A Nursing Specialization Framework for Nursing and Midwifery - Essay Example

Table of contents Table of contents 1 Introduction 1 Objectives of the essay 2 Scope of work and approach employed by the commissioned team 3 The six source criteria adopted by the commissioned team 5 Weaknesses of the approach adopted 6 The strengths of the approach adopted 7 Outcomes expected from the approach adopted 9 Critique to the approach adopted by the commissioned team 12 Conclusion 15 Bibliography 16 Introduction According to National Nursing and Nursing Education Taskforce (2006, pp.1-2) the nursing framework for nursing and midwifery in Australia had specialization problems. The nursing and midwifery specialties were characterized by absence of uniformity in education, practice and regulatory standards (National Nursing and Nursing Education Taskforce 2006, pp.3) and (National Review of Nursing Education 2002). The Australian Nursing and midwifery specialties suffered from ‘…a near lack of flexibility and mobility of nursing and midwifery workforce’ according to National Review of Nursing Education (2002, pp.120). Similarly, National Review of Nursing Education (2002) indicated that there were no ‘…nationally agreed principles that could have governed State and Territory nursing legislation and regulations’. Australian Council for Safety and Quality in Health Care (2002) found that there was lack of ‘…assessment competencies for initial registration of registered nurses and enrolled nurses’. Australian Health Ministers’ Conference (2004) found that ‘…lack of restrictions towards entry into the nursing and midwifery specialties was not protecting healthcare consumers from unqualified care practitioners’. Similar observations were made by Australian Council for Safety and Quality in Health Care (2004). Australian Nursing and Midwifery Council (2004) suggested ‘…that nurses and midwives internationally fit into a Para-professional group as they are typically not trained in the same way as the “higher-level” professional, but at times may actually have superior training for certain types of care’ . According to Department of Human Services Victoria (2003, pp. 17) ‘…the primary purpose of the legislation regulating the practice of nurses and midwives is to protect the public, not to protect the interests of the professions – this form of regulatory regime is known as a ‘protective jurisdiction’. Department of Human Services Victoria (2003b) indicated that the ‘…protective jurisdiction’ was a barrier for initial entry into the healthcare profession by untrained persons. Objectives of the essay This essay is a review of the “A Nursing Specialization Framework for Nursing and Midwifery” in Australia. The essay addresses the following areas namely: a) The approach that was used by the NNNET commissioned team of Deakin University towards addressing the problem of nursing and midwifery specialization framework. b) Outcomes of the nursing and midwifery specialty as a result of recommendation by the commission referred to the National Nursing and Nursing Education Taskforce (NNNET) by the state, territory and commonwealth ministers. c) Strengths and weaknesses of the approach that was adopted by the Deakin University team towards development of specialization in nursing and impacts of the approach in specific specialties. Scope of work and approach employed by the commissioned team The NNNET commissioned team drawn from Deakin University was mandated to formulate and design a National Nursing and Midwifery specialization framework aimed at developing a consistent framework for categorizing specialties that would help in health workforce planning and policy development (National Nursing and Nursing Education Taskforce 2006, pp. 1-2). National Nursing and Nursing Education Taskforce (2006) indicated that the deakin University team employed a bottom down approach with respect to: a) Identification and formulation of criteria for recognizing National specialty (National Nursing and Nursing Education Taskforce 2006, pp.3). b) Application of the formulated criteria to areas of practice (National Nursing and Nursing Education Taskforce 2006, pp.4). c) Identification of required skill sets or skill domain (National Nursing and Nursing Education Taskforce 2006, pp.4). d) Identification of practice strands (National Nursing and Nursing Education Taskforce 2006, pp.4). The bottom down approach was used to identify components or elements that defined ‘…an area of practice’ according to Australian context. This was backed by literature review from national and international criteria for specialty assessment in nursing and midwifery and six sources were employed as basis for developing appropriate criteria for Australian context (National Nursing and Nursing Education Taskforce 2006, pp.2). The specialization framework elements used by the commissioned team were: a) Criteria for a recognized specialty b) Identification of areas of practice that satisfied the criteria c) Areas that had common skill groups but varied knowledge bases d) Areas of practice that failed