The Enigma of Nursing Regulation
An enigma is a riddle, mystery, or puzzle that many find like a maze or labyrinth of statutes and rules as it relates to nursing regulation and the protection of the public for the safe practice of nursing. What most nurses feel is excitement and elation when the notice arrives from their designated regulatory body that they have successfully passed "state board" examinations to be a registered nurse. Today with National Council Licensure Examination (NCLEX) and compact licensure, the system of assuring the public that a nurse is truly a safe practitioner becomes more complicated, with attempts to ensure uniformity and constancy in the regulations for the safe practice of nursing.
In the past, Nursing Administration Quarterly addressed regulatory practice issues in 2 sequential volumes-Vol 9:2 (Managing the Troubled Nurse) and Vol 9:3 (The Troubled Nurse: Management Strategies). In the era of 1980s' nursing administration practice, a regulatory body was usually not contacted until there was a problem with a practicing nurse, more often a substance abuse and misuse situation. In 2006, Nursing Administration Quarterly added a Regulatory Issues column by Randy Hudspeth so that nurse executives and managers could keep abreast of the many ways our regulatory agencies assist us in providing safe practicing nurses to the public.
The Enigma of Nursing Regulation is long overdue and the guest issue editor is Randall Hudspeth, MS, APRN, CNS/NP, FRE, FAANP, director of advanced and specialty practice, Saint Alphonsus Regional Medical Center, Boise, Idaho. He is a fellow in the Institute of Regulatory Excellence, sponsored by the National Council of State Boards of Nursing; has served as the chair and vice chair of the Idaho Board of Nursing, appointed by the governor; and serves on the National Council of State Boards Advanced Practice Registered Nurses (APRN) Committee. He was instrumental in spearheading the changes in the Idaho Nurse Practice Act to remove the requirement for physician supervision of advanced practice registered nurses.
As a nurse administrator, he belongs to the American Organization of Nurse Executives and American Nurses' Association and is a member of The National Association of Clinical Nurse Specialists as well as a fellow of the American Academy of Nurse Practitioners. As a nursing student, he was elected to be the Editor of Imprint from 1975 to 1976. Randy's positive energy and leadership for nursing oftentimes find him "overengaged" and reports that there are more commonalities in licensure, standards, and the scope of practice, which will continue to expand our horizons in the international nursing workforce.
In a recent international meeting in Doha, Qatar, from March 23 to 27, 2008, sponsored by the Qatar Foundation and the Fulbright Academy of Science and Technology, Human Health and Environmental Challenges in the Middle East, which I was privileged to be invited to participate in, most Middle East countries indicate that nursing regulation is not the customary practice. In fact, a representative from Beirut, Lebanon, Dr Huda Abu-Saad Huijer, director, School of Nursing, American University of Beirut, discussed the Order of Nurses in Lebanon as a model for other Middle East countries to begin their indigenous regulation of nursing practice. They have developed the scope of practice for nursing in line with internationally recognized developments and taken into consideration the healthcare needs of the country. A revised nursing law that regulates nursing practice has been proposed that includes 3 categories-nurse, specialist nurse, and nurse assistant. This includes the roles, responsibilities, and activities that nurses engage in on the basis of educational preparation and professional competencies.
In developing a white paper for the conference, Current Reflections on Saudi Nurses, a Social Stigma, I acknowledged that although nursing has not been able to establish a regulation of practice, progress has been made in that King Abdullah is now allowing "associations by petition," so Saudi nurses are now in the process of forming the Saudi Arabian Nurses Association. Saudi nursing, as a recognized regulated profession, is in its infancy as is the regulation of nursing in many other countries. The World Health Organization and the International Council of Nursing welcome the opportunity to assist nurse leaders to establish the regulation of nursing practice, wherever requested to participate.
As I reflect on more than 50 years of nursing practice, I have had so much support from the Wisconsin State Board, especially in leading Alverno College, Department of Nursing, to regain its accreditation and also in developing programs to assist "troubled nurses" during my tenure as a nurse administrator there.
To practice in a country where there is no regulation, except that determined by the employer-as in my tenure as associate executive director at the King Faisal Specialist Hospital and Research Centre, in Riyadh, Saudi Arabia-is like leading a tossing and lurching ship through a tumultuous storm, without a lighthouse beaconing to find the course to shore:
Safe Patient Care and Safe Nursing Practice.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP, Editor-in-Chief
Nursing Administration Quarterly