JAMAICAN DIASPORA HEALTH

FORUM: CANADA 2014Presentation by

Mrs. Pearline Cooper Sharpe, BH(M), JP

M.P.H., R.N. R.M

Chairman

The Nursing Council of Jamaica

July 11, 2014

HEALTH HUMAN RESOURCES PLANNING STRATEGIES, CREDENTIALING, INTERNATIONAL ACCREDITATION AND MODERNIZATION OF THE POLICY AND REGULATORY FRAMEWORK.

OBJECTIVES

At the end of this session the following would have been presented:

• Brief history of the Nursing Council of Jamaica (NCJ)

• Outline of the functions of the Nursing Council of Jamaica as the legal/ regulatory agency for nursing/ midwifery

• State the role of the Nursing Council in enabling the Ministry of Health to actualize its strategic objectives

• Explain how the Nursing Council ensures that it remains relevant in the context of international nursing human resource best practices

• Identify challenges that the Council experiences

THE REGULATION OF NURSING AND MIDWIFERY EDUCATION AND PRACTICE IN JAMAICA BEGAN IN 1964 WITH THE ESTABLISHMENT OF THE NURSES AND MIDWIVES ACT.

THIS WAS FOLLOWED BY THE ENACTMENT OF THE REGULATIONS IN 1966.

TO ACCOMMODATE BIENNIAL RELICENSING, AMENDMENTS WERE MADE TO THE ACT AND ASSOCIATED REGULATIONS IN 2005.

FOLLOWING A REVIEW OF THE ACT AND REGULATIONS IN 2011, RECOMMENDATIONS FOR AMENDMENTS WERE MADE.

THE ACT ESTABLISHED THE NURSING COUNCIL WITH A MANDATE TO CONTROL THE TRAINING AND PRACTICE OF REGISTERED NURSES, MIDWIVES, AND ENROLLED ASSISTANT NURSES AND TO REGISTER THESE PRACTITIONERS IN JAMAICA.

THE COUNCIL IS A SELF REGULATING PROFESSIONAL BODY THAT IS COMMITTED TO ENSURING THE SAFETY OF THE PUBLIC AND ENHANCING THE PROFESSIONALISM OF NURSES AND MIDWIVES.

IT IS SELF REGULATING BECAUSE IT DETERMINES THE PROCESSES BY WHICH IT CARRIES OUT ITS FUNCTIONS UNDER THE NURSES AND MIDWIVES ACT. IT IS THE FINAL AUTHORITY ON THE INTERPRETATION AND ENFORCEMENT OF THE ACT, AND IS RESPONSIBLE TO THE GOVERNMENT OF JAMAICA FOR ITS PROPER FUNCTIONING. THE FIFTEEN (15) MEMBER COUNCIL REPORTS TO THE MINISTER OF HEALTH THROUGH THE CHAIRMAN WHO HE APPOINTS. HE ALSO APPOINTS A LAWYER AND AN EDUCATOR.

THE OTHER THIRTEEN (13) MEMBERS ARE NOMINATED BY THE PROFESSIONAL ASSOCIATIONS OF THE REGISTERED NURSES, MIDWIVES, ENROLLED ASSISTANT NURSES AND MENTAL HEALTH NURSES.

THE CREDENTIALING FRAME WORK OF THE COUNCIL INCLUDES EXAMINATIONS, REGISTRATION/ ENROLMENT, LICENSING AND APPROVAL PROCESSES.

CURRENTLY THE REGISTRATION, LICENSING AND ENROLMENT ARE DONE ELECTRONICALLY AND AS OF OCTOBER 2014, THE LICENSURE EXAMINATION FOR REGISTERED NURSES WILL ALSO BE PROCESSED ELECTRONICALLY.

CREDENTIALLING

• Credentialing is a core component of clinical/professional governance or self-regulation

• Credentialing and privileging follow licensure, and is the process through which a provider obtains authorization to practice in health care settings. Each step builds upon an educational foundation in the specialized area of care. 

