Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Ake v Health Care Complaints Commission [2019] NSWCATOD 165 Hearing dates: 12 August 2019 Date of orders: 28 October 2019 Decision date: 28 October 2019 Jurisdiction: Occupational Division Before: A Britton, Principal Member S Shultz-Robinson, Senior Member J Flood, Senior Member A Johnston, General Member Decision: (1) Pursuant to s 163B(1) of the Health Practitioner Regulation National Law (the National Law), Ms Ake is reinstated to the register of nurses maintained by the Australian Health Practitioner Regulation Agency in conjunction with the Nursing and Midwifery Board of Australia. (2) Pursuant to s 163B(4) of the National Law, the following conditions are imposed on Ms Ake's registration for a period of 12 months or such longer period as determined by the Nursing and Midwifery Council of NSW (the Council): (a) Not to undertake agency nursing; (b) Not to be the nurse in charge of any shift, ward or unit; (c) Not to work night duty (22:00 to 06:00); (d) To practise under indirect supervision in accordance with the Council's Regulatory Supervision Policy, and as subsequently determined by the appropriate review body; (e) To nominate a supervisor for approval by the Council within 14 days of commencing work, or as specified by the Council; (f) To undertake the three-month structured training and development program, which the Northern Sydney Local Health District undertook in these proceedings to provide Ms Ake (the Training), if her registration is reinstated; (g) To authorise the Northern Sydney Local Health District to give to the Council a report outlining whether she has successfully completed the Training, within 14 days of completing the Training. (3) While Ms Ake's principal place of practice is in NSW, the Council is the appropriate review body for the purposes of Pt 8, Div 8 of the Health Practitioner Regulation National Law (NSW). (4) Ms Ake must pay the costs of the Commission as agreed or assessed. Catchwords: TRADES AND PROFESSIONS –– reinstatement of health practitioner under Health Practitioner Regulation National Law COSTS — application of compensatory principle where applicant practitioner is successful in application for review of cancellation order Legislation Cited: Civil and Administrative Tribunal Act 2013 (NSW) Health Practitioner Regulation National Law (NSW) Cases Cited: Ameisen v Medical Council of New South Wales [2015] NSWCATOD 49 Bahramy v Medical Council of New South Wales [2014] NSWCATOD 116 Donnelly v Health Care Complaints Commission [2014] NSWCATOD 155 Haber v Health Care Complaints Commission [2018] NSWCATOD 16 Health Care Complaints Commission v Ake [2018] NSWCATOD 7 Health Care Complaints Commission v Do [2014] NSWCA 307 Health Care Complaints Commission v Philipiah [2013] NSWCA 342 Mnyandu v Health Care Complaints Commission [2015] NSWCATOD 43 Qasim v Health Care Complaints Commission [2015] NSWCA 282 Ristevski v Medical Council of NSW [2016] NSWCATOD 18 Roberts v Medical Council of New South Wales [2015] NSWCATOD 35 Scully v HCCC [2013] NSWNMT 7 Shah v Health Care Complaints Commission (No 2) [2016] NSWCATOD 102 Shah v Health Care Complaints Commission [2014] NSWCATOD 94 Vo v Medical Council of NSW [2018] NSWCATOD 18 Category: Principal judgment Parties: Merelita Ake (Applicant) Health Care Complaints Commission (Respondent) Representation: Counsel: I Chatterjee (Respondent) Solicitors: NSW Nurse Association (Applicant) Health Care Complaints Commission (Respondent) File Number(s): 2019/00131891 Publication restriction: Pursuant to s 64(1) of the Civil and Administrative Tribunal Act 2013, the disclosure and/or publication of the name of the Patient A is prohibited. REASONS FOR DECISION 1. In January 2018, the Tribunal (differently constituted) made orders cancelling Ms Merelita Ake's registration as a nurse: Health Care Complaints Commission v Ake [2018] NSWCATOD 7. In addition, the Tribunal made orders prohibiting Ms Ake from applying for review of the cancellation order for 12 months. 2. Ms Ake now exercises the right conferred by s 163A of the Health Practitioner Regulation National Law (NSW) (the National Law) to apply for review of the cancellation order. Ms Ake requests that the Tribunal reinstate her registration and undertakes to submit to any conditions on her registration that the Tribunal considers appropriate. The Health Care Complaints Commission (the Commission) neither supports nor opposes Ms Ake's application for reinstatement. 3. For the reasons that follow, we have decided to reinstate Ms Ake's registration and to impose conditions on her registration. Complaint referred by the Commission 1. The initiating complaint referred by the Commission to NCAT (the Complaint), concerned the care Ms Ake provided to 74-year-old, Patient A, in the eight hours prior to her death on 4 July 2015. 2. Patient A had a long history of schizophrenia and anorexia nervosa. Following a relapse, she was admitted to Hornsby Hospital and later to the Specialist Mental Health Service for Older People-Acute Inpatient Unit Manly Hospital (the Acute Inpatient Unit). Ms Ake was the Senior Nurse in charge of that unit on the day of Patient A's death. 