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NURSE LICENSURE AND REGULATION IN SOUTHERN AFRICA: A SHARED HISTORY AND A BRIGHT FUTURE
Leah Hart Peter Johnson Sunday, May 19, 2013 Room 208

Objectives:
Define professional regulation, regulators and the impact of regulation Discuss the current regulatory environment in Southern Africa Briefly describe the history of NEBBLS in Southern Africa Describe task analysis as a tool for regulatory strengthening
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Definition of professional regulation:

All of those legitimate and appropriate means (whether government, professional, or privatedriven) whereby order, consistency, identity and control are brought to the profession
Affara and Styles 1999

The impact of regulation:

Defines the profession and its members Determines who can be admitted into an education program Designates who can practice (through registration and licensure) Determines scope of practice Influences curriculum, job descriptions & deployment policies
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What gets regulated?

Individuals providing healthcare services

Healthcare service delivery

Educational programs and agencies

Who are the regulators?

Governments Registrar Professional bodies
Councils Boards Associations

MOH logos for Swaziland, Lesotho and Botswana

The aim of regulators:

To protect the public They do so by
Monitoring those providing services in order to assure

quality care

Why a recent global interest in professional regulation? Mobility of the global population nurses may want to practice outside the original area of licensure

Global nursing shortage, impacting ability to fulfill Millennium Development Goals

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Workforce planning:
A register can be an important source of data for those who are trying to address workforce needs Dealing with a diverse workforce: generalist nurse, auxiliary nurse, nurse-midwife, etc. The emergence of advanced practice with competencies shared across disciplines (leads to blurring of accountability)
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An up-to-date nurse register is an important resource:

Outdated, ineffectual registration system

Inappropriate Deployment of Nursing Workforce

Health care needs of a country are not met

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Global trends in nursing regulation: Greater sophistication in standards setting, accreditation, assessing continued competence GATS encouraged mutual recognition agreements and standardization Common international/regional competencies (e.g. ICN, ICM, WHO, Western Pacific, ESCACON, EU)
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Whats the deal with nursing regulation globally? ICN Regulation study in 1985 concluded that the laws related to nursing practice in 106 countries reflected poorly defined profession and diverse roles Inadequate definition leads to inadequate governance

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Whats the history of nursing regulation?

Since the 1800s Profession of nursing did not see itself having a role in its own regulation or education left others to decide who was a nurse and what could they do? Nursing classes were given by physicians and Boards of Physicians regulated the nursing profession
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The Nursing Examination Board of Botswana, Lesotho and Swaziland (NEBBLS):

Licensed nurses (via written exam) for twenty years, starting in 1964 When it disbanded, the countries were left to create their own regulatory mechanisms for nurses and midwives

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The challenge for nursing councils:

Regulate, but not too rigidly Well-designed regulatory systems can allow flexibility in how a profession practices according to what makes sense (what new diseases have emerged, what new qualifications have emerged, etc.)

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Jhpiego partnering with nursing councils:

Build the capacity of regulators with projects that focus on improving:
Licensure Registration Accreditation

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Nursing and Midwifery Council of Botswana (NMCB): Requested Jhpiegos assistance creating a nurse licensure examination Current practice: register nurses upon receipt of PSE graduation documentation Goals: to create a written MCQ exam for new graduates and an OSCE for foreign trained nurses, to test competency of experienced nurses
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Lesotho Nursing and Midwifery Council:

Partnering with MOH to improve regulation and education practices With to strengthen:
New graduate mentorship Pre-service and In-service curriculum Deployment practices Nurse licensure examination content
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Task Analysis as a Tool for Regulatory Strengthening: Jhpiego has conducted a task analysis with nurses in Botswana to provide an up to date database upon which licensure exam questions can be based
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Partnering within the region:

Botswana Jhpiego team hosted Lesotho Jhpiego team conducting task analysis to observe data collection activities for the Botswana nursing task analysis Applied lessons learned to the Lesotho task analysis study

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Task Analysis as a Tool for Regulatory Strengthening: Nursing task analysis and social development cadre task analysis currently happening in Lesotho

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In conclusion:
Nursing regulation is an important consideration in global health systems strengthening After a long history of lack of nursing self regulation, since the 1980s, nursing councils have taken a strong role in nursing regulation in Southern Africa Jhpiego has used task analysis to help strengthen the regulatory environment in Southern Africa
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Thank you for your attention!

Questions?

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