• Registered nurses working in specialized fields and other disciplines have developed credentialing as a means to ensure standards of practice and competence within their specialist domain beyond entry to practice e.g. the Advanced Practice Nurse whom the amended Act will recognize.

PATHWAYS TO THE REGISTER / ROLL ARE THROUGH THE COUNCIL’S EXAMINATION AND THE EXAMINATIONS OF APPROVED EDUCATIONAL INSTITUTIONS

TO KEEP PRACTITIONERS ON THE CUTTING EDGE OF THE HEALTHCARE LANDSCAPE, THE COUNCIL REQUIRES A PRE-REQUISITE FOR BIENNIAL RE- LICENSURE IS EVIDENCE OF MANDATORY PROFESSIONAL DEVELOPMENT ON THE FORM OF CONTINUING EDUCATION UNITS.

THE NURSING COUNCIL / MINISTRY OF HEALTHTHE COUNCIL IS THE “WATCH – DOG” FOR THE

MINISTRY’S MANDATE TO PROTECT THE PUBLIC. BY ENSURING THAT PROFESSIONALS WHO ARE LICENSED / ENROLLED MEET THE REQUIRED STANDARDS.

THE AMENDED ACT WILL ADDRESS THE REGULATION OF THE TRAINING OF AND PRACTICE OF NON- PROFESSIONAL CARE GIVERS i.e. SUPPORT WORKERS/ UNLICENSED ASSISTIVE PERSONNEL

THERE IS A CLOSE WORKING RELATIONSHIP WITH THE CHIEF NURSING OFFICER WHO IS RESPONSIBLE FOR NURSING MANPOWER PLANNING FOR THE ISLAND OF JAMAICA.

THE NCJ IS RECOGNIZED INTERNATIONALLY IN RELATION TO ITS APPROVED CURRICULUM FOR RN SCHOOLS OF NURSING AND THE LICENSURE EXAMINATION FOR REGISTERED NURSES. COUNCIL’S REGISTRATION AND LICENCE VERIFICATION ARE ACCEPTED INTERNATIONALLY.

THE COUNCIL IS COGNIZANT THAT THERE IS THE NEED TO RESPOND TO NEW DEVELOPMENTS IN NURSING AND MIDWIFERY EDUCATION, PRACTICE AND POLICIES GLOBALLY AND THIS HAS PROMPTED A REVIEW OF THE EXISTING ACT AND REGULATIONS IN ORDER TO MODERNIZE THE POLICY REGULATORY FRAMEWORK.THESE HAVE BEEN ANALYZED IN AND GEARED TOWARDS MEETING THE DEMANDS OF THE DEMOGRAPHIC, EPIDEMIOLOGICAL AND SOCIAL PARADIGM SHIFTS TAKING PLACE LOCALLY, REGIONALLY AND INTERNATIONALLY.

THE RESULTANT RECOMMENDED CHANGES ARE RESPONSES TO CHANGING DEMANDS OF THE JAMAICAN HEALTH SYSTEM, CHALLENGES IN THE HUMAN HEALTH HUMAN RESOURCES ARENA, A MORE INFORMED ASSERTIVE GROUP OF HEALTH CARE CONSUMERS AND ADVANCEMENT IN HEALTH KNOWLEDGE AND TECHNOLOGIES.

Evidence – Based Nursing Regulations is a challenge for Regulators.

These are complex times for regulators on nursing councils mainly from three areas:

1. They must stay abreast of emerging practice issues emanating from technological advances, systems thinking, a more diverse patient population living longer with multiple chronic illnesses. An international focus on patient safety and error prevention.

2. There is an international call for transformation of nursing education ( Benner, Sutphen, Leonard, & Day, 2009; Griener,& Knebel, 2003) and nursing councils are increasingly aware of numbers of inadequately prepared graduates and practices.

