Role of regulatory bodies

DEFINITION Regulation of nursing practice

Nursing practice act: legally defined and described regulations of nursing practice by an administrative board such as state board of nurse examiners. These boards have the authority to regulate nursing practice and education within the state. (Fedorka and Resnick, 2001)

REGULATORY MECHANISMS IN NURSING

Each state legislature has passed laws designed to enact the state nursing practice act by describing the scope of nursing including licensure, credentialing, disciplinary procedure and professional standards. LICENSURE: - It is a legal permit that government agency grants to individuals to engage in practice of a profession and to use a particular title. It is meant o ensure that practising nurses have met the minimum competencies set by the state to protect public. For profession to obtain licence, 3 criteria must be satisfied There is a need to protect public safety and welfare. The occupation is clearly delineated as separate distinct areas of work. There is proper authority to assume obligations of licensing process. Each state has also the power to revoke licenses in case of incompetency on the part of nurse or in case of professional misconduct or committing crime such as use or sale of legal drugs etc. Recent advances in health care delivery have led to establishment of new regulatory model named the mutual recognition model which allows for multi state licensure. Another innovation is the interstate compact called Nurse Licensure Compact which is the mechanism used to create mutual recognition among states. CREDENTIALING: - A voluntary form of self-regulation process in which the nursing profession maintains standards of practice and accountability for educational preparation of its members. Accreditation: most nursing boards establish educational requirements for nursing programs and continuing education courses within a given state. The board usually requires that for a nursing program to be accredited it must meet requirements established by National League for Nursing Accrediting Commission (NLNAC) and Commission on collegiate Nursing Education (CCNE). This helps ensure that students get a well rounded education and patients are cared for by safe practitioners. Certification: it is the voluntary practise of validating that an individual nurse has minimum standards of nursing competencies in speciality areas. To become licensed as an advanced practise nurse, national certification is necessary.

DISCIPLINARY PROCEDURES: State boards commonly enforce requirements by establishing disciplinary procedures followed unprofessional conduct by nurses. E.g. violation of nursing practise acts fraud and deceit, unethical conduct.

STANDARDS OF PRACTICE: Standards of care are the skills and learning possessed by the members of the profession. They can be classified into two- internal and external. Internal include the nurses job description, education, expertise and individual institutional policies and procedures. External include nurse practice acts, professional organizations, federal organizations and nursing speciality practice organizations.

REGULATORY BODIES
The regulatory bodies that define the laws and regulations in nursing practice are the nursing council at the international, national, and state levels.

International council for nurses: ICN was found in the year 1899 by Mrs. Bedford Fenwick, an English woman. It is the oldest international association of professional women. In order to maintain regulations in nursing practice, it opens membership for all self governing national nurses associations. The main activities and accomplishments are publication of the code for nurses, the world wide accepted definition of a nurse and the nurses Dilemma, a book of ethics. The Guidelines for National Nurses Associations in the Indian Nursing Yearbook, 1988-89 is one e.g. of how the Council works to improve nursing education and practice. FUNCTIONS Improve the standards of nursing and the competence of nursing To promote the development of strong national nurses association To serve as authoritative voice for nurses internationally To assist the national nurses association to improve the status of nurses

Indian Nursing Council: INC was established under the act of parliament known as INC act, 1947 followed a recommendation made by the Bhore committee in 1946. The act was then amended in 1950 and 1957. The INC was constituted in 1949. Section 3(1) of INC act describes the constitution and composition of the council. INC has statutory obligations to see that the minimum standards which are prescribed are being met. In order to fulfil this function, schools of nursing are inspected and the conduct of examinations is regulated. The council has the power to withdraw recognition if minimum requirement are not met. The submission of annual report by the schools and colleges is another means of regulating control to ensure that the minimum requirements laid down are met. It is an autonomous body and its official relationship with the state is through state governments INC is given authority to prescribe curricula for nursing education in all the states. INC was also asked to provide registration of foreign nurses and the maintenance of the Indian nurses register. Inc authorises state nurses registration councils and examining boards to issue qualify certificates. FUNCTIONS To establish and monitor a uniform standard of nursing education by doing inspection of the institutions. To recognize the qualifications for the purpose of registration and employment in India and abroad. To give approval for registration of Indian and Foreign Nurses possessing foreign qualification

To prescribe the syllabus & regulations for Nursing programs. Power to withdraw the recognition of qualification in case an institution fails to maintain its standards that an institution recognized by a State Council To advise the State Nursing Councils, Examining Boards, State Governments and Central Government regarding Nursing Education in the Country.

