Final report

Development of national standards for the

assessment of internationally qualified nurses
and midwives for registration and migration

August 2009

Report prepared for Australian Nursing and Midwifery Council

By Carramar Consulting June 2008
Foreword

The Australian Nursing and Midwifery Council (ANMC) is a peak national body established in 1992 to facilitate
a national approach to nursing and midwifery regulation. The ANMC works in partnership with the state and
territory nursing and midwifery regulatory authorities in evolving standards for statutory nursing and midwifery
regulation which are flexible, effective and responsive to health care requirements of the Australian population.

Another function of the ANMC is to act as the assessing authority for the Department of Immigration and
Citizenship (DIAC) to undertake assessments of internationally qualified nurses and midwives for permanent
migration to Australia.

These assessments aim to be consistent with the registration requirements of the Australian Nursing and
Midwifery Regulatory Authorities (NMRAs) in each state and territory, however, nationally consistent assessment
of those applying for permanent migration and registration remains elusive because of the differing legislative
requirements in the states and territories.

Acknowledging these difficulties, the ANMC resolved to commence work on a project to develop national
standards for the assessment of internationally qualified nurses and midwives for registration and migration.
The project was funded by the Commonwealth Department of Education Science and Training (DEST)
during 2007/2008 to establish standards upon which assessment of internationally qualified nurses and midwives
are based.

With the proposed introduction of a national accreditation and registration scheme on 1 July 2010, the ANMC saw
this as an opportune time to develop nationally consistent standards and criteria for registration and migration of
nurses and midwives into Australia. At the ANMC Board meeting in November 2008, five out of the six standards
were approved by the ANMC for implementation by January 2010.

To ensure a consistent approach to the implementation of Standards 1–5, the ANMC and State and Territory
NRMA’s agreed to implement Standard 2 on 1 July 2009 and Standards 1, 3–5 by 1 January 2010.

Alyson Smith
Chair, ANMC Registration Standards Committee
Table of Contents

Foreword iii

Acknowledgements vi

Abbreviations and Acronyms vii

Executive Summary 1

The Six Standards 2

Recommendations 3

PROJECT BACKGROUND 4
Purpose of the project 4
Scope of the project 4

Report—Development of National Standards for the assessment of internationally

qualified nurses and midwives for registration and migration 5
Summary of Literature Review Findings 5
Literature Review 6
Introduction 6

Search Strategies and Methods. 6

Globalisation and Trends in International Nurse Migration 7

Regulation 8

Mutual Recognition Agreements 8

Educational Preparation of Nurses in Australia and from Selected Other Countries 9

Credentialing and Licensure of Internationally Qualified Nurses in Selected Other Countries 11

Experience of Internationally Qualified Nurses and Midwives in the Workplace 13

Assessment of English Language Proficiency 14

Assessment of Competency 16

Recency of Practise 17

Australian Regulatory Issues and Guidelines for Internationally Qualified Nurses 17

Other Professions in Australia 18

Conclusion 18

iv Australian Nursing and Midwifery Council

 Standards Development 19
Standards Defined 19

Consultation during development 20

Draft Standards 21
Standard One: The applicant establishes their identity. 21

Standard Two: The applicant meets English Language Proficiency requirements for the nursing
and midwifery professions. 22

Standard Three: The applicant is assessed as meeting current Australian nursing and
midwifery educational standards. 23

Standard Four: The applicant provides evidence of having practised as a nurse and/or
midwife within a defined period of time preceding the application. 24

Standard Five: The applicant demonstrates they are ‘Fit to Practise’ nursing and/or midwifery in Australia. 25

Proposed National Adaptation Program 28

Purpose of the National Adaptation Program 28

Program Elements 28

Delivery of the National Adaptation Program 30

Suggested Process for Managing Applications from Internationally Qualified Nurses and Midwives 30

Glossary of Terms 33

Appendix One 35

Appendix Two 38

Reference List 45

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration v
Acknowledgements

The high quality of this project revolved around many people in particular.

> Members of the ANMC Registration Standards Committee

> Carramar Consultants
> The State and Territory Nursing and Midwifery Regulatory Authorities (NMRAs) and New Zealand
Nursing Council
> The Department of Education, Science and Training (DEST) Professional Services Development Program
(PSDP) for funding the project

vi Australian Nursing and Midwifery Council

Abbreviations and Acronyms

ANMC Australian Nursing and Midwifery Council

CINAHL Cumulative Index to Nursing and Allied Health Literature

DEST Department of Education, Science and Training

DIAC Department of Immigration and Citizenship

EU European Union

EEA European Economic Area

IELTS International English Language Testing System

OET Overseas English Test

MRA Mutual Recognition Agreement

ONP Overseas Nurses Program

RSC Registration Standards Committee

TTMRA Trans Tasman Mutual Recognition Agreement

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration vii
viii Australian Nursing and Midwifery Council
Executive Summary

ANMC is the assessing authority for the Department
of Immigration and Citizenship, and a function of
the ANMC since its establishment in 1992 has been to
undertake assessments of internationally qualified
nurses and midwives for permanent migration
to Australia.
In May 2007 ANMC Council proposed that a project
to research and formulate national standards for the
assessment of internationally qualified nurses and
midwives who apply for registration in, and migration
to Australia irrespective of their country of origin,
be undertaken.

There has been a sustained request from the nursing
and midwifery professions and the health sector
more broadly, both nationally and internationally, to
standardise the assessment for nurses and midwives
and ensure that all internationally qualified applicants
are treated in an equitable, transparent manner,
regardless of their country of origin. A number of
significant issues have been identified with regard to
the current approach to assessment. These include a
variety of standards being implemented, variation in
application of the standards depending on the country
of origin of the applicant, and increasing numbers
of internationally qualified nurses and midwives
seeking assessment. These issues combined with
limited human and financial resources to undertake
the work, the ability to keep abreast of changes in over
200 countries as well as develop contemporary policies
in a timely fashion has an impact on the NMRAs
capacity to protect the Australian community.
This project was funded by the Commonwealth
Department of Education, Science and Training
during 2007/2008 and has resulted in the development
of six national standards for the assessment of
internationally qualified nurses and midwives seeking
registration and migration. This provides for an
equitable and transparent process that is able to be
consistently applied to all internationally qualified
nurses and midwives seeking migration and/or
registration, thereby ensuring the protection of the
public of Australia. Implementation of this work is
seen as extremely important because it contributes
to the primary aims of the national registration and
accreditation scheme due for implementation on
1 July 2010.

Lending weight to the need for improving national

consistency are the changing international
circumstances that impact on the assessment of
international nurses and midwives for migration. In
September 2005, the Nursing and Midwifery Council
of the United Kingdom changed the criteria for entry
of foreign nurses and midwives into England with
every nurse and midwife being required to do a
competency based assessment and provide evidence
of English Proficiency. However, foreign nurses and
midwives from EU countries were exempted from
this requirement despite coming from a non‑English
speaking country. Until recently, when the UK changed
its policy, nurses and midwives coming to Australia
from the EU via the United Kingdom may not have had
any English language skills and, because of the policy
with regard to nurses and midwives from the United
Kingdom, been accepted into the Australian health
system without the requirement to provide evidence of
their English proficiency.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 1
The Six Standards

Standard One: The applicant establishes their identity

Standard Two: The applicant meets English Language

Proficiency for the nursing and midwifery professions

Standard Three: The applicant is assessed as meeting

current Australian nursing and midwifery educational
standards

Standard Four: The applicant provides evidence of

having practised as a nurse and/or midwife within a
defined period of time preceding the application

Standard Five: The applicant demonstrates they are

‘Fit to Practise’ nursing and/or midwifery in Australia

Standard Six: The applicant successfully completes

the National Adaptation Program for internationally
qualified nurses and midwives

