Skill S33 — scope, teamwork and cultural safety: the professional context that frames every clinical skill you'll be assessed on.
Facilitator
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Date
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Running time
9:00am – 4:00pm
Welcome & housekeeping: name tags, Wi-Fi, breaks at 10:30, 12:15 (lunch) and a fixed finish of 4:00pm.
Frame the day: S33 is the professional context behind every skill — scope, teamwork, cultural safety.
Be explicit: this is where skilled internationally-qualified RNs most often lose marks, not on clinical technique.
Tip: press A for the agenda, N for these notes, arrow keys to navigate.
Acknowledgement of Country
We acknowledge the Traditional Custodians of the lands on which we meet and learn today, and pay our respects to Elders past, present and emerging.
We extend that respect to all Aboriginal and Torres Strait Islander peoples here today — and carry it into today's focus on culturally safe practice.
Keep it brief and sincere; invite a moment of reflection.
Bridge to today: cultural safety is defined by the person receiving care — a thread through every scenario today.
The plan
Day at a glance
09:00–10:30Session 1 — Theory A: scope of practice & the NMBA Decision-Making Framework90m
10:30–10:45☕ Morning tea15m
10:45–12:15Session 2 — Theory B: the structured (ISOBAR) referral, consent & privacy90m
12:15–12:45🍽 Lunch30m
12:45–14:00Session 3 — Deep-dive: common errors, documentation & Skills-Book walkthroughs75m
14:00–15:15Session 4 — Interactive scenarios (worked live as a class)75m
15:15–16:00Session 5 — Consolidation: formative quiz, recap & set practice45m
Press Agenda (bottom-right) any time to jump to a block. Use the Timer to keep sessions and breaks on track.
Orient learners: three breaks are fixed; we finish at 4:00pm sharp.
Set expectation: Sessions 1–2 are theory; Session 3 connects it to the Skills Book; Session 4 is live practice.
The importance behind the skill
Why this matters
Patient safety
Decisions made outside scope, and incomplete handovers, are leading causes of avoidable harm. A clear referral is the safety net that gets the patient to the right clinician.
Where IQRNs lose marks
Australian practice differs from many systems: flat teams, explicit documented consent, and audited documentation. These differences — not clinical skill — are where candidates most often fall short.
It threads every station
Scope, consent and cultural safety are assessed across the OSCE — not in one station. Get these right and you protect your marks everywhere.
Discussion prompt: "What feels different about practising as a nurse in Australia compared with where you trained?" Collect 3–4 answers on the board.
Reassure: clinical knowledge is strong in this cohort; today builds the professional framing assessors look for.
By the end of today you can…
Learning objectives
1
Identify a clinical, functional or psychosocial need that exceeds RN scope and select the correct referral pathway.
2
Make a structured (ISOBAR) referral with consent, sharing only the minimum necessary information.
3
Apply the NMBA Decision-Making Framework to scope-of-practice decisions.
4
Describe culturally safe practice for IQRNs and the key Australian-practice differences (consent, flat teams, documentation, audited standards).
Read each aloud; tell learners we will return to these in the Session 5 quiz.
Objectives 1–2 are doing; 3–4 are reasoning — both are marked.
The exam lens
What AHPRA & the NMBA assess
How the OSCE works
A multi-station OSCE, marked criterion-referenced against the NMBA Registered Nurse Standards for Practice.
Assessors score observable behaviours — what you say and do, not what you intend.
This skill maps to the assessment, planning, communication and professional practice domains.
Pass = meeting the station criteria and committing no critical-safety breach.
CRITICAL-SAFETY — AUTO-FLAGS THIS SKILL
1 · Acting outside RN scope
Performing or accepting tasks beyond your competence/authorisation instead of escalating.
2 · Breach of consent / privacy
Sharing information without consent, or sharing more than is necessary.
Either can fail the station regardless of other marks.
