A couple of days ago, I sent an email to the Nursing and Midwifery Board of Australia (NMBA) asking some clarification of the reason for their nearly 40% increase in 2012 registration fees.
Specifically, I requested a copy of their 2010-11 financial statement and/or a ballpark financial breakdown of their projected expenditures for 2012.

After all they are now asking us to part with a collective fifty three million, one hundred and forty-nine thousand, six hundred dollars of our hard earned money.
I have posted a copy of the reply below for your examination. But before you read it, here are my comments:

  • I did not receive a copy of the financial statement as requested, or any financial breakdown of the boards justification for this increase in fees. I cannot seem to locate any information around this online…perhaps some of you will have more luck.
  • The NMBA states that its new ‘heart’ is public safety.
    Developing best practice policy, standards, codes and guidelines to ensure this is achieved.
    Agreed, there is plenty of information confirming this on their site….but how many of us nurses develop best practice policy, guidelines and standards in the course of our everyday work activities as nurses. In fact such work is expected of nurses in more senior roles.
    Could we have a 40% pay rise?…...Oh.
  • With amazing logical edification the NMBA defines another of its roles as registering nurses and midwives and setting national registration requirements and fees.
    So at least we can be assured some of our money is being well used to ensure we pay them more money. Excellent.
  • Another role, is to “Assesses internationally qualified nurses and midwives who wish to practise in Australia”.
    Now, from conversations with my collegues, OS nurse’s and midwives are already paying an up-front fee to have their qualifications assessed prior to registration.
    If it requires additional money to do this, I see no reason why nurses and midwives should be subsidising it. The current nursing shortage in Australia is due to past Government mismanagement and we should not be asked to pay to help fix this problem.

The letter then goes on to….no, I’ll let you be the judge.
But in conclusion I simply do not see these activities as costing $53 million each year.
Does anyone disagree with this? I would love you to shout me down.

In fact, I would be personally willing to develop and provide up-to-date standards, best practice guidelines (and even some position statements) for the nurses and midwives of Australia for only 1 million, one thousand, eight hundred and twenty six dollars a year.
That has got to be a substantial savings and lead to reduced fees for 2013!
No. Really….its the least I could do.

Here is the letter.

Dear Ian,

Since its inception (and first meeting in Melbourne in September 2009) the Nursing & Midwifery Board of Australia (the National Board) has worked tirelessly, and met at least monthly, to make sure members of the public are kept safe by ensuring that everyone has access to nurses and midwives who are qualified and competent, and meet the new national standards. Public safety is at the heart of the new National Registration and Accreditation Scheme (the National Scheme), and the National Board is committed to developing policy that is consistent with international best practice standards. One of the biggest achievements to date has been establishing national policy for the registration and endorsement of nurses and midwives in Australia. To achieve this, the National Board had to address a number of differences that existed between each previous state and territory board as well as the requirements of the new Health Practitioner Regulation National Law (the National Law), as in force in each state and territory. The result is that nurses and midwives now only need to register once, and then renew their registration yearly, to practise – even if they work across states and territories.

The National Law defines the respective roles of the National Board as:

• Registers nurses, midwives and students of nursing and midwifery

• Sets the national registration requirements and fees

• Develops professional standards, codes, guidelines and position statements to guide nursing and midwifery practice

• Manages notifications, investigations and panel hearings

• Assesses internationally qualified nurses and midwives who wish to practise in Australia

• Approves national accreditation standards and accredited programs of study leading to registration and endorsement

The National Board then works in partnership with the Australian Health Practitioner Regulation Agency (AHPRA), in accordance with the National Law, to:

• Administer the National Scheme and provide operational and administrative support for the National Boards in their core role of protecting the public

• Manage all registration and notification matters on behalf of the National Board and nine other National Boards

• Manage the registration renewal process

In 2010, the first year of the National Scheme, the National Board set the registration fee based on the best available financial information.

Note: A new aspect to the National Scheme is that it is self-funding (there is no cross subsidisation between professions in the scheme) as the National Board is responsible for being financially independent. The National Board’s only source of funding is registrant fees meaning that registration fees from nurses and midwives must fund all the costs of regulating 330,000 nurses, midwives and students of nursing and midwifery in every Australian state and territory. The annual registration fee is set to ensure the Board continues to meet its obligations under the National Law, and to continue keeping the public safe. This ensures a robust regulatory framework.

