Fitness to Practice in Clinical Placement

The UniSA School of Nursing and Midwifery is committed to supporting the rights of all people who wish to pursue a career in nursing or midwifery.  The Fitness to Practice in Clinical Placement Requirement Statements have been developed to provide guidance to prospective students regarding the physical, sensory, mental, emotional and behavioural requirements needed to undertake nursing and midwifery work place learning.  The School of Nursing and Midwifery Fitness to Practice in Clinical Placements (Practice-based Learning) Guidelines and Procedures  establish fitness for practice clearance process for all students and describe the processes to be followed when concerns are raised regarding a student’s ability to meet the Fitness to Practice in Clinical Placement requirements of a program and/or course.

The Fitness to Practice in Clinical Placement Requirement Statements identify the essential abilities, knowledge and skills needed to achieve the core learning outcomes of accredited programs required for professional registration with the Nursing and Midwifery Board of Australia (NMBA) through the Australian Health Practitioner Regulatory Agency (APHRA), inclusive of programs that require a clinical placement experience (on or off campus) to meet the program/course learning outcomes. The programs included are:

“Fitness to Practice in Clinical Placements” means the requirements of a program (clustered under eight domains) that are essential to undertake nursing and midwifery placement activities in a range of practice-based learning environments (including the UniSA Horizon Hospital and Health Service, hospitals and health services/clinics) and are described in further detail in the Fitness to Practice in Clinical Placement Requirement document.

Nursing and midwifery programs include substantial practice-based learning elements in which students are exposed to clinical practice and the public.  The School of Nursing and Midwifery has an obligation under the National Law to notify AHPRA if a student enrolled in an approved program has:

“an impairment that, in the course of the student undertaking clinical training, may place the public at substantial risk of harm” (Clause 141 (1) (b).

The Fitness to Practice in Clinical Placements Requirement Statements have been developed to advise students of the requirements necessary to undertake a clinical placement as a student in preparation for entry (registration) into the nursing and midwifery professions or for specialist/advanced practice. All students must confirm that they meet the Fitness to Practice in Clinical Placements requirements  on entry to the program and on each re-enrolment in the program. It is important to note that the Fitness to Practice in Clinical Placements requirements of the programs are not necessarily synonymous with an impairment requiring notification under the National Law. 

Students with a disability or chronic health condition may be able to have reasonable adjustments made to teaching and learning, assessment, clinical practice and other activities to enable them to participate in their course and meet the Fitness to Practice in Clinical Placements requirements. However, reasonable adjustments should not fundamentally change the nature of the Fitness to Practice in Clinical Placements requirements.

Making Your Fitness to Practice Declaration

The School of Nursing and Midwifery will contact you via email with your personal and confidential access link where you will be required to make a declaration regarding your Fitness to Practice in Clinical Placement requirements at the beginning of your program and/or for a specific course throughout your program

All students enrolled in programs will be advised of their obligations’ under the National Law, University rules and policies and School procedures associated with practice-based learning through the School of Nursing and Midwifery Clinical Placement Unit website.

Student Services and Support

The University provides a range of student services and support. Students who have a disability, mental health or medical condition which may impact on their studies are strongly encouraged to Register for Disability Services on accepting an offer into a program.

Students with a disability or medical condition who have an assessment with a Disability Adviser may be provided with an Access Plan (AP).  This document will include an ‘Impact Statement’ which details the impact of the student’s disability and supports the negotiation of reasonable adjustments that can be made to assist the student to achieve the relevant program’s Fitness to Practice in Clinical Placement Requirement Statements aligned to the program learning outcomes and program rules.  Disability Advisers can assist students in this negotiation process, providing information and advice regarding support options.  The reasonable adjustments in clinical courses are negotiated with the Program Director (or nominee) and may be subject to amendment if the School considers the adjustments proposed are inconsistent with the Fitness to Practice in Clinical Placement Requirement Statements of the relevant program.  The provision of an AP should not be construed as a determination by the University that the student can meet the Fitness to Practice in Clinical Placements Requirement Statements of the relevant program. 

Fitness to Practice Procedure

The following procedure must be initiated when concerns are raised regarding a student’s ability to meet each of the eight domains of Fitness to Practice in Clinical Placements.

It is essential that any concerns of this nature are properly investigated.  Students who are not fit to practice during a clinical placement may pose a risk to the public, clinical placement host staff, UniSA staff and other students if they are permitted to participate in clinical placements.  These students may also fall within the mandatory notification requirements under the National Law.  The University shall carry out the procedure described below in a manner that is as timely and discrete as reasonably practicable and provides procedural fairness for students who are the subject of investigations.  All information collected by the School of Nursing and Midwifery as part of the procedure described below shall be retained and dealt with in a manner that is consistent with the UniSA Confidentiality of students’ personal information.

