Why should nurses care about regulation? Because through regulation there is the power to shape nursing. If we, as experts in our field, set out our own universal standards of excellence in education and practice, then we can influence what nursing can contribute to health care across the globe.
Workforce regulation has become an important political and social issue in our time and health care is one of its key target areas. The debate rages as to what should be regulated; how it should be done; and who should do it. In recognition of this, the International Council of Nurses (ICN) embarked on an international regulation project in 1987, involving nurses from over 80 countries. What was learned from project participants, and from the growing interest of governments and other groups, led ICN to establish regulation as one of its three pillars, alongside practice and the socio-economic welfare of nurses.
Over the past two decades, the World Health Assembly has called on governments to strengthen nursing regulatory frameworks in order to deploy the nursing workforce more effectively. Recently, ICN and the World Health Organization (WHO) joined forces and issued a ‘futures perspective’ statement on nursing regulation (ICN & WHO 2005) This statement repositions professional regulation in the light of international developments in the field and reaffirms that self-regulation should continue to underpin 21st-century regulatory systems for nursing.
But with the privilege of self-regulation comes the responsibility of maintaining relevant, coherent and cost-effective regulatory policies and practices that draw on good practice and available evidence of their efficacy. To promote appropriate and effective professional regulation globally, a new initiative spearheaded by ICN and the International Confederation of Midwives will increase collaboration among national regulators as well as provide multiple possibilities for sharing and working together. ICN will provide an early-warning system thorough the ‘Observatory on Licensure and Registration’ that will seek to anticipate and respond in a timely, appropriate manner to international regulatory developments by providing leadership for influencing policy on global regulatory matters.
We also should be aware of potential difficulties. Achieving even a small a degree of self-regulation is not easy in countries where regulation is civil service-based and bureaucratic. In such systems, advancing standards for nursing care and professional development tend to be low priorities. Besides, how can self-governance be accomplished when nursing itself is too often poorly organized, and when differences in power, status and education in relation to other healthcare professions render nursing invisible, inarticulate and separated from the decision-making process? Furthermore, how can self-regulation be achieved in highly centralized government systems, or ones dominated by powerful interest groups?
Where the privilege of self-governance already has been acquired, nurses need to be vigilant to protect that achievement. With international bodies (e.g. World Trade Organisation) and regional organizations (e.g. the European Union) seeking to facilitate the movement of goods and services between countries, professional regulation inevitably will fall under their scope of interest, especially if it is seen to restrict these freedoms. Increasing commercial and international interests in fields such as education, health care and credentialing, attract even more groups seeking to influence the regulatory process. The danger is that, although a decision may make perfect commercial sense, it may not necessarily promote quality of service nor strengthen national systems of public protection.
Professional organizations and regulators are already grappling with maintaining standards in the face of ever-larger numbers of nurses seeking licensure in jurisdictions other than the ones in which they hold a license. Also affecting regulation are cross-jurisdictional issues that arise from cross-border practice. How do we regulate international telehealth health services and e-education programmes that provide professional qualifications when the recipient is situated in another jurisdiction (ICN 2000)? To govern successfully our own profession we need to be positioned to provide co-ordinated responses that outline feasible criteria for mutual recognition processes, and create the mechanisms that allow portability of qualifications.
But self-regulation does not live up to its promise when it fosters professional self-interest; when it is carried out behind closed doors; and when it maintains structures and privileges that are unacceptable in the current climate. Our challenge is to demonstrate the value of professional regulation to an increasingly sophisticated public, and show our commitment to pursuing professional excellence while providing assurances about the qualifications and competence of individual nurses.