The advanced practice registered nurse is an umbrella term given to a registered nurse (RN) who has met advanced educational and clinical practice requirements beyond the two to four years of basic nursing education required of all RNs. Advanced practice registered nurses includes nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. Nurse Practitioners may practice independently, or they may work in hospitals, long-term care facilities, and for various health care agencies. Most NPs function primarily as clinicians. NPs may diagnose and treat a wide range of acute and chronic illnesses and injuries, interpret lab results, counsel patients, develop treatment plans, and they may prescribe medication. Clinical Nurse Specialists (CNS), like Nurse Practitioners, practices independently, or works in hospitals, long-term care facilities, and for various health care agencies. CNSs may also function as administrators, researchers, policy-makers, educators, or consultants. Certified Registered Nurse Anesthetist (CRNA) provides anesthetics to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified health care professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. Military, Public Health Services and Department of Veterans Affairs health care facilities. Certified Nurse Midwives (CNMs) provide primary health care to women. This includes evaluation, assessment, treatment, and referral to a specialist, if required. CNMs provide preconception counseling, care during pregnancy and childbirth, normal gynecological services, and care of the peri- and post-menopausal woman ().
Changes in nursing in Hong Kong over the past decade have had more to do with the changes in the world and the region’s economy and population than the changes instituted by the Republic of China. Hong Kong’s nearly 7 million people’s health is, like in other places, threatened by a shortage of skilled and experienced nurses. Hong Kong’s three major university-based nursing programs, if they can work together creatively, have the potential to avert a decline in quality of healthcare in Hong Kong and advance nursing at the same time ( 2006).
The first Master of Science nurse practitioner program commenced in 2001 in the Department of Nursing and Health Sciences (now School of Nursing), at the Hong Kong Polytechnic University. Initially, the Yale School of Nursing in the USA was invited and agreed to provide consultative teaching for Master’s students to prepare them to become Adult Health Nurse Practitioners (NP) in Hong Kong. The aim of this program is to offer experienced registered nurses an opportunity to develop the knowledge, understanding and competencies to function effectively as Adult Nurse Practitioners and as nurses leaders in meeting the changing needs of Hong Kong’ s health care system.
The initiative to develop an education program for nurse practitioners is supported by the Hospital Authority, which is the largest employer of nurses in Hong Kong. The Hospital Authority has indicated that a Master’s degree with a clinical focus will be requires for promotion, and position of advanced Practice nurse was introduced in 2003 – 2004. it is envisioned that the nurse practitioner’s role would be more visible and a planning group would need to be established to delineate the roles of Nurse practitioners (NP) and to discuss related- regulations in Hong Kong.
Nurse clinics have been set – up on hospital and community setting. These clinics now are run by registered nurses with advance academic and clinical experience. The nurse practitioners, with the support of the medical team, focus I n health maintenance, disease prevention, counseling and patient education in a wide variety of setting within different specialties. Nurse Practitioners are professionally accountable for their practice; they also must be given the authority to make decisions in the best interest of patients and within the scope of practice supported by the medical team. The establishment of nurse – clinics in Hospital authority is still at developmental stage. It is understood that important issues such as: legal authority for prescribing, professional liability, regulation of independence practice certification and registration need to be establishes by the Hog Kong Nursing Council ( 2004)
A Code of Professional Conduct for Nurses in Hong Kong was formulated in 1986 by the then Nursing Board of Hong Kong. To keep pace with contemporary health care development commensurate with societal and cultural changes, the Nursing Council of Hong Kong which replaced the Nursing Board of Hong Kong in 1999 has now revised the code and also devised a Code of Ethics for an accurate representation of Nurses’ ethical responsibilities. The Code of Ethics is adapted largely from the “Code of Ethics for Nurses in the New Millennium” published in a Chinese nursing magazine《中華護理雜誌》with due regard to practices in the international community.
Code of Professional Conduct for Nurses in Hong Kong
Each nurse (registered or enrolled) is accountable for his/her practice. In the exercise of his/her professional responsibilities, each nurse has an obligation to uphold and adhere to the Code of Professional Conduct for Nurses in Hong Kong. The code aims to make explicit the standards for professional conduct that nurses shall act at all times in their course of duty. It may also serve to provide the public with a basis for decisions regarding standards of professional conduct.
