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MEDICATION ENDORSEMENT FOR ENROLLED NURSES Administration of Medications by Enrolled Nurses Only enrolled nurses who have completed a course approved by the Nurses and Midwives Board may administer medications including schedule 4 medications (but not including drugs of addiction in accordance with the Poisons and Therapeutic Goods Act). In administering medications, enrolled nurses must comply with the Poisons and Therapeutic Goods Act and refer to a valid order. A valid order is one that satisfies the requirements of the Poisons and Therapeutic Goods Act and relevant NSW Health Department policies. Usually this will be an order written and signed by a medical practitioner, nurse practitioner, or dentist. Other forms of prescription may be valid, for example a telephone order may be valid if the circumstances satisfy requirements identified in relevant NSW Health Department policies. A label or other document prepared by a pharmacist is not a valid order. Enrolled nurses practise under the direction and supervision of registered nurses or registered midwives. The extent and closeness of supervision is decided by the registered nurse or registered midwife who is responsible for directing and supervising an enrolled nurse. In considering the level of supervision required, the registered nurse or registered midwife will consider factors such as the needs of the patient/client, the knowledge, skills and experience of the enrolled nurse, the particular clinical activities being undertaken, and the environment in which the enrolled nurse is working. Endorsement by the Nurses and Midwives Board To assist employers, the Nurses and Midwives Board will endorse the authority to practise certificates of enrolled nurses who have completed an approved education program. Enrolled nurses who have completed approved education programs will be issued a letter confirming endorsement to administer medications and words to this effect will be added to their authority to practise certificates, when next issued. On completion of a course, which is approved to lead to enrolment and which includes the specified medications content, applicants will be eligible for medication endorsement when they are granted enrolment. Persons completing the TAFE Certificate IV in Nursing (Enrolled Nurse) course No 314, for which the first intake of students was in October 2003, will be eligible for endorsement when enrolment is granted on successful completion of the course. Enrolled nurses, who completed earlier education programs leading to enrolment, may undertake a post-enrolment course that is approved to lead to medication endorsement. Some courses may be designed for those who already hold a Certificate IV or equivalent qualification as an enrolled nurse. Enrolled nurses who were educated in earlier years in hospitals or TAFE certificate courses will be required to upgrade to Certificate IV level as well as undertake the preparation for medication administration, in order to be eligible for endorsement. It is anticipated that one or more courses will be available for this purpose. On completion of an approved post-enrolment course, enrolled nurses may submit an application form together with appropriate documentation certifying completion of the course. No fee is required. Application forms are available. Applications under Mutual Recognition Where an enrolled nurse is permitted to administer medications as part of practice as an enrolled nurse in another Australian state or territory or in New Zealand, the nurse will be able to lodge an application for endorsement under mutual recognition legislation. Applicants must provide an application under mutual recognition legislation and must provide a current practising certificate for the other jurisdiction. Generally in these circumstances, the Board will grant equivalent entitlement to that which the enrolled nurse has in the other jurisdiction. Sometimes conditions may be applied in order to achieve equivalence with practice in the other jurisdiction. If applicable, nurses will be issued with authority to practise certificates with an endorsement such as “medications endorsement, conditions apply - contact Registrar”. Nurses will also receive a letter which states that they applied for endorsement under one of the mutual recognition acts and the letter will state any conditions which apply. Employers will be able to contact the Nurses and Midwives Board to confirm the conditions or limitations that apply to an individual nurse's practice in relation to medications administration. Where medications endorsement is granted with conditions or restrictions, the enrolled nurse may have the conditions lifted by successfully completing a course approved by the Nurses and Midwives Board. In some cases it may be possible to apply for credit or advanced standing when undertaking a further course in New South Wales. Attention Employers Employers should be aware that, under the mutual recognition legislation, the Board is required to grant equivalent practising entitlement to that which the nurse has in the other jurisdiction. However the nurse might have been granted that practising entitlement without completing an education program of the standard that has been established in this State. Therefore, while employers should check that an enrolled nurse has been granted endorsement for medications administration and any conditions relating to that endorsement, employers are advised also to ascertain the basis on which that endorsement was granted and to confirm that the enrolled nurse has knowledge and skills commensurate with employers' expectations. Other applications Where enrolled nurses have completed education programs, including medication administration, in other states of Australia or in other countries, applications under the Nurses and Midwives Act will be considered individually. In order for the Board to consider an individual application for endorsement, the enrolled nurse must lodge the approved application form and provide documents clearly showing the relevant content of the education program completed by the nurse. The documents must show both that the education program satisfies the requirements specified in Enrolled Nurse Education: Guidelines for the Development of Educational Component in the Administration of Medications. In this regard, documents must show that the curriculum included sufficient scientific knowledge to enable students to understand the underlying condition of clients/patients and the likely impact of the medication being administered. It must also be shown that the curriculum included sufficient theory and practice to enable students to understand and apply the principles of safe medication administration by all routes, including drug calculations, relevant anatomy and physiology, legal aspects, and pharmacology including pharmacodynamics. Further, it must be demonstrated that there was appropriate assessment of both theory and practice within the course. Education Programs Courses in Medication Administration for Enrolled Nurses. Enrolled Nurse Education: Guidelines for the Development of Educational Component in the Administration of Medications Course Requirements for Enrolled Nurse Education