Submission to Nursing Council of New Zealand: Re scope of practice.
The College of Nurses represents registered nurses with a strong and proven
commitment to professional development. In order to prepare this submission
we have collected comments through a participatory web site location and
some discussion on our electronic discussion group.
With regard to the scopes, whatever titles are adopted, it will be important
for the Council to undertake a public education project as a part of Council’s
role in ensuring the public safety. There is a wonderful opportunity at
this point in history to set aside some misconceptions in the public mind
and establish the perception of nurses as independent health focused professionals
who make a critical difference to patient safety and levels of community
wellness. It is interesting currently, to observe the concerted campaign
by pharmacists to replace business lost through changes in dispensing
costs with a rapid move into primary health care provision and a clear
clash with nursing expertise.
General comment:
We ask that in addressing the issue of scopes of practice the Council
take a strong and courageous stand and set the profession on a clear path
forward, free of some of the debates and uncertainties which have plagued
us. This view came through strongly in the submissions from College members
who often expressed a sense of desperation about the ambiguities which
are perpetuated.
Nursing suffers from what has been described in the literature as the
“tyranny of niceness”. Out of compassion we often make decisions
or allow situations to persist which are not professionally constructive.
These comments pertain particularly to the choosing of a title for the
third scope of practice currently known as enrolled nurse. This will be
clarified later in our submission.
In addition these comments pertain to some media and professional newspaper
comment from the NZNO in which it has been suggested that we do not need
to put artificial barriers around levels of nursing. Whilst this might
be an admirable sentiment around equal valuing of the different levels
of contribution it is a shocking example of the persistence of an undercurrent
in nursing which continues to ignore the relationship between public safety,
health outcomes, higher levels of practice and the extensive appropriate
education and preparation necessary for designated roles.
Scope One: Nurse Practitioner
There is almost universal agreement that this is indeed a separate scope
and should be legislated as such. Nursing Council is to be commended for
the strong, visionary and nurse focused approach which underpins the establishment
and ongoing development of this role in NZ
Scope Two
The choice of nurse or registered nurse has raised much discussion and
there is ambivalence. The value of using “nurse” alone is
understood to aid in protection of the title but at the end of the day
it is felt that strong action by the Nursing Council of New Zealand should
manage protection of the title even with inclusion of the designation
“registered”. There is obviously a tension in giving up registered
if the third scope is to carry some variation of the title nurse. Finally
there is international recognition of the letters RN and this appears
to be valued. We acknowledge that even if ‘nurse” is selected
the abbreviation of RN may well usefully persist.
It is suggested that the definition of “Nurse” be amended
as follows
Nurses utilize nursing knowledge and complex nursing judgement
to assess and provide care, and to advise and support people to maximize
their health and to manage their health problems. They practice independently
and in collaboration with other health care professionals. (NOTE: we
want no reference to delegating and directing “second-level nurses”
). They provide comprehensive nursing assessments to develop, implement
and evaluate an integrated plan of health care, and provide nursing
interventions that require substantial scientific and professional knowledge
and skills. This occurs in a range of settings in partnership with individuals,
families, whanau and communities. Nurses may draw on their expertise
to manage, teach, evaluate and research nursing practice.
The use of the terms psychiatric, psychopaedic, general and obstetric
in the description of the scope seems anachronistic and unnecessary. The
notation of these previous categories of registration under “Conditions”
would seem to be sufficient.
Third scope
Our position in this context is well known to Nursing Council. Since
we strongly resisted the reinstatement of training for a health worker
to be known as enrolled nurse, subsequent events have clearly endorsed
or substantiated our concerns.
Earlier research and the recent history of the enrolled nurse have shown
that there is no legitimate place for confusing everyone from the person
with the title, to the public and other health disciplines as to the nature
and potential of the role. Such a situation simply creates distress and
risk and should not be allowed to continue.
Members report that those completing the two current EN programs are
finding it difficult to gain employment in their “scope” and
“area of focus”. Others are attempting to circumvent their
scope and focus by gaining employment as “nursing assistants”
in acute care settings. We of course feel concern for existing long-standing
enrolled nurses but this cannot be used as a reason for determining the
future.
Nursing Council has already shaped the nature of the submissions
received by stating in the consultation document that Council was seeking
a title for this level which included the term nurse. It will thus be
inappropriate to state that the profession has requested that this level
be designated nurse.
Titles for this level
It is noted that any type of title which includes the word nurse will
simply perpetuate the problems associated with the title enrolled nurse.
For this reason associate nurse and similar titles are strongly rejected.
There is some support for the title certified nursing assistant and more
for simply nursing assistant.
General comment and conclusion
College members very strongly requested that the Nursing Council take
a strong stand and sort this out “once and for all”. There
is huge concern at the lack of a nationally standardized and widely available
preparation for a person to assist nursing in acute settings with non
nursing work and to provide delegated care of people in non acute settings.
We request that the title nurse is not used in order to prevent :
? Inappropriate employment or allocation of responsibility in the care
of the frail elderly
? Inappropriate assumptions that replacements can be made for registered
nurses in acute settings in times of shortage
? Ongoing lack of clarity in the public mind as to the nature of nursing
.
We wish the Council well in these difficult deliberations. Despite our
assertions we do appreciate the challenges in such decision making but
also appreciate that at the end of the day, leadership is never easy but
terribly important.
Yours sincerely
Professor Jenny Carryer
RN PhD FCNA ( NZ) MNZM
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