PPSPN amendments 2024

Release date: 2 September 2024

The Australian College of Perioperative Nurses (ACORN) has completed a review and consultation period for the updating of the Professional Practice Standards for Perioperative Nurses (PPSPN). This consultation process included members of the ACORN Board of Directors, local association members, health service organisations and relevant external governing bodies, e.g. Nurses and Midwives Board of Australia (NMBA).

Please note that all changes are reflected in both the PPSPN for Individuals and PPSPN for Organisations volumes.

Advanced life support requirements

The ‘requirement’ of all perioperative nursing staff to demonstrate current competence in advanced life support has been amended to ‘recommendation’. While ACORN remains a strong advocate for perioperative nursing staff being proficient in advanced life support practices, more rigorous and specific evidence is required to support this as a mandatory requirement. Consultation with health service organisations also highlighted the need for workforce sustainability, recruitment and retention in the perioperative environment.

Care to ‘all’ patients

The originally published version of the PPSPNs included a standard statement for each of the perioperative nursing roles referring to ‘Australian patients’. This has been amended to ‘all patients’ to be inclusive of all patients, regardless of residency or citizenship status.

Enrolled nurses included in Anaesthesia nurse role

After consultation with the NMBA, health service organisations and ACORN members, the Anaesthesia nurse standard now includes that the role is ‘suitable for both registered nurses and enrolled nurses’. The NMBA provisions for enrolled nurses in this role are consistent with the other perioperative nursing roles in that the enrolled nurse is to have qualifications, confidence and competence in the safe administration of medications. All evidence to support the inclusion of enrolled nurses in this role was assessed and the consensus of the Board of Directors was that this amendment is deemed appropriate.

Mothercraft nursing included in glossary

In response to feedback from the perioperative community, ACORN has included an explanation about mothercraft nursing within the ‘Enrolled nurse’ glossary entry in the glossaries of all relevant perioperative nursing roles. The explanation is in direct alignment with the NMBA definition to ensure clarity and consistency across organisations.

Enrolled nurse: a person who provides nursing care under the direct or indirect supervision of a registered nurse. They have completed the prescribed education preparation and demonstrate competence to practise under the Health Practitioner Regulation National Law as an enrolled nurse in Australia. Enrolled nurses are accountable for their own practice and remain responsible to a registered nurse for the delegated care.^{1, p.6}

Note: Some ENs are registered by AHPRA with the notations ‘May only practise in the area of mothercraft nursing’ and ‘Does not hold a Board approved qualification in medication administration’. This is because from 1 July 2010 mothercraft nursing has not been a registration type on the Nursing and Midwifery Board of Australia (NMBA) register. ENs registered with these notations are either:

‘a registrant who held registration as a mothercraft nurse and had their registration changed to registration as an enrolled nurse on 1 July 2010, with the notation “May only practise in the area of mothercraft nursing” and the notation “Does not hold a Board approved qualification in medication administration”’,² or ‘an individual who was previously registered as a mothercraft nurse or as an EN with the notations “May only practise in the area of mothercraft nursing” and “Does not hold a Board approved qualification in medication administration” but let their registration lapse and have returned to the register after consideration and approval by the NMBA’.²

Wording for knowledge and skills in relation to invasive lines

A minor amendment has been made to wording of the Anaesthesia nurse standard and PACU nurse standard regarding the knowledge and skills required in relation to invasive, indwelling lines and catheters. This has been amended to ‘The … nurse shall have in-depth knowledge of and skills in assisting with the insertion and care of invasive, indwelling lines and catheters’. This amendment is made in alignment with NMBA standards for practice, ANZCA PS08(A) Position statement on the assistant for the anaesthetist, and ACORN member feedback to provide clarity and ensure that perioperative nurses are working within their scope of practice. It is outside the scope of practice of perioperative nurses to be inserting lines such as central venous catheters, arterial lines and pulmonary artery catheters.

Enrolled nurses’ supervision requirements aligned with NMBA standards for practice

An additional sentence has been added to all perioperative nursing roles, that are suitable for enrolled nurses – ‘ENs administering medication shall be supervised by an appropriately qualified RN, in accordance with the NMBA Enrolled nurse standards for practice’. This is to ensure direct alignment with the NMBA standards for practice and scope of practice.

Recommendation for nurse educators to undertake postgraduate studies

While it may seem minor, there is a difference in meaning between the words ‘can’ and ‘are recommended to’ and they provide different weight. While there is no evidence supporting a mandatory requirement for nurse educators to have post-graduate qualifications in perioperative nursing and/or teaching and learning, ACORN strongly advocates for nurse educators to undertake further education to support expert practice and develop knowledge and skills in education methodology. It is important to note that in some health services organisations there may be an expectation of a post-graduate qualification to meet the requirements of the role/position description.

Addition to PACU nurse knowledge and skills

A gap analysis of the PACU nurse standard identified that ‘neurovascular assessment’ and ‘assessment and management of post-operative wounds and wound dressings’ were missing from the knowledge and skills section of the standard. These have now been included and ensure alignment with ANZCA PS04(A) Position statement on the post-anaesthesia care unit (2020).

Change to perioperative manager competencies

After consultation with health service organisations and ACORN members, and in line with current research, ‘advanced life support’ and ‘anaesthetic and surgical emergencies’ have been removed from the perioperative manager competency criteria. This amendment is due to the evolving role of the perioperative manager (at times no longer a clinical perioperative manager), limited evidence to support this as a mandatory requirement, workforce sustainability and applicability, and organisational variations in the perioperative manager role. While ACORN advocates that all clinicians be educated and competent in providing anaesthetic and surgical emergency care, we also appreciate that the perioperative manager role may not be in a clinical capacity.

Amendments to remove discrepancies between volumes

A gap analysis and comparison of the PPSPN Standards for Individuals and PPSPN Standards for Organisations highlighted some minor differences in terminology and structure between the volumes. Amendments have been made to ensure direct alignment between the two volumes.

 

ACORN received over 1000 pieces of feedback from ACORN members, health service organisations and other perioperative stakeholders. Every piece of feedback was read and assessed for immediate action, future action or inclusion of additional context or commentary. We thank the perioperative community for taking the time to provide their constructive feedback, suggestions and research to support ACORN in ensuring that ACORN’s professional practice standards remain up to date, relevant and applicable to the Australian health care environment.

For further information, and to view the video recording of these amendments, please view the vide below.

 

 

Edwina Eaton (Clinical Excellence Coordinator)

On behalf of the ACORN Board of Directors

 

References

1. Nursing and Midwifery Board of Australia (NMBA). Registered nurse standards for practice [Internet]. Melbourne: NMBA; 2016 [cited 2021 Aug 31]. Available from: www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
2. Nursing and Midwifery Board of Australia (NMBA). Mothercraft nurses (Definitions) [Internet]. Melbourne: NMBA; [updated 2017 Oct 13, cited 2024 Mar 1]. Available from: www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Policies/Mothercraft-nurses.aspx