The earliest recorded Parkinson’s Disease and Movement Disorders Nurse Specialist (PDMDNS) in Australia was Beverley Zielinski, who began her work in 1985 as a Drug Study Nurse for the bromocriptine versus Sinemet PD Multicentre Study at Westmead Hospital, funded by industry (McAnally, 2016). Early PDMDNS positions were largely funded by industry, with most nurses serving as research coordinators or clinical trials nurses. Other early pioneers with significant contributions to the field include Barbara Higgins at Westmead Hospital (NSW) from 1990 to 2000 (retired), Marion Hoffman at Austin Health (VIC) from 1994 to 2021 (retired), Mary Jones since 1996 (retired), Janet McLeod at Parkinson’s WA from 1998 to 2024 (retired), Sue Mercer at Concord Repatriation General Hospital (NSW) from 1998 to present (active), Laraine McAnally at Westmead Hospital (NSW) from 2001 to 2011 (retired), Evelyn Collins at John Hunter Hospital (Newcastle, NSW) from 2001 to present (active), Karen O’Maley from 2001 to present (active) and Sarah Bray 2002 to present (active).
The role of the PDMDNS was then formally introduced in Australia in 1997. The Parkinson’s Society of Western Australia (PWA) advocated to the state government for funding to support a pilot position for a Parkinson’s Disease Nurse Specialist through the Western Australian Department of Health. This position was modelled on the PDMDNS roles established in the United Kingdom (McLeod, 2010), whose development has played a crucial role in shaping the specialist role in Australia.
In New Zealand, Lorraine MacDonald was established as Movement disorder nurse specialist at Auckland in 1996.
The PDMDNS role was initially established within the United Kingdom’s National Health Service (NHS) in 1989. Since then, the role has expanded across the UK and internationally, becoming a recognised nursing specialty (McLeod, 2010).
The National Institute for Health and Clinical Excellence (NICE) produces clinical guidelines on request from the Department of Health in the UK. These guidelines, renowned for their rigorous development process and evidence-based approach, are globally acknowledged (NICE, 2014). The guidelines have been instrumental in supporting the establishment of PDNS roles for individuals with Parkinson’s disease. In June 2006, NICE issued Clinical Guideline 35 for Movement Disorders, which led to the NHS Good Practice Guide for Neurological Conditions, highlighting the importance of specialist nurses (NICE, 2006).
Building on these developments, competencies for PDMDNS were refined by the Royal College of Nursing (RCN) in collaboration with the Parkinson’s Disease Nurse Specialist Association (PDNSA) and the Parkinson’s Disease Society, now known as Parkinson’s UK. These competencies were released as the Competency Framework for Nurses Working in Parkinson’s Disease Management (Royal College of Nursing, 2016).
While these advancements progressed in the UK, the expansion of specialist nursing roles in Australia was more gradual. Following the initial pilot position in 1997, the Western Australian Government allocated additional funding to create a second PDNS position in 1998. In 2007, through member donations and bequests, the PWA funded a third PDNS position (McLeod, 2010).
In May 2008, the Government of Western Australia developed a Parkinson’s Disease Services Model of Care (Department of Health WA, 2008), incorporating the 2006 NICE guidelines as the best-practice framework for Parkinson’s disease services.
In July 2010, after successful advocacy by the PWA, the WA Government fully funded the PDNS position, marking a significant milestone in the state’s Parkinson’s disease services (McLeod, 2010).
Following the success of the WA service, Parkinson’s Australia launched an initiative ahead of the 2010 federal election, highlighting four critical challenges faced by individuals with Parkinson’s, their families, and carers (Parkinson’s Australia, 2010):
Limited services focusing specifically on movement disorders.
Lack of awareness and understanding of the condition in healthcare, aged care, and the general community.
Inadequate services for people with early-onset Parkinson’s disease.
Financial barriers to accessing effective treatment options.
The initiative aimed to achieve two key outcomes:
Improve the quality of life for Australians with movement disorders, helping them remain employed, live at home longer, and reduce hospitalisations.
