Applicability of the Accountancy Disciplines

to Nursing

WTO Workshop on Domestic Regulation

Geneva, 30 March 2004

Nursing is a good test of the Nursing is a good test of the general applicability of the general applicability of the

disciplinesdisciplines

Complex Varying models/degrees of regulation Good support within the profession International tools Highly mobile

ICN:ICN:

• Established in 1899, to promote high standards of nursing practice and education globally

• First and widest reaching international organisation for health professionals

• Speaks international for roughly 12 million nurses

• ICN works to ensure quality nursing care for all, sound health policies globally, and the advancement of nursing

Nurses are on the move to pursue education, a better job, to escape a local situation, to send money home, to experience a new culture, etc.

They want to move with ease and be treated equally with others

Interest in regulatory frameworks is high

MRAs are popular e.g. EU, NAFTA, Trans Tasmania,

Caribbean, ECSA

ICN’s contributions to regulationICN’s contributions to regulation

• Code of Ethics for Nurses• Regulation Framework• Standards and guidelines (practice,

education, research)• Competencies (generalist nurse,

nurse practitioner, telenursing)• Framework for standards

development

ICN’s contributions to regulationICN’s contributions to regulation

• Ethical recruitment

• Policies on definition, scope, protection of title

• Credentialing Framework

• C/E Accreditation Guidelines

• National Licensure Database

Governance must provide:Governance must provide:

• High standards for personal/professional growth and performance;

• Public sanction;• Participation of the profession in

public policy;• Accountability to the public and• Proper recognition and

remuneration

According to ICN, regulation should:According to ICN, regulation should:

• Be designed to achieve the stated purpose

• Have standards based upon clear definitions of professional scope and accountability

• Promote the fullest development of the profession commensurate with its potential social contribution

• Recognise and incorporate the legitimate roles and responsibilities of interested parties in standard-setting and administration

According to ICN, regulation should:According to ICN, regulation should:

• Acknowledge and balance interdependent interests

• Provide and be limited to those controls and restrictions necessary to achieve their objectives

• Be sufficiently broad and flexible to achieve their objectives and permit freedom for innovation, growth, and change

• Operate in the most efficient manner, ensuring coherence and co-ordination among their parts

According to ICN, regulation should:According to ICN, regulation should:

• Promote universal standards of performance and foster professional identity and mobility to the fullest extent compatible with local needs and circumstances

• Provide honest and just treatment for those parties regulated

• Recognise the equality and interdependence of professions

Concerns relate to:Concerns relate to:1. Interpretation of terms1. Interpretation of terms

How are these to be interpreted What will be the impact? What constitutes quality service? Who

decides? Are there other criteria that need to be

in place? What will be the impact on care?

Concerns relate to:Concerns relate to:2. The necessity test2. The necessity test

What constitutes “not more trade restrictive than necessary”?

Regulators worry about loss of autonomy

Might a system that is not culturally appropriate be imposed?

Concerns relate to:Concerns relate to:3. Fear that 3. Fear that standards will standards will

be loweredbe lowered

Standards have already fallen

Private education institutions, hospitals, and nursing homes

Concerns relate to:Concerns relate to:

4. Loss of control4. Loss of control

5. Impact of changes 5. Impact of changes arising from dispute arising from dispute resolutionresolution

Other issues:Other issues:

1. Transparency – difficult for poorer countries

2. Qualification requirements – what it means

3. Poor countries/those with under-developed systems

4. Need to communication

Regulation, which assures the public that nurses are

competent to provide care and advice, is key.

The nursing profession is interested in sound, transparent national regulatory systems and

global standards, which are responsive to the evolution of

nursing and patient care.

It is important that governments undertake to support the

strengthening of regulatory systems where they are weak or

lacking.

ICN advocates an approach sufficiently broad and flexible to permit freedom for innovation, growth, and change; facilitating

sound regulatory process principles that aim to protect the

public and provide for just treatment of those regulated.