In short
A performance concern is about the quality or safety of your clinical care, measured against the standards for practice for your role. It is a formal category, unsatisfactory professional performance, separate from conduct and health. Common triggers include failing to escalate a deteriorating patient, assessment gaps, medication and documentation issues, and falls management. The NMBA may refer you for a performance assessment, and outcomes often focus on education and supervision. A response that maps the concern to the standard, reflects honestly, and evidences remediation is what a Board is looking for.
What are clinical care and performance concerns?
They are concerns about the quality or safety of your care, judged against the standards for practice, and captured by the formal category of unsatisfactory professional performance.
Australian regulation looks at a notification through one of three lenses: conduct, performance or health. A performance concern asks whether your clinical care met the standard reasonably expected of a nurse or midwife with your level of training and experience. The NMBA Standards for Practice set those expectations, and you are expected to demonstrate knowledge, skill and judgement at that level. For the wider process, see our guide to what happens after a notification to the NMBA.
What performance concerns are most common for nurses?
Care of a deteriorating patient tops the list, alongside assessment, medication, documentation and falls.
Regulator and professional sources point to a consistent set of performance triggers. Recognising them helps you understand what a Board looks at, and where to focus your own practice.
- Deteriorating patient, or failing to escalate care
- Assessment skills, or improper assessment
- Medication errors or omissions
- Documentation that is incomplete or inaccurate
- Falls and head-injury management
- Time management and failing to act
Why is failure to escalate so significant?
Because failing to recognise and act on a deteriorating patient is directly linked to preventable harm, it is one of the most serious performance concerns.
Missing or not acting on signs of deterioration can lead to critical illness or death that was preventable, which is why it features so often in notifications. The safe pattern is well established, and showing that you understand and follow it is central to a strong response. It also reassures a Board that, whatever happened on one occasion, your usual practice is safe.
Step 1
Recognise
Complete and review observations, and note trends or warning-score triggers.
Step 2
Escalate
Act on the trigger and call for help through the rapid response pathway.
Step 3
Communicate
Hand over clearly, for example using an SBAR structure.
Step 4
Document
Record what you saw, did and escalated, contemporaneously.
What is a performance assessment?
It is a structured review the NMBA can arrange to assess whether your practice meets the expected standard.
At the assessment stage, the NMBA can decide to take no further action, investigate, or refer you for a performance or health assessment. A performance assessment looks objectively at your knowledge, skill and judgement in practice. It is not designed to catch you out, but to identify whether there is a genuine gap and, if so, what education or support would address it. Approaching it openly, and showing you have already started to address any feedback, works in your favour.
What outcomes can follow a performance notification?
Most commonly education and support, with conditions such as supervised practice where a genuine gap is found.
Performance matters are often resolved through a focus on education rather than punishment, because the aim is safe practice. Where the Board finds a gap, it may impose conditions such as supervised practice, further training or mentoring, which are removed once the risk is addressed. Our guide to notification outcomes explains the full range, and where there is a serious risk the Board can take immediate action.
How should you respond to a performance notification?
Map the concern to the standard, reflect honestly, and evidence targeted remediation that closes the specific gap.
Identify exactly which standard for practice the concern touches, then show, in a reflective account, that you understand why it mattered for patient safety. Back it with real remediation aimed at the exact gap, such as clinical competence training and a changed routine. For performance matters, evidence of improved practice, including audit or supervisor feedback, is especially persuasive.
Illustrative example
The concern: A nurse did not escalate a patient whose observations met the rapid response criteria, and the delay was raised in a notification.
Mapping to the standard: The nurse identifies the assessment and escalation expectations in the standards for practice that the delay touched.
Reflection: They set out honestly how the missed escalation risked serious harm, without shifting blame to workload alone.
Remediation: They complete CPD on clinical competence and recognising deterioration, adopt a personal rule to escalate on any trigger, and evidence improved practice through a short audit.
How can you reduce the risk of a performance concern?
Be proactive about your own practice, act on feedback early, and keep your skills current before a concern ever arises.
