Auditor s Report and Financial Statements 2003
Contents Contents Presidential Review...5 Education and Training...7 Nursing Careers Centre...14 Administration...17 Registration and Fitness to Practise...21 Auditors Report and Financial Statements...27 Appendix 1 Members of An Bord Altranais...38 Appendix 2 Board Committees...40 Appendix 3 Board Representation on External Committees...43 Appendix 4 Staff of An Bord Altranais...44 Appendix 5 Schools of Nursing/Midwifery...45 Appendix 6 Membership of the Steering Committee for Review of Nurses and Midwives in the Prescribing and Administration of Medicinal Products Project...47 An Bord Altranais Annual Report 2003 1
Report for the Year 2003 Published in Accordance with Section 50 of the Nurses Act, 1985
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Presidential Statement It is my great pleasure to present the 2003 Annual Report of the activities of An Bord Altranais, including a Financial Report, to both Houses of the Oireachtais, to the Professions of Nursing and Midwifery and to the Public. It is a time of great and fundamental change in the profession and I am pleased to report that An Bord Altranais continued to play a central and vital role in ensuring that the highest standards in education and practice were maintained throughout the profession. Following the 2002 elections the current Board of An Bord Altranais held its first meeting January 2003. As can be seen from the reports enclosed the Board was responsible for delivering a substantial volume of work during the first year of its term of office. The Board published a number of documents during 2003 including a guidance document to students, guidelines on developing a clinical learning environment and the interim report of the Review of Nurses and Midwives in the Prescribing and Administration of Medicinal Products project. The profession is facing a major challenge in relation to the proposed EU Directive on the Recognition of Professional Qualifications. The Board continued to work closely with the other Health Sector regulatory bodies to ensure that our concerns are adequately addressed. The statutory Fitness to Practise Committee meets regularly to administer an ever increasing number of applications for inquiry into the fitness to practise of nurses and midwives. A detailed report on the Fitness to Practise function is contained in this report. The increasing activity levels in applications for registration experienced by the Board in previous years continued in 2003. The registration process is complex and the increased number of applications has increased the workload of the Board significantly. I am pleased with the management of the finances of the Board, the continued investment in educational projects and in the general administration of the Boards activities. I acknowledge our close working relationship with the Department of Health and Children and in particular the Nursing Policy Division. I appreciate the co-operation and assistance we received from Health Boards, Voluntary Hospitals, Nurse Planning and Midwifery Development Units, Nursing Homes and the Higher Education Institutions. I wish to thank all of my fellow Board members for their commitment during the past year and in particular for their involvement in Board Committees. I acknowledge in particular the work of the members of the statutory Fitness to Practise Committee and thank them for their commitment during the year. Lastly I wish to thank the Chief Executive Officer and his staff for their work in administering the affairs of the Board. Anne Carrigy President of An Bord Altranais Presidential Statement ANNE CARRIGY An Bord Altranais Annual Report 2003 5
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Education and Training
Education and Training Education and Training The general concern of An Bord Altranais is the promotion of high standards of professional education, training and practice and professional conduct among nurses and midwives thus ensuring the protection of the public. The introduction of a registration /degree programme of professional preparation for the general, psychiatric and mental handicap divisions of the Register of Nurses from 2002 enhances the commitment of An Bord Altranais to being proactive, guiding, supportive and responsive to the changing educational structures and processes that support the pre-registration degree in nursing. An Bord Altranais also embraced opportunities to develop, extend and strengthen the principle of partnership with all parties involved in the educational experience while maintaining its statutory independence in conducting on-site visits to the Higher Education Institutions and the linked health care services. The concern of An Bord Altranais in the protection of the public acknowledges the issue of quality in education, actual practice of nurses and midwives and the need for practice to be grounded in appropriate current evidence. In keeping with its responsibility for protecting the public through the promotion of high standards of professional education, training, practice and professional conduct among nurses and midwives, the Board is committed to the effectiveness and efficiency of the accreditation processes. The Board is charged with establishing the professional standards and credentialing of education for pre-registration and post registration nurse and midwifery education. The Board through its quality of education framework continued its monitoring and evaluation role of standards in practice for the education and training of nurses and midwives throughout 2003. An Bord Altranais operationalises this process through rules under the Nurses Act, 1985 setting standards to be adhered to in the education and training of nurses and in their continuing education as registered nurses. The rules provide for the approval of higher education institutions and of hospitals and health care institutions providing training to ensure that valuable clinical and theoretical experience is provided. The various aspects of the regulatory functions being carried out are illustrated as follows. Site visits to Healthcare Institutions and linked Third Level Institutions Under Section 34 of the Nurses Act, 1985 the Board is required to satisfy itself as to the adequacy and suitability of hospitals and institutions for nurse education and training at least once every five years. On-site visits to Higher Education Institutions and Healthcare Institutions are required as a component of determining "the suitability of third level institutions and health care institutions in respect of educational programmes leading to registration" (Requirements and Standards for Nurse Registration Education Programmes, November 2000). The focus of the site visit through a partnership approach is to Assess that all statutory and regulatory requirements of An Bord Altranais and the European Directives are met. Assess the effectiveness and efficiency of the curriculum structures, processes and outcomes. Assess the quality and appropriateness of the educational experiences. Site visits, as a component