Generate substantial savings in hospital and aged care costs, alongside productivity benefits for the government.
A major component of this initiative was the proposal to secure federal funding to employ over 50 specialist neurological nurse educators across Australia (Parkinson’s Australia, 2010). The initiative emphasised the potential for significant improvements in the management of neurological conditions, such as Parkinson’s, and the potential savings from reduced hospital admissions and early intervention.
In addition to reflecting on the events outlined above, the Australian Parkinson’s Nurses Network (APNN) was established in 2004 during a formal, industry-funded meeting held in Sydney. In 2005, the following office bearers were elected: President Evelyn Collins, Vice President Marion Hoffman, Secretary Noeline Davies, and Assistant Secretary Karen O’Maley. The network continued to operate, ultimately recognising the need for a more formal organizational structure to support its growth and provide a platform for further development.
In 2010, the Faculty of Movement Disorder Nurses was launched within the Royal College of Nursing, strengthening the community of Parkinson’s nurses across Australia. In 2013, the RCNA and the NSW College of Nursing merged to form the Australian College of Nursing (ACN), with the faculty evolving into a Community of Interest. The Steering Group for this Community of Interest recognised the need for a distinct professional identity and the development of competencies for nurses working with individuals with movement disorders (ACN, 2014). This working group explored ways to establish an organisational framework to support the professional development and career pathways for Australian Parkinson’s nurses.
In 2016, the Australasian Neuroscience Nurses Association (ANNA) launched the inaugural Movement Disorders Chapter (MDC), marking a significant milestone in the continued growth of this nursing specialty across Australasia. Sue Williams served as the first chairperson of the ANNA MDC from 2016 to 2019, providing leadership and direction during the chapter’s formative years. Other committee members during this period included Emma Everingham, Sheree Ambrosini, Amy Jones, and David Tsui. In 2019, David Tsui took over as chairperson, serving until 2022. Between 2022 to 2025, he co-chaired the MDC alongside Sue Williams further advancing the development and recognition of this specialty. The MDC was subsequently handed over to Sheree Ambrosini as the chairperson from the end of 2025 to present.
As the chapter continues to grow, mentoring the next generation of PDMDNS is a priority to ensure seamless succession planning. We hope that emerging leaders will build on the MDC’s achievements, further advancing the role of Parkinson’s Disease and Movement Disorder Nurse Specialists across the region. Moving forward, the Movement Disorder Chapter of ANNA aims to uphold a culture of clinical excellence, professionalism, mutual support, and altruism.
Parkinson’s disease is a multifaceted condition affecting all aspects of life thus bringing a huge long-term impact on both the person with the diagnosis and their partner and family. While the introduction of levodopa in the 1960’s changed the life expectancy and quality of life of those affected by the disease process it was the introduction of the PDMDNS almost three decades later which transformed the management of Parkinson’s from a medical model to a collaboration of professionals and those living with Parkinson’s (McLeod, 2018, as cited in Australasian Neuroscience Nurses’ Association, 2018).
The role of the Parkinson’s Disease and Movement Disorder Nurse Specialist (PDMDNS) in Australia and New Zealand is diverse and varies significantly across states, territories, and country. This diversity is evident in the categorisation, grading, and skill mix of roles, as well as the differences in employment conditions and educational qualifications.
Geographically, there are notable distinctions in the roles of PDMDNSs depending on whether they are located in metropolitan, regional, or rural areas. The type of employer also influences the role, with PDMDNSs employed by a range of organisations, including state health departments, consumer organisations, the pharmaceutical industry, private practice, primary health networks, and academic institutions.
The permanency of funding and contract arrangements for PDMDNS positions also varies, with some nurses holding permanent roles while others work in positions with short-term or project-based funding. Additionally, the educational backgrounds of PDMDNSs differ, with nurses holding qualifications ranging from Bachelor’s degrees to higher-level qualifications such as Graduate Diplomas, Master’s degrees, and PhDs. The varying levels of experience among PDMDNSs also contribute to the role’s diversity.
