Arousing passions among sister organisations.

The current hot topic among some other nursing organisations in New Zealand is not fair pay or safe staffing but the serious threat NZNO is said to pose to nursing, by supporting retention of the title "enrolled nurse" (EN).

NZNO has consistently supported maintaining and strengthening the role of ENs against long-standing attempts to remove them from the professional landscape. NZNO values the EN training programmes because they are an important entry point to nursing for many, and because the care provided by ENs is an essential component of a fully developed professional nursing workforce.

When the Nursing Council released its new scope of practice for ENs and nurse assistants (NA), NZNO welcomed its recognition of the importance of a second-level nurse. But NZNO had to address the particular problem of the decision to give graduates of the post-2001 EN programmes the title NA.

There is considerable support for NZNO's concern that this title is too readily confused with titles commonly applied to unregulated health workers. As is the way of an effective and professional organisation, NZNO has explored every avenue for advancing our position. We will continue to do so.

Distress among sister organisations

However, it is in advancing this position that we have engaged the passions and caused distress among some of our sister nursing organisations. They say that by challenging one aspect of the Nursing Council's scopes of practice we are jeopardising the entire nursing scopes' framework and placing the very authority of the Nursing Council at risk of being "overturned by doctors and politicians".

It is disappointing that passions have been enlivened, not by the merits or otherwise of our advocacy for the EN role, but by the precept that debate should not be had. It is demanded of us that we be silent on matters we consider of great importance to nursing and the public, for the good of the profession.

NZNO will not be silenced. We have no wish to antagonise sister organisations but we are bound to advance those things we consider vital to our profession. NZNO values its relations with sister organisations, but our concern for what is right must always take precedence over our concern to maintain congenial relations.

Construction of the profession

In reflecting upon the response of some nursing organisations to our advocacy of this issue, I find myself perplexed by the construction of the profession those organisations apparently hold. Is our profession a fragile collection of weak minded nurses, dependent on the direction and protection of a few "leaders" who determine what we think, do and aspire to be? Or are we a collection of strong minded, well educated practitioners, demanding to be free to exercise our own professional judgement in the pursuit of what is best for our clients?

Should nursing preoccupy itself with constructing and maintaining defences against perceived more powerful enemies and with building alliances to shore up our weakness? Or should we expect the respect and authority we are due, by virtue of our contributions to society?

The actions of those who would bid us be silent for fear we will unleash the might of enemy professions who will cast us down, affirm a view I firmly reject. The hundreds of nurses I have worked alongside and admired over the past 20 years or so are capable, confident, in dependent practitioners who would reject that view as surely as I do.

Alongside this fear of defeat by greater powers, comes an insidious professional self-doubt. A weak profession populated with inept practitioners surely would rely on its few accidentally able practitioners to specify what "the profession" may think, say and do. Control of dissident opinion and tactics of oppression and intimidation would be the features of such a profession. Surely this is not what I am observing when I hear NZNO's support for retaining the EN title described as a display of "self interest", "jeopardising all nurses" and risking "disaster" for us all?

I have no problem with the fact that some nurses disagree with NZNO's position in support of ENs. Let's continue to examine our differing views. What I do find of concern is the notion that nurses should not engage in professional discourse with rigour and candour. Inherent in the call for NZNO to be silent and the cry for the profession to rally to the side of the Nursing Council, is the assumption that the authority of Nursing Council to regulate nursing is in grave danger of collapse. Why some would make this assumption, I do not know. The fact is the Nursing Council is in no danger of failing and is fully able to speak and act for itself. Nursing Council has proven ability to exercise its legitimate, statutory authority to regulate nursing. NZNO recognises and respects that authority and holds no fears that our challenge on one point will precipitate its collapse.

Importance of ENs

It is perhaps ironic that lost in the clamour for silence is the fact that, on the matter of the importance of ENs in the profession, NZNO stands more closely with the Nursing Council than many of our sister organisations. In its scopes of practice, the Nursing Council has continued to recognise the importance of the second-level nurse in the profession, when some have argued nursing care should be provided only by degree-prepared registered nurses. Now there is a debate!