Recency of practice: Ali’s story

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This is a guest post by Ali about her recency of practice dilemma.

At the bottom of this post, you will find links to previous Nurse Uncut posts on this issue, plus links to information about refresher courses, scholarships and the new NSWNMA professional indemnity insurance.

I am a Registered Nurse currently on maternity leave caring for my third child. My children are aged four, two and five months. I have returned to work on two separate occasions since first taking maternity leave in September 2008, but due to the close age gaps between my children I still remain 16 shifts short of completing the number of hours required by the Recency of Practice Standard over a five-year period. For me this means I will have to return to work when my baby is 10 months old (April 2013) in order to complete these shifts (without losing my registration).

I only became aware of the Recency Of Practice Standard while on maternity leave with my second baby and six months pregnant with my third child. I had not received any information about the changes and was shocked to learn that I was at risk of losing my registration and also that the standard was retrospective. I was also disappointed to find that the standard had been made in 2010 but no notification had been sent with registration renewal. If I had become aware of the change earlier I would have returned to work from my second stint of maternity leave eight weeks earlier so as not to be in this position now.

When I did return to work when my second child was 22 months old, it was only feasible for me to work two days per week. I worked as long as I was able, until my 38th week of my third pregnancy. This arrangement was a challenge, despite my then-youngest child being a lot older than the 10 months my now-youngest will be next April. The thought of returning to work when the baby is only 10 months old is heartbreaking to me. I plan to breastfeed him until two years of age (as recommended by the World Health Organisation) and feel that returning to work at this time could interfere with my breastfeeding goal, as I’ve recently seen happen to a friend when she returned to work with a baby of the same age.

My baby refuses a bottle at this stage and I am finding the thought of leaving him for a nine to 10-hour day to be very stressful. At this stage in my life I could not be busier, with three young children to care for – I can see expressing enough milk may also be an issue even if he does eventually accept a bottle.

The cost of putting three children into daycare will be high, but more stressful for me is the thought of putting my 10-month-old into care. I realise many people make returning to work positive for their own families and it works for them. However, my husband and I made a personal decision prior to having children that it was extremely important to us for me to have the option of staying at home with our children as long as we felt was necessary. We worked very hard prior to having children and planned very carefully to build up our savings to allow me to remain at home caring for them, without huge financial pressure to return to work. We have lived frugally and regularly gone without so as to achieve this. It is frustrating to be forced back to work to keep my registration.

I have returned to work twice after having kids, first after 15 months of leave and then following 22 months of leave. Both times I found the transition back to work quite easy and was quickly able to pick up on any changes and develop any new skills necessary to perform my job efficiently, safely and professionally. Probably the biggest challenge for me was my level of fatigue and I know that will also be an issue this time around as my two youngest children still wake regularly throughout the night and my eldest sometimes wakes. I feel if I was forced back to work, fatigue would be the biggest risk to my being an unsafe practitioner, not my knowledge or skill level, which I feel is well up-to-date. I have of course been completing my CPD hours, which is also helping me keep up-to-date while on leave.

I am simply requesting to be able to stay at home with my children until my maternity leave ends when my baby will be 23 months old (May 2014). I feel this is not unreasonable as I am still employed by my area health service and the maternity leave is part of the award.

I love being home with my children, but I also love my job and do not want to lose my registration. I have plans to undertake further study when my children are a little older. I am only 30  and we are not having any more children so I am looking forward to many more years in my profession.

This is an edited version of the letter I wrote to three members of federal Parliament, Tanya Plibersek, Kate Ellis and Julie Owens.

Hi Tanya, Kate and Julie,

I am writing to you in the hope that you can help me. I don’t follow politics closely but I have seen both Tanya and Kate on Q&A and feel you are both very trustworthy and feel strongly about women’s rights/issues and are in politics for the right reasons, so I feel if any politicians will be able to help me then you will!

I am a Registered Nurse and mum to three young children. I am currently on maternity leave with my 3rd baby. AHPRA (the Australian Health Practitioner Regulation Agency) has enforced a Recency of Practice Standard in which nurses are required to complete 480 hours of work in their field over five years or they must complete a re-entry course.