Drive home: criterion-referenced means there's no curve — meet the criteria, avoid the critical errors.
These two critical-safety points recur all day; flag them now so learners listen for them.
The actual rubric · each criterion marked S / NYS
How Station 33 is marked
1 · Identification of referral need
Identifies a clinical, functional, psychosocial or risk-related need beyond RN scope
Confirms the appropriate referral pathway
2 · Communication of the referral
Uses structured communication (ISOBAR)
Clear background, current status, specific request & urgency
Confirms receipt & accepted action by the receiver
3 · Consent & information sharing
Obtains informed consent for the referral & sharing
Shares only the minimum necessary information (Privacy Act, NMBA Code)
This is the live S / NYS checklist the assessor uses — print it and mark against it during the walkthroughs.
Most-missed criteria (bolded): confirming the receiver accepted the action, and following up that the referral was actioned. Candidates stop at "I'll refer" — drill the close-the-loop steps.
Equipment for this station: patient clinical record · local referral form/pathway · service contact details (MO, allied health, NDIS, My Aged Care, mental health, palliative care) · ISOBAR template · consent record.
Session 1 · Theory block A · 90 min
Scope of practice & the NMBA Decision-Making Framework
What you may do, how you decide, and what to do when a need exceeds your scope.
Two skill foci this session: (a) scope of practice, (b) the Decision-Making Framework as the tool for scope decisions.
Start the session timer so you land morning tea at 10:30.
Foundations
What is scope of practice?
The full range of roles, functions and responsibilities that an RN is educated, competent and authorised to perform. Scope is both what your profession may do and what you, individually, are currently competent to do.
Education & competence
Have you been trained and assessed, and do you maintain currency?
Context & policy
Does your setting, employer policy and available support permit this activity?
Authorisation
Are you authorised to do it — and accountable for the outcome?
Key nuance for IQRNs: a task can be within the profession's scope but outside your individual scope today. Both must be true.
Ask: "Where does scope come from?" Answer: education + standards + context/policy + authorisation.
Your decision tool
The NMBA Decision-Making Framework (DMF)
Use the DMF to decide whether an activity is within your scope. Work the questions in order — if any answer is "no", you don't proceed alone.
01
Is the activity in the patient's best interest and supported by evidence?
02
Am I educated & competent to perform it safely?
03
Is it supported by policy, protocol and my role?
04
Am I authorised, and are the right resources & support available?
05
Am I prepared to be accountable for the decision and outcome?
If any answer is "no"
Do not proceed alone → seek support, escalate or refer, and document your reasoning.
The DMF is a reasoning tool, not a tick-box — assessors want to hear you think aloud.
Paraphrased here; direct learners to the full NMBA "Decision-making framework for nursing and midwifery".
Apply it
Worked example — the pressure to "just do it"
Scenario: A patient needs a medication via a route you've never been credentialed to administer. The ward is short-staffed; a colleague says, "you'll be fine, just do it."
Work the DMF — what do you decide?▾
Competent? No — never credentialed for this route. Authorised? No.
Best interest? An unsafe administration is not in the patient's interest.
Decision: Decline to proceed alone. Seek a credentialed colleague or escalate to the team leader; arrange supervision/credentialing if appropriate.
Then: Document the decision and your reasoning. Peer pressure does not change scope.
Let learners attempt the DMF aloud before revealing.
Reinforce: declining unsafe practice is professional, not obstructive — and it's mark-positive in the OSCE.
CRITICAL-SAFETY POINT 1
Acting outside RN scope
What it looks like
Performing tasks beyond your competence or authorisation
Accepting unsafe delegation or verbal pressure
Not escalating a need you can't safely meet
"Helping out" beyond role in a busy moment
The safe behaviour
Recognise the limit of your scope
Decline to proceed unsafely
Escalate / refer to the right person
Document the decision and rationale
Consequences of getting this wrong: patient harm · critical fail in the OSCE · professional accountability and possible AHPRA notification.