3. The Complaint was in three parts. The Tribunal found proven Complaints 1 and 3 but not Complaint 2. 4. In Complaint 1, the Tribunal found Ms Ake guilty of "unsatisfactory professional conduct" under s 139B(1)(a) of the National Law — "conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of the practitioner's profession is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience". The Tribunal found proven four of the five particulars of Complaint 1, that is Ms Ake's failure: 1. to undertake or cause to undertake, adequate observations of Patient A in the eight hours before her death during which she was classified as being in the "Red care zone"; 2. to adequately consider Patient's A history and identified risks including of silent aspiration, when at 02:00 she observed that Patient A's breathing "appeared reduced"; 3. to take appropriate action on finding Patient A "non-responsive" at 06:00; 4. to demonstrate the appropriate communication skills of a senior nurse in an emergency situation on finding Patient A non-responsive at 06:00. 1. In Complaint 3, the Tribunal found Ms Ake guilty of "professional misconduct" under s 139E of the National Law: "unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration". 2. A NSW Deputy State Coroner determined Patient A had died of natural causes with her "direct cause of death being aspiration of gastric contents antecedent to a left middle cerebral artery cerebrovascular accident". Employment history 1. Ms Ake worked as a nurse in Fiji between 1971 and 1980, in the area of mental health. 2. In 2004, after graduating with a Bachelor degree in Nursing from the Australian Catholic University, Ms Ake registered as a nurse in Australia. In 2007, Ms Ake was awarded a graduate certificate in Mental Health by the University of Technology, Sydney. 3. In the 11 years before Patient A's death, Ms Ake worked continuously as a registered nurse in NSW, in the area of mental health. In October 2013, she commenced work at the Acute Inpatient Unit, where she was working on the day of Patient A's death. The Unit cares for people with mental illness who are over 65 years of age. 4. The conduct involving Patient A which resulted in the cancellation of her registration, was the first and only complaint made about Ms Ake's conduct as a nurse. 5. In the intervening period between Patient A's death and the Tribunal's decision to cancel her registration (July 2015 to January 2018), Ms Ake continued to work as a nurse under a management plan formulated by her employer, the Northern Sydney Local Health District (NSLHD). Under that plan, Ms Ake was required, among other things, to undertake additional training. Material in support of Ms Ake's application for review 1. In a statement prepared in support of her application for review of the cancellation order, Ms Ake wrote that she acknowledges that the "guilt, depression and remorse" she experienced following Patient A's death was incomparable to the "loss and inconsolable grief that [Patient A's] family would have experienced". She wrote that she accepted "full responsibility" for her shortcomings in her care of Patient A, including her failure to undertake appropriate and regular observations, to respond appropriately when there were signs Patient A's condition was deteriorating, and to escalate the situation when she found Patient A unresponsive at 06:00. 2. Ms Ake wrote that since the cancellation of her registration in January 2018, she had taken steps to overcome her lack of clinical knowledge and deficiencies in her clinical practice, identified by the Tribunal. Ms Ake stated that she has undertaken self-directed learning together with continuing professional development covering, among other topics, basic life support, clinical handover and clinical documentation. In her view, not only have these courses assisted her to improve her clinical knowledge and skills but "most importantly" to "take responsibility for any mistakes I may make, so as to better rectify the situation". 3. After the cancellation of her registration, Ms Ake continued to be employed by the NSLHD, initially in an administrative role and from August 2018 as an assistant-in-nursing (AIN). In that role, Ms Ake worked as a "Patient Special" providing one-to-one care for patients with mental illness at Royal North Shore Hospital under the direct supervision of a Registered Nurse. According to Ms Ake, as an AIN, her primary role is to observe patients and, where appropriate, to notify the supervising nurse of any change in their mental or physical condition. Ms Ake claims that in that role, her knowledge and experience of caring for patients with physical illnesses has increased significantly. She points out that in the mental health area where she had been working exclusively until the time of Patient A's death, she had limited experience in caring for patients with acute physical illnesses. In her view, over the period she has worked as an AIN, she has become "much more confident" about her ability to care for such patients. Anthony Dombkins 1. In a letter of support dated 12 March 2019, the Director, Nursing and Midwifery, NSLHD, Anthony Dombkins, wrote that since August 2018 Ms Ake has performed the duties within the "scope of practice" of an AIN and, in addition, has met the required "mandatory competencies of nursing and midwifery within the NSLHD". Mr Dombkins wrote that if Ms Ake's registration as a nurse is reinstated, he undertakes that a "robust structured education program" will be put in place to support Ms Ake's transition back to work as a Registered Nurse. 