5. Professional issues in practice.

Becoming a midwife is the 16th series of'Midwifery basics' targeted at practising midwives and midwifery students. The aim of these articles is to provide information to raise awareness of the impact of professionalism on women's experience, consider the implications for midwives'practice and encourage midwives to seek further information through a series of activities relating to the topic. In this fifth article of the series, Jancis Shepherd explores issues of supervision of student midwives in perineal suturing, the practical and legal implications of misadministration of medicines and accountability issues.

Fitness to practise for student nurses: principles, standards and procedures.

Since 2009, all schools of nursing have been required to establish a fitness to practise committee to consider any pre-registration student health or character issues (Nursing and Midwifery Council, 2008). In 2009, fitness to practice standards were published (NMC, 2009a). This article outlines how fitness to practise procedures apply to nursing and midwifery students in the U.K. and explains the key differences between how they are applied to trainees and to registered nurses.

Recruiting minimum-age nurses: is the profession ready?

The minimum age restriction for entry onto nursing courses of 17.5 years has recently been removed. Students of 16 and 17 years could potentially be on nurse education programmes and therefore in clinical practice in the very near future. This could be a beginning of a trend, and might be influenced by the current economic climate affecting education and employment. This article outlines the context of the situation, and describes the strategy taken by one higher education institution in conjunction with clinical practice providers to devise processes and protocols in readiness for young people applying to enter nurse education. Clinical practice concerns are discussed, with emphasis on implications for risk assessments. The authors presented the key findings at the Royal College of Nursing Admissions Tutors Conference on 7 November 2008, where considerable interest was generated in the issues arising.

'Do no harm'? Professional regulation of disabled nursing students and nurses in Great Britain.

AIM: This paper is a report of the findings of a General Formal Investigation launched by the Disability Rights Commission, Great Britain into the impact of regulatory fitness standards on disabled people, and on nursing students and nurses in particular. BACKGROUND: The potential for systemic discrimination against disabled nursing professionals lies in the existence and nature of regulatory fitness standards, as well as in how these are interpreted and implemented in practice. METHODS: A review of relevant legislation, regulation and guidance was conducted to explore the interaction of the regulatory framework with the Disability Discrimination Act. A formal call to key national stakeholder organizations solicited information on perceptions of the regulatory framework and the adequacy of guidance issued. Independent research was commissioned on disabled people's disclosure of disability, informal and formal decision-making around fitness within the educational, and employment contexts. An Inquiry Panel examined all evidence sources, solicited further oral evidence from key organizations, and developed recommendations. FINDINGS: No mention was found of the Disability Discrimination Act in any regulation and guidance governing nursing prior to 2006. There are particular requirements for 'good health and good character'. Respondents from key national stakeholder organizations, higher educational institutions and employers struggle to interpret the fitness requirements consistently. Implementation is variable, with reliance on ad hoc self-initiated strategies. The variability of interpretation and implementation can lead to discrimination against disabled people. CONCLUSION: The imprecision of fitness requirements and variability of implementation raise serious doubts about their utility in managing risk.

Perception of legal liability by registered nurses in Korea.

Liability to the nursing profession is imperative if nurses are to act as an autonomous body. Assessing and communicating effectively is a vital part of nursing for patient safety. This study was designed to identify the attitudes of Korean nurses toward liability in assessment and communication and to investigate the relationship among the variables (i.e., legal awareness, attitudes toward doctor's duty to supervise nurses). The attitudes toward doctor's duty reflect the status of nurses' dependency on doctor's supervision. The study participants were 288 registered nurses in RN-BSN courses at two colleges in Korea. The level of legal awareness was measured using a 25-item Legal Awareness Questionnaire developed by the authors. The measuring instrument for attitudes toward doctor's duty to supervise nurses and nurses' liability was the Attitude toward Duty and Liability Questionnaire, which was modified by the authors. There were significant correlation between attitude toward doctor's duty and nurses' liability, but not between legal awareness and liability attitude. The results of this study suggest that the present educational content aimed at improving liability attitudes of nurses should be refocused with attitude-oriented education and should include an understanding of the increased accountability that comes with greater autonomy in nursing practice.

Section 5(4) of the Mental Health Act 1983: the art of applying the Act.

