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SCOPE OF PRACTICE FOR NURSES AND MIDWIVES IN GHANA

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INTRODUCTION

Various authorities perceive the ways and manner which nurses and midwives should discharge their roles and duties apparently because of their different mandates. In academia, these roles and duties are described as objectives of the programme whereas the employer describes the roles and duties as job description. The regulator similarly describes these roles and duties as scope of practice.

The International Council of Nurses (ICN) indicates that scope of practice is not limited to specific tasks, functions or responsibilities but includes direct care giving and evaluation of its impact, advocating for patients and for health, supervising and delegating to others, leading, managing, teaching, undertaking research and developing health policy for health care systems. Furthermore, as the scope of practice is dynamic and responsive to health needs, development of knowledge, and technological advances, periodic review is required to ensure that it continues to be consistent with current health needs and supports improved health outcomes (ICN 1998, revised 2004).

The Nursing and Midwifery Board of Ireland (NMBI) on the other hand views the scope of practice as a range of roles, functions, responsibilities and activities which a registered nurse/midwife is educated, competent and has authority to perform (NMBI, 2000).

The American Nurses Association (ANA) has indicated that scope of practice are the services that a qualified health professional is deemed competent to perform, and permitted to undertake – in keeping with the terms of their professional license (ANA, 2021).

In reference to the aforementioned descriptions, the Nursing and Midwifery Council of Ghana (N&MC) describes scope of practice as the roles and duties that a qualified nurse/midwife is deemed competent to perform which is not limited to specific tasks or functions but include the independent, dependent and interdependent functions or roles of the nurse/midwife as enshrined in the N&MC’s regulations or Legislative Instrument (LI 683, 1971). These could also be deemed as the expanded and extended roles of the nurse/midwife. The scope of practice will be reviewed every 3-5 years.

This scope of practice for Nurses and Midwives in Ghana is hinged primarily on the following nursing theories and one nursing principle: Florence Nightingale, Hildegard Peplau and Ida Orlando’s, Dorothea Orem’s and Virginia Henderson’s theories, Fuerst and Wolf’s nursing principle and the Nursing Process.

The diagrams below illustrate broadly the relationship between the theories stated supra.

nmcgh-sop-conceptual-framework

STATUTORY MANDATE OF THE NURSING AND MIDWIFERY COUNCIL

The Nursing and Midwifery Council (N&MC) is an agency under the Ministry of Health, Ghana. It is also a statutory body established by Part III of the Health Professions Regulatory Bodies Act 2013 (Act 857).

Statutorily, the object of the Council is to “secure in the public interest the highest standards of training and practice of nursing and midwifery”.

Specifically, as enshrined in the Act 2013 (Act 857), to achieve the object, the Council shall:

  1. establish standards and provide guidelines for the development of a curriculum for the training of nurse assistants, nurses and midwives;
  2. register and maintain a register of practitioners;
  3. exercise disciplinary powers over practitioners;
  4. prescribe and maintain professional standards and conduct for practitioners;
  5. in collaboration with appropriate government agencies ensure that nursing and midwifery institutions are accredited;
  6. determine and implement post-registration, continuing education and continuing professional development programmes for practitioners;
  7. conduct licensing examination for certification and registration of nurses and midwives;
  8. ensure that the education and training of nurses and midwives and other nursing practitioners are carried out at approved educational institutions for efficient nursing and midwifery practice;
  9. advise the Minister for Health on matters relating to the training and practice of nursing and midwifery;
  10. monitor and inspect training institutions and health facilities in collaboration with the Health Facilities Regulatory Agency; and
  11. perform any other functions that are ancillary to the object of the Council

The Council recognizes the collaborative roles of various health institutions in service delivery in Ghana such as the Ghana Health Service, Christian Health Association of Ghana, Ahmadiya Muslim Mission Hospitals, Teaching Hospitals, Quaternary Hospital, Military Hospitals, Police Hospitals, Private Hospitals, other Quasi Government Hospitals etc.

The Council further acknowledges that the right staff mix may not be in existence in some hospitals/facilities; thus, institutions have proactively developed policies/protocols for effective and efficient service delivery.

The Council therefore mandates that once all such policies/protocols are written, jointly signed and dated by the appropriate authorities and the Council, they can be used for service delivery. Nurses/midwives should therefore be trained before the policies/protocols are implemented. Similarly, nursing and midwifery training institutions could have policies and protocols to direct faculty practice.

