Processes for disciplining nurses for unprofessional conduct of a serious nature : a critique

Aims: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies.

Background: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses.

Methods: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies.

Results: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors.

Conclusion: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.

The first Australian nurse practitioner census : a protocol to guide standardized collection of information about an emergent professional group

Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28 existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time.

Nursing Sans Frontieres: A Three Year Case Study of Multi-State Registration of Support Nursing Practice Using Information Technology

Objective: To highlight the registration issues for nurses who wish to practice nationally, particularly those practicing within the telehealth sector. Design: As part of a national clinical research study, applications were made to every state and territory for mutual recognition of nursing registration and fee waiver for telenursing cross boarder practice for a period of three years. These processes are described using a case study approach. Outcome: The aim of this case study was to achieve registration in every state and territory of Australia without paying multiple fees by using mutual recognition provisions and the cross-border fee waiver policy of the nurse regulatory authorities in order to practice telenursing. Results: Mutual recognition and fee waiver for cross-border practice was granted unconditionally in two states: Victoria (Vic) and Tasmania (Tas), and one territory: the Northern Territory (NT). The remainder of the Australian states and territories would only grant temporary registration for the period of the project or not at all, due to policy restrictions or nurse regulatory authority (NRA) Board decisions. As a consequence of gaining fee waiver the annual cost of registration was a maximum of $145 per annum as opposed to the potential $959 for initial registration and $625 for annual renewal. Conclusions: Having eight individual nurses Acts and NRAs for a population of 265,000 nurses would clearly indicate a case for over regulation in this country. The structure of regulation of nursing in Australia is a barrier to the changing and evolving role of nurses in the 21st century and a significant factor when considering workforce planning.

Lesser auger beetle Heterobostrychus aequalis(Coleoptera: Bostrichidae) in Australia: absent or elusive?

The lesser auger beetle, Heterobostrychus aequalis (Waterhouse), is a serious pest of seasoned hardwood timber throughout the Oriental region and several areas beyond. Some early collection records of H. aequalis from Australia in the 1950s and 1960s indicated that the insect was present in northern Queensland, but no confirmed breeding population has been found in the past few decades suggesting either that it may have not established permanently or it is difficult to detect. The ambiguity about the breeding status of the pest in Australia has caused confusion for regulating authorities needing to respond to each new post-border detection. We examined records of H. aequalis in Australian insect collections and from intensive plant pest surveillance activities in Queensland and northern Australia over the past 48 years to resolve this confusion. Until very recently, available evidence suggested that H. aequalis was not established in Australia, despite multiple introductions and apparently suitable climate and hosts. Collection records of the pest are predominantly linked to intercepted items or are recorded as of unknown origin, and no established populations have been found during many years of targeted surveillance. However, a detection of H. aequalis in suburban Cairns, north Queensland, in late 2013 and two more in mid-2015 in the same general locality do not appear to be linked to any imported material, indicating that there is at least a tenuously established local population. Investigations are underway to confirm this, but the insect is not widely established in Australia and, if present, remains elusive. Our recommended response to any future detection of H. aequalis is to fumigate or destroy the infested material, conduct tracing enquiries and limit surveys to the immediate vicinity of the detection.

