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Introduction
In July 2000, the Joint Liaison Group (JLG) with nursing executives
of the Hospital Authority Head Office (HAHO), representatives
from the Nurses Staff Group Consultative Committee (NSGCC)
and the Co-ordinating Committee in Nursing (COC(N) ) was established
to discuss on the issue of Nursing Grade Reform. After three
meetings held to discuss on the issue, the Nursing Section
of the HAHO released a Consultation Paper on Nursing Grade
Reform for staff consultation in November 2000. The paper
emphases mainly on the framework for reform, the proposed
nursing practice model and professional nursing structure
in a clinical unit.
2. For the issue of Nursing Grade Reform, the Association
of Hong Kong Nursing Staff (AHKNS) has held deliberate discussions
with our executive members, and has widely solicited our members
for their feedback and comments from November 2000 to December
2000. This paper is prepared to put forward the Association's
views together with our members' feedback to the HAHO for
consideration.
Key
Objectives of the Reform
3. The Association agrees, in principle, to the following
objectives of the reform:
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a. To rationalize the levels of professional accountability;
b. To focus on professional nursing practice on clinical
care;
c. To assure quality nursing care with improved supervision;
d. To enhance career development for nurses; and
e. To enhance productivity in the provision of patient
care services. |
Nursing
Practice Model
4. Nursing is a knowledge-based practice profession, and each
Registered Nurse is responsible and accountable for individual
nursing judgements and actions as stipulated by the Nursing
Council. Any form of nursing practice model is only a means
to facilitate the delivery of nursing care to our clients.
An intellectual understanding of model design is a prerequisite
for its successful implementation. Nursing practice model
design is the framework within which roles are defined and
clinical knowledge is required and crystallized.
5. The Association perceives the need for formalizing the
nursing practice model for a better organization of nursing
care that will lead to an increased professional accountability.
A professional is one who engages in autonomous decision making
based on an identifiable body of knowledge acquired in a formal
education program (Manthey, 1990). There are not necessary
to uniform the use of nursing practice model in all HA hospitals.
No matter which delivery system (named-nurse system, case
management or primary nursing) is adopted, the elements of
clinical decision-making, work allocation, communication and
management should be the foundation of the system. The more
clearly they are articulated, the better they will be.
Development
of Nurse Graduates
6. The Preceptorship Scheme is established to guide and coach
the newly nurse graduates and new comers to facilitate their
adaptation and socialization to work in hospital environment.
The scheme should not be used as a means to test the suitability
of individual staff, which would be the issue of human resources
policy in terms of probation.
7. To enhance the hand-on practice of tertiary nurse graduates,
the Association recommends the Hospital Authority to discuss
with the universities to offer a period of internship with
clinical rotation for student nurses before they sit for the
Registration Examination of the Nursing Council.
8. Efforts should be made to improve the post-registration
professional development of nurses, that would include adequate
accommodation for clinical placement/rotation, facilitation
to complete the training program, structured on-the-job coaching
or accessibility to healthcare information. The mechanism
of accreditation for specialty training programs and conversion
degree programs should also be established.
Professional Nursing Structure
9. To enhance supervision and accountability, the present
grading structure in a hospital can be broadbanded into 2-tier
with 5 levels (i.e. Practice Nurse and Advanced Practice Nurse
sub-divided into EN-RN-NO-SNO-CNO ranking structure). Practice
Nurses, who form the basic nursing tier, will provide clinical
services as healthcare team members under supervision, whereas
Advanced Practice Nurses, who form the supervisory nursing
tier, will provide and supervise, where appropriate, clinical
services as healthcare members or leaders. The Advanced Practice
Nurses should possess at least a nursing degree level in additional
to specialty or management qualifications.
10. ENs will be encouraged and facilitated to take up conversion
courses to acquire RN qualification according to their own
schedule. To support ENs for converting to RNs, the Association
recommends to convert some of the EN positions to RN positions
for appointing the serving ENs with RN qualification.
11. Nurse graduates from nursing schools will be encouraged
and facilitated to take up conversion degree according to
their own schedule.
12. The proposed professional nursing structure in a hospital
is:
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First
Tier: Practice Nurse
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ENs
will be encouraged and facilitated to take up
conversion courses to acquire RN qualification
according to their own schedule.