I have returned to work between all my children. I will now be forced to return to work when my youngest is 10 months old to complete 16 shifts before my five-year period is up. I understand the standard is a federal policy, which is why I am writing to you. The issues I have with the standard are:

1. It was retrospective. I first went on leave in 2008. The standard was made in 2010. I was not given any extra time to complete my hours. Many nurses who had been away from the job for 5 years but had dutifully been paying their registration every year were told they could no longer practice as a nurse unless they re-trained.

2. AHPRA didn’t tell anyone about the standard. The information started to circulate around the workplace as a rumour that nobody believed could be true! As I was on leave I only found out about the new policy when I was six months pregnant with my third child, with a three year old and 20 month old to care for at home. I would have had to return to work four days a week, which was impossible for me at that time. I returned to work two days a week till 38 weeks of pregnancy, but remain 16 shifts short of achieving my hours.

3. I feel it is discrimination against pregnant women and mothers caring for young children. I am entitled to 23 months of maternity leave to care for my baby under the Award. However I will be forced back to work 13 months earlier to meet the requirements of the standard. I plan to breastfeed until my son is at least 2 years old and I feed on demand. I feel very nervous and emotional about leaving him at that age.

4. In NSW if you are required to complete a re-entry course this involves paying $10,000 for the course. There is currently only one course available, which is one month fulltime and must be completed on campus at the Royal College of Nursing in Sydney (2 hours travel time each way for me and obviously much further if you live in rural areas). Nurses are then required to work unpaid in a clinical setting for one month. [Please see update on this information below.]

5. If I do return and complete my 16 shifts I can then take another four years and nine months off with no questions asked! The longest amount of time I have been away from nursing is 22 months and yet I am being told I cannot continue to practice as an RN if I don’t complete these 16 shifts!

I wrote to AHPRA requesting an extension on the time I had to complete my 16 shifts. I was told this was not possible as the standard does not allow for exceptions.

I am only 30 years old and this is our last baby. I have many many years left in the nursing profession! With a predicted nursing shortage of 109,000 by 2025, I cannot believe the government is placing so many barriers in front of experienced nurses returning to work!

Both times I returned to work following maternity leave I quickly picked up on any small changes that had occurred. I am extremely confident I can do my job safely and effectively! (Returning to work earlier than planned with two kids that wake several times every night and a third who occasionally wakes of a night is a different story! This standard is supposed to ensure safe practice, but with my current level of fatigue I don’t think I would be a safe practitioner!)

I love my profession but my young children come first at this time in my life. I am torn between somehow making it possible to return to work to complete these shifts or leaving nursing. I am sure you can understand though that it is difficult to throw away my career.

I have four months until I will be forced back to work. Thank you for taking the time to read my email. I know you all must be incredibly busy, but please help me!

Yours sincerely,

Ali

AHPRA have rejected my request to be allowed to complete my maternity leave. My only choices now are to return to work in four months time when my baby is 10 months old or complete the re-entry course. I have several friends with children my age who are teachers. Interestingly teachers have no problems taking time away from their profession to raise children. This is another double standard.

Updated info: 

  • The pressure that was brought to bear by the NSWNMA on this issue earlier in 2012 resulted in the NSW Ministry of Health offering re-entry scholarships to nurses. Apparently not all the scholarships were taken up, ie. places are still available.
  • Membership of the NSWNMA now automatically gives you professional indemnity insurance, which is necessary if doing supervised practice during refresher courses.
  • There is now an online re-entry program available: Institute of Health and Nursing Australia http://www.ihna.edu.au

Previous Nurse Uncut blog posts on this issue:

National registration for nurses

Frustration over new national registration

Unnecessary hurdles for nurses wanting to return to work

Unnecessary hurdles part 2

Return to nursing? Not at $10,000

18 COMMENTS

  1. If you were thinking, that AHPRA would be “reasonable” with your request … then you obviously didn’t read through the few hundred posts on this website, that identify just how “reasonable” AHPRA is …

    Sorry, but welcome to the world of ‘Post July 2010’ …

  2. Our society has lost common sense. We should be encouraging young Mums to care for their children not rush back to work before they are ready. Obviously with the high cost of childcare Alice would probably not even make any money and put her family under a lot of stress and for what? With 3 small children Alice has enough to do without contemplating paid work and this time in her and her kids lives is so short and can never be replaced. She has years of paid work ahead of her and her experience gained as a mother to 3 small children will be invaluable to her future nursing practice. Come on APHRA give her and other young mothers a fair go.

