Nursing and Midwifery Regulation

• Regulation of nursing and midwifery is important
• The Nurses and Midwives Act is covered
• The lecture covers various aspects of professionalism and regulation in nursing and midwifery
• It also discusses social media's impact and the importance of handling complaints

Definition of a Profession

• Mastery of complex knowledge and skills is the core element
• It is a vocation rooted in science, learning, or art used in service of others
• Members adhere to codes of ethics and commit to competence and integrity
• It includes promoting the public good
• The basis is a social contract between the profession and society
• The profession gains a monopoly over its knowledge base
• It also gains autonomy in practice and self-regulation
• Professions are accountable to those they serve and to society

Elements of Professional Regulation

• Registration determines who can enter the profession
• This also determines what those who enter might look like
• Codes and guidelines dictate professional conduct
• Complaints and notifications set criteria for exclusion from the profession
• Accreditation oversees the preparation of entrants into the profession

Numbers of nurses and midwives to 2022

• In 2022, the total number of nurses/midwives was 43,772
• 27,512 worked in public institutions
• 11,489 worked in non-public
• 4,771 were not in active practice.
• The nurse to population ratio was 1:129
• There were 7.8 nurses per 1,000 population

Numbers of registered nurses and enrolled nurses to 2022

• In 2022, there were 36,995 registered nurses
• 23,720 were public
• 9,606 were Non-Public
• 3,669 were not In Active Practice
• In 2022, there were 6,715 enrolled nurses
• 3,767 were public
• 1,857 were Non-Public
• 1,091 were not In Active Practice

Regulation of Health Professionals

• Regulation is part of administrative law, acting as a "protective jurisdiction"
• Professional self-regulation aims to safeguard and champion patient safety
• Achieved through:
• Standard setting to ensure qualified individuals enter the profession
• Advice and guidance for competent and ethical practice
• Mechanisms to protect the public when practitioners are incompetent or unethical

Singapore Nursing Board (SNB)

• The SNB regulates nurses and midwives in Singapore
• The Nurses and Midwives Act (Chapter 209) defines its scope and functions
• These including registration, enrolment of nurses, registration of midwives and certification of Advanced Practice Nurses.
• World-Class Nursing for a Healthy Nation is the vision
• Its mission is to uphold Professional Nursing Standards and Honour the Public Trust
• The values are Compassion, Commitment, Integrity, Professional Excellence, Respect, and Transparency

Nurses & Midwives Act: Functions of the Board

• Approving or rejecting applications for registration, enrolment, and certification
• Issuing practising certificates
• Accrediting courses and institutions in Singapore for nursing and midwifery education
• Regulating standards for training and education
• Regulating the standards and scope of practice
• Regulating professional conduct and ethics
• Performing necessary actions authorized under the Act

Definition of "Act of Nursing"

• Observation, care, and counsel of the ill, injured, or infirm
• Maintenance of health or prevention of illness
• Supervision or teaching of nursing
• Requires skill and knowledge from an accredited nursing course or equivalent
• A "qualified nurse" is a registered or enrolled nurse with a valid practicing certificate

Protecting Titles of Nurse and Midwife

• It is illegal for unqualified individuals to use the titles "nurse" or "midwife"
• The act prevents unqualified people from practicing or being employed as nurses/midwives
• A nurse's agent cannot arrange for an unqualified person to perform nursing acts

Standards, Competencies, and Codes

• Registration standards and endorsements is part of regulation
• Core competencies, the New SNB Code, Professional boundaries document, and Social media advice also play a part

Codes and Guidelines

• Codes and guidelines help decide who enters the profession
• Considerations determining entrance include:
• Physical and mental well-being
• Fitness to practise
• Prior educational experience
• Educational qualifications
• Language proficiency
• Criminal record checks
• Professional indemnity insurance
• Recency of practice
• Age of entry

Professional standards includes:

• Sets of competencies, generic skills, and other standards required for entry and ongoing practice
• Codes of conduct and ethics
• Professional guidelines

Core Competency Standards

• Singapore Nursing Board's Core Competencies exist for Registered Nurses
• This set of standards defines the qualities, attributes, and skills for RNs in Singapore
• Core Competencies supplement the Standards of Practice for Nurses and Midwives, defining the minimum performance level at entry
• Core Competencies are applicable in all practice settings
• The Core Competencies sets the foundation for RNs to maintain their competence
• It also sets the foundation to acquire additional competencies or advanced clinical skills to deliver safe client care
• This is in response to healthcare needs and technology
• The Core Competencies are organised into 4 domains:
• Professional, Legal and Ethical Nursing Practice
• Management of Care
• Leadership and Nursing Management
• Professional Development

Generic Skills

• Generic skills are skills registered nurses (RN) must perform upon entering practice in Singapore
• Core Competencies and Generic Skills together define the requirements for RN registration
• Organized into categories and specific skills to ease assessment