of the approval mechanism for three new registration/degree education programmes which were established in 2002, were conducted; Tralee Institute of Technology - Southern Health Board Psychiatric Services Waterford Institute of Technology - South Eastern Health Board Learning Disability Services Letterkenny Institute of Technology - North Western Health Board Learning Disability Services Post Registration Courses The Board approves post-registration education courses for nurses and midwives based on criteria formulated in 1989. These criteria divide courses into two categories. Post-Registration Category I Courses Post Registration Category I courses include in-service training/education, seminars, study days, conferences and refresher courses considered by the Chief Education Officer to contribute to the practice, education and management of nursing and midwifery. In 2003 two hundred and thirteen Post-Registration Category I courses were approved. Post-Registration Category II Courses Post-Registration Category II courses are specialist courses and excludes those courses leading to registration. These courses are considered by the Education and Training Committee and approval is granted if programmes meet the criteria of the Education and Training Committee. The following Post-Registration Category II courses were approved in 2003: 8 An Bord Altranais Annual Report 2003
Continuing Education Courses approved at 31st December 2003 Department of Nursing & Health Studies, Dundalk Institute of Technology - Graduate Diploma in Nursing in Renal Nursing - Graduate Diploma in Nursing in Trauma & Orthopaedic Nursing - Graduate Diploma in Nursing in Gerontological Nursing - Graduate Diploma in Nursing in Mental Health Nursing (Adult) - Graduate Diploma in Nursing in Mental Health Nursing (Older Person) - Graduate Diploma in Nursing in Intellectual Disability Nursing (Challenging Behaviour) - Graduate Diploma in Nursing in Intellectual Disability Nursing (Older Person) Galway-Mayo Institute of Technology at Castlebar - Bachelor of Science in Nursing National University of Ireland Galway - Higher Diploma in Nursing Studies (Mental Health) - Higher Diploma in Nursing Studies (Orthopaedic Nursing) - Higher Diploma in Nursing Studies (Public Health Nursing) (Competencies) - Higher Diploma in Gerontology Royal College of Surgeons in Ireland - Higher Diploma in Wound Management and Tissue Viability - Higher Diploma in Respiratory Care - Higher Diploma in Nursing (Neonatal Intensive Care) Sheffield Hallam University in Partnership with South Eastern Health Board - - Diploma in Mental Health Practice: Enduring Mental Illness. St. Angela s College Sligo in Partnership with Sligo General Hospital - Higher Diploma in Nursing Studies (Orthopaedic Nursing). St. Angela s College, Sligo and School of Nursing Cregg House. - Higher Diploma in Nursing Studies (Community Intellectual Disability Nursing). University of Dublin, Trinity College, School of Nursing and Midwifery Studies - Diploma in Midwifery - Direct Entry (Pilot Programme) 1 cohort only. - Post-Graduate Diploma in Clinical Health Sciences Education - Masters in Science in Nursing/Midwifery (Health Sciences Education) University College Dublin - Master of Science (Nursing) - Master of Science (Midwifery) - Higher Diploma in Nursing Studies (Critical Care Nursing) - Higher Diploma in Nursing Studies (Diabetes Nursing) - Higher Diploma in Nursing Studies (Emergency Nursing) - Higher Diploma in Nursing Studies (Accelerated Programme) (Oncology Nursing) - Higher Diploma in Nursing Studies (Palliative Care) - Higher Diploma in Nursing Studies (Peri-anaesthesia Nursing) - Diploma in Nursing Studies (Nursing Informatics) Waterford Institute of Technology and Waterford Regional Hospital - Graduate Diploma in Nursing (Critical Care, A&E, Perioperative, Theatre, Tissue Viability). Return to Nursing Practice Course - The Return to Nursing Practice Course is organised by healthcare institutions for nurses whose training does not comply with EU Directives which were transposed in June 1979 and nurses returning to work following an absence from practice of more than five years. Six Return to Nursing Practice courses were submitted for approval in 2003. An Bord Altranais Annual Report 2003 9
Education and Training CONTINUED 10 An Bord Altranais Annual Report 2003 Return to Midwifery Practice - Return to Midwifery Practice Courses are organised for midwives from outside Ireland who need to undertake the course as a prerequisite to registration as a midwife and midwives returning to midwifery practice following an absence of five years or more. One Return to Midwifery course was submitted for approval in 2003. Bachelor of Nursing Studies (Distance Education) 2002-3 - The Bachelor of Nursing Studies programme is presented nationally by Oscail, the National Distance Education Centre, in co-operation with An Bord Altranais. Its work is overseen by a programme team consisting of members of Oscail and An Bord Altranais, together with representatives from other universities and the profession. The degree is modular in structure and students have direct entry onto the degree level modules or may take an access programme. The programme runs from March to November each year and students may choose how many modules they wish to study each year. Review of Nurses and Midwives in the Prescribing and Administration of Medicinal Products Project The Review of Nurses and Midwives in the Prescribing and Administration of Medicinal Products Project commenced in September 2001. This project was borne out of the recommendations from the Commission on Nursing and Review of Scope of Practice for Nursing and Midwifery to examine the role of the nurse and midwife in the practice of prescribing. It is a joint collaboration between An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery. The Steering Committee membership is given in Appendix 6. The terms of reference for the project are: Review of current practice, identifying relevant issues Review of appropriate international literature and experience Review of national and international legislation related to nurse and midwife prescribing Review of the Guidance to Nurses and Midwives on the Administration of Medical Preparations (An Bord Altranais 2000) Review of intra and inter professional boundaries and their implications for nurse and midwife prescribing Consideration of the circumstances in which nurses and midwives might prescribe Identification of pilot sites suitable for the initiation of nurse and midwife prescribing Identification and delivery of educational preparation necessary to support nurse and midwife prescribing Consideration of documentation necessary to support nurse and midwife prescribing Initiation and evaluation of nurse and midwife prescribing in pilot sites Produce detailed guidelines including a framework for nurse and midwife prescribing where appropriate. The Steering Committee met on five occasions during 2003. The pilot site study entitled An evaluation of the effectiveness of nurses and midwives collaboratively prescribing using medication