Health Practitioners’ Competence Assurance Act

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• Introduction
• The Health Practitioners Competence Assurance (HPCA) Act (2003)
  • Professional Conduct Committee (PCC)
  • Health Practitioners Disciplinary Tribunal
  • Mandatory reporting, competence and fitness to practise
  • Nursing Council of New Zealand (NCNZ)/Te Kaunihera Tapuhi O Aotearoa
  • Midwifery Council of New Zealand (MCNZ)/Te Tatau o te Whare Kahu
• Dual registration
• Maintaining competence for annual practising certificate and audit
  • Costs
• Professional Development and Recognition Programmes (PDRPs)
• Useful resources

Introduction

Nursing is a regulated profession, and it is important that nurses understand the requirements of regulation, their obligations under the Health Practitioners Competence Assurance (HPCA) Act 2003 and what this means in terms of their professional responsibility and accountability. It is the responsibility of every nurse to know and understand the legislative frameworks they work within.

The Health Practitioners’ Competence Assurance Act was passed in September 2003 and has undergone several amendments since then. The HPCA Act (2003) was developed in response to: very public examples of medical error; demands from lobbyists to make health professionals more accountable and respect health care consumers’ rights; needing to streamline some of the bureaucratic processes by having main health professional groups under one piece of legislation; needing to update older legislation, like the 1977 Nurses’ Act. The principal purpose of the Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.

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The Health Practitioners Competence Assurance (HPCA) Act (2003)

The Act includes provisions that:

1. Prohibit persons who are not qualified to be registered as health practitioners of a profession from claiming or implying to be health practitioners of that profession.
2. Prohibit persons other than registered health practitioners of a profession with current practising certificates from claiming to be practising the profession.
3. Prohibit health practitioners from practising their professions without current practising certificates or from practising their professions outside their scopes of practice.
4. Authorise the making of Orders in Council restricting the provision of the whole or part of certain health services to health practitioners who are permitted to perform those activities by their scopes of practice.

The Act also sets out conditions a health professional must meet in order to practise; provides mechanisms for improving the competence of health practitioners to provide protection from practitioners who practice below that required standard of competence or are unable to perform the functions required; provides for each regulatory authority to establish a professional conduct committee to investigate complaints about health practitioners; and provides for the establishment of a single tribunal, called the Health Practitioners Disciplinary Tribunal, to hear charges brought by the Director of Proceedings or by a professional conduct committee against a practitioner.

Professions currently regulated by the Act (2003) include:

• Chinese medicine services
• Chiropractic
• Medicine
• Dentistry
• Occupational therapy
• Optometry and optical dispensing
• Nursing
• Midwifery
• Medical imaging and radiation therapy
• Dietetics
• Medical laboratory science
• Anaesthetic technology
• Osteopathy
• Paramedic services
• Pharmacy
• Physiotherapy
• Podiatry
• Psychology and psychotherapy.

The key provisions include:

• Unqualified person must not claim to be a health practitioner
• Health practitioners must not practise outside scope of practice
• Certain activities are restricted to particular health practitioners
• There is also power to issue search warrants in respect of offences against Section 7 or Section 9 of the Act.

Regulatory Authorities set up under the Act are responsible for:

• Specifying scopes of practice
• Prescribing qualifications for entry to the profession
• Maintain a register of health practitioners
• Monitor and review competency and fitness to practice
• Respond to notifications about practice below the required standard of competence.

Professional Conduct Committee (PCC)

NCNZ may appoint a Professional Conduct Committee (PCC) in relation to a particular complaint/case. The PCC will consist of two health practitioners and one layperson. Committees may appoint legal advisors and investigators. If the PCC wishes to lay a charge against the health practitioner, it must refer to the Health Practitioners Disciplinary Tribunal.

Health Practitioners Disciplinary Tribunal

Complaints or issues of competence will be referred by the director of proceedings or the PCC to the Health Practitioners Disciplinary Tribunal. The tribunal is made up of a chairperson and 1 or more deputy chairpersons, each of whom must be a barrister or solicitor of the High Court of not less than 7 years’ practice. This Committee is made of members from all professional groups and must also include lay persons.