to meet proposed full criteria for a national specialty (National Nursing and Nursing Education Taskforce 2006: pp.3-4). The six source criteria adopted by the commissioned team The six source criteria adopted associated national nursing and midwifery specialty as: First ‘…a specialty that is national in its geographic scope’ and called for mutual recognition through establishment of equivalence of educational preparation, competence and suitability to practice capacity to facilitate movement of nurses and midwives across jurisdictional boundaries with no or minimal impediments powers of regulatory authorities to determine their scopes of practice (National Nursing and Nursing Education Taskforce 2006, pp.2) Second “…the specialty defined itself and subscribed to the overall purpose, functions and ethical standards of nursing or midwifery” through development, adoption, reviewing and monitoring standards of education and nursing or midwifery practice (National Nursing and Nursing Education Taskforce 2006, pp.2). Third, “…the specialty is distinct and a defined area of nursing or midwifery practice which required application of specially focused knowledge and skill sets” that satisfy competency standards and other entry requirements for registration, enrolment or endorsement as a nurse or midwife who can provide safe, high-quality nursing and midwifery care to the community. Fourth, ‘…there is demand for and need for a specialty service from the community’ and that the community is confident that there are universal standards for professional practice that are designed to ensure competence, health and conduct protocols are followed to the letter in establishing fitness of nurses and midwives to practice (one; at initial level entry to nursing and midwifery practice; two, there is additional qualifications and practice privileges for nursing or midwifery; three, addressed transfer issues of nurses and midwives from one jurisdiction to another) Fifth, ‘…the specialty practice is based on a core body of nursing or midwifery knowledge, which is being continually expanded and refined’, the specialty ought to be backed up by competent education and research in the relevant areas of practice. On the same note, there should be registered institutions that qualify and satisfy standards for training nursing and midwifery specialists. Sixth, “…specialty expertise is gained through various combination of experience, formal and informal education programs including but not limited to continuing education and professional development’. This transforms into need for nurses to take part in promotional campaigns, educational forums, national meetings as well as information disseminations (National Nursing and Nursing Education Taskforce 2006, pp.7). Weaknesses of the approach adopted The weaknesses of the approach that was adopted by the NNNET commissioned team of Deakin University were: a) There were areas of specialty like sub-specialties and super-specialties that were not included in the workforce data collection that was used by the team (National Nursing and Nursing Education Taskforce 2006, pp.2-3). b) The deakin university team excluded areas of practice that seemed to have little or no association with the nursing or midwifery specialty like intellectual disability and developmental disabilities (National Nursing and Nursing Education Taskforce 2006, pp.3) yet they are in the domain of nursing and midwifery specialty. c) The deakin university team identified potential specialties that didn’t meet full criteria for a specialty as practice strands. The potential specialties were sub-sets of nursing and midwifery specialty and ought to have been given a consideration because the deakin university team factored and endorsed skill domains of practice strands to be shared among other specialties (National Nursing and Nursing Education Taskforce 2006, pp.3-4). d) The deakin university team evaluated qualification of a specialty depending on literature review and published competencies without looking into the Australian context (National Nursing and Nursing Education Taskforce 2006, pp.3). The strengths of the approach adopted The strengths of the approach adopted by the NNNET commissioned team were: a) First, inclusion of practice strands paved way for the positioning of specialization framework that was geared towards ensuring proper health planning was responsive to needs of the community. b) Second, the team proposed that practice strands that overtime satisfied full criteria for specialty were to share skill sets (National Nursing and Nursing Education Taskforce 2006, pp.4). For instance, upon satisfaction of specialty standards neonatology was supposed to share skill domain with maternity care with midwifery through associated knowledge bases and will then be practiced by nurses and midwives alike (National Nursing and Nursing Education Taskforce 2006, pp.4). c) Third, the deakin university team pointed out identification of skill sets that would add value to the specialization framework by bringing together specialties that have