You are not penalised for having a health condition. Ahpra and the NMBA do not take action simply because a nurse or midwife is unwell. They only act where a health issue is placing the public at risk, and their aim is to support safe practice.
In short
A health, or impairment, notification is about a health issue that may be affecting your capacity to practise safely, including mental health and substance use. The threshold for a mandatory notification is high: only where practising with the impairment places the public at risk of substantial harm. Not all conditions need to be reported, especially where effective controls are in place. The health pathway is supportive and aims to keep you working safely. If you are struggling, free confidential support is available now.
What is a health or impairment notification?
It is a concern that a health issue may be detrimentally affecting your capacity to practise safely.
Health is one of the three streams a notification can fall into, alongside conduct and performance. An impairment means a physical or mental health condition, including substance use, that may affect your ability to practise safely. Many impairment notifications relate to mental health. The law allows the NMBA to look at health matters only where there is concern that health may be affecting safe practice, and the whole approach is protective rather than punitive. For the wider process, see our guide to what happens after a notification to the NMBA.
What is the threshold for a health notification?
A mandatory notification about impairment is only required where practising with the impairment places the public at risk of substantial harm.
This is a deliberately high bar. Having a health condition, even a serious one, is not itself notifiable. A mandatory notification is only triggered where a practitioner is placing the public at risk of substantial harm by practising with the impairment. For treating practitioners, the threshold is set even higher, specifically so that nurses and midwives feel able to seek help without fear of automatic reporting. The message from the regulator is clear: seeking care for your health is encouraged, and is not the same as being reported.
When do you not need to notify?
Where effective controls are managing the impairment and reducing the risk, a notification is generally not required.
The guidelines recognise that a well-managed condition need not be reported. You generally do not need to notify where there are effective controls in place, such as:
- Treatment that is managing the condition
- A break from practice, such as sick leave
- A modified scope of practice that removes the risk
- Strategies used to manage the impact of the impairment
- Compliance with monitoring and supervision
In other words, a nurse who recognises a health issue and manages it responsibly, with appropriate support, is doing exactly what the system wants, and is often not a notification matter at all.
How are intoxication and substance use treated?
Practising while intoxicated, or misusing or diverting workplace medicines, is treated seriously, but seeking help for a substance issue is supported.
There are two different things here. Practising while intoxicated by alcohol or drugs, or misappropriating medicines from your workplace, is a serious conduct matter and can lead to significant consequences. That is separate from having a substance use health issue that you are addressing. The regulator actively encourages nurses and midwives to seek help for substance use, and would only need to make a mandatory notification where someone is placing the public at substantial risk of harm by practising with an impairment. If you are worried about your own alcohol or drug use, reaching out for support early is both the safest and the most professional thing you can do.
Why is the health pathway supportive?
Because the goal is safe practice, so the health stream is built around treatment and monitoring, not punishment.
Where a health matter proceeds, the NMBA may arrange a health assessment to understand your situation, and can put supportive arrangements in place. These often allow you to keep working safely, for example through treatment, monitoring, supervision, or a temporarily modified scope, and they are reviewed and removed as your health improves. A well-managed condition is generally no barrier to continuing to practise. The focus throughout is on getting you to a place where you can work safely, which is in everyone's interest.
Where can you get support?
Free, confidential support is available specifically for nurses and midwives, and reaching out does not trigger a notification.
Nurse & Midwife Support
A national, free and confidential support service for nurses, midwives and students, available 24 hours a day, 7 days a week. It provides support and guidance, and does not report concerns to Ahpra or the NMBA itself.
Your treating practitioner, your professional association and your indemnity insurer are also important sources of support. Engaging with your own health care early is viewed positively, not negatively.
If you are not sure whether your health is affecting your practice, that uncertainty is itself a good reason to reach out. Confidential self-assessment tools exist to help you reflect privately on your own alcohol or drug use, and a support service can talk it through with you without any of it going further. And if you are worried about a colleague rather than yourself, the same services can help you think through how to support them, and whether a concern even reaches the high threshold for a notification. Looking out for one another, early and kindly, keeps far more matters out of the regulatory system than it puts in.
How should you respond, and how can CPD help?
Engage with treatment, be open about how you are managing the risk, and use reflection and CPD to show insight.
The strongest response to a health matter is evidence that you understand any risk and are actively managing it with your treating team. Where CPD is relevant, structured learning on fitness to practise, aligned with your CPD registration standard, can help you show insight into how health and safe practice connect, and support a reflective account. This sits alongside your health care and any remediation, and it never replaces treatment or advice. For serious matters, take advice from your indemnity insurer.
To evidence insight and fitness to practise
Courses to support your response
Structured CPD to help you show insight into fitness to practise. These sit alongside your health care and advice, and never replace them. Independent CPD you can use as evidence of remediation.
Fitness to Practise for Healthcare Professionals
- Understand how fitness to practise is assessed
- See how health connects to safe practice
- Evidence insight for your response
How to Deal With a Notification or Investigation
- Understand each stage of the NMBA process
- Know what to do, and what to avoid, early
- Respond calmly and well prepared
Module on Reflection
- Write a reflective account with insight
- Show understanding of the risk and its management
- Prepare a statement you can submit
Module on Remediation
- Evidence the steps you are taking
- Show a plan that reduces future risk
- Document remediation for your response
See the full range of CPD for nurses and midwives.
Official sources
Frequently asked questions
Will I be reported just for having a health condition?
No. Ahpra and the NMBA do not take action simply because a nurse or midwife is unwell. A mandatory notification about impairment is only required where practising with the impairment places the public at risk of substantial harm.
Do I have to notify if I am getting treatment?
Generally no. Where effective controls are in place, such as treatment, a break from practice, a modified scope, or monitoring and supervision, a well-managed condition usually does not need to be notified.
Will seeking help for alcohol or drug use get me reported?
Seeking help is encouraged and is not the same as being reported. A mandatory notification is only needed where someone places the public at substantial risk of harm by practising with an impairment. Support services do not report to the NMBA.
Is practising while intoxicated the same as a health issue?
No. Practising while intoxicated, or misusing or diverting workplace medicines, is a serious conduct matter with significant consequences. Having a substance use health issue that you are addressing with support is treated as a health matter.
Can I keep working with a health condition?
Usually yes. A well-managed condition is generally no barrier to practising. Where a matter proceeds, supportive arrangements such as treatment, monitoring or a modified scope often allow you to keep working safely.
What is a health assessment?
It is an assessment the NMBA can arrange to understand your health and its effect on safe practice. It is supportive in aim, and helps identify what treatment or arrangements would allow you to practise safely.
Where can I get confidential support?
Nurse & Midwife Support is a free, confidential national service for nurses and midwives, available 24/7 on 1800 667 877. It provides support and guidance and does not report concerns to Ahpra or the NMBA itself.
Does CPD help with a health notification?
It can support your response by showing insight into fitness to practise, alongside your treatment and advice. CPD never replaces health care, but structured learning aligned with your CPD registration standard can help evidence your understanding.
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 or medical advice. If you have received a notification, seek advice from your professional indemnity insurer or a health law solicitor, and speak with your treating practitioner about your health.