State nursing councils: Almost all the states in the country have a nursing council with its own registrar and is responsible for the registration of nurses, midwives, health visitors and auxiliary nurses. Every professional nurse who wishes to be active in nursing profession either here or abroad must be registered with one of the state nurses registration council. The state council functions as the official control of standards of nursing practice. It registers only those who have completed recognized programmes of nursing education who meet requirements of competence and character. This serves as a legal protection to the nurse and protects the public from incompetent nursing practice or poor nursing care.

Karnataka nursing council: The functions include, Regulation of the training programmes of the diploma, degree and post graduation courses. Supervision of the practice of the profession by its member. Granting recognition to the training institutions and periodical inspection. Prescribing syllabus and curriculum for various courses. Registration and granting certificate to qualified persons to practice their profession.

The procedure for registration is usually initiated by the nursing administration of the respective institution. A nurse is qualified to register when they have completed the recognized programme of nursing education and passed the qualifying exam (board exam) conducted by the Rajiv Gandhi university. The university will issue a diploma or degree certificate, which must be send with copies and a properly filled out application form to the registrar of the Karnataka nurses registration council. When the name and correct data have been entered in the state register, will be issue the Karnataka registration certificate with registration number. This certificate is a legal proof of the registry and should be kept with copies in a safe place. Application of the registration to a foreign is also channelled through the state nurses registration council.

Rajiv Gandhi University of Health Sciences: The RGUHS was established in 1988 as a premier health university in Karnataka. The university is the regulating body for all medical and allied courses in the state. There are over 200 nursing colleges affiliated under this university and the university lays down guidance for the curriculum to be followed, the revision of curriculum, scheme of examinations, awarding of degree and all other related academic activities.

COLLECTIVE BARGAINING
DEFINITION:
Collective bargaining is an agreement between a single employer or an association of employers on the one hand and a labour union on the other, which regulates the terms and conditions of employment (Tudwig Teller) Collective bargaining is a process of discussion and negotiation between two parties, one or both of whom is a group of persons acting in concest. More specifically it is the procedure by which an employer or employers and a group of employees agree upon the conditions of work (The encyclopaedia of social science) UNION/LABOUR ORGANIZATION: An organization in which employees participate for the purpose of negotiating with the employer about grievances, labour disagreement, wages, hours of work and conditions of employment. CHARACTERISTICKS OF LABOUR UNIONS: Union certification- any seven persons can from a trade Defining membership of the bargaining unit both union and employer attempt to specify which worker classifications are eligible for membership in bargaining unit. PREPARATION FOR COLLECTIVE BARGAINING: Preparation should begin months before the contract talks. Chairperson should be establish and maintain pleasant relationship with union representatives by treating them courteously in social situations, grievance hearing. Obtain information from other nurse executives about union activities in neighbouring health agencies. Review other labour contracts negotiating in other agencies to determine what type of demands were made by various worker categories. Keep ongoing recording agencys employees grievances and analyse these before negotiation begins. Research the wage salary structures of other health agencies in the community and compare against agencies current wage package. Should read the act to identify limitations. PROCESSES OF UNIONIZATION The process of unionization consists of following steps: Selection of a bargaining agent. Certification to contract. Contract administration. The nurse managers role. Decertification.

Selection of bargaining agent: The process of establishing a union in any setting begins with the selection of a bargaining agent certified to conduct labour negotiations for a group of individuals. This process is known as a representative election and is presided over by the national labour relationship board. For an election occurs, the union must demonstrate that interest is shown by at least 30% of the employees affected by this action. Once the 30% level is reached, the union can petition the national labour relations board to conduct an election. At the conclusion of this meeting the board will have determined three things: Who is eligible to participate in the union: - This is problematic issue and not easily resolved, because registered nurses employed as staff nurses are eligible for collective bargaining but registered nurses employed as management are not. Whether the signatories are employees of the organization. A date for union election: - the election is conducted by the board within 45 days, using a secret ballot. All individuals eligible for represent action by the union are notified of the election time and date. On Election Day, eligible employees are asked to choose not only whether they wish to be representatives of the union but also which union they want to represent.

Many unions represent registered nurses in collective bargaining; therefore the ballot may contain several choices for the bargaining agent. In addition to various state nurses associations (SNAs), other major unions representing nurses are: American federation of, county and municipal employees (AFSCME). Service employees international union (SEIU).

The election outcome is determined by the group receiving a simple majority of the votes cast. The union winning this election certified to enter into contract negotiations with the employer. The process of selecting a bargaining agent produces a tense, emotional climate that affects everyone in the organization. It is important for both nurse and managers and staff nurses to remember that during this period, the rules of unfair labour practice apply. Staff nurses also must be careful that their discussions regarding collective bargaining take place away from the work site and not on work time.