3. Disciplinary issues involving nurses have increased exponentially over the last decade, forcing regulators to stay on their toes regarding disciplinary investigations and actions. In this challenging climate, the time is ripe to focus on evidence- based regulation, and so research has moved high on the totem pole for the NCJ.

Observations

Nursing regulation is still emerging; regulators do not have a great deal of evidence on which to base regulatory decisions.

The knowledge base needs to be broadened and the science developed, so that critical issues can be studied rigorously.

• Few initiatives have taken place that encourage the collaboration and interaction of regulators and researchers.

• Mentors for evidence- based regulation are lacking. According to Ridenour (2009) a significant regulatory challenge is the difficulty of attaining dollar value to public protection. Executive members of the Nursing Council serve diverse stakeholders, from nursing applicants to legislators, always with the mission of public protection. This market place of public protection is not easy to measure and sometimes the margins of difference and objectively get blurred.

CHALLENGES CONTD.

• The resources for conducting research or collecting data by nursing councils are rarely considered a priority. In discussing knowledge management, Sin (2008) outlines several challenges related to the structures and culture of public institutions, which are barriers to evidence- based regulations e. g. confidential nature of some information which inhibits sharing and access, high staff turnover and bureaucratic structures that slow communication and decision–making.

CHALLENGES CONTD

In spite of the challenges, the NCJ has commenced the process of implementing evidence – based regulation with the rejuvenation of a robust Research Committee that partners with other research groups in medicine and allied health.

This will enable the “integration of best research evidence with clinical expertise and patient values” (Sackett, Straus, Richardson, & Haynes, 2000 p 1)

The NCJ believes that Evidence Based Health Care Policy is the merger of evidence- based practice, Evidence- Based Regulation and Evidence- Based Education.

CHALLENGES CONTD

1. KEEPING LEGISLATION AND REGULATION CURRENT IN THE CONTEXT OF RAPID CHANGING HEALTH CARE LANDSCAPE

2. INADEQUACY OF HUMAN, FINANCIAL AND MATERIAL RESOURCES NEEDED TO CARRY OUT THE COUNCIL’S MANDATE

3. SELECTING COUNCIL MEMBERS WHO HAVE THE REQUIRED COMPETENCES TO ENSURE THE APPROPRIATE BALANCING NEEDED FOR PROTECTION OF THE PUBLIC AND THE PROFESSIONALISM OF NURSES AND MIDWIVES SIMULTANEOUSLY.

4. CHANGING VALUE SYSTEM AMONG PROSPECTIVE ENTRANTS TO THE PROFESSION

5. LICENSING OF NURSES TRAINED ABROAD

CHALLENGES CONTD.

NURSES TRAINED ABROAD

Nurses and midwives trained outside the CARICOM Region have been admitted to our register if they satisfy the education and practice requirements of the NCJ. We also seek verification of good character and language competence

• The NCJ HAS REQUIREMENTS FOR LICENSURE, BUT MANY APPLICANTS FROM OVERSEAS APPEAR NOT TO REGARD THESE e.g. THERE ARE STIPULATIONS FOR CURRICULUM HOURS IN ORDER TO QUALIFY FOR ENDORSEMENT AND THESE MUST BE MET.

• PERSONS SEEKING TEMPORARY LICENSES OFTEN DISREGARD THE REQUIRED TIME FRAME FOR SUBMITTING DOCUMENTS, AND STILL EXPECT TO BE GRANTED THE LICENSE ON THEIR TERMS

ACHIEVEMENTS

• Regulation of all health professionals

• Introduction of a single regional mechanism for registration and monitoring of the practice of all categories of health personnel with the exception of support workers / Unlicensed Assistive Personnel

• Competency – based curricula

• Mandatory continuing education as pre- requisite to periodic relicensure and enrolment.