The grading and skill mix across PDMDNS roles also reflect this diversity. Roles such as Nurse Practitioners, Clinical Nurse Consultants (CNCs), Clinical Nurse Specialists (CNSs), Registered Nurse Prescribers (RNPs) and Registered Nurses (RNs) reflect differing levels of responsibility, skill, and expertise (Heaton et. al., 2025).
Given this variation, it is essential that national standards for practice be established and routinely revised. These standards help ensure evidence-based practice, uphold professional standards, and be agreed upon by subject matter experts and peak professional bodies. Such standards will help provide consistency and clarity in the role of the PDMDNS and ensure that these specialists deliver high-quality, consistent care to individuals living with Parkinson’s disease and other movement disorders.
As regulated health professionals in both Australia and New Zealand, Parkinson’s Disease and Movement Disorder Nurse Specialists (PDMDNS) are accountable to their respective regulatory bodies. In Australia, they are responsible to the Nursing and Midwifery Board of Australia (NMBA), and the national Registered Nurse (RN) standards for practice form the foundation of current practice. These NMBA standards have directly influenced the development of these Standards of Practice.
In New Zealand, Movement Disorders Nurses are accountable to the Nursing Council of New Zealand under the Health Practitioners Competence Assurance (HPCA) Act 2003. This includes consideration of the Treaty of Waitangi, emphasizing a partnership between Māori and the Crown.
Benner’s Stages of Clinical Competence outlines the development of nursing skills across five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. This document acknowledges that a newly employed PDMDNS is, in Benner’s terms, a novice or advanced beginner. At this stage, they may lack experience in specific clinical situations and will require support and supervision as their knowledge and skills develop (Benner, 1984).
A new PDMDNS is expected to work toward achieving competency at the levels of ‘competent’, ‘proficient’, and ‘expert’ nursing, as described by Benner. A competent nurse typically has two to three years of experience and demonstrates efficiency and confidence in their clinical actions within an appropriate timeframe, working independently. A proficient nurse learns from experience, recognising when the clinical situation changes, and adapts accordingly. The expert nurse has an intuitive grasp of clinical situations, underpinned by a holistic model. They possess a deep understanding of clinical scenarios and a high level of proficiency, aiding decision-making, even in unfamiliar situations (Benner, 1984).
The Parkinson’s Disease Nurse Specialist Association (PDNSA) in the United Kingdom defines three levels of clinical expertise in their “Competencies: A Competency Framework for Nurses Working in Parkinson’s Disease Management” (2016). These levels align with the UK’s Healthcare Assistants Skills for Health, Career Framework for Health (2005) and include:
Level 5 – Competent nurse: The entry point for registered nurses into the PD specialty, who are in the process of developing their knowledge and skills.
Level 6 – Experienced specialist nurse: A nurse who has developed a deeper understanding and mastery of their skills.
Level 7 – Expert specialist nurse: A nurse with advanced expertise and high-level decision-making capabilities.
Level 8 – Consultant nurse: A nurse regarded as a specialist or expert practitioner who coordinates comprehensive care autonomously, following local protocols.
This document serves as a comprehensive guide for nurses working with individuals diagnosed with Parkinson’s disease, as well as other movement disorders. The Standards for Practice framework can be applied in various contexts, including but not limited to:
Performance management and evaluation
Revision of existing position descriptions
Development of new job descriptions and scopes of practice
Facilitation of continuing professional development
Recognition of the expertise and proficiency of Parkinson’s Disease and Movement Disorder Nurse Specialists (PDMDNS)
In Australia, the Nursing and Midwifery Board of Australia (NMBA) Registered Nurse (RN) and Nurse Practitioner (NP) titles are the nationally recognised and consistent terms. However, it is important to note that varying terms exist across different states, reflecting differences in skill levels and remuneration (see Table 1. Grading Alignment Table). This document provides a robust framework and clear terms of reference for PDMDNS to substantiate their expertise and competence within the field. PDMDNS can utilise this framework to map their evidence against each competency, thus demonstrating their progression and achievement. The evidence gathered will be aligned with local position grading and reaccreditation criteria.