Certificate to contract: Certification by the National Labour Relations Board (NLRB) of a union to be the bargaining agent does mean that a group of people have the right to enter into a contract with an employer, a concept known as certification to contract. The actual contract and its provision must be written and voted on by the union membership a process that may take some time. Issues considered mandatory subjects of bargaining are rates of pay, wages, hours of employment and grievance procedures. Additionally, the contract may specify other areas provided that both parties agree they should be included. These can include:

A union among security clause. A management rights clause. Seniority. Fringe benefits. Layoff and reduction in work language. Floating procedure. Insurance. Retirement issues. Professional issues.

The contract is considered to be in effect when both management of the organization and employees agree on its content. The final agreement is subject to a ratification vote by the affected employees. Passage of the contract, or ratification, is obtained by a simple majority of eligible members who vote.

Contract administration: The role of administrating the contract then falls to an individual designated as the union representative. The individual may be an employee of the union or a member of the nursing staff. It is the duty of the union representative to provide fair and equal representation to all members of the unit. The role of the union representative is explain the provisions of the contract to the union membership and be available to help in the grievance process.

The nurse managers role: The nurse manager in a health care organization where nurses are organized into a collective bargaining unit participates in resolving grievances, using the agreed upon grievance procedure.

CLASSIFICATION OF GRIEVANCE: Grievance can usually be classified as o Those caused by misunderstanding. o Those caused by intentional contract violations. o Those caused by symptomatic problems outside the scope of the labour agreement. Grievance caused by a misunderstanding usually stem from circumstances surrounding the grievance, a lack of familiarity with the contract or an inadequate labour agreement. Intentional violation of a contract is usually an effort to capitalize on ambiguous contract language or past practices. Symptomatic grievances are simply a means for the employee to show dissatisfaction or frustration and stem from the human element in management / labour relationship.

THE GRIEVANCE PROCESS: an example; The following steps comprise the typical grievance process: Step 1:- the employee talks informally with her or his direct supervisor, usually as soon as possible after the incident has occurred. A representative of bargaining agent is allowed to be present. A written request for the next step is given to the immediate supervisor within ten work days. The employee, supervisor, and agent will be present for any discussion. Step 2:- if the response to step 1 is not satisfactory, a written appeal may be submitted within 10 work days to the director of nursing. The employee, agent, grievance chairperson and the top nursing administrator or designs can be provided in 5 work days subsequent to these meetings. Step 3:- the employee, agent, grievance chairperson, nursing administrator and director of human resources meet for discussion. The 10 and 5 day time limits for appeal and answer are again observed. Step 4:- the final step is arbitration, which is invoked when no solution suggested is acceptable. An arbitrator who is a neutral third party is selected and is present at these meetings. The submission of grievance may be required within 15 days after step 3 is completed.

SUGGESTIONS HELPFUL IN HANDLING GRIEVANCE: The objective of the grievance process is not to achieve conquest. You have to work with one another after resolution of the grievance, so treat each other with courtesy and respect. Do not, whatever your position, allow disagreements or disputes among members of your team to be public. Expedience is a must; delaying tactics serve only to heighten emotions. However allow time to consider the facts. Stay objective: emotionalism usually leads to further problems. Implementing decisions or filing grievances requires planning. Get all the facts and informations, evaluated and anticipates the other partys response. Seek guidance from those higher in administrative positions. Never refuse to meet with the grievant representatives. The bargaining unit representative, though in a unique position, is not immune from reprimand or discipline. Integral to bargaining are solutions that may also accommodate future changes and needs. Be prepared to give or take acceptable compromises and alternate solutions within the framework of the contract, no matter which party suggests them. Pat formulas do not settle grievance or solve problems. Observe the time limits. If you do not, the bargaining unit may lose the right to continue the grievance to the next level. In adjusting a grievance, knowledge is very important. Gloating over a nursing is human but remember that you may lose the next one; dont become overconfident.

THE GRIEVANCE HEARING In the grievance hearing, remember this key behaviour: Decertification: Occasionally, members of a particular may decide that the union they want or that no union at all is needed. In such a case, the members of the bargaining unit have the right to either change their union affiliation or remove the union by using a process known as decertification. This process is essentially the same as that following by the NLRB for a representation election. TYPES OF STRIKES: Put the grievant at ease. Do not interrupt or disagree. Listen openly and carefully. Discuss the problem calmly and with an open mind. Get the story straight. Get all the facts ask logical questions. Consider the grievant view points Avoid snap judgements. Do not jump to conclusions Make an equitable decision, and then give it to the grievant promptly.

