Administration of Medicines Course & Competencies Important information for registered and enrolled nurses and midwives. This publication is produced by Australian Nursing Federation (Victorian Branch) to assist registered, enrolled nurses and midwives understand the scope of practice of enrolled nurses, with particular reference to administration of medications. The information contained in this document is intended as guidance and is not a substitute for proper legal advice. Financial members of the Australian Nursing Federation (Victorian Branch) are able to access legal advice as a membership entitlement.
Further information is also available on the NMBA website: www. nursingmidwiferyboard. gov. au CONTENTS Page 3 Page 4 Page 4 Page 5 Background Transitional Process Enrolled Nurse Scope of Practice Medication Administration – NMBA Approved Programs and Essentials units of study Medication Administration Qualifications for Enrolled Nurses Course Entry Level Criteria Integrating the Administration of Medicine Competencies into Enrolled Nurse Scope of Practice Course Overview Further Reading.
Page 6 Page 7 Page 8 Page 9 Page 10 Background In accordance with changes associated with the shift to national registration, in effect since July 2010, medication endorsement is no longer displayed on an enrolled nurse’s registration. Instead, the public register identifies where an enrolled nurse is unable to administer medicine as part of their scope of practice.
1 It is assumed by the NMBA that: • enrolled nurses graduating from approved pre-enrolment courses run after 2008 have completed the relevant medicine administration units of competence from the national Health Training Package (HTP); and, enrolled nurses graduating from the Diploma of Nursing after 2010 will achieve the relevant education units of competence for administering medicine. • In Victoria, prior to the introduction of the national registration scheme, there were several training programs in the administration of medicine available to enrolled nurses.
Completion of the associated units of competency enabled enrolled nurses to expand their scope of practice. This resulted in Victorian enrolled nurses having an endorsement to administer medicines placed on their practising certificate. This endorsement notation no longer appears on the registration papers of endorsed enrolled nurses. In jurisdictions other than Victoria the completion of units of competence in administration of medicine may not have resulted in an ‘endorsement’ on the individual nurse’s qualification.
Rather, the scope of practice and administration of medicine was an employment matter. The NMBA has stated they will allow those enrolled nurses to continue administering medications. As of July 2010 only Board-approved programs are recognised. The Board will consider programs recognised by the Australian Nursing and Midwifery Council (ANMC) Ltd for approval . 2 It is the stated intention of the NMBA that all enrolled nurses practising in Australia will, as part of their educational program, have undertaken the relevant units of study enabling them to administer medications safely.
3 NB: Mothercraft nurses (including Division 5 nurses in Victoria) will transition to enrolled nurse with a condition next to their name, limiting their practice to mothercraft nursing. 1 NMBA 2010 Explanatory Notes: Enrolled nurses and medicine administration, http://www. nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx 2 NMBA 2010 Explanatory Notes: Enrolled nurses and medicine administration, http://www. nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx 3 NMBA 2010 Explanatory Notes: Enrolled nurses and medicine administration, http://www.
nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx 3 Transitional Process The NMBA have established a transitional process to assist enrolled nurses who are not qualified to administer medicines. The transitional process informs health professionals and the public when an individual enrolled nurse has not yet completed the approved and required educational units of competence to administer medicine. It does so by placing a notation on the national nursing register (public register) against the individual enrolled nurse’s name.
The notation states: “Does not hold Boardapproved qualification in the administration of medicines”. 4 The NMBA states the notation should not be seen as a punitive measure; rather it is a strategy to inform and protect the public. A transitional notation against an individual enrolled nurse’s name will remain in place for five years or until the individual enrolled nurse provides evidence to the NMBA of having completed an approved education in medicine administration. The ANF is advised the NMBA will review the transitional arrangement policy at the end of a five year period .
5 Enrolled Nurse – Scope of Practice Because it is assumed, unless otherwise indicated, that all enrolled nurses are able to administer medication there will be no indication of the route of administration the enrolled nurse is authorised to administer medication by, that is orally, intramuscularly, subcutaneously and/or intravenously. It is the responsibility of the employer to sight every enrolled nurse’s qualification to practise, including their qualification to administer medication. and it is the responsibility of the enrolled nurse to work within their scope of practice.
The extended scope of practice for enrolled nurses includes the administration of medication under the Health Practitioner Regulation National Law Act 2009. Under the Nurses Act 1993 and the Drugs, Poisons and Controlled Substances Regulations 2006, the enrolled nurse was legally authorised to administer a prescribed drug of dependence, a Schedule 4 poison, Schedule 8 poison or Schedule 9 poison via the route cited in the enrolled nurse’s qualifications. Therefore, each State and Territory has legislation which regulates the management of drugs and poisons.
