Unidad y multiplicidad indeterminada en los entes sensibles, el alma y las Ideas

In 1966, Virginia Henderson described nursing as assistance to an individual (sick or well), by the performance of activities that contribute to health or its recovery (or to a peaceful death) that the individual would perform themselves, if they had the strength, will or knowledge (Henderson, 1966). It is considered that each country (or society) has its own unique health dynamic and that recognising the distinctive cultural, social and health dynamic is fundamental to the role of the nurse. The International Council of Nurses defines nursing as encompassing:

Autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are

also key nursing roles. (International Council of Nurses, 2010, para. 1)

The Nursing Council of New Zealand (NCNZ) is the statutory authority that governs the practice of nurses. The Council’s primary concern is that of public safety and it sets and monitors various standards relating to nursing practice. The legislative requirement that gives the NCNZ this authority is the Health Practitioners Competence Assurance Act 2003 (previously the Nurses Act 1977).

The Nursing Council of New Zealand defines nursing practice as “using nursing knowledge in a direct relationship with clients or working in nursing management, nursing administration, nursing education, nursing research, nursing professional advice or nursing policy development roles, which impact on public safety” (NCNZ, 2008a, para. 3) and this highlights the diversity that exists in the nursing workforce.

New Zealand has established three layers of nursing – nurse assistants/enrolled nurses, registered nurses and nurse practitioners all of whom have different scopes of practice and expected competencies for practice. In essence, nurse assistants or enrolled nurses work under the supervision of registered nurses and nurse practitioners are expert registered nurses who work in a specific area. At the time of writing this thesis, the Nursing Council of New Zealand was in the process of reinstating enrolled nurses, and disestablishing the nurse assistant role.

3.1.1 Role of Science in Nursing Practice

According to the Nursing Council of New Zealand’s scope of practice for registered nurses, nurses “utilise nursing knowledge and complex nursing judgement to assess health needs and provide care, and to advise and support people to manage their health” (NCNZ, 2008b, p. 20). This scope of practice includes the provision of “nursing interventions that require substantial scientific and professional knowledge and skills” (p. 3). In the Nursing Council of New Zealand’s Education Standards for Registered Nurse Scope of Practice (NCNZ, 2005a), it states that registered nurses require “bioscience, social and behavioural science, pharmacology, pathophysiology, genetics and disease states” (NCNZ,

2005a, p. 5) in their educational programmes. The actual content of this is left up to the individual nursing schools to define.

Nurse practitioners are expert nurses who are required to have a clinically-focused master’s degree (approved by the NCNZ), as well as meeting nurse practitioner competencies. In the scope of practice, it states that nurse practitioners diagnose and are able to order, conduct and interpret diagnostic and laboratory tests and administer therapies (NCNZ, 2008c). Nurse practitioners may also prescribe medicines but to do so they are required to have a prescribing component within their master’s degree. The nurse practitioner competencies state that a competent nurse practitioner “Demonstrates an extensive knowledge base in specific area of practice and applies knowledge of biological, pharmacological and human sciences” (NCNZ, 2008c, p. 7).

While the Nursing Council of New Zealand’s Education Standards for Registered Nurse Scope of Practice states that registered nurses require “bioscience, … pharmacology, pathophysiology, genetics and disease states” (NCNZ, 2005a, p. 5) in their educational programme, the Nurse Assistant Educational Standards require “physiological knowledge” (NCNZ, 2005b, p. 5). Note, that during the writing of this thesis, the nursing council was considering reinstating enrolled nurses, in preference to nurse assistants. In the Education Standards for Enrolled Nurse Scope of Practice it states that enrolled nursing programmes must provide “anatomy and physiology, wound-care, infection prevention and control, pharmacology” (NCNZ, 2010a, p. 7, 8). With no further definition or indication of content or depth of topic that would be required to meet any scope of practice, there is the possibility that schools and their stakeholders may interpret these requirements differently.

Since the role of science knowledge in nursing is not made explicit in the standards or competencies that regulate the nursing workforce, it is reasonable to assume that science content is in the curriculum to support nursing practice. All three layers of nursing practice (assistant/enrolled, registered and practitioner levels) appear to require science knowledge as science topics are stated in their education standards (NCNZ, 2005a; 2005b; 2008c; 2010a).

Nurse practitioners have greater responsibilities than that of a registered nurse, and the expert knowledge required to diagnose and interpret tests, administer therapies and prescribe medications would be reliant on higher levels of science knowledge than those expected from a registered nurse. However, this extra science knowledge does not appear to be compulsory in most of the educational programmes for nurse practitioners within the clinical masters’ degree structure. Those that wish to prescribe have to complete an approved prescribing component within their masters’ study but extra science knowledge does not appear to be compulsory, indicating perhaps an assumption that the science content in the undergraduate programme is sufficient. What is required to become a nurse practitioner is a minimum of four years of practice experience in a specific area (presumably the area of practice the nurse wishes to specialise in). It is possible that an assumption is being made that an experienced practicing nurse has gained the science knowledge that would be required to underpin the nurse practitioners practice, in the workplace, after these years of experience. It is another possibility that the extra science knowledge (above that required of the registered nurse) required to support expert clinical decision making is not established or recognised, and so is difficult to articulate into a curriculum.

To summarise, nursing practice is considered to have unique characteristics in each community, but that it involves the provision of care, advocacy, health promotion and education. Nursing has established three layers of nurses, all of which appear to require science education content and all of which appear to use science knowledge in their practice. The Nursing Council of New Zealand does not stipulate the detail required for this education, however registered nurses appear to have responsibility to make decisions on nursing care, and nurse practitioners appear to gain the complex science knowledge required to meet their scope of practice from their practice experience in the nursing workplace.