This is auto-flag #1. Say it plainly: stepping outside scope can fail the station on its own.
Discussion: "Have you felt pressure to work beyond scope? What made it hard to say no?"
Objective 1
Identifying a need that exceeds RN scope
Your assessment may reveal a need you can't safely meet alone. Name the type of need — it points you to the right referral.
Clinical
e.g. a wound deteriorating beyond protocol, a medication review, early signs of deterioration.
→ medical review / escalation
Functional
e.g. mobility, swallowing, activities of daily living, equipment needs.
→ physio / OT / speech / dietitian
Psychosocial
e.g. housing, finances, grief, family safety, isolation.
→ social work / mental health
Cue for learners: "If I can't safely meet this need within my role, that's the trigger to refer."
Ask the room to throw out an example for each type before moving on.
Who do you refer to?
Referral pathways & the team
Medical
GP, nurse practitioner, medical officer, specialist teams.
Wound, stomal, diabetes & mental-health nurses; community / Hospital-in-the-Home.
NDIS & My Aged Care
Disability & aged-care assessment, supports and care coordination.
Social work, mental health & palliative care
Psychosocial & safety, crisis/liaison, and end-of-life care.
Internal escalation
Team leader, rapid-response / MET, and Aboriginal & Torres Strait Islander Health Workers for culturally safe care.
Emphasise: referral is a two-way collaboration, not "passing the patient on".
Remind learners that escalation for a deteriorating patient is time-critical — use the rapid-response pathway.
Talk it through · reveal the model answer
Discussion — in scope, or refer?
A participant asks you to adjust their wheelchair seating.▾
Functional need beyond RN scope — seating prescription is an OT/physio role. Acknowledge, ensure comfort/safety now, and refer to OT.
A patient quietly says they feel unsafe at home.▾
Psychosocial + safety. Respond with empathy, gain consent, and refer to social work / the relevant safety pathway. Share only what's necessary; document.
A wound looks infected and is beyond the dressing protocol.▾
Clinical need beyond scope — escalate for medical review. Hand over with ISOBAR; don't continue an inappropriate plan.
Run as think-pair-share; take answers before revealing each.
Watch for the IQRN habit of trying to "manage it themselves" — name it kindly.
☕ Morning tea
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Back at 10:45 for Session 2 — the structured referral.
Start the 15-minute timer; a chime sounds when it ends.
Use the break to reset the room for ISOBAR practice.
Session 2 · Theory block B · 90 min
The structured referral — ISOBAR, consent & privacy
Saying it clearly, with consent, sharing only what's necessary.
Foci: the ISOBAR structure, then consent and privacy as the conditions for sharing.
Land lunch at 12:15.
Objective 2 · the Australian handover standard
ISOBAR — structure every referral & handover
I
Identify — yourself, the patient, and who you're referring to.
S
Situation — why you're referring, right now.
O
Observations — relevant, current findings (vitals, assessment).
B
Background — the relevant history and context.
A
Agreed plan — your clear ask, the actions and who is responsible.
R
Read-back & risk — confirm shared understanding; flag any risks.
ISOBAR is the ACSQHC-aligned Australian clinical-handover structure; assessors expect a structured handover.
The two most-missed letters: A (a clear ask) and R (read-back).
A condition of sharing
Consent in referral
Valid consent is…
Voluntary — free from pressure
Informed — what, why and with whom
Specific — to this referral / sharing
Current, by a person with capacity
Australian-practice difference
Consent is explicit and documented — not assumed. Implied consent within the care team is limited. Explain the referral and ask, then record it.
Exceptions (serious risk to safety, legal obligations) are narrow — escalate if unsure.
Key IQRN difference: in many systems consent to share within the team is assumed — here it's explicit and documented.
Model the sentence: "I'd like to refer you to… so they can… Is that okay with you?"