Jurisdictional Strikes

recognition strikes

Economic Strikes

TYPES OF STRIKES

sympathy strikes

Illegal Strikes

unfair labour strikes

Economic strikes: Employees attempt to get their employer to meet their demands by their services. An employ cannot be fired for participating in an economic strike but can be replaced.

Unfair labour strikes: Result from an unfair labour practice by an employer or a union.

Sympathy strikes: Employees of one employer strike in support of another. Workers can refuse to cross to picket lines. Jurisdictional strike: In jurisdictional strike there is a work stoppage over the assignment of work to two or more unions. Employees may strike because the employer assigned a particular job to another union. Recognition strikes: It is a work stoppage to force an employer to bargain with a particular organisation. Illegal strikes: The category of illegal strike comprises violent strikes, boycott or secondary strikes and wildcat or surprise strikes that are not authorised by the union.

ADVANTAGES AND DISADVANTAGES OF COLLECTIVE BARGAINING: Advantages: o o o o o Equalization of power Viable grievance procedure Equitable distribution of work Professionalism promoted Nurses control practice

Disadvantages: o o o o o Adversary relationship Strikes may not be prevented Leadership may be difficult to obtain Unprofessional behaviour Interference with management

MAJOR ISSUES IN COLLECTIVE BARGAINING FOR NURSES: Unit determination: The term unit determination refers to the decision. Making process the NLRB uses to determine the composition of a given group for collective bargaining. In this process the NLRB could use their discretion in determining unit composition because the guidelines given by congress in 1974 amendments instructed that there be no undue unit proliferation. Following passage of the 1974 amendments, the NLRB determined the composition of each bargaining unit on a case by case basis. To meet the congressional mandate that there be no undue unit proliferation, the NLRB adopted a standard to determine unit composition called community of interest.

In 1984, the NLRB changed from a community of interest standard to a disparity of interest standard. Under the community of interest standard, the NLRB accepted any of 6 existing units-registered nurses, other professionals, technical employees, service and maintenance workers, business office clerical and guards. Unclear the new disparity of interest standards, the NLRB recognised only 4 unitsprofessionals, technical employees, service maintenance employees and guards. Hospital management groups wanted to recognise only those unions composed of all professionals, all non professionals and guards. This dispute resulted in the NLRB on September 1st, 1988 proposing a rule identifying 8 separate eligible bargaining units in health care: o o o o o o Registered nurses Physicians All professionals except registered nurses Technical employees Guards Non professional employees

After a number of legal challenges, these rules were eventually upheld by the U.S Supreme Court in April 1991. Labour management committees: A popular development during the last decades in the formation labour management committees. This allows staff nurses and nursing managers to communicate on a less formal basis to help resolve potential or actual problem. However institutions that use labour management committees may be in violation of federal labour law. The national relations act defines a labour organisation as any organisation of any kind or any agency or employee representation committee in which employees participate and which exists or the purpose of dealing with employees. Furthermore, the law defines one unfair labour practise by the employer as being to dominate or interfere with the formation or administration of any labour organisation or contribute financial or other support to it. The recommendation made by the committee may or may not be implemented by the organisation and may be subject to change in the future by the organisation without the consent or consultation of the committees.

NURSES, UNIONS AND PROFESSIONAL ASSOCIATIONS: Since its inception, the Americans Nurses association (ANA) has an active interest in the economic security of nurses. Although it was useful in helping to shape the role of the profession in supporting collective bargaining for nurses, the ANA did not officially adopt an economic security programme that included collective bargaining until 1946. Since that time, the ANA has actively promoted collective bargaining for nurses through the economic and general welfare programme which currently called department of labour relations and work place advocacy.

ANA is a registered labour organisations but it does not engage in direct collective bargaining. Although the ANA supports collective bargaining and takes an active role in promoting collective bargaining, the SNAs have the freedom to independently decide their own level of participation regarding collective bargaining. All the SNAs have a labour relations programme as a part of their purpose and conduct programmes to address the needs of the nurses in their state regarding financial and job security. Many people believe that collective bargaining is a new movement in nursing but the fact is that nurses have been concerned with their economic and general welfare for sometimes. In the early 1900s, working conditions and salaries for nurses were extremely poor. Nurses working conditions were abysmal, long hours, no fringe benefit and sub-stand and wages. Just prior to the collapse of the economy in 1929, some nurses began to recognise that protest and collective action were necessary if the conditions of the nurses were to improve. In 1974, the health care amendments referred to earlier made it possible for nurses to use legal sanctions if necessary to ensure bargaining related to conditions of employment. Since the passage of these amendments, many state nurses associations have qualified as legal bargaining agents for nurses. Collective bargaining looks increasingly attractive to nurses because of their growing frustrations about the inability to practice nursing as they believe it should be practiced to influence their working conditions or to bring about improved personal policies and benefits. Nurses meet their in many ways. Some nurses believe that the professional organisations should not serve as labour organisations, that this dualism represents a conflict of professional purposes and standards. In summary, the NLRB and federal appeals decisions have upheld the supervisory nurses rights to belong to the professional associations. So as long as she or he does not participate in the administration of any aspect of the organisations that assists collective bargaining activities.

