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Renal S ociet y of Australasia Jou rna l // March 2013 Vol 9 No 1 35
Introduction
Registered and enrolled nurses are required to make several
statutory disclosures each time they renew their nursing
registration. This paper was written in response to many
discussions across several forums that highlighted the need to
clarify the Nursing and Midwifery board of Australia (NMBA)
and the Nursing Council of New Zealand (the Council)
requirements relating to maintaining competence to practise.
In particular, this paper will focus on the requirements for
continuing professional development (CPD) and provide
guidance on how nephrology nurses should meet and verify
their continued competence to practise. With the exception of
nurse practitioners, nursing registration board requirements for
continued registration do not discriminate between generalist
and specialist nurses. Consequently, the requirements to maintain
competency to practise as discussed in this paper can be applied
to the entire nursing audience, regardless of practice context.
This paper will not consider the context of midwives or student
nurses.
Maintaining competence to practise
Maintaining competence to practise is one of the core elements
of nursing registration renewal. With ever-increasing patient
acuity and public expectations, nurses have a professional
responsibility to maintain competency in order to deliver
continued high standards of care (Australian Nursing and
Abstract
Australian and New Zealand nurses are required to make statutory disclosures as part of their nursing registration renewal. One
area of self-disclosure relates to maintaining competence to practise. Nurses are required to develop and maintain a portfolio
that demonstrates their assessment of practice, continuing professional development (CPD) and recency of practice in order to
meet their registering bodies’ required standards. One of the obstacles for nurses is a clear understanding of what constitutes
a professional portfolio as well as what is required of them to demonstrate continuing competence. This paper discusses, from
both the Australian and New Zealand regulation authorities’ perspectives, the maintenance of competency, the requirements for
demonstrating CPD, and how a professional portfolio assists in providing this evidence.
Professional nephrology nursing portfolios: maintaining
competence to practise
Peter M Sinclair, Lynette Bowen and Blair Donkin
Sinclair, P. M., Bowen, L. & Donkin, B. (2013). Professional nephrology nursing portfolios: maintaining competence to practise.
Renal Society of Australasia Journal, 9(1), 35-40.
Submitted July 2012, Accepted August 2012
Author details Peter M Sinclair, Lecturer, The University of Newcastle, NSW
Lynette Bowen, Lecturer, The University of Newcastle, NSW
Blair Donkin, Registered Nurse, Southern District Health Board, South Island, New Zealand
Correspondence to Peter M Sinclair, Faculty of Health, RW2-36, University of Newcastle, Callaghan, NSW 2308
Peter.sinclair@newcastle.edu.au
Keywords
Continuing professional development, professional portfolio, competence.
Midwifery Council (ANMC), 2009). Competence has been
defined as “The combination of skills, knowledge, attitudes,
values, and abilities that underpin effective performance in a
professional/occupational area” (ANC, 2002, p. 1). Continuing
competence, therefore, is a nurse’s ability and responsibility to
demonstrate maintaining competency against the competency
standards of a particular jurisdiction (ANMC, 2009; Nursing
Council of New Zealand, 2012).
In Australia, nurses are guided by the NMBA Continuing
Professional Development Registration Standard (NMBA,
2010a), a document strongly informed by the ANMC
continuing competence framework (ANMC, 2009). The
ANMC framework consisted of four components: assessment
of practice; CPD; recency of practice; and professional portfolio
that enable nurses to “systematically evaluate their practice
against the relevant ANMC competency standards (ANMC,
2009, p. 2). This is achieved through a cyclical, self-assessment
process whereby each nurse reflects on their own clinical
practice in relation to the ANMC competency standards
to identify clinical strengths and areas requiring further
development. This process can be articulated in the form of a
statement that demonstrates how or why learning needs were
identified. Such statements may be based on personal reflection,
annual performance reviews, peer performance assessments,
or regulatory authority statements related to competency in
36 Renal S ociet y of Australasia Jou rna l // March 2013 Vol 9 No 1
relation to one’s context and scope of practice. The nurse then
links learning needs to appropriate CPD opportunities in order
to inform their future professional development plan. CPD
activities are then undertaken and the nurse reflects on how they
impacted on their competence to practise. The process is then
completed with a self-declaration of continued competence
to practise. The final component of maintaining competence
to practise is that each nurse meets the recency of practice
requirements for their corresponding registration body. The
NMBA (2010a) require nurses to keep written evidence of how
they maintain their competence to practise and will conduct
random competence audits to ensure competency requirements
are being met. Records must be kept for a minimum of three
years in the event that the nurse’s registration is audited. At
the time of writing, the Australian registering authority is yet
to conduct registration audits but is legally empowered to do
so (NMBA, 2010a). Under the respective state Acts, failure to
comply with standards or codes may result in the removal of a
licence to practise. However, the Board does have the power to
give exemptions in certain situations (NMBA, 2010a).