2. In evidence given in these proceedings, Mr Dombkins stated that he was confident that if Ms Ake were to return to work as a nurse, she would not pose a risk to patient safety. He reported that throughout the period Ms Ake has been working as an AIN, the NSLHD has not received any adverse reports about Ms Ake. Indeed, throughout that period the NSLHD has received many favourable reports from patients and nursing staff about her work. Jenny Neilson 1. Acting Director, Nursing and Midwifery, NSLHD, Jenny Neilson, has been responsible for providing support and professional development to Ms Ake since her registration was cancelled. In addition, in March 2019 Ms Neilson assessed Ms Ake's competence to practice as an AIN. 2. In undertaking that assessment, Ms Neilson used the competency standards developed by the Nursing and Midwifery Board of Australia, Registered Nurses Standards for Practice for Registered Nurses (the Standards). She explained that she used the Standards because the Board is yet to develop competency standards for AINs. 3. In assessing Ms Ake, Ms Neilson used "Bondy Scoring", a tool used to measure a person's competence to practise as a nurse. Using a score of one to seven, Bondy Scoring assesses a person's competence to practise against the Standard's seven "competency standards". Those standards are broken down into 41 "criteria elements". A score of one indicates that the person is "Dependent – unable to demonstrate nursing practice"; a score of seven indicates that the person is "Proficient: performs skills proficiently and accurately; no supervision required; demonstrates effective use of knowledge, time and skills; evidence of advanced nurse competence utilised". 4. In a report prepared for these proceedings, Ms Neilson set out the results of her assessment of Ms Ake. The report was based on interviews conducted by Ms Neilson with registered nurses who had supervised Ms Ake as an AIN. With respect to most critical elements, Ms Ake's scores fell mainly in the mid-range. However, for 12 of the 41 critical elements, Ms Ake's scored in the second lowest band. Ms Neilson explained that these low scores were attributable to Ms Ake being unable to demonstrate competency in those practice areas because they fell outside the scope of practice of an AIN. 5. Included in Ms Neilson's report were comments made by Ms Ake's supervisors about her work as an AIN. All were extremely complimentary about Ms Ake's professionalism and skill. 6. According to Ms Neilson, over the period she has been responsible for overseeing and supporting her (March 2018 to date), Ms Ake has developed confidence and has demonstrated a willingness to ask questions of her supervisors and colleagues when she has concerns about patients. 7. Ms Neilson explained that like Ms Ake, many mental health nurses have limited experience working with patients with acute physical illnesses and, as a consequence, often lack the necessary clinical skill and experience to care for these patients. She explained that the reverse is also the case. Many "general" nurses lack the clinical skill and experience necessary to care for patients with mental illnesses. She stated that many nurses with whom Ms Ake has been working at Royal North Shore Hospital have commented to her that their knowledge of mental health has been enhanced as a result of working with Ms Ake. 8. Ms Neilson stated that if Ms Ake's registration is reinstated, the NSLHD will provide her with a three-month structured training program, to ensure that she is competent to practice as a Registered Nurse in all areas covered by the Standard. She explained that Ms Ake will not be permitted to work as a Registered Nurse until such time as her performance has been properly assessed and any areas of deficiencies addressed. 9. Ms Neilson agreed with Mr Dombkins' opinion that Ms Ake would not pose a risk to patient safety if she were to resume work as a nurse. The principles governing review of a cancellation order 1. Where, as here, the Tribunal receives an application for review of a cancellation order and any disqualification period imposed under s 149C(7) has expired, the appropriate review body, in this case the Tribunal, must conduct an inquiry: s 163B of the National Law. In conducting that inquiry, the Tribunal cannot review the original decision to make a cancellation order or any findings of fact made by the original Tribunal in connection with that decision: s 163C(2). Rather, the Tribunal's task is "to determine the appropriateness, at the time of the review, of the order concerned": s 163C(1). 