protocols commenced in April 2003. In September thirty two nurses and midwives from 14 sites (2 sites had previously withdrawn) successfully completed the RCSI education programme which received An Bord Altranais Category II Post Registration approval. The implementation phase, which was scheduled to begin in October, had been deferred due to operational issues fundamental to the pilot study. An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery worked closely with the Department of Health and Children in resolving these concerns. It is planned to resume the implementation phase early in 2004. Guidance to Nurses and Midwives on Medication Management (An Bord Altranais, 2003) was approved in June 2003 and subsequently distributed to the profession in August. It has been well received by nurses and midwives and all comments regarding its structure and content are being compiled for future revisions. The document was also made available on the An Bord Altranais website. A database was established to facilitate the collection and analysis of medication management queries submitted to the Project Office. A summary of this information will be provided in the Final Report of the project review. The Project Team have presented at numerous nursing conferences and meetings to provide an overview of the progress of the review and associated topics in relation to medication management and prescribing. Review of Assessment of Clinical Practice and Competencies A plan to conduct an evaluation of the e-learning package was agreed by the Education and Training Committee. An Bord Altranais distributed over 1,000 CDs to those requesting the package and the programme was made available to a number of websites including An Bord Altranais. Five Points of Entry Phase 1 of the project, which was to examine the rationale for, and impact of maintaining five points of entry to the Register, was considered at the Board meeting on 11 September 2003. This phase involved an extensive review of the international literature related to the education and training of nurses (General, Psychiatric, Mental Handicap, Sick Children s and Midwifery). An exploration of the historical issues that led to the five points of access to preregistration programmes in nursing in Ireland was also considered. The aim of phase two is to explore the perceptions of all relevant key stakeholders in relation to the rationale for and impact of maintaining the five points of entry to the Register. This exploration will be informed by the literature review completed as phase one of the study. Terms of Reference for Phase 2 Conduct extensive informed consultation with the profession and key stakeholders, including consumers, taking account of geographic considerations. Explore demographic trends for future nursing and midwifery manpower and future health needs.
Explore through needs analysis the required points of access to the Register of Nurses which includes midwives. Produce a final report with recommendations. Guidelines on the Key Points that may be considered when Developing a Quality Clinical Learning Environment In April 2003, An Bord Altranais published a document entitled Guidelines on the Key Points that may be considered when Developing a Quality Clinical Learning Environment. Each registered nurse/midwife has a duty to provide students with clinical support to enable them become safe, caring, competent decision-makers willing to accept personal and professional accountability for evidence-based nursing/midwifery care. The guidance document develops on the values and standards articulated by An Bord Altranais in The Code of Professional Conduct for Each Nurse and Midwife, (April 2000). The guidance document is accompanied by an A4 poster. Guidance for Nursing Students In April, 2003 An Bord Altranais published a guidance document to all pre-registration student nurses. The purpose of the Guidance for Nursing Students document is to outline some information about An Bord Altranais and to provide guidance for the clinical practice experience that the student will undertake during the programme of study and introduce the student to the concept of professional practice. Each student who applies has their name entered on the Candidate Register of An Bord Altranais. The student will receive an An Bord Altranais student card which identifies for placement areas that the students are enrolled on the Candidate Register. Pilot Project on an Education Programme for Nurses Registered Overseas A pilot education programme for nurses registered overseas commenced in October 2003. The aim of the project was to deliver a pilot education programme that addressed the theoretical and clinical deficits identified in the education programmes undertaken by participating nurses from overseas when compared to the requirements and standards for nurse registration education programmes as set by An Bord Altranais in line with European Union (EU) directives. The programme will run until March 2004. An Bord Altranais in conjunction with Oscail (National Distance Education Centre) will deliver and review the programme which requires the nurse to demonstrate competence. Midwifery Registration Education Programme (Direct Entry) The pilot programme concluded on 31st May 2003. An independent consultancy review was commissioned by An Bord Altranais and conducted by a team from the University of Nottingham. The evaluation made a number of recommendations which were shared with the Department of Health and Children and the stakeholders to inform the future development of midwifery registration programmes. Framework of Qualifications for Nurses and Midwives The primary function of An Bord Altranais is to promote high standards of professional education and conduct among nurses. The current agenda for An Bord Altranais is the setting of standards of education for in-service education, specialist education and continuing education. In 2003 An Bord Altranais commenced a reform of the approval mechanisms for postregistration education and established consultation with key stakeholders to develop a framework for qualifications for nurses and midwives within the National Framework of Qualifications (National Qualifications Authority of Ireland). It is envisaged that the project would be completed by Spring 2005. Conferences and Seminars 2003 A national conference was held in City West Hotel, Dublin on 11 June 2003 entitled "Transcultural Nursing Practice in the 21st Century an examination of the concept and issues for regulation and practice". The objective of the conference was to provide a forum to consider and discuss the issues of transcultural nursing, its importance and implications for nurses. Over one hundred and fifty nurses attended the conference. Mr Ivor Callely T.D., Minister of State at the Department of Health and Children, with special responsibility for Services for Older People opened the conference and launched a new publication by An Bord Altranais on overseas policy and assessment procedures for overseas nurses applying for registration. An Bord Altranais Annual Report 2003 11