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Nurse
graduates from nursing schools will be encouraged
and facilitated to take up conversion degree
according to their own schedule.
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| Second
Tier: Advanced Practice Nurse |
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Nursing
Officer/
Clinical Teacher/
Nurse Specialist/
Ward Manager |
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| NOs
are the 1st level of nurse supervisors taking up
the clinical, supervisory or management duties in
clinical wards/units or nursing departments. Job-related
allowances will be granted to those nurses who take
up managerial and specialist function. |
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Senior
Nursing Officer
(SNO) |
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| Senior
Nursing Officer/ Department Operations Manager |
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| SNOs
are the 2nd level of nurse supervisors taking up
the clinical, supervisory and management duties
in clinical or nursing departments. Job-related
allowances will be granted to those nurses who take
up managerial and specialist function. |
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Chief
Nursing Officer
(CNO) |
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| General
Manager (Nursing) |
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| CNO
is a Head Nurse of the hospital co-ordinating and
managing nursing and hospital services. |
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13. The 2-tier professional accountability concept has already
assimilated into the current practice. It may be taken forward
but refined to take into account of inter-specialty and inter-hospital
variations, as well as complexity in the clinical environment.
14. There should be a more desirable ratio of Advanced Practice
Nurse to Practice Nurse (1:5). Initiatives to improve professional
supervision should be spearheaded through consensus on standards
of clinical supervision and service provision. Hospital and
departmental management should take up line management on staff
motivation and compliance. Internal audit mechanism should be
taken in place to monitor the performance level and improvement.
15. Manpower planning on the various clinical specialties should
be conformed to the established nursing manpower indicators,
and the indicators should be regularly reviewed to meet the
service needs.
16. A core competence model based on the roles and responsibilities
of nurses should be developed to manage the advancement of individual
staff in the new grading structure. The core competence model
can be incorporated into the Staff Development Review (SDR)
process.
17. A merit increment scheme may be applied in managing the
pay progression of individual staff. Measures should be taken
to ensure fairness in the implementation of the merit increment
scheme, and to lessen the punitive elements. Mechanism should
be set up to monitor the implementation, and an appeal mechanism
should also be established to ensure fairness. Furthermore,
there should be training of supervisory staff on the system.
18. Existing staff should be offered with the option to remain
in the old structure or convert to the new structure. For those
opt to remain in the old structure, their employment package
will not be affected. Civil servants should be allowed to preserve
the civil service terms of employment under the Shadow Promotion
Scheme.
Staff Feedback and Sentiments
19. During the consultation process, the Association has gathered
the following staff feedback and sentiments in response to the
Consultation Paper:
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a.
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unclear
role delineation of the proposed nursing structure by
the Hospital Authority; |
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b.
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it
is unrealistic to adopt the primary nursing practice model
in view of short length of stay for clients and stringent
nursing manpower situation; |
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c.
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speculation
on the objective of the reform is to cut cost; |
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d.
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concerns
on a decrease in take-home-pay on conversion to the new
structure; |
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e.
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promotion
prospect will be limited in the new structure; |
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f.
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uncertainty
in job security after the reform; |
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g.
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merit
increment scheme may promote a shoe-polishing culture; |
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h.
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concerns over the fairness on the implementation of merit
increment scheme; |
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i.
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concerns
on the increased ratio of healthcare assistants to nurses
that will affect the quality of healthcare services. |
20. The above-mentioned
staff feedback and sentiments are very sensitive issues that
should be envisaged and addressed through direct communication
at staff forums, newsletters or staff consultative machinery
in order to allay their fear and anxieties on the reform.
The Way Ahead
21. To facilitate the process of the reform, the Association
suggests that more concrete details of the reform, such as
ranking structure, pay structure, conversion arrangement,
merit increment scheme, core competence model, training opportunity,
job security and nursing manpower should be released shortly.
To seek further staff feedback on the nursing grade reform,
clustered-based staff consultation forums and special meeting
for nursing students of universities/nursing schools should
be organized after the release of the 2nd consultation document.
William
POON
Hon. Secretary
Association of Hong Kong Nursing Staff
5 January 2001
(Submission to the Hospital Authority, January 2001)
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