common and related skill sets (National Nursing and Nursing Education Taskforce 2006, pp.4). For instance, specialties of emergency care and critical care should share skill sets that include among others rapid patient assessment, rapid patient resuscitation and intervention and were therefore grouped under the skill domain of “time critical care” (National Nursing and Nursing Education Taskforce 2006, pp.4). d) The fourth strength of the approach adopted by the NNNET is based on cross border of specialties that share skill sets and knowledge for use in other specialties. For example, mental health care may cross boarder to maternity care to look into issues of women who have been diagnosed with postnatal depression. e) The fifth strength of the approach adopted by NNNET commissioned team is associated with provision of a link for constructive educational programs meant to create opportunities for re-designing and re-structuring parts of the program or courses ‘to encompass common skill sets with areas of specialization as elective components’ (National Nursing and Nursing Education Taskforce 2006, pp.4). Outcomes expected from the approach adopted The following are the possible outcomes for the specialization framework in nursing and midwifery. According to National Nursing and Nursing Education Taskforce (2006) the nursing and midwifery specialties will subscribe itself to overall purpose of delivering healthcare and abide by standards of ethics that govern operations of nursing and midwifery specialties. According to Nolan (2000) the nursing and midwifery specialties will have a Professional Portfolio in place. Nolan (2000) indicated that a professional portfolio is a reference folder that will allow nurses and midwives to gather evidence that they can use to demonstrate their goals, competencies, career achievements and accomplishments and experiences. Nolan (2000) suggested that a professional portfolio will be used as a record of ongoing professional development of either the nurses or the midwives. Nolan (2000) added that a professional portfolio could be used to ‘…provide evidence of the skills and abilities of nurses and midwives’. National Nursing and Nursing Education Taskforce (2006) suggested that Practice strands will have a room to develop into specialties if they will be able to satisfy full criteria for a specialty. Australian Health Ministers’ Conference (2004) indicated that the governments will ‘…establish and maintain effective arrangements to maximize efficiency of new and amended regulation and avoid unnecessary compliance costs and restrictions on competition’. Australian Health Ministers’ Conference (2004) suggested there will be more reforms ‘…to enhance regulatory consistency across jurisdictions or reduce duplication and overlap in regulation and in the role and operation of regulatory bodies’. There will be use of contemporary language to refer to and address different specialties that measures to the international standards. The responsiveness of the workforce management and planning will be increased due to inclusion of practice strands into the specialization framework. National Nursing and Nursing Education Taskforce (2006) indicated that it will be possible for certain skill sets to cross borders of specialty and be used in other specialties. In addition, Needleman and Buerhaus (2002) and Needleman and Buerhaus (2003) have all indicated that ‘…The portals of entry and the mobility and flexibility of the nursing and midwifery workforce across jurisdictions will be possible’. National Nursing and Nursing Education Taskforce (2006) added that the skill domain element of the specialization framework will facilitate ‘…structuring of educational programs by creating opportunities to develop and redesign parts of a program or course such that it takes into account common skill sets and leave out areas of socialization as elective options’. National Nursing and Nursing Education Taskforce (2006) suggested there will be withdrawal of terms that are not relevant in the today’s contemporary society, like use of the term disability. National Nursing and Nursing Education Taskforce (2006) pointed out that there will be improved focus for identifying specific skills that are required within a specific area of practice and this will improve efficiency as well as safety in the nursing and midwifery specialties. Australian Health Ministers’ Conference (2004) had suggested that with improved specialization framework for the nursing and midwifery specialties, registration of nurses and midwives will be based on ‘…uniform national standard’. Australian Health Ministers’ Conference (2004) added that education and training qualifications that are recognized by the national accreditation board will provide basis for national registration standards. Australian Health Ministers’ Conference (2004) proposed that ‘…any additional registration requirements should also be standardized nationally’. National Nursing and Nursing Education Taskforce (2006) indicated there will be a common understanding on definition and terms