The following circumstances are examples which could raise doubts about a student’s ability to meet one or more of the Fitness to Practice in Clinical Placements requirements and potentially cause a student to be unfit to practice during a clinical placement. 

These examples are illustrative only and are not intended to be exhaustive:

  1. Evidence of chronic drug or alcohol misuse;
  2. Evidence of un-controlled mental illness or other disability which impairs a student’s capacity to meet fitness to practice requirements regardless of reasonable adjustments;
  3. Acting in a violent or aggressive manner;
  4. Intimidation of patients/clients, placement host staff, UniSA staff and fellow students;
  5. Fraudulent or dishonest behaviour;
  6. Failure to comply with legislative and compulsory pre-clinical document requirements for clinical placement; and
  7. Convicted or found guilty of an offence punishable by imprisonment in Australia and/or overseas.

Requirement for Medical Clearance

Where the Program Director or Head of School decides that a medical clearance from a registered medical practitioner is necessary to make a determination about a student’s fitness to practice the student will be requested to provide within ten (10) business days (or such longer period as may be approved by the Program Director or Head of School) a report from a medical professional.  A template form has been developed by the School of Nursing and Midwifery for this purpose. Through the Program Director or Head of School, the University can stipulate the medical practitioner the student is required to consult for an independent assessment.

Concerns about a nursing or midwifery student’s ability to meet the Fitness to Practice in Clinical Placement requirements of the program and to demonstrate fitness to practice on a clinical placement, will be managed in accordance with the UniSA Assessment Policies and Procedures Manual Subclause 4.3 Suitability for practice-based learning activities.

Related policies, rules and procedures

  1. Fitness to Practice in Clinical Placements (Practice-based Learning) Guidelines and Procedures are subject to all policies of the University.

    Examples of pertinent University policies and procedures include:
    Assessment Policies and Procedures Manual, Section 4
    A-46.8 - Confidentiality of students’ personal information
    C-7.4 Students with Disability Policy
    Statute 7: Student Misconduct
    UniSA Work Health and Safety Wellbeing
    UniSA Code of Conduct for Students
    UniSA Clinical Placement Unit - Division of Health Sciences Clinical Placement Policy
    UniSA Clinical Placement Unit: Students with Disabilities section
    UniSA Confidentiality of students’ personal information
     
  2. National Laws

    Nursing and Midwifery Board of Australia’s Registered Nurse Standards for Practice
    Health Practitioner Regulation National Law (South Australia) Act 2010
     
  3. Nursing and Midwifery Board of Australia (NMBA)
    NMBA Professional Standards
    • Code of Conduct for Midwives (March 2018)
    • Code of Conduct for Nurses (March 2018)
    • Midwifery competency standards (July 2010)
    • Registered nurse standards for practice (June 2016)

Acknowledgements

The UniSA, School of Nursing and Midwifery, Fitness to Practice Guidelines and Procedures are based on the following work. 

Johnson, A., Allan, T., Phillips, K., Azzopardi, T., Dickson, C., Goldsmith, M & Hengstberger-Sims, C. (2011). Program Requirements of Nursing Education (IRONE), UWS School of Nursing & Midwifery and Student Equity & Disability Services.

Edith Cowen University (2016) School of Nursing and Midwifery, Fitness to Practice in Clinical Placements Guidelines and Procedures.  


Fitness to Practice in Clinical Placement Requirement Statements

These statements identify the essential abilities, knowledge and skills needed to achieve the learning outcomes of programs offered in the School of Nursing and Midwifery that require a clinical placement experience to meet program/course learning outcomes.

There are eight domains of Fitness to Practice (some of which have sub-domains) as described below.

 

1. Ethical behaviour

Nursing and midwifery are professions governed by competency standards, codes of ethics, professional conduct and professional boundaries where nurses are both accountable and responsible for ensuring professional and ethical behaviour in all contexts. Students in this program must therefore demonstrate knowledge of, and engage in ethical behaviour in practice at all times.

Why is this requirement of the program?

Compliance with the standards, codes, guidelines and policies facilitates safe, competent interactions and relationships for students and/or the people with whom they engage. This supports the physical, psychological, emotional and spiritual wellbeing of all.

What support can be provided?