2 Australian Nursing and Midwifery Council

Recommendations

The recommendations arising from the ANMC Board

in November 2008 and subsequently agreed by the
state and territory Nursing and Midwifery Regulatory
Authorities were:
1. That the Australian Nursing and Midwifery Council
and Nursing and Midwifery Regulatory Authorities
endorse Standards one to five.
2. That Standards one to five be implemented by
1 January 2010.
3. That the ANMC and NMRAs implement standard
two at an agreed time frame of 1 July 2009.
4. That the ANMC and NMRAs conduct further
consultation with other stakeholders before
proceeding with the implementation of an
adaptation program.
5. That ANMC publish the report of the project on the
ANMC website.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 3
Project Background
Purpose of the project
The purpose of the project was:
> to research and formulate national standards for
the assessment of internationally qualified nurses
and midwives who apply for registration in, and
migration to Australia
> develop an implementation strategy for the new
national standards
4 Australian Nursing and Midwifery Council
Scope of the project
The project had the following scope and objectives:
> A review of national and international literature;
> A review of existing national and international
standards;
> Production of a report on the literature review and
its findings;
> Identification of minimum desirable standards in
terms of English language proficiency, competence
assessment and orientation to the Australian
health context;
> Development of a model for application of
standards at jurisdictional level; and
> Development of an implementation strategy for
uptake of the new standards for assessment at
national and state/territory level, including the
identification of any constraints to implementation
that may be perceived.
Report
Development of National Standards for the
Assessment of Internationally Qualified
Nurses and Midwives for Registration
and Migration
Summary of Literature Review Findings
The Assessment of Internationally Qualified Nurses
and Midwives raises many issues for both the
destination country and for the nurse applying for
registration from the source country. One hundred and
eight articles and papers were reviewed that addressed
many of the aspects that need to be considered by
a regulatory body in developing standards for the
assessment of internationally qualified nurses. Eighty
five articles were directly relevant, many cited in this
preliminary literature review. In the literature some of
the aspects were covered in more detail than others.
Many of the articles and papers expressed an opinion,
based on simple surveys, anecdotal evidence and/
or experience and would not strictly be considered
evidence based.
Consistent themes and issues were evident. Useful
information from recent work done in both the
United Kingdom and Canada assists to inform current
thinking regarding the difficulties that need to be
addressed. A comprehensive piece of work analysing
the assessment of internationally qualified nurses
and midwives by Australian Authorities was also
extremely informative.
What is apparent is that for internationally qualified
nurses migrating to English speaking countries the
assessment process for registration in the destination
country can be arduous, lengthy, inconsistent and
confusing and even more so in countries where there
is no ‘one national’ system.
Educational support for internationally qualified
nurses and midwives is often sporadic and
inconsistent. Some countries do better than others
but it is universally commented on that it could be
better. Employers understanding of integration issues
and learning needs of internationally qualified nurses
is varied. Many employers reported use of bridging
programs or periods of supervised practice with
the conclusion there was more value in providing
programs specifically designed for internationally
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 5
qualified nurses and midwives. In one study the
period of supervised practice required by many
internationally qualified nurses was longer than
the minimum specified by the regulatory authority.
The educational standard required by most English
speaking countries is completion of secondary
schooling, and for nurses to be Bachelor qualified or
to have undertaken an equivalent course of study of
at least 3 years full time at an undergraduate level.
The curricula of such courses need to match the
destination country’s standard.
In spite of efforts being undertaken to standardize
the educational preparation of nurses from a global
perspective, it is clear that the culture in which a nurse
learns their profession significantly influences the
way they practice and if moving to another country a
period of acculturation takes place.
Language and communication is a significant issue
and should be part of any program for non English
speaking background nurses. Medical terminology
and acculturation with local policy and practice is
important in assisting the transition, whether from
an English speaking background or non English
speaking background. There is favour for English
language testing to be “in context” and a high level of
proficiency seems to be required from both a consumer
and professional point of view.
The assessment of competence to practice by written
examination only, is open to challenge. Particularly as
the education literature is replete with the limitations
of written tests and there is a great deal of evidence
and opinion that competency is multidimensional
and goes beyond possession of knowledge. There is
some argument for a holistic approach to competency
whereby an understanding of the context and
culture in the assessment process occurs. A period
of supervised practice for internationally qualified
nurses has some merit given the fact that assessment
of competence is not necessarily predictive and there
is recognition of the importance of issues associated
with acculturation and the opportunity to practice
in context.
There is no substantial evidence on recency of practice
other than to acknowledge that with the substantial
changes and growth in knowledge, technology and
workplace reform there is a need for professionals to
demonstrate they are contemporary and can practice
from an evidence based framework.
Many countries are grappling with similar issues and
some have used different approaches to assessment,
registration and integration to assist in meeting their
workforce needs. Whatever frameworks and processes
are used by destination countries in undertaking these
assessments, it is clear that they need to be flexible
enough to cope with the changing pace of health care
delivery and the changing nature of nursing practice
and expanding nursing roles, whilst also being robust
enough to maintain professional standards.
Literature Review
Introduction
It is evident from the literature that there are
specific challenges in assessing internationally
qualified nurses and midwives. Some of these relate
to variations between countries on issues such as
educational preparation for nursing, different usage
of the title of ‘nurse’, variations in the roles and scope
of practice for nursing, and differing professional
standards across different countries. Further
challenges are related to issues such as language
proficiency and the inherent difficulties associated
with assessment of professional competence. Also,
there is a lack of reliable international data available
to assist assessors and also little congruency in the
way countries deal with reciprocity (Jeans et al. 2005).
It is impossible to consider the subject of development
of national standards for the assessment of
internationally qualified nurses and midwives without
some consideration of the wider policy context
in which nurse migration is occurring around the
world. This is commonly termed in the literature
as the “Globalisation” of the nursing workforce.
Herdman (2004) refers to Globalisation as the transfer
of economic, political and socio‑cultural values
across international borders with globalisation
describing world systems as opposed to national
systems. In another definition Biscoe, (2001) defines
globalization as the process whereby nations increase
their interrelatedness and interdependency through,
among other things, the spread of democracy, the
integration of economies in a world wide market, the
transformation of production systems and labour
forces. This definition provides the context for what is
topical at present, namely the international migration
6 Australian Nursing and Midwifery Council
of labour with greater trade intensity being linked
to the mobility of professionals which also includes
nurses (Manning and Sidorenko 2007).
Search Strategies and Methods.
An initial search of the relevant databases was
performed. These included CINAHL, Medline,
ProQuest, Ovid, ERIC and Web of Knowledge. The
initial search terms used were: Internationally
educated nurses, education standards nursing,
credentialing, qualifications, international nurse,
international midwives, English language proficiency,
health professionals, assessment of competency,
regulatory standards, international standards,
regulation and regulatory standards. A further search
was carried out using the following terms: recency of
practice, and qualification assessment.
Reference lists and bibliographies of retrieved
articles were also searched to identify further
relevant literature. Lastly a broader internet search
using Google as a search engine was conducted
in an effort to identify non published government
and professional related websites that may have
relevant contemporary information. The results were
varied and included opinion papers, government
and professional reviews and policy papers, and
descriptions of existing guidelines. The search
was also conducted to identify other professions’
approaches in Australia.
The articles and papers were grouped into themes,
reported on here. Follow up phone calls and emails
were also undertaken to some organisations both
internationally and in Australia in order to elicit
further information and advice from experts. Very little
literature was found to relate specifically to midwives
or second level nurses. Most papers appeared to use
the term nurse generically and it is assumed that in
some instances the processes and issues would be
similar for midwives and second level nurses. Unless
the term midwife was used in the literature the term
nurse is used to reflect what the literature reported.
For the purposes of this paper the following definitions
(terminology) are used to allow comparability
between countries. A first level nurse is a registered
nurse and a second level nurse is the equivalent of an
enrolled nurse or nurse required to practice under the
supervision of a registered or first level nurse. The term
of Internationally Qualified Nurses (IQNs) is used in a
generic sense and at times includes midwives. Issues
specific to midwifery are reported on separately.
Globalisation and Trends in International
Nurse Migration
It is acknowledged that the delivery of nursing
and health care services is increasingly global in
nature, largely as the result of international trade
and migration (Buchan 2001; Buchan, Kingma, and
Lorenzo 2005; Kingma 2006) with the current high
level of nurse migration largely caused by nursing
shortages in developed countries combined with the
existence of ‘push’ factors in developing countries.
It is recognised that the factors associated with
international mobility, migration and recruitment
of nurses are complex, reflecting not only western
demand but also the growing participation of women
in skilled migration, their desire for improved quality
of life and enhanced professional opportunity and
remuneration (Buchan, Kingma, and Lorenzo 2005;
Hawthorne 2001; Herdman 2004). The impact of
this on international labour and labour markets has
been significant. Nurse migration is often a result of
a failure of policy or relative under‑investment in the
profession and its career structure in the destination
countries (Aiken et al. 2004) along with a growing
demand in health care, the absence of economic
incentives to attract and keep local nurses and chronic
wastage rates in the nursing workforce.
For some countries nursing labour is often more
abundant and less expensive globally than it is from
its own national pool (Buchan 2001; Herdman 2004).
The global shortage has forced some countries such
as Australia to reconsider their approach to nurses
applying from countries that have not previously been
considered as having suitable educational preparation
for work here. Wickett and McCutcheon (2002) and
others (Hancock 2002) highlight the many issues to be
considered when trying to define or assess suitability
of nurses educational background for migration and
capacity to practice in a different environment. These
include comparability of initial nurse education and
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 7
training, subsequent post qualification practice and
experience and English language proficiency.
The increasing globalisation of nursing has also
meant the demand for the development of global
standards of nurse education and practice are seen by
some to also be important. The International Council
of Nurses has for some years attempted to develop
international competencies for the general nurse
(Hancock 2002) and this program is ongoing with work
being conducted to identify key elements and issues
critical to the development of a set of international
standards for initial nursing and midwifery education.
(Morin and Yan 2007). These standards will focus on
five areas.
> program admission criteria,
> program development requirements,
> program content components,
> faculty qualifications and
> program graduate characteristics.
Hancock (2002) is unsure of the value of such efforts
as she believes that nurses are inextricably entwined
in the culture within which they deliver care. This
means different things for the nurses themselves, the
patients, their families communities and governments.
The globalisation of education continues with
exchange programs, international research,
development of offshore campuses and increase in
overseas fee paying students. Herdman (2004) believes
such globalisation of education and the opportunities
it offers also means that professional inclusion or
exclusion to practice in a destination country can
become less easy to define.
In Australia, we have seen the diversification of the
nursing profession with nurses entering Australia from
English speaking background (ESB) source countries
and non English speaking background (NESB) source
countries. From the English speaking background
countries, shared language, common education
curricula and post colonial ties between countries
influence which countries are targeted by Australian
employers as sources of labour (Buchan 2001).
According to Hawthorne (2001) the nurses from
English speaking backgrounds pass relatively
seamlessly into the system as opposed to the nurses
from NESB who frequently have to overcome three
major hurdles: mandatory English language testing,
qualifications accreditation and access to full mobility
within employment once they are in the country.
Regulation
The two common forms of regulatory control for health
professionals, including nurses, include statutory
and self regulation. These systems involve mandatory
and voluntary components (Bryant 2005). Statutory
regulation is derived from an act of parliament and
is enacted by an independent body, whereas self
regulation is overseen by the professional nursing
organisations (Wickett 2006). Statutory regulation
determines educational standards and the standards
for continuing registration. This is complemented
by self regulation which provides the framework for
nursing practice by determining scope of practice
and defining ethical and competent practice in
addition to establishing systems of accountability
and credentialing in order to protect the public
(Bryant 2001; Styles 1997) Two papers (Ashworth,
Boyne, and Walker 2002; Walsh 2002), commenting
on health care regulation in the UK, highlight the
fact that, in spite of some problems with regulation,
there is a need for independent bodies to maintain
standards. They also state that the characteristics of
effective regulation are: that it must be responsive
to the needs of those regulated, whilst recognising
diversity of organisations and the needs of the
community; with a range of regulatory interventions
to avoid the ‘one size fits all’ approach. Most
importantly regulation needs to balance independence
and accountability whilst maintaining a distance
from political interference (Walsh 2002). Moore
and Picherak, cited in (Bryant 2005) believe that a
new era of regulation has arisen with competing
interests between public policy and the ‘protection
of the public’ mandate but believe there is a need to
balance these two interests, particularly in light of
the globalisation of the nursing workforce and the
associated workforce shortages in some countries.
The major regulatory measures identified as affecting
international mobility of the labour force are visa
requirements and procedures, labour market tests and
other domestic regulatory requirements (Manning and
Sidorenko 2007). The supply of health care is often
highly regulated in a domestic market. Most countries
have quite country specific laws and guidelines
which are often overseen by powerful professional
8 Australian Nursing and Midwifery Council
organisations. This type of regulation can be a
significant barrier to entry for foreign professionals
(Manning and Sidorenko 2007). Such professional
regulation at national, state or provincial levels is an
accepted characteristic of the health care professions,
particularly medicine and nursing (Kingma 2006). One
of the reasons for this is that health care is distinct
from other service sectors as there is a direct link
between the provision of health services and human
health and wellbeing (Manning and Sidorenko 2007).
A challenge therefore arises for countries attempting
to address workforce mobility issues whilst trying to
ensure a high standard of care is delivered.
As the statutory component of regulation determines
educational preparation and standards it means that
recognition of a nurse’s qualifications is part of the
regulatory process. However, holding a qualification
does not necessarily mean a nurse will be assessed
as competent to practice, particularly if that nurse
qualified overseas (Wickett and McCutcheon 2002).
They must undergo a process to have their
qualifications recognised and assessed against the
destination country’s standards and requirements and
this can be a frustrating and time consuming process
for many nurses. The assessment of and/or recognition
of international qualifications can happen through
a variety of means, although two specific processes
are commonly used in many countries. It can occur
through an independent process decided by the
destination country or it can happen through a mutual
recognition agreement.
Mutual Recognition Agreements
Mutual recognition is based on the notion of
equivalence where the host or destination country’s
goals and standards are also addressed by the home
or source country’s regulatory and education system.
Where aspects of a destination country’s regulation
are not met the destination country is permitted to set
additional requirements for recognition (International
Council of Nurses 2007). One of the most common
requirements imposed relates to language proficiency
(Manning and Sidorenko 2007). Mutual recognition
agreements become important within the larger
context of globalisation as such agreements along with
the World Trade Agreements do influence the ability of
nurses to migrate to other countries (Wickett 2006).
The International Council of Nurses state that
mutual recognition agreements are important
as the past process of unilateral recognition and
assessment of a professional’s qualifications by a
relevant regulatory authority in another country is
now either unworkable or inappropriate in many
situations due to the explosion of the global economy
(International Council of Nurses 2007). One method
of modernising the unilateral approach to recognition
to a reciprocal form of recognition is through these
Mutual Recognition Agreements (MRAs). In spite of
the significant benefits it is acknowledged that the
administration of MRAs is not without problems and
the process of recognition is complex (International
Council of Nurses 2007; Neilson 2003). Some of
the issues highlighted in the literature include
the following:
> The wide range of practices among countries in
relation to the educational levels and training of
professionals, as well as the equally wide range of
cultural influences and assumptions that lie behind
these, create difficulties, especially in interpretation
and deciding equivalencies.
> Fear of a loss of regulatory control, or fear that
recognition through a negotiated process would
lead to the lowest common denominator for
standards. The result for government regulators and
professional bodies is that mutual recognition may
result in a lowering of professional standards.
> There is uncertainty as to the impact of MRAs
on crucial public health and safety matters as a
result of the transfer of regulatory authority and
duties from national regulatory agencies to foreign
entities. The latter may operate under different
cultural values, and have different conflict of
interest standards, rules of transparency, and
liability systems. The end result could be that
regulatory autonomy is severely limited to the
detriment of the public and the profession.
> There are differences in regulation between
countries. For example some countries such as
Australia and the USA regulate a second level
of nurse whilst others regulate only one level,
and some countries register midwives separately
whereas some may have no specific category
(Bryant 2005; De Raeve 2007; International Council
of Nurses 2007).
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 9
> How to effectively link local, national and
international credentialing within some quality
framework that assures validity and reliability.
There are currently some mutual recognition
arrangements in nursing throughout the world.
The European Union Nursing Directives on Mutual
Recognition of Professional Qualifications across
the EU is such an example. This MRA may indirectly
affect Australia, as the United Kingdom has been,
historically and presently, a target import country
for Australia’s nursing shortages. Nurses from EU
countries can move to and practice in the UK (subject
to UK regulatory requirements). These nurses may
decide at a future date to migrate to Australia.
Currently Australian NMRAs recognise nurse’s
qualifications from 8 countries, of which the United
Kingdom is one.
The main MRA directly affecting Australia is the Trans
Tasman Mutual Recognition Agreement (TTMRA).
This applies to New Zealand and all the States
and Territories of Australia. It provides for mutual
recognition of equivalent registration/enrolment
and a streamlined registration process. Effectively
this means Australian and New Zealand educated
nurses are eligible to register in each country without
assessment of their qualifications. Wickett (2006),
reports that to date the TTMRA is the only mutual or
reciprocal agreement to occupations that Australia has
with any other country.
Educational Preparation of Nurses in
Australia and from Selected Other Countries
The following countries’ educational preparation
requirements are included. Australia (for
comparability), the European Union, the United
Kingdom and South Africa. These countries were
chosen as the information was readily available and
they are countries that are accepted by the ANMC
indicating that the standards are comparable with
Australian standards. Additionally, South Africa has
a level 2 nurse category. In addition to these three
countries, information on China, India and Thailand
are also briefly summarised as some nurses from these
countries are seeking registration in Australia.
In Australia the educational requirements for
registration as a nurse, midwife or enrolled nurse vary
slightly between States and Territories but commonly