2. Having conducted an inquiry into the application for review of a cancellation order, the Tribunal may, among other things: dismiss the application, make a reinstatement order or impose conditions on the person's registration: s 163B. 3. In the exercise of the power to conduct an inquiry under s 163B of the National Law, the protection of the health and safety of the public must be the paramount consideration: s 3A. The objectives of the National Law include to "provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered": s 3(2)(a). To practise as a health practitioner a person must, be a "fit and proper person for general registration" and be able to practise his or her profession competently and safely: s 55(1)(h). 4. The principles relating to the reinstatement of deregistered health practitioners under the National Law are settled and have been considered in recent Tribunal decisions including, Bahramy v Medical Council of New South Wales [2014] NSWCATOD 116; Scully v HCCC [2013] NSWNMT 7 (Scully) and Shah v Health Care Complaints Commission [2014] NSWCATOD 94 (Shah). Those principles were succinctly stated in Shah at [34]: (1) the applicant bears the onus of proving that he or she is a fit and proper person to be engaged in the profession … (see Scully v HCCC [2013] NSWNMT 7 (Scully) [41] and the authorities there referred to); (2) the standard of proof to be applied by the Tribunal is the civil standard of proof, the balance of probabilities, tempered by the requirements of Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336; (see Scully [41] and the authorities there referred to; see also In Re Jason Martin [2010] NSWMT 13); (3) the purpose of the jurisdiction is "not punishment or further punishment" of the former practitioner, rather the jurisdiction that is exercised is for the protection of the public (see Scully [47] and the authority there referred to); (4) the power to reinstate should "be exercised with great caution and only upon solid and substantial grounds" (see Scully [48] and the authority there referred to); (5) there is no public interest in denying forever the chance of redemption and rehabilitation to former practitioners. The public is better served if, in appropriate cases, those who have offended, once they have affirmatively proved reform, are afforded a second chance (see Scully [49] and the authority there referred to); (6) in making an assessment of the applicant's worthiness and reliability for the future, the Tribunal may draw inferences from what has happened in the past and, in particular, what led to their being removed from the Register. In Scully, the Tribunal referred at [50] to In Re Jason Martin [2010] NSWMT 13 where the Medical Tribunal pointed out it is not "a question of what an applicant has suffered in the past. It is a question of his [or her] worthiness and his [or her] reliability for the future". That Tribunal noted the difficulty associated with predicting how a practitioner would behave in the future and remarked "the decision in the particular case is to a greater or lesser extent dependent upon the Tribunal's assessment of the applicant". 1. In Scully, the Nurses and Midwives Tribunal also considered the relevant principles relating to applications for reinstatement. It applied the principles outlined above in an unexceptional way, but it is noteworthy for a reference to a dissenting judgment of Kirby P in Dawson v Law Society of NSW [1989] NSWCA 58 at [17] in which His Honour remarked: There is no public interest in denying forever the chance of redemption and rehabilitation to former practitioners. On the contrary, the public is better served if, in appropriate cases, those who have offended, once they have affirmatively proved reform, are afforded a second chance ... Submissions 1. Ms Ake submits that the Tribunal can be comfortably satisfied that the conduct which resulted in the cancellation of her registration will not be repeated for the following reasons. 2. First, she accepts full responsibility for that conduct. In particular, she admits that it was a significant failure on her part to conduct only "superficial observations", especially from 02:00, when there were signs that Patient A's condition was deteriorating. Having had the opportunity to reflect on the reasons given by the original Tribunal for deciding to cancel her registration, she accepts that when the Tribunal heard the Complaint, she was unwilling to take responsibility for the mistakes she made with respect to the care of Patient A. 3. Second, Ms Ake contends that the self-directed learning and continued professional development provided by her employer has assisted her to work towards remedying the defects in her practice, which were demonstrated by the care she provided to Patient A on the day of her death. 4. Third, Ms Ake contends that the Tribunal can be confident that she will embrace the opportunity provided by her employer to support her transition back to work as a Registered Nurse and, critically, to remedy any identified defects in her practice. 5. Fourth, pointing to the supporting opinion expressed by Ms Neilson, Ms Ake contends that her confidence in general nursing has been bolstered as a result of the intensive training and support received from her employer since her registration was cancelled. She states that the Tribunal can be confident that her failure to convey to her nurse colleague the seriousness of the situation when she found Patient A to be non-responsive at 06:00, which she accepts was a serious shortcoming on her part, will not be repeated. 