Patentes e etanol lignocelulósico

Produção intelectual e desenvolvimento tecnológico podem diferenciar países e regiões no processo de desenvolvimento socioeconômico. No caso do Brasil, observa-se o papel energético do etanol combustível para veículos motorizados leves como um resultado importante do avanço tecnológico do país, que vai além da aptidão agroclimática. A contínua busca pela especialização tecnológica verticalizada do setor sucroenergético poderia levar o Brasil a uma posição, se não autônoma, mais confortável, não só de produtor de matéria-prima, mas de processos agregadores de valor no que diz respeito aos processos de produção de etanol de segunda geração, produzido a partir de biomassa lignocelulósica. O objetivo desta dissertação é analisar os esforços de P&D que resultaram em Depósitos e Publicações de patentes em órgãos oficiais como o United States Patent and Trademark Office (USPTO), o European Patent Office (EPO), e o Instituto Nacional de Propriedade Industrial (INPI), no tema etanol de segunda geração. Ainda, verifica-se se esses esforços impactam no poder concorrencial de países e firmas depositantes de patentes. Além das coletas e observações dos dados dos órgãos acima mencionados, foram calculados para os dados de depósitos e publicações de patentes no tema bioetanol lignocelulósico os índices de Herfindahl Hirschman (HHI) e a razão de concentração (Concentration Ratio) CR4, tradicionalmente utilizados para que órgãos reguladores de defesa do consumidor autorizem fusões e aquisições entre participantes de um determinado mercado. Esse método permite a observação do grau de competitividade entre as firmas depositantes de patentes no tema e a possível tendência sobre a detenção do controle em futuro próximo e a corrida para venda de royalties dos processos desenvolvidos em diferentes áreas tecnológicas para incrementar a produção industrial de etanol avançado. Os resultados indicam uma concentração elevada dos esforços de pesquisa, medidos pelos depósitos de patentes, referentes a etanol de segunda geração, em um número muito reduzido de empresas norte-americanas, quando analisada a base de dados dos EUA. O sucesso desses esforços, mensurados pela publicação de patentes, contudo, não se mostra concentrado nem nos EUA nem na União Europeia. No caso do Brasil, ainda não são encontradas publicações de patentes no tema Lignocellulosic Bioethanol, bem como apenas uma empresa brasileira possui uma patente publicada nos Estados Unidos. Esses resultados sugerem que investimentos em pesquisa científica no Brasil podem produzir mais artigos publicados e titulação acadêmica/científica que propriamente o registro de patentes em órgãos especializados em qualificar a invenção de métodos, processos ou fórmulas, dentro e fora do país. Isso pode significar tanto baixo esforço em pesquisa no assunto quanto à perda pelo autor e/ou sua instituição da oportunidade de ter seu esforço de pesquisa recompensado por meio de royalties, como compensação pela criatividade, dedicação intelectual e de recursos econômicos. Os resultados deste estudo contribuem para o debate a respeito da crescente necessidade de produção e abastecimento de fontes renováveis de energia, como o biocombustível etanol avançado à base do derivado bagaço de cana-de-açúcar, a custos mais competitivos como matéria-prima adicional e para produção incremental de etanol em futuro próximo. As conclusões do estudo indicam a necessidade do aumento na produção de conhecimento aplicado e em esforços para garantir sua propriedade intelectual, permitindo o retorno patrimonial com royalties.

Antidumping as Strategic Trade Policy Under Asymmetric Information

In the last two decades, trade liberalization under GATT/WTO has been partly offset by an increase in antidumping protection. Economists have argued convincingly that this is partly due to the inclusion of sales below cost in the definition of dumping during the GATT Tokyo Round. The introduction of the cost- based dumping definition gives regulating authorities a better opportunity to choose protection according to their liking. This paper investigates the domestic government's antidumping duty choice in an asymmetric information framework where the foreign firm's cost is observed by the domestic firm, but not by the government. To induce truthful revelation, the government can design a tariff schedule, contingent on firms' cost reports, accompanied by a threat to collect additional information for report verification (i.e., auditing) and, in case misreporting is detected, to set penalty duties. We show that depending on the concrete assumptions, the domestic government may not only be able to extract the true cost information, but also succeeds in implementing the full-information, governmental welfare-maximizing duty. In this case, the antidumping framework within GATT/WTO does not only offer the means to pursue strategic trade policy disguised as fair trade policy, but it also helps overcome the informational problems with regard to correctly determining the optimal strategic trade policy.

