Bryan v Nursing Board of Tasmania
[2001] TASSC 69
•28 June 2001
[2001] TASSC 69
CITATION: Bryan v Nursing Board of Tasmania [2001] TASSC 69
PARTIES: BRYAN, Kathleen Mary
v
NURSING BOARD OF TASMANIA
BRAMICH, Sallyanne
v
NURSING BOARD OF TASMANIA
TITLE OF COURT: SUPREME COURT OF TASMANIA
JURISDICTION: APPELLATE
FILE NO/S: LCA 9/2001 (BDR)
LCA 10/2001 (BDR)
DELIVERED ON: 28 June 2001
DELIVERED AT: Burnie
HEARING DATES: 13 June 2001
JUDGMENT OF: Blow J
CATCHWORDS:
Professions and Trades - Medical and related professions - Other fields of practice - Nurses - Suspension of right of practice - Nursing Act 1995 (Tas) - Procedural fairness - Whether suspension necessary for investigation - Whether suspension in the public interest.
Nursing Act 1995 (Tas), ss58(2)(a), 67(1)(g), (h), (3).
Aust Dig Professions and Trades [219]
REPRESENTATION:
Counsel:
Appellants: R C Glover
Respondent: D Barclay
Solicitors:
Appellants: Smith & Glover
Respondent: C Wilding
Judgment Number: [2001] TASSC 69
Number of Paragraphs: 27
Serial No 69/2001
File Nos LCA 9/2001LCA 10/2001
KATHLEEN MARY BRYAN v NURSING BOARD OF TASMANIA
SALLYANNE BRAMICH v NURSING BOARD OF TASMANIA
REASONS FOR JUDGMENT BLOW J
28 June 2001
The appellants have appealed pursuant to the Nursing Act 1995 ("the Act"), s72(1)(e), in respect of decisions by the respondent ("the Board") to suspend their rights of practice as enrolled nurses. Both counsel treated the appeal as one in the nature of a rehearing on the basis of the material that was before the Board.
At all material times the appellants were employed by Emmerton Park Inc, an association which operates a residential aged care hostel in Smithton, and also provides community care services, independent living units, and a day care facility. Both appellants had the status of enrolled nurses under the Act. The Act distinguishes between registered nurses and enrolled nurses, but does not make clear the nature of the distinction. However, I have been provided with extracts from the Nursing Code, which is in force pursuant to the Act, s11, and they make it clear that a greater degree of competence is required to be displayed in order for a nurse to be registered, rather than merely enrolled.
From the material before me, it appears that the Board decided to conduct what it referred to as an "annual audit" in relation to five per cent of the enrolled nurses in Tasmania who were renewing their enrolments. Those to be audited were chosen at random. One of the appellants was so chosen. In the course of the audit procedure, one of the Board's officers, a woman named Waddington, discovered that Emmerton Park Inc employed two enrolled nurses, ie, the two appellants, but no registered nurses. She phoned the hostel, spoke to the appellant Bryan at length about arrangements for the administration of medication to hostel residents, and made a note of her conversation. She wrote the following:
"I asked Kathleen what happened when there were issues that required nursing care beyond the scope of an enrolled nurse and specifically asked about residents becoming unwell, needing complex dressings or medication. I was informed that if unwell or needing dressings that residents were assisted to attend Dr's surgery and that residents were mainly able to self medicate although some needed assistance. I asked if any residents were prescribed S8 [I presume this refers to medications listed in the Poisons Regulations 1975, Sch8] or insulin and what processes were in place for administration of these medication. I was informed that no residents were on S8s and that two residents were prescribed insulin. Kathleen Bryan informed me that the staff on duty prepared the insulin for the residents in question and that one of them self administered the injection whilst the other resident was assisted to self medicate."
As a result of that telephone conversation, the Emmerton Park Hostel was discussed at a meeting of the Board on 20 December 2000. The hostel had been assessed by a company called Aged Care Standards and Accreditation Agency Ltd. It decided on 15 September 2000 to accredit the hostel for a period of three years from that date in accordance with Part 2, Division 3, Subdivision 4 of the Accreditation Grant Principles 1999. Those principles are a species of subordinate legislation under the Aged Care Act 1997 (Cth). An executive summary of an assessment team's report in relation to the accreditation decision was placed before the Board. That summary included the following:
"No registered nurse is currently employed at Emmerton Park, and personal care staff is comprised of:
· two enrolled nurses, one of whom is the hostel supervisor. The enrolled nurses have not been endorsed to administer medications.