6. The Commission neither opposes nor supports Ms Ake's application for reinstatement. The Commission accepts that Ms Ake's application for reinstatement is assisted by the "remarkable institutional support" provided by her employer. In addition, the Commission concedes that the further training and education undertaken by Ms Ake over the past few years, together with her preparedness to recognise the defects in her practice in relation to Patient A, demonstrate that Ms Ake is now a fit and proper person for registration as a nurse. However, the Commission submits that the assessment undertaken by Ms Neilson provides limited assistance to the Tribunal in determining whether Ms Ake now has the necessary level of competency in all areas of nursing practice. If the option of reinstatement is to be considered, the Commission urges the Tribunal to impose conditions on Ms Ake's registration, including that Ms Ake be required to undertake a structured training program. Is cancellation now the appropriate order? 1. It is against the principles set out above that Ms Ake bears the onus of proving, on the balance of probabilities, that she is a fit and proper person for registration and is able to practise the profession of nursing competently and safely. The key issue raised in this review is whether Ms Ake can now be trusted to practise the profession of nursing in a way that conforms to the professional standards expected of a nurse and, in particular, in a manner that presents no material risk to the safety of patients, especially those who are acutely unwell. 2. We accept Ms Ake's claim to have insight into and to be contrite for the defects in her care and management of Patient A in the eight hours before her death. In addition, we accept Ms Ake's claim that since that time, she has demonstrated a willingness to review her practice, learn and address any identified shortcomings. We agree with Ms Neilson that it is significant that Ms Ake, by nature a shy and reserved person, has grown in confidence and is now likely to be assertive and to speak up if patient safety demands. 3. Weighing against those factors which favour reinstatement is the fact that it is yet untested whether Ms Ake will be able to use the knowledge and skill she has now gained and respond appropriately if she is again caring for a patient whose physical health is compromised or deteriorating. As acknowledged by both Ms Ake and the Commission, the assessment undertaken by Ms Neilson is of limited assistance because Ms Neilson was unable to test, or adequately test, Ms Ake's competence to practise in areas outside the scope of practice as an AIN. While the available evidence indicates that throughout Ms Ake's long career she has been a caring and diligent nurse, demonstrating high level skills in caring for patients with mental illness, the circumstances which led to the cancellation of her registration demonstrated a significant lack of knowledge and judgement in the care of patients whose physical health is deteriorating. It goes without saying that there is little margin for error in the care of such patients. 4. Given the significant support that the NSLHD has been providing to Ms Ake and has undertaken to continue to provide, together with her demonstrated willingness to rectify any identified deficiencies in her practice, we are comfortably satisfied that, with conditions, Ms Ake does not pose a risk to patient safety. In reaching that decision, we have given significant weight to the opinions expressed by Ms Neilson and Mr Dombkins that Ms Ake does not pose a risk to patient safety. Both are experienced nurses who have been involved in monitoring Ms Ake's performance and have given thoughtful consideration to her competence to practice. 5. We have decided it is appropriate to exercise the power to reinstate Ms Ake's registration and to impose conditions on her registration. The conditions, which we set out below, restrict the type of work that Ms Ake can undertake; require her to work under "indirect supervision"; require that she undertake a three-month structured training program provided by the NSLHD; and to authorise the NSLHD to advise the Nursing and Midwifery Council of NSW whether she has successfully completed that training. Should Ms Ake be required to pay the Commission's costs? 1. The Commission seeks an order that Ms Ake pay its costs in these proceedings. Ms Ake opposes that application and submits that she does not have the capacity to pay the Commission's costs. 2. In exercising the power to award costs, conferred by cl 13, Sch 5D to the National Law, the general "rule" is that costs follow the event: Health Care Complaints Commission v Philipiah [2013] NSWCA 342 at [42]; Qasim v Health Care Complaints Commission [2015] NSWCA 282 at [85] and Health Care Complaints Commission v Do [2014] NSWCA 307 at [51]. 