IMPORTANT: NZNO members are advised to contact NZNO Membership Support Centre (MSC), on 0800283848, as soon as possible if they receive notification that they have been referred to their regulatory authority or received notification of an investigation for the Office of the Health and Disability Commissioner or coronial enquiry (rules of NZNO indemnity insurance apply for eligibility for legal support).

Mandatory reporting, competence and fitness to practise

The HPCA Act (2003) specifies conditions under which a health practitioner must be referred to the regulator and when the regulator must inform other authorities. The Act also specifies when other authorities must notify NCNZ of an investigation of a nurse on the register.

• Employers must inform NCNZ if a nurse resigns or is dismissed for reasons relating to competence (it is a good idea for organisations to have a protocol on this to guide team leaders etc.)
• If there is reason to believe a nurse may pose a risk of harm to the public by practising below the required standard of competence she may be reported by colleagues to NCNZ.
• If NCNZ has concerns about competence they must inform:
  • ACC, Director General of Health, Health & Disability Commissioner, the employer, and may inform those working in partnership or association with the nurse.
• Employers must report to NCNZ if a nurse cannot practise because of mental or physical condition.
• The Health & Disability Services Commissioner’s Office must report to NCNZ any concerns about a nurses competence arising from investigations.

IMPORTANT: It is important to be aware of these mandatory reporting requirements and NZNO members are advised to seek advice before resigning while the employer is questioning their practice.

Nursing Council of New Zealand (NCNZ)/Te Kaunihera Tapuhi O Aotearoa

The NCNZ is responsible for regulating Enrolled Nurses (EN), Registered Nurses (RN) and Nurse Practitioners (NP). NCNZ is made up of the Council and staff. Council members are appointed by the Minister of Health and at any one time there must be at least two lay people appointed to the council. When vacancies exist, nurses are invited to nominate individuals for appointment as NCNZ members. An election process is run to select practitioner members of the council. Elected terms are three years with a maximum of nine years. Get more information about the Executive Leadership team and the Council.

The primary function of NCNZ is to protect the health and safety of members of the public by ensuring nurses are competent and fit to practise. They do this by:

• Registering nurses
• Setting ongoing competence requirements and issuing practising certificates
• Setting scopes of practice and the qualifications required for registration
• Accrediting and monitoring education providers and setting the state examination
• Providing guidelines and standards for practice
• Receiving and acting on notifications of health and competence concerns
• Receiving and acting on complaints about the conduct of nurses
• Promoting public awareness of the Council's responsibilities.

Midwifery Council of New Zealand (MCNZ)/Te Tatau o te Whare Kahu

A separate Midwifery Council was established on 18 December 2003. The primary function of the council is protect the health and safety of mother and babies by ensuring midwives are competent and fit to practise. They do this by:

• Setting qualifications needed to become a midwife and to accredit pre-registration programmes of education
• Setting standards for clinical competence, cultural competence and conduct of midwives which includes competencies that will enable effective interaction with Māori
• Registering midwives
• Recertify midwives every year
• Reviewing competence and fitness of midwives.

The Midwifery Council currently has eight members. Members are appointed by the Minister of Health. Two of these are lay people appointment by the Minister of Health. The appointments process are managed by the Ministry of Health who advertise when vacancies become due. Terms are three years with a maximum of nine years.

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Dual registration

Those holding both a nursing and midwifery qualification will need to consider what to do in relation to practising certificates. To maintain practising certificates in both disciplines, the requirements of both Councils for competence based practising certificates need to be met. Those who are practising nursing and not practising midwifery, will hold a practising certificate for nursing only. This does not mean that that person’s name is removed from the Register of Midwives. It does mean that she or he cannot practise as a midwife until he or she can meet the requirements of a competence based practising certificate for midwives. Conversely those practising midwifery and not nursing will hold a practising certificate in midwifery but not in nursing. Their names will remain on the Register for Nurses, but they need to meet the requirements for a competence based practising certificate should they return to nursing.

