Nursing and Midwifery Board of Australia (NMBA) and Legislated Registration Standards undertakes the regulation and functioning of nursing practice and midwifery in each state in Australia and identify their key roles in protecting the public. Qualified nurses and midwives who apply for registration in NMBA are assessed against these registration standards for the fulfilment of requirements for practicing nursing and midwifery in Australia. The Legislation Registration Standards are approved by NMBA for seeking of initial registration like English communication skills, recency of practice, Professional Indemnity and criminal history. Therefore, the following report involves the exploration of these registered and regulatory management standards and its application in the future nursing practice as an Enrolled Nurse (Nursingmidwiferyboard, Australia, 2017).
NMBA functions as outlined by Health Practitioner Regulation National Law carries out function in each territory and state regulating the nursing practice midwifery In Australia with a major objective of protecting public. The function of NMBA include registration of nursing and midwifery practitioners and nursing students, development of nursing guidelines, standards, codes for the nursing and midwifery practice and profession. They also handle complaints, notifications, disciplinary hearings and investigations in the nursing practice. The assessment of overseas-trained practitioners is also done by NMBA who wish to practice nursing in Australia. The Accreditation standards are approved and accreditation of nursing course of study is also done by NMBA supporting the work of the National Board in national scheme in Australia (Nursingmidwiferyboard, Australia, 2017).
In Australia, ANMF is the largest union having around 249,000 members. It is run by nurses, assistants and midwives in the profession of nursing for the advancement of political, industrial and professional status. It has active and strong branches in each territory and state throughout Australia. The role of this federation is to provide high quality, accessible and affordable healthcare services to every Australian in every healthcare setting whether remote or rural, big or small hospitals. Protection of public and patient safety and care are the priorities of ANMF. The body stands for high quality care and universal healthcare to patients and make the nurses, assistants and midwives understand their roles in nursing practice. ANMF is fighting for the rights of Australians ensuring that Medicare remains free and health bureaucrats and politicians understand the funding for healthcare as a priority. ANMF prioritize to provide highest level of healthcare services and mainly focus on preventative care to reduce the burden of disease in Australia. ANMF fights for the rights of nurses in Aged Care shifts and make improvements for graduate nurses ensuring that they gain employment after their completion of qualifications and degree (Lee Thomas & Annie Butler, 2017).
This registration standard in NMBA sets out minimum requirements for nurses for continuing their professional development for registered nurses, enrolled nurses and midwives. To meet this registration standard, one must complete minimum 20 hours in CPD per registration period. The registered or enrolled nurse needs to complete the minimum CPD requirements for nursing and midwifery practice in Australia. This standard looks into the maintenance, improvement and broadening of nursing profession in their knowledge, competence and expertise. It also helps nurses and midwives in the development of qualities required for the nursing profession at personal and professional level. This registration standard evaluates the completion of CPD requirements of registered nurses or nurse practitioners who is holding an endorsement ("Australian Health Practitioner Regulation Agency - Continuing professional development", 2017).
This regulation standard evaluates the criminal history of any nurse or midwife who is applying for registration in NMBA in all countries including Australia. On the behalf of NMBA, the main role of this standard is to check the criminal history management of an applicant during the registration process ensuring that only those applicants (nurses and midwives) are selected who are safe and suitable for registration and nursing practice in Australia. This standard checks that all nurses and midwives who are registering for nursing practice must be free from any offence punishable by 12 months of imprisonment. In addition, criminal history standard also checks that whether convict or found guilty of an offence is punished by imprisonment in Australia or overseas ("Optometry Board of Australia - Criminal history", 2017).
NMBA has set out this standard to evaluate that all the applicants who are applying for initial registration are capable of demonstrating English language skills and thus, are suitable for registration. The role of this standard is to set out how the applicant has the capability to demonstrate English in their communication and competency to the Board that is sufficient for practicing nursing or midwifery. Two English language skills are registered in the standard that comprises of common English language applicable during initial registration and NM English language skills applicable for all nurses and midwives ("Nursing and Midwifery Board of Australia - English language skills", 2017).
Australian Health Workforce Ministerial Council approves this registration standard stating that no nurses and midwives who have not covered appropriate professional indemnity insurance (PII) arrangements are allowed to practice in their respective profession. The board has approved appropriate PII guidelines in conjunction with NMBA standards. The standard checks that whether registered health practitioners hold PII arrangements that is important part of National Scheme in protecting public and addressing of risk posed by practitioners who are uninsured. PII covers civil liability, unlimited retroactive and runoff in different types of nursing practice. Nurses and midwives who are holding insurance coverage in their own name are required to retain and show documentary evidence of PII or any insurance arrangements to the Board ("Nursing and Midwifery Board of Australia - English language skills", 2017).
This standard means that a nurse or midwife should maintain adequate connection with the recent practice in their profession for which they are obtaining registration. The standard evaluates that the applicant is carrying valid and current nursing or midwifery registration either in Australia or overseas. It also sets out the role of nurses or midwives applying for registration whether they possess appropriate skills and qualifications relevant in their area of practice in nursing ("Australian Health Practitioner Regulation Agency - Recency of practice", 2017).
This standard includes core practice guidelines providing a framework for the nurses for the assessment of enrolled nurse (EN) practice. NMBA sets out three domains under this standard that demonstrates that EN should work in collaboration with registered nurses, work towards provision of care and reflect analytical practice. This standard assesses the knowledge, capabilities, attitudes and skills of enrolled nurses within the clinically focused domains ("Australian Health Practitioner Regulation Agency - Recency of practice", 2017).