Section 5(4) of the Mental Health Act 1983 allows patients to be detained by nurses of the 'prescribed class' for a maximum of 6 hours. There is a paucity of research on the subject of Section 5(4); however, the little research that has been conducted has shown that there are gaps in the knowledge of registered nurses and nursing students due to be registered with regard to the following areas of Section 5(4): duration of the holding power; whether the client can be treated against their will; eligibility for detention; and criteria for implementation. This article will seek to clarify these gaps and provide nurses with a comprehensive systematic guide to follow should they have to invoke the section.

Disability law and nursing education: an update.

Over the past decade, the courts have been called upon to apply the provisions of the Americans With Disabilities Act and Section 504 of the Rehabilitation Act in several cases with implications for programs of nursing education. Courts have restricted who may be considered a qualified individual with disabilities. They have clarified the relative obligations of both students and educators in determining accommodations. Courts have been especially deferential to educational programs preparing health care professionals when program standards and pedagogical requirements are clearly articulated. However, accessibility and compliance with recommendations for accommodations are required at all sites where students are educated. Less clear are judicial interpretations related to making technology accessible and to the disclosure by programs of information about students' disabilities during licensing. These findings lead to several conclusions. First is the need for development of profession-wide standards of competencies and skills for nurses. Second is the need for dialogue about the potential for disability discrimination between nursing educators and state licensing bodies. Last is that faculty and administrators can proceed with some degree of confidence in protecting program practices that are based on sound pedagogical reasoning.

Don't let the grievance process cause grief.

Faculty in a division of nursing at a state university has developed a unique way to handle student grievances. Community nurses serve on arbitration boards. These boards hear relevant evidence from both sides and render decisions, which are binding within the division. The process has been successful and has helped take "grief" out of the grievance process.

Guidelines to the United Kingdom Disability Discrimination Act (DDA) 1995 and the Special Educational Needs and Disability Act (SENDA) 2001 with regard to nurse education and dyslexia.

This paper concerns the impact of disability legislation on nurse education, nurse educators and student nurses, in relation to academic work and clinical placement, with regard to dyslexia. The two United Kingdom acts considered are the Disability Discrimination Act (DDA), 1995 and the Special Educational Needs and Disability Act (SENDA), 2001, which is an amendment to the DDA. The paper examines and defines the main points of the acts, such as discrimination; less favourable treatment and its justification; reasonable adjustments; making adjustments in advance; disclosure and confidentiality requests; substantial disadvantage; current systems and regulations and concludes by raising issues which require clarification.

The Americans with Disabilities Act of 1990 and its impact on higher education and nursing education.

This paper outlines the Americans with Disabilities Act of 1990 (ADA) and explores the extensive impact the ADA legislation has had on institutions that provide higher education and nursing education in the United States.

Criminal background checks: necessary admission criteria?

The issues that nursing school admissions staff may face in evaluating potential students' criminal backgrounds are discussed. There has been a trend to require criminal background checks for health care professionals throughout the United States related to taking the NCLEX-RN and securing employment in health care agencies. The majority of state boards of nursing are now requiring criminal background checks on potential licensees. Ultimately, the decision of whether or not to perform criminal background checks rests with individual schools. While admitting students without performing criminal background checks could, in some cases, lead to undesirable consequences and injure the reputation of the school and the nursing profession, denying admission to otherwise qualified applicants because of certain past criminal infractions could exclude potentially well-qualified students. This article offers guidelines for nursing programs that choose to perform background checks.

Responsibilities of nursing education: the lessons of Russell v Salve Regina.

In August 1985 Sharon Russell was dismissed from Salve Regina College just before her senior year of nursing education. The reasons given for her dismissal focused on Russell's obesity and her inability to lose weight. The issues raised by this case pose important questions that nursing programs and nurse educators must address. This article explores the questions raised by Russell: (1) What constitutes substantial compliance with both academic and nonacademic performance criteria in a contract between a student and an educational institution? (2) What duties to preserve the privacy interests of students may be imposed on programs and educators? Ms Russell's case has been settled. She established that she had met the terms of the contract and substantially complied with the academic and nonacademic criteria of the nursing curriculum. She was awarded monetary damages for the college's breach of contract in nonperformance of an agreement to educate. She did not prevail in her claims of intentional infliction of emotional distress or invasion of privacy. She did, however, put nursing education programs on notice that colleges and universities are not immune from these contractual challenges and must demonstrate respect and consideration for student's personal concerns.