock. The
midwife asks the support person to telephone an ambulance and it take longer
than expected to arrive. On transfer to the hospital, the admitting team seems
abrupt and abrasive towards the midwife and the woman.
What care strategies are important in this situation?
Strategies:
! discuss early in the antenatal relationship, the benefits of having another
person to assist at the birth in the event of an emergency for the woman
and/or infant;
! negotiate a care plan that includes a booking at an appropriate health
facility and discuss the benefits of this arrangement;
! establish and maintain competence for practice in this care setting (eg.
resuscitation);
! ensure equipment, including suction and oxygen, is maintained and ready
for use;
! ensure the woman had oxytocic prescribed, dispensed and available at the
birth;
! establish, in the antenatal period, an Ambulance Service relationship;
! negotiate and arrange in advance a transfer strategy/protocol;
! work cooperatively with other professionals to ensure continuing care in a
climate of mutual respect. (A:4.1; 4.2; 4.4; 4.5; 4.6; 4.7; 4.12; 4.13; 4.14;
4.15)
REPORTING AND DOCUMENTATION
Clear and accurate oral and written reports and maintenance of records are part of
a professional practice. In addition, all reports and documentation relating to
midwifery care are subject to the principles of confidentiality (p.4-5) and may also
be used in court to support a legal action. In midwifery practice, well-written
reports and contemporary detailed records are mandatory. (A: 4.12)
Principles of Report Writing
! update reports as close to the ‘event’ as practical;
! be accurate and complete with notations;
! record data objectively;
! write legibly, minimise abbreviations, and date and sign each entry;
! rule neatly through a mistake (so it is still visible), write the correction at
the time of the mistake, and initial and date both records;
! do not re-write a report at a later date;
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 18 -
! do not transcribe information from one document to another, as this
increases the risk of documentation error; and
! do not record for another person, unless you are in an emergency situation
where you are the designated recorder.
Midwives’ Record keeping
! review and update records at each professional contact with the woman;
! file reports appropriately;
! with the consent of the woman, make records accessible and available to
relevant and appropriate persons;
! ensure confidentiality;
! comply with legal obligations for birth and death notification; and
! record accurate perinatal data (A: 4.9; A.12; 4.15)
It is recommended that records make in professional midwifery relationships be
stored safely, where others cannot access them, for a minimum period of 25 years.
Where entries are make electronically, it is important that you do not reveal your
identification access code to anyone.
Organisations employing midwives are the legal owners of case records and they
have a responsibility to maintain confidentiality. The woman’s access to records
will depend on the organisation’s protocols. Midwives in private practice must
ensure confidentiality of case records. (A: 4.5; 4.12; 4.15.)
PROFESSIONAL DEVELOPMENT
Women place their trust in midwives. They need to know that appropriately
educated and skilled midwives are providing their care and treatment. This
requires midwives to be responsible for their ongoing professional learning needs
and development.
Professional development encompasses a range of activities including the sharing
of knowledge, and skills of inquiry and analysis. It depends on an effective
learning environment in which individuals are teams are able to develop
professional knowledge and practice for better health outcomes.
Professional development involves:
! identifying learning supports – mentors, preceptors, peer support groups;
! critically reviewing your practice, identifying your strengths and learning
needs, and undertaking relevant education activities for the necessary
contemporary knowledge and skills;
! initiating and/or being involved in individual and team review of clinical
practice;
! reading critically and evaluating practice in relation to research evidence;
! receiving feedback from women utilising your midwifery care;
! active involvement in clinical teaching of midwifery students and other
team members;
! attending relevant study days, workshops, seminars and conferences;
! supporting and/or participating in midwifery research; and
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 19 -
! developing and maintaining a professional portfolio of evidence of
competence and achievement, ongoing education, and related skills.
(A: 4.5; 4.6; 4.7; 4.11.)
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 20 -
SCENARIO
Beth (an experienced midwife) and Nicole (a new graduate) are on night duty in
the postnatal ward. The ward has a breastfeeding policy based on the Ten Steps to
Successful Breastfeeding. Several times through the night breastfeeding assistance
is given to one of the mothers but her baby remains unsettled. The woman, upset
and tearful, says she is very tired and wants to have a sleep. Beth offers to take the
baby to the nursery. There, she ask Nicole to give the baby a small artificial milk
feed.
What options are available to Nicole?
Strategies:
! review the baby’s feeding history and physiological status, and see if the
mother had given previous permission for artificial milk feeds;
! discuss with Beth her reasons for wanting the baby to have an artificial
milk feed;
! identify and discuss other options for settling the baby that are supportive
of the Ten Steps to Successful Breastfeeding;
! offer to initiate clinical strategies to soothe the baby;
! discuss with Beth her support for ward policy, and the stipulation to obtain
valid consent for artificial milk feeds;
! share her concern about giving the baby artificial milk, make it clear that
she is unable to comply and negotiate an appropriate alternative option.
! at the next breastfeed, observe the interaction between the mother and her
baby and utilise strategies that promote the mother’s confidence in caring
for her baby;
! discuss with her mentor or the ward Clinical Nurse Consultant (or other
appropriate person), her understanding of the ward policy and ask that
Beth be involved in collaborative discussion on the issue; and
! at an appropriate time, suggest or initiate a ward discussion, seminar, or
study day on current research on breastfeeding. (A: 4.5; 4.6; 4.7; 4.11)
As a midwife, you are encourage to report any concerns or incidents that
jeopardise care standards in your work environment. Make your report in
accordance with your work environment protocols. It is reasonable to expect
feedback relating to any concern or incident. (A: 4.5; 4.7; 4.10)
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
- 21 -
CONCLUSION
In the Guidelines for Midwifery practice we have offered some information and
ideas to assist your practice. While it is not possible to discuss all practice issues,
we have focused on some important areas identified in the Code of Practice for
Midwives. We anticipate that you will reflect on the information and scenario
strategies and use them as a springboard for discussion in your practice area.
Health care occurs in a dynamic environment and new information is always
becoming available. The Guidelines for Midwifery Practice will be subject to
formal review in the future and you will be invited to make suggestions.
ACKNOWLEDGEMENTS
In developing this booklet many resources were accessed. A list of those resources
is available on request.
BIBLIOGRAPHY
Australian College of Midwives Incorporated (1998). Competency Standards for
Midwives. February. Melbourne: ACMI
Bennett B. (1997) Law and medicine. Sydney: The Law Book Company
Dimond, B. The legal aspects of midwifery. London: Books for Midwives Press.
English National Board for Nursing, Midwifery and Health Visiting (1996)
New dimensions in midwifery care. London: English National Board
Frith, L. (1996) Ethics and midwifery; Issues in contemporary practice. Oxford:
Butterworth-Heinemann.
MacFarlane, P. (1999) Queensland health law handbook. Brisbane: Queensland
Department of Health
National Health Medical Research Council (1996) Options for effective care in
childbirth. Canberra: National Health Medical Research Council.
National Health Medical Research Council (1996) Review of services offered by
midwives.. Canberra: National Health Medical Research Council.
New Zealand College of Midwives Inc (1996) Midwives handbook for practice.
Christchurch: New Zealand College of Midwives.
Staunton, P. & Whyburn, B (1997) Midwives handbook for practice. Sydney: WB
Saunders
United Kingdom Central Council for Nursing, Midwifery and Health Visiting
(1996) Guidelines for professional practice, London: UKCC.
United Kingdom Central Council for Nursing, Midwifery and Health Visiting
(1996) Midwives rules and code of practice, London: UKCC.
Authorised by the ACT Parliamentary Counsel–also accessible at www.legislation.act.gov.au