for registered nurses and midwives involve undergoing
an approved course of study at an approved institution
leading to a Bachelor Degree Qualification. This
course of study also includes holding a diploma or
other certificate recognised by the relevant regulatory
authority. This arises as nursing education only
moved into the tertiary sector in 1993 and some nurses
still practicing may not have undergone further
formal study to supplement their primary nursing
qualification. Additionally, until recently direct
entry midwifery was not available in Australia and
many midwives would have undertaken midwifery
study following initial nursing registration. For
enrolled nurses the educational preparation involves
undergoing an approved course of study recognised by
the regulatory authority for enrolment. This is usually
at Certificate IV and/or Diploma level.
Each of the nursing and midwifery Regulatory
Authorities has its own requirements and standards
for programs leading to registration. This means that
there is diversity regarding issues of course length,
course content, and theoretical and clinical hours,
and assessment (Australian Health Ministers Advisory
Council 2006). The ANMC is currently working to
develop a national framework for the accreditation of
programs leading to registration and enrolment.
In the United Kingdom, the Nursing and Midwifery
Council’s (NMC) standards are consistent with those
of the European Union. The main NMC standards are
as follows:
> Entry is requisite on the student having completed
secondary school education.
> The length of the programs shall be no less than
3 years or 4600 hours in length and where delivered
as a full time program must be completed in not
more than five years.
> The programs shall comprise a common
foundation of 12 months and a branch foundation
of two years in adult, mental health, disability or
children’s nursing.
> The balance of learning shall be 50% theory and
50% practice in both the foundation and branch
programs and there must be a period of at least
3 months clinical practice towards the end of the
10 Australian Nursing and Midwifery Council
pre registration program to enable students to
consolidate and apply their learning in practice.
> As a minimum, pre registration programs must lead
to an award of a diploma of higher education.
The European Union directives (2005/36/EC) state
> That the programs must comprise a three year
program and/or 4600 hours of instruction
> The balance of theoretical instruction and clinical
instruction must not be less than one third theory
and one half practice. They define both theoretical
and clinical instruction.
> The practical instruction must include exposure
to medicine, surgery, paediatrics, child care,
maternity, mental health, aged care and
home nursing.
The South African nursing registration system for
nurses and midwives states that nurses and midwives
must have completed secondary school and have
undertaken a four (academic) year course at university
level at an approved nursing education institution.
An academic year is a period of at least 44 weeks.
For enrolled nursing the nurse must have reached an
academic standard of ten (grade 12) and undergo two
academic years of study at an approved nursing school
(South African Nursing Council 1997; South African
Nursing Council 1998).
Between 1966 and 1976 in Mainland China, there
were no nursing education programs available as
a result of the Cultural Revolution. Since the 1980’s
different levels of nursing educational training have
been provided. This includes a Certificate in Nursing
(which is being phased out), 2 or 3 year Diploma,
a 5 year Bachelor and a 4 year Baccalaureate which
includes a clinical internship year of 12 months. Entry
into the programs are at two levels, directly after
junior high (9 years of schooling) and after senior high
(Smith 2004).
The curriculum content broadly covers medical &
surgical nursing and mental health, with aged care
and community nursing appearing to be limited.
Maternity, obstetrics and paediatrics are studied
as part of extension programs. The balance of
learning varies between 1500–2500 hours of theory
and 24–50 weeks of practical. There is an optional
international exchange program with Singapore
where successful applicants are placed in a 2–3 year
clinical placement. This placement includes theory
and practical and gives them the option to choose a
specialty such as midwifery or cardio‑thoracic nursing.
Nursing education in India requires a prerequisite of
completing year 12 with preferable subjects in physics,
chemistry and biology. The entrance age is no less
than 17 years and no greater than 35 years. The courses
offered include a 2 year Auxillary Nurse Midwife
program, 3 ½ year Diploma in General Nursing and
Midwifery, 4 year Bachelor of Science in Nursing.
The composition of these programs includes acute
medical/surgical, community, maternity/obstetrics,
paediatrics, orthopaedics and oncology. Mental
health and aged care did not appear to be covered
in the curriculum content. The type of assessments
undertaken by the students is not outlined and the
proportion of theory and practical is not specified.
The Nursing Council of Thailand states the
requirement for entry into nursing is the completion
secondary school (grade 12). Courses offered are a
2 year Technical Nurse with an optional additional
2 year Bachelor of Nursing, or a 4 year Bachelor of
Nursing. The two levels in nursing and midwifery
are first class degree or diploma level and second
class certificate level. Curriculum content includes
acute medical/surgical, mental health, aged care,
community, maternity/obstetrics and paediatrics.
There is no specification for the proportion of theory
and practical components and courses are conducted
in the written and spoken Thai language.
Credentialing and Licensure of Internationally
Qualified Nurses in Selected Other Countries
Prior to discussing the literature it is important to
clarify the terms surrounding credentialing and
licensure. The terms are used widely and imprecisely
in everyday language and it is important to clearly
relay the literature’s content.
Licensure is the process by which a governmental
agency grants permission to persons to engage in their
profession. Accreditation is the process by which an
agency or organisation recognises an institution or
program of study as meeting certain predetermined
criteria or standards. Certification is the process by
which a non government association grants recognition
to an individual who has met certain predetermined
criteria or standards.
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 11
Credentialing is the administrative process for
validating the qualifications of licensed professionals,
organizational members or organizations, and
assessing their background and legitimacy. The
process is generally an objective evaluation of a
subject’s current licensure, training or experience,
competence, and ability to provide particular services
or perform particular procedures (Yu, Zhaomin, and
Jianhui 1999).
Kennedy (2003) wrote a paper for the International
Council of Nurses’ credentialing forum, looking at
credentialing in nine selected countries. Whilst this
report did not specifically look at credentialing and/
or licensure of internationally qualified nurses in each
of the countries it did summarise trends identified in
the regulatory environment some of which are relevant
to the issue of assessment of internationally qualified
nurses. These trends were identified as follows:
> Staff shortages and migration of nurses are
driving changes to facilitate the accreditation and
credentialing of internationally qualified nurses.
> Most countries are currently working actively
on continuing education and credentialing of
nurse practitioners and nurses in specialist or
advanced practice.
> Regulation of education and registration for
training as a nurse is more standardised and
comparable across countries although there
are changes in entry level with both a widening
and lowering of entrance in some countries, in
addition to increased opportunities for higher level
specialist education.
> Regulation of post graduate nursing or continuing
education is different across countries ranging
from local, professional association or national
agreement. Some specialist groups are even seeking
international accreditation.
> There is increasing emphasis on competency based
education and assessment.
> There is a changing emphasis in the roles of
regulatory bodies (for example an increased
role in standard setting and competency
assurance as opposed to advocacy) and in some
jurisdictions a potential loss of statutory powers
and independence.
In her paper Kennedy reports that one of Canada’s
priorities for credentialing was to complete
the regulatory framework for the integration of
internationally educated nurses and the development
of tools and resources to assist the integration of
international nurse applicants. This work is ongoing in
Canada and was undertaken in response to workforce
shortages and the large numbers of nurses desiring to
enter the country.
The United Kingdom in 2006 changed its
requirements for internationally qualified nurses to be
able to register with the NMC. From 1 September 2006
the only route to registration with the NMC is through
the Overseas Nurses Program (ONP). All applicants
who apply for nurse registration and who meet NMC
minimum requirements will be required to undertake
all or part of the ONP. The ONP sets out common
entry standards, a core compulsory 20‑day period of
protected learning for all nurses educated outside
the European Economic Area (EEA) and, where
appropriate, a period of supervised practice. Every
applicant will have to pass the specified International
English Language Test (IELTS) before they can apply
to go onto the ONP. As of February 2007 the IELTS
standard to be achieved is a score of 7 in each of the
four bands. (Nursing and Midwifery Council 2007;
Nursing and Midwifery Council 2005; Nursing and
Midwifery Council 2007).
All overseas applicants are individually assessed,
however the nurse must have successfully completed
at least 10 years of school education and practiced for
12 months after qualifying and must have practiced
for at least 450 hours in the previous three years. They
will not accept second level nurses (enrolled nurses)
for registration.
The twenty days of protected learning is designed
to contain study specifically relevant to the practice
of nursing in the UK and address the relevant
competencies for the field of practice the nurse intends
to work in. If the nurse is required to undertake
supervised practice it is conducted in an accredited
institution with the appointment of an appropriate
mentor (Nursing and Midwifery Council 2007;
Nursing and Midwifery Council 2005).
Midwives after meeting certain education and
training requirements are required to participate
in an “Adaptation to Midwifery” program aimed
at preparing and assessing a midwife’s ability to
12 Australian Nursing and Midwifery Council
practice in the UK setting. The education and training
requirements include completing a three year full
time (or if a registered nurse in the UK, an 18 month)
course focused entirely on midwifery with a balance
of half clinical and half theory. Instruction in a list
of theoretical and practical topics is listed as being
compulsory. Applicants must have completed one
year’s post qualification experience and be of good
character and have practised for at least 450 hours in
the past 5 years (Nursing and Midwifery Council 2005).
Canada is similar to Australia in that the many
provinces have their own processes and authorities
for dealing with nursing education accreditation
and recognition. In total there are 25 regulatory
bodies assessing internationally qualified nurses
in Canada. This makes it very confusing for the
applicant. A review of the processes reported on
in 2005 (Jeans et al. 2005) identified that all regulatory
bodies have similar policies regarding assessment
but with many varying processes associated with the
requirements for assessing educational qualifications,
practice requirements, competencies and English
Language testing and proficiency. The differences
are too numerous to mention in this paper, however
in spite of the differences, all share common themes
aimed at assessing equivalence with the Canadian
Standard and ensuring competency within the
Canadian context.
All applicants must sit for the Canadian Registered
Nurse Examination (CNRE) which is maintained by
the Canadian Nurses Association in collaboration
with the regulatory authorities. (Canadian Nurses
Association 2006). The regulatory authorities
administer the exam and determine the eligibility to
write it. Statistics over a 5 year period (1998–2002)
showed that only 43% of applicants were eligible
to write the examination with incomplete data
meaning that it was difficult to draw conclusions
on the percentage of applicants who actually pass.
(Jeans et al. 2005). The exam is available to first level
general and psychiatric nurses and second level
nurses. At present the examination can only be taken
in Canada.
The review of process for internationally qualified
nurses found that the examination was seen to be
culturally based and therefore making it difficult
for internationally qualified nurses to understand.
The multiple choice format was also difficult to
understand for applicants who had English as a
second language. The entire process of immigration,
credential assessment and attending the examination
was also found to be fragmented, costly and confusing
and extremely time consuming for the applicants
(Jeans et al. 2005). Midwifery in Canada is only
recognised as a separate entity in 5 of the provinces
(Canadian Nurses Association 2006) with each
province having their own assessment processes.
To enter the United States of America an overseas
qualified nurse must apply to the Commission on
Graduates of Foreign Nursing Schools (CGFNS) the
CGFNS is responsible for evaluating foreign nurse
graduates via the CGFNS exam before they leave their
home country, to assess their likelihood of passing
the National Council Licensure Examination for
Registered Nurses (NCLEX‑RN). The credentialing
process looks at the level of secondary education and
nursing educational preparation for qualification as
a Registered Nurse. The process also covers English
language testing. More recently nurses have been
able to undertake the NCLEX at overseas sites and if
successful in the NCLEX is not required to undertake
the CGFNS exam (Alexander 2005; Yu, Zhaomin, and
Jianhui 1999). The United States has reported data
(through the CGFNS) on the NCLEX which found
that the longer the IQN has been in practice the less
likely they will pass the exam on first attempt. This
is difficult to interpret as it would be reasonably
safe to assume that a nurse with several years of
experience has developed more competencies than a
new graduate (Davis 2002). This is one example of the
possible limitations of examination.
Overseas applicants wishing to practice in New
Zealand must be registered with an overseas
regulatory authority and have either an overseas
qualification assessed as being equivalent to a New
Zealand Qualification or have successfully completed
a program approved by the New Zealand Nursing
Council for the purpose of assessing competencies for
the registered nurse scope of practice (Nursing Council
of New Zealand 2007).
Applicants must also demonstrate that they are “fit
to practice nursing” and are able to prove English
language proficiency. Fitness for registration is
assessed on a case by case basis and there is a list
of requirements including not having any criminal
convictions or be the subject of professional
disciplinary hearings. Applicants who cannot
demonstrate recency of practice (time not specified)
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 13
may be required to undergo a 6–8 week competence
assessment program in order to assess competence
within the scope of practice of the New Zealand
framework. The competence assessment program
includes both a clinical and theoretical component.
(Nursing Council of New Zealand 2007). This procedure
is similar for both level one registered nurses and level
two nurses.
Midwives wishing to practice in New Zealand are
assessed by the Midwifery Council of New Zealand.
The process differs from that above. Pre‑registration
education and experience in midwifery is assessed
as well as fitness to practice. If there is insufficient
evidence to determine equivalence the midwife may
undergo competency assessment. If equivalence is
determined then the midwife is admitted to the register
with conditions attached to their scope of practice.
In addition they have to undergo, within 18 months,
a New Zealand specific competence program that
includes the NZ maternity system, midwifery
partnership, cultural education and pharmacology
and prescribing. When the conditions have been met
for competent practice then full registration is granted
(New Zealand Midwifery Council undated).
Experience of Internationally Qualified
Nurses and Midwives in the Workplace
One of the main reasons for the active recruitment of
internationally qualified nurses to a country is the
lack of available local nurses. Australia is recognised
as having a workforce shortage and a need for
overseas trained nurses (Magnusdottir 2005). There
is not a lot of literature regarding the experience of
internationally qualified nurses and midwives in the
Australian workplace.
In Australia, a study by Hawthorne (2001) concluded
that foreign nurses from non English speaking
backgrounds (NESB) experience major barriers in
attempting to integrate and practice in the Australian
setting. These barriers effectively limit NESB nurses to
the geriatric sector. Additionally they meet significant
peer rejection. She states this experience is in sharp
contrast to the employment opportunities of overseas
trained English speaking nurses who move into initial,
and later senior, nursing positions (Hawthorne 2001).
This finding is supported by Allen and Larsen
(2003) in the UK who interviewed 67 nurses from
18 countries and 5 continents and found perceived
discrimination, exploitation, professional exclusion by
colleagues, conflicts with local practices and language
problems. Similar issues were identified in Canada
(Turrittin 2002).
The Canadians, in another review, have identified
that the greatest challenge for employers of
internationally qualified nurses was language and
communication with the communication barriers
leading to frustration and confusion for staff and
patients alike (Jeans et al. 2005). Ongoing research
into internationally qualified nurses in the UK has
identified strong recurring themes from many different
studies with a consistency that suggests some validity
to the findings. These themes are:
> That once recruited the continuing professional
development and career progression opportunities
available are not always provided in ways that
meet the specific needs of internationally qualified
nurses, who are then prevented from applying
successfully for promotion.
> Internationally qualified nurses find many of the
skills and qualifications they have learnt and used
in their own country are not utilised in their new
country and they need extra support to use their
skills in the new context.
> Many overseas healthcare professionals experience
direct and indirect discrimination and racism from
colleagues patients and relatives (Allan 2005).
A further theme that emerged from Canada and
other literature was the difficulty the internationally
qualified nurses had adapting to the medical
terminology used, especially abbreviations and jargon
and the names of drugs in different countries. This
was found to be true even of Filipino nurses who were
reasonably fluent in and had actually studied nursing
in English (Daniel, Chamberlain, and Gordon 2001;
Hawthorne 2001; Jeans et al. 2005).
Bridging programs can be useful although many
nurses reported that many were designed for nurses
re‑entering the workforce from inside the country and
were of less value than specifically designed courses
that meet the particular needs of Internationally
qualified nurses and midwives (Jeans et al. 2005;
Pinkerton 2006). The value of offering bridging
programs in overseas countries before nurses
migrate has been raised in work done by the Nurses
Board of South Australia (Nurses Board of Western
Australia 2006).
14 Australian Nursing and Midwifery Council
Another study (Gerrish and Griffith 2004) evaluated
an adaptation program for internationally qualified
nurses in the UK. This study found that all nurses
took longer than the minimum period of supervised
practice specified by the NMC. The authors do
however, state caution in citing this result as there
was no comparative data in the UK that was available
on completion rates for bridging and adaptation
programs or on the time taken to gain professional
registration for internationally qualified nurses. This
study did conclude that the ease with which nurses
integrated into the nursing workforce was influenced
by the characteristics of the work environment, the
organisational context and level of support available
to them in the workplace.
American studies also showed, not surprisingly, that
English speaking nurses integrated more quickly into
the workplace and that this was further helped by the
support of outside social support networks. (Dumpel
and Joint Practice Nursing 2005; Hawthorne 2001).
Assessment of English Language Proficiency
Literature on testing for English language proficiency
was not as abundant as other information on
internationally qualified nurses and midwives. One
of the first considerations relates to the validity of
English Language testing whereby the influence of
factors other than language in assessing ability to
perform in particular occupational contexts needs to
be considered (Elder and Brown 1997). McNamarra
(1990) makes the point that there are tasks where
language is a necessary but insufficient condition
for the successful execution of a task, yet language is
assessed independently of these other factors that are
involved in the task’s successful performance (cited in
(Elder and Brown 1997). As the purpose of assessing
English language proficiency of nurses is to assess the
capability of performing to a professional standard,
testing for English proficiency in relation to the
occupational context must be considered.
Numerous tests of language proficiency are used to
assess nurses in other English Speaking countries.
The most common ones are the International
English Language Testing System (IELTS) which is a
British/Australian test which follows British English
Conventions, the Test of English as a Foreign Language
(TOEFL) which follows American conventions (Davies,
Hamp Lyons, and Kemp 2003). Also there is the Test
of English for International Communication (TOEIC),
a Test of Spoken English (TSE) and Test Written
English (TWE) and in Australia and New Zealand, the
Occupational English Test (OET).
IELTS, although one of the most common English
proficiency tests used globally, is not occupation
specific like the OET. The test is designed to establish
the candidate’s ability to operate and communicate
in English. There are four main elements for testing
language skills. These include listening, reading—
academic or general tests, writing—academic or
general tests and speaking. Test scores are reported in
a scale of 1 (non user)—9 (expert user). Nursing and
Midwifery Councils globally have accepted a test score
of 6.5 to 7 prior to being eligible for registration.
The IELTS global network consists of 320 test centres
who offer tests in more than 500 locations. There are
48 test dates per year, test results are sent out to the
candidate and the sponsor within 14 days of testing
and the results are valid for a period of two years.
There are no imitations on the number of times a
candidate can retake the test at a cost of $280 per test.
Candidates with special needs such as visual and
hearing difficulties and learning difficulties such as
dyslexia are accommodated for.
The most commonly used test in the United Kingdom,
is the International English Language Testing System.
Up to 2007 the score to be achieved in the IELTS