Share only what's needed
Privacy & the minimum necessary
Information sharing in Australia is governed by the Privacy Act 1988 and the Australian Privacy Principles. The rule of thumb: need-to-know, minimum necessary.
Do
Share only information relevant to this referral
Use secure, professional channels
Record what was shared, with whom and why
Avoid
Oversharing history that isn't relevant
Corridor / lift conversations about patients
Social, cultural or family detail with no bearing on care
Test for relevance: "Does the person I'm referring to need this to act safely?" If no, leave it out.
Note: cultural or social detail is sometimes relevant (e.g. an interpreter need) — relevance, not avoidance, is the test.
CRITICAL-SAFETY POINT 2
Breach of consent / privacy in sharing
What it looks like
Sharing information without consent
Sharing more than is necessary
Discussing patients where others can hear
Accessing records without a care reason
The safe behaviour
Consent first, then share
Minimum necessary information
Use secure channels
Document the consent obtained
Consequences: loss of trust & harm · critical fail in the OSCE · breach of the Privacy Act · AHPRA accountability.
Auto-flag #2. Pair it with point 1 — together they're the two most common ways to fail this skill.
Quick poll: "Name one everyday privacy breach you've seen." (Corridor handovers are the usual answer.)
Worked example · social-work referral
A full ISOBAR referral, said aloud
I — "Hi, I'm Aria, RN on ward 4B, calling the social work team about Mrs Patel, bed 12."
S — "She's medically ready for discharge tomorrow but has told me she can't manage at home alone and is fearful about her living situation."
O — "Obs stable. She's independent with care on the ward but anxious and tearful when discharge is discussed."
B — "72, admitted with a fall, lives alone, limited supports. She has consented to this referral."
A — "Could you complete a psychosocial assessment and discharge-planning review before tomorrow? I'll document and flag it to the team."
R — "So you'll see her this afternoon and let me know the plan — is that right?"
What did the nurse do well?▾
Got and stated consent; shared minimum necessary info; made a clear ask with a timeframe; closed with a read-back; committed to document.
Read it aloud in role; then have a pair re-do it for a different patient.
Point out the consent statement sits inside Background — make it explicit, every time.
Talk it through · reveal the model answer
Discussion — getting sharing right
A relative phones asking how the patient is. What do you do?▾
Don't assume consent to disclose. Confirm the patient's wishes/consent first; if not established, don't share — explain why politely and check the documented preferences.
You're rushed — is it okay to skip the read-back?▾
No — read-back is where errors are caught. It takes seconds and is an assessed behaviour. Never trade it for speed.
The patient lacks capacity to consent right now.▾
Act in their best interests, involve the substitute decision-maker per policy, share only what's necessary for safe care, and document the basis for your decision.
These mirror real OSCE traps. Keep answers short; reinforce consent + minimum-necessary + read-back.
🍽 Lunch
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Back at 12:45 for the deep-dive & skill walkthroughs.
30-minute timer. Afternoon is more interactive — re-energise the room on return.
Session 3 · Deep-dive · 75 min
Common errors, documentation & the Skills Book
Where marks are won and lost — and the cultural-safety differences at the heart of this skill.
This session connects the theory to the marking rubric and the eight critical-safety behaviours.
Cultural-safety slide is the most important of the day — give it time.
Reveal the fix
Common errors IQRNs make — and the fix
Deferring entirely to doctors▾
Flat teams expect nurses to contribute, question and escalate. Speaking up is your role.
Assuming implied consent▾
Ask explicitly and document it. Don't assume sharing is okay because it's "within the team".
Oversharing in the referral▾
Share only what's relevant to the ask. More is not better.
Vague referral, no clear ask▾
State the action you want and confirm with a read-back. The "A" and "R" of ISOBAR.
Acting on verbal pressure▾
"Just do it" doesn't change your scope. Apply the DMF; decline and escalate if unsafe.
Under-documenting reasoning▾
Record the need, your decision and consent. "Not documented = not done."