Support must ensure the standards, codes, guidelines and policies are not compromised or result in unethical behaviour. Support specific to the individual can be discussed with the Program Director or SEU student support staff. Examples may include additional learning support or counselling.

What examples demonstrate that you have met the requirement?

  • demonstrating appropriate behaviour with confidential information in classroom and clinical settings
  • demonstrating the ability to reflect on ethical dilemmas and issues and take responsibility for ensuring awareness of ethical behaviour.

Return to top

2. Behavioural stability

Behavioural stability is required to function and adapt effectively and sensitively in the nursing and midwifery professions. Students must demonstrate behavioural stability to work constructively in a diverse and changing academic and clinical environment.

Why is this a program requirement?

Behavioural stability is required to work individually and in teams in changing and unpredictable environments. Nursing and midwifery students will be exposed to emergency situations and human suffering and will be required to have behavioural stability to manage these events.

What support can be provided?

Support should enable stable, effective and professional behaviour in both academic and clinical settings. Support specific to the individual can be discussed with the Program Director or SEU support staff. Adjustments and support may include provision of counselling to assist students in managing emotional challenges; locating placements so that students can maintain access to support networks.

What examples demonstrate that you may have met the requirement?

  • being receptive and responding appropriately to constructive feedback
  • coping with your own emotions and behaviour effectively when dealing with individuals in the clinical setting
  • reacting appropriately in stressful and changing situations in a clinical setting, for example, with patients who have cardiac arrest, severe wounds and or are dying
  • dealing with bodily functions appropriately.

Return to top

3. Legal compliance

Nursing and midwifery practice are mandated by legislation to enable the safe delivery of care and students must demonstrate knowledge and compliance with Australian Law, professional regulations and scope of practice.

Why is this a program requirement?

Knowledge, understanding and compliance with legislative and regulatory requirements are necessary pre-requisites to clinical placements in order to reduce the risk of harm to self and others. Compliance with these professional regulations and the Australian Law ensures that students are both responsible and accountable for their practice.

What support can be provided?

Support must be consistent with legislative and regulatory requirements. Support specific to the individual can be discussed with the Program Director or SEU student support staff.

What examples demonstrate that you have may met the requirement?

  • complying with the requirement for student registration with the Australian Health Practitioner Regulation Agency (AHPRA)
  • complying with relevant child protection and safety legislation.

Return to top

4. Communication

Nursing and midwifery students require effective, verbal, non-verbal and written communication skills.

Verbal

This requirement includes:

  • sensitivity to individual and/or cultural differences
  • the ability to understand and respond to verbal communication accurately, appropriately and in a timely manner
  • the ability to provide clear instructions in the context of the situation
  • timely clear feedback and reporting.

Why is this a program requirement?

Effective verbal communication, in English, is an essential requirement to provide safe delivery of care. Nurses and midwives are required to communicate in a way that displays respect and empathy to others and develops trusting relationships. In addition, communication may be restricted to verbal because of physical limitations of the individual (e.g. injury, disease or congenital conditions) and speed and interactivity of communication may be critical for individual safety or treatment. Timely, accurate and effective delivery of instructions is critical to individual safety, treatment and management.

What support can be provided?

Support must address effectiveness, timeliness, clarity and accuracy issues to ensure safety and appropriate care. Support specific to the individual can be discussed with a UniSA counsellor, Learning Adviser or Disability Advisor. Support may include provision of additional communication skills development programs.

What examples demonstrate that you may have met the requirement?

  • participating in tutorial, simulation and clinical discussions
  • responding appropriately to a care request in the clinical environment.

Non-verbal

Effective non-verbal communication is fundamental to nursing and midwifery practice and needs to be respectful, clear, attentive, empathetic and non-judgmental. This requirement includes:

  • the capacity to recognise, interpret and respond appropriately to behavioural cues
  • consistent and appropriate awareness of own behaviours
  • sensitivity to individual and/or cultural differences.

Why is this a program requirement?

The ability to observe and understand non-verbal cues assists with building rapport with people and gaining their trust and respect in academic and professional relationships. Displaying consistent and appropriate facial expressions, eye contact, being mindful of space, time boundaries and body movements and gestures promotes trust in academic and professional relationships. Being sensitive to individual and/or cultural differences displays respect and empathy to others and develops trusting relationships. The ability to observe and understand non-verbal cues is essential for the safe and effective observation of patient symptoms and reactions to facilitate the assessment and treatment of patients.

What support can be provided?

