Codes of Conduct - A New Era for Nursing and Midwifery in Australia.

The Nursing and Midwifery Board of Australia has developed and approved the new Code of Conduct for Nurses and Code of Conduct for Midwives which applies from 1 March 2018. The primary role of the Nursing and Midwifery Board of Australia (NMBA), is to protect the public by ensuring only those who are suitably qualified and trained to practise in a competent and ethical manner are registered. One mechanism by which this objective is achieved is the registration of practitioners who are required not only to meet the mandatory registration standards but also conduct their practice in accordance with the NMBA's standards, codes and guidelines. The language of these new codes clearly articulates the mandatory obligations imposed on nurses and midwives to establish and maintain specified standards of conduct that ensure safe practice. It is therefore important for nurses and midwives not only to read the codes, but incorporate the terms contained therein meaningfully into their practice.

Nurse-to-patient and midwife-to-patient ratios.

The Queensland Government has recently passed the Hospital and Health Boards (Safe Nurse-to-Patient and Midwife-to-Patient Ratios) Amendment Act 2015 (Qld) which legislatively mandates minimum nursing and midwifery staff ratios. Though there is both national and international research which demonstrates the impact of nursing and midwifery workloads and skill mix on the quality of patient care and patient outcomes, there has been little legislative response to address the issue. Queensland is the second State, after Victoria, to mandate minimum nursing and midwifery ratios as a mechanism to address the delivery of safe high-quality patient care.

RECOGNISING AND RESPONDING TO THE DETERIORATING PATIENT.

The timely and appropriate identification of, and response to, a patient's deteriorating condition by health professionals is essential for optimal patient outcomes and the avoidance of preventable harm. National regulatory authorities, the Australian Commission on Safety and Quality in Health Care, State, Territory and federal health departments, health care facilities and institutions have all recognised the importance of implementing frameworks, standards and processes to facilitate the prompt recognition of the deteriorating patient and appropriate mechanisms for responding to and escalating such matters. Factors that may affect identification and response include the level of knowledge and skill of the health professionals, the culture of the organisation and the parameters of the assessment and audit tools. The 2014 findings of the Coroner in the inquest into the death of Graeme Barry Gulliver highlights the significance to nursing practice of recognising and responding to the deteriorating patient in an appropriate and timely manner.

Legal capacity in a health care context: an opportunity to review.

The Commonwealth government, as a signatory to the United Nations Convention on the Rights of Persons with Disabilities, is committed to the equal recognition, before the law, of persons with disability. Consistent with the obligations imposed under the Convention, the Commonwealth government has initiated an inquiry and report from the Australian Law Reform Commission (ALRC). The ALRC is to examine and report on the laws and legal frameworks within the Commonwealth jurisdiction that deny or diminish the rights of persons with disabilities to equal recognition before the law and their ability to exercise their legal capacity. The Commonwealth inquiry provides an opportunity for all State and Territory jurisdictions to examine their respective legislative provisions which benchmark standards of legal capacity for decision-making and the resulting appointment and role of substitute decision-makers.

Nursing documentation: a valuable clinical activity.

Professional codes and guidelines in combination with organisational and institutional policies and procedures identify and benchmark the standards of good documentation practices within a health care context. The Nursing and Midwifery Board of Australia has adopted, as part of the regulatory framework for nursing and midwifery practice, the principles essential for good documentation. Although these principles have remained unchanged for decades, issues based on poor documentation practices continue to be raised in courts and tribunals. This column seeks to highlight the importance of recognising documentation as a valuable clinical activity and therefore deserving of closer attention and adherence.

A new beginning for health complaints in Queensland: the Health Ombudsman Act 2013 (QLD).

The Queensland Government has recently passed the Health Ombudsman Act 2013 (Qld) which will render Queensland a co-regulatory jurisdiction for the purpose of complaints in relation to all regulated health practitioners. The Act also establishes a single entry complaints management system which will apply not only to regulated health practitioners but also unregulated practitioners and health service facilities and organisations. This column considers the legislatively created positions and processes aimed at strengthening the capacity of the health complaints system to protect the public, ensure safe and competent practice, maintain high standards of service delivery and public confidence in both the practitioners and the system.