· extended care assistants, seven of whom have completed, or are in the process of completing traineeships in Personal Care Certificate III.
There is no formal procedure for training, or assessing competencies of extended care assistants carrying out procedures such as testing of blood sugar levels and blood pressure readings. The service needs to ensure that staff have appropriate knowledge and skills to perform roles such as these effectively.
Residents in need of specialised nursing services, such as injections and complex wound care, are assisted to access staff at the local medical centre or through community health nursing services.
Some residents self medicate, however, most residents are assisted to self-administer medications; this includes the use of injection equipment for insulin dependent residents. Some areas of medication management do not comply with regulatory and professional guidelines; for example, there is no provision made for recording administration times of Pro Re Nata (PRN as needed) medications. The service needs to ensure that medications are administered safely and correctly."
It appears from affidavits sworn by the chairperson of the Board that it resolved on 15 December 2000 to commence an investigation concerning the appellants, and to appoint one of its officers to conduct a preliminary investigation, in relation to a matter or matters that it considered could be grounds for a complaint against them. The power to investigate a matter of the Board's own motion is conferred by s57(b)(2), which reads as follows:
"(2) The Board, on its own motion, may also investigate any matter that it considers could be grounds for a complaint against a registered or enrolled nurse."
The procedure in relation to a preliminary investigation is governed by s58, which reads as follows:
"58 ¾ (1) The Board may direct a committee, inspector or other person to conduct a preliminary investigation of ¾
(a)a complaint; or
(b)a matter that it considers could be grounds for a complaint against a registered or enrolled nurse.
(2) In a case to which subsection (1) applies, the Board must ¾
(a)give a notice setting out full particulars of the complaint or matter to the nurse concerned; and
(b)allow the nurse to make submissions to the committee, inspector or person conducting the preliminary investigation.
(3) The committee, inspector or person conducting the preliminary investigation must give the Board and the nurse concerned a written report of the findings of the preliminary investigation and any opinions based on those findings."
As a result of the Board's resolution, each of the appellants was sent a letter dated 20 December 2000, and also a "notice of complaint" of the same date. Both documents were vague as to the subject matter of the Board's resolution and the so-called complaint. Each notice said that the Board had "resolved to investigate the allegation that in the course of your duties at Emmerton Park Hostel situate at Smith Street, Smithton ('the facility') you routinely practice outside the scope of practice for an enrolled nurse and by doing so you are guilty of professional misconduct." The letter did not reveal quite as much, in that no reference was made to professional misconduct. The appellants were not notified with any greater particularity of the allegation that the Board had resolved to investigate. They were thus told that it had been alleged that they were doing something they should not, but not told what that was. The Board thus failed to comply with the requirements of s58(2)(a), in that its notice did not set out "full particulars" of the matter it considered could be grounds for a complaint.
Various matters in respect of which a complaint may be made are listed in the Act, s56(1). By virtue of s56(1)(e), a person may complain that a nurse is guilty of professional misconduct. By virtue of s56(2)(c), a nurse is guilty of professional misconduct if he or she contravenes a provision of the Nursing Code. There is a non-exhaustive list of matters that may constitute professional misconduct in s56(2). It may be that a contravention of the Poisons Regulations 1975 in the course of nurses' work might constitute professional misconduct, depending on how serious a contravention it is, even if it does not amount to a contravention of a provision of the Nursing Code. The Poisons Regulations, reg37C, provides as follows:
"37C ¾ … an enrolled nurse may administer a substance listed in Schedule 2, 3 or 4 of the Poisons List if the enrolled nurse ¾
(a)acts ¾
(i) in accordance with the written authority of a medical practitioner or dentist; and
(ii) under the supervision of a medical practitioner, dentist or registered nurse; and
(b)holds any qualifications the Executive Officer of the Nursing Board of Tasmania determines are appropriate for the administration of that substance."
In the notices to the appellants, in order to set out full particulars as required by s58(2)(a), any provisions of the Nursing Code that were alleged or suspected to have been contravened should have been referred to, and the manner in which each such provision was alleged or suspected to have been contravened should have been particularised. If it was alleged or suspected that any provision of the Poisons Regulations had been contravened, the relevant provision should have been referred to, and the nature of the alleged or suspected contraventions particularised.