for nursing was 6.5. The Nursing and Midwifery
Council in the UK have recently, as a result of public
consultations and evidence collected from the British
Council, decided that a score of 7 is the lowest
acceptable level of English proficiency for overseas
trained nurses (Atkinson 2006; Nursing and Midwifery
Council 2007). The NMC believes this is necessary for
the protection of the public and more positive nurse
patient relationships. It is reported that patient groups
lobbied hard for a higher requirement as they felt
poor command of English was a source of enormous
frustration (Atkinson 2006). This new standard of an
IELTS of 7 applies equally to nurses and midwives and
commenced in February 2007.
There are similar requirements in Ireland. Non EU
nursing applicants for registration must pass an
approved English Language test. In Ireland these
include the IELTS, TOEFL or TSE and TWE. An overall
score of 7 is required on the IELTS. For the TOEFL the
computer based score required is 230, the Internet
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 15
based score (iBT) required is 88 and the paper based
score required is 570. The TSE score required is 50 with
a TWE score of 5.5.
In Canada nine different English Language
Examinations are used to assess proficiency with most
regulatory bodies accepting more than one test. The
most commonly accepted are the TOEFL and Test of
Spoken English. In Canada the CELBAN (Canadian
English Language Benchmarks Assessment for Nurses)
is accepted by many bodies but not all. The CELBAN
was developed in Canada to address the minimum
English communication standards required for nurses
in English Speaking Canada and contains vocabulary
appropriate to nursing and health care something
not dealt with by other language assessment tests.
(Jeans et al. 2005). It is reported many Canadian
employers felt that the language test requirements
accepted by the regulatory bodies were too low and
did not guarantee that internationally qualified
nurses could communicate effectively for safe practice
(Jeans et al. 2005).
In the United States the National Council of State
Boards recently underwent an exercise to determine a
recommended proficiency level in English Language
Testing for the TOEFL. Two standard setting
procedures were used in conjunction with other
processes to produce a recommended standard score
of 220 on the computer based TOEFL and a score of 560
on the paper based version of the same test (O’Neill,
Marks, and Wendt 2005b). English language testing is
one part of the Commission on Graduates of Foreign
Nursing Schools (CGFNS) qualifying examination to
practice nursing in the United States (Yu, Zhaomin,
and Jianhui 1999).
The Nursing Council of New Zealand will usually
require overseas applicants to demonstrate English
proficiency. The Council accepts an academic IELTS of
a minimum score of 7 for each band reading, listening,
writing and speaking. It also accepts the Occupational
English Test with a B band in each section (Nursing
Council of New Zealand 2006).
Assessment of Competency
There are numerous articles on competence and
the assessment of competence in nursing. As it is
not the purpose of this literature review to focus on
competence, the information here is only a summary
of some of the opinions and studies.
There appears to be no consensus in the literature on
the definition of competence (Bradshaw 1997; Cowan,
Norman, and Coopamah 2007; Pearson et al. 2002;
Watson et al. 2002). With some authors suggesting it
is easier to define by its antithesis “incompetence”
(McAllister 1998; Watson 2002). In much of the
literature, competence has been considered on a wide
continuum from its narrowest application as a list of
tasks able to be completed, to more complex abstract
abilities needed in order to provide an appropriate
level of professional practice in a variety of contexts
(Pearson et al. 2002). Gonczi (1994) describes three
main conceptualizations of competence
> The first conceptualization of competence is
task based and perceived as discrete behaviours
associated with undertaking certain tasks.
Gonczi believes it ignores the complexity of
performing in real world situations and ignores
the role of professional judgment linked to
intelligent performance.
> The second conceptualization is perceived as
independent of context and is concerned with
the general attributes of the practitioner that are
necessary for effective practice. These include
things such as knowledge and critical thinking.
> The third conceptualization is described as the
integrated holistic approach which links the
general attributes approach to the context in
which they will be applied. This allows complex
combinations of knowledge, skills, attitudes
and values to be synthesized and applied to the
particular situations the professional may find
themselves in. It allows for the incorporation of
ethics and values as elements of competence and
recognizes the need for reflective practice and
the importance of context which may lead to a
variance in how one demonstrates competence in
practice. (Cowan, Norman, and Coopamah 2007;
Cowan 2005; Gonczi 1994).
Cowan et al. (2007) argue strongly that an acceptance
of the integrated holistic approach would lead
16 Australian Nursing and Midwifery Council
to greater acceptance of the role of competency
assessment and the development of valid tools
to measure competency (Cowan, Norman, and
Coopamah 2007). The integrated holistic approach
appears to have relevance if one expects nurses to
deliver culturally competent nursing care and respect
the values, customs and beliefs of all individuals and
groups in our society. McMurray (2004) believes some
elements of competence are found not in the nurse
alone but also in the relationship that exists between
the nurse, their colleagues, the patients and families
as well. Competency standards need to acknowledge
these aspects of care (Chiarella 2006).
It is acknowledged that a significant aspect of
competence based assessment is the focus on outcome
performance as opposed to the means taken to
acquire an ability (Pearson et al. 2002) and many have
criticized competency based approaches to assessment
as being invalid and unreliable (Cowan, Norman, and
Coopamah 2007; Watson et al. 2002). What someone
demonstrates as competence today does not hold a
lot of predictive value on their ability to demonstrate
competence in another setting or on another day,
with other influences affecting their practice. There
is also the issue of what level of competency is being
assessed. Is it for beginning (initial) competence or for
continuing competence?
Authorities charged with the regulation of nursing and
midwifery practice in Australia have been provided
by the Australian Nursing and Midwifery Council
with a set of competency standards which serves as a
national benchmark for the performance of individuals
seeking registration as a nurse or midwife. To assist
those responsible for the assessment of competence
against those National Competency Standards, the
Australian Nursing Council (2002) identified a number
of critical issues. Prominent among these issues is the
accountability of the assessor to the profession and to
the regulatory authority for making a valid and reliable
assessment about a nurse candidate’s performance
against the identified competency standards. The
validity and reliability of any competency assessment
process therefore is related to the extent to which the
assessment and associated assessors consistently
and accurately meet the stated purpose and achieve
the intended outcomes. From this it would not be
unreasonable to infer that the training of the assessors
is just as important as the process of assessment and
the education of those being assessed.
Recency of Practise
There was little evidence in the literature to support
the decisions made regarding recency of practise for
nurses or health professionals. Most of the professions
acknowledge that with the substantial changes and
growth in knowledge, pharmacology, technology and
workplace reform there is a need for professionals to
demonstrate they are contemporary and can practise
from an evidence based framework.
A number of professional groups were reviewed in
terms of their definition, criteria and strategies for
determining and dealing with recency of practise
within their profession. These groups included
Nursing and Midwifery Councils from the UK, NZ
and Canada, Dentists, Occupational Therapists,
Physiotherapists, Psychologists, Medical Practitioners,
Medical Radiation Practitioners, Engineers and Legal
Practitioners. Whilst the definition was not always
clear, the criteria for meeting ongoing registration and/
or re registration or licensing had been set.
The groups specified recency of practise being that
of registered or licensed practise within the previous
three to five years. Practise was defined as working in
the profession, administration, teaching, research or
continuing professional development. Specification
was also given to the number of days or hours of
accumulated practise within the profession over the
allocated time period. This ranged from 250 hours each
year over 5 years (Dentists) to 2000 hours in 3 years
(Engineers). Legal Practitioners place restrictions on
specialist practise if greater than twelve months leave
was taken.
Criteria for the eligibility of ongoing registration or
licensing included self assessment of practise, meeting
the nominated point system or hours for continuing
professional development and fitness for practise. A
number of strategies have been developed to assist
applicants to re‑register and recommence practise in
their profession. These ranged from examinations,
practical assessments, competency assessments,
supervised practise, re‑education and return to
practise programs.
Pearson (2002), argues there is a strong need to
work toward the development of common legislative
conditions relating to recency of practise across
Australia. Many of the professions in Australia have
a ‘Recency of Practise’ policy. These include but
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 17
are not limited to Psychologists, Physiotherapists,
Occupational Therapists and Medical Practitioners.
The Guidelines for Medical Radiation Practitioners
in Victoria (MRPB 2007) include a Return to Practise
Pathway for those who have been, two to five years,
five to ten years and greater than ten years out of
regulated practise. The requirements for reinstatement
vary with the length of time the practitioner has been
out of practise. Many of the other professions state that
individuals must have practised within the last five
years with only some nominating a specific number
of hours. As has been mentioned earlier the NMC and
ANMC both specify recency of practise requirements in
their assessment process.
Australian Regulatory Issues and Guidelines
for Internationally Qualified Nurses
In Australia the Australian Nursing and Midwifery
Council (ANMC) sets the standards for assessment
of nurses and midwives for migration purposes
(Australian Nursing and Midwifery Council 2005).
Those standards state that with the exception of NSW
the ANMC deems the following countries nursing
qualifications as being acceptable for the purposes of
registration as a nurse in Australia.
> United Kingdom
> Canada (proof of English Language also required
from provinces of Quebec and New Brunswick)
> The Republic of South Africa (proof of English
Language competence also required)
> The Republic of Ireland
> Singapore (proof of English Language competence
also required)
> United States of America
> Hong Kong (proof of English Language competence
also required)
> European Member States where the nursing
education meets the EU directive 2005/36/EC (proof
of English Language competence also required)
The ANMC also states that midwives (with the
exception of NSW) having gained their qualifications
from the following countries are also suitable for
registration in Australia:
> The United Kingdom
> The Republic of Ireland
> EU member states where midwifery education
meets the EU directive 2005/36/EC (proof of English
Language competence also required)
The current standards for the assessment of nurses
and midwives for migration purposes state that
the applicant must provide evidence of successful
completion of an English language test that is
acceptable to the ANMC. Most nursing and midwifery
regulatory authorities in Australia have adopted these
standards (Wickett 2006). Currently in Australia the
Nursing and Midwifery Regulatory Authorities all
accept the International English Language Testing
System (IELTS), or the Occupational English Language
Test (OET) with some of the authorities accepting other
tests such as the Australian and International Second
Language Proficiency Rating and the Combined
Universities Language Tests. The requirement to
undertake an English Language Test may be waived
under certain conditions, eg if a nurse completed
his/her initial nursing education in Canada where
the instruction and examination was in English or if
nurses had undertaken a degree course within the last
two years at an Australian University.
Other requirements are that the nurse or midwife must
have no found disciplinary matters against them or
have conditions placed on their registration and they
must provide evidence of experience within five years
preceding their application (Australian Nursing and
Midwifery Council 2005).
Other Professions in Australia
The assessment processes of other professions were
reviewed for internationally qualified applicants
wishing to obtain recognition of their qualifications
in Australia and who wish to obtain registration
to practice.
The Australian Dental Council (ADC) has three
options for recognising overseas qualifications in
order to enter the profession in Australia. Immediate
recognition of existing qualifications are granted
if these were obtained in the UK or Ireland and for
all individuals who were licensed to practice in
NZ regardless of where they were educated. If this
criterion is not met, an overseas educated dentist is
18 Australian Nursing and Midwifery Council
eligible to sit for the ADC examinations if they have
completed and passed a minimum 4 year course at a
university recognised by the ADC and are currently
registered as a dentist. They need to be successful
at passing a written and clinical component with
unlimited attempts to pass. Alternatively, they can
enrol in an Australian dental school and be granted
credit for previous study. The OET is used to test
English proficiency with an acceptable pass of A or B
and no other English proficiency tests are accepted.
(Dentistry in Australia, 2007)
Engineers Australia is the designated authority
to assess overseas qualified engineers for
registration. There are two pathways for recognition
of qualifications depending on the category of
engineer—professional (4 year professional degree),
technologists (3 year technology degree), and
associate (2 year advanced diploma). Professionals
are accredited if their qualifications are listed on the
Washington Accord and technologists are accredited
if they are qualified in Canada, Hong Kong, Ireland,
NZ, South Africa and the UK. If their qualifications
are not recognised and therefore accredited, then
applicants can seek recognition through a competency
assessment process. This process includes a
Competency Assessment Report which provides
information on the qualification and grades obtained,
employment history, major learning experiences,
demonstrated achievement of competencies and
evidence of English language proficiency. IELTS is
used to test English proficiency with a minimum
band of 6 accepted in each area of testing (Engineers
Australia 2007).
Conclusion
It is clear that the assessment of internationally
qualified nurses is a complex and expensive process
with many elements that need to be addressed in
order to ensure that the outcome for employers,
consumers, and the nurses themselves is satisfactory.
The challenge was to develop draft standards
within a process that is flexible enough to cope with
change but rigid enough to satisfy the requirements
of ‘protection of the public’ and maintenance of
professional standards.
Standards Development
As can be seen from the literature that for
internationally qualified nurses and midwives
migrating to English speaking countries the
assessment process for registration in the destination
country can be arduous, lengthy, inconsistent and
confusing and even more so in countries where
there is no ‘one national’ system. Therefore as part
of this project, it would appear that in developing
draft standards for the assessment of internationally
qualified nurses and midwives there would be merit
in attempting to keep the standards consistent and to
the minimum number possible. Hopefully then the
processes to support the standards assessment can be
simply explained and can be implemented nationally
and consistently across the various jurisdictions.
Certainly the proposed move to a national system of
registration has assisted in this aim.
In developing the draft standards it is evident that
many factors need to be considered in how these
standards would then be implemented and what
processes would be required to support them.
Although some consideration has been given to
these matters it seems premature to spend too
much time either researching or documenting these
elements until there is consensus as to whether the
suggested approach contained herein is feasible and/
or acceptable.
What has been considered is the cost and time
involved, that any change of this magnitude dictates.
The standards have been developed in a manner and
context which could be facilitated and implemented
in the interim by the current regulatory and industry
structures which are already well developed in this
country. The draft standards have also been developed
taking into account the framework of both the national
and jurisdictional roles which currently occur and will
need to continue for some time and possibly even in
some format even after Australia moves to a national
regulatory system.
Obviously more detail surrounding each standard
will need to occur once a set of standards has
been agreed. The biggest challenge will be gaining
agreement on what the standards should be. The more
standards there are the more difficult it may be to
gain agreement. What is presented here as a result of
an extensive review of the literature, discussion with
the Nursing and Midwifery Regulatory Authorities
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 19
(NMRAs) and a review of what is currently occurring
here in Australia, is a set of minimum standards that
an internationally qualified nurse or midwife should
meet to practise in this country.
This document makes a case for the introduction of
a National Adaptation Program for internationally
qualified nurses and midwives. As part of this program
every overseas qualified nurse and midwife must
undergo an orientation to the Australian health care
system and an assessment of competence to practise.
It may be viewed by some that this is too extreme. It
was felt however, on balance, that to practise safely
in this, the Australian health care system, every nurse
and/or midwife needs to know and understand what
is expected of them in this country in relation to the
manner in which they practise their profession. Nurses
usually undergo an orientation program in any new
environment and this has taken this one step further
to say that in the environment of a new country, there
is some extra knowledge an internationally qualified
nurse or midwife needs to know, that is different
and in addition to, an organizational orientation.
The proposed National Adaptation Program for
internationally qualified nurses and midwives is
further explained and expanded on at the conclusion
of the section on the six standards.
The opportunity being offered by the move to a
national regulatory system seems to be an ideal time
to be looking at a national approach to an adaptation
program. Having said this, it is acknowledged
that there remain jurisdictional issues which will
need to be addressed at State and Territory level
until the National system is implemented. An
attempt to accommodate this has been considered
by ensuring that there is a role for the State and
Territory authorities to have input into and to have
responsibility for elements of the process for the
assessment of internationally qualified nurses
and midwives.
Standards Defined
Standards are seen as a means of communicating
thresholds to be attained or applied to a product or
system. They can also provide a means for establishing
consensus among interested stakeholders (Kupfer
and Prince 2002; Tunajek 2006). Tunajek (2006)
describes standards and other practise parameters
as a means of helping to confirm what constitutes
acceptable knowledge, skills and practise within a
professional framework, with practise standards being
the highest mandate for individual judgment and
clinical behaviour.
This document uses the term standard to describe
a benchmark or level of performance expected to
be achieved by a nurse or midwife applying for
registration in Australia. The term “criteria” are used
to describe statements derived from the standard that
detail the exact requirement (Baker 2006).
Standard 3 is considered to be a standard dealing
with content, which primarily serves to describe the
content of an academic or professional program.
Other standards, (standards 2 and 4) are considered
benchmark standards providing a clear description
of knowledge, attribute or skill that one must acquire
or have at a particular point in time. These are often
seen as a developmentally appropriate expression of
knowledge or skill that is more broadly stated in the
content standard (Kendall 2001).
Performance standards (standard 5 and 6), are
concerned with “how good” is good enough and
relate to issues of assessment that gauge the degree
to which the content standards have been attained
and describes the level of performance in respect
to the knowledge or skill desired (Kendall 2001).
A performance standard anticipates consistency,
and minimal variation in its application in similar
circumstances, and serves to define individual
accountability (Tunajek 2006).
The six draft standards are explained in the following
pages. Each standard is documented and supported
by criteria, principles, rationale and/or evidence
and accompanying comments. A diagram depicting
how the standards would articulate for the purpose
of assessing an internationally qualified nurse or
midwife is included.
20 Australian Nursing and Midwifery Council
Consultation during development
A second version of the draft standards for the
assessment of internationally qualified nurses
and midwives was sent out for consultation in late
February 2008. This second round of consultation
occurred following a telephone consultation with
the NMRAs in relation to the first draft presented in
person at the January 2008 meeting of the ANMC.
A questionnaire was used to gain response to this
second round. A copy of the questionnaire distributed
is attached as appendix one.
Eight questionnaires were distributed with seven
responses received in reply. Twenty two questions were
posed in relation to the six standards. Seventeen of
these responses were able to be presented graphically
and are included along with the survey responses
which are summarised in a table at the completion of
this report as appendix two.
Most diversity of opinion was reflected in three areas
1. in relation to the English language requirements,
(questions 4.2 and 4.3)
2. the definition of ‘professional practise’ and
whether there should be a minimum number
of hours set in determining recency of practise,
and (questions 6.3 and 6.4)
3. issues around ‘fitness to practice’ where an
applicant has an outstanding disciplinary
proceeding underway (question 7.1)
There was unanimous support for the National
Adaptation Program with strong support for it to be
inclusive of drug nomenclature and to be developed
independently but in consultation with stakeholders.
There obviously still needs to be much discussion
regarding how the program should be administered
and who should be responsible for which elements of
the administration.
A third and fourth round of consultation was
conducted in May and June 2008.
Draft Standards