Furthermore, all nurses are subject to the parameters prescribed within organisational policies and guidelines of the respective health departments and health services, and the standards set by the NMBA. 4 NMBA 2010 Explanatory Notes: Enrolled nurses and medicine administration, http://www. nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx 5 NMBA 2010 Explanatory Notes: Enrolled nurses and medicine administration, http://www. nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx 4.
Medication administration: NMBA approved programs and essential units study The NMBA has defined the difference between ‘essential requirements’ and ‘units of study’ in their 2010 Explanatory Note for enrolled nurses and medicine administration. 6 The essential requirement enabling enrolled nurses to administer medicines comes when an enrolled nurse who has completed a Certificate IV – Nursing has satisfactorily completed the following units of competence from the Health Training Package: • • HLTAP501A – Analyse Health Information; and HLTEN507A – Administer and Monitor Medications in the Work Environment.
7 The ‘essential requirement’ listed above is included in the Certification IV and Diploma in Nursing qualification undergraduate preparation from 2010. Enrolled nurses who have satisfactorily completed the above units of competence may then be offered: • HLTEN519A – Administer and Monitor Intravenous Medication in the Nursing Environment8 an elective unit of competence, included as part of the Diploma of Nursing qualification, or as a separate unit of competence. This elective unit of competence is intended to be left separate from the ‘essential requirements’ for administration of medicine.
This enables Certificate IV – Nursing graduates prior to 2008 to obtain competence in administration of intravenous medicine once the required prerequisite learning has been achieved. 6 NMBA 2010 Explanatory Note: Enrolled Nurses and Medicine Administration. http://www. nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx 7 National Training Information Service (NTIS). 2007 Health Training Package 2007 – Enrolled Nurse Units of Competence www. ntis. gov. au/Default. aspx?
/trainingpackage/HLT07/volume/HLT07_5/unitsector/Enrolled_Division_2_Registered_Nursing_703 8 National Training Information Service (NTIS). 2007 Health Training Package 2007 – Enrolled Nurse Units of Competence www. ntis. gov. au/Default. aspx? /trainingpackage/HLT07/volume/HLT07_5/unitsector/Enrolled_Division_2_Registered_Nursing_703 5 Medicine Administration Qualifications for Enrolled Nurses Medicine administration courses are designed to equip the enrolled nurse with the knowledge, and skills to administer medication in a competent manner under the direction and supervision of a registered nurse or midwife.
These courses consist of the delivery of units leading to endorsement for the enrolled nurse to administer medication and is classed as a short course comprising two compulsory units of competence. The two compulsory educational units of competence are: HLTAP501A Analyse Health Information (30 hours) This educational unit of competency describes the application of in-depth level of knowledge of anatomy and physiology required to analyse available health information in relation to specific services to be provided. This unit is a prerequisite for unit HLTEN507A.
9 HLTEN507A Administer and Monitor Medications in the Work Environment (104 Hours) This educational unit of competency describes the skill and knowledge required of enrolled nurses to administer and monitor medications and evaluate their effectiveness for clients within a health environment. 10 This unit can only be undertaken by a student who has successfully completed HLTAP501A. The course content hours total 210 hours. The delivery of the course is divided into 134 hours of theory and 76 hours of clinical experience.
Enrolled nurses must be assessed as competent in both the theoretic and clinical elements of the course to be recognised by the NMBA to be able to administer medicine. 9 National Training Information Service (NTIS). 2007 Health Training Package 2007 – Enrolled Nurse Units of Competence www. ntis. gov. au/Default. aspx? /trainingpackage/HLT07/volume/HLT07_5/unitsector/Enrolled_Division_2_Registered_Nursing_703 10 National Training Information Service (NTIS). 2007 Health Training Package 2007 – Enrolled Nurse Units of Competence www.
ntis. gov. au/Default. aspx? /trainingpackage/HLT07/volume/HLT07_5/unitsector/Enrolled_Division_2_Registered_Nursing_703 6 Entry Level Criteria Pre 1995 enrolled nurses Enrolled nurses who completed their undergraduate qualification or hospital-based training before 1995 are required to demonstrate their competency to undertake the administration of medicines qualification. Enrolled nurses in this category are required to pass an assessment in Anatomy and Physiology, Numeracy, and Literacy.
Additionally, course applicants must demonstrate the following entry level criteria prior to being accepted into a medication administration course: 1. 2. 3. 4. 5. Australian Citizen/Permanent Resident of Australia; registration with the Nursing and Midwifery Board of Australia in Division 2 of the national register as an Enrolled Nurse; Human Anatomy and Physiology (at the level of the Certificate IV in Health (Nursing) NRS3 Mathematics; and NRS4 Literacy.