Education and Training CONTINUED An Bord Altranais Research Awards 2003 An Bord Altranais has promoted research by Nurses and Midwives by the awarding of Research Scholarships. Between 1992 and 2003, 713,416 has been awarded to 203 Nurses and Midwives, as follows: All-Ireland Research Fellowships, jointly funded by the Nursing Board for Northern Ireland (NBNI), whereby 380,922 has been awarded to 27 Nurses and Midwives An Bord Altranais Doctoral Scholarships, whereby 167,605 has been awarded to 9 Nurses and Midwives Cross-Border Research Project, whereby 7,618 has been awarded to 4 Nurses and Midwives An Bord Altranais Research Scholarships, whereby 157,271 has been awarded to 139 Nurses and Midwives, including twenty four awards in 2003. The 2003 awards covered a wide range of research topics in both the spheres of education and clinical practice. The completed research is placed in the Library in An Bord Altranais, and is used extensively by many of the Nurses and Midwives visiting the Library. Library The following services continued to be provided: British Nursing Index (BNI) and CINAHL databases on CD- ROM plus online access to the Cochrane Library and PubMed. Reference services for nurses studying, practising or seeking information for interview preparation. Document supply via the British Library and the Irish Healthcare Library network to staff, students and bodies such as the National Council for the Professional Development of Nursing and Midwifery. Registration Procedures Applicable to Nurses & Midwives from Overseas Policy Update An Bord Altranais updated its policy pertaining to the eligibility of nurses and midwives from overseas for registration, with effect from July 1st 2003. An Bord Altranais reviewed its policy regarding the eligibility of applicants from overseas for registration with regard to its regulatory authority to promote high standards of professional education and training and professional conduct among nurses and midwives and its mission to protect the public through these functions. The Nurses Act, 1985, together with the European Union (EU) Directives ensures applications are processed fairly and transparently from candidates holding EU nursing and midwifery qualifications. The assessment of applications for candidates holding non-eu qualifications required a comprehensive evaluation to ensure the suitability of an applicant to have his/her name entered in a division of the register maintained by An Bord Altranais. The new procedures will ensure fair and transparent processing of these applications by introducing 1) new application procedures and 2) new clinical assessment procedures. Information for applicants An information booklet titled Information for Nurses & Midwives Educated & Trained Overseas in non-eu Countries Regarding Eligibility to Register with An Bord Altranais (An Bord Altranais, 2003) was developed. The booklet provides detailed information to nurses and midwives from non-eu countries on the application procedures to be followed when applying to An Bord Altranais for registration. It is also applicable to nurses and midwives from within EU member states who do not qualify for registration under EU directives. English language competence English language competence is required at a level that supports communication and enables the applicant to practice nursing and midwifery safely and effectively in Ireland. Therefore proof of English language competence in cases where English is not the first language or primary language of expression of the applicant is a new requirement. The applicant is required to provide evidence of competence through the achievement of an overall band score of 6.5 on the International English Language Testing System (IELTS) Academic Test. Period of adaptation Following the evaluation of an application for registration by an officer in the Education Department of An Bord Altranais, an applicant may be required to undertake a period of adaptation. The term period of adaptation replaces the term supervised clinical nursing or midwifery practice/orientation and assessment. A period of adaptation is a period of supervised practice possibly being accompanied by further education and training. An applicant undergoing a period of adaptation will have his/her name entered on a Candidate Register maintained by An Bord Altranais and will be issued a Certificate of Candidate Registration. This replaces the Certificate of Temporary Registration in operation prior to July 1st 2003. A nurse undergoing a period of adaptation and whose name is entered on the Candidate Register maintained by An Bord Altranais is referred to as a Candidate Nurse. The period of adaptation is under the responsibility of a qualified nurse and this period of supervised practice is the subject of assessment. The assessment shall represent achievement of An Bord Altranais Competencies for Entry to the Register. Competencies for Entry to the Register An Bord Altranais developed a framework of five domains of Competencies for Entry to the Register of Nurses as identified in the Requirements and Standards for Nurse Registration Education Programmes (An Bord Altranais, 2000) document. A new document for the assessment of nurses from overseas was developed based on these domains and candidates requiring adaptation will be measured against the five domains of competence. These domains represent a broad enabling framework that facilitates the assessment of the Candidate Nurse s clinical practice during the period of adaptation. The document titled Competence Assessment Tool for Nurses Educated & Trained Overseas in non-eu Countries (An Bord Altranais, 2003) consists of the assessment tool and a section 12 An Bord Altranais Annual Report 2003
providing guidance on the provision of a period of adaptation and assessment to nurses from overseas. This assessment was introduced for applicants from 1st July 2003. Midwife applicants A midwife undergoing a period of adaptation is referred to using the term Candidate Midwife. The period of adaptation is under the responsibility of a registered midwife and shall be the subject of assessment. The assessment shall be carried out and documented utilising the Performance Assessment for Midwives form developed by An Bord Altranais. When the Competencies for Entry to the midwives division of the register are developed, these will form the basis for assessment. Timeframe of the adaptation and assessment period The minimum time frame recommended by An Bord Altranais for completing the period of adaptation and assessment successfully is 6 weeks with an acknowledgement that most Candidate Nurses could require up to 12 weeks to achieve the identified competencies. The Director of Nursing of a hospital or an institution approved for the education and training of nurses who agrees to accept Candidate Nurses for adaptation, is at liberty to extend the period of adaptation and assessment to a maximum of 12 weeks in order to facilitate the achievement of the competencies. An extension beyond this timeframe must be negotiated with An Bord Altranais. Eligibility for