In a new series, we would like to highlight the important work of our Board members. In the first of our series, we speak with Essene Cassidy, NMBI President.
When did you join the Board of NMBI and why? How did you know about it?
I was elected as a representative from Public Health Nursing in October 2012. The then Minister for Health, James Reilly signed my letter of appointment in December of that year and my first official Board meeting was in April 2013. We were the first Board to serve under the provisions of the Nurses and Midwives Act 2011 which replaced An Bord Altranais (under the Nurses Act, 1985). This new legislation brought forward significant changes including reducing the size of the Board from 29 to 23 members with a lay majority.
I learned about the work of the Board when in early 2012, with a group of my colleagues, I attended an information session explaining the changes that were to be introduced under the Nurses and Midwives Act 2011. There was a lot of discussion about what the lay majority of the Board would mean for the professions. This resonated with me because I have always worked closely and supported colleagues in the workplace, so when the Board election was called, I felt that I should step forward as a candidate to give something back to the professions and to support professional development. I did not expect to be selected as I was one of the new cohort of Public Health Nurses who did not hold a midwifery qualification. The mandatory midwifery requirement for eligibility for the Public Health Nursing programme had been removed by An Bord Altrainis in 2007 and I wondered if my peers would consider if I had enough experience to represent the division. However, I was first elected in 2012 and then reappointed unopposed to a second term in 2017. As I near the end of my term I hope that over the years I have succeeded in providing an insight into the challenges and rewards associated with public health and community nursing.
Tell us a bit about the main functions of the Board of NMBI, why it is there and what it does?
That’s a really interesting question because I firmly believe that in the past people viewed the main functions of the Board as fitness to practice and getting registered but actually the Board does a whole lot more. Our core functions are the protection of the public and the maintenance of the integrity of the professions of nursing and midwifery in their interactions with the public. We achieve this by setting the standards and requirements for undergraduate and postgraduate nursing and midwifery programs that lead to registration and monitoring compliance with these standards to ensure a positive learning environment for students on clinical placement. Once nurses and midwives are registered, we provide guidance and advice to support competent practice. If there is a concern or a complaint raised with the Board regarding a registrant’s professional performance or misconduct, we investigate these prima facia complaints through our fitness to practice processes and finally we consider applications for restoration to the register to allow nurses and midwives to return to practice. So, in summary, fitness to practice is only a very small part of the work of the Board.
For me, having pride and professional integrity is the most important aspect of the work of the Board. As Board members we all have had different pathways to the Boardroom, we bring a wide range of experience from our workplaces and lived experience so that collectively our aim is to maintain professional pride and to uphold the quality of nursing and midwifery care at every single step in the persons journey and involvement with the professions of nursing and midwifery.
How is the Board different to the CEO and the Management team and what different role does it play?
From a Board perspective, as 23 people we operate as a collective and we set the strategic direction of the organisation. The CEO and executive’s job is to run the business of the organisation. For good governance it is really important that the Board speak with one voice, operate on a consensus basis and support the CEO and executive to deliver on our strategy goals.
Readers might be wondering how the work of the Board impacts them – could you give us some examples of the real impact that Board actions and decisions have on nurses and midwives?
During my time on the Board, I have become more aware of the amount of work that we do in collaboration with our key stakeholders around setting standards, supporting practice initiatives and promoting quality care provision by nurses and midwives.
A couple of key examples I recall, include the removal of the requirements for Collaborative Practice Agreements (CPAs) for nurse prescribers. This change has allowed our nurse prescribers to become autonomous practitioners. We also worked with the Department of Health on the advanced practice policy and revised the Advanced Nurse Practitioner pathways.
We undertook revisions to our Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives in response to legislative changes including the repeal of the 8th Amendment to the Constitution in relation to conscious objection for example and to support registrants in the provision of care in emergency situations presented as part of the public health response to the Covid-19 global pandemic. I believe that the Code is a key document for registered nurses and midwives and is the piece I am most proud of as a Board member. It is essentially the overarching constitution for nurses and midwives that supports the integrity of the professions and ensures that both nurses and midwives, and the public are kept safe. Registrants from a certain vintage will remember the Code as the ‘Little green book’ issued by An Bord Altranais in 1985. This was revised in 2015 and the little green book was replaced by a slightly bigger version. At the time I was Chair of the Ethics Committee which supported the development of this revision of the Code. While we believed that it was future proofed, here we are in 2021 and the Code has been revised again which shows the pace of change within nursing and midwifery, and within the healthcare environment. To me the Code is a living, breathing document and I have no doubt that it will be revised on a more regular basis as we deliver nursing and midwifery changes and expand over the coming years.
We also undertook a number of initiatives to support our students during the Covid-19 global pandemic. The Board made adjustments to how we measure students’ clinical practice to ensure timely progression to registration. Through the CEO and the executive, and in partnership with the Department of Health, the Office of the Nursing and Midwifery Services Director (ONMSD), the Higher Education Institutes (HEIs), the Institutes of Technology (IOTs) and the staff organisations we championed and supported learning in other ways. Through the use of artificial intelligence and hybrid approaches to learning and by focusing on the high-level definitions of domains of competency we supported our undergraduate and post graduate students to complete their clinical placements and ensure that they progressed in a timely manner through to registration. This ensured that compliance with the requirements of the EU Directive was maintained.