The Code of Professional Conduct for Nurses in Hong Kong highlights eight aspects of professional conduct that nurses are to comply with in discharging their professional duties. The explanatory statements provide guidelines regarding the way each aspect of professional conduct is to be enacted in practice situations.
Eight aspects of professional conduct: In discharging his/her duty in a professional capacity, each nurse shall act, at all times, in such a manner as to: (1) Respect the dignity, uniqueness, values, culture and beliefs of patients/clients and their families in the provision of nursing care. (2) Hold in confidence personal information obtained in a professional capacity. (3) Safeguard informed decision-making and the wellbeing of patients/clients in the provision of care. (4) Provide safe and competent nursing care. (5) Maintain the agreed standard of practice. (6) Foster the trust that is inherent in the privileged relationship between nurses and their patients/clients. (7) Uphold the image of nurses and the profession by refusing advantages. (8) Practice in accordance with laws of Hong Kong relevant to the area of nursing practice.
Some Examples of Laws of Hong Kong Related to Nursing Practice are listed in the annex. There are many ordinances which have a direct or indirect application to nursing. The following is a selected list of ordinances related to nursing practice. It is not intended to be exhaustive:
Name of Ordinance
Chapter
Antibiotics Ordinance
137
Births and Deaths Registration Ordinance
174
Coroners Ordinance
504
Dangerous Drugs Ordinance
134
Defamation Ordinance
21
Hong Kong Bill of Rights Ordinance
383
Hospital Authority Ordinance
113
Hospitals, Nursing Homes and Maternity Homes Registration Ordinance
165
Human Organ Transplant Ordinance
465
Interpretation and General Clauses Ordinance
278
Medical (Therapy, Education and Research) Ordinance
278
Mental Health Ordinance
136
Midwives Registration Ordinance
162
Nurses Registration Ordinance
164
Occupational Safety and Health Ordinance
509
Offences Against the Person Ordinance
212
Personal Data (Privacy) Ordinance
486
Pharmacy and Poisons Ordinance
138
Prevention of Bribery Ordinance
201
Quarantine and Prevention of Disease Ordinance
141
Annex 1: Some Examples of Laws of Hong Kong Related to Nursing Practice Source: The Nursing Council of Hong Kong Code of Professional Conduct and Code of Ethics for Nurses in Hong Kong
The role and function of the regulatory authority in maintaining professional conduct of nurses in Hong Kong they have the Disciplinary Powers that enables them to (1) conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violations which is stated in Chapter 164, section 17, 18 and 19 under the title of Nurses Registration Ordinance. (2) Issue, suspend, and revoke certificates of registration for the practice of nursing in accordance to the chapter 164, section 24 under the heading of penalties for assumptions of title of nurses, etc. (3) Monitor and enforce quality standards of nursing practice. (4) Employ necessary measures to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing in line with the chapter 164A under the title of nurses (registration and Disciplinary procedure). (5) Make certain quality nursing education setting the guidelines of enrolled nurses that is under the title, enrolled Nurses (Enrolment and Disciplinary Procedure) regulations ( Chapter 4. 2004). (6) Declare Code of Ethics for nurses (, 2002).
2. Future Trend of accountability of Advanced Practice Nurse
Many authors describe the expansion of the role of the nurse to incorporate roles outside that of the traditional acute care setting. Such roles include health promotion and teaching in the community ( 1997). Further, the role of the nurse in community care, especially for the advanced practitioner and the clinical nurse specialist, is also a potential role in the future because new opportunities are being made available for nurses as a result of the expansion of home care , 1997). Such nurses are recognised as having developed a specialist expertise and are utilized as educators and advisers in addition to the role of clinician. Further, an increased involvement in the area of rehabilitation is seen to be increasingly vital to facilitate the earlier release of clients back to their homes. It is argued that the role of the nurse is insufficiently recognised and so not utilized as effectively as may be possible ( 1996).