registration A Director of Nursing of an institution approved for the education and training of nurses shall furnish to An Bord Altranais a report on each Candidate Nurse for registration who has completed a period of adaptation in that institution and any clinical site attached thereto. To facilitate this An Bord Altranais has developed a new Eligibility Report Form. Education Department Enquiries Database Staff of the Education Department established an Enquiries Database in 2003. A project team designed the database in collaboration with staff utilising a two-phase approach. The first phase, lasting 5 months, consisted of the collaborative construction of the database, the information codes and categories and protocol for use. The team piloted the database over a 3 month period. An educational exercise was initiated to familiarise all staff with the database. Further revisions to the database were made based on feedback received. The Department will commence implementing the system in January 2004. The system will be introduced to the profession and the public through a range of media. Phase two will focus on refining the system in response to user feedback and an evaluation of reports generated from the data analysis of queries. The central computerised enquiries database is designed to manage and analyse communication received from nurses/midwives, other health care professionals and the general public. Understanding the concerns of nurses and midwives and responding to those concerns is a priority of the Education Department. The purpose of the database is to enable the Chief Education Officer to review and monitor data on sources and types of enquiries made to the department. This will ensure continuous quality improvement and advancement of the work of the department, responding to issues of concern and interest to members of the nursing and midwifery profession and members of the public. As a data controller An Bord Altranais has key responsibilities in relation to the information kept on computer about individuals. The database has been developed in line with the key responsibilities outlined in both Data Protection Acts, 1988 & 2003 and Freedom of Information Act, 1997 & 2001. Incorporated into the Protocol for Use of the Education Department Enquiries Database is a mechanism to ensure internal quality review of the database. Sigma Theta Tau International s 15th International Nursing Research Congress Ireland is to host the 15th International Nursing Research Congress of the Honor Society of Nursing, Sigma Theta Tau International in July 2004. This will mark a major event in the international nursing and midwifery calendar and An Bord Altranais is delighted to be involved in the planning of this congress. The Nursing Research Congress is titled "Building Community Through Research". The congress will also include the Evidence-Based Practice Pre-conference, titled "Evidence-Based Nursing: Strategies for Improving Practice,". Mrs. Anne-Marie Ryan, Chief Education Officer of An Bord Altranais has been selected as a member of the Planning Committee and a member of staff of the education department has been designated responsibility to liaise with staff of Sigma Theta Tau International in co-ordinating the organisation and planning of the congress. An Bord Altranais Annual Report 2003 13
Nursing Careers Centre Nursing Careers Centre 2003 The Nursing Careers Centre (NCC), was set up under the management of An Bord Altranais in November 1998, to: 1) Facilitate a centralised system of processing and selection of applicants wishing to enter nursing 2) Promote and market nursing as a career 3) Provision of information to registered nurses and midwives In carrying out its functions, the NCC continues to work closely with a number of key stakeholders, including: Department of Health and Children; the Healthcare Sector; the Office of the Civil Service and Local Appointments Commissioners (OCSLAC); the Central Applications Office (CAO); the Higher Education Institutions (HEIs); the Institute of Guidance Counsellors (IGC); the Nursing Promotion and Marketing Liaison Group as set up by the NCC, and others from time to time. The NCC carries out its work in an open and transparent manner, with efficient and clear communication as its keynotes, and with due cognisance to the principle of cost effectiveness. To carry out its work in an efficient manner the NCC needs to maintain positive communication with a wide cross section of persons and groups. During peak season there is an average of one hundred queries per day to the NCC. The NCC sets as its standard to be a one-stop-shop in handling queries regarding a career in nursing, aiming to respond to 95% plus of queries in an effective and courteous manner within a twenty-four hour period. 1) Facilitate a Centralised System of Processing and Selection of Applicants Wishing to Enter Nursing Application A major discussion paper regarding the application form for nursing was written by the NCC and circulated to all key stakeholders. Options offered in this discussion paper included the possible number of sections on the CAO application form and if mature code and standard code should remain separate. The result of the consultative process was that, from 2003: nursing would be part of the main CAO degree list where more than one of the same course exists within the HEI, one code only would be given, the exception being the Adelaide Hospital mature and standard would retain separate codes. There were 34 courses with 1,640 places in 2003 for both standard and mature students: - 14 courses (1,057 places) in general nursing - 12 courses (343 places) in psychiatric nursing - 8 courses (240 places) in mental handicap nursing From 2003, an applicant can receive only two offers maximum at any one round of offers, one degree and one diploma/certificate. Mature Code Applicants The NCC facilitated the assessment process for mature code applicants to nursing in 2003 by means of a written assessment and interview. Of the 1,585 mature code applicants who were called for the written assessment, 797 were successful and called for interview. There were 640 successful at the interview and these were placed on an order of merit list for each course for which they applied. The offers commenced in August 2003. Applications 2003 The year 2003 was a historical year. For the first time nursing was in direct competition with all other CAO degree courses when it became part of the CAO Degree list for the first time. Despite the competition, the numbers applying in 2003 were excellent. The interest in nursing remained very high, both among school-leavers, and among mature applicants considering their career options. Overview of Applications 2003 NUMBER Total Nursing Applications: 7,507 Total Mature Nursing Applications: 1,650 (of these, 1585 were valid) Total Standard Nursing Applications: 6,069 General Nursing Applications: 6,289 Psychiatric Nursing Applications: 3,089 Mental Handicap Nursing Applications: 2,020 Overview of Gender 2003 APPLICANTS MALE FEMALE % MALE Total 937 6570 12.5% Mature 356 1229 22.5% General 594 5695 9.5% Psychiatric 602 2487 19.5% Mental Handicap 222 1798 11% 2) Promote and Market Nursing as a Career Introduction Since its inception, the NCC has carried out a major campaign in the whole area of promotion and marketing of nursing, including: The production and dissemination of high quality promotional materials including: Stands, Posters, and Publications The development of an active NCC website Effective liaison with key stakeholders in the HEIs and Healthcare system, including meetings to address many policy issues 14 An Bord Altranais Annual Report 2003