The experience of being an advanced practice nurse within Australian acute care settings : a systematic review of qualitative evidence

Background There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective. Objective To identify the experience of being an advanced practice nurse working in Australian acute care settings. Inclusion criteria -Types of participants Registered nurses working in advanced practice roles in acute care settings throughout Australia. -Phenomena of interest The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves. -Types of studies Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography. -Search strategy A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011. -Methodological quality Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument. -Data extraction Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool. -Data synthesis Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument. Results Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings. Conclusions The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people.

Mapping postgraduate nurse education in Australia 2001-2002

Workforce planning at a national level within nursing and midwifery has been largely fragmented and uncoordinated with health-care organisations, state health authorities, peak nursing organisations and the tertiary sector often engaging in independent decision making and planning. In order to gain an increased understanding of the complexity of contemporary nurse education and to quantify the number of graduates of nursing education courses into categories that are meaningful for workforce planning, the federal Department of Education, Science and Training commissioned a national study in 2002. The aim of this study was to map and quantify current and projected numbers of Australian domestic nursing postgraduate students within their respective specialisation according to each State/Territory. All Australian universities offering postgraduate courses in nursing were electronically surveyed (n=30). Two non-university providers of postgraduate nursing education were also asked to participate, but only one responded. Data were gathered on the number of domestic postgraduate nursing students enrolled in 2002, the number of course completions in 2001 and projected completions for 2002. Of the 13 broad band specialty categories developed for the study, the specialties of Midwifery and High Dependency were dominant in both student enrolments and course completions, including projected completions. The range of specialties that were offered varied by State/Territory, as did the number and percentage of students enrolled, completing and projected to complete each specialty program. Generic courses (without listed specialisations) continue to complicate the process of attempting to tease out and quantify accurately the number of enrolled and completing postgraduate students according to area of specialty practice.

Regulating more effectively : the relationship between procedural justice, legitimacy and tax non-compliance

In recent years, a significant number of middle-income taxpayers have been making use of aggressive tax planning strategies to reduce tax. In many cases, it is unclear whether these are designed and used by tax- payers to minimize tax legally or to avoid tax illegally. Those that are designed to exploit loopholes in tax law need to be dealt with in a way that restores faith and equity to the system. But how can tax authorities best manage taxpayers who may have inadvertently become involved in such illegal tax planning practices? Using longitudinal survey data, it will be shown that attempts to coerce and threaten taxpayers into compliance can undermine the legitimacy of the Tax Office's authority, which in turn can affect taxpayers' subsequent compliance behaviour. Responsive regulation, which is based on principles of procedural justice, will be discussed as an alternative enforcement strategy.

An analysis of potential barriers and enablers to regulating the television marketing of unhealthy foods to children at the state government level in Australia

Background In Australia there have been many calls for government action to halt the effects of unhealthy food marketing on children's health, yet implementation has not occurred. The attitudes of those involved in the policy-making process towards regulatory intervention governing unhealthy food marketing are not well understood. The objective of this research was to understand the perceptions of senior representatives from Australian state and territory governments, statutory authorities and non-government organisations regarding the feasibility of state-level government regulation of television marketing of unhealthy food to children in Australia.

Method Data from in-depth semi-structured interviews with senior representatives from state and territory government departments, statutory authorities and non-government organisations (n=22) were analysed to determine participants' views about regulation of television marketing of unhealthy food to children at the state government level. Data were analysed using content and thematic analyses.

Results Regulation of television marketing of unhealthy food to children was supported as a strategy for obesity prevention. Barriers to implementing regulation at the state level were: the perception that regulation of television advertising is a Commonwealth, not state/territory, responsibility; the power of the food industry and; the need for clear evidence that demonstrates the effectiveness of regulation. Evidence of community support for regulation was also cited as an important factor in determining feasibility.

Conclusions The regulation of unhealthy food marketing to children is perceived to be a feasible strategy for obesity prevention however barriers to implementation at the state level exist. Those involved in state-level policy making generally indicated a preference for Commonwealth-led regulation. This research suggests that implementation of regulation of the television marketing of unhealthy food to children should ideally occur under the direction of the Commonwealth government. However, given that regulation is technically feasible at the state level, in the absence of Commonwealth action, states/territories could act independently. The relevance of our findings is likely to extend beyond Australia as unhealthy food marketing to children is a global issue.

