Nursing Act 2005 Regulations on Scope of Practice for Nurses and Midwives

The Nursing Act 2005 (the Act) is the cornerstone legislation governing the nursing and midwifery professions in many Commonwealth jurisdictions. A series of regulations made under the Act define the precise scope of practice for registered nurses, enrolled nurses, and midwives. Understanding these regulations is essential for practitioners, employers, educators, and policy makers. This page summarises the key provisions, explains how the scope is applied in everyday practice, and outlines the responsibilities that arise from these regulations.

1. Legal Foundations

Regulations on scope of practice arise from two principal sources:

• The Nursing Act 2005 provides the statutory authority for the Nursing and Midwifery Board (the Board) to make regulations.
• Regulations made under the Act chiefly the Nursing Act 2005 (Regulations) 2020, which contain the detailed sections on scope of practice.

The Board is tasked with protecting the public by ensuring that only appropriately qualified and competent persons perform nursing and midwifery activities.

2. Definitions

The regulations define several categories of practitioner:

• Registered Nurse (RN) a person who holds a current registration with the Board and has completed an approved bachelorlevel program.
• Enrolled Nurse (EN) a person who holds a current registration and has completed an approved diplomalevel program.
• Midwife a registered practitioner who has completed an approved midwifery education program.
• Practitioner any person who is permitted by law to provide nursing or midwifery services.

3. General Principles of Scope

All practitioners must act within the limits of their authorised scope. The regulations emphasise three guiding principles:

1. Competence a practitioner may only perform tasks for which they have the requisite knowledge, skill and judgment.
2. Safety any activity must safeguard the health and wellbeing of the client.
3. Accountability practitioners remain personally responsible for the quality of care they deliver, even when working as part of a team.

4. Scope of Practice for Registered Nurses

Registered Nurses enjoy the broadest scope under the Act. Their core functions include:

• Comprehensive health assessment and diagnosis of nursing problems.
• Planning, implementing and evaluating nursing care plans.
• Administration of medication, including controlled substances, provided they have completed the required competency verification.
• Performing advanced clinical procedures (e.g., insertion of peripheral intravenous catheters, wound debridement) when endorsed by an authorised supervising practitioner.
• Educating patients, families and communities about health promotion and disease prevention.
• Supervising enrolled nurses and health care assistants.

RNs may expand their scope through:

• Specialist endorsement (e.g., mental health, oncology, paediatrics).
• Additional certifications (e.g., Advanced Cardiac Life Support).
• Formal delegation agreements with medical practitioners.

5. Scope of Practice for Enrolled Nurses

Enrolled Nurses operate under a more limited scope, centred on providing direct nursing care under the direction of an RN or other authorised practitioner. Key activities include:

• Performing basic assessments and recording observations.
• Administering medication that is not classified as a highrisk drug, provided they have completed the relevant competency unit.
• Assisting with wound care, catheter care, and basic procedural support.
• Providing health education and promoting selfcare.
• Documenting care accurately and reporting changes in client condition.

ENs must always act under the supervision, direction, or delegation of an RN, a medical practitioner, or another appropriately authorised professional.

6. Scope of Practice for Midwives

Midwives have a distinct but complementary scope focused on maternity care. Their responsibilities encompass:

• Conducting antenatal assessments and identifying risk factors.
• Providing prenatal education and counselling.
• Managing normal labour and birth, including the use of nonpharmacological pain relief techniques.
• Performing postnatal reviews of mother and newborn.
• Administering prescribed medications related to pregnancy, labour and the postpartum period.
• Collaborating with obstetricians, GPs and other health professionals for highrisk pregnancies.

Midwives may also be authorised to prescribe certain medications after completing the Boards prescribing module, extending their autonomous practice.

7. Delegation and Supervision

The regulations set out clear requirements for delegation:

1. Appropriate match tasks delegated must be within the delegatees scope and competence.
2. Clear communication the delegating practitioner must give explicit instructions, including the expected outcomes and timeframes.
3. Supervision level the delegating practitioner remains accountable for the delegated activity and must provide appropriate oversight.
4. Documentation all delegated tasks must be recorded in the clients health record, noting who performed the activity and who supervised it.

8. Education, Registration and Ongoing Competence

To practise within the regulated scope, a practitioner must:

• Hold a current registration with the Board.
• Maintain a portfolio of evidence demonstrating ongoing competence (e.g., continuing professional development points, reflective practice logs).
• Complete any required competency assessments before undertaking new or expanded tasks.

Failure to meet these requirements can result in registration suspension, fines, or legal action.

9. Breaches and Enforcement

The Act empowers the Board to investigate alleged breaches of scope. Typical enforcement actions include:

• Issuing a warning or reprimand.
• Mandating remedial education or supervised practice.
• Suspending or cancelling registration.
• Referring matters to a tribunal for civil penalties.

Clients who believe they have suffered harm due to a practitioner acting outside their scope can lodge a complaint with the Board, which will then conduct a formal inquiry.

10. Practical Implications for Health Care Settings

Healthcare organisations must embed the scope regulations into policies and daily routines:

• Orientation programs should clearly outline each staff members permitted activities.
• Clinical pathways must identify which professional can perform each step of care.
• Electronic health records can be configured with alerts to prevent unauthorized orders.
• Audits and incident reports should monitor compliance with scope requirements.

By aligning organisational processes with the regulations, employers protect patients and minimise legal risk.

11. Future Directions

The nursing and midwifery landscape continues to evolve. Anticipated changes include:

• Greater autonomy for advanced practice nurses, potentially extending prescribing rights.
• Expansion of telehealth services, requiring clarification of scope in virtual environments.
• Continued emphasis on interprofessional collaboration and shared decisionmaking.

Stakeholders are encouraged to stay informed through the Boards website, professional bodies, and ongoing education.

12. Key Takeaways

1. The Nursing Act 2005 provides the legal framework for defining nursing and midwifery scope of practice.
2. Registered Nurses have the broadest scope; Enrolled Nurses work under supervision; Midwives focus on maternity care.
3. Scope is driven by competence, safety and accountability.
4. Delegation must be explicit, appropriate, and documented.
5. Continual registration, education and competency verification are mandatory.
6. Breaches can lead to serious professional and legal consequences.

For detailed regulatory text, visit the Nursing and Midwifery Board website or consult the latest edition of the Nursing Act 2005 (Regulations) 2020.