Editorial| Volume 20, ISSUE 2, P75-77, June 2013

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Community safety, consistency and competence - national accreditation for nursing and midwifery education programs

      It is not business as before with the introduction of the new national accreditation scheme for nursing and midwifery education programs leading to registration or endorsement in Australia – there is a new world out there!
      In April 2010 the Australian Nursing and Midwifery Council (ANMC, now the Australian Nursing and Midwifery Accreditation Council – ANMAC) was assigned the role as the accreditation authority for the nursing and midwifery professions by the Australian Health Workforce Ministerial Council prior to the commencement of the National Scheme. ANMAC plays an important role in protecting the health and safety of the Australian community by promoting high standards of nursing and midwifery education. Quality education assures the community that nurses and midwives who complete accredited programs can become registered, practice and care for people in a safe and competent manner. ANMAC was assigned the role of independent accreditation authority for an initial period of three years, with that three-year period expiring on 30 June 2013. A review process was commenced in 2012, founded on review principles agreed by the National Boards, the accreditation authorities through the Australian Health Professions Councils’ Forum and the Australian Health Professions Regulatory Agency (AHPRA). The review included wide-ranging consultation as required by the National Law.
      In February 2013, the Nursing and Midwifery Board of Australia (NMBA) formally provided the ANMAC with the submissions received; and a summary of the issues they had identified from the analysis of the information they had received following the NMBA review of accreditation arrangements required under section 253 of the Health Practitioner Regulation National Law as in force in each state and territory (the National Law).
      At its meeting on 24 January 2013, after consideration of the detailed submission provided by ANMAC, and the feedback received during the review process, the NMBA approved, in principle, to appoint ANMAC as the nursing and midwifery professions’ accreditation authority for a five year period from 1 July 2013 to 30 June 2018.
      So what is different from what occurred before 1 July 2010? Prior to that date eight State and Territory nursing and midwifery regulatory authorities had this role. This differed from the other nine health professional groups entering the scheme at that time as all of these already had national accreditation councils established, enabling the transition to the national registration and accreditation scheme to be relatively painless in the area of accreditation for these professions.
      National accreditation of nursing and midwifery education programs leading to registration and endorsement now means that with national accreditation standards, all programs are assessed and an accreditation determination made by one single organisation. This is no mean feat as it has been calculated that in Australia there are approximately 480 accredited nursing and midwifery education programs and these are delivered by approximately 160 education providers in two education sectors – the higher education sector and the vocational education and training (VET) sector.
      To be able to first build and then to successfully operationalise this huge enterprise, has required the development of a robust governance scheme to ensure quality, efficiency, effectiveness and consistency of the assessment and determination processes. This is especially so, as the NMBA, an independent regulatory authority to ANMAC makes a subsequent and independent decision as to whether an education program accredited by ANMAC is to be approved as a program leading to a qualification suitable for the purposes of registration or endorsement. Therefore there has to be confidence in that initial accreditation determination made by ANMAC and confidence in the assessment processes that lead up to that determination.
      How is this being achieved? It is with the buy-in of the nursing and midwifery professions. Fig. 1 below outlines the governance arrangements for the ANMAC accreditation scheme. The scheme has four critical layers of assessment and decision making.
      These are:
      • 1.
        The preliminary documentary review by an ANMAC Accreditation Manager to ensure the application and curriculum have all the necessary information and navigation tools to send out to the assessment team.
      • 2.
        The assessment by the assessment team involving a documentary review of the materials presented by the education provider and a site visit to all the principal sites or campuses where the program is to be delivered. The assessment team is made up of the ANMAC Accreditation Manager and an independent team of practicing academic and clinical experts in the relevant profession. The approach is based upon the key principles of quality improvement and ‘no surprises’; and the accreditation standards are the lens through which the curriculum and supporting documents are examined. If the assessment team is not satisfied they have adequate evidence to be satisfied the standards have been met, they will provide this information to the education provider and agree on a timeline for being provided with the information that will satisfy the assessment team.
      • 3.
        The review by the ANMAC Accreditation Committee (Registered Nurse, Midwifery, Nurse Practitioner or Enrolled Nurse) relevant to the program. The Committee of academic and clinical experts is the key mechanism for ensuring the inter-rater reliability of the assessment process as they are a standing committee of the same persons who see all the programs in the registration or endorsement category. As the central technical expert panel, the Committee's role is to review the assessment process and test the evidence relied upon by the diverse assessment teams in reaching their view as to whether all the accreditation standards have been met. At this stage also, the Committee may require ANMAC to go back to the education provider to request further information if the Committee is not satisfied all the standards have been met. The Committee has discretion to do this and is independent of the assessment team. Their deliberations and findings are key to the next step of the process.
      • 4.
        The determination made by ANMAC. The ANMAC CEO has the delegation to make an independent accreditation determination based on the recommendations of the relevant accreditation committee where the assessment process has been straightforward and without controversy. Where the assessment process raises questions that require application of material conditions, burdensome reporting requirements or refusal of accreditation; the accreditation determination will be referred to the ANMAC Board for their decision.
      ANMAC informs NMBA of its determination on the accreditation status of the provider and NMBA makes its own independent determination as to whether it will approve the accredited program. The completion of an accredited program leads to fulfilment of the educational requirements that enables the graduate to apply for registration or endorsement.