Obviously the Board was not in a position to provide particulars as to the administration of particular drugs to particular hostel residents on particular days. The Board obviously could not provide particulars in any greater detail than the information it had received. However, the obligation imposed by s58(2)(a) as to the provision of full particulars, required the Board to specify what routine activities, outside the scope of practice for enrolled nurses, were alleged or suspected. I will deal with the significance of the deficiencies of the s58(2)(a) notices later in these reasons.
The investigation initiated by the Board proceeded slowly. Eventually an officer of the Board went to Smithton on 5 March 2001. She spoke to the executive officer of Emmerton Park Inc, and the chairman of its Board. They told her residents at the hostel were only ever assisted with self-medication, and that the appellants did not administer medication. They told her that drug charts were signed on each drug round by whomever assisted each resident to take his or her medication. She requested permission to inspect the premises, but permission was refused. She was told that the representatives of the association wished to get legal advice.
The Board's reaction was to suspend the appellants from practice as enrolled nurses the next day. An extraordinary meeting of the Board was held at 3pm on 6 March 2001. The minutes of that meeting record the following as to the appellants' suspensions and the background thereto:
"The above two nurses are enrolled nurses at Emmerton Park Residential Care. They first came to the attention of the Board during the Annual Audit for the year 2000 renewal period when one was randomly chosen in the 5% of nurses to be audited.
L Waddington, Nurse Adviser Education and Registration phoned the above nurses and was informed that no registered nurses were employed at Emmerton Park. Both nurses confirmed that they were employed at Emmerton Park Residential Care as enrolled nurses. It became apparent during this conversation that Bramich and Bryan were involved in the administration of medication eg Digoxin and Insulin. Both enrolled nurses do not have medication endorsement and even if they did they could not legally administer these medications.
The Aged Care Accreditation results of Emmerton Park Residential Care were then obtained and this document states in the 2nd last paragraph on page 4 'Some areas of medication management do not comply with regulatory and professional guidelines; for example, there is no provision made for recording administration times of Pro Re Nata (PRN as needed) medication. The service needs to ensure that medications are administered safely and correctly'.
Also on page 4, 1st paragraph, it is stated, 'The admission process includes the assessment of residents' care needs regarding pain management, palliative care, nutrition and hydration, skin care, and continence management'. The document does not discuss who assesses the residents' needs.
Correspondence was sent to the Managers of Emmerton Park Residential Care and the two enrolled nurses stating that the Nurse Adviser Professional Conduct would be in the area on 5 March to interview staff and seize documents. When Mrs Wilding arrived at the facility management would not allow her access to any documentation or any staff on site.
As Mrs Wilding was unable to access the above documentation to confirm whether or not the enrolled nurses were practising outside their scope of practice, the Board passed the following motions.
Moved K Linegar and seconded C Pollard that enrolled nurse Sallyanne Bramich be suspended pursuant to section 67(1)(g) and/or in the alternative section 67(1)(h) of the Nursing Act 1995.
carried
Moved K Linegar and seconded E Verrell that enrolled nurse Kathleen Mary Bryan be suspended pursuant to section 67(1)(g) and/or in the alternative section 67(1)(h) of the Nursing Act 1995.
carried"
On 7 March 2001, the day after the meeting, the executive officer of the Board sent each of the appellants a letter and a "notice of suspension". Apart from referring to s67(1)(g) and (h), the notices of suspension contained no information as to the reasons for the suspensions. The only information provided at that time as to the Board's reasons was contained in a passage in each of the letters, which read as follows:
"By way of explanation following a meeting with the Executive Officer of Emmerton Park, Mr Rodney Greene and the Chair of the Emmerton Park Board, Mr Johnathan [sic] Smith, Catherine Wilding, the inspector appointed by the Board in the matter was not permitted to inspect the site of your employment and could not accordingly interview witnesses and inspect/seize documents as foreshadowed in Mrs Wildings [sic] letter to you dated 31st January 2001.
The Board did not suspend your right of practice initially on receipt of the Complaint, even though the matters raised therein were of a most serious nature because it was the Board's hope that the investigation into the matter could be expedited in a timely manner. This is now not possible for the reasons outlined above."
