Public safety or patch protection? The health sector as a whole needs to determine whether regulation of new health professionals is safe and enabling or simply an expensive barrier to innovation.
Subject: Public health administration (Analysis)
Nursing services (Laws, regulations and rules)
Nursing services (Recruiting)
Nursing services (Innovations)
Author: Head, Marilyn
Pub Date: 08/01/2011
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2011 Source Volume: 17 Source Issue: 7
Topic: Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 280 Personnel administration Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation; Industry hiring
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 266344849
Full Text: With the imminent regulation of anaesthetic technicians (and Chinese medicine practitioners and paramedics waiting in the wings), it is perhaps timely to consider the wider implications of introducing new health professions to regulation under the Health Practitioners Competence Assurance (HPCA) Act (2003).

Balancing the interests of public safety--assurance health professionals are fit and competent to practise--against the expense of supporting robust registration and recertification processes is difficult, particularly in the current context of fiscal constraint. Add differing professional perspectives, traditional hierarchies, and the exigencies of a health "market" responding variously to the potential of new technologies and models of care, and it is easy to see why regulation of a new profession can be a fraught process.

It has been a long wait for anaesthetic technicians (ATs) whose regulation was mooted several years ago, but who struggled to find the right authority to be responsible for a role which straddled medical, technology and nursing disciplines. The Medical Science Laboratory Board, soon to morph into the Medical Science Council, however, took up the challenge. In anticipation of Cabinet approval, it has fast-tracked consultation on two new scopes of practice, in order to have a registration framework in place by October 1, 2011.

The speed does not stop there. The board proposes a mere six months for those currently working in the profession to transition to the registered role. NZNO welcomes the regulation of ATs and was pleased to see transition arrangements and ongoing certification of registered nurses (RNs) and enrolled nurses (ENs) who work in the AT rote. However, the unnecessarily short timeframe risks the profession, at its inception, of losing skilled staff, who may have taken time off for parental leave or overseas travel.

Of more concern, however, are the less stringent requirements for overseas-qualified operating department practitioners (ODPs). Compared with requirements for locally-trained nurses, ODPs are neither educated in Aotearoa New Zealand, nor covered under the HPCA Act. To be registered, an RN must "demonstrate he/ she has practised anaesthetic technology either exclusively during the five-year period, or for a minimum of 4800 hours in the five-year period (ie 20 hours per week,)" while ODPs, trained in the United Kingdom, are only required to do 3600 hours. The ODP rote is broader than the AT role as it stands (as is the RN expanded scope), but it has been developed in a different workforce and health context. NZNO submitted it is not safe, nor appropriate, to have an easier registration pathway for overseas-trained practitioners when there are clear differences in competency and practice requirements and experience. The scope of practice determines not only what a health practitioner may do, but what they may not do; nurses, who have experienced the negative consequences of confusion over regulated roles, understand the need for caution when creating a narrower scope for regulated health professionals than for those who are unregulated.

Since the AT rote is within the new RN expanded scope of practice, NZNO did not support the dual registration for RNs, because of duplication. It could also lead to the same problems that emerged over the RN first surgical assist rote, before the new RN expanded scope was clarified. Nor did NZNO support the registration of the advanced trainee technician scope of practice, since a trainee is, by definition, not qualified to practise. The only exception would be for students who already have a registered scope of practice such as an RN or EN.

These are grey areas, where the full implications and impact of regulation may not be realised before implementation in the workplace, but they are the details that determine whether health workforce regulation is an expensive barrier to innovation, or safe and enabling. To appreciate the difference, and avoid unintended consequences affecting patient safety, employment, professional development and responsibility, wide consultation is necessary. This is particularly so with professions where there is a potential for confusion in the context of clinical care delivery.

Collaboration with nursing needed

It was disappointing, therefore, there was no representative nursing input in the development of the AT scope of practice, as there is the potential for advanced AT activity to move into nurses' scrub and circulating roles. Robust consultation and collaboration with the nursing profession, and others, would have clarified the interface between these two professions and resulted in more appropriate training, education and qualification parameters for ATs, which would assure public safety and minimise cost and administrative barriers.

Interdisciplinary communication and collaboration would also be useful in education and training. The AT proposal refers to "postgraduate" qualifications, though currently all AT education is at an undergraduate level NZNO would welcome opportunities for nurses in postgraduate education in anaesthesia. This is available in other countries, supporting nurse anaesthetists, a scope the board evidently has not considered. (Indeed, Health Workforce New Zealand's Anaesthesia Workforce Service Review specifically eschewed nurse anaesthetists though, as far as we know, no nursing body was consulted.) Shared educational opportunities at graduate and postgraduate levels is not only a cost effective means of ensuring consistent professional standards and skills, it is a sound basis for effective collaboration in multidisciplinary teams.

The HPCA Act offers a robust and enabling framework for the health professions, but it is only that. Achieving the right balance between costs and public safety, and between a restricted or enabled workforce, requires the combined energy and input of the whole sector: professions, employers and regulators.

By policy analyst Marilyn Head
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