A Nursing Council competence review is the Council's assessment, under section 36 of the Health Practitioners Competence Assurance Act 2003 (the HPCA Act), of whether your nursing practice meets the standard required for your scope of practice. Reviewers appointed by the Council look at your records, speak to you and to people you work with, can observe you in practice, and report to the Council. If the Council finds your practice does not meet the standard, it can order a competence programme, which is a set of objectives you must meet under supervision within a timeframe, place conditions on your scope of practice, or require you to pass an assessment. Speak to NZNO or your indemnity insurer as soon as the letter arrives, keep every record as it is, and start preparing your evidence before the review begins.
What triggers a review
The Council can order a review whenever it has reason to believe a nurse's practice may be below the required standard of competence. The concern can reach it in these ways:
- An employer's mandatory notification. Under section 34 of the HPCA Act, an employer must tell the Council when a nurse resigns or is dismissed for reasons relating to competence. Your employer's report is the starting document; ask the Council for a copy.
- A notification from a colleague. Another health practitioner who has reason to believe your practice may be below the standard can notify the Council.
- A complaint. A patient or their whānau can complain, and a complaint about care is passed to the Health and Disability Commissioner, who can refer it back to the Council.
- A Professional Conduct Committee recommendation. A Committee can recommend that the Council review your competence; the guide to how a Professional Conduct Committee process runs explains when.
The guide to what happens after a notification to the Nursing Council explains how the Council chooses between the competence, health and conduct routes.
What the review measures you against
The reviewers assess your practice against the competencies for your scope of practice, whether you are registered as a registered nurse, an enrolled nurse or a nurse practitioner, and against the Council's Code of Conduct. They look at the work you do in your own setting: medicines management, assessment and escalation of a deteriorating patient, documentation, communication, delegation, cultural safety and working within your scope. The guide to how the Nursing Council's Code of Conduct is used shows how a concern is matched to the Code.
How the review runs, step by step
- Notice of the review. The Council writes to tell you it is reviewing your competence, why, and what the review will cover. You can respond in writing to the reasons it gives.
- Information gathering. You are asked for details of your practice: your role, your setting, your hours and your professional development. The Council can ask your employer for a report and for position descriptions and policies.
- The review itself. The reviewers read a sample of your documentation, interview you about your decisions in real cases, can observe you in practice, and can speak to colleagues and your manager. You can be asked to complete a written reflection or an assessment.
- The report. The reviewers report to the Council on whether your practice meets the competencies for your scope, with their reasons. You are given the report and the chance to comment before the Council decides.
- The Council's decision. The Council decides the outcome and tells you in writing, including what it will tell your employer and what will appear on the register.
- The programme or conditions. If the Council orders a competence programme or conditions, you work through them with a supervisor or preceptor, and reports go to the Council until it is satisfied.
What a competence programme is
A competence programme is the plan the Council can order when a review finds your practice below the standard. It names the competencies you must show, the activities that will get you there, a supervisor or preceptor, the evidence you must provide and the timeframe. You can keep working while you complete it, and your supervisor reports to the Council on your progress. At the end, the Council considers the evidence and decides whether you now meet the standard.
The Council can also place conditions on your scope of practice alongside or instead of a programme: working under supervision, not working as the only registered nurse on a shift, not administering certain medicines without a second check, or working only in a named setting. It can require you to pass an examination or assessment, or arrange counselling or assistance for you.
A recertification programme is different. The Act lets the Council set recertification programmes so that nurses show they are keeping their competence up to date, and the Council's continuing competence requirements are checked when you renew your practising certificate and through audit. A gap found at audit can itself lead to a competence review.
Interim orders during a review
If the Council has reason to believe your practice poses a risk of serious harm while the review is under way, it can suspend your practising certificate or impose conditions in the interim. You are entitled to be heard first. A nurse who has already agreed with an employer to work under supervision, or away from the part of practice concerned, and shown that in writing gives the Council a reason not to suspend. The guide to interim suspension and conditions on practice explains the risk test and how an order is lifted.