The Council is the regulatory authority charged, according to
the Health Practitioners Competency Assurance Act 2003 (District
Health Board (DHB) Shared Services, 2012a), to be responsible
for the registration of nurses and for the protection of the
health and safety of the New Zealand public by ensuring that
nurses are fit for and competent to practise (Health Practitioners
Competency Assurance Act, 2003; Nursing Council of New
Zealand, 2012a). The Council achieves this by defining scopes
of practice for nurses on the register. These scopes describe the
required knowledge, practice activities and skills the Council
has mandated as required by nurses to fulfill these scopes of
practice. Under each of the enrolled and registered nurse scopes
of practice there are up to 20 related competencies and over
80 associated indicators that cover all of the competencies
(Nursing Council of New Zealand, 2007; Nursing Council of
New Zealand, 2010). In the workplace an assessment of the
nurse’s practice is made annually against these competencies,
in the form of an annual performance review, and the onus of
responsibility is on each individual nurse to provide evidence
to demonstrate how their practice meets the Council’s
requirements.
At present, New Zealand nurses can also voluntarily undertake
a Council-approved Professional Development Recognition
Program (PDRP) to gain recognition. PDRPs have been
defined as a “Competence-based programme that assesses
nursing practice against competencies, recognises level of
practice and supports ongoing professional development”
(National Nursing Organisations, 2004, p. 24 as cited in DHB
Shared Services, 2012). For nearly 20 years now the concept
of PDRP has been a feature of the New Zealand nursing
professional development scene and has existed in numerous
forms during that time (DHB Shared Services, 2012a). While
PDRPs are developed by individual organisations, they must
not only reflect the National PDRP framework but also be
approved by the Council (New Zealand Nurses Organisation,
2012), in order for a nurse who has completed one of these
programs to be exempt from a Council competency audit.
To achieve recognition through a PDRP, extensive evidence
is required of the nurse to support the application that their
practice satisfies the requirements for Proficient/Expert RN
or Proficient/Accomplished EN practice. Success in attaining
such a leveling is valid for three years and attracts a financial
enhancement to salary at the Proficient, Expert or Accomplished
levels. Successfully gaining recognition on a Council-approved
PDRP program exempts a nurse from competency audit by the
Council for the same three-year period. After three years, the
nurse must complete a recertification process in order to retain
this status (DHB Shared Services, 2012b).
With the development of the National PDRP Framework and
Council approval and recognition of PDRPs, there is the ability
to transfer one’s PDRP achievement between organisations.
Because there is no one national PDRP program, local
coordinators can advise nurses, when transferring employment,
as to the new employer’s requirements. This assists nurses when
seeking prior recognition of PDRP program status or to meet
the new requirements for the same PDRP status to be granted
(DHB Shared Services, 2012a).
While PDRP completion is not a compulsory requirement
in all District Health Boards or private providers, it is in some.
In some of these providers, if not most, it is the experience
of nurses that PDRP completion is an expectation that is
integrated into a nurse’s professional development goals as part
of the annual performance appraisal process (DHB Shared
Services, 2012b).
Annual random competency audits are undertaken by the
Council of 5% of all nurses who hold a current annual practising
certificate, prior to a new certificate being issued (Nursing
Council of New Zealand, 2012b). The intention of these audits
is to demonstrate that the competencies nurses are required to
meet are able to be evidenced as being met in order to protect
the New Zealand public.
The minimum registration requirements for each jurisdiction
are presented in Table 1. The components of competency
assessment, CPD and recency of practice must be demonstrated
by any nurse on their respective country’s nursing register in the
form of a professional portfolio (NMBA, 2010). The professional
portfolio is the accepted method for demonstrating these
components.