The structure of the placement and the credentials and expertise of the clinical teacher(s) employed to supervise the placement must also be approved by the Australian Nursing and Midwifery Board of Australia. The modules are aligned with the Australian Nursing and Midwifery Council (ANMC) Competency Standards for the Enrolled Nurse and are delivered in accordance with the scope of practice of the enrolled nurse in Australia.
The ANMC competencies which apply to this course are: • • • • • • • functions in accordance with legislation, policies and procedures affecting enrolled nursing practice; accepts accountability and responsibility for own actions within enrolled nursing practice; provides nursing care according to organizational policies and guidelines; acts in accordance with own competency level and recognized standards of enrolled nursing practice; identifies and clarifies enrolled nurse responsibility for aspects of care in consultation with the registered nurse or midwife and other members of the health care team organizational policy; recognizes own level of competence; acts in accordance with enrolled nurse educational preparation; 7 Entry Level Criteria.
• • • • • • consults with the responsible registered nurse or midwife to ensure that tasks and responsibilities delegated by the registered nurse or midwife are commensurate with own level of competence; recognizes differences in accountability and responsibility of the registered nurse or midwife and enrolled nurse in the provision of nursing care; differentiates the responsibility and accountability of the registered nurse or midwife and enrolled nurse in the delegation of nursing care;
Sseeks additional knowledge/information when presented with unfamiliar situations; reports changes in health and functional status to the registered nurse or midwife; and, ensures communication, reporting and documentation are timely and accurate. 11 Integrating the administration of medicine competencies into the enrolled nurse scope of practice. On completion of the medication administration course and competencies the enrolled nurse should be able to: • • • • • • •
• • analyse health information; plan action(s) to address identified health status; implement services; minimize potential risk to safe administration of medications; prepare for medication administration within scope of enrolled nurse; administer medication within legal parameters; monitor and evaluate client response to administered medication; monitor peripheral intravenous therapy; and, develop strategies for pain management. 11 ANMC 2002 ANMC National Competency Standards for the Enrolled Nurse https://
www. cshisc. com. au/docs/upload/ANMC%20competencies%20for%20the%20Enrolled%20 Nurse. pdf 8 Course Overview Nursing assessment skills Students are educated in assessment skills, including: • • assessment of patient responses to medications – adverse reactions, therapeutic effects; and, physical assessment of patient including skin, conscious state, vital signs. The enrolled nurse is expected to report and record any changes in functional health patterns to the registered nurse or midwife.
Practical skills Students achieve competency by utilising assessment skills and practical procedures simulated in a laboratory setting (i. e. manikin) and through 76 hours of clinical placement.
Medication administration Students must: • • • • • • identify appropriate methods of monitoring unexpected and potential adverse reactions to pharmacological agents such as allergic reactions, drug interactions, idiosyncratic reactions, altered metabolism and/or excretion and age/ethnic differences; identify client and methods in which consent can be given prior to administration of medication and recognize the client’s right to refuse treatment; display knowledge of pharmacology: drug name, classifications and actions;
Adverse effects; drug dose calculations; and drug interactions; demonstrate an understanding of safe preparation and administration of medications including preparation from ampoules and vials; the potential contraindications of mixing one or more medications; and insulin administration; demonstrate understanding of dosage calculations and ability to calculate desired dosages; and, convert between/among systems, convert and calculate body weight. 9 SUGGESTED READING Explanatory Note: Enrolled Nurses and Medicine Administration.
Nursing and Midwifery Board of Australia. 2010. www. nursingmidwiferyboard. gov. au/FAQ-and-Fact-Sheets. aspx Accessed 24. 8. 2010 National Competency Standards for the Enrolled Nurse. Australian Nursing and Midwifery Council. 2002.
Guidelines for Medication Management in Residential Aged Care Facilities. Australian Pharmaceutical Advisory Council. 3rd. ed. 2002 (recommendations 1-14). Managing Drugs in Residential Aged Care Services. Department of Health Victoria. Drugs and Poisons Controls in Victoria. www. health. vic. gov. au/dpu/agedcare-manage. htm Accessed 24. 8. 2010. Health Training Package 2007 – Enrolled Nurse Units of Competence National Training Information Service (NTIS).
www. ntis. gov. au/Default. aspx? /trainingpackage/HLT07/volume/ HLT07_5/unitsector/Enrolled_Division_2_Registered_Nursing_703 10 Victorian Branch Australian Nursing Federation (Victorian Branch) 540 Elizabeth Street Melbourne www. anfvic. asn. asn.