The Report of the Commission on Nursing proposes a radical restructuring of the profession to ensure nurses are better trained, more skilled and adequately rewarded. It says the changes should be implemented over four years and a monitoring committee set up to produce annual reports on progress.
While it says that nurses enjoy the confidence of patients and an international reputation for professionalism, a new framework is needed to cope with the changing nature of society and the health services. It proposes restructuring An Bord Altranais to make it more representative of the profession and more independent of the Minister for Health. The report proposes that the number of ministerial nominees should be reduced from 12 to three and the board should also have the option of nominating up to four people from specified categories, to be appointed by the Minister.
The board itself should amend its fitness to practise procedures, which the commission characterises as "inflexible and excessively legalistic". Because midwifery has a distinctive focus, the commission recommends the establishment of a statutory midwives committee within the board.
However, the commission believes that An Bord Altranais should lose some of its current responsibilities in the education and development area. A National Council for the Professional Development of Nursing and Midwifery should be set up to oversee specialist training.
It proposes that nurse education should move to full degree status. It identifies a number of flaws in the old "apprenticeship on the wards" model, although it stresses the importance of practical experience. It says that the current college-based diploma course should be developed into a four-year degree programme with one year spent on the wards.
Students would receive 80 per cent of the basic staff-nurse salary while on placement and after graduation would begin working on the second point of the staffnurse scale.
But it is in the area of career development for qualified nurses that the commission makes its most wide-ranging proposals. It recommends the creation of a clinical nurse or midwife specialist. This means that nurses who obtain additional qualifications, skills and relevant experience in these areas should be put on salary grades equivalent to ward sisters.
Nurses with clinical practitioner skills should also be eligible for promotion in a clinical capacity. Nurses and midwives with these advanced clinical specialisations should be placed on grades equivalent to those of assistant matrons.
The aim of both proposals is to keep highly-skilled nurses who want to work with patients on the wards, rather than see them skimmed off to management positions.
It also proposes that more responsibility be devolved to ward sisters, who should be redesignated as clinical nurse managers (CNMs). Grade I CNMs would be the equivalent of junior ward sisters, Grade II CNMs would be the equivalent of senior ward sisters and Grade III CNMs would be a new grade to reward sisters operating in larger and more demanding units.