The Board's powers and obligations in relation to suspensions are provided for in the Act, s67, which includes the following:
"67 ¾ (1) The Board may suspend the right of practice or authorisation of a nurse for such period not exceeding 12 months as the Board in the circumstances considers appropriate if ¾
…
(g)the Board reasonably considers the suspension necessary for the purposes of inquiring into a complaint made against that nurse or inquiring into a matter that could be the subject of a complaint against that nurse; or
(h)the Board considers that it is in the public interest to suspend the registration.
(1A) The suspension may be ¾
(a)a total suspension of the right of practice or authorisation; or
(b)a partial suspension of the right of practice or authorisation, being suspension that applies only to certain areas of the practice of nursing specified by the Board.
(2) …
(3) If the Board decides to suspend a nurse's right of practice or authorisation it may afford that nurse an opportunity to be heard but it is not required to do so.
(4) If the Board decides to suspend a nurse's right of practice or authorisation it must make an appropriate note of the suspension and the reasons for the suspension in the register or roll and give the nurse notice of ¾
(a) the suspension and the reasons for the suspension; and
…
(5) When the giving of the notice is effected in the case of a total suspension of a right of practice or authorisation, the nurse ceases to be entitled to practise or ceases to hold the authorisation, as the case may be, until the period of suspension specified in the notice expires or the suspension is revoked by the Board."
In my view, the Board has the power to suspend a nurse's right of practice under s67(1), not only upon the conclusion of a disciplinary investigation, but also before the conclusion of an investigation. Such a course would be appropriate before the conclusion of an investigation if, for example, there was an urgent need to protect patients or nursing home residents from a nurse who was considered likely to harm them. There is nothing in s67 to suggest that Parliament intended the power of suspension to be exercised only after a matter was fully investigated, whereas the presence of s67(1)(g) suggests that Parliament intended the Board to have the power to suspend a nurse prior to the completion of an investigation.
Since s67(4)(a) requires an appropriate note of the reasons for each suspension to be made in the register or the roll, and a suspended nurse to be given notice of the reasons for his or her suspension, it would be highly desirable, whenever the Board suspends a nurse, for it to pass a resolution containing the text of the reasons for the suspension. That course was not taken in relation to the appellants. Instead, the Board apparently left it to its executive officer to give each appellant notice of her suspension and of its reasons for her suspension. The danger of proceeding in that way is that the executive officer's perceptions of the Board's reasons might be inaccurate or incomplete.
In her affidavits, the chairperson of the Board has advanced reasons for the suspension of the appellants that were not referred to in the executive officer's letter. Referring to the resolutions to suspend the appellants, she deposed as follows:
"15The Board took this step to maintain the status quo of the evidence as it has in the past experienced cases where nurses have tampered with documents upon which the Board has needed to rely ¾ for example medication charts. Further the Board was concerned to protect the public given the delay that may affect the investigation.
16The Board did not take the step to suspend the nurses when the matter first came before it as even though it was certainly a borderline case, given that the investigation was scheduled to be conducted in a timely manner it did not wish to take this harsh step. The Board is mindful of the effect suspension has on a nurses [sic] practice and professional standing and only exercises its powers in this way in the most serious of cases.
17The Board considered it had to act when the investigation was prevented from proceeding as no indication that this was the Parks [sic] intention had been revealed prior to the 5th March 2001, even though the Board had written to Mr Greene and others on the 31st January 2000 (annexure 'G'). The Board had evidence that the nurses may have been practicing [sic] outside their scope of practice but was now prevented from investigating that allegation.
18The Board has a statutory mandate to ensure the public are protected from unsafe, incompetent and unethical nursing practices pursuant to Section 9 of the Act. In making its decision to suspend the nurses it acted in good faith and has been anxious not to prejudge the matter. Its primary concern in making its decision was to protect the public and to maintain the status quo until such times as the investigation could proceed by way of warrant or such other means."
Insofar as the paragraphs I have quoted set out reasoning not referred to in the Board's minutes or its executive officer's letters to the appellants, they do not constitute anything more than a description of the deponent's perceptions of the Board's reasons for the appellants' suspensions. However, for the purposes of these reasons, I will assume that the quoted paragraphs accurately represent reasons relied upon by the Board in deciding to suspend the appellants.
Under the Act, s69(1), the Board has the power to appoint inspectors for the purposes of investigating compliance with the Act, investigating compliance with the Nursing Code, investigating complaints, and investigating matters that could be the subject of complaints. Such inspectors have powers of search and seizure that are governed by ss70 and 71, which include the following:
"70 ¾ …
(2) An inspector may, on production of his or her identity card ¾
(a)enter any premises at any time with the consent of the occupier of those premises or enter any premises where a health service is provided if that place is open for entry; and
(b)exercise all or any of the powers specified in section 71 with the consent of the occupier of those premises.
