Do you employ nurses in your practice

Registration and indemnity

There are four main ‘types’ of nurses registered with the Nursing and Midwifery Board of Australia (NMBA) – Registered Nurse; Enrolled Nurse; Nurse Practitioner; and Midwife.

Each type has their own professional standards and registration requirements. Ahpra has a public register of practitioners which includes nurses. Check the register prior to employing a nurse (and annually) for valid registration, also noting any conditions that may have been imposed by the NMBA. Renewal of NMBA registration is due 31 May each year.

One of the requirements for registration is professional indemnity insurance (PII) – ask for evidence that all nurses in your practice have PII (including contractors). Nurses coming from a hospital role, in which insurance is usually provided, may have little experience with insurance in the private sector.

PII for nurses is available from various insurers, including MDA National via our Practice Indemnity Policy (PIP).

Scope of practice

Nurses must only deliver care within their individual scope of practice. An individual nurse’s scope of practice will vary depending on their education, clinical experience, context of practice, relevant

legislation, and the employment setting. A guide on scope of practice is available at nursingmidwiferyboard.gov.au. Employers should also be aware of nurses’ requirements in this regard.

What’s the difference between an Enrolled Nurse (EN) and a Registered Nurse (RN)?

From an education perspective, ENs will usually have a diploma and RNs will generally have a degree.

ENs must work under the supervision of an RN. This supervision can be indirect (if the RN agrees that the EN is experienced), but the RN should be available or contactable whenever the EN is working.

ENs cannot be supervised by doctors. See nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/Enrolled-nurse-standards-for-practice.aspx.

You can have more than one RN being the supervisor (to cover leave or days off, etc), but there needs to be agreement between all, and the RNs are responsible for assessing that the EN can work under ‘indirect’ supervision (i.e. RN is available to contact, but is not on site at all times).

A doctor can ‘request’ or ‘direct’ a nurse to provide patient care, but cannot be the formal supervisor.

Administration of medications and immunisations

Generally, nurses require a written medication order from the treating doctor to proceed with administration of medications.

The main exception in most states is vaccines administered for the National Immunisation Schedule, on the proviso that the nurse has an approved immunisation certificate. If a nurse is not experienced within the area of immunisation, then they should consider completing a formal immunisation course.

Regulations are state-specific, so nurses should be aware of the regulations applicable to the state in which they are working.

We recommend that a second practitioner double-checks the medication being administered, and nurses need to be up to date with anaphylaxis management.

Medicare items cannot be billed for immunisations if there is no doctor present (except for COVID-19 vaccine items which still require a doctor to be on site).

Cosmetics

The NMBA has published a position statement on nurses and cosmetic medical procedures that states:

The main focus of this position statement is minor (non-surgical) cosmetic medical procedures (‘cosmetic medical procedures’). Nurses practising in the area of major cosmetic medical and surgical procedures (‘cosmetic surgery’) work with a medical practitioner.

The Medical Board of Australia’s guidelines for registered medical practitioners who perform cosmetic surgery and procedures note that the medical practitioner who prescribes a cosmetic injectable is responsible for the management of the patient (including appropriate post-procedure care) and is also responsible for ensuring the nurse has appropriate qualifications, etc.

Nurses working in the area of cosmetic medical procedures must know and comply with organisational requirements and the relevant state, territory and Commonwealth requirements, as jurisdictional differences are common.

It is not within a midwife’s therapeutic model of care to work in the area of cosmetic medical procedures.

Ear syringing

Some insurers have withdrawn cover for nurses conducting ear syringing, and we have received many enquiries about this. Our current advice to holders of an MDA National PIP is:

We will cover nurse employees on the proviso the ear syringe procedure is within the nurse’s scope of practice, they have undertaken appropriate training, have been assessed as competent, are confident to conduct this procedure, and the Practice has agreed documented policies and procedures. The nurses must be added to the Practice Indemnity Policy if not done previously.

It is acceptable for a senior RN who has appropriate training and experience to train or upskill other nurses, provide supervision, and sign them off as competent.

More resources

• Royal Australian College of General Practitioners – Ear wax management
• MDA National – Minimising vaccination errors
• Department of Health and Aged Care – About nurses and midwives
• Nursing and Midwifery Board – Position statement on nurses and cosmetic medical procedures
• Medical Board of Australia – Guidelines for registered medical practitioners who perform cosmetic surgery and procedures
  

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