Standard One: The applicant establishes their identity.

Principle:
The applicant is able to demonstrate that they are the person whose name will be entered onto the register to
practise nursing or midwifery.

Rationale:
There is a need to establish that only those qualified to practise nursing or midwifery are registered in
this country.

The Standard is met when the applicant’s identity is established

Criteria Assessment of Criteria

1. The applicant must provide documentary and
photographic evidence that they are the person
seeking to be registered.
> Documents must meet the requirements for the
100 point identification check as set out by the
Australian Government with at least 70 points from
the primary document category.
> All documents must be an original or certified as a
true copy of the original by a National Regulatory
Authority approved certifier.

2. Documents must be current > The documents have not expired.

3. Evidence of current professional registration/ > Evidence of verification of registration/licensure.

licensure, (or eligibility for registration)
with an overseas Nursing and Midwifery
Regulatory Authority

4. Evidence that names match verified qualifications > The correct name matches all qualifications with
documentation to support evidence of a name
change (eg marriage certificate or change of
name certificate).

Identification of refugees may need to be dealt with on a case by case basis by the National Regulatory Body.
In the interim, prior to National Regulation a clear process needs to be determined by each State or Territory
regulatory authority.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 21
Standard Two: The applicant meets English Language Proficiency requirements for the nursing and
midwifery professions.

Principle:
English Language Proficiency is a regulatory requirement for registration and/or licensure and is essential for
safe care and effective communication.

