Ahead of her retirement, Dr Anne-Marie Ryan shares the story of her long and distinguished career and reflects on the many opportunities the profession can offer.

Anne-Marie joined NMBI in 2001. During her time with the organisation Anne-Marie has worked as Chief Education Officer, Director of Registration and is currently Director of Professional Standards and Education (Nursing).

As far as I remember I always wanted to be a nurse. Over the last 43 years I have had a wonderful career with many opportunities. After qualifying as a general nurse from St Laurence’s Hospital (the Richmond) I got my first staff nurse position in Mercers Hospital, initially on the medical wards and then in theatre. When Mercers closed, I went to work on the Oncology/Haematology Unit in St James’s Hospital, and I was there for the first bone marrow transplant. I learnt a great deal there including the value of interdisciplinary working and the role of nurses in the team. I undertook the oncology course at St Luke’s Hospital where I got to see the integration of services across the Dublin area in a number of the hospitals. We were encouraged to recognise the deteriorating patient and to use our judgement and knowledge to intervene on a patient’s behalf. In working with the inpatient team and then leading on the day treatment team I learnt how nurses made a real impact on the patient’s journey. The importance of knowledgeable professional interventions and support influences how patients at a vulnerable time in their lives cope with their treatment journey and their well-being through this journey.

Wanting to expand on my knowledge and research of nursing practices in oncology I embarked on the 3-year full-time Bachelor of Nursing Studies (BNS) in UCD that also gave an Registered Nurse Tutor (RNT) qualification. Through this programme I became a nurse tutor and subsequently Principal Nurse Tutor in Beaumont Hospital actively involved in the transition from the apprentice to the diploma education programme. I worked as a lecturer in UCD on the tutors programme and with the publication of the Report of the Commission on Nursing (1998) that recommended a degree level programme to commence in 2002, I was successful in securing a position in TCD as a lecturer. During this time the post of Chief Education Officer in An Bord Altranais (NMBI) became available and I was encouraged to apply to assist with the regulatory introduction of the degree programmes for nursing.  

Since 2001 I have had a most rewarding career in regulation at national and European fora including a position as Deputy Chief Nursing Officer in the Department of Health. Throughout this time, I have learnt the importance of having nurses in positions of influence and decision making at the tables where legislation is proposed and considered for professional development and change. Without this we would not have had the introduction of nurse prescribing of medicinal products and referral for radiological procedures and the expansion of practice in specialisms and advanced practice.

Challenges and opportunities ahead for the profession

I see many opportunities ahead for nurses including the expansion of practice to meet patient and service need. Nurses have the capacity and capability to contribute much more to care provision to patients and their families as part of interprofessional teams. I look forward to seeing more nurse-led initiatives in the community where we can keep our older population safe and comfortable in their own homes and manage chronic disease more efficiently. Unfortunately, there are a few barriers that we need to address in how we work together as health care professionals. In this I would like to see more interprofessional teaching and learning with and from each other. We all are needed in a health care team as we all bring different strengths and skills.  

The importance of regulation and professional standards

Setting standards and expectations of care is vitally important. We need to ensure that there is a standard and a code of practice and ethics that all are abiding to. In healthcare it is critical that standards are respected and adhered to. Having a common shared vision of values is most important as it gives a benchmark of expectations of behaviour that reflect our compassion, care and commitment.

My advice for future nurses and midwives

Nursing and midwifery is a wonderful career. The world, as well as the profession, is your oyster and you can make it what you wish if you keep your mind open to new learning and development. Be the best you can for your patient and work to the top of your education and training, and develop your capability to embrace new technology, research and treatment options for patients not forgetting your roots in compassion, care and commitment.

As I change direction, I am taking with me some wonderful friendships. I encourage all young nurses to support each other and encourage each other to challenge and question for the better good. I have always liked the writings of John O’Donoghue and I’d like to share this: “may the sacredness of your work bring healing, light and renewal to those who work with you and to those who see and receive your work.” (Blessing, from Anam Cara by John O’Donohue).

NMBI would like to remind all registered nurses and midwives that the updated Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (the Code) came into effect on 11 May 2021.

The updated Code is available on our website and a link is being issued to each nurse and midwife on our Register by email.

The Code is the keystone of the NMBI’s professional guidance and is mandated by the Nurses and Midwives Act 2011. The updated Code reflects recent legislative changes and will guide nurses and midwives in the delivery of patient care in their day-to-day practice. Each nurse and midwife has a responsibility to uphold the values of the professions to ensure their practice reflects high standards and protects the public.

The updated Code includes updates on the following:

• Considerations of relevant Irish legislation enacted since 2015:

• Assisted Decision Making (Capacity) Act 2015
• Children First Act 2015
• Civil Liability (Amendment) Act 2017
• Data Protection Acts 1988-2018
• Freedom of Information Act 2014
• Health (Regulation of Termination of Pregnancy) Act 2018
• United Nations Convention on the Rights of Persons with Disabilities, 2007 (ratified by the Irish Government in 2018)

• Principle 1 – respect for the dignity of the person:

• Revision and additions to the standards of conduct related to termination of pregnancy and conscientious objection; and capacity
• Additional supporting guidance for capacity

• Principle 2 – Professional responsibility and accountability:

• Revision to the standard of conduct relating to health and safety of patients and personal safety
• Update to the standards of conduct relating to conscientious objection.

