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Subspecialisation--is it good for nursing? A recent international nursing forum discussed the future of nursing specialisation and the increasing demand from nurses for accreditation of subspecialties.

Subspecialisation in nursing was a key issue at the sixth International Council of Nurses' (ICN) Credentialing Forum held in Copenhagen, Denmark, last November. NZNO president Marion Guy and I attended, along with Nursing Council chief executive Marion Clark. In total, 22 national nursing association and regulatory body representatives from Denmark, England, Ireland, Canada, the United States (US), Australia and Taiwan attended. Representatives from Spain, Jamaica and Japan were unable to attend.

This forum was established by ICN in 2001 to:

* serve as a vehicle for countries with dynamic credentialing programmes to communicate, consult and collaborate with one another on trends, problems and solutions;

* promote and enable nursing's rote at the forefront of health care and professional credentialing and quality assurance; and

* advise ICN on developments and needs in the field of regulation, credentialing and quality assurance.

Despite its relatively smart size, New Zealand has a wealth of experience in credentialing through NZNO's certification and accreditation processes, employer professional development and recognition programmes and the Nursing Council's registration processes. New Zealand is an international leader in credentialing and our experience contributed positively to discussion on credentialing frameworks, mechanisms, identification of issues and the range of possible solutions. Our position statement on nurse credentialing articulates NZNO's policy on credentialing definitions, frameworks, research, systems and remuneration. (1)

The agenda structure for the 2006 forum differed from previous years, in that it focused on two key issues: care assistants and their regulation; and subspecialisation in nursing. Most of a day was spent on each topic. Other agenda items including emerging issues in credentialing, the impact of globalisation and mutual recognition agreements, increasing government control over health professional regulation and the respective rotes of both the regulator and the professional association in credentialing were covered in the first day and formed the backdrop and context to this discussion.

In this professional focus, I want to provoke thought and hopefully spark a debate on the issue of subspecialisation. Credentialing of unregulated caregivers will be covered in a future professional focus.

Key questions are emerging in the international debate on subspecialisation. Interestingly, NZNO has been pushing to have this topic on the agenda for more than three years. The increasing demand on NZNO for subspecialty credentialing (accreditation) began to come to the fore a number of years ago. The resource implications for NZNO in establishing and maintaining credentialing systems and the non-viability of smart subspecialty education programmes immediately became apparent, because of the relatively small critical mass of nurses in New Zealand. It is only in the last year or so that larger countries have recognised nurses' almost insatiable demand for more subspecialisation, and mechanisms to validate expertise in subspecialties is a key credentialing issue. The national nursing associations of England, the US and Canada are those with the most experience of the accreditation of subspecialties but they are realising they cannot continue to agree to increasing subspecialisation.

Key questions

Key questions arising internationally are:

* What should nursing specialisation look like in the future?

* How should specialists be named?

* What systems are needed to support the development and sustainability of nursing specialties?

* Does education for specialty practice belong at the post basic or postgraduate level?

* How does the trend towards multidisciplinary teams affect specialisation?

* What is the connection between specialisation and continuing competence?

* Is specialisation fragmenting the profession or helping it develop?

* If nurses specialise, who will do basic nursing care?

* Are generalist nurses really specialists? What rote should experience and education play in specialisation?

* Does specialty credentialing make a difference to patient outcomes?

* How should nursing specialists be regulated?

* Can we afford an increasing number of subspecialities within nursing in New Zealand?

Considered debate needed

These are important questions for the profession. They are important for NZNO too; for its structures, particularly corteges and sections and their accreditation processes. The questions require considered debate, taking into account the social contract nursing has with society, the capacity of education and of credentialing bodies in the tight of the nursing population, and the way in which services and nursing practice are being reconfigured by government policy. An example of this reconfiguration is the impact of the primary health care strategy on traditional rotes of primary health care nurses, as the strategy is rotted out and funding silos change. It is a debate which needs time before a view on what nursing specialisation should took like in the future can be determined, as the issues are very complex.

Many nurses hold dear to the subspecialty niche they have carved out within health and are rightly proud of their expertise. That should not stop them from looking at the broader issues of the impact of subspecialisation on nursing as a whole and what services will best meet population and personal health needs.

It is timely to have this debate and I trust you will contribute through letters to the editor and articles for Kai Tiaki Nursing New Zealand.

By NZNO professional nursing adviser Susanne Trim
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Article Details
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Author:Trim, Susanne
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Conference news
Geographic Code:4EUDE
Date:Feb 1, 2007
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