Rationale:
Health care providers, consumers and their families need to be confident that nurses and midwives can
communicate effectively. Other professional groups within Australia have set a minimum score of 7 in the IELTS.
The Department of Immigration and Citizenship (DIAC) recognises IELTS and OET as the official tests for the
purposes of immigration to Australia.

The Standard is met when the applicant can demonstrate achievement of the required score in either the
IELTS or OET English Language Test.

All applicants are required to meet the English Language Testing Criterion regardless of their country of origin.

Criterion Assessment of Criterion

1. The applicant must achieve a score of 7 in all areas
of the academic International English Language
Testing System (IELTS); or
2. The applicant achieves a B pass in all areas of the
Occupational English Test (OET).
> The applicant must achieve this score at a single
test sitting and the test must have been completed
within the last two years.
> The applicant can undertake the test either onshore
or offshore
> The applicant must organise for documentary
evidence of the test outcome to be supplied directly
to the regulatory authority.

These two tests have been chosen as they are the most common. The levels recommended for a pass appear to
be comparable in terms of difficulty. An OET‑IELTS benchmarking study concludes that although the two tests
are approximately equal in degree of difficulty and do test some common features they are not strictly equivalent
in what they measure. However the best fit is between the IELTS band 7 and straight B grades on the OET
(Elder 2007).

22 Australian Nursing and Midwifery Council

Standard Three: The applicant is assessed as meeting current Australian nursing and midwifery
educational standards.

Principle:
Internationally qualified nurses and midwives must meet the educational standard set for Australian qualified
registered nurses, enrolled nurses and midwives.

Rationale:
This standard is in line with the pre existing Australian standards and consistent with other developed
countries with health systems similar in nature to the Australian Health Care System. Registered Nursing and
Midwifery knowledge requires advanced critical thinking and research skills which is usually attained through
higher education experiences and/or through involvement in a continuing education pathway.

Standard for a Registered Nurse/Midwife is met when

The applicant has a minimum qualification of a Bachelor degree, or qualification combined with experience
that is comparable in duration and content to the nationally agreed minimal educational standard for nursing
and midwifery in Australia.

The Standard for an Enrolled Nurse is met when

The applicant has a minimum qualification of a Diploma, or qualification combined with experience that is
comparable in duration and content to the nationally agreed minimum educational standard for enrolled
nursing in Australia.

Criterion Assessment of Criterion

Applicant must provide documentary evidence
that their qualifications and/or qualifications and
experience meet the accepted educational standard for
nursing and midwifery in Australia
For a registered nurse or midwife the evidence
provided by the applicant demonstrates that their
educational preparation meets the ANMC current
accredited standards for nursing.
> University based Bachelor degree with a minimum
length equivalent to six full time semesters and

Midwifery
> Direct entry
> Eighteen month
For an enrolled nurse the evidence provided by
the applicant demonstrates that their educational
preparation meets the ANMC current accredited
standards for enrolled nursing in Australia which is a
diploma based course.

Documentary evidence to include original or certified

copies of a
> Transcript of theoretical content of their course,
including total hours for each subject, and clinical
experience
> The certificate gained and evidence of completion
of the course.

Courses assessed as comparable with the current standard and accepted for registration, need to be standardised
nationally and recorded. This would include those nurses and midwives who were educated prior to a university
based curricula. It is beyond the scope of this project to make these individual determinations. This standard will
need to be further informed by the work currently being carried out on accreditation of National Programs in the
nursing and midwifery professions.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 23
Standard Four: The applicant provides evidence of having practised as a nurse and/or midwife within a
defined period of time preceding the application.

Principle:
The constantly changing nature of technology, treatment modalities, models of care and expanding roles for
nurses and midwives, means that nurses and midwives must be able to demonstrate contemporary knowledge,
experience and the maintenance of skills in order to practice safely.

Rationale:
There is little evidence available; but there is reasonable consensus both within the profession and the NMRAs,
with the principle underlying this standard.

Other professions in Australia and internationally, require evidence of recency of practise.

The Standard is met when

The applicant has practised as a registered nurse, enrolled nurse or registered midwife in the 5 years preceding
their application determination date.

Criterion Assessment of Criterion

In relation to the basis for the application
> The applicant must hold, or be eligible to hold,
a current Nursing and/or Midwifery registration
or licence to practice either in their country of
residence, and/or their country of initial education
and must have practised within the 5 years
preceding their application.
> Applicant must provide original or certified
documentary evidence of currency or eligibility of
registration or licensure in the country from which
they last worked.
> Applicant must provide certified documentary
evidence from their current and previous employers
that they have practised nursing and/or midwifery
in the 5 years preceding their application.
> If not currently employed the applicant must
provide certified documentary evidence from their
most recent employer.
> Applicant must have practised nursing or midwifery
in their area of practice as defined by the ANMC
definitions of “practice”.

NB. If the applicant is applying from a country > It is beyond the scope of this project to make these
which either individual determinations it would require the
application of the knowledge and experience of the
> does not have a regulatory system or NMRAs to determine these criteria.
> cannot provide evidence, then the applicant’s
eligibility will need to be individually assessed
against nationally agreed criteria (yet to
be determined)

In this standard ‘recency of practise’ is considered to be different to ‘demonstration of continuing competence’.

Competence with ANMC standards will not be demonstrated until assessed as competent. Once a nurse or
midwife is assessed as competent they are then responsible for demonstrating continuing competence. This
standard needs to be informed in the future by the work being carried out on other National Programs in the
nursing and midwifery profession.

24 Australian Nursing and Midwifery Council

Standard Five: The applicant demonstrates they are ‘Fit to Practise’ nursing and/or midwifery
in Australia.

Principle :
Fitness to practise is required for demonstration to the wider public, of the integrity of the profession and its
processes governing regulation.

Rationale:
A major purpose of regulation is to protect the public and having such a requirement demonstrates to both
the profession and the public that adequate measures are in place to protect the public from professional
misconduct, or adverse outcomes as a result of a nurse suffering from a physical or mental incapacity. Only
those fit to practise are granted licensure.

The Standard is met when

The applicant can demonstrate that they are fit to practise, with or without restrictions, within Code of
Professional Conduct (2008) for Nurses in Australia, the National Code of Ethics for Nurses in Australia (2002)
and the Code of Ethics and Professional Conduct for Midwives (2008).

Criterion Assessment of Criterion

1. The applicant must produce evidence of fitness to
practise from a registering authority verifying that
the applicant has no previous proven disciplinary
proceedings against them.
> The applicant must provide documentary evidence
of fitness to practise in the form of verification
which must be supplied directly from the relevant
regulatory authority, or in the absence of a
regulatory system from the highest relevant nursing
authority or professional body under which they
have previously practised.

2. The applicant must produce evidence of fitness to
practise from a registering authority verifying that
the applicant has no restrictions resulting from
mental incapacity.
> The applicant must provide documentary evidence
of fitness to practise in the form of verification
which must be supplied directly from the relevant
regulatory authority, or in the absence of a
regulatory system from the highest relevant nursing
authority or professional body under which they
have previously practised.

3. The applicant must produce evidence of fitness to
practise from a registering authority verifying that
the applicant has no restrictions resulting from
physical incapacity.
> The applicant must provide documentary evidence
of fitness to practise in the form of verification
which must be supplied directly from the relevant
regulatory authority, or in the absence of a
regulatory system, from the highest relevant nursing
authority or professional body in the jurisdictions in
which they have previously practiced.

4. The applicant must attest that they have no criminal > The applicant must provide a statutory declaration
convictions which would preclude them from attesting to the fact that they have no criminal
practicing as a nurse or midwife in this country. convictions which would preclude them from
practising in this country.

5. The applicant must attest that they have no
professional impediment or physical or mental
incapacity which would preclude them from
practicing as a nurse or midwife in this country.
> The applicant must provide a statutory declaration
attesting to the fact that they have no outstanding
disciplinary proceedings that would preclude
them from practising nursing or midwifery in
this country.
> The applicant must provide a statutory declaration
attesting to the fact that they have no health
problems which would preclude them from
practising in this country.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 25
Standard Six: The applicant successfully completes the National Adaptation Program for internationally
qualified nurses and midwives.

Principle:
The program orientates the applicant to the Australian Health care system and demonstrates that the applicant
can meet Australian Nursing and midwifery competency standards.

Rationale:
This serves as a strategy to minimize risks for the applicant, the profession, the consumer and the community.
Studies from the United Kingdom and Canada clearly demonstrate that a period of acculturation occurs for all
nurses irrespective of their country of education and that this period of adaptation can in fact take longer than
first anticipated.

The Standard is met when

The Applicant has passed the theoretical content and is assessed as meeting ANMC competency standards,
by an accredited assessor as part of the approved national adaptation program (Adaptation Program for
internationally qualified nurses/midwives).

Criteria Assessment of Criteria

1. A nurse or midwife is eligible to undertake the > The nurse and/or midwife meet standards one
national adaptation program for internationally to five.
qualified nurses and/or midwives

2. A nurse or midwife must undertake and > The nurse and/or midwife successfully completes
successfully complete the theoretical and the National Adaptation Program for internationally
clinical placement components of the National qualified nurses and midwives.
Adaptation Program.

As New Zealand education is recognized under the Mutual Recognition arrangements for most Australian States
and Territories, New Zealand educated nurses and midwives would not be subject to this process in the States
and Territories where mutual recognition is granted.

26 Australian Nursing and Midwifery Council

Figure One: Flowchart depicting relationship of the six standards to successful registration

2. Applicant meets English Undertakes English

1. Applicant is able to N
Y Language Proficiency Language Development or
establish their true identity
Requirements No Further Progress
Successful English
Language Development

N Y 3. Applicant meets minimal

nursing/midwifery
educational standards
No Further
Progress for
Applicant Y N

4. Applicant meets recency

of practise requirements

Y N

5. Applicant meets ‘Fit to

Satisfactory determination
Practise’ requirements

Individual Determination N Y
Required, or
No Further Progress

Determination of Adaptation Pathway in

National Adaptation Program

Band One Band Two

(4 week (6–12 week
Adaptation Adaptation
Program) program)

6. Meets ANMC
Bridging Program
Competency Standards
or other Formal
Education Pathway
with clinical
component
Y N
Successful
Completion &
meets other
REGISTRATION requirements for
Registration

