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Professional self-governance

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A recent case in England has highlighted issues concerning professional self-governance from a medical perspective. Known as the Bristol case, it has emerged that several medical colleagues were aware of an increasing incompetence amongst at least one if not two paediatric heart surgeons. Although this appears to have been common knowledge amongst several medics in the area, no-one actually spoke out and suggested that the individual stopped practising or received staff development. It is particularly interesting that in the hospital group concerned, the Chief Executive was a doctor who had formally been a consultant colleague of these doctors. This case has hit the headlines in England and served to undermine the public's confidence in self-regulation of healthcare professionals.

Historically in the United Kingdom self-governance of the nursing profession has been accepted as a right. Yet it is important to remember that the prime reason for the existence of self-governing bodies is to protect the public from disreputable professional practitioners and not to provide a `cosy' system for regulation of practitioners by practitioners. The need to protect the public is made explicit in the approach to self-regulation enshrined in the rules and regulations of the United Kingdom Central Council for Nurses, Midwives and Health Visitors (UKCC).

It should be noted that cases reported to the professional conduct or health committee at the UKCC are probably only the `tip of the iceberg'; the vast majority of problems that arise in nursing are dealt with satisfactorily by employers and nurses themselves. Many nurses take self-regulation seriously and report when they are unfit to practise. In such cases an individual nurse concerned about their incompetency to practise as a result of ill health reports this to their employer. For example, where an individual has stated that they have developed a psychotic illness, it is up to the employee's occupational health department, the employee and the employer to sort out the most appropriate way forward. In many instances the individual practitioner may be able to continue to nurse but not necessarily in the environment where they have been practising. When individuals declare a health problem it is beholden on the employer to attempt to find alternative work while protecting the public as appropriate. In these situations resolutions must be sought swiftly in order that the employee and the public can be protected. Where such cases are effectively managed they are never referred to the UKCC and rarely publicized.

The most positive scenario in the future would be for every clinical nurse to recognize not only their `duty to themselves' and their patients and clients in terms of professional regulation, but also their duty to the colleagues with whom they work. If individual nurses more frequently tried to help colleagues whom they observed to be in trouble, either through incompetence or ill health, self-regulation of the nursing profession might be seen by the public to be more effective.

Throughout the world nurses are accountable for each others' practice in that all nurses recognize the need to protect the public from harm. The most effective way of doing this is to take the trouble to assist a nurse with whom you are working when early warning signs become apparent. If doctors in Bristol had been prepared to act in this way (a small proportion did) it is likely that fewer children would have suffered as a result of what is now recognized as incompetent surgical practice. Incompetent nursing practice is more difficult to measure than interventional surgery, but most nurses are aware of situations where they have observed inappropriate care. It is our professional duty to ensure that we define self-regulation from a personal perspective as involving not only our own practice but also that of our colleagues in order to ensure that the highest standards of care are delivered to the public.

Unless nurses take this day-to-day self-regulation more seriously, the public may soon demand the end to professional self-regulation. They may require nursing and other healthcare professions to be regulated through a process that involves a more publicly accountable legislative framework, with members of the public and employers being involved in making decisions about the rights of nurses to maintain registration.