Support must enable the recognition, initiation of or appropriate response to effective non-verbal communication in a timely and appropriate manner. Support specific to the individual can be discussed with the Program Director or SEU student support staff.

What examples demonstrate that you may have met the requirement?

  • recognising and responding appropriately in classroom situations
  • recognising and responding appropriately to cues in the clinical environment.

Written

Nursing and midwifery students must demonstrate the capacity to construct coherent and effective written communication, in English, appropriate to the circumstances.

Why is this a program requirement?

Effective written communication, in English, is a fundamental nursing responsibility with professional and legal ramifications. Construction of written text-based assessment tasks to reflect the required academic standards are necessary to convey knowledge and understanding of relevant subject matter for professional practice. Accurate written communication, including record-keeping and patient notes, is vital to provide consistent and safe patient care.

What support can be provided?

Support must meet necessary standards of clarity, accuracy and accessibility to ensure effective recording and transmission of information in both academic and clinical settings. Support specific to the individual can be discussed with the Program Director or SEU student support staff.

What examples demonstrate that you may have met the requirement?

  • constructing an essay to academic standards
  • constructing a nursing report in a timely manner that meets professional standards.

Return to top

5. Cognition

This course requires knowledge of theory and the skills of cognition, literacy and numeracy.

Knowledge and cognitive skills

Consistent knowledge and effective cognitive skills must be demonstrated to provide safe and competent nursing and / or midwifery care. This includes:

  • the capacity to locate appropriate and relevant information
  • the ability to process information relevant to practice
  • the ability to integrate and implement knowledge in practice.

Why is this a program requirement?

Safe and effective delivery of nursing care is based on comprehensive knowledge that must be sourced, understood and applied appropriately.

What support can be provided?

Support must ensure that a clear demonstration of knowledge and cognitive skills is not compromised or impeded. Support specific to the individual can be discussed with the Program Director or SEU student support staff.

What examples demonstrate that you may have met the requirement?

  • ability to conceptualise and use appropriate knowledge in response to academic assessment items
  • applying knowledge of policy and procedures in the clinical setting.

Literacy (language)

Competent literacy skills are essential to provide safe and effective delivery of care. This includes:

  • the ability to acquire information and accurately convey appropriate, effective messages
  • the ability to read and comprehend a range of literature and information
  • the capacity to understand and implement academic conventions to construct written text in a scholarly manner.

Why is this a program requirement?

The ability to acquire information and to accurately convey messages is fundamental to ensure safe and effective assessment, treatment and delivery of care. The ability to read, decode, interpret and comprehend multiple sources of information is fundamental for the safe and effective delivery of nursing and / or midwifery care.

What support can be provided?

Support must achieve a capacity to effectively acquire, comprehend, apply and communicate accurate information. Support specific to the individual can be discussed with the Program Director or SEU student support staff.

What examples demonstrate that you may have met the requirement?

  • demonstrates the ability to listen to information, for example, on the telephone, in an emergency situation, in tutorials
  • demonstrates the ability to convey a spoken message accurately
  • demonstrates the ability to paraphrase, summarise and reference in accordance with appropriate academic conventions
  • demonstrates accurate, concise and clear nursing documentation

Numeracy

Competent and accurate numeracy skills means that you have the ability to interpret and correctly apply data, measurements and numerical criteria.

Why is this a program requirement?

Competent and accurate application of numeracy skills is essential in nursing to facilitate the safe and effective delivery of nursing and / or midwifery care.

What support can be provided?

Support must demonstrate a capacity to interpret and apply concepts and processes appropriately in a timely, accurate and effective manner. Support specific to the individual can be discussed with the Program Director or SEU student support staff.

What examples demonstrate that you may have met the requirement?

  • performing accurate drug calculations
  • demonstrating accurate recording on a fluid balance chart.

Return to top

6. Sensory ability

This course requires adequate visual, auditory and tactile abilities (sight, hearing, touch).

Visual ability

Students must demonstrate sufficient visual acuity to perform the required range of skills.

Why is this a program requirement?

Adequate visual acuity is required to provide safe and effective nursing care. Sufficient visual acuity is necessary to demonstrate the required range of skills, tasks and assessments to maintain consistent, accurate and safe care of self and to others. Visual observations, examination and assessment are fundamental to safe and effective nursing practice.

What reasonable adjustments can be made?

Adjustments must address the need to perform the full range of tasks involved in clinical practice. Any strategies to address the effects of the vision impairment must be effective, consistent and not compromise treatment or safety. Adjustments specific to the individual can be discussed with a Disability Advisor.