Those with dual registration practising in both nursing and midwifery need to meet the requirements for practising certificates of both Councils. This may be difficult to achieve, depending on the requirements determined by the Councils and the employment setting. If it is a requirement of a particular employment position, for example, rural settings, then there is an obligation by an employer to assist in maintaining competence requirements in both disciplines. NZNO can provide advice to members if there is any difficulty in reaching agreement.

A number of practitioners with dual registration work in specialised areas where they use both nursing skills and those from their midwifery practise, for example, neonatology and Plunket. It is important to determine the nature and scope of the practise in making a decision about holding a practising certificate for these roles. Competence requirements for practising certificates for midwives will be based on the standards for registration as a midwife, that is the continuum of midwifery practise. Neonatology and Plunket would fall under nursing and so a nursing practising certificate will be required. Those with dual Registration who will hold only one practising certificate will need to be quite clear about their scope of practise and not practise the other discipline until they have competence based practising certificate.

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Maintaining competence for annual practising certificate and audit

Both NCNZ and MCNZ have annual practising certificates as required under the HPCA Act (2003). NCNZ randomly selects five percent of nurses on the register yearly and requires them to complete a recertification audit under section 41 of the HPCA Act (2023) to ensure nurses meet the continuing competence requirements. During the audit process nurses are asked to provide the following information:

• A declaration of 450 practice hours (or 60 days) in the last three years
• A declaration of 60 professional development hours in the last three years
• Two competence assessments, a self-assessment and a senior nurse assessment against the NCNZ competencies for the nurse’s scope of practice.

Nurses are required to supply statements of learning and how the activity affirmed or influenced their practice. This can be a short statement for each course/activity or a more detailed statement for three courses/activities. A template is available from the NCNZ website. You can also log into MyNC, go to the continuing competence tab and record your professional development activity.

Nurses can be exempt from this process by completing a NCNZ approved PDRP portfolio.

• Get information about the PDRP and audit processes.

The MCNZ recertification programme education components consists of the following:

• Midwifery Emergency Skills Refresher (Annually)
• Continuing Midwifery Education (Eight hours per year)
• Professional Activities (Eight hours per year)
• Midwifery Standards review (Three yearly)
• Abortion Legislation Education.

A recertification planner is provided by MCNZ to assist midwives in planning ahead to meet the requirements. Completed continuing education and professional activities can be updated on the CPD tab of the midwife’s MyMCANZ portal and having accurate and up to date records is a requirement for processing an APC application.

Get further information about the requirements for a midwifery APC on the NCNZ and MCNZ websites.

Costs

Costs for Annual Practising Certificates may change. Find them on the NCNZ and MCNZ websites.

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Professional Development and Recognition Programmes (PDRPs)

If your organisation has a PDRP the organisation can apply to NCNZ to have the programme approved. If the programme does gain NCNZ approval then nurses on that programme will automatically be considered as meeting NCNZ requirements of demonstrating competence for their Annual Practising Certificates and will not have to submit evidence to NCNZ for audit.

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Useful resources

• www.moh.govt.nz/hpca - HPCA update
• www.moh.govt.nz - for a variety of different resouces
• www.nursingcouncil.org.nz for the following documents:

  • Code of Conduct for nurses

  • Guidelines: Professional Boundaries

  • Guidelines: Social Media and Electronic communication

  • Competencies for Registered Nurses

  • Competencies for Enrolled Nurses

  • Competencies for the nurse practitioner scope of Practice

  • Guideline Expanded Practice for Registered Nurses

  • Guidelines for Cultural Safety, Te Tiriti o Waitangi and Māori Health

  • Guidelines for Practice, including direction and delegation.

• www.midwiferycouncil.health.nz for the following resources and related documents:
  • Standards of Clinical & Cultural Competence & Conduct.

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