Given the multifaceted nature of PDMDNS roles, the evidence required to demonstrate expertise will vary according to individual circumstances. Potential forms of evidence include:
Case presentations that showcase knowledge of Parkinson’s disease, clinical assessment abilities, patient education, clinical interventions, and active involvement in multidisciplinary team settings
Audit and review of written documentation, such as patient notes, letters, and clinical reports
Self-assessment through observation and critical analysis of everyday clinical practice
Written testimonials from colleagues and supervising medical practitioners affirming the PDMDNS’s clinical capabilities
Certificates of attendance and evaluations of learning outcomes from relevant study days and professional courses
Demonstrated evidence of informed clinical practice, supported by relevant literature, for instance in the development of protocols, guidelines, and policies.
Active participation in clinical supervision and mentorship programs
Demonstration of leadership in the creation and delivery of quality care services
Involvement in or leadership of local educational initiatives for patients, carers, and healthcare colleagues
The effectiveness of these Standards for Practice will be periodically reviewed in response to ongoing developments and changes in clinical practice within Australia and New Zealand.
The Parkinson’s Disease and Movement Disorder Nurse Specialist Standards 3rd edition was developed by the nominated members of the Movement Disorder Chapter Committee, with expert consultation throughout the process. The final draft of the document was circulated for feedback to the broader PDMDNS community.
The framework’s effectiveness will be assessed through a dedicated focus group that will evaluate:
The extent and manner in which the framework is being utilised
The ease of use, as well as any challenges or barriers encountered
Any gaps in the information or guidance provided by the framework
Outcome measures for the evaluation of the framework will include:
A baseline self-assessment survey conducted with a representative group of PDMDNS to establish the existing level of competence in relation to the framework
Identification of specific competence gaps, which will inform the development and delivery of targeted education and training for Parkinson’s nurses
A follow-up self-assessment survey conducted after a defined period, assessing the progression in competence and the impact of the framework on practice development
“Aligning Grades of Nursing Specialisation Across Australia and New Zealand” illustrates how the terms Competent Nurse, Experienced Specialist Nurse, and Expert Nurse are used within this document and align with grading and pay scales across different states and countries.
| Grading: | Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse |
| Parkinson’s Disease and Movement Disorder Nurse Specialist Standards for Practice (ANNA MDC) | Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse |
| PDNSA Competencies: A Competency Framework for Nurses Working in Parkinson’s Disease Management | Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse |
| Corresponding Level of Post-Graduate Education | Bachelor of Nursing | Graduate Certificate | Masters |
| Benner’s stages of clinical competence (1984) | Competent Nurse | Proficient Nurse | Expert Nurse |
| State / Country Grading: | Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse |
| New South Wales | Registered Nurse | Clinical Nurse Specialist Grade 2 | Clinical Nurse Consultant Grade 2, 3 |
| Queensland | Nurse Grade 5 | Nurse Grade 6 | Nurse Grade 7 |
| Victoria | Registered Nurse (Grade2) | Clinical Nurse Specialist (Grade 3) | Clinical Nurse Consultant (Grade 4~5) |
| South Australia | RN level 1 | RN Level 2 (Clinical Nurse) | RN Level 3 (Clinical Nurse Consultant) |
| Western Australia | RN Level 1–2 | Senior registered Nurse level 1–4 | Senior registered nurse Level 5–6 |
| Australian Capital Territory | Registered Nurse Level 2 | Registered Nurse Level 3 | Registered Nurse Level 3 |
| Tasmania | RN Level 2 | RN Level 3 | |
| Northern Territory | Nurse 3–4 | Nurse 5–6 | Nurse 7–8 |
| New Zealand | RN level 3–4 | Nurse Specialist | Nurse Specialist-Senior |
Clinical Knowledge and Understanding of Parkinson’s Disease