Deregulation strategies and its regulating effects: The case of the termination of Social Assistance for rejected asylum seekers in Switzerland

Deregulation strategies and their regulating effects: The case of the termination of Social Assistance for rejected asylum seekers in Switzerland. In Switzerland, rejected asylum seekers no longer have any residence rights. In 2003 the Swiss state decided to terminate the so far granted social assistance for people with a non-entry decision on their asylum request. In 2008 the termination of social assistance was expanded to all rejected asylum seekers. Nevertheless, facing the impossibility of deporting them, the Swiss state entitled this group of people to emergency assistance. It is a basic, which is stated in the Swiss Federal constitution. In this context, new structures were established specially for rejected asylum seekers. These structures had to be set up, financed, controlled, managed and legitimized. For example, collective centres were set up exclusively for rejected asylum seekers. In this speech, I want to analyze the political and bureaucratic process of terminating social assistance for rejected asylum seekers. The exclusion of rejected asylum seekers from social aid was embedded in a wider austerity program of the Federal State. The Federal Migration Office had been requested to save money. The main official goal was to reduce the support of these illegalized people, reduce any structures that would prolong their stay on Swiss ground and to set incentives so that they would leave the country on their own. But during the implementation, new regulating effects emerged. Drawing on ethnographic material, I will highlight these “messy procedures” (Sciortino 2004). First, I will analyze the means and goals developed by the Federal authorities while conceptualising the termination of social assistance. Second, I will focus on the new built structures and elaborate the practices and legitimating strategies of the authorities. As a conclusion, I will analyze the ambivalences of these processes which, at the end, established specific structures for the “unwanted”.

Policy analysis of Texas Senate Bill 532 and the regulation of nurse practitioners in the convenience care model

Background. Retail clinics, also called convenience care clinics, have become a rapidly growing trend since their initial development in 2000. These clinics are coupled within a larger retail operation and are generally located in "big-box" discount stores such as Wal-mart or Target, grocery stores such as Publix or H-E-B, or in retail pharmacies such as CVS or Walgreen's (Deloitte Center for Health Solutions, 2008). Care is typically provided by nurse practitioners. Research indicates that this new health care delivery system reduces cost, raises quality, and provides a means of access to the uninsured population (e.g., Deloitte Center for Health Solutions, 2008; Convenient Care Association, 2008a, 2008b, 2008c; Hansen-Turton, Miller, Nash, Ryan, Counts, 2007; Salinsky, 2009; Scott, 2006; Ahmed & Fincham, 2010). Some healthcare analysts even suggest that retail clinics offer a feasible solution to the shortage of primary care physicians facing the nation (AHRQ Health Care Innovations Exchange, 2010). ^ The development and performance of retail clinics is heavily dependent upon individual state policies regulating NPs. Texas currently has one of the most highly regulated practice environments for NPs (Stout & Elton, 2007; Hammonds, 2008). In September 2009, Texas passed Senate Bill 532 addressing the scope of practice of nurse practitioners in the convenience care model. In comparison to other states, this law still heavily regulates nurse practitioners. However, little research has been conducted to evaluate the impact of state laws regulating nurse practitioners on the development and performance of retail clinics. ^ Objectives. (1). To describe the potential impact that SB 532 has on retail clinic performance. (2). To discuss the effectiveness, efficiency, and equity of the convenience care model. (3). To describe possible alternatives to Texas' nurse practitioner scope of practice guidelines as delineated in Texas Senate Bill 532. (4). To describe the type of nurse practitioner state regulation (i.e. independent, light, moderate, or heavy) that best promotes the convenience care model. ^ Methods. State regulations governing nurse practitioners can be characterized as independent, light, moderate, and heavy. Four state NP regulatory types and retail clinic performance were compared and contrasted to that of Texas regulations using Dunn and Aday's theoretical models for conducting policy analysis and evaluating healthcare systems. Criteria for measurement included effectiveness, efficiency, and equity. Comparison states were Arizona (Independent), Minnesota (Light), Massachusetts (Moderate), and Florida (Heavy). ^ Results. A comparative states analysis of Texas SB 532 and alternative NP scope of practice guidelines among the four states: Arizona, Florida, Massachusetts, and Minnesota, indicated that SB 532 has minimal potential to affect the shortage of primary care providers in the state. Although SB 532 may increase the number of NPs a physician may supervise, NPs are still heavily restricted in their scope of practice and limited in their ability to act as primary care providers. Arizona's example of independent NP practice provided the best alternative to affect the shortage of PCPs in Texas as evidenced by a lower uninsured rate and less ED visits per 1,000 population. A survey of comparison states suggests that retail clinics thrive in states that more heavily restrict NP scope of practice as opposed to those that are more permissive, with the exception of Arizona. An analysis of effectiveness, efficiency, and equity of the convenience care model indicates that retail clinics perform well in the areas of effectiveness and efficiency; but, fall short in the area of equity. ^ Conclusion. Texas Senate 532 represents an incremental step towards addressing the problem of a shortage of PCPs in the state. A comparative policy analysis of the other four states with varying degrees of NP scope of practice indicate that a more aggressive policy allowing for independent NP practice will be needed to achieve positive changes in health outcomes. Retail clinics pose a temporary solution to the shortage of PCPs and will need to expand their locations to poorer regions and incorporate some chronic care to obtain measurable health outcomes. ^