Ask which error resonates most with each table; normalise that these are habits from other systems, not failings.
"Not documented = not done"
Documentation standards
What to document for a referral
Assessment findings & the need identified
Your DMF reasoning / scope decision
Consent obtained
The referral — who, when, what was shared
Read-back & agreed plan
Follow-up / evaluation
Australian standard
Contemporaneous — at the time, or as soon as possible
Factual, objective, legible
Signed, dated, timed
Audited against standards — and discoverable as a legal record
Stress that documentation is routinely audited here — a difference from some systems.
Tie back: your scope decision and consent only "count" if they're recorded.
Recap from Day 1 · any breach can be an auto-fail
The eight critical-safety behaviours
01
Patient identification & consent
02
Practise within scope; escalate
03
Hand hygiene & infection control
04
Safe medication practice
05
Recognise & respond to deterioration
06
Privacy & confidentiality
07
Accurate, contemporaneous documentation
08
Culturally safe, respectful communication
Facilitator note: confirm this list matches your program's Day 1 Skills Book; #2 and #6 are the two that apply most directly to S33.
These are the behaviours that can fail a station regardless of other performance — link 02 and 06 to today's two critical-safety points.
If your program's wording differs, edit the cards to match the Skills Book.
The heart of today
Cultural safety & the Australian-practice differences
Cultural safety is defined by the person receiving care, not the practitioner. It means examining your own assumptions, power and bias — and the NMBA Code requires it. For IQRNs, name the practice differences where marks are most often lost:
Consent
Explicit, patient-led and documented — not assumed.
Flat teams
Nurses question, advocate and escalate; hierarchy is functional, not deferential.
Documentation
Detailed, audited and accountable.
Standards & autonomy
Criterion-referenced, evidence-based; patient autonomy & shared decision-making are central.
Spend time here. This is where this cohort most often loses marks.
Discussion: "Where do these differ most from where you trained?" Let learners lead — culturally safe facilitation models the point.
Note cultural safety also specifically underpins care for Aboriginal & Torres Strait Islander peoples.
Against the checklist · reveal each step
Skills Book walkthrough — the referral, step by step
1 · Prepare▾
Hand hygiene, introduce yourself, confirm patient identity, ensure privacy.
2 · Assess & identify need▾
Name the clinical / functional / psychosocial need.
3 · Apply the DMF▾
Decide in/out of scope; if out, refer/escalate.
4 · Gain consent▾
Explain what, why and to whom; obtain and note consent.
5 · Structure with ISOBAR▾
Deliver a clear, structured handover with a defined ask.
6 · Read-back, document & evaluate▾
Confirm understanding, document the episode, follow up on the outcome.
Facilitator note: demonstrate against your Skills Book checklist and have learners tick each step as you go.
If you have manikins/role-play space, demonstrate steps 4–6 live.
Map each step to the marking rubric so learners see how marks accrue.
Session 4 · Interactive scenarios · 75 min
Work the scenarios — together
Three live briefs. For each: identify the need, decide scope, gain consent, and structure the referral. Reveal the model decision after the class commits to an answer.
~20–25 min per scenario. Don't reveal until the room has decided.
Rotate who "makes the call" so everyone speaks up — practising the flat-team behaviour.
Scenario 1
Mrs P — discharge & safety
Brief: Mrs P, 72, is medically ready for discharge. During discharge planning she tells you she can't manage at home and is fearful of her son. She becomes tearful.
What need(s) are present?▾
Functional (managing at home) + psychosocial + a potential safety concern.
In scope to resolve alone?▾
No — refer to social work and escalate the safety concern per policy; don't discharge unsafely.
Consent & information?▾
Explain who you'll involve and why, gain consent, document it, and share only the minimum necessary.
Structure the referral▾
ISOBAR to social work with a clear ask (psychosocial & safety assessment before discharge) and a read-back.