In this era of 4th Industrial Revolution, the Council encourages all nursing and midwifery practitioners to rest their practice on ICT for delightful service delivery. In this regard, all electronic verifiable instructions or sanctions are approved as formal.

The Council emphasizes that all activities that contribute to CPD-points acquisition in the CPD policy document (2020) constitute to the scope of practice for all cadre of nurses and midwives.

Signed
Felix Nyante (FWACN, FGCNM)
Registrar

ACKNOWLEDGEMENT

The Nursing and Midwifery Council of Ghana is indebted to the Minister for Health with his Directors for the policy direction during the development of this Scope of Practice for Nurses and Midwives. The Council is grateful to the Chairperson and Members of the 15th Governing for their strategic direction throughout the development process. To the Registrar, Mr. Felix Nyante, the Council remains grateful for his visionary and transformational leadership roles.

The N&MC is also grateful to its Stakeholders for the sustained cooperation and validation of this document. They are:

  1. Prof. Lydia Aziato - Consultant for the Project and Dean, SoNM – UG, Legon

  2. Hannah Oparebea Acquah - Rector, GCNM

  3. Dr. Barnabas Kwame Yeboah - CPO, N&MS MOH-HQ

  4. Eva Mensah - DNMS, GHS

  5. Perpetual Ofori Ampofo - President, GRNMA

  6. Netta Forson Ackon - President, GRMA

  7. Fredrica Hanson - General Secretary, GRMA

  8. Chief Supt. Dr. Kennedy Japiong - DNMS, Ghana Police Hospital

  9. Col. Rex Kudjoe Adzagba - DNMS, Ghana Armed Forces Medical Services

  10. Judith Asiamah - DNMS, UGMC, Accra

  11. Rita Aryee - DNMS, KBTH, Accra

  12. Sophia Blankson - DNMS, CCTH, Cape Coast

  13. Innocentia Ruby Gborgblorvor - DNMS, HTH, Ho

  14. Marina Assabill - CNO, KATH, Kumasi

  15. Rita Amonoo-Neizer - DDNS, GHS - HQ

  16. Bismark Tufour - DDNS, Ankaful Psychiatric Hospital, Ankaful

  17. Roberta Asiedu - Chief Nurse, CHAG

  18. Selina Dussey - PNO, PPME – MOH

  19. Supt. Paulina Animwaa - Police Hospital

  20. Rev. Philemon Gyapong - National Assistant PRO, GRNMA

  21. Raphael Korkortsi - Secretary, Nurse Specialist Society



The following officers of the Council are also duly acknowledged for their immense contribution towards the development of this document

  1. Philomina A.N. Woolley - Deputy Registrar (Operations)

  2. Agnes Oppong-Baah - Deputy Director (Operations)

  3. Victoria Lamina - Deputy Director (Operations)

  4. Priscilla Arthur Baiden - Deputy Director (Operations)

  5. Ampem Darko Oklodu-Abbey - Deputy Director (Operations)

  6. Hephizibah E. Gyimah - Deputy Director (Operations)

  7. Grace Dankwa - Deputy Director (Operations)

  8. Florence Animwaa Darko - Principal Operations Officer

  9. Gloria Esenam Simpong - Principal Operations Officer

  10. Sophia Wiredu - Principal Operations Officer

  11. Annie F. Oddoye - Senior Operations Officer

  12. Vera Antwi-Amamoo - Senior Operations Officer

  13. Priscilla K. Zigah - Senior Operations Officer

  14. Ophelia Princess Prempeh - Senior Operations Officer

  15. Patsy Ago Adams - Operations Officer

  16. Lydia Dsane-Selby - Operations Officer

  17. Jacqueline Incoom - Operations Officer

  18. Louisa Boateng - Operations Officer

  19. Helena Baaba Botchway - Assistant Operations Officer

  20. Emmanuel Febiri - Assistant Operations Officer

  21. Philemon Aning-Antoh - Assistant Operations Officer

  22. Grace Adjeley Annum - Assistant Administrative Officer

  23. Rexford Siaw - Administrative Officer

  24. Haruna Jalil Yusif - Administrative Officer

  25. Joel T. Josiah - Principal Administrative Assistant

  26. Samuel Nii Odoi Anang - Chief Driver