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Pathophysiology | Able to clearly demonstrate understanding of dopamine depletion, Lewy body pathology, and the progressive nature of Parkinson’s disease. | Able to demonstrate a deep understanding of dopamine depletion, Lewy body pathology, and Braak’s hypothesis, including the proposed progression of pathology from the gut to the brainstem and subsequently to the midbrain and higher cortical regions, as well as a clear understanding of α-synuclein aggregation processes. | Able to demonstrate a deep understanding of dopamine depletion, Lewy body pathology, and Braak’s hypothesis, including the role of α-synuclein aggregation and propagation, and a clear understanding of how the underlying pathophysiology of atypical parkinsonian syndromes differs from Parkinson’s disease, such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), vascular parkinsonism (VP), Corticobasal Syndrome (CBS) and Normal Pressure Hydrocephalus (NPH). |
| Clinical Phenomenology and Symptomatology | Able to demonstrate a clear understanding of ON and OFF motor fluctuations, as well as peak-dose dyskinesia and how these phenomena relate in the context of dopaminergic therapy, dopamine levels and disease progression. | Able to demonstrate a clear understanding of ON and OFF motor fluctuations, as well as peak-dose dyskinesia, intermediate dose symptoms such as diphasic dyskinesias and beginning-of-dose motor deterioration (BDMD), and how these phenomena relate in the context of dopaminergic therapy, dopamine levels and disease progression. | Able to demonstrate an expert-level understanding of ON and OFF motor fluctuations, including peak-dose dyskinesia, intermediate-dose effects such as diphasic dyskinesias, and beginning-of-dose motor deterioration (BDMD), with insight into how these phenomena relate to dopaminergic therapy, dynamic dopamine levels, and disease progression. |
| Able to demonstrate a sound understanding of the classic motor features of Parkinson’s disease, including tremor, rigidity, bradykinesia, and postural instability. | Able to demonstrate a sound understanding of the classic motor features of Parkinson’s disease, including tremor, rigidity, bradykinesia, and postural instability, with the ability to recognise atypical presentations that warrant escalation for further assessment by senior clinicians. | Able to demonstrate a expert level understanding of the classic motor features of Parkinson’s disease, including tremor, rigidity, bradykinesia, and postural instability, with the ability to distinguish typical from atypical presentations, identify the likely underlying neuroanatomical regions responsible, and determine which additional targeted examinations are required to guide clinical assessment. | |
| Able to demonstrate awareness that Parkinson’s disease includes non-motor symptoms, including neuropsychiatric, sleep-related, autonomic, cognitive, and sensory disturbances. | Able to demonstrate understanding of how non-motor symptoms impact Parkinson’s disease management, including assessment of severity, need for escalation, and influence on overall patient care. | Able to demonstrate expertlevel understanding of the different non-motor symptoms, their underlying pathophysiology, and why they occur. | |
| Differential Diagnosis: | Able to demonstrate awareness of atypical parkinsonian syndromes, including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), vascular parkinsonism (VP), corticobasal syndrome (CBS), and normal pressure hydrocephalus (NPH). | Able to demonstrate an experienced understanding of atypical parkinsonism, including basic phenomenology and recognition of red flags that differentiate these conditions from Parkinson’s disease. | Able to demonstrate expert-level understanding of atypical parkinsonism, including detailed knowledge of clinical presentations, underlying pathophysiology, and neuroanatomical correlates, enabling accurate direction of further targeted investigations, examinations, and assessments. |
Clinical Assessment of Parkinson’s Disease
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Clinical Assessment – History | Able to demonstrate awareness of prodromal symptoms of Parkinson’s disease, including early non-motor features, and understand the importance of factors such as age of onset, disease duration, and family history in the clinical context. | Able to demonstrate an experienced understanding of prodromal symptoms and the relevance of age of onset, disease duration, and family history, recognising red flags that may indicate atypical parkinsonism and warrant escalation to senior clinicians. | Able to demonstrate expert understanding of prodromal features, age of onset, disease duration, and family history in the diagnostic weighting of differential diagnoses. |
