Commonwealth Nurses Federation (CNF) and International Council of Nurses (ICN) Meetings

Open Council

26th July 2007Agenda Item:

Agenda Item 07/80

Commonwealth Nurses Federation (CNF) and International Council of Nurses (ICN) Meetings and Conferences 2007

1. Purpose

1.1 To report on outcomes of CNF and ICN business meetings and conference in May and June 2007 and recommend review of process for agreeing attendance at ICN.

1. Background

2.1The Commonwealth Nurses Federation meets every two years in a Commonwealth country, usually just before the International Council of Nurses. Most of its members are also ICN members. It has only one member of staff, housed in the RCN, and very limited financial resource. The Presidency is currently held by the Chief Executive of the Singapore Nurses Association. The meeting this year was hosted by the Malaysian Nurses Association.

2.2The International Council of Nurses business meeting takes place every two years, increasingly followed by an ICN conference and a regulators conference. Every four years it holds a Congress, when elections also take place during the business meeting to the ICN Board. The next Congress is in 2009. This year’s meeting and conference was hosted by the Japanese Nurses Association. The current President of ICN is also Japanese.

1. Detail

3.1Commonwealth Nurses Federation meeting

The two day meeting focused mainly on CNF’s future direction, as requested by the European members of CNF, and the need for the organisation to identify its unique role and target its very limited resources more effectively. This was particularly urgent given the withdrawal of one of the Canadian Nurses Association from CNF given its lack of direction and focus and the intended retirement of the current Executive Secretary for the organisation, Michael Stubbings.

3.2This was the first meeting chaired by CNF President Susie Kong, who is Chief Executive of the Singapore Nurses Association. The RCN was represented by Maura Buchanan, RCN President and Susan Williams, Head of International Affairs.

3.3.Members agreed at the meeting that in future the organisation should focus on:

1. advocacy work in for a where CNF is the only nursing organisation with a voice i.e. at the annual Commonwealth Health Ministers meeting, and within the Commonwealth Steering Committee for Nursing and Midwifery established by that group, and at the Heads of Government meetings.
2. continued collaboration with other Commonwealth non governmental organisations to share work and maximise impact.
3. Shifting from regional workshops, which were not cost effective, to encouraging in-country activity, particularly activities likely to recruit members into or back into CNF.
4. Income generation including sponsorship, admin charges/fees for events, share of profits on events.
5. Recruitment of new Executive Secretary with skill and knowledge base to reflect the above (may not be based in London).

3.4In practical terms CNF agreed:

1. a timetable for feeding into the next Commonwealth Health Ministers meeting (CHMM) in May 2008 on e-health and commissioning a report to submit to ministers.
2. A theme to be proposed through the Commonwealth Secretariat for the 2009 CHMM to look at communicable disease and global mobility.
3. CNF to play a more pro-active role in the virtual Commonwealth Steering Committee, and propose four key areas of work for that group to report into ministers – human resources, education, evidence based practice and strengthening the nursing voice.
4. Executive Secretary post to be re-advertised shortly and current post holder to continue in post until replacement found.
5. CNF to update the Canadian Nurses Association at ICN on progress made and encourage them to reconsider their position.

3.5ICN Council of National Representatives meeting (CNR)

This is the biennial business meeting of ICN. The RCN was represented by Maura Buchanan, RCN President, Peter Carter, RCN General Secretary and Susan Williams, Head of International Affairs.

About 70 of ICN’s 129 member associations were represented, with observers from Palestine, East Timor, Bulgaria and Vietnam The main outcomes were:

1. a strong statement on the Bulgarian nurses and Palestinian doctor still held in Libya on HIV/AIDS charges, ICN is continuing efforts to try and visit the nurses.
2. a call for support within the UN for the stalled proposal for a UN women’s agency (RCN specifically thanked for their lobbying and support on this).
3. ICN to lobby WHO about the tiny number of nurse specialists employed by the organisation – with an actual decrease from 2.2% in 2003 to 1.8% in 2006, despite World Health Assembly resolutions on strengthening nursing and midwifery. Jean Yan, Chief Nurse Scientist at WHO confirmed that WHO would be establishing a group to look at targets and would include ICN in this work.
4. CNR agreed to postpone discussion on a challenge made by the recently established regulatory body in Romania to the current ICN member, a much smaller nurses association. The RCN supported this motion put forward by Norway and seconded a further motion proposed by Denmark for ICN to establish a working group to relook at its membership models before the CNR in 2009.
5. ICN President agreed to take forward with ICN Board a proposal from the RCN from 2005 that ICN consider establishing a collective Presidential fund to allow a candidate to stand from any nurses association as ICN President.

3.6The CNR also held a number of discussions to inform ICN’s future policy and position statements:

1. revisiting ICN’s vision – most groups agreed that this was still relevant today with some minor additions or shift in emphasis to encompass inclusiveness, partnership, nurses as knowledge workers, team work and nurses role in policy development.
2. Health and social care interface – this was a pre-policy discussion to look at areas of consensus, which included the key role of the nurse as care coordinator and as the link between social and medical care (assessment, planning, monitoring and evaluation).
3. Preparing for the Unexpected – after group discussions ICN was advised to focus on following gaps: strategic planning for preparedness ; environment, health and well-being and the impact of restructuring of health delivery
4. Delegation and Supervision – no major gaps in ICN work identified but ICN asked to: collate examples of best practice, promote the development of a delegation and supervision framework that promotes decision making and quality patient care. Need for evidence base on impact of delegation and supervision on patient care
5. Education/service Gap - ICN asked to develop a framework on education to include accreditation, models of facilitating learning in practice and capacity planning. Also asked to analyse education and policy trends to look at the impact on education/service gap of levels of initial preparation, privatisation of education, non-governmental and World Bank financial policies and migration.
6. Changing roles and numbers – Agreed that ICN largely had policies in this area but the challenge was to see them implemented. ICN is already working on a definition of competencies.