Greater autonomy is clearly indicated by discussion of the new role of independent nurse practitioners which have been recently identified through a longitudinal study in Australia to be an important new role for the registered nurse ( 1996) This role has been particularly targeted for meeting the needs of rural communities ( 1995) and has been variously described as either working in conjunction with a medical practitioner or perhaps replacing the general practitioner in those more isolated settings in which a doctor is not available. A greater autonomy, particularly when linked to the nurse practitioner, facilitates the provision of a variety of services in, for example, women’s health (, 1996), and so further expand the areas in which nursing is practised. This also involves increased collaboration with the patient (, 1997). The ideal of advocacy is linked to holism and caring which have both gained significant prominence in nursing philosophy over the last decade. There has also been discussion over new responsibilities that are less directly linked to clinical nursing care. One of these new directions is the role of Case Manager ( 1997). Such a role involves autonomy and coordination responsibilities for the care of clients. Increased research activity has also been identified as being increasingly central to the role of the registered nurse (1997). The increased emphasis on evidence-based practice ( , 1997; 1997) also dictates that nurses must be able to consume and conduct research to ensure that the best possible principles of care are being followed. The role of researcher is one which continues to be highly regarded as a role which can facilitate change within the health care delivery system (, 1997). The implication of research having a more central position in the nurses duties is that nursing knowledge will be more congruent with the clinical setting (, 1997) and so ensuring that practice is always effective.
A number of authors also believe that there will be (or should be) a bigger participation of nurses in health policy development ( 1997; , 1997). The arguments revolve around the notions of empowerment for nurses to make decisions regarding resources to ensure that the clients needs can be met. Central to these arguments is a strong commitment to ensuring continued quality of care for a client who aligns with the earlier discussion of holism and advocacy.
Considering the future role of the nurse from a global perspective, the World Health organisation released a report in 1994 (, 1994). The report suggested that nurses need to address the health needs of people in vulnerable groups. In addition, the report suggested that nurses should consider their reluctance to work in rural areas as these areas were suffering a shortage of health personnel.
Therefore, one may conclude that accountability of APN is largely greater in the future in meeting the demands of the clients. Since, they integrate into their practice elements such as diagnosing and treating health problems and prescribing drugs. Nurse practitioners work autonomously, from initiating the care process to monitoring health outcomes, and they do work in collaboration with other health care professionals. Nurse practitioners practice in a variety of community, acute care and long term care settings. These include but are not limited to community health centers, nursing outposts, specialty units and clinics, emergency departments and long- term facilities.
In the context of the statement above, an advanced nurse practitioner must be competent enough to practice the nursing profession especially in critical situations and its practice must be evidence – based that is gained in additional clinical practice, education and experience. If one fails to do this, one is not endangering the life of the client or patient, ergo; safe, efficient and effective care wasn’t met. For an instance, wrong prescription, over dosage or under dosage of medicines that would lead to different result as expected thus, endangering the life of the client and it might even cause death. Prescriptive authority should be within of the license to practice in order to avoid any medication error and proper referrals are given to help achieve the desired pre-illness phase of the patient. It is said that nurses can now work independently as well as collaboration with other health care professionals, this means to say that nurses must not only knowledge and skills equipped at the same time; attitude must be healthy enough that conforms with the different aspects of a person. Accountability could be further enhanced if nurses were more involved in the decision making processes which influenced health care. Accountability was directly linked to the perception of autonomy. It is indicated that there is a desire for increased autonomy and an acknowledgment that this autonomy should be matched with a need for increased knowledge and recognition of this knowledge by others in the health care field.
The Nursing Council in Hong Kong must maintain the ideal status of the nurses with their rules and regulations that not only meet the standards of quality education and quality care; they must be able to expand their horizons to new opportunities by continuous research. Since, the nature of practice that requires advanced knowledge, clinical proficiency, independent decision – making and autonomy. The risk of harm from unsafe and incompetent providers at this level of complex is high. In order for one to be qualified as an advanced nurse practitioner there must be an advanced practice graduate nursing education and professional certification examinations that should meet the established criteria. This will require a commitment to ongoing education and professional development due to the fact that nursing blends with the changing of times so does the health of the people. It is unwise to continue to proliferate subspecialty programs because graduates of these advanced nurse practitioner programs are expected to be licensed and legal recognition of narrow is cope is inappropriate that is why it is important to continue to meet the criteria for licensure and subsequent licensure for broader category for it is a test that shall measure the competence of the examination takers.
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