CPD
CPD affords nurses the opportunity to “maintain, improve
and broaden their knowledge, expertise and competence, and
develop the personal and professional qualities” required to
Professional nephrology nursing portfolios: maintaining competence to practise
Renal S ociet y of Australasia Jou rna l // March 2013 Vol 9 No 1 37
maintain and develop their competence to practise (NMBA,
2010a, p. 1). It must be relevant to the nurse’s context of
practice and, for Australian nurses, consist of a minimum of 20
hours of active learning per year. The NZNC requirement will
require nurses to complete professional development on the
code of conduct and professional boundaries (NCNZ, 2012).
New Zealand nurses are required to have completed 60 hours
of CPD over the previous three years. Context of practice
relates to the environmental setting that characterises a nurse’s
practice (NMBA, 2010a). This includes the type and location of
practice setting (for example, urban satellite unit, rural dialysis
unit, tertiary referral nephrology ward), the characteristics of
health consumers, the focus and complexity of nursing practice
(for example, pre-dialysis education, home training, research,
management) and the degree of autonomous practice (ANMC,
2009).
One hour of active learning equals one hour of CPD and the
onus is on the nurse to identify how many hours of learning
have occurred (ANMC, 2009). Active learning relates to the
generation and exploration of new knowledge and establishing
how it benefits one’s practice (Hoke & Robbins, 2005;
Horner, 1995). Nurse practitioners with scheduled medicines
endorsement are required by law to complete a further 10 hours
related to their endorsement (NMBA, 2010a).
The NMBA (2010b) highlights very clearly what activities
are acceptable for CPD. Table 2 provides an abridged version
of these requirements. Education relating to mandatory skill
acquisition such as disaster response or life support may also
count as CPD as long as the nurse is able to demonstrate within
their professional portfolio that active learning has occurred
which is relevant to their context of practice (NMBA, 2010a).
Australian nurses who want more information on this
can view the full registration standard online at www.
nursingmidwiferyboard.gov.au/Registration-Standards.aspx.
New Zealand nurses can view the required standards online at
http://www.nursingcouncil.org.nz/index.cfm/1,28,0,0,html/
New-Zealand-Registration
From speaking with other nurses across various forums,
clarifying potential confusion about the requirement for either
Continuing Nurse Education (CNE) points and/or CPD hours
was necessary. The regulation bodies do not discuss requirements
in terms of CNE points. In the Australian context, CNE points
are awarded via Royal College of Nursing-endorsed activities
with one ‘point’ being the equivalent of one hour of active
learning. However, the carte blanche awarding of CNE points
causes some confusion and may not accurately reflect the time
the nurse spent actively learning. To illustrate, one of the authors
recently attended a national conference and received a certificate
stating that they had earned 17.5 CNE points. This is taken to
mean that they spent 17.5 hours of active learning throughout
the conference which was not the case. To put this into the
Professional nephrology nursing portfolios: maintaining competence to practise
Table 1. Registration minimum requirements for each jurisdiction (NMBA, 2010a;
NMBA, 2010c; Nursing Council of New Zealand, 2012c).
Requirement Australia New Zealand
Practice hours 3 months full-time (or
equivalent) within last
5 years
60 day or 450 hours
CPD 20 hours per year,
relevant to context
of practice (+ extra
10 hours for nurse
practitioners with
scheduled medicines
endorsement)
60 hours of professional
development across 3
years relevant to nurses’
practice area, work
context and appropriate
to a nurse’s scope of
practice.
Competence Relevant competency
standards, Code of
professional conduct,
Code of Ethics
provide guidance on
expectations to the
profession
Meet Council
competencies for their
scope of practice
Table 2. What constitutes a CPD activity? Adapted from NMBA (2010b).
Participation in clinical audits, critical incident monitoring, case
reviews and clinical meetings such as morbidity or mortality reviews
Reading professional journals or books and/or participating in
journal clubs or similar
Writing or reviewing educational materials, journal articles, books
Active membership of professional groups and committees
Writing for publication
Developing policy, protocols or guidelines
Working with a mentor to improve practice
Presenting at or attending conferences, lectures, seminars, workshops
or in-services
Undertaking contextually relevant online education (see for
example http://www.nen.org.au/e-learning-modules/)
Undertaking undergraduate or postgraduate studies which are of
relevance to the context of practice
Conducting or contributing to research
38 Renal S ociet y of Australasia Jou rna l // March 2013 Vol 9 No 1
context of maintaining competence to practise and achieving
the requisite number of CPD hours, the author would need to
demonstrate within their portfolio a process of self-reflection
which identified areas of development and then make the
link to how attendance at conference sessions impacted on
their continuing competence. This would need to be coupled
with a breakdown of the sessions attended and an accurate
account of the number of hours engaged in active learning.
