1. Self Regulation is dead. The 1985 Nurses Act provided for Self Regulation by a Board on which 17 of the 29 members are Nurses and Fitness to Practice had a majority of Elected Nurses.
The New Bill provides for majorities of both the Board and Fitness to Practice to be non- Nurses.
This principle underpins the Medical Practitioners Act and others and has been insisted upon by all political parties because of the failings of other self regulating professions.
2. The numbers elected by the profession are reduced from 17 to 8. However the numbers elected by Psychiatric Nurses reduces from 4 to 1 and Intellectual Disability from 3 to 1. This is disproportionate and offensive to our disciplines.
The numbers on the Board are reduced from 29 to 23. We will now have 23 Board members to regulate over 50,000 Nurses in public and private practice; the Medical Council have 25 to regulate 7000 medical practitioners and the Allied Health Professionals Council have 21 to regulate less than 6,000.
3.The Bill exerts control over the Board which is not seen in other statutory frameworks establishing similar Regulatory Bodies. James Reilly TD (Fine Gael) describes this as ‘every action the Board takes must be directed by the Minister, with the agreement of the Minister’. He might have added – and paid for by Nurses-. Jan O Sullivan TD (Labour) describes it as ‘heavy handed control’. What is the Minister and her Department afraid of?
The Minister will be empowered to appoint the President of the new Board. While this is an appalling provision it is at least honest. Since the Minister is appointing the Majority of Board Members she can control who is elected President anyway.
However, it is arrogant and patronising and treats Nursing differently that other profession’s (similar) Statutory Bodies.
4.The CEO of the Board is forbidden to make any statements which do not correspond to Government Policy. This smacks of control.
5.The Board cannot provide any support to Nurses in moral crises over conditions in their services. So, the farce continues. If a nurse is upset, offended or even in moral distress over issues related to short staffing or poor care or resourcing of care they can phone the Board and will be advised to contact their Union. The Board is not allowed to raise concerns about care, not allowed to contact HIQA, not allowed to send an inspector, not allowed to do anything...............unless you want to accuse a nurse of some wrong doing and then they will spend a fortune on legal fees to secure a prosecution.
6.The Board will be given a responsibility for ensuring continuing competence. As of now we have no idea what will be involved in this process, or to what extent the HSE and other Employers will have a responsibility to support continuing education. One thing is certain is that Retention Fees will increase to pay for this
7.The Board have advised the Minister that the introduction of Continuing Professional Development and verification of competence is likely to result in more Fitness to Practice cases with the resultant increase in Retention Fees.
8. Fitness to Practice is to be held in public, except where the Committee accede to a request from a witness or the accused to hear the case , or part thereof, in private. Jan O Sullivan notes that ‘public interest and patient safety are the primary concern but where a person’s good name is at stake it may be appropriate to hold hearings in private’. We insist that it is essential that many cases are held in private to safeguard the innocent and to avoid a perceived deterrent to witnesses coming forward.
9.The National Council for the Development of Nursing and Midwifery was established as a result of a Recommendation of the Commission on Nursing and has been funded from the Exchequer. The Bill now proposes the integration of the Council with An Bord Altranais. It is suggested that in the current environment the Minister will insist on Nurses taking on this cost as well.................another increase in Retention Fees.
10.James Reilly TD also condemns what he sees as the Bill ‘providing for a significant role for the HSE which is not replicated in other similar legislation’. He says any objective observer would be concerned at any undue influence in this area by the HSE ‘a body that has little public confidence’.
11.For the first time students will be required to register on a ‘candidate register’ and pay a fee for the privilege. Apart from accumulating more money from nurses it is difficult to understand the reasoning behind this proposal.
12.The Bill provides for the registration of Advanced Nurse Practitioners, but only where a Post is provided. In other words HSE Control.
We pose the question : If an ANP leaves a post to travel abroad or to move to a different part of the Country is s/he still not an ANP?S/he has not lost the qualifications and skills which led to the ANP status in the first instance. Nurses will surely see this as an artificial limitation on the development of the profession.