| Clinical Assessment – Certification in Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) | Certified in UPDRS through MDS training and able to administer the test as part of routine history taking. | Certified in UPDRS through MDS, able to administer the assessment confidently, familiar with the flow and structure of the tool, and able to interpret its results to identify gaps or limitations, integrating additional assessments as needed. | Certified in UPDRS through MDS, able to administer the assessment fluently without reference to score sheets or prompts, with near-complete mastery of the tool, and able to use the results to guide management, direct care planning, and target interventions precisely. |
| Clinical Assessment – Physical Examination | Able to perform a safe clinical examination using UPDRS Part 3 as a guide, including scoring, with attention to patient safety during manoeuvres such as the pull test for postural instability. | Able to conduct a proficient clinical examination using UPDRS Part 3, completing the assessment with smooth flow and minimal prompts, and able to recognise abnormal findings that may indicate atypical features requiring escalation to a senior clinician. | Able to perform the clinical examination proficiently but also identify atypical clinical signs and integrate additional targeted neurological assessments, such as eye movements, cerebellar function, and frontal lobe testing, to correlate with red flags from the history. |
| Clinical Assessment – Other Assessment tools | Able to demonstrate awareness of other and/or MDS-recommended rating scales and able to administer appropriate tools for routine clinical care. | Able to understand which assessment tools and/or MDS-recommended rating scales are suitable for specific clinical settings and when to incorporate additional tools based on patient history and clinical assessment. | Able to select, critically appraise, and develop appropriate rating scales, and design protocols that integrate combinations of scales effectively for clinical service delivery or research, with consideration of the time required for admin- |
| Clinical Assessment – Cognitive Testing | Able to demonstrate awareness of cognitive assessment tools appropriate for Parkinson’s disease and able to administer them in routine clinical care. | Able to select and administer cognitive tests confidently and understand which tools are most suitable for specific clinical settings or patient contexts. | Able to administer and interpret cognitive assessments in the context of the overall clinical situation, using results to aid in differential diagnosis (including atypical parkinsonism), evaluate suitability for device-assisted therapies such as DBS, and guide treatment planning and clinical management. |
| Clinical Assessment – Diagnostic Assessments | Able to demonstrate understanding of different diagnostic assessments that may be performed by a PDMDNS based on referral needs, such as levodopa challenge or dose cycles, to support phenomenological characterisation and diagnosis. | Able to proficiently perform diagnostic assessments, including levodopa challenges and medication dose cycles, and adapt these approaches to other diagnostic contexts where appropriate, such as tap tests for suspected normal pressure hydrocephalus (NPH). | Able to proficiently perform and critically analyse diagnostic assessment results. |
| Clinical Assessment – Telehealth | Able to conduct structured telehealth assessments for people with Parkinson’s disease, including obtaining a relevant history, assessing motor and non-motor symptoms within the limitations of virtual review, and identifying red flags requiring escalation. | Able to perform comprehensive and targeted telehealth assessments, adapting examination techniques to optimise remote evaluation of motor function (e.g. tremor, bradykinesia, gait where feasible) and non-motor symptoms. | Able to lead and deliver advanced telehealth assessments with a high level of clinical reasoning, integrating complex clinical information to guide management decisions. |
Medication Management
Disclaimer: Medication dosing and titration for device-assisted therapies (DATs) must only be performed by a nurse with prescribing authority or in collaboration with a medical officer.