Safe and competency are two core pillars of Code of Professional Conduct for Nurses in Australia. As a part of the decision-making framework if a nurse is not aware of the technique of certain procedure, she is free to take help from other experienced nurses in order practice in accordance with the nursing standards. I was not aware of the insertion of nasogastric tube so I preferred taking help and guidance from the experienced nurses in that ward (Nursing and Midwifery Board of Australia, 2017).
Observation of the patient’s condition both before and after is the principal observational approach that must be undertaken while inserting a nasogastric tube. Here the observation of the condition encompass, proper tabulation of the body temperature, blood pressure level, respiratory rate, pulse rate, heart beat and the level of oxygen saturation. After the successful insertion of the nasogastric tube, the actual position of the tube inside the body must be radiologically confirmed and with the pH balance (less than or equal to 5). If the patient has a previour reported cases of oesophageal varices or other chronic coagulopathy then, I learned that the insertion of the nasogastric (NG) tube must be undertaken under the supervision of a professional radiologist. Patients with dry mouth syndrome, moistening of the buccal cavity with a moisten cotton bud is must.
In spite of taking several preventive measures, the insertion of nasograstric tube might feel uncomfortable for certain patients. During the course of my learning process, I came to know that in order to increase the comfprt quotient, Lidnocaine gel can be use either in from of gel (inside the nostrils) or in form of spray at the back side of the throat. However, Lindocaine gel is associated with certain degree of allergic symptoms to smaller group of patients, so allergic test is must before the use of the gel.
The standard process of NG tube insertion is based on the guidelines NSW, Ministry of Health, Australia. In order to assist insertion, the patient must be postured in an upright position with optimal neck/head alignment. The nostrils needs to checked in order to detect the presence of any deformity as this ill guide the best possible way of insertion. Not only this accurate measurement from the tip of the nose up to the earlobe and xiphisternum needs to be taken in centimetre calculations and then simultaneously marked over the NG tube. After the measurements are done, the tube must be lubricated adequately and then only it should to inserted within the nostrils. After insertion, the positioning must be reconfirmed via the use of radiography. If in any case, a patient is found coughing profusely or experiencing sound breathing problem then the entire insertion needs to redone on an immediate basis. However, it must also be noted that absence of coughing syndromes, do not necessarily means that tube placement has been done successfully (Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017).
During the course of my training, I also learnt that the faulty insertion of the NG tube can generate trauma in the adjoining areas along with pneumothorax. Other threats of incorrect insertion of NG tube include aspiration along with tube dislodgement, occurrence of pneumonitis. Pneumonitis occurs when the nasogastric feed get deposited inside the pulmonary cavities. In rare cases, due to error in insertion, the tube can get misplaced inside the lungs. This kind of fatal occurrence is common among the patients with cribriform plate disruption intracranial insertion ((Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017).
As a trainee nurse, I have gained huge knowledge regarding NG tube insertion as a part of the continuous professional development (Nursing and Midwifery Board of Australia - Continuing professional development, 2017). When I will start my career as an registered nurse via gathering experience from my training session, I will always keep in mind that the patients who are critically ill or at a palliative care unit are more susceptible of getting affect with the NG tube complications. Moreover, I will also remain alert that when I am inserting a NG, I must do that in zero reflexes. Any negligence in this level can cast fatal harm to the patients. For the patients with impaired blood clotting syndrome and tracheostomy, I will observe extra caution. Lastly, fine bore NG tube may cause leakage of the gastric content causing fatal oesophageal erosions, the conditions are more severe with patients who are suffering from gastro-oesophageal reflux disease (GERD). I will never forget to refrigerate the NG tube prior insertion (Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017).
Thus from the above discussion it can be stated that a nurse must practice according to the norms of Nursing and Midwifery Board of Australia (NMBA) in order deliver quality care to the patients. Nurses must also abide by the registration standards of the NMBA in order to successfully qualify as a registered nurse.
Australian Health Practitioner Regulation Agency - Continuing professional development. (2017). Ahpra.gov.au. Retrieved 8 November 2017, from https://www.ahpra.gov.au/Registration/Registration-Standards/CPD.aspx
Australian Health Practitioner Regulation Agency - Recency of practice. (2017). Ahpra.gov.au. Retrieved 8 November 2017, from https://www.ahpra.gov.au/Registration/Registration-Standards/Recency-of-practice.aspx
Fine Bore Nasogastric Feeding Tubes for Adult Policy. (2017) (pp. 1 to 8). Australia. Retrieved from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments
Lee Thomas, A., & Annie Butler, A. (2017). Australian Nursing & Midwifery Federation. Anmf.org.au. Retrieved 8 November 2017, from https://anmf.org.au/
Nursing and Midwifery Board of Australia - Continuing professional development. (2017). Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Continuing-professional-development.aspx
Nursing and Midwifery Board of Australia - English language skills. (2017). Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/English-language-skills.aspx
Nursing and Midwifery Board of Australia - Home. (2017). Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/
Nursingmidwiferyboard, Australia. (2017). Nursing and Midwifery Board of Australia - Home. Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/
Optometry Board of Australia - Criminal history. (2017). Optometryboard.gov.au. Retrieved 8 November 2017, from https://www.optometryboard.gov.au/Registration-Standards/Criminal-history.aspx
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