The presentation of the certificate stating the attainment of
17.5 points (even if we assumed this equated to 17.5 hours of
active learning) would not be sufficient if the author’s nursing
registration was audited. The same level of rigour is required
of New Zealand nurses with regard to evidencing relevance of
CPD activities to practice.
One’s CPD plan should align directly with their professional
portfolio and the theme of providing evidence of maintaining
continued competence to practise. Figure 1 provides an
overview on how to develop and execute a CPD plan; this
process should be documented clearly within the nurses
professional portfolio.
Figure 1. Developing and executing your CPD plan, a quick guide.
1. Assess your learning needs (performance appraisal and peer
review will assist with this)
2. Develop goals to address learning needs
3. Write learning objectives that are measurable
4. Describe the learning activities that will meet your learning
needs
5. Set target dates to complete learning
6. Set dates to review progress
7. Identify how you will demonstrate learning has been
achieved.
8. Reflect on progress and evidence of attainment.
What should my professional portfolio look like?
The professional portfolio is far more than just a lever arch
file or box to keep evidence (such as certificates!) of CPD.
Numerous definitions for professional portfolios exist, but in
essence they are a purposeful collection of tangible evidence
that provides proof of accomplishments, competency and
learning (Byrne et al., 2007; McCready, 2007; McMullen et al.,
2003; Neades, 2003).
Some definitions promote a more dynamic approach, including
reflection as a tool to direct professional growth (McCready,
2007). Reflecting on the learning and its application to practice
may facilitate the identification of future learning needs. This
approach provides a continuous cyclic process of professional
development, which underpins the position taken in this paper.
Portfolios are used for a range of purposes and are variously
described in different ways. Some nurses may have used
portfolios as learners to assess their learning, often within the
context of a clinical placement (Mills, 2009; Neades, 2003).
Others may have put together a specific set of their best
evidence to support their claims for suitability for a job, clinical
role or promotion (Andre & Heartfield, 2011). A professional
portfolio that demonstrates elements of self-assessment, CPD
and reflections on active learning has also been described as a
“Learning” or “Working” portfolio (Mills, 2009). This type of
portfolio reflects the requirements of both Australian and New
Zealand registering nursing authorities (NMBA, 2010; Nursing
Council of New Zealand, 2012).
The portfolio can be developed using a traditional paper-
based system. For those who enjoy being creative using
word processing programs, an attractive portfolio in a folder,
compartmentalised into specific categories may be their
preferred option. A paper-based system may be the option
where some evidence is best presented in a paper or hard copy
form. The limitations of this method can be its portability and
bulkiness (Andre & Heartfield, 2011). Some nurses may create
an electronic folder system on their computer and store their
evidence and other related items as electronic files. Many online
courses deliver certificates of completion in an electronic form
also, so it becomes easy to store. The limitations may relate
to the individual’s computer literacy and the time required
creating the initial electronic template (Andre & Heartfield,
2011). Another option to consider is the use of a professional
e-portfolio platform. Some nursing organisations and businesses
(for example, the Royal College of Nursing, Australia,
Australian Nurses Federation, Ausmed Online) have versions of
e-portfolios that record CPD and, in some cases, contain other
aspects of a professional portfolio. There are also commercially
produced platforms such as PebblePad (see http://www.
pebblepad.co.uk/), iFolio (see www.ifolio.com.au/) or Mahara
(see https://mahara.org/). The benefits of e-portfolios pertain
to their flexibility and the type of items that can be uploaded
to the portfolio (Thompson, 2011). Some versions can also be
copied onto transportable mediums such as compact discs or
universal serial bus (USB) sticks, reproduced in a paper version
or made accessible to others for viewing.
Regardless of the medium in which the professional portfolio
is created, there are some key inclusions that will assist the
nurse in demonstrating how they maintain their competence to
practise. Table 3 provides a suggested structure for a professional
portfolio.
