Mastery Of Nasogastric Tube Insertion In Nursing Practice: NMBA Standards And Decision Making Framework

Function of NMBA

Discuss about the Mastery of Nasogastric Tube Insertion.

Australia is a multicultural nation where meeting health care needs and safety of people is a critical responsibility of the health care system. The performance and standards of nursing care is regulated in Australia by the NMBA and the ANMF. The report gives insight into the role of NMBA and ANMF in improving nursing practice and making care safe, affordable and accessible to people. It also gives idea about different registration standards that nurses or midwives must adhere to prevent cancellation of registration. This includes recency of practice, criminal history, continuous professional development management, professional indemnity, English language and Enrolled Nurse Standards for Practice. As nurse are often faced with several dilemma during the clinical practice, the decision making framework has also been provided by NMBA to support nurses to identify the best action needed in specific scenario. The decision making framework has also been used in relation to a scenario to decide the best strategy that nurse can take to engage in decision making during their placement.

Function of NMBA: The Nursing and Midwifery Board of Australia (NMBA) is the regulatory board established in each state and territory of Australia to carry out all work set up by the Health Practitioner Regulation National Law. It mainly deals with establishing regulatory, ethical, legal and professional practice standards for nurse and midwives and promote the health and safety of patient. It also plays key role in registering nursing and midwifery students, handling discipline hearing and approving accreditation standards for nurses (Nursing and Midwifery Board of Australia – About, 2017). 

Function of ANMF: The Australian Nursing and Midwifery Federation is a strong union of nurses and midwives that believes in improving the professional and industrial status of its member. They stand up for all Australians to provide universal healthcare and high quality patient care. It members work in every health setting such as nursing home, hospital, GP clinic and community health practice in rural and urban Australia. They strive to provide good quality affordable and accessible care to every Australians. Currently, it is the largest union in Australia with about 2, 59, 000 members (Australian Nursing & Midwifery Federation, 2017).

Registration standard: Continuous Professional Development: The NMBA registration standard for continuous professional development provides guidance to EN, RN and midwives regarding the minimum requirement for CPD. The first requirement to meet registration is standard is to complete minimum 20 hours of CPD. However, for nurses who hole an endorsement or those who are nurse practitioner, they need to complete additional 10 hours of CPD apart from the minimum 20 hours.  In addition, the additional 10 hours of CPD is also applicable for midwives who hold an endorsement (Nursing and Midwifery Board of Australia – Continuing professional development, 2017). As I am going to register as a nurse soon, this registration standard is important for my preparedness and knowing the time needed for me to engage in continuous professional development.

Function of ANMF

To develop suitable and safe practice environment within health care organization in Australia, the NMBA sets out standard to check applicant’s criminal history during the registration process. All nurses and midwives must inform NMBA if

• They are charged with an offence that is punishable by 12 months imprisonment
• They are convicted or found guilty of an offence

The NMBA also considers the following regarding criminal history of applicants:

• Nature and gravity of offence and its impact on health care practice
• Time elapsed since the offence and records of guilty or conviction due to the offence
• Type of sentence imposed for the offence and age of health practitioner at the time of offence
• Changes in health practitioner’s behavior since the offence and chances of risk to patient from the nurse or midwives
• Explanation given by the applicant regarding their criminal history (Nursing and Midwifery Board of Australia – Criminal history, 2017). 

The knowledge about criminal history is relevant to my professional practice as I am going to register for nursing practice soon and I must be aware of disclosing this information if applicable to ensure that the registration process is smooth.

Registration standard: English language

          NMBA focus a lot on English language competency skills of nurses and midwives. They need to demonstrate their English language competence by showing:

• English as primary language by studying it for at least six years of primary and secondary education OR
• Getting relevant professional communication in English in one of the recognized countries OR
• All registered nurse, EN and midwives need to provide proof of completing 5 years of education in English OR
• Candidates must achieve minimum score in language test like IELTS, OET or PTE Academic (Nursing and Midwifery Board of Australia – English language skills, 2017). 

Registration standard: Professional indemnity: The NMBA minimum requirement for professional indemnity insurance (PII) for nurse, EN and RN defines the following:

• All nurse/midwife must cover their own or third party professional indemnity arrangement management for aspects of practice, location or working part time or full-time
• The PII cove must include civil liability, retroactive cover and
• Candidate must not practice if any practice area is excluded from PII
• Individual PII arrangement must also be in place to cover any practice (Nursing and Midwifery Board of Australia – Professional indemnity insurance arrangements 2017). 

Knowledge about PII arrangement is essential for me as it will me to secure and get certain PII coverage.

NMBA has defined the criteria for nurse and midwife to maintain recency of practice. Meeting the minimum requirements for recency is necessary not just to fulfill professional and ethical responsibilities in care, but it is also necessary to maintain limits of competence and provide safe and effective care. The recency requirements can be fulfilled by nurses and midwives by demonstrating completion of minimum 450 hours of practice in the past 5 years or successful completion of NMBA approved assessment. Another option is successful completion of supervised practice (Nursing and Midwifery Board of Australia – Recency of practice, 2017). The knowledge about this registration standard will be useful for me in the future to understand my criteria to fulfill recency requirements of NMBA.