Watch for learners trying to "counsel" the patient themselves — redirect to refer + escalate.
If raised: disclosure of feeling unsafe may trigger local safety/escalation policy — name it.
Scenario 2
A busy shift — delegation & pressure
Brief: It's a busy shift. You consider delegating a task to an AIN, and a medical officer asks you to perform a procedure you're not credentialed for, saying "it's quick".
Can you delegate the task?▾
Only if it's within the AIN's scope and you apply the rights of delegation (right task, circumstance, person, direction, supervision). You remain accountable.
The procedure you're not credentialed for?▾
Apply the DMF — not competent/authorised → decline, explain why, offer to find a credentialed clinician, and document.
The cultural-safety angle?▾
Speaking up to a senior is expected here. A respectful "no, because…" is professional, not insubordinate.
What's the critical-safety risk?▾
Acting outside scope under pressure — auto-flag #1. Pressure never changes scope.
Role-play the "respectful no" — give learners a sentence stem: "I'm not credentialed for that; I'll find someone who is."
Scenario 3
A deteriorating wound
Brief: A wound looks infected and is beyond the dressing protocol. Observations are trending up — early signs of deterioration.
What's the need & is it in scope?▾
Clinical need beyond the protocol → medical review; escalate per the deterioration pathway.
Recognising deterioration▾
Act on the trend — escalate early (critical-safety behaviour 05). Don't wait for a crisis.
Structure the escalation▾
ISOBAR to the medical officer; clear ask for review within a timeframe; read-back; document.
Do consent & privacy still apply?▾
Yes — keep the patient informed and share only what's necessary, even under time pressure.
Contrast with Scenario 1: here escalation is time-critical. Speed + structure together.
Session 5 · Consolidation · 45 min
Consolidation & set practice
Formative quiz, recap of the critical-safety behaviours, and the self-directed work to complete before Day 4.
Keep energy up — quiz first as a game, then recap, then set the homework clearly.
Check understanding · reveal the answer
Formative quiz
1 · Name the two critical-safety points specific to this skill.▾
Acting outside RN scope; breach of consent / privacy in information sharing.
2 · What does the "A" in ISOBAR stand for — and why does it matter?▾
Agreed plan — your clear ask, the actions and who's responsible. Without it, a referral is just information.
3 · Before sharing information to refer, what must you obtain and document?▾
Consent — and share only the minimum necessary information.
4 · An MO pressures you to work beyond scope. Which framework guides you?▾
The NMBA Decision-Making Framework — decline if not competent/authorised, escalate, and document.
Run as hands-up or table-teams; reveal after each. Tie answers back to the learning objectives.
The one thing to remember
Recap — protect these, protect your marks
TWO CRITICAL-SAFETY POINTS
1 · Stay within scope — escalate when a need exceeds it.
2 · Consent first, then share the minimum necessary.
And remember…
Use the DMF to reason aloud about scope.
Structure every referral with ISOBAR — clear ask + read-back.
In a flat team, speak up and escalate.
Document — not documented = not done.
Cultural safety is defined by the patient.
If they remember nothing else: scope + consent. Everything else hangs off those two.
Before Day 4
Set practice — self-directed work
1
Complete the self-directed scenarios in your Skills Book.
2
Practise an ISOBAR referral aloud with a peer — include consent and read-back.
3
Read the NMBA Decision-Making Framework and the cultural-safety section of the Code of Conduct.
Be specific about what's due and when. Point to the exact Skills Book pages if you have them.
Encourage peer practice — saying it aloud is the fastest way to consolidate.
That's Day 3
Scope. Consent. Cultural safety.
Today you learned to recognise when a need exceeds your scope, refer with a structured ISOBAR handover, protect consent and privacy, and practise in a culturally safe way.
Thank you — see you on Day 4.
Close on the two critical-safety points one more time.
Preview Day 4 and confirm logistics; thank the cohort.