Conclusion
Nurses eligible for listing by Australian or New Zealand
registration bodies are required to provide evidence of
their continued competency to practise. This involves
the maintenance of a professional portfolio which clearly
demonstrates how the nurse has assessed their own practice,
identified learning needs, planned and participated in
Professional nephrology nursing portfolios: maintaining competence to practise
Renal S ociet y of Australasia Jou rna l // March 2013 Vol 9 No 1 39
contextually relevant learning activities, and reflected on the
value of those activities to their continued competence within
their context of practice. Keeping a drawer or box full of
certificates or merely stating the date, type of activity, education
provider and a summary of learning are not enough. Professional
portfolios are dynamic and evolutionary tools which provide
evidence to support the maintenance of CPD and competence
as a registered nurse.
References
Andre, K., & Heartfield, M. (2011). Nursing and Midwifery portfolios,
evidence of continuing competence. Sydney, Australia: Elsevier.
Australian Nursing Council. (2002). Principles for the assessment of national
competency standards for Registered and Enrolled nurses. Retrieved July 8,
2012 from: www.nursingmidwiferyboard.gov.au/documents/
Australian Nursing & Midwifery Council. (2009). Continuing competence
framework. Canberra: ANMC.
Byrne, M., Delarose, T., King, C. A., Leske, J., Sapnas, K., & Schroeter, K.
(2007). Continued professional competence and portfolios. Journal of
Trauma Nursing, 14(1), 24–31.
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Professional nephrology nursing portfolios: maintaining competence to practise
Table 3. Suggested structure for a professional portfolio.
Component Structure
Title page Indicates the name of the portfolio owner. The
inclusion of a picture can personalise the portfolio,
but otherwise it should be kept simple and
uncluttered.
Table of
contents
Lists each section of the portfolio. Sections may be
numbered, but avoid page numbering in a paper
form. In an electronic form, this page can provide
the links to each section.
Qualifications
and experience
Some biographical data may be included in this
section, particularly contact details. Details of
relevant qualifications and abridged curriculum
vitae (CV) of relevant professional experience are
contained within this section. The CV provides
evidence of recency of practice which, for
registration renewal, is practice equivalent to three
months in the previous five years or 60 days (or
450 hrs) in the previous three years for Australian
and New Zealand nurses respectively (ANMC,
2009; Nursing Council of New Zealand, 2012).
Self-assessment Enables the identification and prioritisation of
learning needs that will support your continuing
development and competence. Annual appraisals
are often a good starting point. Ask your nurse
manager or educator for a copy of your appraisal.
Appraisals often ask you to reflect on your
performance, as well as provide you with the
opportunity to gain formal feedback from your
manager. NB: In the NZ context, application for
levelling or certification on the PDRP framework
must contain an appraisal that is current, at the
most within the last 12 months, preferably six, of
the application date.
Learning plan Should contain goals related to learning needs
identified in your self-assessment. It should also
outline a strategy to achieve the goals and some
target dates.
CPD log Registering author ities have specific requirements
regarding CPD, dependent on jurisdiction. Keeping
a concise record of the type of activity, hours
spent on the activity and the outcomes will assist
in meeting this requirement. Suitable types of
activities will be discussed below.
Reflections on
learning and
practice
Reflections may be kept as an ongoing journal/
diary, or may be directed towards specific situations
or activities that enhance the nurses’ competence
and address learning needs. This should include
CPD activities recorded in your log. The reflection
should also identify any future learning needs,
which can support your self-assessment, thus
supporting the cyclical nature of professional
development.
Appendices The evidence to support the claims made in the
portfolio will be found in this section. Some
examples of such evidence include:
• copies of attendance/completion
certificates
• clinical competencies
• performance appraisal/review
• journal club participation
• in-service education/papers presented
• poster presentations
40 Renal S ociet y of Australasia Jou rna l // March 2013 Vol 9 No 1
Nursing and Midwifery Board of Australia. (2010c). Recency of practice
registration standard. Melbourne: NMBA. Accessed on April 8, 2011
from http://www.nursingmidwiferyboard.gov.au/Registration-
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Regulating nursing practice to protect public safety. Retrieved 5 July 2012
http://www.nursingcouncil.org.nz/download/73/rn-comp12.pdf
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Professional nephrology nursing portfolios: maintaining competence to practise
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