How to prepare
- Get advice first. NZNO or your indemnity insurer, before you put anything in writing to the Council or your employer.
- Read the competencies for your scope. Note where your practice meets them and where the concern says it does not.
- Write a reflection. On a separate document, take the events behind the concern and set out what happened, why, what you understand now and what you do differently.
- Gather your evidence. Professional development records, appraisals, feedback from colleagues, any supervision you have arranged, and dated certificates for courses completed since the concern was raised.
- Practise talking about your decisions. Ask a senior colleague to take you through two or three real cases and question your reasoning.
How the review closes
A review closes when the Council decides your practice meets the standard, either straight after the report or once a programme has been completed and conditions lifted. If a programme is not completed to the standard set, the Act lets the Council take further steps, including conditions or suspension. The guide to what happens in a competence review covers the same process for every profession, and the guide to what happens after a notification to any Council or Board gives the whole HPCA Act process.
Where remediation fits
A review looks at your practice now, so what you have done since the concern was raised counts. Courses completed before the review, with dated certificates in your evidence, show work already done on the competencies in question. Ensuring Clinical Competence and Patient Safety covers assessment, escalation and working within your competence. Professionalism for Nurses is written against the Nursing Council's Code of Conduct. Reflection for Fitness to Practise covers the written reflection reviewers read, and Remediation for Fitness to Practise covers building a plan of evidence.
Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Council or put in your remediation plan. The remediation courses for nurses facing a Nursing Council investigation are on one page, and the Council and Board investigation process explained shows where each sits. The guides to showing insight and building a remediation plan and how to write a response to a Council or Board notification cover what you send the Council.
Sources and further reading
- Nursing Council of New Zealand: the Code of Conduct, the competencies for each scope of practice and the Council's pages on competence reviews and recertification.
- Health Practitioners Competence Assurance Act 2003: section 34 on notifications and the competence review provisions from section 36.
- Health and Disability Commissioner: how a complaint about nursing care is assessed and referred.
Frequently asked questions
Is a competence review the same as a disciplinary investigation?
No. A competence review under section 36 of the HPCA Act asks whether your practice meets the standard for your scope. A conduct concern goes to a Professional Conduct Committee, which is a separate process that can lead to a charge before the Health Practitioners Disciplinary Tribunal. A review can still lead to a programme or conditions on your scope of practice, so take advice and prepare your evidence with care.
What is the difference between a competence programme and a recertification programme?
A competence programme is ordered for you after a review finds your practice below the standard: set objectives, a supervisor, evidence and a timeframe. A recertification programme is set by the Council under the Act so that nurses show they are keeping their competence up to date, and its requirements are checked at renewal and through audit. A gap found at audit can lead to a competence review.
Will my employer be told about the review?
If your employer made the notification, it already knows, and the Council can ask it for a report. When the Council orders a programme or conditions, your employer needs to know what you can and cannot do, and conditions can appear on the public register. Ask the Council in writing what it will tell your employer and what it will record, and take advice from NZNO before you speak to your manager about it.
Can I keep working during a competence review?
In the ordinary course, yes. The Council can suspend your practising certificate or impose conditions in the interim only if it has reason to believe your practice poses a risk of serious harm, and you are entitled to be heard first. Arranging supervision with your employer, or stopping work in the part of practice concerned, and telling the Council in writing gives it a reason not to suspend.
Should I contact NZNO before I respond to the Council?
Yes, on the day the letter arrives, or your indemnity insurer if you hold cover elsewhere. NZNO has advisers who deal with Nursing Council matters and the employment matters that run alongside them. They can tell you what to send, how to word your response to the reasons the Council gives, and whether a lawyer should be instructed. Healthcare Ethics New Zealand offers remediation courses and does not give legal advice.