that constitute a specialty. National Nursing and Nursing Education Taskforce (2006) indicated that this achievement will make it possible for states and territories to collect data on common issues and make it easier for analysis to be carried out. National Nursing and Nursing Education Taskforce (2006) suggested there will be a framework for nursing and midwifery specialties and this will make it possible ‘…to plan and develop appropriate educational programs for the workforce’. National Nursing and Nursing Education Taskforce (2006) proposed that this will be able to put under control expansions of areas that used to be declared as specialties. National Nursing and Nursing Education Taskforce (2006) suggested there will be consolidation of different ‘specialties’ in order for them to conform to international standards. For instance, education, research, health education and health promotion, clinical research or disease education or disease management will all fall under one specialty, thus education and research. National Nursing and Nursing Education Taskforce (2006) suggested that there will be a Uniform processes for initial entry to nursing and midwifery practice, periodic renewal of license to the nursing and midwifery practice and also upon re-entry to practice of a nurse or midwife. National Nursing and Nursing Education Taskforce (2006) indicated that midwifery will no longer be considered as a sub-set of nursing. Nursing and midwifery will be distinct specialties but with shared skill sets. Critique to the approach adopted by the commissioned team Although the NNNET commissioned team provided a specialty framework on nursing and midwifery, there was no framework on specific skills that were proposed for a given area of practice (National Nursing and Nursing Education Taskforce 2006). The NNNET commissioned team of Deakin University therefore didn’t complete the task of developing specialty framework for nursing and midwifery. According to National Nursing and Nursing Education Taskforce (2006), the NNNET did not propose guidelines or methods for identifying skill domain deficit. At the same time, NNNET team did not propose measures for predicting skill set inadequacy in nursing and midwifery. The NNNET commissioned team did not address legislative issues concerning universal standards for professional nursing and midwifery practice. According to National Nursing and Nursing Education Taskforce (2006) the NNNET failed to address an assessment process that is appropriate to assess fitness of a nurse or midwife to return to practice nursing or midwifery after a period away from practice. At the same time the NNNET team did not propose appropriate methodology for return-to-work formula for such nurses or midwives like presence of tailored refresher and re-entry courses or periods of supervised practice to enable a return to a safe level of competence of the supposed nurse or midwife. The NNNET team did not provide guidelines for nursing or midwifery specialty Education and training qualifications that ought to be recognized by the national accreditation board and didn’t provide a way forward for the national registration standards. The NNNET team didn’t provide guidelines for examining mechanisms for safeguarding the community from mediocre nurses or midwives by providing standards for monitoring competence, conduct, health and suitability to practice of nurses and midwives at the checkpoints of: initial entry to practice; returning to practice after a period away from practice; renewal of the right to practice on a periodic basis; working in specific or specialized areas of practice. The NNNET did not provide a standard system for reporting, investigating and dealing with issues of professional conduct, professional performance and the ability to practice of nurses and midwives and did not highlight mechanisms for making the public and employers to readily identify nurses and midwives who are registered or enrolled. The impacts of the NNNET commissioned team on development of specialization in nursing and midwifery include development of common language that measures to international standards of nursing and midwifery, a step that will lead into removal of common terms that are used in Australian nursing and midwifery like disability, and gradual development of professional development courses for instance courses offered by renal society of Australasian and Australasian urological nurses society Inc., increase in employment based education programs (National Nursing and Nursing Education Taskforce, 2006:7). There will also be an increase in nurse enrolment in courses and programs that are aligned with areas of practice that have specialty status (National Nursing and Nursing Education Taskforce, 2006:8). There will also be improved assessment, analysis and efficient planning for health care for patients suffering from renal dysfunction (National Nursing and Nursing Education Taskforce, 2006:7-8). At the same time, nurses in general practice nursing will be required to identify or be identified with areas of