Election planning for the next Nursing Council in 2009: the Minister of Health was expected to announce a new Nursing Council as this magazine went to press. How will it function and is it time to revise the appointment process for its members?

The appointment of the first Nursing Council tasked with functioning under the Health Practitioners Competence Assurance (HPCA) Act 20031 was imminent as this journal went to press. It is therefore timely to reflect on the Council's role and function as the newly appointed members come together with those continuing their term. The new Council will shape and oversee its process and direction(s) for the next three years. A new chairperson will be elected, following the departure of Annette Huntington.

The recent Council forums in Auckland, Wellington and Christchurch served as reminders of the statutory role the Council plays alongside the other 14 health professional groups under the HPCA. There are 13 "Functions of authorities" outlined in Section 118 of the Act. The Council's mandate is to protect public safety, by:

* maintaining a nursing register of practising nurses--a public document;

* issuing annual practising certificates only to nurses who have maintained their competence to continue practising nursing;

* monitoring the training of nursing students and new nurses to ensure their nursing education is appropriate;

* requiring nurses to continue their nursing education once they enter the workforce;

* carrying out competence assessments of nurses in response to a concern expressed by a patient, colleague or any other person;

* requiring a nurse to receive treatment if s/he is suffering from an illness that is affecting her or his practice; and

* having the authority to suspend a nurse's practice.

These controlling functions seem reasonable and sensible for the safety of patients and the public. All health professionals registered with the 15 authorities are under the disciplinary jurisdiction of the Health Practitioners' Disciplinary Tribunal. The HPCA Act was drafted to ensure objective and transparent disciplinary processes, giving the public confidence that high standards of practice would be provided by health professionals.

New Zealand in 1901 was the first country in the world to register its nurses with the passing of the Nurses' Registration Act. At that time, the statutory role of the Registrar was assigned to the Inspector-General of Hospitals--medical practitioner Duncan MacGregor. Essentially, this meant the governance of nurses was in the hands of one person. (2) It wasn't until 1926 that statutory regulation of nursing was shifted to a board of health professionals, with a nurse being designated as Registrar. The Registration Board consisted of the Director-General of Health, the Director of the Division of Nursing in the Department of Health, a registered medical practitioner who was appointed on the recommendation of the Minister of Health, and a registered nurse and a registered midwife, both appointed on the "recommendation of the New Zealand Trained Nurses' Association, or other association or society approved by the Minister for the purpose". (2) From 1926 until the establishment of the Council in 1971, the Registrar was always the Director, Division of Nursing.

Membership of Nurses' Registration Board

The 1925 Act designated the Director-General of Health as Chairman of the Nurses' Registration Board (in his absence, any registered medical practitioner who was an officer of the Department could deputise as chair). The Nurses' and Midwives' Act 1945 increased membership of the board with the addition of more nominees from the nurses' association. This structure continued until 1971 when the Nursing Council was established.

The Nurses Act 1971 established the Council as the statutory body, tasked to "provide for the registration and control of nurses". (2) The Act required the Council chair to be elected. The Council's first appointed Registrar was a layperson. Whether the Registrar should have been a nurse or layperson was debated by the Council and the profession over the following decades. (2)

The current Registrar (deemed chief executive officer) is Marion Clark, who has held the position since 1998. The outgoing Council, under the HPCA Act, has delegated a raft of duties to Clark, who then further delegates the operational aspects to Council staff members. The 1999 Health Occupational Registration Acts Amendment Bill took away the right of the nursing profession, through NZNO, to nominate five members to the Council.

It is noteworthy that the new Council members wilt all be appointed by the Minister of Health, following a call for nominations. Despite the intention of the HPCA Act to increase accountabilities by bringing the 15 health authorities into the public arena, nursing remains beholden to the Minister to appoint "its" members. This is in contrast to both the medical and dental health authorities who elect their members and have high expectations that these same members will be appointed by the Minister. It seems that nursing, from 1901 onwards, has been content to accept externally sanctioned representation and, by implication, professional standards and accountabilities, at least where its governance is concerned.

Despite the shifting focuses of nursing over the past 102 years, and the development of management theory where empowerment and participation are usually recognised as strengthening accountabilities, the Council retains the top-down approach to governance, in principle, as established in 1901. However, there is a ray of hope: in passing the HPCA Act, Parliament made it clear that a new, participative approach is possible. Election of representatives on council(s) is described under Section 120 (4): "Regulations made under this Act may provide that one or more health practitioners appointed, under subsection (1), as members of an authority must be practitioners who have been elected in an election conducted by the authority in accordance with those regulations." (1) This means that nurses could elect practitioners to the Nursing Council as doctors and dentists do. What it would mean is that there is a direct line of accountability to the regulated nursing workforce which, in turn, would invite engagement and dialogue.

There seems to be a solid case for arguing that 21st century nursing governance should be accountable to nurses, rather than to a benign "colonial" structure that may have been appropriate in the days of "King Dick" Seddon.

References

1) Health Practitioners' Competence Assurance Act (2003) Wellington: New Zealand Government.

2) Wood, P.J. & Papps, E. (2001) Safety to practise: Reflections of chairpersons of the Nursing Council of New Zealand 1971-2001. Wellington: Author.

3) Nurses' and Midwives' Registration Act (1925) Section 4. Wellington: New Zealand Government.

By professional nursing adviser Anne Brinkman