19 September 2012 Submission on English language internationally qualified nurses requirements for I To the Health Select Committee This submission is from: The PO Box 9644 WELLINGTON We wish to appear. Contact: Carolyn Reed Chief Executive Officer/Registrar Carolyn@nursingcouncil.org.nz 048020231 Pam Doole Director of Strategic Policy Pam@nursingcouncil.org.nz 048020232 Ana Shanks Registration Manager Ana@nursingcouncil.orq.nz 048020242
2 Submission of the on the English language requirements for internationally qualified nurses 1. Background 1.1 The Nursing Council of the New Zealand ("NCNZ") is the responsible authority under the Health Practitioners Competence Assurance Act (2003) ("Act") for ensuring that the health and safety of the public is protected by ensuring that nurses are competent and fit to practice. 1.2 The Nursing Council regulates 50,000 nurses with practising certificates by setting standards for education programmes, registration, continuing competence and setting standards of clinical competence, cultural competence and ethical conduct. 1.3 The Council is responsible for ensuring that all applicants entering the register meet fitness to practice requirements including the ability to communicate in and comprehend English sufficiently to protect the health and safety of the public. 1.4 The Nursing Council therefore has a strong interest in the English language requirements for Internationally Oualified Nurses ("IONs") applying for registration in New Zealand. 1.5 IONs currently make up 24% of the nursing workforce in New Zealand and the country of origin has changed in the last five years from predominately English speaking countries such as the United Kingdom to the Philippines and India. 1.6 This change of country of origin has resulted in increased complexity in assessing IONs, not least the ability to communicate effectively to ensure public safety is protected. This is expanded on further in this submission. 1.7 In a recent independent audit of the NCNZ the Council for Health Care Regulatory Excellence ("CHRE") stated: "regulation has a vital role to play in ensuring the quality of the workforce and thus patient safety. But good patient care also depends on a supply of competent professionals and regulation inevitably affects supply. It is important that regulators are able to remain independently focused on patient safety and the competence of health professionals must not compromise quality to support workforce needs". (CHRE report to NCNZ July 2012). 2. Current English language requirements 2.1 The Nursing Council implemented the current policy of requiring seven in all bands of IEL TS (not required to achieve in one sitting but within twelve months of initial test) or a B pass in all bands of the OET (not required to achieve in one sitting but within twelve months of initial test) in June 2008. 2.2 All IONs are required to provide evidence of passing the test regardless of country of origin. 2.3 The Council considers individual requests from applicants to waiver the English language requirement.
3 2.4 The Council has not received any complaints/notifications since the implementation of the English language policy in regard to a nurse's inability to communicate. 2.5 The Nursing Council has recently (May 2012) consulted again on the English language requirements for IONs applying for registration in New Zealand and the Council has yet to consider the results of the submissions and implications for policy changes. 2.6 The submissions supported applicants achieving the required scores in one sitting, however the Council staff are aware of this Select Committee interest in English language requirements and of research currently being conducted in Australia and therefore believe it may be inappropriate to change the current English language requirements. 2.7 Council staff are also of the opinion that there is little research evidence to support that the test is less rigorous or valid if "clubbing" of results is allowed. 3. Trans Tasman Mutual Recognition (TTMR) Act 1997 3.1 The Australian Health Practitioners Regulatory Authority ("AHPRA") requires ION's except from: Australia; Canada, Ireland, South Africa, United kingdom and the United States of America to achieve the same standards as New Zealand but in one sitting. 3.2 This has led to a small number of IONs registering in New Zealand under less stringent English language requirements and then automatically seek registration in Australia where they then practise. Conversely a small number of IONs from the exemption countries identified register in Australia without having to complete an English language test and seek automatic registration in New Zealand where they then practise. 4. Complexity of assessing English language 4.1 Assessing communication in terms of fitness for registration as required by the Act is complex and language testing is only one component. 4.2 Increasingly IONs applying for registration in New Zealand come from countries that do not have a similar education, health care system and registered nurse role. 4.3 Communicating effectively includes communication skills that enhance therapeutic relationships, communicating effectively (and assertively) in a multidisciplinary team, effectively communicating empathy, advocating effectively for health consumers and respecting the individual rights of the health consumer. 4.4 Sound communication skills are a core component of safe practice. 4.5 Health practitioners are meeting health consumers when they are at their most vulnerable and the responsibility to communicate effectively must lie with the health practitioner.
4 4.6 Many health consumers have additional barriers to communication such as hearing impairment, sight impairment and reduced cognitive capacity brought on by a medical condition and/or the effects of pain and medication. 5. Barriers to Pacific Island nurses 5.1 The Nursing Council is aware that the English language requirements are seen as a barrier to nurses from the Pacific Islands registering. 5.2 The qualification gained for registration in most Pacific Islands is lower than that gained in New Zealand. It is at an enrolled nurse level. 5.3 There is no differentiation in the English language requirements for scopes of practice as both scopes are required to communicate effectively to protect public safety. 5.4 The Nursing Council is also aware of the research conducted in Counties Manukau regarding Pacific Island nurses registering in New Zealand and the barrier of English language (Wright. T & Graham-Smith, H, 2010, Pacific return to nursing pilot. Evaluation report. Prepared for Counties Manukau District Health Board). 5.5 The Council has considered this and has determined that it is not appropriate to lower the standards for one cultural group. 5.6 Nurses are registered to practice in any area with all population groups in New Zealand. 5.7 The Nursing Council has supported the view of "growing your own" and does this through supporting registration requirements for pilots of Pacific Island nurses and through accrediting and monitoring Pacific Island nursing programmes in New Zealand. It is recognised that students within these programmes may take longer to complete their studies and require a more encompassing approach to education. 6. Research 6.1 The Nursing Council notes there is some opposition to the current English language requirements (IELTS Research Reports, Vol. 10(4),2009). 6.2 The New Zealand Nurses Organisation has voiced its objection to English language tests and believes they are not valid for the New Zealand health system context. 6.3 The Nursing Council has recently participated in research being conducted by Dr Leslie Hawthorn into the efficacy of language tests available as a measure of a health professional's ability to communicate effectively. 6.4 This research is commissioned by AHPRA and results will be made available to the Nursing Council at the end of this year. 6.5 The role of the Nursing Council is to ensure there is a mechanism to ensure that all nurses entering the register are able to communicate sufficiently to protect public safety.
5 6.6 The Nursing Council has based its decisions on the level of English Language required and the testing it will accept on the research available to the Council at the time. 6.7 The Nursing Council is aware that the New Zealand Qualifications Authority has developed a level five certificate qualification in English language. 6.8 The Nursing Council is of the opinion that this qualification was developed for a different purpose and would require research evidence to support accepting this qualification as a standard for entry to practice. 6.9 The Nursing Council was not consulted in the development of the qualification.