Nurses need to have completed an accredited nurse immunisation course and have completed an accredited TST and/or BCG course in an accredited institution according to the Authority to Supply Poisons and Restricted Substances for Registered Nurses and Registered Midwives and the Authorised Nurse Immunisers and Authorised Midwife Immunisers policy directive (PD2024_004) before commencing the practical competency assessment outlined in this document.
Supervised training and competency assessment is required for Authorised Nurse Immunisers to independently order and administer TST and BCG in NSW following the authorised course. From 2024 this will be undertaken within NSW Health. Prior to 2024 this was undertaken as part of the Australian College of Nursing accredited courses. This assessment is required for new TB nurses working in or with TB services across NSW. This document outlines the requirements and recommendations for both initial and ongoing competency.
Nurses working in or with a NSW TB clinic (e.g. Staff Health, Public Health Unit, Sydney Children's Hospital Network Immunisation service) are required to undertake supervised training and competency assessment before independently ordering, administering, and interpreting (reading) TST and/or BCG. They must be assessed by an approved assessor.
TST: A minimum of five TST administrations and five TST interpretation/readings are required. A minimum of two readings greater than 5mm are required. If it is difficult for the nurse to encounter two readings >5mm, they can be provided with provisional competency with the undertaking that TST readings are double checked with an accredited TST nurse until such time as the two readings of >5mm have been achieved. Nurses are further required to reflect on their skill, ensure accurate documentation, as well as demonstrate management of patients that have a positive TST result.
BCG: A minimum of five BCG vaccinations from which a visible wheal is observed are required to be deemed competent. Nurses are required to provide pre and post BCG education to the carer and/or patient as part of their assessed competency. The nurse should ensure effective utilisation of protective eye wear for themselves, the carer and/or the patient. Timely and accurate documentation is also deemed part of the competency assessment.
The Authorised Nurse Immunisers and Authorised Midwife Immunisers policy directive (PD2024_004) requires annual review of best practice policy for immunisation to maintain authority to immunise and an annual statement of proficiency in cardio-pulmonary resuscitation, including paediatric basic life support where relevant for practice.
It is recommended that nurses that have previously been assessed as competent undertake supervised training of a minimum of three TSTs (three administrations and readings) and/or three BCG vaccinations with an approved assessor if they have not administered a TST and/or BCG in a period of more than 12 months.
Nurses who are TST and BCG accredited in the following roles and have actively undertaken TST (for TST assessment) and BCG (for BCG assessment) for more than 12 months, are able to assess competency for initial and ongoing accreditation:
If the individuals in these roles need to become accredited, they should seek out an accredited person in their district that occupies one of these roles or contact the TB NSW Program for further assistance.
Nurses are required to practice in accordance with the Authority to Supply Poisons and Restricted Substances for Registered Nurses and Registered Midwives and the Authorised Nurse Immunisers and Authorised Midwife Immunisers policy directive (PD2024_004).
The completed competency assessment for TST and BCG should be kept by the relevant nurse and uploaded to the nurse's individual HETI record.