  3. Yep, agree with Gordo, how could anyone expect AHPRA to be fair and reasonable? They haven’t so far! Obviously not a skerrick of common sense among them.
    I had to return to work for financial reasons when my children were 7-8 weeks old. I was still studying for my degree at the time, so juggling this with work plus new baby was difficult to say the least. I would have loved 22 months maternity leave – or even 6 months! I did express and my children were fed nothing but breastmilk as recommended. I was lucky that they all took a bottle though, none of them cared where the milk came from.

    I thought that online course looked good until I saw the price! How can they possibly justify $7500?! A great little money spinner for them, taken from the pockets of those who care for others……….

  4. I’ve only picked up on this in the last few days:

    Both Nurse Uncut and the NSWNMA are promoting the IHNA online course for $8,250. as an alternative to the CoN course at $10,000.

    The IHNA course is Victorian-based and if you live in NSW and complete this course, you will not be processed by AHPRA.

    Why haven’t the above two parties realised this?

    [Admin note: this is incorrect. Please read Admin comment in full on this issue.]

  5. We contacted the IHNA (Institute of Health and Nursing Australia) to ask about this and this is their reply:

    I can confirm our Online Registered Nurse Re-entry to Practice Program is accredited by the Australian Nursing and Midwifery Accreditation Council (ANMAC) to be provided Australia-wide.

    Our Registered Nurse Re-entry to Practice Program can be delivered face to face also, but only in Victoria and Perth, and this is accredited also by the Australian Nursing and Midwifery Accreditation Council (ANMAC).

    I hope this clarifies our credentials.

    Regards,

    Mia Montagliani
    IHNA

  6. The AHPRA website lists courses that are accredited for re-entry requirements in Australia. It is a bit confusing, as the list states the location of the course (eg: NSW/Vic). However, this is the location of the *provider’s office*, not their coverage; they are all nationally accredited to provide re-entry programs for registration with AHPRA. So a nurse can access any of those courses listed, regardless of where they live and intend to register.

    Some will offer online, while others may not. When the training provider applies for accreditation of their course, they must submit the curriculum and the mode that their course will be provided in: ie. face to face and/or online and are accredited accordingly – so the INHA course is accredited to provide face to face or online – and, as they say, they only offer face to face in Vic and WA.

    The nurse will need to also complete the practical component and should consider the steps for securing a placement for this. Usually the provider will assist or the nurse can find a placement themselves. (This is no different from, for example, rural nurses who travel to Sydney to do the face to face, but then want do the practical component closer to home.)

    In terms of fees, the scholarship program in NSW* offers scholarships of up to $10,000 to undertake the accredited re-entry course run at the College of Nursing in NSW, subject to criteria about working in the public system. (Midwives can apply for scholarship funds to attend re-entry courses interstate as there are no courses for re-entry for midwifery in NSW.)

    Nurses accessing other accredited courses interstate or online would have to meet the costs themselves as the scholarship program is currently for the College of Nursing course only.

    As mentioned previously on this thread, the Professional Indemnity Insurance now automatically conferred on financial members of the NSWNMA covers re-entry students on placement, so you should make this clear to potential placement facilities.

  7. Reading these comments makes me wonder why anyone now would choose nursing as a career, when it is made so hard for women to stay in nursing.
    You can thank the academics who pushed for recency of practice, among them being the College of Nursing.
    And who are the ones we are supposed to be encouraging to take up nursing – it is of course the younger nurses, particularly females, who make up most of the nurses we now have – and what do they do when they are young? Of course have families.
    I am glad I am nearing the end of my time nursing, being in my 50s, as I wouldn’t recommend it to anyone younger any more – unfortunately. What a joke – pay lots of money to a university, it’s mainly all do it yourself learning, adult learning they call it. Then do very little practical and when you do it, go into a health facility to work and the academics leave you with some experienced nurses who have their own workload and then are expected to teach you also, while the academic is heaven knows where…
    And now this – another nail in the coffin for nursing – recency of practice – someone who doesn’t have any kids has dreamed this up. And if the poor women who have to comply with this take it on it means they have to leave their children at some childcare place while they go and look after someone else, to prove they can still do it.
    Well you academics who sit behind desks you are the ones who need the recency of practice – if you were in the real world away from your computers you might be able to see who is a good nurse. Basic caregiving doesn’t change – the only things that change in care are technology or maybe some new treatment or procedure, which someone can show you how to do anyway. And most nurses who are not sure of something will ask how to do it.
    Another one of their ideas or someone in the NSW Health – probably another desk jockey – decided that everyone has to do night shift – I would have to asky why? In my over 30 years of nursing I have worked various shifts which suited my family situation at the time – and I have found that if you give people the shifts they want or suit them, then they’ll turn up and work well. If not they are just under stress, which none of us need in a difficult, poorly paid job anyway.

