NZNO's complaint against nursing council heard.

NZNO wants a single title and a single scope of practice for second-level nurses. In a complaint to Parliament's Regulations Review Committee (RRC), filed last December and heard early this month, NZNO asked the RRC to direct the Council to rescind its 2004 decision, reconfirmed in 2006, to introduce a new title, nurse assistant (NA), and scope of practice for second-level nurses trained after 2000. This decision was "discriminatory " and had caused confusion in the health sector, NZNO stated.

NZNO wanted all second-level nurses to practise under the same title and scope of practice, as two scopes and titles for second-level nurses had created confusion among the public, employers, providers and nurses themselves, NZNO chief executive Geoff Annals told the RRC in an oral submission presented early this month.

Nurse assistant was "alarmingly similar" to existing names for unregulated health workers and implied the title holder was not a nurse regulated by the Nursing Council, but an assistant to a nurse and thus was misleading.

New Zealand's second-level nursing workforce was in decline, resulting in the inappropriate substitution of second-level nurses with unregulated workers. "This places those workers, their nurse colleagues, service providers and the public at unreasonable risk. That risk is unnecessary and was created by the Nursing Council's decision," Annals told the committee.

NZNO's central problem, giving rise to its complaint, was "serious concern for the quality, effectiveness and safety of nursing services".

'Sector has not accepted NA title'

Annals also rebutted the Nursing Council's claim in its written response to NZNO's complaint, that the title NA was now established and accepted as the title for the second-level nurse. "This statement is simply wrong. The sector had not accepted the title."

Responding to questions from RRC members, head of nursing at Christchurch Polytechnic Institute of Technology (CPIT) Cathy Andrew said their research had shown the change from EN to NA had been a major factor in the decline in numbers doing the course, which peaked at 48 in the first year, 2003, and this year was 23.

Lynette King, who began her EN training before the title change, told the RRC the title change undervalued all who had done the training. "We had an expectation of becoming ENs. The Nursing Council had approved the course and we received EN badges, which we are now not allowed to wear." Some on her course had student loans of up to $20,000 and were now back on the benefit as there were no jobs for NAs.

Manager of an aged-care facility in Auckland, Jan Featherston, said there was a public perception that an NA was not a qualified and accountable nurse.

In a written statement to the RRC, director of nursing and midwifery at Northland District Health Board, Denise Brewster-Webb, said the community at large had a limited understanding of regulation and its purpose but if they did truly understand the concept, they would want qualified and accountable staff providing care.

Having two titles and two scopes of practice for second-Level nurses added more complexity to registered nurses' decision making around delegation and supervision of these groups, she said. Responding to NZNO's oral submission, Nursing Council chief executive Marion Clark provided some historical background to the current situation and said after its rounds of consultation and vigorous debate, the Council decided to "ring fence" the old EN title and introduce the NA title for newly trained second-level nurses. This was because the public did not understand what ENs did, there had been important public safety issues around some ENs' practice and the NA title reflected what NAs did. All registered nurses had also undergone a title change, with the introduction of scopes of practice, as required under the Health Practitioners Competence Assurance (HPCA) Act.

Responding to the Nursing Council, RRC chair, National MP Richard Worth said he felt the EN title hinted at training and a qualification while the NA title didn't do that at all.

In his response to the Council's oral submission, Annals rebutted the public safety concerns and said in a number of high profile Health and Disability Commissioner cases the primary problems were not with the practice of ENs; and the change in title for RNs did not diminish their status, as the change in title had for NAs. At the end of the hearing, Worth said the RRC had three options: to dismiss the complaint; to recommend to the House to grant what NZNO was seeking; or to recommend to the Minister [of Health] to intervene to deal with the issue. Both NZNO and the Council had one week to provide further written information to the RRC, arising from the oral hearing.

Speaking after the hearing, Annals said it had been valuable to appear before the committee and to have the support of nursing leaders in education, aged-care and the public and private sectors. "It was also very important to have Lynette King there to share her feelings and experiences because you can't rebut those."

NZNO's written complaint outlined the background leading up to the Council's decision. It contends the Nursing Council misinterpreted the result of its first round of consultation, in which 50 percent of submissions favoured retaining the EN title. NZNO's written complaint to the committee was based on a number of grounds including that the Council's decision was not in accordance with the general objects and intentions of the HPCA Act under which it was made.

NZNO stated the Council's decision was arbitrary and there was no rationale for it. NZNO's complaint expressed a number of arguments under each of the specific grounds.

* The Nursing Council has approved an NA course at Southland Institute of Technology and Marion Clark told the RRC she expected another three or four courses to come before the Council for approval. Head of nursing at CPIT Cathy Andrew said the school has developed a perioperative NA course in response to industry demand. Manukau Institute of Technology was also interested in offering the course.

Enrolled nurses' desire for education was evidenced at two recent study days, one in Wellington and one in Christchurch, each attended by hundreds of ENs. Full report next month.