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OVERVIEW OF REGULATION
OF NURSING IN PACIFIC
COUNTRIES
Mary MacManus.
Auckland University of Technology,
New Zealand.,
Kim Usher.
James Cook University, Cairns,
Australia
ENHANCING THE QUALITY OF NURSING
AND MIDWIFERY EDUCATIONAL
PROGRAMMES AND SERVICES IN THE
PACIFIC
JCU/AUT Pacific Project 2010-2012
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
Countries Included
Countries Visited
Data collected at SPNF 2010
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
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 Affara Fadwa 1998 ICN ON REGULATION Towards 21st
Century Models
Areas in Nursing
Legislative
• Role
• Education
• Definition and scope of a
• Entry requirements
regulatory body
• Duration of initial education
• Establishment of regulatory body
• Educational expectations
• Scopes and Registration
• Licencing/ Practicing
• Definition of nursing/midwifery
Certificates
• Roles of nurses/ midwives
• Requirements for achieving
licensure
• Categories/levels of
nurses/midwives
• Requirements for maintaining
licensure
• Registration
• Fitness to practice
• Standards
• Disciplinary processes
• Standards of conduct
• Practice standards or
competencies
PROJECT RESULTS
From 15 Pacific Countries
Type of Legislation
From 13 countries
Type of Legislation
No
Notes
Act specific for Nursing
9
Within legislation for Health
Professions
3
Included in Medical Act
1
No legislation governing nursing
2
Niue and Tokelau
Legislation greater than 20
years old
5
Legislation or date not
available
Legislation reviewed since 2000
4
Growing trend for new
legislation
Scopes of Practice
Results from 13 countries with legislation governing
nursing
• All countries recognised Registered Nurses
• 6 countries recognised advanced practice nurses e.g.
Nurse Practitioners
• 7 recognised a second level nurse or health care
assistant
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
Regulation in Pacific
From the 13 countries with Nursing legislation
• 10 Countries have regulatory processes for
nursing (including 1 in development)
• Few had full regulatory processes or
procedures to implement the regulation
• 8 Countries had competencies for RN practice
(Including 1 in progress)
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
• 5 also require conditions e.g. education or performance appraisals
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
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 deregister but this was rarely used
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
NURSING EDUCATION
12 programmes over
9 countries
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
Regulation of Nursing
Education
Countries
Process in regulation
to approve nursing education
7
Outlined requirements for
nursing programme
5
5 yearly review of programme
6
Educational standards or
criteria for approval/review
?
Comment
Little evidence of this
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 trained in 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
MIDWIFERY REGULATION
From 15 countries
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)
Midwifery Regulation
• In all Pacific countries midwifery was seen as a
advanced qualification in nursing
• Legislation governing Midwifery in only 8 countries out
of the 15, and
• Midwifery registration – 9 countries
• Scope of practice for midwives - 8 countries
• Midwifery competencies – 4 countries
Midwifery Schools
COUNTRY
Fiji
SCHOOL
Fiji School of Nursing
Kiribati
Kiribati School of Midwifery MHMS
University of Papua New Guinea
Papua New Guinea Pacific Adventist University
Samoa
Solomon Islands
Divine Word University
National University of Samoa
Tonga
Solomon Islands College of Higher
Education/Ministry of Health and Medical
Services
Queen Solate School of Nursing
Vanuatu
Vanuatu school of Midwifery
Midwifery Education
Qualification
Length of
programme
Total hrs.
Theory hrs.
Clinical hrs.
Fiji
Post Grad Diploma
52 wks
1960
680
1280
Kiribati
Post Grad Cert
35 wks
1065
490
575
PNG
Degree
Degree
Degree
52 wks
52 wks
50 wks
2789
1992
2000
1344
312
720
1445
1680
1280
Samoa
Post Grad Diploma
52 wks
1120
480
640
Solomon Adv Dip Nursing
Islands (Midwifery)
52 wks
1169
504
665
Tonga
40 wks
Not available
Not available Not available
Not
available
Not available
Not available Not available
Certificate
Vanuatu Diploma
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
THANK YOU