    Yeah, nursing – why would you want to be one now?

  8. It seems to me that with the setting up a national registering authority which covers a number of health professions, the registering authority has been able to distance itself from the clientele and give itself the power of a despot. These faceless people are not working in the interests of nurses, the health consumer and certainly not the profession or the employers. So who do they work for? Themselves. It is a well known fact that the larger the organisation, the more remote they become from the sector they are supposed to serve and service. No one ever asked nurses if they wanted a national registering authority or even if they wanted to move from a Nurses Registration Board.

  9. You would think APHRA standards could at least be in line with the State Nurses Awards. Clearly they are not, in the case of the Recency of Practice standard. I wonder how many other APHRA standards contradict the various Nurses Awards?

  10. I have been a nurse since 1975. I recently have had time off to have surgery and was looking forward to returning to the workforce and my career as a nurse, until my niece Alice Haynes told me I would have to pay $10,000 for a refresher course. Unfortunately I am unable to afford this, as our family is currently a one income family, we have 3 children aged 18, 13 and 11. We can’t even afford to take our kids on holidays. I can’t believe a refresher course would cost $10,000. So ends my nursing career. Looking for employment/retraining elsewhere now.

  11. Does anyone know of any lawyers in Sydney who have experience dealing with the appeals process against AHPRA de-registration due to recency of practice?

    Shane

  12. I have just had my registration declined on the grounds of not meeting the ‘recency of practice’ standards. I’m a Registered Nurse (BA Nursing, graduating with High Distinction) and Midwife (Masters of Midwifery graduation with High Distinction average) and took 4.5yrs off work to have three children (of which I have absolutely no regrets as my family is my clear priority). I re-registered last year fine (with the ‘recency of practice’ hours coming from the work I did before having my children), applied at our local country hospital in Sept and finally was orientated in the Feb. I’ve been working casually since Feb in a maternity women’s health unit, thus working as both an RN and midwife, and working across the board of pre-natal, intrapartum and post-natal care. Coming up to registration for this next year I have only been able to count the hours I’ve done since returning to work (around 200) as my previous employment has now fallen beyond the ‘last 5 years’. I was told yesterday that my registration as both RN and Midwife has been refused and I would have to complete a refresher to get back in – that is a refresher for nursing and/or a refresher for midwifery. I was also told there are no midwifery refreshers available in Qld and that you can not re-enter midwifery via supervised hours. Funnily enough it was made clear to me that the letter outlining the above would take 30 days to get to me so I’m fine to keep working up till then. So ultimately, I’m competent now, but in 30 days I won’t be. I understand the recency of practice standards completely, but in this situation where I am currently employed and working, I feel that the decision of my competence should be made by my employer/nurse unit manager etc – those that can actually testify of my competence. Since Feb I have completed all mandatory training for my position and multiple online education courses provided by the hospital’s educator (which is much of what a refresher course would offer I’m sure!) I have maintained CPD for both RN and Midwife and my time away from work, birthing and raising my own babies, I sincerely believe has only made me a better and more compassionate nurse and midwife. Yet now I walk away because of flawed ‘legislation’. My last few shifts will be strange – knowing that a looming date will deem me incompetent in doing what I’m doing at that very second.

  13. I to am an RN but firstly a mum of 3 young boys and I am facing the same losing battle with AHPRA. Is there anything legally that can be done? There appears to be so many mothers around Australia in the same boat and it sounds like they are all getting the door slammed in their faces by AHPRA.

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