Applicability of the Accountancy Disciplines to Nursing WTO Workshop on Domestic Regulation Geneva, 30 March 2004

Nursing is a good test of the general applicability of the disciplines  Complex  Varying models/degrees of regulation  Good support within the profession  International tools  Highly mobile

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 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 regulation Ethical recruitment Policies on definition, scope, protection of title Credentialing Framework C/E Accreditation Guidelines National Licensure Database

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: 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: 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: 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: 1. 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: 2. 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: 3. Fear that standards will be lowered Standards have already fallen Private education institutions, hospitals, and nursing homes

Concerns relate to: 4. Loss of control 5. Impact of changes arising from dispute resolution

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.