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Medication Management - Parkinson’s medications | Able to demonstrate understanding of the mechanisms of action, key differences, and common side effects of Parkinson’s medications, including dopaminergic agents, MAO-B inhibitors, COMT inhibitors, and dopamine agonists. | Able to understand treatment rationale, recognise when medication regimens or schedules appear suboptimal, and identify issues that warrant escalation to senior clinicians. | Able to critically evaluate and optimise prescribing, including dosing, frequency, and titration plans. |
| Medication Management – Other medications | Able to demonstrate awareness of other medications used to manage conditions commonly associated with Parkinson’s disease, such as restless legs syndrome (RLS), REM sleep behaviour disorder (RBD), constipation, cognitive impairment, and neuropsychiatric symptoms. | Able to recognise symptoms that are not part of the core features of Parkinson’s disease but are commonly associated with the condition. | Able to accurately identify Parkinson’s-related symptoms, select and prescribe appropriate treatments with clear clinical rationale, and design titration and care plans tailored to the individual. |
| Medication Management – Side Effect Monitoring | Able to demonstrate awareness of common Parkinson’s medication side effects, such as hypotension, nausea, and dyskinesia. | Able to identify and differentiate medication side effects from non-motor symptoms of Parkinson’s disease, and develop appropriate management strategies to mitigate these side effects. | Able to accurately distinguish medication side effects from disease-related symptoms, design and implement advanced management strategies—including alternative titration approaches—and prescribe or recommend additional medications when appropriate to optimise symptom control while minimising adverse effects. |
Device Assisted Therapies (DAT) Management
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Device Assisted Therapies (DAT) Management – Theory | Able to demonstrate awareness of currently available device-assisted therapies (DATs), including apomorphine, Foslevodopa/Foscarbidopa (Vyalev®), Levodopa-Carbidopa Intestinal Gel (Duodopa®), and Deep Brain Stimulation (DBS), and has a basic understanding of how these treatments work. | Able to demonstrate a solid understanding of DATs, including mechanisms of delivery, identify patients who may be potentially suitable, and provide informed recommendations for referral, advising appropriately on whether a DAT is likely to be beneficial or less suitable based on clinical assessment. | Demonstrates expert knowledge of DATs, including mechanisms of action, treatment suitability to patient, and treatment implications. |
| Device Assisted Therapies (DAT) Management – Apomorphine Injections and Infusions | Able to demonstrate a good understanding of apomorphine therapy, including its role as a rescue treatment and as an infusion therapy, the clinical situations and symptoms for which it is indicated, expected treatment response times and duration of benefit, and the need for side effect monitoring, including impulse control disorders (ICDs). | Able to demonstrate practical understanding of apomorphine therapy, including injections and infusion. | Able to demonstrate expert understanding of apomorphine therapy, including detailed mechanisms of action, dosing, titration, and frequency. |
| Device Assisted Therapies (DAT) Management – | Able to demonstrate a good understanding of apomorphine therapy, including its role as a rescue treatment the clinical situations and and as an infusion therapy, symptoms for which it is indicated, expected treatment response times and duration of benefit, and the need for side effect monitoring, including impulse control disorders (ICDs) and infusion site reactions. | Able to demonstrate practical understanding of apomorphine therapy, including injections and infusion. | Able to demonstrate expert understanding of apomorphine therapy, including detailed mechanisms of action, dosing, titration, and frequency. |
| Device Assisted Therapies (DAT) Management – | Able to demonstrate a good understanding of Foslevodopa/Foscarbidopa (Vyalev®) therapy, including its role as a continuous subcutaneous levodopa infusion, the clinical situations and symptoms for which it is indicated, expected treatment response times and duration of benefit, and the need for side effect monitoring, including dyskinesias, infusion site reactions, and neuropsychiatric effects. | Able to demonstrate practical understanding of Foslevodopa/Foscarbidopa therapy, including patient education and training on correct use of equipment. | Able to demonstrate expert understanding of Foslevodopa/Foscarbidopa therapy, including detailed pharmacology, mechanisms of action, dosing principles, titration strategies, and frequency adjustments. |
| Device Assisted Therapies (DAT) Management – | Able to demonstrate a good understanding of Duodopa® therapy, including its role as a continuous intestinal levodopa infusion, the clinical situations and symptoms for which it is indicated, expected treatment response times and duration of benefit, and common complications associated with PEG-J therapy, including device-related and gastrointestinal issues. | Able to demonstrate practical understanding of Duodopa® therapy, including patient education and training on daily pump use, cassette handling, and basic troubleshooting. | Able to demonstrate expert understanding of Duodopa® therapy, including pharmacology, dosing principles, titration strategies, and infusion scheduling. |