• Updated references and resources.

LGBT Ireland and the INMO hosted a Pride Webinar on 25 June, entitled ‘Building an LGBTI+ Inclusive Healthcare System Together’.

NMBI CEO Sheila McClelland addressed the webinar on the topic of an inclusive nursing and midwifery curriculum as a pathway to inclusive patient care.

The audience also heard from the Minister for Health, Stephen Donnelly and HSE CEO, Paul Reid, as well as representatives from LGBT Ireland, the INMO, industry leaders and service users.

LGBT Ireland is working to drive positive change and create an inclusive healthcare system in Ireland through the LGBT Champions Programme. Further details are available on the LGBT Ireland website.

NMBI’s presentation can be viewed here.

NMBI is inviting calls for expressions of interest from public interest representatives, registered midwives and registered midwives with community midwifery experience to fill three vacancies on the Midwives Committee.

Details of these vacancies and how to apply are on our website.

Committee terms of reference

The role of the Midwives Committee is to provide advice to the Board in relation to all matters pertaining to midwifery practice. Appointees to the Midwives Committee may be asked to participate on sub-committees and working groups as and when they are convened.

The terms of reference of the Midwives Committee are available here.

The 32nd International Confederation of Midwives (ICM) Virtual Triennial Congress has been taking place every Wednesday throughout June and NMBI was invited to speak at this year’s event.

Dawn Johnston, Director of Midwifery presented on the work undertaken to develop a National Competency Assessment tool for student midwives. 

The ICM represents members in over 120 countries and works to strengthen professional associations of midwives throughout the world.

Due to the Covid-19 pandemic, this year’s conference was held virtually with midwives from around the world attending the sessions via Zoom.

NMBI’s presentation on the development of a National Competency Assessment tool for Student Midwives is available here.

The Government has approved the Sláintecare Implementation Strategy and Action Plan for the period 2021-2023.

The plan sets out the priorities and actions for the next phase of the reform programme and aims to improve safe, timely access to care and address health inequalities by delivering a universal health service that offers the right care, in the right place, at the right time, at low or no cost.

The new strategy was developed from lessons learned during the Covid-19 pandemic and follows on from the Sláintecare Implementation Strategy approved by Government in July 2018.

The Strategy and Action Plan focuses on two new reform programmes.

• Reform Programme 1: Improving Safe, Timely Access to Care, and Promoting Health and Wellbeing
• Reform Programme 2: Addressing Health Inequalities - towards Universal Healthcare.

Full details on the Sláintecare Implementation Strategy and Action Plan 2021-2023 is available here.

HIQA study shows vaccines are the most effective safeguard against Covid-19

The Health Information and Quality Authority (HIQA) has published its advice to the National Public Health Emergency Team (NPHET) on interventions and preventions to reduce the risk of serious Covid-19.

HIQA, who provide evidence-based advice to NPHET to inform public health policy in the context of Covid-19, examined 46 cohort studies which focused on modifiable health-related risk factors. These included being overweight/obese, exercising, smoking, being Vitamin D sufficient and alcohol consumption.

Additionally, HIQA advised on the effectiveness of drug (excluding vaccines) and non-drug interventions. They found there is insufficient evidence for any interventions, other than vaccines, were effective at reducing the risk Covid-19.

HIQA identified five relevant controlled drug trials, four of which considered ivermectin (conventionally used to treat parasitic worm infestations) and one which considered bamlanivimab (an immune therapy). The report found insufficient evidence on whether ivermectin or bamlanivimab is safe in preventing or reducing the severity of Covid and has advised against the use of these drugs outside of well-designed, regulated clinical trials.

The European Medical Agency (EMA) have strongly advised against the use of ivermectin to prevent or treat Covid-19 outside of controlled and regulated clinical trials. The EMA has approved bamlanivimab for emergency treatment of patients with severe Covid-19, however it has not been approved to prevent the disease.

Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, encouraged people to avail of the vaccine “as it continues to be the most effective safeguard against serious illness due to Covid-19”.

An overview of the advice is available here.

Construction underway on a new mental health campus in Tuam

Work is underway on the redevelopment of the Old Grove Hospital in Tuam after it was bought by the former Western Health Board twenty years ago.

The site is due to be transformed into a modern mental health campus and centre for disability and early intervention services. The project will see part-demolition, refurbishment and remodelling of the building at Vicar Street.

Work is also planned to begin at the end of July/early August on a new community nursing unit in the area.

The new facilities are expected to create between 250 and 300 jobs for people working in the health sector.

For more on the new development click here.

