3.10 Legal and professional issues

Registered and enrolled nurses practice within a regulatory framework which consists of:
• the national competency standards for the registered nurse
• the national competency standards for the enrolled nurse
• the Code of Ethics for Nurses in Australia
• the Code of Professional Conduct.

These core standards are available free of charge from the Australian Nursing and Midwifery Council website at
http://www.anmc.org.au

Additional standards which a practice nurse may be assessed against include the competency standards for nurses in general practice and the competency standards for the advanced registered nurse and advanced enrolled nurse. These are available from the Australian Nursing Federation at http://anf.org.au

Each nursing and midwifery regulatory authority (NMRA) has the responsibility to administer the relevant legislation pertaining to nursing practice in that state or territory. These acts are known as the Nurses Act or Nurses and Midwives Act in some states, but may also be known as the Health Professionals Act as in the ACT where omnibus legislation was recently introduced.

All registered and enrolled nurses should be aware of the relevant legislation in their state or territory. More information can
be obtained from Nursing and Midwifery Regulatory Authorities in each state:

• Nurses and Midwives Board New South Wales
• http://www.nmb.nsw.gov.au/

• Health Professionals Licensing Authority, Northern Territory.
• http://www.nt.gov.au/health/org_supp/prof_boards/prof_licensing_auth.shtml

• Nurses Board of South Australia
• http://www.nursesboard.sa.gov.au/index.html

• Nursing Board of Tasmania
• http://www.nursingboardtas.org.au/nbtonline.nsf/$LookupDocName/home

• Nurses Board of Victoria
• http://www.nbv.org.au/

• Nurses Board of Western Australia
• http://www.nbwa.org.au/

• Queensland Nursing Council
• http://www.qnc.qld.gov.au/home/index.aspx

• ACT Nursing and Midwifery Board
• http://www.nursesboard.act.gov.au/

• Nurses in General Practice Codes of Ethical and Professional Conduct
• http://www.rcna.org.au/content/nigp.pdf

• the ANF website
• www.anf.org.au

Professional indemnity insurance

The RCNA’s Nursing in General Practice — guide for the general practice team provides the following information regarding
professional liability and indemnity:

If a patient is harmed, or is allegedly harmed, as a result of the negligent acts or omissions of a nurse working in general practice, the general practitioners legal responsibility in part depends on whether the practice nurse is an employee of the practice or an independent contractor. Employers are legally responsible for an employee’s negligence, based on the principle of vicarious liability. Under this principle,
an employer is legally liable for the negligent acts and omissions of its employees where those acts and omissions arise from or occur in the scope and course of the employment relationship.

However, the employer, or very rarely, the patient may decide to sue the nurse or the nurse as well as the employer.

The principle of vicarious liability does not apply if the nurse is an independent contractor from a nursing agency, division of general practice or similar. In this case liability for any negligent act by a nurse lies with that nurse. A nurse who is an independent contractor should therefore obtain her/his own professional indemnity cover and the practice engaging the nurse should ensure that the nurse has appropriate and sufficient professional indemnity insurance.

The nurse (employee or contractor) and the general practitioner should identify and agree on a range of issues that govern the rights, roles and responsibilities of the practice nurse; and that they have a shared, accurate understanding of the scope and availability of insurance coverage, and in particular the extent to which the insurance taken out by the general practitioner provides appropriate protection for the nurse.4

For more information contact:

• your local division of general practice at http://www.adgp.com.au/site/index.cfm?module=DIVISION
• the RACGP at http://www.racgp.org.au
• the AMA at http://www.ama.com.au

Information on professional indemnity insurance for nurses can be sought at:

• ANF http://www.anf.org.au
• APNA http://apna.asn.au (professional indemnity package specifically designed for nurses in general practice)
• RCNA (Guild Insurance) http://www.rcna.org.au

Scope of practice

All nurses should work within their scope of practice, competency level, and the policies established by the individual general practice.

The scope of practice for each nurse is based on the individual’s education, knowledge, competency and extent of experience and lawful authority…A part of a nurse’s legal responsibility is that they do not practice outside their scope of practice.’5

General practitioners and nurses should discuss and agree on, and then document, an acceptable scope of practice to ensure that the nurse and other members of the team have a shared understanding. Expansion of each individual nurse’s scope of practice through professional development activities and other relevant experience should also be documented. In those states where decision-making frameworks are in place, nurses should ensure that these are followed and requirements met before expanding their practice. In 2007, the ANMC will be releasing a national decision making framework. Details of this are available on the ANMC website.

For more information visit:

http://www.anmc.org.au
http://www.apna.asn.au
http://www.rcna.org.au

Supervision of the enrolled nurse

Nurses working in general practice may be either registered or enrolled nurses (Division 1 and Division 2 in Victoria). Enrolled nurses are associates to the registered nurse and are generally required to have a registered nurse as a professional supervisor when providing nursing care.

Where enrolled nurses are employed, it is the obligation of the employing general practice to ensure the enrolled nurse is either directly or indirectly supervised by a registered nurse.

The level of supervision required depends on the abilities, education, qualifications, scope of practice and experience of the enrolled nurse and external factors such as geographical setting and size of the practice.

For more information see ‘For the employer’ section 2.7 of this resource kit.