Climate and grazing control nurse effects in an Ecuadorian dry shrubby community

Positive plant interactions have strong effects on plant diversity at several spatial scales, expanding species distribution under stressful conditions. We evaluated the joint effect of climate and grazing on the nurse effect of Croton wagneri, by monitoring several community attributes at two spatial scales: microhabitat and plant community. Two very close locations that only differed in grazing intensity were surveyed in an Ecuadorian dry scrub ecosystem. At each location, two 30 × 30-m plots were established at four altitudinal levels (1500, 2630, 1959 and 2100 m asl) and 40 microsites were surveyed in each plot. Croton wagneri acted as community hubs, increasing species richness and plant cover at both scales. Beneath nurses mean richness and cover values were 3.4 and 21.9%, and in open areas 2.3 and 4.5%, respectively. Magnitude of nurse effect was dependent on climate and grazing conditions. In ungrazed locations, cover increased and diversity reduced with altitude, while grazed locations showed the opposite trend. In ungrazed plots the interactions shifted from positive to negative with altitude, in grazed locations interactions remained positive. We conclude that the nurse effect is a key mechanism regulating community properties not only at microsite but also at the entire community scale.

Rural and Isolated Practice Registered Nurse (RIPRN)-Emergency nurses of the Queensland `bush'

The Rural and Isolated practice endorsement for Queensland Registered Nurses has attracted interest from other state health authorities with respect to expanding the scope of practice of nurses working in rural and remote Australia. This discussion article outlines the endorsement program and sheds a spotlight on the program for the emergency and greater nursing community. The paper draws a similarity between rural and emergency nursing and stimulates the notion that other states could look to Queensland's model, for scope of practice expansion in other specialties such as emergency Nursing.

The Audit Commission:guiding, steering and regulating local government

How does the non-executant state ensure that its agents are fulfilling their obligations to deliver nationally determined policies? In the case of elected local government in England and Wales, this function is carried out by the Audit Commission (AC) for Local Authorities and the Health Service for England and Wales. Since being established in 1983, it is the means by which local authorities are held to account by central government, both for its own purposes and on behalf of other interested stakeholders. Although the primary function of the AC is to ensure that local authorities are fulfilling their obligations, it does so by using different methods. By acting as a regulator, an independent expert, an opinion former and a mediator, the AC steers local authorities to ensure that they are compliant with the regulatory regime and are implementing legislation properly.