Effective communication with Guidance Counsellors, including; Workshops with local Branches; Meetings with the National executive; Speaking at national CAO information days Participation at Conferences, including: Higher Options Conference; IGC Conference; Young Scientist of the Year Conference; CAO Annual Conference and many local Conferences The development and implementation of media strategies including a major Newspaper and Radio publicity campaign. The NCC pursued an active promotion and marketing campaign in 2003. ERA Award The NCC was nominated for an Excellence in Recruitment Advertising (ERA) Award in 2003. These nominations are based on the advertisements for the previous twelve months that are considered by the panel of judges to be excellent. Of the 10 nominations, the NCC was the only nomination not backed by a marketing/promotion company. 3) Provision of Information to Registered Nurses and Midwives In October 2003 the NCC developed a publication called Nursing/Midwifery: Career Development Post-Registration Courses, outlining the various post-registration education opportunities for Registered Nurses and Midwives. It comprises a number of sections, including: A historical perspective of continuing education Courses leading to an additional registration Degree courses Return to Practice courses for nurses and midwives Post-Registration Category 2 An Bord Altranais approved courses Financing of courses Contact details for all relevant organisations. The publication was in paper form, plus it was available on the newly developed NCC website. An abridged leaflet version of the publication was published in December for use as part of the Promotional Strategy. entering into the nursing profession. Further Education This section is of benefit to the registered nurse or midwife interested in pursuing further education. Publications This section contains a list of relevant publications. An Bord Altranais publications are contained in PDF format and may be viewed in full or downloaded. Links This section contains details of all relevant organisations, including, healthcare agencies, higher education institutions, nursing and midwifery planning and development units, national organisations. The name, address and telephone number are included. Also included is the website address and a link can be made directly to each site. Events This section contains relevant conferences, seminars etc. This particular section has proved very popular, and at times over 80 events were posted. Frequently Asked Questions (FAQ s) This section contains frequently asked questions and answers related to a career or on a continued career in nursing. Contact Us By clicking on this section it shows the NCC contact details. By clicking on the email, a message can be sent directly to the NCC. Accessibility The website meets the public sector accessibility guidelines and therefore complies with recommendations in relation to usage by persons with a disability. CAREERS WEBSITE www.nursingcareers.ie In 2003, the NCC developed a website dedicated to providing information on careers in nursing/midwifery. This website is of interest to the school-leaver, the mature person considering career options, or the registered nurse/midwife deciding to pursue further education. The website is organic, dynamic and current, and updates are generally posted on a daily basis. The website contains a number of sections including: Becoming a Nurse This section deals with the pre-registration four-year degree courses in mental handicap nursing, psychiatric nursing, and general nursing, and interests the person considering
16 An Bord Altranais Annual Report 2003
Administration
Administration Administration 2003 Accounts The auditors report and the Financial Statements for the year ended 31st December 2003 are on page 27. A surplus of Income over Expenditure amounting to 274,372 was achieved in the year, which compares to a surplus of 44,915 for the previous year. This arose as a result of Income increasing by 103,521 and Expenditure decreasing by 125,936. The increase in Income can primarily be attributed to increases in Registration fees and funding for projects managed by the Board, offset by a decrease in Examination fees, a reduction in funding for the NCC and the abolition of the Candidate Registration fee. The decreased Expenditure can primarily be attributed to the fact that the 2002 Accounts reflected once off charges amounting to 0.3m relating to Board Elections and Depreciation which did not occur in 2003. The costs of administering the Nursing Career Centre (NCC) reduced significantly due to the full integration of pre-registration nursing courses into CAO systems. Other Administration costs show a decrease compared to 2002 arising from cost savings achieved in Staff training, Recruitment, Legal and Professional fees. Offsetting this were increases in staff costs due to recruitment of new staff, payments under Benchmarking, as well as increases in Fitness to Practice costs. The current year surplus is reflected in the financial position of the Board as at 31st December 2003 and the net worth of An Bord Altranais increased by 274,155 to 4,731,112. The value of cash and cash equivalents has increased by 103,256 during 2003. Property The Board owns the building its occupies at 31/32 Fitzwilliam Square. The property was initially leased and the Board purchased it in 1993 for 0.95m ( 0.75m). The mortgage on the property was fully repaid during 2003. The Board was granted planning permission for an Education Centre at the rear of our premises in January 2002. During 2003 the Board decided not to proceed with the development at this time as it was not economically viable. Internet The Boards website www.nursingboard.ie contains a comprehensive range of documents including published guidance documents, annual reports and newsletters. The website also contains a large volume of statistics that are widely used for research purposes by students and nurses. All staff members have a full e-mail service and they can be contacted by using their first initial and surname @ nursingboard.ie Partnership The Partnership Committee established in An Bord Altranais in 2000 continues to flourish. The committee was set up under the auspices of the National Health Service Partnership Forum and comprises of representatives of management, staff and both unions in the organisation, IMPACT and the INO. Health and Safety As with previous years An Bord Altranais is continuing it s efforts to ensure the safety, health and welfare of it s employees and visitors to the organisation. The in-house Partnership Group oversees health and safety issues and it revised the Boards safety statement during 2003 to account for recent changes in legislation. Public Board Meetings The Board continued it s commitment to hold some of its Board Meetings in public. In 2003 public meetings were held in Portlaoise and Galway. There was a good attendance from the nursing profession at the meeting in Galway. Prompt Payment of Accounts Act, 1997 An Bord Altranais has been prompt in the payment of its creditor accounts and the requirements of the Act do not pose any problem for the Board. The Board is complying with the provisions of the Act and there is a system in place, which provides for a regular review of all accounts to ensure that payment is neither overlooked nor unnecessarily delayed. 18 An Bord Altranais Annual Report 2003
