New challenges ahead for nurse managers
The importance for the registered nurse to develop and maintain competence under the proposed new bill will now be explicit in order to sustain professional registration, write Justin Kerr and Margaret Prendergast.
The anticipated introduction of a proposed new Nurses and Midwives Act 2010 supports the progression of the nursing profession in order to meet the needs of a changing society. Equally this move forward also presents a challenge to all nurses.
The purpose of the new Act which is detailed as“…to enhance the protection of the public in its dealings with nurses and midwives and to ensure the integrity of the practice of nursing and midwifery. It will provide for a modern, efficient, transparent and accountable system for the regulation of the nursing professions, which will satisfy the public and these professions, that all nurses and midwives are appropriately qualified and competent to practice in a safe manner on an ongoing basis”. This article offers an insight into some of the issues that nurse managers will need to consider for future service delivery in the context of nursing competence.
It could be asserted, however, that there is a general lack of awareness of the significance of competence in nursing among nurses themselves
At the time of writing, the new Nurses and Midwives Bill 2010 has been referred to an Oireachtas select committee (May 2010). The Minister for Health & Children stated during the recent Florence Nightingale Memorial Celebration in Dublin Castle that it is anticipated that the bill may be enacted before the end of 2010.
The proposed new legislation places a statutory responsibility on the registered nurse/midwife in a number of key areas including the maintenance of professional competence.
It is stated under section 89 parts (1) and (2) “that a Registered Nurse and a Registered Midwife shall maintain competence on a regular basis and whenever required by the board to do so, demonstrate competence to the satisfaction of the board in accordance with any requirement of the board”.
Parallels can be drawn with the Nursing and Midwifery Council (NMC) in the United Kingdom with regard to the standards for post registration education and practice (PREP) whereby standards to maintain registration are defined; the NMC acknowledges that this is good governance as opposed to ensuring competence, however the proposed new Nurses and Midwives Act 2010 goes further than PREP and makes explicit the expectations regarding competence and this is affirmed though the authority of “the board to develop, establish and operate one or more than one scheme for the purpose of monitoring and maintenance of professional competence by registered nurses and registered midwives”.
The regulatory body for nursing in Ireland, An Bord Altranais, introduced the Scope of Nursing and Midwifery practice framework in 2000 which outlines the expectation of the board in relation the role of the registered nurse/midwife, regarding accountability and autonomy for professional decision making. This has proved a useful framework on which nurses currently base their practice.
The level of professional standards expected by managers of nurses are diverse and therefore are difficult to measure
However increased public expectation and debate regarding high profile cases have contributed to the need for the profession to examine the governance issues which oversee the ability of nurses to practice safely, in a modern healthcare environment. Appreciably expectations on behalf of the public concerning standards of care have increased. With this in mind, the importance for the registered nurse to develop and maintain competence under the proposed new bill will now be explicit in order to sustain professional registration.
The Code of Professional Conduct for each Nurse and Midwife (2000) further states that the nurse or midwife must take measures to develop and maintain the competence necessary for professional practice. It could be asserted however that there is a general lack of awareness of the significance of competence in nursing among nurses themselves. This is despite the existing Code of Professional Conduct and various new standards of nursing care published by the board on a regular basis. Currently expectations for nurses & midwives to maintain competence are not clearly articulated in everyday practice, therefore the level of professional standards expected by managers of nurses are diverse and therefore are difficult to measure.
It is difficult to predict what the precise issues that may emerge on the implementation of the Act, however we anticipate that arising from the proposals in the new legislation, it is now not enough to simply state that a “nurse or midwife must take measures to develop and maintain competence” as identified in the Code of Professional Conduct. In order to reassure the public that a nurse caring for a patient does indeed have the necessary skills and attributes to deliver care safely and effectively they must now make that explicit to their governing body. A key aim of the new Nurses and Midwives Act 2010 is greater protection of the public.
To date the profession has witnessed the welcome development of specialist nursing roles and the emergence of a structured approach to the advancement of extended roles for the registered nurse in everyday practice.
Evidence of this is demonstrated in legislative changes supporting Nurse Prescribing of Medicinal Products enacted in 2007. This has supported service objectives in many ways; however the challenge now for nursing management is to position itself effectively to respond to the expectation of the nursing board in terms of developing systems that enable the truly competent professional practitioner as well as meeting their management responsibilities to the employer.
The proposed new legislation places a clear responsibility on employing agencies concerning their level of responsibility to their employees, especially in areas such as training and role extension. It is stated in section 92 subsection (1) that “An employer of a registered nurse or registered midwife shall facilitate the maintenance by that nurse or midwife of his or her professional competence pursuant to a professional competence scheme applicable to the nurse or midwife concerned.” However how this may be achieved will certainly attract debate as it is further stated in subsection (2) “Without prejudice to the generality of subsection (1), the employer may facilitate the maintenance of professional competence by a registered nurse or registered midwife it employs by providing learning opportunities for that nurse or midwife in the workplace”.
This may result in the development of different approaches across the HSE as to how Registered Nurses and Midwives actually achieve competence as the precise responsibilities of the employing agency are not explicit. Nurse managers may be faced with challenges to their professional responsibility as a supervisor of nurses.
The management role involves assuring staff that this is the only game in town
The current pace of change in the HSE is unprecedented and nurse managers are finding themselves faced with difficult professional decisions in order to manage resources, maintain patient safety and promote nursing standards. Significant challenges lie ahead for nurse managers with regard to future service delivery and the maintenance of nursing competency; however it is clear that nurse managers will need to make competence management a priority. This may mean additional professional practice development needs that require nurses to be released to attend updated training programmes; not withstanding the existing day to day pressures of their current management role and perhaps more significantly those managers may now be faced with dealing directly with staff who do not perform to the standard that is required of them.
No existing mechanism
Nurse Managers have a key responsibility in developing and maintaining standards of care in their jurisdiction. This is often done through delegated procedures and protocols – but how do nurse managers really know that their staff are up to their job in line with best practice standards? Nurse managers need to respond to the effect of this pending legislation. This may mean that greater emphasis now needs to be placed on the requirements contained within the job description of registered nurses and midwives to ensure that role specifications are clearly identified and that job descriptions are fluid enough to promote autonomy, and professional development. Performance management in nursing needs to be a HSE priority.
We suggest that it may be appropriate for nurse managers to ensure that staff who report to them are working under job descriptions that reflect current standards of practice; since in many cases no mechanism exists which ensure the expected levels of competence is reflected in a continuously updated job description and role specification that mirror the expectations of the patients under our care and the requirement of the professional body.
Nurses at all levels will need to examine their individual competence. Nurse Managers will need to develop a critical awareness of the key issues involved and identify systems and processes which facilitate the introduction and maintenance of the requirements of the proposed new Nurses and Midwives Act 2010. All of this may be achieved through an appropriate competency framework at service level.
Nurse Managers have a key role in leading out on the development of nursing competencies. This means that they will need to take a strong leadership role creating an environment where nurses are prepared to declare themselves competent in their individual area of practice. The management role involves assuring staff that this is the only game in town and competence management is about protecting the nurse as well as serving the public interest. From an organisational perspective it means that managers will need to assure themselves that internal governance systems are aligned with organisational objectives and clear strategies which support the nurse who is not competent are suitably developed to respond quickly and completely to the demands that nurses are now faced with.
from:www.oireachtas.ie/parliament/ [accessed August 2010]
Justin Kerr is Asst. Director of Nursing, Mayo General Hospital, Castlebar, Co Mayo.
Margaret Prendergast is a Lecturer in Nursing, GMIT, Castlebar, Co Mayo.