The National Board did not significantly increase its fees (and suspended the late fee) during the first year of operation to minimise the impact of the National Scheme on transitioning registrants and to provide time to assess the new environment and build a three year strategic plan. Once the National Scheme was in place, it became clear that the Board had an obligation to review the fees so it could meet its responsibilities under the National Law. Because, in addition to the costs of setting and administering registration standards as well as professional, codes, standards and guidelines to facilitate the provision of high quality education of health practitioners, these fees also needed to contribute to the cost of the Australian Nursing and Midwifery Accreditation Council (ANMAC). ANMAC is responsible for accrediting and monitoring more than 400 nursing and midwifery programs of study that lead to registration or endorsement: an essential component of the National Scheme. And, after careful review and analysis, the National Board has set the fee for registration for nurses and midwives at a level that enables it to provide a robust regulatory framework that protects the public.

Note: The 2012 registration renewal fee for midwives and nurses has been set at a flat fee of $160, and applies to all nurses and midwives (regardless of whether they hold an endorsement or more than one registration).

As you can see, the National Board has endeavoured to smooth the transition for nurses and midwives where possible, but has other obligations to the public and under the National Law to meet as well. Unfortunately, neither AHPRA nor the National Board have any involvement or sway over pay negotiations for nurses and midwives, but I can imagine that National Board members would sympathise with you, being nurses and midwives themselves.

21 Responses to “Letter from Nursing and Midwifery Board of Australia.”

  1. I have just paid the $320.00 that Iam required to make before my application can even be submitted to AHPRA.
    The Application fee is $160.00 also! I was also informed that any application fee is non-refundable.
    Who are they kidding, what choice do I have but to call staffing tomorrow and let them know that this little AIN is available for yet more shifts in the aged care areas of the hospital !

  2. I checked over check butts and see nov 2010 my cheque to register as a registered nurse was 34$
    That is a 500% increase over 1 1/2 years!!! outrageous.
    PH

  3. I’d be more than happy to pay this increased fee if AHPRA incuded AINs, PCs & any other unregulated workers in the health system.

  4. Okay, I get that fees in the past may have been subsidized by health care professions that had to pay higher fees. Nationalization, more bureaucracy, less service, whatever. But why do current practitioners need to pay for education regulation? Shouldn’t that be the realm of the educational institutions to pay for their programs to become accredited? Or you’d think maybe the health department could fork out some of its budget as it’d be in their best interests to be employing well educated graduates. I don’t understand why it’s something we’re now responsible for funding.

  5. Apart from the fact that it operates on a national level, all the functions of the new NMBA look the same as those of the old state Boards. And I wholly agree with Matgrad – the overwhelming majority of nurses I know have only practiced in one state or territory for the totality of their careers – the exceptions have predominantly worked overseas for a period, where national registration would make no difference, rather than interstate, and with three exceptions (two of whom lived near state borders) the interstate workers moved for a period of years to the second state.

    Shelby’s right that the chief function of all of the Boards is to protect the public from practitioners rather than to represent nurses, though this is unchanged from the previous system. A highlight for me of the annual Nexus newsletter we got from the Victorian Board was the summary of complaints against nurses and midwives; it included a comparison to the number of previous cases in each category, and more detail about three or four particular cases. There was also a breakdown of stats (eg number of registrations, how this had changed in the past twelve months) that I found interesting.

    I’m confused by the statement that the “union is not well liked and is part of the reason we are now no longer protected” – as I said earlier, the primary function of the individual boards was to protect the public from malpractice, followed by a duty to protect the profession from unqualified people practicing as registered nurses. In the twenty-plus years I’ve been practicing I’ve never been under the illusion that the Board would protect me, or look at my best interests, in the event there was a valid (or tenuous but serious) complaint about my practice. That’s part of the reason I’m glad that, should I ever find myself in front of the Board, I’ll have ANF representation.

    However, surely nationalising the Boards doesn’t result in an increase in complaints or cases, so costs whouldn’t have gone up on that front. Or, indeed, on any front. Wouldn’t going from seven Boards and Councils to one creating policies, advising government etc reduce staffing, time and money?

    The only contact I’ve had thus far, apart from registration renewal, was to raise my concern during Victoria’s recent EBA negotiations, that I wouldn’t be able to meet my responsibilities under their regulations if my workload increased and we added PCAs that I’d be legally required to oversee. You can imagine my surprise when the eventual response didn’t address my concerns, even though I framed them in terms of concern about my inability to practice within the Board’s guidelines.