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 27
Proposed National Adaptation Program
Purpose of the National Adaptation Program
The literature, and other overseas experience, has
clearly shown that a period of adaptation needs
to occur for internationally qualified nurses and
midwives transitioning to practise in a new country.
Notably, employers’ understanding of integration
issues and learning needs of internationally qualified
nurses is varied. This being the case it seems logical
to ensure that there is a suitable program available
nationally that prepares internationally qualified
nurses and midwives to practise in Australia and that
there is some consistency, validity and reliability in
terms of who assesses the applicant and how they are
assessed as meeting the ANMC competency standards.
It is proposed the National Adaptation Program would
have two main themes:
1. Providing health care in Australia, consisting of
> The cultural context of the Australian health
care client base,
> The Australian health care system and the
Australian health care organisation culture, and
> Drug nomenclature
2. The AMNC competency standards (by which
performance would be assessed to register
to practise).
It is not envisaged that the education program be
attached to any award course program. While the
adaptation program would require an educational
component to facilitate knowledge and skills in the
theme areas, it should be designed to meet the needs
of adaptation of a currently internationally qualified
registered nurse and/or registered midwife who can
demonstrate recency of practise; rather than that of an
“out of practise” nurse or midwife or one wishing to
upgrade nursing/educational qualifications. Further,
applicants must undertake the clinical component
of the adaptation program in the workplace rather
than in an educational institution where a limited
amount of clinical practise is offered, as this may
only serve to further alienate internationally qualified
applicants rather than facilitate adaptation. This also
facilitates the program being able to be offered and
delivered across a whole range of practice settings.
The adaptation program should be designated a
continuing education, non award program and nationally
accredited for delivery in each state and territory.
28 Australian Nursing and Midwifery Council
The theoretical component could be developed as a
distance learning education package delivered online
or by other means. The curricula of the program would
need to be agreed across all States and Territories.
Nurses whilst undergoing the program would be
provisionally registered in the respective state and
territory until they have successfully completed the
National Adaptation Program.
> Whilst a nurse or midwife is undertaking the
National Adaptation Program they would be
required to work within the bounds of the National
Adaptation Program;
It is envisaged that there would be two main levels of
administration and monitoring of the program at a
National and State/Territory level, with a third local
level providing the capacity for individual employers
to have some choice in relation to whom they engaged
with regard to providers and assessors is also possible.
Program Elements
Clinical Placement
A clinical placement provider would have to
demonstrate an ability to provide a range of relevant
learning experiences for the applicant while
ensuring adequate support during the period of
provisional registration.
Education Program
An education provider would need to be able to
demonstrate compliance with the requirements of
an education provider as prescribed by the national
regulatory authority and would be in accordance with
the Australian Quality Training Framework.
Assessment by an Accredited Clinical Assessor
The clinical venue (clinical placement provider)
would either provide, or organise for a nationally
accredited clinical assessor, to assess competence
to practise. Assessors are accountable to the
nursing profession and the public to ensure that the
assessment is valid and reliable and undertaken in
the practise setting. Assessors must be competent
and confident to ensure that applicants who have not
demonstrated competence in the practise setting are
not recommended to the national regulatory authority
for registration.
Training of Clinical Assessors
While it is recommended in the ANMC National
Competency Standards document (2006) that
assessors should be familiar with the full document
titled “Principles for Assessment of National
Competency Standards for Nurses and Midwives”,
a national training program based on this document
to nationally accredit clinical competence assessors
would not only enhance validity, reliability and
inter‑rater reliability in the national competency
assessment model but would also provide prominence
to the critical role of the assessor. Discussion with
educators indicates that it would be possible to
develop a national program to train clinical assessors
in a ‘train the trainer’ format that could be relatively
easily disseminated across Australia. Such a program
could be designed to be delivered in a two day
workshop and could be coordinated through the
NMRAs in each State and Territory.
Having nationally accredited assessors who are
practicing nurses and midwives, assists in providing
some balance in this equation and aids in the
practicality of how the rigour can be obtained.
The assessment thus becomes a partnership of
key stakeholders. Clear guidelines as to the role of
each component in the program would need to be
established to ensure that there is a team approach to
the delivery of the national adaptation program.
Two pathways
Recognising that this period of adaptation will vary
for differing applicants it is suggested that there are
two pathways, one shorter one of 4 weeks duration
and a longer one of 6–12 weeks duration. Applicants
achieving competence would exit the National
Adaptation Program at the completion of the specified
duration. Unsuccessful applicants would be advised
to undertake a bridging program or another formal
education program. However, if in the opinion of
the clinical assessor and placement provider, an
applicant simply requires more time to achieve
competence rather than lacks knowledge and skills to
obtain competence, a further period of four weeks, in
addition to the adaptation program duration, could
be negotiated.
Criteria would need to be developed and agreed upon
nationally in order to be able to fairly determine the
most appropriate pathway for applicants. The simpler
the criteria the easier it will be to administer and the
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 29
easier it will be to understand for overseas applicants.
For example it may be that agreement and consensus
could be obtained on the following basis
Band One National Adaptation Program: Duration
four (4) weeks (full time equivalent)
Criteria
> Meets the first four standards; and
> Can demonstrate adequate duration of practise in
a country in “band one countries” as defined from
time to time by ANMC (or regulatory authority).
Band Two National Adaptation Program: Duration
six (6) weeks (full time equivalent)—twelve (12) weeks
(full time equivalent)
Criteria
> Meets the first four standards; and
> Can demonstrate adequate duration of practise in
a country in “band two countries” as defined from
time to time by ANMC (or regulatory authority)
One of the NMRAs has requested a definition of band
one and band two countries. This is provided, in part,
above; however it is considered beyond the scope of
these consultants to decide which countries should be
included in which band. It is assumed that the NMRAs
and ANMC would already have some mechanism for
identifying which country’s educational preparation
was consistent with Australia’s.
What might assist in clarifying the intent of the
recommendation is to consider an example of what
would be considered Band One Countries. These
would be nurses or midwives having obtained their
qualifications in one of the following countries as
listed by the ANMC as being adequate for the purpose
of registration as a nurse or midwife in Australia.
For Registered Nurses this would include
> United Kingdom
> Canada
> The Republic of South Africa
> The Republic of Ireland
> Singapore
> United States of America
> Hong Kong
> EU member states where the nursing education
meets the EU directive 2005/36/EC
For Midwives this would include
> United Kingdom
> The Republic of Ireland
> EU member states where the midwifery education
meets the EU directive 2005/36/EC
Ownership of the National Adaptation Program
The program would be the intellectual property of
the ANMC and the national regulatory authority.
This would ensure that key stakeholders own the
program, have the ability to consult directly with the
industry and the profession and have control over the
program’s content and delivery.
Monitoring of the ongoing suitability of the
National Adaptation Program
It is essential that the ongoing suitability of the
adaptation program is monitored. This would need
to be a joint monitoring process by the industry,
the ANMC and the national regulatory authority.
Agreed key performance indicators would need to be
monitored and reported on by each State and Territory.
National Adaptation Program Evaluation Timeframe
The adaptation program should be formally evaluated
after the first twelve months of operation and then
every third year.
Development of the National Adaptation Program
There was strong support for an independent
education consultant or organisation to develop the
national adaptation program. This would obviously
need to occur in consultation with the key and other
industry stakeholders.
30 Australian Nursing and Midwifery Council
Delivery of the National Adaptation Program
Education providers could deliver the program
nationally. Education providers could be few or
many, and need not be tertiary institutions. State
and Territory regulatory offices could take the
responsibility for choosing and maintaining the
register of approved providers in their jurisdictions.
This ensures the program could be delivered in the
manner which best suited the individual State or
Territory. This has the added advantage of ensuring
that until National Regulation occurs the local
regulatory body has an active involvement in the
program and its impact.
Funding of the National Adaptation Program
Currently the health care sector and the regulatory
sector bear the cost of the inclusion of an
internationally qualified nurse or midwife into the
system. What has been suggested here does not
change that dynamic. It would however possibly
change the amount each sector bears. Further work
on this would be required if the concept of a national
adaptation program were to be pursued but has not
been undertaken at this stage.
Suggested Process for Managing
Applications from Internationally Qualified
Nurses and Midwives
In designing a pathway for the management of
unsuccessful applications one needs to understand
what the process might be for the management of
successful applications by internationally qualified
nurses and midwives to practice in this country.
A pathway has therefore been developed on the
assumption that it would closely follow what currently
happens in Australia in relation to applications from
health professionals seeking to register in this country.
The pathway for managing applications has been
devised based upon the following principles.
> Procedural fairness and equity,
> Ownership of the Standards by the profession in
this country, and
> Open and honest communication regarding the
requirements needed to meet the standards and the
time frame taken to process the applications.
Assumptions that the processes would include In the United Kingdom the Nursing and Midwifery
Council (NMC 2007) list in their documentation that
> Clarity regarding the standards required for the basis of the appeal can not be about the standards
applicants seeking to register in this country to but on the basis of the applicant believing
limit the event of unsuccessful applications due
either to a misunderstanding on the basis of > That all of their experience has not
been considered,
– administrative non compliance; or
> The information supplied may have been
– ineligibility to be registered to practice nursing misunderstood, and/or
or midwifery in this country
> More information could be supplied. It would seem
> Communication with the applicant over sensible that in this instance the extra information
the expected time frame required to assess to be supplied could only be in the area that they
the application. were non compliant.
> Reasonable processes for managing the A draft flow chart depicting how the process for
applications in a timely way. The processes managing applications is detailed below in Figure two.
would include keeping complete records of the
administrative process, how the applicant was
rated against the criteria and any correspondence
with the applicant.
> Early assessment and notification of non complying
documentation, so swift follow up can occur.
> Time period for the applicant to comply with
further documentation or other requests.
> A robust process for communicating the outcome
of the assessment to the applicant. For example
if it is intended to refuse an applicant it may be
appropriate to give the applicant an opportunity to
have a hearing prior to the final determination, if
the applicant so wishes.
If an applicant was unsuccessful then the only
possible pathways would be
1. No further action by the applicant
2. A process of appeal for the applicant. At this stage
the applicant would enter a different pathway
which would be an appeals pathway.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 31
Figure Two: Flowchart depicting the process for managing applications of internationally
qualified nurses and midwives for registration in Australia

Applicant submits
Application lapses when
– Application form
no response provided by
– Certified/Requested
Written notification from applicant—informed by
Documents
ANMC informing that ANMC in writing
– Application Fee
application will lapse if
additional requirements
not met within
specified timeframe

Application Assessed

Y N
All application
requirements submitted?

Applicant provides
additional
Y N information/evidence
and/or documentse

Applicant sent written

request for additional Applicants applies in
information, evidence writing for extension to
and/or documentation. provide additional
Given 90 days to respond requirements

Appeal Enters
process appeal
Enters Adaptation Program initiated pathway
and Meets ANMC
Competency Standards

Notified in writing and Initiates options to be

Informed of options eligible to resubmit
including appeal process an application
Y N

Application successful REGISTRATION Application closed

32 Australian Nursing and Midwifery Council

Glossary of Terms
ANMC Competency Standards: Consists of essential
(core) competency standards and competency units
and elements for registration or licensure.
Applicant: An internationally qualified nurse or
midwife who applies to the ANMC for assessment
for registration to practise as a nurse or midwife
in Australia. The Nurse or Midwife must have
evidence of registration/licensure (or eligibility for
registration) with an overseas Nursing or Midwifery
Regulatory Authority.
Assessment: A process whereby documents and
information supplied by the applicant are evaluated
against the ANMC standards and criteria, and the
applicant successfully completes the National
Adaptation Program.
Accredited Clinical Assessor: A registered nurse or
registered midwife with four years or more clinical
experience since qualifying, who has successfully
completed the national program for assessment
of competence and holds current accreditation for
this program.
Bachelor Degree or equivalent: A course of study
leading to a qualification that is recognised as being
consistent with the standards accepted by the National
Nursing and Midwifery Regulatory Body and the
Australian Higher Education System. (These are yet to
be determined).
Competence: The combination of skills, knowledge,
attitudes, values and abilities that underpin effective
and/or superior performance in a profession/
occupational area.
Clinical Placement Provider: An organisation,
hospital or health care facility that is able to provide
suitable, clinical or adaptation experiences for the
applicant for them to meet the objectives of the
National Adaptation Program.
Education Provider: An organisation or entity
responsible for the conduct or supervision of the
National Adaptation Program.
Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 33
English Language Proficiency: The ability to operate
and communicate in English. This is determined
by the applicant achieving the acceptable score in
one of two language tests, International English
Language Testing System (IELTS) or Occupational
English Test (OET).
Enrolled Nurse: A person licensed under an
Australian State or Territory Nurses Act or Health
Professionals Act to provide nursing care under the
supervision of a Registered Nurse. Referred to as a
Registered Nurse Division II in Victoria.
Fit to Practise: The applicant does not have any
health condition, criminal conviction or disciplinary
action against them that would affect their
competence to practice nursing and/or midwifery
in Australia.
National Adaptation Program: An orientation
and education program that assists internationally
qualified nurses and midwives to provide health care
within the cultural context of the Australian health
care system and prepares them to meet the ANMC
competency standards so they may register to practise
nursing and midwifery in this country.
Band One National Adaptation Program A
program of 4 weeks duration (full time equivalent)
that applicants enter who have successfully met
the first four ANMC competency standards and can
demonstrate adequate education and duration of
practise in a country specified under ‘band one
countries’ determined by the ANMC e.g. United
Kingdom or New Zealand.
Band Two National Adaptation Program
A program of 6–12 weeks duration (full time
equivalent) that applicants enter who have
successfully met the first four ANMC competency
standards and can demonstrate adequate education
and duration of practise in a country specified
under ‘band two countries’ determined by the
ANMC e.g. China or India.
Midwife: A person licensed to practise midwifery
under an Australian State or Territory Midwifery
and/or Nurses Act or Health Professionals
Act to be registered and/or legally licensed to
practise midwifery.
Practise: Includes either clinical practise, policy and
administration, research or education.
Qualified: The applicant has met the conditions or
requirements set.

Recency of Practise: Registered or licensed practise

within the previous five years.

Registered Nurse: A person licensed to practise

nursing under an Australian State or Territory
Midwifery and/or Nurses Act or Health Professionals
Act. Referred to as a Registered Nurse Division 1
in Victoria.

Registration: In this document the term

“registration” encompasses registration, endorsement
and authorisation.

Universities: Those institutions which meet the

requirements of protocols A and D of the National
Protocols for Higher Education Processes (2006), are
established by and Australian legislative instrument,
as defined in Part 3 of the National Protocols and
may include those institutions that operate with a
‘university college’ title or with a specialised university
title, where they meet these protocols.

34 Australian Nursing and Midwifery Council

Appendix One

Sample Questionnaire General feedback

We would appreciate you answering the following
Project to Develop the ANMC National Standards for
questions to provide a general response to the draft
Assessment of Internationally Qualified Nurses and
standards. Specific questions for each standard follow
Midwives for Registration
on after these.
February 2008
1. Do the draft standards reflect all of the necessary
areas for assessment of internationally qualified
NMRA FEEDBACK QUESTIONNAIRE nurses and midwives for registration?