3. Whether the discretion to award costs should be exercised in favour of the Commission raises the issue of whether the so-called compensatory principle — that without some disentitling conduct a successful party is generally entitled to recover their costs — can and should be applied where the Tribunal makes a reinstatement order under s 163B of the National Law. 4. This issue was addressed in Ameisen v Medical Council of New South Wales [2015] NSWCATOD 49 (Ameisen). There, the Tribunal considered it a misnomer to describe an applicant who is reinstated following an inquiry to review a "relevant order" as having been "successful". Reasoning that this characterisation "misunderstands the nature of the respondent's involvement in the proceedings", the Tribunal pointed out at [90] that reinstatement proceedings "arise because of the prior misconduct of the applicant [practitioner], and can be seen as ancillary [to the original proceedings which resulted in the cancellation of the practitioner's registration]". The Tribunal ordered Dr Ameisen to pay the respondent Council's costs, notwithstanding its decision that he be reinstated to the register of medical practitioners. 5. This approach was followed in Ristevski v Medical Council of NSW [2016] NSWCATOD 18. There the Tribunal concluded at [87]: Provided the respondent conducts its case appropriately, it should be compensated regardless of whether the order is granted or refused. 1. In Ristevski the Tribunal examined a number of cases where on review of the relevant order, the applicant practitioner was reinstated but not ordered to pay the costs of the respondent Council or Commission: Mnyandu v Health Care Complaints Commission [2015] NSWCATOD 43, Donnelly v Health Care Complaints Commission [2014] NSWCATOD 155 and Roberts v Medical Council of New South Wales [2015] NSWCATOD 35. The Tribunal concluded that each case had "exceptional features" and the relevant Tribunal had been critical of aspects of the respondent's participation in the inquiry: Ristevski at [74], [78], [82] and [88]. (See also Vo v Medical Council of NSW [2018] NSWCATOD 18 at [144]. Cf Haber v Health Care Complaints Commission [2018] NSWCATOD 16; Shah v Health Care Complaints Commission (No 2) [2016] NSWCATOD 102) 2. We agree with the view expressed by the Tribunal in Ristevski at [70]-[71] that in conducting a review of a relevant order under s 163B of the National Law, there is a public interest in the Tribunal being assisted by the relevant practitioner Council or the Commission. Without a respondent in this class of matters, there is a risk that the Tribunal might only have available the self-serving evidence adduced by the applicant practitioner. The involvement of, to use the term coined in Ristevski, a "public interest respondent" in review proceedings, assists the Tribunal in discharging its obligation to ensure that all relevant material is disclosed so as to enable it to determine all relevant facts in issue: s 38(6)(a) of the Civil and Administrative Tribunal Act 2013 (NSW). 3. While we have considerable sympathy for Ms Ake's position and the inevitable financial burden imposed by a costs order, the authorities have consistently stated that mere impecuniosity of the losing party is not a justifiable reason to departing from the usual rules in respect of costs: Health Care Complaints Commission v Philipiah at [42]. 4. Adopting the approach taken in Ristevski and Ameisen, we have decided to order that Ms Ake pay the costs of the Commission as agreed or assessed. Orders 1. Pursuant to s 163B(1) of the Health Practitioner Regulation National Law (the National Law), Ms Ake is reinstated to the register of nurses maintained by the Australian Health Practitioner Regulation Agency in conjunction with the Nursing and Midwifery Board of Australia. 2. Pursuant to s 163B(4) of the National Law, the following conditions are imposed on Ms Ake's registration for a period of 12 months or such longer period as determined by the Nursing and Midwifery Council of NSW (the Council): 1. Not to undertake agency nursing; 2. Not to be the nurse in charge of any shift, ward or unit; 3. Not to work night duty (22:00 to 06:00); 4. To practise under indirect supervision in accordance with the Council's Regulatory Supervision Policy, and as subsequently determined by the appropriate review body; 5. To nominate a supervisor for approval by the Council within 14 days of commencing work, or as specified by the Council; 6. To undertake the three-month structured training and development program, which the Northern Sydney Local Health District undertook in these proceedings to provide Ms Ake (the Training), if her registration is reinstated; 7. To authorise the Northern Sydney Local Health District to give to the Council a report outlining whether she has successfully completed the Training, within 14 days of completing the Training. 1. While Ms Ake's principal place of practice is in NSW, the Council is the appropriate review body for the purposes of Pt 8, Div 8 of the Health Practitioner Regulation National Law (NSW). 2. Ms Ake must pay the costs of the Commission as agreed or assessed. ********** I hereby certify that this is a true and accurate record of the reasons for decision of the New South Wales Civil and Administrative Tribunal. Registrar I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales. Registrar DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 28 October 2019