| Device Assisted Therapies (DAT) Management – | Able to demonstrate awareness of Deep Brain Stimulation (DBS) as a treatment option for Parkinson’s disease and other movement disorders, including basic principles of how DBS works, common targets, and general indications. | Able to demonstrate a solid understanding of DBS therapy, including patient suitability criteria, expected benefits, limitations, and common contraindications. | Able to demonstrate expert-level understanding of DBS therapy, including mechanisms of action, target selection (e.g. STN vs GPi), and the interaction between stimulation and both motor and non-motor symptoms. |
Comprehensive Health Assessment, Formulating Clinical Impressions, and Care Planning
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Comprehensive Health Assessment | Able to enhance clinical assessments into a comprehensive health assessment (CHA) by considering the broader biopsychosocial aspects of care for patients with Parkinson’s disease. | Able to apply comprehensive clinical assessment to target referrals appropriately, specifying reasons for allied health involvement based on individual patient needs. | Able to provide detailed, directive guidance to allied health teams regarding referral rationale, expected interventions, and priorities based on thorough clinical assessment. |
| Formulating Clinical Impressions | Able to identify issues from the comprehensive health assessment and list them clearly. Demonstrates basic understanding of what is happening with the patient. | Able to refine assessment findings to generate a shortlist of likely differential diagnoses and identify key clinical issues affecting the patient. | Able to accurately formulate clinical impressions, integrating all assessment findings, and use these to develop comprehensive care plans. |
| Care Planning | Able to perform a basic care plan for the patient, addressing immediate and straightforward issues. | Able to create a care plan that considers Parkinson’s disease–related needs alongside biological, psychological, and social factors. Integrates multidisciplinary team (MDT) coordination and ensures appropriate referrals are made to allied health, psychological support, and social services. | Able to develop highly detailed, complex, and comprehensive care plans that integrate disease-specific management, comorbidities, biopsychosocial factors, and long-term patient goals. |
Documentation and Comprehensive Reports
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Documentation | Able to document patient information, assessment findings, and interventions accurately in clinical records. Maintains patient confidentiality in a documentation. | Able to produce structured clinical notes and reports, including assessment summaries, medication changes, care plans, and MDT communications. | Able to create comprehensive, high-level reports integrating assessment data, diagnostic findings, clinical reasoning, care plans, and MDT input. |
Professional Leadership
| Competent Nurse | Experienced Specialist Nurse | Expert Specialist Nurse | |
|---|---|---|---|
| Professional Development and Leadership | Engaged with peak professional bodies, such as ANNA and MDC, for peer supervision. | Contributes to clinical research and quality improvement initiatives to advance care for patients with Parkinson’s disease. | Teaches advanced clinical skills to colleagues and students, fostering a learning environment for the development of Parkinson’s nursing expertise. |
The Standards for Practice for Parkinson’s Disease and Movement Disorder Nurse Specialists (PDMDNS) provide a structured framework to support clinical excellence, professional development, and consistency of care across Australia and New Zealand. As the complexity of Parkinson’s disease and movement disorders continues to evolve, so too must the role of the PDMDNS, and these standards aim to guide that progression.
This document recognises the breadth and diversity of the PDMDNS role, while supporting nurses to develop their expertise, contribute to multidisciplinary care, and improve outcomes for people living with movement disorders.
In acknowledging the foundations of this specialty, appreciation is extended to the early leaders of Parkinson’s nursing across Australia and New Zealand, who have pioneered the way and helped establish a culture of clinical excellence, professionalism, mutual support, and altruism.
As the Movement Disorder Chapter of the Australasian Neuroscience Nurses’ Association continues to evolve, there remains a shared responsibility to uphold and build upon this legacy. As we move forward, may we continue to embody these values and remain grounded in our purpose—ensuring that our practice is always centred on the needs of the people we care for.
In the words of Laraine McAnally, whose mentorship has shaped many within this field:
“Despite all your achievements, always keep your feet grounded…Because that is where your patients need you.”
Laraine McAnally (2009) Retired Clinical Nurse Consultant, Epilepsy, Parkinson’s & Movement Disorders, Westmead Hospital, NSW, Australia