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Interview - Above board

Protecting the public and the professional development of nurses and midwives are the main concerns of NMBI president, Paul Gallagher. Interview by Gillian Tsoi

Protecting the public is a main area of focus for Paul Gallagher in his role as president of the Nursing and Midwifery Board of Ireland (NMBI), the regulating body for nursing and midwifery in Ireland.

Mr Gallagher is also director of nursing at St James’s Hospital in Dublin and was elected as president of the NMBI in April 2013. He says that since then, he has received “fantastic“ support from his fellow Board members, who have been on a “steep learning curve“ since coming together.

The new Board was established in March 2013, after An Bord Altranais changed its name to ‘Bord Altranais agus Cnáimhseachais na hÉireann’, or, ‘Nursing and Midwifery Board of Ireland’ in 2012.

Paul Gallagher is president of the NMBI and director of nursing at St James’s Hospital, Dublin

“We have a Board that is gelling very well and we are working very cohesively together, and this makes my role as President a lot easier. Our main focus relates to enhancing protection of the public, and this is a distinct requirement of our new legislation,’ said Mr Gallagher.

The Board consists of 23 members and, for the first time, has a lay majority. Eight registered nurses and midwives were elected by the professions. They represent general, children’s, psychiatric, intellectual disability and public health nursing, midwifery, the education and care of older people, and a nurse and midwife educator.

The Minister for Health, Dr James Reilly, nominated Mr Gallagher to the Board. With its primary goal of protecting the public, the NMBI has established three statutory committees as follows:

  • Preliminary Proceedings Committee
  • Fitness to Practise Committee
  • Midwifery Committee.

The establishment of the Midwifery Committee on a statutory basis was prompted by the introduction into legislation of the Nurses and Midwives Act 2011. The Act, for the first time, clearly defined the role of the midwife as having a separate, unique function to that of a nurse.

Other committees of the NMBI include:

  • Education and Training Committee
  • Ethics Committee
  • Registration Committee
  • Audit and Finance Committee.

According to Mr Gallagher, the various committees allow the Board to carry out its work, while also helping to develop and enhance the roles of nurses and midwives. He said: “When setting up our Committees we publicly sought input from nurses, midwives and lay persons, who were not Board members, to participate on our committees. We received an excellent response and many of these people are now on our committees, contributing their expertise to the Board.

“This initiative has also fostered the active participation of nurses and midwives, from a wide range of practice environments, in all areas of Board business.”

Role of the NMBI

The main role of the Nursing and Midwifery Board of Ireland is to:

  • To establish and maintain a register of nurses and midwives
  • To provide for the education and training of qualified, and student, nurses and midwives
  • To give guidance to the professions
  • To manage the Careers Centre, which was set up in 1998 to facilitate a centralised system of processing and selection of applicants wishing to enter nursing or midwifery; to promote and market nursing and midwifery as careers; and to provide career information to registered nurses and midwives
  • To consider complaints against nurses and midwives

Mr Gallagher continued: “There is a lot of work involved in terms of ensuring that we focus on enhancing the protection of the public and this is a distinct requirement of the Nurses and Midwives Act 2011. We also have a responsibility to support and enable nurses and midwives throughout the country to do their job. The Board is responsible for ensuring that the necessary regulatory structures are put in place to help nurses and midwives to provide care at the highest possible standard.

“This gives the public a level of assurance in terms of their safety, that when they come into a hospital, or they are being cared for by a nurse or a midwife in the community, that the care they receive is provided at the highest level and the highest standard.’’

The INMB and the INMO collaborated with SIPTU and the Psychiatric Nurses Association (PNA) to produce this social media guide for nurses and midwives

Increasing visibility
According to Mr Gallagher, the NMBI is working to increase its visibility among nurses and midwives, and to change the traditional view of registrants towards the Board. “We are very conscious that there is a requirement for the Board to proactively engage with registrants and we have been meeting with all grades of staff throughout the country in this regard.’’

To date, this engagement has included a national consultation process relating to the draft Code of Professional Conduct and Ethics, which is being managed by the Board. Nurses, midwives and the general public actively debated and provided feedback in relation to this important document.

According to the NMBI president, it is important that both registrants and members of the general public are given opportunities to engage with the Board so that their views and opinions are heard.

He said: “We are open to receiving any comments, letters or otherwise, from anyone out there, especially from nurses and midwives, that will help us to do our work more effectively.’’

In recent months, the NMBI has commenced discussions with directors of nursing and midwifery to gauge what they, and other registrants, want from the Board in terms of additional support and guidance. “We are using engagement with directors of nursing and midwifery as an opportunity to look at developing guidelines for them which is a very new focus for the Board and will be progressed during 2014.”

Nurses and midwives are also encouraged to attend Board meetings that are held in public. “This is also another opportunity for nurses and midwives to come and hear what we do and it is important for them to know what we’re about.’’

Social media guidance
The NMBI recently worked in collaboration with the INMO, the Psychiatric Nurses Association (PNA) and SIPTU, in drawing up a guide for nurses and midwives on the appropriate use of social media. The guide was launched by the Minister for Health, and includes top tips for the use of social media and social networking.