specialization required for a particular general practice setting. The general nurses will also be required to take up professional courses in areas of general practice that have les available skills are not sufficient. General practice Nurses and midwives will be required to register to serve in their states or territories according to legislations that are applicable in the states or territories. Nurses in general practice nursing, renal care and rural and remote nursing will be required to practice in a specialized area of nursing (National Nursing and Nursing Education Taskforce 2006, pp. 8-12). There is likely increase in number of nurses and midwifes opting for continuing education and professional development by seeking scholarships through ‘the Australian rural and remote health professional scholarship scheme (ARRHPSS) that supports qualified allied health professionals. There is also a corresponding number for on-the-job training and postgraduate courses at universities of Monash that offers bachelor of rural health practice which is a double degree with bachelor of nursing (National Nursing and Nursing Education Taskforce, 2006:10). Conclusion In conclusion, the NNNET commissioned team provided a viable solution to issues related to nursing and midwifery specialty practice in Australia by developing a nursing and midwifery specialization framework. The NNNET recommendation lead into establishment of fourteen specialty areas that are: critical care, community health, education and research, emergency care, family health, health care planning and management, mental health, midwifery, neurological care, oncology care, pediatric care, perioperative care and renal care. The team also proposed skill domains that are associated with skill set sharing as primary care for both family health and community health specialties, maternity are for the midwifery specialty, care of the older person for the gerontic health specialty, mental health care for the mental health specialty, time critical care for both emergency and critical care specialties, acute and supportive care for renal care, neurological care and oncology care specialties, perioperative care for the perioperative specialty, pediatric care for the pediatric care specialty, resource management for the healthcare planning and management specialty and knowledge acquisition and dissemination for education and research specialty (National Nursing and Nursing Education Taskforce, 2006:5-6). The team also developed a framework for naming specialties and areas of practice following merging and removal of some areas of practice that did not conform with international standards of nursing and midwifery. The naming of a specialty is based on how the specialty is described in terms of body systems, disease, service or setting and therapy or interventions that are applied (National Nursing and Nursing Education Taskforce, 2006:1). This helped to address conflict of interest that had been brought about by lack of national agreement on what constitutes a specialty and created a framework for specialties hence paving the way forward for future workforce planning and development and development of appropriate educational programs for the nursing and midwifery workforce. The NNNET commissioned team developed criteria for national nursing and midwifery specialty Bibliography Australian Council for Safety and Quality In Healthcare (2002). “Lessons from the inquiry into obstetrics and gynecological services at King Edward Memorial Hospital” 1990-2000. Australian Council for Safety and Quality in Healthcare (2004). “Standards for credentialing and defining the scope of clinical practice: a national standard for credentialing and defining the scope of clinical practice and medical practitioners for use in public and private hospitals”. Australian Health Ministers Council (2004). “National health workforce strategic framework”. Sydney, Australian health ministers’ conference. Australian nursing and midwifery council (2004). “strategic plan 2004-2007”. Department Of Human Services Victoria (2003). “Hospital Admission Risk Program (HARP)”: technology working party report. Melbourne. Department Of Human Services Victoria (2003). “Regulation of health profession in Victoria: a discussion paper”, Melbourne, policy and strategic projects division, Victorian government. Department of human services. National Nursing and Nursing Education Taskforce. (2006, May). A national Specialisation Framework for Nursing and Midwifery: Defining and Identifying Specialty Areas of Practice in Australia. pp.1-13. Needleman, J. and P. Buerhaus (2002). “Nurse- staffing levels and the quality of care in hospitals”. New England journal of medicine. 346: 1715-1722. Needleman, J. and P. Buerhaus (2003). “Nurse staffing and patient safety: current knowledge and implication for action”. international journal for quality in healthcare 15(4) : 257-277. Nolan (2000) “The Professional Nurse Portfolio: School of Nursing”. Florida Gulf Coast University: http://ruby.fgcu.edu/courses/anolan/portfolios/profportfolio.html Read More