1. The Commission on Nursing A blue print for the future….?

2. Lecture outline Background to the Commission Process of the Commission Report of the Commission 1998 Annual report of the Implemenation of the Recommendations of Commission- Monitoring Committee- 2000-2002

3. Background to the Commission Established in March 1997 Series of industrial relations problems Nursing Alliance of unions and health service employers agreed terms of reference of Commission- as recommended by Labour Court “to examine and report on the role of nurses in the health service…”

4. Areas to be examined Evolving role of the nurse, professional development, management role Promotion Structurual changes required by role Requirements of nurses “segmentation” of the grade Training and education requirements Added- role and functions of An Bord Altranais

5. Membership of Commission Chair- Justice Mella Carroll Representation from: Health boards DoHC Unions Education External (outside health sector)

6. Process of Commission’s work Consultative process Written submissions Consultative fora Meetings with individuals and groups Meetings with main stakeholders Interim report Published October 1997 Identified issues emerging from consultation

7. Process….. Regional seminars 600 people, by branch of nursing/midwifery Dublin, Cork, Monaghan Visit to Australia by 5 members Degree pre-registration education Clinical pathways- CNS and nurse consultant 3 sub-committees Education, management, regulation (later)

8. Literature reviews undertaken for the Commission Changes in professional role of nurse in Ireland (Condell) Changes professional role outside Ireland (Savage) Management in health services- nurse role (Flynn) International developments in nurse education (Tyrrell) International perspective on community nursing (Leahy-Warren) Joint appointments in nusing (L-W & Tyrrell)

9. Commission Final Report Chapter 2: evolution of nursing in Ireland until 1980s (Robins) Chapter 3: the future direction.. Chapter 4- regulation of the profession Recommends a new structure, greater ownership by profession, protection of public central, scope of practice framework required, Examine prescribing guidelines, Midwifery- return of a statutory committee

10. Chapter 5: Preparation for the profession History- apprenticeship, diploma, degree Discussion of relative merits Generic vs branch/specialist programmes Recommended degree programme Implementation to be planned by a forum One year continuous placement Planned intake for 2002 Entry- Leaving Cert + interview Centres for nurse education

11. Professional development Recommendations: National Council Regional P & D Units Clinical career pathway Clinical nurse/midwife specialist Advanced nurse/midwife practitioner (vs specialist nursing/midwifery) Nursing & midwifery research Funding, strategy

12. Chapters… Role of nursing in health service management 3 grades Clinical nurse/Midwife manager I, II (ward/unit), III (department) Nursing in the community Nusing care of older people Mental handicap and sick children’s nursing, midwifery “Other issues”- retirement, bullying…

13. Final chapter… Implementation of recommendations of Commission All to be implemented by end 2002 Regulation New legislation by end 1999 (still awaiting) Care assistants entry working group Preparation Education forum, CAO, 2002 degree Professional development Council, specialist posts Nurses’ role in management Chief Nursing Officer, NMPDUs

14. Implementation of recommendations? Establishment of a monitoring committee recommended in report Nurses’ strike in October 1999 Settlement- Priority Action Plan for the implementation of core recommendations during 2000 and 2001 Monitoring Committee established 1 Feb 2000 First report in 2001- reports on 2000 1998/1999 Establishment Forum, Resource Steering Group, CPC and PDC posts permanent, HRB budget for nursing, Council established, more advisors DoHC

15. Implementation- key points 2000 Regional NMPDUs: Units not yet fully operational- concern to Committee Pilot direct entry midwifery programme 2001 Approval for degree education Clinical pathway posts approved Steering group- strategy for community nursing/midwifery Transfer to CAO 2002 CN/MS posts- 1416 by end 2002 Nursing and Midwifery Resource final report Degree started

16. Summery of the Commission with recommendations for An Bord Altranais A need for the nursing profession to take greater responsibility for its own regulation and practice A more pro-active professional leadership role whilst ensuring the protection of the public. Give the Board a more distinctly independent identity Revise membership of the Board Review of the Fitness to Practice Procedures Need to recognise Midwives as distinct identity and concerns-statutory midwives committee within the Board

17. Conclusion Process Content Outcome

18. References: Carroll, M. (1998) Report of The Commission on Nursing. A blueprint for the future. Government of Ireland, The Stationary Office, Dublin