Mr Gallagher said: ‘If you use social media, keep it separate from your profession, keep it positive and most importantly, keep it patient/client and colleague free!’

Tackling lack of resources
According to Mr Gallagher, the NMBI is acutely aware of the issue relating to resources and staffing in the daily working lives of registrants. He believes that the advancement of the continuous professional development (CPD) framework through a competence assurance scheme will be an important initiative by the Board in helping nurses and midwives to work more efficiently and safely under such conditions.

The Board has been looking nationally and internationally at CPD models and has also consulted with the Irish Medical Council and the Pharmaceutical Society of Ireland with regard to competency frameworks that have been introduced. Mr Gallagher believes that nurses and midwives are aware that they have a personal responsibility for their own professional development, and will welcome the establishment of a framework that meets the specific needs of nurses and midwives.

The process of creating this new CPD framework, which will be “as practical as possible” for registrants, is an essential component of the Nurses and Midwives Act 2011. “I think it is really important that there is a partnership approach taken between the Board and registrants to introducing this important initiative,” said the NMBI head.

Supporting students
The NMBI serves a very important role in relation to the education of nurses and midwives in Ireland. Mr Gallagher said that “international regulators are very envious of the Irish model of education.”

The NMBI regulates the education programmes for both undergraduate and postgraduate registration courses and this includes site inspections and reviews of third level colleges and the health service providers that they are partnered with.

“This system is important in maintaining a high standard of education for the nursing and midwifery professions in Ireland. The link between the lecture theatre and the bedside is fundamental and the role of the NMBI in this regard is essential.”

The INMO believes that the solid support of nursing and midwifery students is vital, considering the current issue of overcrowding and understaffing in hospitals nationwide. The president of the Board said it is taking the necessary steps to ensure that appropriate supports remain in place in the clinical setting to assist students as they pass through the four-year degree programme.

“In terms of the clinical placements, the supports that are available for our students are essential and these must be maintained.”

WIN asked Mr Gallagher:

  • Are there enough clinical placement coordinators available?
  • Are there enough staff nurses available
  • Are there other specific models of care that are put in place to support student nurses through their training and education?
  • Does the model of care reflect what is required from an education and standards perspective from the respective undergraduate programme?

He said that all of these essential requirements for undergraduate education are considered by the NMBI to ensure that the student experience is of the highest standard so that the overall result is a competent nurse or midwife who has developed the necessary skills to fulfil their roles to the required level.

Increase in the annual retention fee
“The Board deliberated and discussed at significant length the matter relating to the Annual Retention Fee (ARF) before a decision was made to increase it by €12 per year,” said Mr Gallagher.

He stated that the main reason for the fee increase was based on the requirement to support the introduction of the Nurses and Midwives Act 2011, which also includes the development of the CPD framework and competence assessment scheme.

“The legislation is a very important driver for how we do our work, and is the main reason for the increase in the ARF,” he said. “The CPD process is an enormous piece of work that is going to change the mindset of registrants regarding how they must focus on their own personal and professional development.”

Defining professional misconduct
The consultation process for the draft Professional Code of Conduct and Ethics ended in January. One of the concerns of the INMO and its members about the proposed Code is that it does not include a definition of ‘professional misconduct’.

Even though professional misconduct is a ground on which a nurse or midwife can be subject to a complaint to the NMBI, Mr Gallagher said that this important matter requires further discussion and clarification before the final document is published.

“We don’t want the code to be perceived as being a negative piece of work because it’s something that should enable and support nurses and midwives to carry out their professional duties,” he said. “It is a matter that will hopefully guide, direct and influence what we do in terms of standards of practice and the NMBI wants to present this in a very positive light.”

A pull-out that appeared in a recent issue of the NMBI newsletter, Regulation Matters (also available at www.nmbi.ie), provides guidance to registrants on the procedure that occurs when a complaint is made against a nurse or midwife. The document includes details relating to the nine grounds for complaints, including issues of professional misconduct, poor professional performance, and noncompliance with the Code of Professional Conduct.

Developing a database
Given the more sophisticated roles that now exist in the professions of nursing and midwifery, an advanced database is being progressed by the NMBI. It is hoped to update their current database of registrants to include details of education, training and specialties.

“It’s very clear that our IT systems can be improved,” Mr Gallagher said. “One of the drivers for the increase in the fees is to ensure that we have suitable IT system that will enable us to do our work better and will enable us to have all of the data, in terms of education, training and the numbers of people on the register.”

He continued: “That will enable us in part to have an IT system that will allow us to gather all of this information and have access to real-time data about nurses and midwives. When finalised, the new system will be user friendly and will be a marked improvement for both the NMBI and registrant.”

Mr Gallagher will fill his role as president of the NMBI for a minimum of three years. At the moment his prime objective, and that of his fellow board members, is to implement the provisions of the Nurses and Midwives Act 2011 in good time.

He said: “We are really doing everything in our power and working very hard to engage with nurses and midwives and also to introduce the legislation in as timely a manner as we possibly can.”

Nurses and midwives throughout Ireland will wish him well in his role as president of the NMBI.

Interview - Above board


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