We are currently developing the standards as outlined

above. Please use this questionnaire to respond to
the second draft of the ANMC National Standards
 Yes  No
for Assessment of Internationally Qualified Nurses
and Midwives. (The second draft is attached as a 2. Does the process flowchart (figure one page
pdf document) fourteen) outlined after the draft standards, reflect
a practical summary process underpinning the
It is requested that this feedback form be emailed to application of the draft standards?
Judy Conroy at: Jconroy@anmc.org.au or may be faxed
to Judy Conroy @ 02 6257 7955

Final dates for submission of this draft: 15 March 2008

 Yes  No
Feedback relating specifically to each standard
Demographic information A comprehensive literature review has informed the
Please complete the following details so that further content of the following standards. This has resulted
consultation can be undertaken where necessary. in changes to the existing criteria therefore requiring
your feedback. Please answer the following questions in
Title / Surname / First name: relation to each standard.
Position:
Mailing address:
Contact phone number: 3. Draft Standard One: The applicant is able to
Email: establish their true identity
NMRA:
3.1 What evidence should be produced to establish
their identity

4. Draft Standard Two: The applicant meets nationally

determined ELP requirements for the nursing and
midwifery profession.

4.1 Should we accept more than 2 options for

testing English Language Proficiency (ELP)—
International English Language Testing System
(IELTS) and Occupational English Test (OET)

 Yes  No
If yes, please comment

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 35
 4.2 Should the IELTS score be changed to 7 in 6.3 Should practice be defined as the following
all areas? areas—clinical practise, policy and
administration and research and education?
 Yes  No
If no, please comment
 Yes  No
If no, please comment on how it should
4.3 Should there be an opportunity to waiver be defined
English testing?
6.4 If the applicant has less than 12 months post
 Yes  No graduate experience, should they be required
to complete a postgraduate program following
Please comment completion of their assessment to practise in
this country?
4.4 Should the ELP testing be offered onshore and/
or offshore?
 Yes  No
Please comment
5. Draft Standard Three: The applicant is assessed as
meeting defined nursing and midwifery educational 6.5 Should the applicant hold current registration
standards for Australia in the country of residence?

5.1 Please comment generally on any issues

relating to this standard  Yes  No
If no, please comment

6. Draft Standard Four: The applicant is able to

provide evidence of recency of practise as a nurse
or midwife within a defined period preceding
the application.
6.1 Should there be a set timeframe for recency of
practise eg 3 or 5 years?
 Yes  No
7. Draft Standard Five: The applicant meets the
standards for ‘fitness to practise’
7.1 Should the application for registration be
accepted (and held) if the applicant has a
current disciplinary proceeding underway
/ pending or an outstanding allegation of
misconduct?

Please comment
6.2 Should there be a minimum number of hours
of practise set for the preceding time frame
(eg x number of hours of practice in the
preceding 5 year period)?
 Yes  No
7.2 Should criminal checks be performed in the
overseas jurisdictions that the nurses are
applying from?

 Yes  No  Yes  No
Please comment
If yes, please comment

36 Australian Nursing and Midwifery Council

8. Draft Standard Six: The applicant is assessed by an
accredited assessor, as meeting ANMC Competency
Standards, following completion of the National
Adaptation Program for internationally qualified
nurses and midwives.

8.1 Do you agree with the concept of the National

Adaptation Program?

 Yes  No
Please comment

8.2 Should a program include drug nomenclature?

 Yes  No
Please comment

8.3 Are the timeframes for the program acceptable

i.e. Band 1—4 weeks and Band 2—6 to 12 weeks
full time equivalent?

 Yes  No
Please comment

8.4 Who should be responsible for the program

monitoring and evaluation of the program?

8.5 Should the program be developed by an

organisation or consultant independent from
the university sector but in consultation with
all key stakeholders?

 Yes  No
Please specify

8.6 Who should be responsible for engaging

education providers in the States or Territory to
deliver the program?

9. Are there any other aspects of the draft standards

document that you wish to make comment on?

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 37
 Figure One: NMRA Responses to Select Questions of Draft Standards

38
Question Number from Questionnnaire Number of Responses
0 1 2 3 4 5 6 7 8

1. Do the draft standards reflect all of the necessary areas

for assessment?

2. Does the process flowchart reflect a practical summary process?

4.1 Should we accept more than 2 options for testing

Appendix Two
English Language Proficiency (ELP)?

Nurses and Midwives

4.2 Should the IELTS score be changed to 7 in all areas?

4.3 Should there be an opportunity to waiver English testing?

4.4 Should the ELP testing be offered onshore and/or offshore?

6.1 Should there be a set timeframe for recency of practise?

6.2 Should there be a minimum number of hours of practise set for

the preceding time frame?
6.3 Should practice be defined as clinical practise, policy and
administration and research and education?
6.4 If the applicant has less than 12 months post graduate experience,
should they be required to complete a postgraduate program?
6.5 Should the applicant hold current registration in the country
of residence?
7.1 Should the application for registration be accepted (and held)
if the applicant has a current disciplinary proceeding underway?
7.2 Should criminal checks be performed in the overseas jurisdictions
that the nurses are applying from?

8.1 Do you agree with the concept of the National Adaptation Program?

8.2 Should a program include drug nomenclature?

8.3 Are the timeframes for the program acceptable i.e. Band 1–4 weeks
and Band 2–6 to 12 weeks full time equivalent?
8.5 Should the program be developed by an organisation or consultant independent
NMRA Questionnaire Responses to Standards for Registration of Internationally Qualified

from the university sector but in consultation with all key stakeholders?
Yes No Not specified

Australian Nursing and Midwifery Council

General Questions for NMRAs Responses

Yes No Not Specified

1 Do the draft standards reflect all of 100%  – – 

the necessary areas for assessment
of internationally qualified nurses
and midwives for registration?

2 Does the process flowchart reflect 86% 14%  –

a practical summary process
underpinning the application of Comment Themes
the draft standards?
Who is the target audience for the flowchart?

What is the meaning of provisional registration and will this be left to

the NMRAs to decide?

3 Draft Standard One: The applicant is able to establish their true identity

Question Comment Themes

3.1 What evidence should be produced Use a 100 point system—documents given a point ranking
to establish their identity
Birth certificate/passport

All documents either original or certified by approved certifier

Include one document with a photograph

Provide evidence of name change

There may be difficulties with refugees providing evidence

4 Draft Standard Two: The applicant meets nationally determined ELP requirements for the nursing
and midwifery profession.

Question Yes No Not Specified

4.1 Should we accept more than 2  – 71% 29%

options for testing ELP—IELTS
and OET Comment Themes

Not unless Dept of Immigration and Citizenship approve

equivalent test

Must be assure of the validity and reliability of any ELP testing system

By accepting both tests which are not strictly equivalent in what they
are measuring, are we disadvantaging one set of applicants?

When resitting IELTS, some applicants scores have gone down in area
that they previously did well in.

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 39
4 Draft Standard Two: The applicant meets nationally determined ELP requirements for the nursing
and midwifery profession.

Question Yes No Not Specified

4.2 Should the IELTS score be changed 43% 43% 14%

to 7 in all areas?
Comment Themes

This would be in line with NMC in UK

A score of 7 would ensure language proficiency

No research to support the IELTS to be changed to 7

The current IELTS scoring appears sufficient as we have not had any
problems with nurses with current scores

Question Yes No Not Specified

4.3 Should there be an opportunity to 43% 57%  –

waiver English testing?
Comment Themes

There would need to be strict pre‑determined criteria

Evidence would have to be clear for ELP

In the UK all nurses and midwives must undertake ELP test

Question Comment Themes Percentage

4.4 Should the ELP testing be offered Both 71%

onshore and/or offshore?
Onshore Only 29%

Comment Themes

Concerns with identity fraud and security if offshore

5 Draft Standard Three: The applicant is assessed as meeting defined nursing and midwifery
educational standards for Australia

Question Comment Themes

5.1 Please comment generally on any Cert IV currently accepted for ENs
issues relating to this standard
Bachelor degree or equivalent

It is really important that we are assessing against the same criteria

EU accepts Diploma

Needs to be standardised nationally and to have a database re courses

which have been assessed as equivalent

40 Australian Nursing and Midwifery Council

6 Draft Standard Four: The applicant is able to provide evidence of recency of practise as a nurse or
midwife within a defined period preceding the application.

Question Yes No Not Specified

6.1 Should there be a set timeframe for 86%  – 14%

recency of practise eg 3 or 5 years?
Comment Themes

5 years A minimum number of hours would assist and

provide clarity

Must demonstrate competence if any longer than 5

years—alternative approaches have been drafted in
new legislation (SA)

No current research to support, however chosen

timeframe for nursing and allied health professionals

3 years Stated in Act 5 years, however for overseas applicants

this could be from time of application, therefore 3
years would be better

Question Yes No Not Specified

6.2 Should there be a minimum 43% 43% 14%

number of hours of practise set
for the preceding time frame Comment Themes
(eg x number of hours of practice
Should be comparable to minimum hours for lapse in practice
in the preceding 5 year period)?
Whatever is acceptable to meet Australian requirements

ANMC draft competency standards states 420 hrs in 3 years. This

should be the same for overseas applicants

This would need to be linked to ANMC National Project on

Continuing Competence

Minimum hours of practice may be considered in those who have

qualifications less than Bachelor of Nursing or Midwifery

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 41
6 Draft Standard Four: The applicant is able to provide evidence of recency of practise as a nurse or
midwife within a defined period preceding the application.

Question Yes No Not Specified

6.3 Should practice be defined as the 43% 43% 14%

following areas—clinical practise,
policy and administration and
research and education?
Comment Themes
Most internationally qualified nurses and midwives are coming to
work in the clinical area—practice should be defined as clinical

Demonstration of ANMC competencies through the adaptation

program would have to be met. Any variation to this would require the
individual to apply for limited registration—eg restricting practice to
research or policy

Use same definition as ANMC National Competency Standards to

define practice

The setting and skills are contextual. It is up to the employer to check

background and experience. Also individual of nurse or midwife to
ensure competence

Question Yes No Not Specified

6.4 If the applicant has less than 12 72% 14% 14%

months post graduate experience,
should they be required to
complete a postgraduate
program following completion
of their assessment to practise in
this country?
Comment Themes
This would need to be stipulated for all nurses and midwives to
maintain consistency and equity
A routine employer induction/orientation program should address
needs if applicant can provide evidence that they meet equivalence
of a program—includes demonstration of competence in the
practice setting

Question Yes No Not Specified

6.5 Should the applicant hold current 57% 43%  –

registration in the country
of residence? Comment Themes

Not required for Australian residents. Applicants should meet recency

of practice requirements

42 Australian Nursing and Midwifery Council

7 Draft Standard Five: The applicant meets the standards for ‘fitness to practise’

Question Yes No Not Specified

7.1 Should the application for 42% 29% 29%

registration be accepted (and
held) if the applicant has a current Comment Themes
disciplinary proceeding underway
This may a decision that needs to be considered by the Registrar on an
/ pending or an outstanding
individual basis, as refusing a nurse or midwife registration without
allegation of misconduct?
them being found guilty of unprofessional conduct could be seen as
denying natural justice

Would need to review each case on its own merit

Further investigation would be required before application proceeds

Question Yes No Not Specified

7.2 Should criminal checks be 57% 29% 14%

performed in the overseas
jurisdictions that the nurses are Comment Themes
applying from?
Not sure—although would be useful

Statutory declaration—if they declare yes they must produce

criminal record

Current draft state legislation allows self declaration

8 Draft Standard Six: The applicant is assessed by an accredited assessor, as meeting ANMC
Competency Standards, following completion of the National Adaptation Program for
internationally qualified nurses and midwives.

Question Yes No Not Specified

8.1 Do you agree with the concept of 100%    

the National Adaptation Program?
Comment Themes

Appears consistent with the UK

This will ensure national consistency

Question Yes No Not Specified

8.2 Should a program include drug 86%   14%

nomenclature?

8.3 Are the timeframes for the 86%   14%

program acceptable i.e. Band 1—4
weeks and Band 2—6 to 12 weeks
full time equivalent?

Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 43
8 Draft Standard Six: The applicant is assessed by an accredited assessor, as meeting ANMC
Competency Standards, following completion of the National Adaptation Program for
internationally qualified nurses and midwives.

Question Comment Themes

8.4 Who should be responsible for ANMC x 4 As the national body

the program monitoring and
evaluation of the program? NMRAs x 1 Once accredited by NMRA, monitoring and
evaluation would be the responsibility of the
accredited provider

Unsure Needs further discussion

Question Yes No Not Specified

8.5 Should the program be developed 86%   14%

by an organisation or consultant
independent from the university
sector but in consultation with all
key stakeholders?

Question Comment Themes

8.6 Who should be responsible for NMRAs x 2 One stated in line with ANMC
engaging education providers in
  the States or Territory to deliver ANMC x 2 One stated in line with NMRA
the program?
  Employers Not responsibility of NMRAs to deliver
program
 
Individuals/agency/ Apply to board to be accredited provider
employers

Question Comment Themes

9 Are there any other aspects of the Will the adaptation program have an online theoretical component?
draft standards document that you
wish to make comment on? Definition of provisional registration—should this be condition on
licence rather than a type of licence

In general a good document that provides clarity

44 Australian Nursing and Midwifery Council

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Report of national standards for the assessment of internationally qualified nurses and midwives for registration and migration 47