Nurses, midwives and the requirement for "appropriate" professional indemnity insurance.

The Health Practitioner Regulation National Law Act 2009 (the National Law) imposes the obligation on nurses and midwives to have appropriate professional indemnity insurance coverage as a condition of applying for, or renewing, their registration to practise in Australia. The National Law also empowers the Nursing and Midwifery Board of Australia to develop a registration standard and guidelines in relation to professional indemnity insurance and to enforce compliance through the registration process. Though not previously a requirement for their registration, nurses and midwives must now understand the nature and extent of the professional indemnity insurance under which they practise and declare that they will not practise their profession unless they have appropriate professional indemnity insurance arrangements which cover the full scope of their practice. This column provides an overview of the obligations and responsibilities imposed on nurses and midwives under the National Law and the Nursing and Midwifery Board of Australia's registration standard and guidelines. It is imperative that nurses and midwives understand the National Law provisions and the standard and guidelines developed by the Board before making decisions about their professional indemnity insurance and self-declaring that they have "appropriate" professional indemnity arrangements in place.

Notifications and mandatory reporting--two years on.

It has been over two years in Australia since the adoption of the Health Practitioner Regulation National Law Act 2009 (the National Law) and the implementation of the National Registration and Accreditation Scheme (the National Scheme). A significant element of the National Scheme was the legislative imposition of mandatory notification obligations on registered health practitioners, employers of health practitioners and education providers. Both the processes of voluntary notification and the imposition of mandatory reporting obligations under the National Law are aimed at protecting the public from the risk of harm. This column considers the operation of the mandatory and voluntary notification provisions in the current Australian health care context.

"I want you to listen to my side of this": is there a role for mediation early in the health care complaints process?

The resolution of disputes that arise out of the provision of health care services has historically taken place at an institutional level, with the hospital administrative unit conducting the process, or through the legal system with the parties traversing the relevant courts and tribunals. Increasingly, the wide range of decisions which must be made in relation to the delivery of patient and client care and the broad scope of variations in expectations as to what a health service is capable of delivering, are providing fertile ground for conflict. This column considers the potential role of mediation as an early intervention strategy to resolve health care disputes.

The growing role of carers in the administration of medications.

The roles of registered nurses, enrolled nurses, nurse practitioners and midwives in the administration of medications are subject to the legislation and regulation in their respective States and Territories in Australia. Underpinning this regulatory framework is a presumption that health professionals who come under the relevant legislation and regulations have attained the levels of competency, skill and knowledge consistent with professional standards and the protection of the public. This column considers the provisions of the Health (Drugs and Poisons) Regulation 1996 (Qld) addressing the administration of controlled and restricted drugs in light of a recent Queensland Civil and Administrative Tribunal decision.

What you see may not be what you get: beware of patients bearing gifts.

The professional boundaries of practice for nurses and midwives are specifically addressed in professional codes of ethics and conduct, employer policies and guidelines and more frequently in the professional literature. There are many forms in which boundary violations and boundary crossings may present or circumstances in which they may occur. This column considers a recent case (involving a bequest to a registered nurse under a will) which came before the Queensland Nursing Tribunal. The decisions of the tribunal, the District Court and the Court of Appeal provide practical guidance to nurses and midwives on the importance of establishing and maintaining the professional boundaries essential to the therapeutic relationship with their patients and clients.

National regulation and accreditation of Australian health practitioners.

In 2010, nurses and midwives, together with a number of other identified health professionals, will come under the Australian National Registration and Accreditation Scheme for Health Professionals. The scheme is focused on the improvement of safety and quality of health care services through the independent accreditation of educational programs and the establishment and maintenance of a national public register. In this column the framework and legislative provisions supporting the scheme are discussed.

The impact of nursing numbers and skills mix on patient outcomes.