Staff Changes Appointment of Education Officers Ms. Ursula Byrne RGN, RM, RNT, BNS, H. Dip, MSc Midwifery was appointed as an Education Officer in a permanent capacity during 2003. Ms. Byrne was working previously in the National Maternity Hospital and had previously served with the Board in a part time capacity. 2003 was a year of significant change with a number of staff both joining and leaving the Board. The Board would like to wish the staff who joined a fulfilling and enjoyable career in An Bord Altranais and the Board would like to thank the staff who left to pursue other opportunities for their commitment and service to the Board and to wish them every success in their future careers. An Bord Altranais Annual Report 2003 19
20 An Bord Altranais Annual Report 2003
Registration and Fitness to Practise
Fitness to Practise and Registration Fitness to Practise REGULATORY FUNCTIONS Part V of the Nurses Act, 1985, provides for an Application for Inquiry to be made into the fitness of a nurse to engage in the practice of nursing on the grounds of alleged professional misconduct and/or alleged unfitness to engage in such practice by reason of physical or mental disability. This part of the Act regulates all aspects of the work of the Fitness to Practise Committee. The application for Inquiry may be made by the Board or by any person. In its investigation of a complaint, the Fitness to Practise Committee may request such other documentation as it requires, and the nurse is also invited to respond to the allegation(s). The Committee will then consider all of the correspondence before it decides whether there is a prima facie case for the holding of an Inquiry into the nurse. The Committee will also confirm the grounds upon which any Inquiry is to be held. In the event that the Committee is of the opinion that there is not a case to answer, the Board may direct the Committee to hold an Inquiry if it is of the opinion that an Inquiry is warranted. The Inquiry is held in private. The Chief Executive Officer presents the case on behalf of the complainant and is represented by Solicitors and Counsel. Members of the Fitness to Practise Committee sit on the Inquiry. A Legal Assessor sits with the Committee to advise on points of law, but takes no part in any decision making of the Committee. The nurse is invited to attend or to be represented at the Inquiry. A Stenographer records the Inquiry proceedings. Witnesses, on behalf of the Chief Executive Officer and on behalf of the nurse, are called and give evidence under Oath. Witnesses can be cross-examined and may also be questioned by the Committee. Following the Inquiry, the Fitness to Practise Committee prepares a Report for consideration by the Board. The Report will include the Committee s findings in relation to the allegation(s), and the reason(s) for its decision. The Report may also include other information such as recommendations to the Board in respect of any sanction to be imposed, by the Board, on the nurse, recommendations on publication, and any other relevant recommendations arising from the Inquiry. The Board will then meet to consider the Report of the Fitness to Practise Committee. The nurse is invited to attend the meeting or to be represented at the meeting, and to make a statement to the Board. The Board will then decide on any sanction to be imposed on the nurse. Where the Board decides to:- Erase the nurse s name from the Register of Nurses; Attach conditions to the retention of the nurse s name in the Register of Nurse; Suspend the nurse s name from the Register of Nurses for a fixed period, the decision must be confirmed by the High Court and the decision may be appealed by the nurse to the High Court. Alternatively, or in conjunction with one of the above detailed sanctions, the Board may decide to:- Advise, Admonish or to Censure a nurse, in relation to his or her professional conduct. The Board, where appropriate, may decide to impose a sanction where no finding of professional misconduct or unfitness to practice nursing has been found by the Fitness to Practise Committee following Inquiry. Where a nurse has been found guilty of professional misconduct, and/or unfit to practice by reason of physical or mental disability, the Board, in protecting the public, may decide to publish the outcome of the Inquiry, the extent of such publication to be decided by the Board. There is always publication to the Minister for Health and Children and to the employer (where known) if a nurse s name is erased or suspended, or where conditions are attached to registration. Level of Activity during 2003 Number of Applications considered: - Nineteen applications carried over from 2002 Twenty one new applications considered in 2003 Decisions in Respect of Applications: - In eleven cases, the committee decided to hold an Inquiry; In fourteen cases, the Committee decided that an Inquiry was not warranted; Fifteen cases were still under consideration at the end of 2003. Inqueries Held in 2003 The Fitness to Practise Committee held four inquiries and commenced a fifth inquiry into the fitness to practise of nurses in 2003. The Committee dealt with issues to include:- Alleged inappropriate nurse/client behaviour/relationship of a sexual nature; Alleged mistreatment of clients to include inappropriate professional behaviour; Alleged unfitness to practice due to medical/mental illness. Grounds for Inquiry Three Inquiries were held on the grounds of alleged professional misconduct (of which one Inquiry was not completed by end 2003); 22 An Bord Altranais Annual Report 2003