First public fertility hub launched at The Coombe

Ireland’s first public fertility hub has been launched at the Coombe Women and Infants University Hospital.

The new hub will offer a multidisciplinary service to individuals and couples who are experiencing fertility issues.

The initiative is supported by the National Women and Infants Health Programme and The Dublin Midlands Hospital Group.

The new clinic is one of the first to be created under the former Minister for Health Simon Harris’ €2 million support plan to provide fertility treatment as part of the public health system. A second hub in Cork is planned for later this year.

Speaking at the launch, Dr Lucy-Ann Behan, Consultant Endocrinologist, at The Coombe Women and Infants University Hospitalsaid it was “an important step in making fertility treatment more accessible to all.”

Access to the hospital's fertility hub service is available to those who have been unable to achieve a pregnancy after 6 months or more of trying and have been referred by their GP. Patients will have an initial consultation with a nurse specialist at the hub who will organise tests and a tailored treatment plan will be devised for the individual, or couple based on their results.

Further information about the Coombe’s new Fertility Hub can be found here.

Postdoctoral research fellow at UCD School of Nursing, Midwifery and Health Systems awarded Fulbright scholarship

Dr Purity Mwendwa,a postdoctoral research fellow at the UCD School of Nursing Midwifery and Health Systems is one of 31 recipients of this year’s Fulbright Irish Awards. The awards are open to all disciplines and offer students, scholars and professionals the opportunity to research, study or lecture in the United States.

Dr Mwendwa,as a Fulbright-HRB Health Impact Scholar,will be hosted in the Herbert Wertheim School of Public Health at the University of California San Diego.

She will undertake research in collaboration with Dr Tala Al-Rousan to study influential factors and mechanisms involved in delivering dementia care and supports to culturally and linguistically diverse communities in San Diego.

Minister for Foreign Affairs and Defence, Simon Coveney announced the 2021 cohort of Fulbright Irish Awardees at an online celebration on 10 June.

To find out more about each of this year’s awardees, click here. 

Minister Donnelly praises healthcare workers involved in Covid-19 vaccine rollout

Minister for Health, Stephen Donnelly has praised healthcare workers for their efforts in the rollout of the Covid-19 vaccine.

In a video message posted on Twitter after he received his first vaccine dose, Minister Donnelly thanked all workers involved in the vaccination programme and gave a “special thanks” to the nurse who administered his dose.

I’ve just had my first #COVID19Vaccine at the centre in Greystones. Thanks so much to everyone involved, I feel privileged. Special thanks to nurse Fiona who made it such a brilliant experience

— Stephen Donnelly (@DonnellyStephen) June 5, 2021

He added that “incredible work” has gone into maintaining the pace of the rollout.

As we continue our series highlighting the committed work of nurses and midwives in Ireland by sharing your stories, this month we talk to Bernadette Finneran, Advanced Nurse Practitioner in Skin Cancer at Roscommon University Hospital (RUH).

Why did you choose a career in nursing/midwifery?

I chose nursing as a career for the same reasons everyone does, I wanted to make a difference and help people when they are at their most vulnerable.

Was this your first career choice and what would you do if you weren’t a nurse/midwife?

I stumbled into my current specialisation which I absolutely love with a passion. I am an Advanced Nurse Practitioner in Skin Cancer and I have almost completed a 2-year Dermoscopy Programme, when completed I will be an International Academic Expert in Dermoscopy.

How do you believe you have made a difference as a nurse/midwife?

This unique role that I am fortunate to have allows me to assess, examine, diagnose, educate, treat and discharge patients. There is nothing more fulfilling than offering a holistic service. Our clinic is unique in that it offers a ‘see and treat’ approach so where necessary any surgical intervention is also carried out on the same day.

Do you have a memory in your job that really stands out?

The proudest moment of my career was running my first see and treat clinic which would not have been possible without the vision of my clinical mentor Ms Deirdre Jones and Director of Nursing Ms Ursula Morgan, and all my colleagues in RUH.

How has Covid-19 changed nursing? Are there any positives that you will take with you?

We adapted our service so that we could continue to provide urgent care throughout Covid and as a result we have introduced some efficiencies and promoted role expansion of other team members which has been really positive both for them and our service.

If you could, what advice would you give to 19 year old you, starting out?

Focus on developing knowledge, skills and staying up-to-date. Don’t be afraid to ask for advice and if you find your passion don’t be afraid to expand your role. Passion for your job is what makes you an invaluable member of the team.

If you were given one million euro to spend on health, how would you spend it?

I would introduce Confocal Microscopy into our clinic, and it would come in at well under a million.

It’s post-pandemic and you’ve just won a holiday to anywhere in the world! Where would you go and why?

I would love to go on a family trip to the Rocky Mountains. This dramatic mountain range offers wilderness, diverse wildlife and alpine lakes...it caters for everything just like our service.

Back to reality…. You’ve a week to spend on holidays in Ireland. Where would you go and why?

You can't beat Enniscrone in Co Sligo and we won't forget to pack the SPF 50.