3.7 This was Judith Oulton, ICN Chief Executive Officer’s, last CNR meeting. She will step down in 2008. Her post is currently being advertised. In her final report to the CNR she described the progress made towards the ICN being a “learning organisation”. Its three remaining weaknesses are that it is still exclusive, it cannot cover its core activity through membership dues and regulation is not being addressed effectively.

3.8During ICN, the RCN General Secretary also had a number of meetings relating to the RCN’s European agenda and the European Federation of Nurses Associations. The UK’s Nursing and Midwifery Council attended the ICN CNR as observers and the ICN conference and regulation seminar. None of the UK’s Chief Nurses attended ICN or CNF.

ICN Conference

3.9This was a three day conference held in a two year cycle between the main quadrennial congresses. There were keynote addresses at three plenary sessions, main sessions in the bigger halls with invited speakers and a series of concurrent workshops based on abstract submissions. The RCN had four presentations chosen by Council Committees in the concurrent workshops which covered workforce planning, violence in the workplace, diabetes and campaigning on deficits, one presented by the RCN’s nomination to the ICN Board on specialist nurses, one poster presentation from the student representative and two poster presentations from the ICN competition winners. The RCN had a delegation of 14 people at the conference.

3.10 The three keynote addresses dealt with positive practice environments, ICN’s theme for nurses day this year and a major strand of work for ICN, ethical globalisation presented by Barbara Stocking Oxfam and Preparing for the unexpected by WHO with main sessions on workforce and clinical issues. Two new networks were launched - a student network, and a commitment for there to be a student gathering every two years concurrent with the ICN business meeting, and the launch of a disaster response network.

3.11Overall the quality of the keynote addresses and main sessions did not match the previous conference. The main areas of learning and exchange for the RCN with nurses associations and other participants during ICN related to the RCN’s working well activities and violence in the workplace, appropriate staffing levels, disaster response, regulation and international partnerships.

3.12RCN was able to gain some feedback from nurses associations on a potential RCN associate membership, but further follow up is required given the logistics at ICN Conference. There is wide support for Sylvia Denton’s candidature for the ICN Board within Europe and beyond.

3.13The RCN reception had an extremely high turnout and included a thank you speech by the ICN’s President, Hiroko Minami, and the welcome meeting for RCN members and UK delegates on the eve of the conference established good networks, particularly for members who had travelled to Japan alone and to ICN for the first time.

ICN regulation Conference

3.14There were approximately 150 delegates at this two day conference that immediately followed ICN with a very strong presence from key staff from national regulators. Sandra MacArthur and Kathy George attended from the NMC.

3.15The keynote speech by Rosemary Gibson, author of the Wall of Silence, was very powerful. She challenged regulators and Governments to develop blame free cultures and not to take punitive action if unintentional errors are made. She argued that greater transparency, more public monitoring and driving out fear where critical factors in terms of improving patient safety.

3.16 Audrey Cowie from the Scottish Executive presented developments in UK regulation including the Trust, Assurance and Safety White Paper. The audience were particularly interested in HCA regulation and the separation of investigation and adjudication. There were also a number of observations that the UK appeared to be concentrating more on individuals rather than systems.

3.17 There were also significant sessions on stand alone versus umbrella models of regulation, language competency, fraud and counterfeiting and the concept of a global license to practice on which ICN will be developing a discussion paper.

3.18 It was clear that ICN are actively seeking to both support and raise the profile of regulators and regulatory issues. There was a consensus amongst delegates that the conference was successful in both these respects.

1. Resources, costs and implications

4.1The overall agreed budget for attendance at the CNF, the ICN business meeting and the ICN conference for 2007/8 is £50,000.

1. Risks

5.1 There have been significant costs attached to attendance at ICN conferences. The main risks for the RCN are that:

• the level of attendance at ICN is not seen as effective use of RCN resource particularly given cost pressures in other areas
• .the work of ICN and CNF are not seen as relevant to UK nursing.

These risks are being addressed by reviewing attendance at ICN’s biennial events and associated expenditure, contributing to and influencing the focus of ICN’s activities and communicating with members about ICN’s and CNF’s work and opportunities for nurses in the UK to get involved.

1. Diversity

6.1RCN participation in ICN needs to reflect more the diversity of the organisation.

1. UK-wide/Four country perspective

7.1The RCN is the UK member of ICN. ICN’s policies and position statements aim to be relevant across nursing and health systems worldwide.

1. Strategic plan

8.1Objective B. That the RCN is recognised locally, nationally and internationally as the voice of UK nursing.

1. Recommendations

10.1Council to note the outcomes of the CNF and ICN meetings

10.2Council to note that an internal audit is reviewing the process for agreeing attendance at ICN conferences and Congress and resource implications.

Susan Williams, Head of International Affairs

July 2007

With input from: Howard Catton, Head of Policy Development & Implementation

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