One Inquiry held on grounds of alleged unfitness to practise by reason of physical or mental disability; One Inquiry was held on the grounds of alleged professional misconduct and alleged unfitness to practice nursing by reason of physical or mental disability. Decisions of the Fitness to Practise Committee following Inquiry Two nurses were found guilty of professional misconduct; Two nurses were found unfit to practise by reason of physical or mental disability. Sanctions Imposed by the Board following these Inquiries In three cases a sanction of Erasure was imposed and each decision was confirmed by the High Court; In one case the sanction of Admonishment was imposed. Nurses with Conditions Attached to the Retention of their Names in the Register of Nurses The monitoring of the conditions attached to the retention of a nurse s name in the Register of Nurses is a function of the Board. In their continuing monitoring of such nurses during 2003, the Board became the Applicant for Inquiry in respect of one of these nurses. A case in respect of this nurse was referred to the Fitness to Practise on the grounds of alleged professional misconduct and/or unfitness to practise by reason of physical or mental disability. The Board removed the conditions attached to the retention of one nurses name in the Register of Nurses. The conditions had been attached for a period of two years, and the Board was satisfied that the nurse had met the terms of the conditions during this period. Section 44 Applications The Board, where it is of the opinion that the public interest is at risk, may make an application to the High Court, so that during a specified period of time, a nurses name does not have effect in the Register. In 2003, the Board considered six such applications. In one case the Board decided not to proceed with an application to the High Court; In one case the Board adjourned consideration generally, and the nurse made an Undertaking to the Board not to engage in the practise of nursing until the Fitness to Practise Inquiry was completed; In one case an application was made to the High Court and the High Court accepted an Undertaking made by the nurse not to engage in the practise of nursing for a specified period of time. This period of time was subsequently extended; In one case an application was made to the High Court and the High Court accepted an Undertaking made by the nurse not to engage in the practise of nursing for a specified period of time; In two cases the High Court confirmed an Order pursuant to Section 44. Section 42 Applications Under Section 42 of the Nurses Act, 1985, where a nurse is convicted of an offence triable on indictment, the Board may decide that the name of such person should be erased from the Register of Nurses. In the first case of such a nature ever to be considered by the Board, the Board decided that the name of the nurse be erased from the Register of Nurses. The High Court confirmed this decision. The nurse had been convicted of a number of offences related to Section 3(2)(b), Section 5(1)(a), and Section 6(1) of the Child Trafficking and Pornography Act, 1998. Fitness to Practise Committee of Inquiry into a Midwife Matters pertaining to an ongoing and well published case heard by the Fitness to Practise Committee, were concluded in 2003. Board Policy on Publication The Board, in September, 2003, approved a policy on publication following a Fitness to Practise Committee Inquiry. The Committee now may include a recommendation in its report to the Board in respect of each case heard by the Committee. An Bord Altranais Annual Report 2003 23
Registration REGULATION Registration The Register of Nurses is maintained by An Bord Altranais in accordance with both the provisions of the Nurses Act, 1985, and the provisions of Rules made in accordance with the Act. STATISTICS Nurses Registered: DATE FEMALE MALE ACTIVE INACTIVE TOTAL 31/12/2003 68,031 5,665 58,981 14,715 73,696 31/12/2002 67,077 5,662 60,084 12,655 72,739 Qualifications Registered as at 31st December, 2003: A nurse may be registered in more than one division of the Register of Nurses. DISCIPLINE FEMALE MALE ACTIVE INACTIVE TOTAL General 59,112 2,565 49,109 12,568 61,677 Psychiatric 8,081 3,500 9,428 2,153 11,581 Sick Children s 4,511 47 3,724 834 4,558 Mental Handicap3,839 465 3,752 552 4,304 Midwifery 16,703 19 13,171 3,551 16,722 Public Health 2,426 1 1,987 440 2,427 Tutor 521 104 512 113 625 Other 587 26 305 308 613 TOTAL 95,780 6,727 81,988 20,519 102,507 Newly registered qualifications during 2003: Place of Training Discipline Ireland EU Other Total General 899 734 733 2,366 Psychiatric 270 88 68 426 Sick Children s 98 36 1 135 Mental Handicap 163 27 190 Midwifery 198 53 25 276 Public Health 121 4 5 130 Tutors 38 38 TOTAL 1,787 942 832 3,561 Verifications issued during 2003: Verifications are issued for nurses wishing to register abroad. Verifications are sent direct from one Registration Authority to the equivalent organisation in the country where a nurse is seeking registration. A nurse may apply for more than one Verification of Registration. COUNTRY 2003 2002 United Kingdom 735 1,516 Other European Countries 15 24 Australia 764 1,014 USA 240 306 Canada 50 1 Other 51 14 TOTAL 1,855 2,875 Inactive File: The Board maintains and Inactive File for nurses who are not engaged in the practice of nursing in Ireland. REASON 2003 2002 Retired 4,285 4,977 Unemployed 665 699 Career Break/Leave of Absence 1,351 1,565 Working Abroad 3,955 4,425 Other 2,399 3,049 TOTAL 12,655 14,715 Candidate Register: An Bord Altranais maintains a Register of Candidates admitted for training: DISCIPLINE 2003 2002 General 964 1,137 Midwifery 184 53 Psychiatric 307 374 Sick Children s 117 27 Mental Handicap 168 229 TOTAL 1,740 1,820 Registration Appeals Committee The inaugural meeting of the Registration Appeals Committee was held on 10th April, 2003. The Committee, comprising four Board members - the President, Vice- President, Chair and Vice-Chair of the Fitness to Practise Committee, considers appeals from applicants for registration who have been unsuccessful in their application. An applicant pays a service fee of 38 for an appeal application and must submit full documentation in support of his or her appeal. The Committee may uphold the original decision made, it may direct that the applicant be 24 An Bord Altranais Annual Report 2003
registered, or it may give such other direction of criteria that the applicant must fulfil before registration is granted. In 2003, the Registration Appeals Committee considered 39 applications in appeal. These applications included appeals following failure of an applicant to successfully complete an adaptation period, applications where the applicant did not hold educational qualification requirements for direct registration, and applications where applicants did not hold educational qualifications that would entitle them to registration with An Bord Altranais. Registration Application Form A new registration application form was introduced in 2003 for non-eu applicants and for EU applicants whose educational qualifications do not meet with EU Directive requirements. The revised application form also took into account changes within the registration application process, to include the introduction of the English Language requirement for non-eu applicants. Candidate Register and Monitoring of Attrition Rates from Nurse Education Programmes Nursing students, both at under-graduate and post-graduate level, continue to register on the Candidate Register. Attrition rates from pre-registration nursing programmes are monitored and reported to the Department of Health and Children annually. An Bord Altranais Annual Report 2003 25