(3) If an inspector considers on reasonable grounds that there is, or is likely to be, on any premises a document or thing that is, or is likely to be, relevant to an investigation being carried out by the inspector, and that it is not possible or reasonable in the circumstances to rely on the power in subsection (2), the inspector may apply to a magistrate for a warrant.
(4) A magistrate to whom an application under subsection (3) is made may issue a warrant if satisfied that ¾
(a)the document or thing referred to in the application is, or is likely to be, relevant to the inspector's investigation; and
(b)there are reasonable grounds for believing that the document or thing is, or is likely to be, on the premises referred to in the application; and
(c)it will not be possible or reasonable in the circumstances for the inspector to rely on the power in subsection (2).
(7) Subject to subsection (6), a warrant issued under this section authorises the inspector named in the warrant to enter and search the premises specified in the warrant and exercise such of the powers specified in section 71 as are not expressly excluded by the magistrate who issued the warrant.
71 ¾ (1) Subject to and for the purposes of section 70(2)(b) and (7), an inspector may exercise the following powers:
(a)inspect and search the premises generally;
(b)require the person apparently in charge of the premises to produce for inspection any document held at the premises;
(c)inspect and take notes of or extracts from any such document;
(d)make a copy of any such document;
(e)ask questions of and require answers from persons on the premises;
(f)take photographs;
…
(j)if the inspector reasonably suspects that this Act or the Nursing Code has been contravened, seize and, on furnishing a receipt, remove anything that in the reasonable opinion of the inspector is evidence of the contravention;
(k)remove, on furnishing a receipt, any document found on the premises to the custody and control of the Board for as long as the Board considers necessary or expedient."
The reference to a warrant in par18 of the chairperson's affidavit is no doubt a reference to a s71 warrant. Obtaining such a warrant is the appropriate means for ensuring documents are not tampered with, if there is some reason to think there is a danger of such tampering.
There is nothing in the minutes of the Board or the other material before me to suggest that there was any reason to think that the appellants, or either of them, might have interfered with medication charts or other documents. There is nothing to suggest that they were untrustworthy. Suspending them from practice could not be relied upon as a strategy for the prevention of interference with documents, since it would not necessarily have resulted in the exclusion of the appellants from their employer's premises. In fact I have been told that their employment continued, not as enrolled nurses, but as carers. I can see no rational basis for the Board considering the suspension of either appellant necessary for the purposes of inquiring into a matter that could be the subject of a complaint against her. That is to say, I can see no rational basis for the Board to have relied upon s67(1)(g).
The other provision relied upon as a basis for the suspension was s67(1)(h). For the Board to rely on that paragraph, it must have considered that it was in the public interest to suspend the registration of each appellant. The material before me suggests that there were reasons to suspect that the appellants had been administering medications to residents of the hostel, as distinct from helping them to administer medications to themselves, contrary to the provisions of the Nursing Code and/or the Poisons Regulations, reg37C. The only other basis for a possible complaint against the appellants that emerges from the material before me is the suggestion that the management had made no provision for the recording of administration times of "as needed" medications, whether administered by the appellants or with their assistance. I have no evidence as to how serious these possible bases for complaints were, save that the assessment team that reported on the hostel for Commonwealth purposes had investigated the situation and recommended the hostel's accreditation for a further three years, and that the Board knew of the possible bases for complaints from December until March, and did nothing to suspend the appellants or expedite its investigation. If there was the slightest danger to any of the residents of the hostel, the refusal of access to the Board's investigator pending the obtaining of legal advice could not have increased that danger. The refusal of access pending the obtaining of legal advice did not suggest that Emmerton Park Inc had more to hide than originally suspected or feared. The refusal of access has to be seen in the context of a dispute between the association and the Board as to where the boundary lay between a nurse administering medication and a nurse helping a person to administer his or her own medication. The apparent willingness of the assessment team and the Board to tolerate the situation as it existed before the appellants' suspensions, and the fact that the lack of co-operation on 5 March 2001 was irrelevant to the question of risk to residents, lead me to the conclusion that it was not in the public interest for the appellants to be suspended.