Most performance notifications are avoidable with a proactive approach. Identify the areas where your practice could be stronger, especially where an employer or colleague has given you specific feedback, and address them rather than waiting. Keep your clinical knowledge current, use the support and education available in your workplace, and treat early warning systems and escalation policies as protections rather than paperwork. Where you feel out of your depth, ask for help early. None of this is a sign of weakness. It is exactly the accountable, safety-focused practice the standards ask for, and it is the surest way to keep a concern from arising in the first place.
How can CPD help with a performance concern?
Targeted CPD on clinical competence and patient safety gives dated evidence that you have closed the specific gap.
Performance concerns are addressed by demonstrating improved practice, and structured CPD aligned with your CPD registration standard is one of the clearest ways to evidence it. Matched to the exact concern, whether recognising deterioration, assessment or medication safety, and paired with a reflective account and improved practice, it directly answers whether the risk has been addressed. Browse the full range of CPD for nurses and midwives.
Matched to performance concerns
Courses for a clinical care notification
Structured CPD chosen for clinical care and performance concerns, to help you evidence remediation. Independent CPD you can use as evidence of remediation.
Ensuring Clinical Competence and Patient Safety
- Directly targets clinical care and safety
- Strengthen assessment and escalation practice
- Evidence competence for your response
Ensuring Effective Communication as Healthcare Professionals
- Improve handover and escalation communication
- Communicate concerns clearly and in time
- Evidence safer communication practice
How to Ensure a Mistake or Misconduct Is Not Repeated
- Show the Board the gap will not recur
- Turn reflection into a lasting change
- Evidence a sustained safeguard
How to Deal With a Notification or Investigation
- Understand each stage of the NMBA process
- Prepare for a performance assessment
- Respond calmly and well prepared
Official sources
Frequently asked questions
What is a performance concern for a nurse?
It is a concern about the quality or safety of your clinical care, judged against the NMBA standards for practice. It is captured by the formal category of unsatisfactory professional performance, which is separate from conduct and health.
What is the most common clinical care complaint about nurses?
Care of a deteriorating patient, including failure to escalate, is among the most common. Assessment skills, medication and documentation issues, and falls management are also frequent triggers for performance notifications.
What is a performance assessment?
It is a structured review the NMBA can arrange to assess whether your practice meets the expected standard. It looks objectively at your knowledge, skill and judgement, and identifies whether education or support would address any genuine gap.
Can I keep working during a performance notification?
Usually yes. Most nurses keep working while a performance matter is assessed. Your registration is only restricted if the Board takes immediate action, used in a small number of higher risk matters after a show cause process.
What outcomes are common for performance concerns?
Performance matters often focus on education rather than punishment. Where a genuine gap is found, the Board may impose conditions such as supervised practice, further training or mentoring, which are removed once the risk is addressed.
What if understaffing contributed to the concern?
Staffing and system factors are relevant context and worth explaining, but avoid using them to shift responsibility. Show what you recognised, did and documented, and what you have changed within your own control.
How do I prepare for a performance assessment?
Approach it openly. Review the relevant standards, reflect honestly on any feedback, and start addressing gaps early through targeted CPD and workplace support. Showing you have already begun to improve works in your favour.
Does CPD help with a clinical care notification?
Yes. CPD targeted at clinical competence and patient safety, aligned with your CPD registration standard, gives dated evidence that you have closed the specific gap. It never guarantees an outcome, but it directly addresses the concern.
Dr Richard
Course Facilitator
A practising clinician with over 21 years of experience and postgraduate training in healthcare law and ethics, so every course reflects both clinical reality and Australian regulatory standards.
Written and reviewed by Dr Richard. Last reviewed . Read full profile
AHPRA Courses is an independent training provider. Our courses are structured CPD that practitioners can use as evidence of remediation. We are not affiliated with, endorsed by, or acting on behalf of Ahpra, the Nursing and Midwifery Board of Australia, or any other regulator. Courses provide evidence of remediation and do not determine the outcome of any matter. This article is general information, not legal advice. If you have received a notification, seek advice from your professional indemnity insurer or a health law solicitor.