What examples demonstrate that you may have met the requirement?

  • accurately drawing up medication to administer
  • observing and detecting subtle changes in wounds and patient condition.

Auditory ability

Auditory ability is required to provide sufficient aural function to undertake the required range of skills.

Why is this a program requirement?

Auditory ability is required to provide safe and effective nursing care. Sufficient auditory ability is necessary to monitor, assess and manage an individual's health needs consistently and accurately. Auditory assessments and observations are fundamental to safe and effective nursing and / or midwifery practice.

What reasonable adjustments can be made?

Adjustments must address the need to perform the full range of tasks involved in clinical practice. Any strategies to address the effects of the hearing loss must be effective, consistent and not compromise treatment or safety. Adjustments specific to the individual can be discussed with a Disability Advisor.

What examples demonstrate that you may have met the requirement?

  • accurately undertaking a blood pressure measurement by auscultation
  • detecting care request by activation of call bell or calls for help.

Tactile ability

Sufficient tactile ability is required to perform competent and safe nursing care. This includes adequate tactile function sufficient to undertake the required range of skills and assessments.

Why is this a program requirement?

Sufficient tactile ability is necessary to monitor, assess and detect patients' physical characteristics and act on any abnormalities detected to provide thorough nursing care. Tactile assessments and observations are fundamental to safe and effective nursing and / or midwifery practice.

What reasonable adjustments can be made?

Adjustments must have the capacity to make effective assessments of physical characteristics and abnormalities within safe time frames. Adjustments specific to the individual can be discussed with a Disability Advisor.

What examples demonstrate that you may have met the requirement?

  • detecting any changes in circulation observations e.g. temperature and pulse palpation
  • conducting a physical assessment and detecting any anatomical abnormalities.

Return to top

7. Strength and mobility

This program requires strength and mobility involving fine and gross motor skills.

Gross motor skills

Nursing and midwifery involve physical demands which include the ability to perform gross motor skills to function within scope of practice. This includes lifting, carrying, pushing, pulling, standing, twisting and bending.

Why is this a program requirement?

Sufficient gross motor skills are necessary to perform, coordinate and prioritise care. Students must be able to demonstrate and perform these tasks consistently and safely to reduce the risk of harm to self and others.

What reasonable adjustments can be made?

Adjustments should facilitate functional effectiveness, safety of self and others and a capacity to provide appropriate care. Adjustments specific to the individual can be discussed with a Disability Advisor.

What examples demonstrate that you may have met the requirement?

  • maintaining balance while safely mobilising and transferring individuals or resources
  • able to safely retrieve and utilise stock and equipment.

Fine motor skills

Nursing and midwifery are professions that require manual dexterity and fine motor skills such as being able to grasp, press, push, turn, squeeze and manipulate various objects and individuals.

Why is this a program requirement?

Sufficient fine motor skills are necessary to perform, coordinate and prioritise care. Students must be able to demonstrate and perform these tasks consistently and safely to reduce the risk of harm to self and others.

What reasonable adjustments can be made?

Adjustments should facilitate functional effectiveness, safety to self and others and a capacity to provide appropriate care. Adjustments specific to the individual can be discussed with a Disability Advisor.

What examples demonstrate that you may have met the requirement?

  • performing an aseptic wound dressing
  • able to prime, accurately insert and set prescribed rate on an infusion device

Return to top

8. Sustainable performance

Nursing and midwifery practice requires both physical and mental performance at a consistent and sustained level. This includes:

  • consistent and sustained level of physical energy to complete a specific task in a timely manner and over time
  • the ability to perform repetitive activities with a level of concentration that ensures a capacity to focus on the activity until it is completed appropriately
  • the capacity to maintain consistency and quality of performance throughout the designated period of time.

Why is this a program requirement?

Sufficient physical and mental endurance is an essential requirement needed to perform multiple tasks in an assigned period to provide safe and effective care.

What reasonable adjustments can be made?

Adjustments must ensure that performance is consistent and sustained over a given period. Adjustments specific to the individual can be discussed with a Disability Advisor.

What examples demonstrate that you may have met the requirement?

  • participating in tutorials, lectures, skills
  • providing consistent care over a negotiated time frame.

Return to top

Developed from: Johnson, A., Allan, T., Phillips, K., Azzopardi, T., Dickson, C., Goldsmith, M & Hengstberger-Sims, C. (2011). Program Requirements of Nursing Education (IRONE), UWS School of Nursing & Midwifery and Student Equity & Disability Services.

Areas of study and research

+ Click to minimise