WAY FORWARDDeveloping a dynamic accreditation system that will

• Provide evidence of relevance of curricula output to health services requirements, professional practice and professional development

• Provide evidence of the impact of scopes of practice, continuing professional education for recertification on health outcomes

• Monitor the regulated for compliance with the mandatory competence assurance process.

A MANAGED ACCREDITATION SYSTEM FOR HEALTH CARE FACILITIES TO ASSURE QUALITY OF PROFESSIONAL SERVICES TO THE PUBLIC;

GREATER INTER- COUNCIL COLLABORATION WITH CARICOM PARTNERS, allowing for proactive risk management given the shared focus on public protection

SUMMARY• The Nurses and Midwives Act of 1966 invests in the Nursing Council of

Jamaica “the power to control the training and practice of nurses, midwives and assistant nurses and to register nurses and midwives and enroll assistant nurses.”

• A basic regulatory principle is that regulation should not be more restrictive than is necessary for public protection, and regulation should not stifle the growth of the nursing profession.

• THE FULCRUM OF THE NURSING COUNCIL RESTS ON THE FOLLOWING TENETS:

1. SETS THE CRITERIA FOR RECRUITMENT i. e . ENTRY INTO THE PROFESSION

2. EDUCATION AND TRAINING OF NURSES AND MIDWIVES AND ASSITANT NURSES BY PRESCRIBING THE CONTENT OF THE CURRICULAE

3. DISCIPLINE OF ITS MEMBERS - the most fair and transparent aspect which a matter of law, a person who is charged with a breach is entitled to be defended by an Attorney of his/ her own choice.

SUMMARY CONTD.

• The NCJ enables the Ministry of Health to realize its strategic objectives by ensuring that nurses who serve the public possess the required cognitive, psychomotor and affective competencies;

• The NCJ is cognizant of challenges from within and without and is taking steps to address them e.g. recommendation to amend the Nurses and Midwives Act and accompanying regulations, initiation of evidence – based research to inform regulations.

SUMMARY

• The Council will establish a committee for the commitment to ongoing regulatory excellence, to identify issues that pose the greatest risk that will negatively impact the public protection function of the Council; and also to identify areas where professionals and other groups rely on Council for information about and resolution of professional issues. This will increase the image and visibility of the Council to employers, educational institutions, health care groups and the general public.

• By promoting excellence in regulatory practices and establishing benchmarks, the Council will better manage regulatory efforts to safeguard the public.

• The NCJ has a vested interest in embracing best practice standards which help to meet public expectations of how effectively the public is protected, as well as serving the rights of individual nurses

REFERENCES CONTD.

Greiner, A. C., & Knebel, E. (Eds.) 2003. Health professions education: Abridge to quality. Washington, D.C.: The National Academies Press.

 

Hammersley, M. (2005). Is the evidence-based practice movement doing

more good than harm? Reflections on Iain Chalmers’ case for research-based policy making and practice. Evidence & Policy, 1(1), 85-100.

http://www.nursingcenter.com/lnc/journalarticle?Article_ID=852760 Retrieved July 4, 2014

https://www.ncsbn.org/EB_Regulation_article_final.pdf - Retrieved July 4, 2014

  

REFERENCES

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation. New Jersey: Jossey-Bass.

Canadian Health Services Research Foundation. 2005 Annual Report. Retrieved from http://www.chsrf.ca/other_documents/annual_ reports/2005/letter-ceo_e.php

 

Cooper, S. R., Betts, V. Trotter, B. K., & Gentry, J. (2009). Evidence-based practice and health policy: A match or a mismatch? In Malloch, K., & Porter-O’Grady, T. (Eds.), Introduction to evidence-based practice in nursing and health care (pp. 275-299). Sudbury, MA: Jones and Bartlett Publishers.

 

Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence

evaluating healthcare interventions. Journal of Clinical Nursing, 12, 77-84. doi: 10.1046/j.1365-2702.2003.00662.x