Enrolled Nurse Standards for practice: This standard provides a framework to assess the practice of Enrolled Nurse (EN). The key domain on the basis of which the practice of EN is evaluated includes professional and collaborative practice, provisions of care and reflective and analytical practice. The key standards in professional and collaborative practice include:

• EN must practice accordance with law, policies and procedures
• They must ensure confidentiality, dignity, rights and respect of patient during care
• They must be accountable for their action

Major standards in the domain of provisions of care include:

• Interpretation of health care information from range of sources to plan care
• Collaboration with RN and other members of the team during care planning
• Involving patients in care decision making and providing efficient and timely care
• Documents and reports care to relevant members

The reflective and analytical practice standards for EN are:

• Provide evidence-based nursing care
• Engages in continuous professional development
• Practice according to safety and quality improvement standards (Standards for practice: Enrolled nurses (2017)

1. After placement in clinical practice, nurses often encounter challenges where decision making becomes a difficult process. Similar challenge was also faced by me when I started my new position as a Graduate Enrolled Nurse in a major metropolitan hospital. I was asked to replace a blocked nasogastric tube. However, the dilemma for me was that although I never learnt about the skills and knowledge required for inserting and replacing nasogastric tube. The immediate action for me in this scenario would be to consult my senior nurse and make them aware that I do not have practical knowledge in conducting nasogastric intubation for patients and doing it without any supervision might lead to error or hazardous outcome for patient. Hence, consulting other health care team or seeking supervision from senior members is the most appropriate action that I need to take in such scenario. This action is also professionally allowed because according to the NMBA decision making framework, it is necessary that nurse be accountable for making professional judgment. According to this criteria, it is critical that nurses assess their education preparedness, experience and confidence to perform any activity safely (National decision-making framework, 2017). I also did similar assessment and identified that nasogastric intubation was outside my capacity of practice. Hence, I decide to start consultation with other members of the health care team according to the decision making framework.
2. To safely perform the activity of replacing and inserting blocked nasogastric tube, I have identified that I need learning or supervision in the following areas:

• Firstly, I need to consult my seniors regarding the medical equipment and devices that I need to perform the nasogastric intubation.
• Secondly, the process of inserting nasogastric tube is a skilful activity where nurses must have knowledge about appropriate insertion technique and proper position of patients. I need to learn these techniques too. There are certain techniques for easier insertion of the tube too which needs to be learned by me.
• The most critical learning need is the method of replacing the blocked tube without causing discomfort to patient. The challenges in the process of removing nasogastric tube is also reduced of patients cooperate and understand the process of intubation (Cason et al., 2015). Hence, communicating with patient will also enable completing the activity safely.

1. The above scenario makes it necessary for me to seek educational opportunities to learn about nasogastric tube intubation. Engaging in learning activity to enhance my competence in nasogastric intubation is also important for me to continuous evolved in my professional practice and gain the confidence to do the same task in the future. This action is also professional important for me because according to the NBMA registration standard, it is necessary for nurses and midwives to maintain a minimum hours of continuous professional development to renew their registration as a nurse. Hence, the opportunity of learning nasogastric intubation will add up to my CPD period and enable me to learn and grow as a confident nurse in the future.

Conclusion:

From thee summary of different registration standards for nurses, midwives or EN and the response of nurse during complex decision making, it is understood that different NMBA standards are there to support nurse to enhance and promote safe nursing practice.

The decision making framework is also useful for nurses as it provides adequate step that nurses can use to be accountable and responsible while providing care to patients.

Reference

Australian Nursing & Midwifery Federation. (2017). Anmf.org.au. Retrieved 5 November 2017, from https://anmf.org.au/pages/about-the-anmf

Cason, M. L., Gilbert, G. E., Schmoll, H. H., Dolinar, S. M., Anderson, J., Nickles, B. M., … & Schaefer, J. J. (2015). Cooperative learning using simulation to achieve mastery of nasogastric tube insertion. Journal of Nursing Education.

National decision-making framework. (2017). Retrieved 5 November 2017, from https://file:///C:/Users/User00/Downloads/Nursing-and-Midwifery-Board—Codes-and-Guidelines—National-framework-for-decision-making—September-2007%20(1).PDF

Nursing and Midwifery Board of Australia – About. (2017). Nursingmidwiferyboard.gov.au. Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/About.aspx

Nursing and Midwifery Board of Australia – Continuing professional development. (2017). Nursingmidwiferyboard.gov.au. Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Continuing-professional-development.aspx

Nursing and Midwifery Board of Australia – Criminal history. (2017). Nursingmidwiferyboard.gov.au. Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Criminal-history.aspx

Nursing and Midwifery Board of Australia – English language skills. (2017). Nursingmidwiferyboard.gov.au. Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/English-language-skills.aspx

Nursing and Midwifery Board of Australia – Professional indemnity insurance arrangements. (2017). Nursingmidwiferyboard.gov.au. Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Professional-indemnity-insurance-arrangements.aspx

Nursing and Midwifery Board of Australia – Recency of practice. (2017). Nursingmidwiferyboard.gov.au. Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Recency-of-practice.aspx

Standards for practice: Enrolled nurses. (2017). Retrieved 5 November 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/Enrolled-nurse-standards-for-practice.aspx