FUTURE OF COLLECTIVE BARGAINING: The use of collective bargaining as a method for nurses to enhance their economic and professional status holds both concerns and promises, especially with the radical changes that are occurring in the health care industry today. The concerns are that the very process of collective bargaining separate rather than unit nurses. Nurses in collective bargaining unit believe that collective bargaining contracts can be vehicles to achieve their goals regarding not only employment and financial issues but also improvements in practice conditions for their patients. The future of collective bargaining for nurses, however, is unknown.

JOURNAL ABSTRACT
1) Acquiring organizational autonomy and control over nursing practice, through a combination of traditional and non-traditional collective bargaining (CB) strategies, is emerging as an important solution to the nursing shortage crisis. For the past 60 years, nurses have improved their economic and general welfare by organizing through traditional CB, particularly during periods of nursing shortages. During the past decade, however, the downsizing of nursing staffs, systems redesign, and oppressive management practices have created such poor nursing practice environments that improvement in wages no longer is viewed as the primary purpose of

CB. Much more essential to nurses is assuring they have a safe practice environment free of mandatory overtime and other work issues, and a voice in the resource allocation decisions that affect their ability to achieve quality health outcomes for patients. The thesis presented in this article is that traditional and non-traditional CB strategies empower nurses to find such a voice and gain control over nursing practice. This article describes the current shortage; discusses how CB can be used to help nurses find a voice to effect change; reviews the American Nurses Association's (ANA's) history of collective action activities; explains differences between traditional and non-traditional CB strategies; and presents a case study in which both strategies were used to improve the present patient care environment. 2) In this article, the writer discusses that professionalism in the field of nursing demands strict self-regulation and continuous improvement of the standard of care through evidence-based recommendations and quality research. The writer notes that professionalism also demands a multi-disciplinary approach in order to arrive at comprehensive, individualized treatment options for the patient. The nurses' roles as researcher, planner, policy-maker, educator, leader and collaborator testify to the ethical responsibilities they share towards patients, colleagues and the populations they affect through their decisions. In practice, the writer maintains that it is the nurse that plays a large part in formulating and implementing patient care plans, evaluating their outcomes and continuously enforcing and improving the quality of care. The writer concludes that accrediting and regulatory bodies are different levels of professional accountability in the nursing profession that protect consumers from unnecessary harm and employers from the legal consequences of the malpractice of individual employees.

CONCLUSION
The collective bargaining has its own way between the labour and organization but still the future of it is unknown for nursing community. collective bargaining in labour relations, procedure whereby an employer or employers agree to discuss the conditions of work by bargaining with representatives of the employees, usually a labour union. Its purpose may be either a discussion of the terms and conditions of employment (wages, work hours, job safety, or job security) or a consideration of the collective relations between both sides (the right to organize workers, recognition of a union, or a guarantee of no reprisals against the workers if a strike has occurred).

BIBLIOGRAPHY
Daly john, speedy Sandra, Jackson derba; professional nursing, concepts, issues and challenges S P publishers, page no.245-248. Russell c swansburg; management for nurse managers (2nd edition) page no. 159-168. Basavanthappa B.T; nursing administration (1st edition), jaypee publication, New Delhi, page no. 312-315. Anna marriner tomey(2004); guide to nursing management and leadership (7th edition), mosby publications, Missouri, page no. 133-139.

JOURNAL
o Karen W. Budd,Linda S. Warino, Mary Ellen Patton, Traditional and NonTraditional Collective Bargaining: Strategies to Improve the Patient Care Environment, From Online Journal of Issues in Nursing, published on june 2004.
o Nursing Regulatory and Accreditation Bodies; Written in 2008 Papers on "Nursing Regulatory and Accreditation Bodies" and similar term paper topics.

PADMASHREE COLLEGE OF NURSING, BANGOLORE-72 SUB: ADVANCED NURSING PRACTICE