This column reviews a recent inquest conducted by the Northern Territory coroner into the death of a patient in the Royal Darwin Hospital (Inquest into the Death of Margaret Winter [2008] NTMC 049). It analyses the impact on patient outcomes of the decisions that are made about nursing numbers and the most appropriate skills mix in particular situations. It also looks at the decision-making processes involved in making such assessments.

Nursing in the aged care sector: resident abuse and the reporting obligations.

Elder abuse is recognised in many countries as a significant social, medical and legal issue. In an attempt to address this issue the Australian Government has recently enacted legislative amendments to the Aged Care Act 1997 (Cth). These amendments apply to providers in the residential aged care sector who are in receipt of Commonwealth Government subsidies. Among a range of obligations aimed at the protection of the elderly is the requirement for the mandatory reporting of sexual and serious assault in the aged care sector. This column considers some of the issues relevant to addressing the abuse of older Australians.

Developments in pharmacists' disciplinary processes and outcomes.

Pharmacy disciplinary processes and outcomes protect consumers by deterring pharmacists from unacceptable practices and maintaining the reputation and standing of the pharmacy profession. It is important that pharmacists are informed of disciplinary processes and outcomes in order to predict what is regarded as unacceptable behaviour and the potential consequences thereof. Disciplinary procedures and outcomes also play an important role in maintaining public trust in the pharmacy profession and it is therefore important that the public has confidence in the disciplinary structure. The outcomes of pharmacy disciplinary cases that reflect the patient care role of pharmacists are particularly important in helping to determine pharmacists' changed professional responsibility and potential legal liability in the provision of these patient care services.

Pharmacy practice developments: the potential impact on pharmacists' legal liability.

The practice of pharmacy has changed over recent years with a greater emphasis on the patient and the provision of patient care services. This expanded role of pharmacists as medication managers has resulted in changes to their professional responsibility and potential legal liability. Recent international case law demonstrates an increased legal liability of pharmacists in certain instances. However, pharmacists' liability in this new context in Australia is yet to be clarified.

Ethico-legal issues in relation to end-of-life care and institutional mental health.

OBJECTIVES: In view of the fact that there is a higher mortality rate for individuals with serious mental illness and that people with mental illness suffer excess mortality due to physical illness, the lack of attention to end-of-life care for patients with a serious mental illness needs addressing. This article seeks to put these issues on the agenda by beginning to explore important ethical-legal issues at the interface of palliative care and institutional mental health. METHODS: Data were collected from eight qualitative interviews conducted with mental health professionals at The Park, Centre for Mental Health, Queensland. The interviews were recorded verbatim, coded and thematically analysed. RESULTS: The findings highlight the inherent tension at the interface of compassionate, patient-centred end-of-life care and the participants' perception of the legal restraints imposed by virtue of being in a mental health institution. This article examines the participants' perceptions of the legal restraints curtailing the provision of palliative care in a mental health institution and considers these findings within an understanding of the limitations imposed by law. Our hope and expectation in undertaking this exploration is to clarify the legal limitations that operate to restrict the type of end-of-life care that can be offered to mental health patients, in order to provide an informed basis for practice.

The establishment of structures and processes for the safe and effective clinical placement of nursing students.

Quality education is essential to ensure the continuous provision of safe and competent health professionals entering the workforce. It is dependent on students experiencing an effective clinical placement. This paper discusses a matrix of organisational frameworks, including structures and processes applicable to the supervision of students' clinical learning by health professionals that potentially reduces patients to risk. The matrix is discussed through an analysis of the following: firstly, the legislative structures that regulate the discipline of nursing; secondly the regulatory structures within health sectors and higher education institutions for example, Deeds of Agreement and curriculum documents, and; thirdly those requisite processes, including communication between higher education institutions and within health sectors that ensure understanding of structures and accordingly adequate preparation of staff to undertake supervision. Safe and competent practice is reliant on clearly articulated structures and operationalising processes between the health service sector and higher education institutions that can assist staff and students meet requisite standards of practice.