Supporting the Board of NMBI are a number of Committees and Sub-Committees, why are they there and how do they assist the Board?
There are eight committees which are essential to keeping the work of the Board going in accordance with our strategic priorities.
Four of these are statutory which means they are set out in the 2011 legislation. These include:
- Fitness to Practice Committee (2011) and a Preliminary Proceedings Committee which are responsible for the running of our complaints management processes.
- There is also a scaled back Fitness to Practice Committee (1985) which will is responsible for the management of legacy complaints coming through under the 1985 legislation and will disband once the last of these cases is closed out.
- Midwives Committee which advises the Board on matters related to Midwifery.
In addition to the statutory committees, we also have a Registration Committee, Business Strategy and Finance Committee, Audit and Risk Committee and the Education, Training and Standards Committee.
I would encourage registrants that if they are interested in becoming involved in the work of the Board, coming forward to work on one of our committees is an excellent introduction to professional regulation and a chance to expand your knowledge and experience.
The Board has a lay majority, what does this mean and what are the benefits of this?
Lay members bring a different viewpoint and they bring a balance to Board discussions. I do find that as a registrant on the Board, at times we can be quite emotional in our thinking and the lay members are really good at asking questions that challenge us and get us thinking outside of our comfort zone. I can see the absolute value in having a balance in Board thinking.
Having served on the Board for almost 10 years, what are the biggest changes you have seen?
One of the biggest changes has been that as a Board, and an organisation, we are more visible to our registrants. That was one of my core objectives when I became President - to be transparent, to communicate and to raise awareness and visibility of the Board with registrants. I think we have achieved this, and I hope that we have become more relevant to the professions of nursing and midwifery.
I hope for the next generation of registrants who are coming behind me, that they can see that yes, professional regulation is everyone’s business and that registrants and members of the public have a role to play in the Board as well. Being involved in the Board gives you an opportunity to expand on and develop your thought processes and develop skills that you really may not have had an opportunity to do otherwise.
During my time with the Board, I have been really lucky to work with and beside such a diverse group of people both here in Ireland and internationally. Through the work undertaken with the International Nursing Regulatory Collaborative (INRC) and CLEAR (Council on Licensure, Education and Regulation), I feel privileged to have had the opportunity to learn and grow from these experiences.
What have been the greatest challenges?
The greatest challenge I have felt was probably during the first few years of my time on the Board as a new Board under the new legislation. Then we faced a lot of different challenging situations in a very short period of time. Trying to balance my time to meet the challenges and understand my responsibilities as a Board member with the demands of working full time as a Public Health Nurse and having four small children, who were quiet young at the time.
To be honest, while the time commitment required of Board members is high, the pride that I feel in what we have achieved when I think about our strategic priorities, I believe it has been time very well spent. I have always been empowered by the Board and supported by my work colleagues and managers and I feel privileged to be the President. I am very fortunate to have a healthy working relationship with the Board and the Executive, and while I may as President be the public face of the Board, everything we do on the Board is done as a collective.
What have been the biggest advances and achievements?
As well as the advancements that I have previously outlined regarding the Code and our pandemic response in supporting the student learning environment, I am also really proud of our celebrations of 100 years of Midwifery Regulation (2018) and Nursing Regulation (2019).
We celebrated both centenaries with a conference and it is amazing to think we are one of the longest professional regulators in the country and internationally. After over 100 years of professional regulation, we are still here, we are relevant, and we are adapting to the professions needs. I think that is a huge achievement for us.
What advice would you give to your younger self, considering the experience you now have on the Board?
First of all, I would say be confident in what you bring, your views are valuable. Be open to learning and never assume anything, always ask questions.
Covid-19 has meant changes for everyone – how has the Board adapted and how have the changes impacted the work of the Board?
As a Board we kept functioning last year. We pivoted in the virtual space and everyone adapted really quickly. Board meetings were held remotely and as soon as possible we were able to move to a hybrid model. We were also able to keep our fitness to practice process going. While we paused initially in the first wave, as a Board we collectively came forward holding hybrid enquiries and Board meetings to ensure completion of the fitness to practice process with minimal delay. I think our ability to adjust to the public health challenges and keep our business going has been a significant achievement.
Finally, if someone is interested in joining the NMBI Board, or any other Board, what are the steps they should take and what advice would you give them?
There is nothing like being a member of a regulatory board. The experience you will get is amazing, as is the learning that you can bring back to your own workplace. The colleagues and the connections that you will make during your journey will stand to you for the rest of your life.
In terms of the steps you should take, you should think about your own professional development and about expanding your understanding of corporate governance as distinct to clinical governance. I believe it is important to step out of your comfort zone and to look outside the world of nursing and midwifery for further training and development. Start the conversations within your workplace with your peers and line managers about the work of the Board and its committees.
Being involved with a professional regulator is a positive for everybody. Yes, it does take a lot of your time but the value you are giving towards the integrity of the professions and the learnings that you can bring back to your workplace negates the time that you have to give. Most of all I would say enjoy it, enjoy every minute.
