Overview of Regulation of Nursing in Pacific Countries

1. Overview of Regulation of Nursing in Pacific Countries Mary MacManus. Auckland University of Technology, New Zealand., Kim Usher. James Cook University, Cairns, Australia

2. Enhancing the Quality of Nursing and MidwiferyEducational Programmes and Services in the Pacific JCU/AUT Pacific Project 2010-2012

3. Project • Part A – Assess the implementation of competencies in Pacific island countries (using the WPSEAR common competencies as a benchmark/comparative tool) and formulate validation measures for these competencies. • Part B – Assess the nursing schools in the Pacific region in their implementation of relevant academic standards for nursing and midwifery education necessary for achieving outcome competencies that are suited/identified for the Pacific

4. Countries Visited Data collected at SPNF 2010 Countries Included

5. ICN Regulation ICN’s position on regulation acknowledges multiple purposes, forms, agents, and subjects of regulation and credentialing. These include, • 1. Mandatory or statutory regulation, by units of government, enforcing licensing/registration standards for nurses or approval/accreditation standards for hospitals or schools, for the purpose of consumer protection; • 2. Voluntary certification of nurse specialists or advanced practice nurses or accreditation of nursing schools or educational programmes, hospitals and other health services or products, by professional organisations or private agencies, for the purpose of designating particular competencies or standards of performance. ICN 1998

6. Think of a world without nursing regulation. . . · a world in which nursing has no national or global identity or name; · a world in which those engaged in what we have come to know as nursing roles and functions have no official sanction for their practice; · a world in which sick people, at their most vulnerable, put themselves in the hand of strangers, with no assurance of their competence or ethics; · a world in which ICN has no means of identifying nurses and in which we nurses have no means of identifying one another and the standards we hold in common. Styles Margretta and AffaraFadwa 1998 ICN ON REGULATION Towards 21st Century Models

7. Areas in Nursing Legislative • Role • Definition and scope of a regulatory body • Establishment of regulatory body • Scopes and Registration • Definition of nursing/midwifery • Roles of nurses/ midwives • Categories/levels of nurses/midwives • Registration • Fitness to practice • Disciplinary processes • Education • Entry requirements • Duration of initial education • Educational expectations • Licencing/ Practicing Certificates • Requirements for achieving licensure • Requirements for maintaining licensure • Standards • Standards of conduct • Practice standards or competencies

8. Project Results From 15 Pacific Countries

9. Type of Legislation From 13 countries

10. Scopes of Practice Results from 13 countries with legislation governing nursing • All countries recognised Registered Nurses • 6countries recognised advanced practice nurses e.g. Nurse Practitioners • 7 recognised a second level nurse or health care assistant

11. Regulation Regulations: • Defines the profession and its members • Determines the scope of practice • Set standards of education • Set standards of ethical and competent practice • Establish systems of accountability • Establish credentialing processes

12. Regulation in Pacific Fromthe 13countries withNursing legislation • 10Countries have regulatory processes for nursing (including 1 in development) • Few had full regulatory processes or procedures to implement the regulation • 8Countries had competencies for RN practice (Including 1 in progress)

13. Nursing Registration • Registration Process • 1 step – 7 • 2 step – 6. • Readiness for registration assessed by • School/principal – 5 • Regulatory authority – 6 • Chief Nurse – 2 • Licencing is • For life – 5 • Re-licence – 8 • Re-licence • Annually renewal of practicing certificate – 5 • 2 yearly renewal – 3 • Requirements to relicensing (8 Countries) • All required an application and payment of fees • 5also require conditions e.g. education or performance appraisals

14. Process for Registration of Foreign Nurses • Foreign applicants are asked to present CV, references and qualifications when applying for registration • Tendency to rely on the material presented and the fact that applicants were registered in another country without checks • Only one countries used competencies to assess suitability for registration • Some countries also require a medical certificate

15. Disciplinary Processes • All countries said they had disciplinary processes • Most followed the Public Service disciplinary processes • In 10 countries the Chief nurse or the nursing regulatory body investigates the complaint • No country used standards/competency criteria on which to base the decisions • Most regulatory bodies said they had a process to de-register but this was rarely used

16. Nursing Regulation Summary Regulation of nursing in Pacific countries is beginning • Many countries already have regulatory processes • Assistance is needed in the use of competencies for regulatory purposes • A number of countries are requesting assistance in the development of regulatory processes including a review of legislation • The development of the PI competencies provides countries without competencies a blueprint to work with • Regulatory processes for nursing are common across countries This is an area where work may be done across countries

17. Nursing Education 12 programmes over 9 countries

18. Nursing Programmes • Schools • Universities – 3 (UPNG, PAU, Samoa and Fiji), • Higher Education Colleges – 5 (SICHE Solomon Islands, Lutheran school PNG, Sangam Fiji Palau, and Marshall Islands) • Hospital based schools – 4(Tonga, Vanuatu, Atoifi Solomon Islands, and Kiribati). • Awards • Bachelor Degree – 3 • Assoc. Degree – 2 • Diploma – 7 (only 3 with educational accreditation) • Length of Programme • 3 years - 11 • 4 years – 1 • One school also ran a 2 year LPN within a 3 year programme

19. Regulation of Nursing Education

20. Nursing Education Summary • There are many nursing education programmes currently being conducted across the Pacific. Often small schools with limited resources • No consistent standard in education and no accepted standards of practice which programme should reach • Few regulatory procedures or criteria for reviewing programmes or benchmarking against other programs. • Regulatory bodies - not skilled or trainedin how to review or audit nursing education. • A common set of standards and a process for approving nursing education in PI countries might strengthen nursing education and benchmark programmes across countries

21. Midwifery Regulation From 15 countries

22. Global Standards for Midwifery Regulation “ The ICM believes that there should be appropriate legislation relating to the practice of midwives in all countries”. 1. Setting the scope of practice 2. Pre-registration education; 3. Registration; 4. Relicensing and continuing competence; 5. Complaints and discipline; and 6. Codes of conduct and ethics. (ICM 2011)

23. Midwifery Regulation • In all Pacific countries midwifery was seen as a advanced qualification in nursing • Legislation governing Midwifery in only8countries out of the 15, and • Midwifery registration – 9 countries • Scope of practice for midwives - 8 countries • Midwifery competencies – 4 countries

24. Midwifery Schools

25. Midwifery Education

26. Midwifery Summary • The lack of appropriate legislation, regulation and scope of practice for Midwifery has caused some confusion between nursing and midwifery in many of the Pacific countries studied in the project • Countries were in agreement on the need for midwifery competencies that are contextualised for the Pacific and include a primary health care focus’. (Nadi 2011) • There was also a strong call from Pacific countries to have a standardised midwifery programme that could be used across Pacific countries or where midwives could be educated for multiple countries

27. Thank you