Code for Nurses and Midwives

• The Code is a set of guiding principles on :
• Professional conduct
• Ethical values
• Practice standards
• Registered nurses and midwives in Singapore act upon and uphold the code
• The Code aims to safeguard the interests and safety of people
• It also aims to ensure nursing/midwifery practice is safe and effective
• Finally, it promotes public trust
• Nurses and midwives commit to upholding the professional requirements set out in the Code upon registration/enrolment

Code of Ethics - Key Areas of Focus

• Nurses/Midwives and People
• Respecting values, needs, and rights
• Promoting autonomy
• Maintaining confidentiality and privacy
• Advocating for the best interest of people
• Nurses/Midwives and their practice
• Practicing in a responsible and accountable manner
• Maintaining competency
• Keeping accurate records
• Nurses/Midwives and their profession
• Promoting professionalism and public trust
• Practicing self-regulation
• Nurses/Midwives and co-workers
• Working collaboratively with the healthcare team

The code principles relating to professional practice are:

• Practice in a responsible and accountable way
• Maintain your competence in patient care
• Practice self-regulation
• Collaborate with all members of the healthcare team

Guidelines on professional boundaries

• Professional boundaries mark the space between the nurse's/midwife's power and the client's vulnerability
• Boundary crossings are brief, inadvertent excursions across professional lines of behaviour
• Boundary violations can occur if the needs of the nurse/midwife and client is confused
• This includes the use of social media and professional sexual misconduct
• Every nurse-client relationship can be plotted on the continuum of professional behaviour

Nurses/Midwives Responsibilities

• Practice in a manner consistent with professional standards
• Be knowledgeable about professional boundaries
• Work to establish and maintain those boundaries
• Examine any boundary-crossing behaviour and seek assistance and counsel from their colleagues and supervisors

Red Flag Behaviours

• Signs of inappropriate behavior include:
• Discussing intimate issues with a client
• Flirting
• Keeping secrets with a patient
• Feeling they are the only one who can help
• Spending too much time with the client
• Disparaging colleagues
• Showing favoritism
• Meeting outside of care settings
• Having inappropriate social media use

Guidelines For Social Media Use

• Be aware of the benefits and risks
• Maintain professionalism
• Keep your personal and professional life separate
• Protect confidentiality
• Do not share client information
• Set and maintain privacy settings
• Follow employer policies
• Ensure accountability

6 social media Ps

• Professional
• Positive
• Patient/Person-free
• Protect yourself
• Privacy
• Pause before you post

Managing complaints includes:

• Competence
• Impairment
• Conduct

Managing Those Who Breach Standards

• Breaches may be due to:
• Lack of competence
• Impairment (physical or mental illness, disability, addiction)
• Conduct matters (unsatisfactory professional behavior or misconduct)

Singapore Nursing Board (SNB) accountability

• Nurses and midwives are held accountable under the Nurses and Midwives Act
• Nurses and midwives are required to maintain appropriate standards of professional conduct
• The 'disciplinary' provisions are professional conduct, impairment and professional performance provisions (Part VI) of the Act

Professional Misconduct

• Any act or omission that deviates from the Code of Ethics
• Abuses the professional relationship with a client
• Brings the nursing profession into disrepute

Cancellation of Registration

• The Board may cancel registration if a nurse/midwife:
• Obtained registration fraudulently
• Contravened specific sections of the Act
• Had registration cancelled or suspended elsewhere
• Was convicted of an offense rendering them unfit
• Was guilty of misconduct or negligence
• Is unable to perform functions due to mental or physical disability
• Has not renewed their practising certificate

Considerations in Making Determinations

• Insight into actions
• Genuine contrition
• Honesty
• Willingness to assist disciplinary body
• Previous records and references
• Requirements of legislation
• Contemporary policy and practice
• Circumstances

Examples of Fitness for Practice

• In 2017, A Registered Nurse was arrested for consumption of Amphetamine and/or Methamphetamine
• The registration was suspended for 9 months
• The nurse was to provide an undertaking to the Board, stating that she does not intend to, and would not, consume controlled drugs in the future
• In 2020, an Enrolled Nurse submitted a false fraudulent Notarial Translation of her Registration Certificate
• Her enrolment was cancelled
• In 2019, a Registered Nurse falsely charted parameters of patients
• The nurse did not enter patient’s room to take the patient’s parameters
• Registration was suspended for 8 months

Accreditation

• Education providers and key professional stakeholders agree to those standards
• Has significant effect on curriculum development in new core competencies and generic skills documents

Education Committee Functions

• Make recommendations to the Board regarding accreditation of courses for registration/enrolment
• Make recommendations regarding accreditation of courses that give qualifications beyond registration/enrolment
• Consider applications for accreditation and advise the Board
• Make recommendations to the Board about accrediting institutions
• Make recommendations about the training and education of nurses and midwives

In conclusion

• Professional regulation: More than just registration
• Four elements protect the public from unsafe practitioners
• You can only practice as a nurse because of regulation
• You must comply with the legislation