  6. hmmm, I believe that APHRA is in place to protect the public, rather than protect it’s members, as the individual state boards did. ( It costs a lot of money to protect the public from the ‘PATEL’S’ of the world.) The union is not well liked and is part of the reason we are now no longer protected. Too much has apparently been ‘swept under the carpet’. Transparency is the key. The public can make an enquiry into our registration and any conditions we may have in place. They can research the same of any Doctor who may be treating them too. There is a big push to screen the OS nurses also, ensuring that, for instance, they really CAN speak english well enough to practice.
    I take MORE offence now at parting with my money for registration, but I do what I must to continue practising. :)

  7. How much was your registration fee in the last couple of years? I will have to pay a registration fee myself at the end of this year as I am in my final year of nursing studies. I figured my fee will be $160 (dollars) as well from looking at AHPRA.

    • I guess a 40% increase equates to a rise of $64 given the current fee is $160 (dollars) which is worth investigating as to what it relates to. I guess any consumer would want to know “what’s in it for me” considering such a hefty increase of 40%. If they provide legal aid and support in terms of a nurse being sued perhaps I could understand that increase as court fees are quite expensive.

  8. I have sent a very similar request to AHPRA as yours Ian and am eagerly awaiting their reply. Its interesting that they use the only need one registration to work anywhere argument and that in this case 160 is probably cheap. As the majority of nurses only work in one state for most of their careers this seems a bit fatuous to me or could it be a bit of the old divide and conquer, or am I just being uncooperative and bloody minded.

  9. Have you tried accessing the financial information through ASIC or freedom of information? Just a thought from when I used to work in government.

  10. Whilst I was at AHPRA, I asked if Nurses & Midwives could use the standard Complaint Form to lodge complaints about the increase in registration fees. I was advised that yes, you could. So here is a link to the Complaint Form http://www.ahpra.gov.au/documents/default.aspx?record=WD10%2F3424&dbid=AP&chksum=Dt5%2BhYlYHajl8ujgLbQWrw%3D%3D

  11. Please take up the invitation to meet the board of the Nursing & Midwifery Board of Australia. I’d love to hear from our representatives how they can say that they are representing our wishes with this increase in registration fees! http://www.nursingmidwiferyboard.gov.au/About.aspx

  12. I wonder how much of an increase their staff recieved especially the chiefs. Is there any way they are able to be independantly audited?

  13. I went into the Melbourne office of AHPRA and N&MBoA today. Hilarious. I had a very nice chat to the receptionist and her manager. I said I just wanted to come in to see what my $160 is paying for! I took a photo, but was told I couldn’t upload it to the ANF RESPECT OUR WORK FaceBook without the ANF approaching them for permission for this to be uploaded to FaceBook!

  14. I wonder how much the staff at ANMAC are paid for their responsibility.

    • Earthnurse: all I do know is that I have done work for free for ANMAC. They have accreditation work that they have to do for RN and EN courses across the country and I volunteer my time to be one of these assessors for Enrolled Nursing as I teach in and manage an Enrolled Nursing programme. There is not money to pay assessors… that’s what we have been told.

  15. Centralise anything and it immediately gets more expensive, less responsive to it members and demonstrably larger in size. The $53 million will be needed for all those bureaucrats salaries, and not a cent will go towards paying nurses or encouraging more of them to join the depleted staff across the nation.

    No body asked me if I wanted this meganursing organisation – so why do we have to pay for it?
    We have to be responsible for our practice not the registration board.

  16. Seems same happening in UK and letter sent to CHRE to ask “in light of “increasing registration fees would there be an audit of NMC finances” Comment was “very snotty letter back”
    This guy highly recommended http://www.hreoc.gov.au/disability_rights/speeches/mii93.htm…..may be worth contacting?

  17. Nice group hug at the end there. Good to know the board members “sympathise” with you, being nurses and all that. Solidarity, yo.

  18. All this could apply to medical registration too. I have just paid an application fee to register, then a registration fee, totalling about $1360, then I will apply for specialist registration again in the next month or so.

  19. And?? where’s the rest of their reply!?!

    Bloody political answer there if you ask me.. god help us they can never actually answer the damn question!

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