In my view, the Board should have given each appellant an opportunity to be heard, personally or by counsel, prior to deciding whether or not to suspend her. It is true that s67(3) provides that, "If the Board decides to suspend a nurse's right of practice or authorisation it may afford that nurse an opportunity to be heard but is not required to do so". No doubt it would be appropriate for the Board to suspend a nurse from practice without warning if, for example, there was an urgent need to protect patients from a nurse considered to be an immediate threat to their health or safety. There may also be times when a suspension in another State after a full and thorough investigation could legitimately result in a suspension in Tasmania without further warning. However, in my view, although s67(3) gives the Board a discretion to depart from the rules of natural justice or procedural fairness, it would normally be unjust for it to do so. There was certainly no reason for the Board to have acted without warning in this case, especially since the appellants had not been informed as to the nature of the alleged or suspected conduct that was under investigation, had been allowed to practice for months without any suggestion that they might be suspended from practice, had not made any submission or representation to the Board as to the subject matter of the investigation, and had apparently not been involved in the decision to refuse access to the Board's investigator. I have no reason to think there was any urgency. In those circumstances, I consider that it was inappropriate for the Board to have considered the question of suspension without having afforded the appellants an opportunity to be heard as to that question.
I have decided to quash the decisions to suspend the appellants because (a) they were not provided with full particulars of the matter being investigated as required by s58(2)(a); (b) there was no rational basis for considering their suspension necessary for the purpose of inquiring into any matter that could be the subject of a complaint against them; (c) there was no basis for thinking that it was in the public interest to suspend their registrations on 6 March 2001; and (d) it was unjust not to give them an opportunity to be heard as to the question whether they should be suspended. I strongly suspect that what the Board did in suspending them was a bloody-minded act of retaliation to their employer's lack of co-operation on the previous day, but it would be inappropriate to make any finding as to the Board's bona fides in the present context.
If the Board's real quarrel was not with the appellants, but with their employer, disciplinary proceedings against the appellants are not the appropriate dispute-resolution mechanism. If there needs to be clarification as to what constitutes the administering of medication by a nurse, as distinct from the self-administering of medication by a person assisted by a nurse, it seems to me that it might be more appropriate for the Board to ask the responsible Minister to seek the amendment of the Poisons Regulations to include an appropriate definition, or even for the Board to seek an injunction restraining the appellants' employer from requiring or permitting them to do certain things in relation to the administering of medication. It is most inappropriate that disciplinary proceedings should be used to resolve a dispute relating to decisions taken at management level or Board level if the nurses in question have simply been obeying their employer's instructions.
There is no reason for me to think that the appellants were ever doing anything other than obeying their employer's instructions, and doing their best to care for the residents of the hostel. I very much doubt that the suspension of either of them could be an appropriate course, but I do not have enough evidence to conclude that the Board's investigation is unwarranted, nor that some form of disciplinary action is entirely out of the question. The only appropriate course is therefore for me to remit the matter to the Board, with directions, for further consideration, pursuant to s73(2)(b). In relation to the directions that need to be given, I should refer briefly to two further deficiencies in the Board's decisions. First, if the Board thinks any suspension warrants consideration, it ought to consider a partial suspension pursuant to s67(1A)(b), whereby the appellants could practise anywhere other than Emmerton Park. Secondly, a suspension under s67(1) must be for a fixed period not exceeding 12 months, but the Board in this case omitted to fix a period of suspension.
For these reasons, I make the following orders in each of these appeals:
(1)The decision made by the respondent on 6 March 2001 to suspend the appellant's right of practice as an enrolled nurse is quashed.
(2)The matter is remitted to the respondent for further consideration with the following directions:
(a) The respondent must provide the appellant with full particulars of the matter that it resolved to investigate in relation to her on 20 December 2000.
(b) If the respondent considers suspending the appellant's right of practice as an enrolled nurse, it must afford her an opportunity to be heard unless there is an urgent risk to one or more members of the public.
(c) If the respondent decides to suspend the appellant's right of practice as an enrolled nurse, (i) it must decide whether such suspension is to be total or partial; (ii) it must decide for how long she is to be suspended; and (iii) it must formulate its reasons for the suspension, make an appropriate note of them in the roll, and give the appellant notice of them.
(d) The respondent must send a copy of these reasons for judgment to all nursing authorities and nursing employer organisations in Australia, New Zealand and the United Kingdom whom it notified of the appellant's suspension.
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