Background

In Hong Kong, the regulation of practice of nurses resembles much to the British system. Currently, there are only a few categories of nursing registration, namely the general, psychiatric, mentally subnormal and sick children. Vast majority of nurses are labeled "general nurses" though they have become highly specialized. With the increasing complexity of health care, changing pattern of health problems, rising demand for quality care for public, as well as the rapid advancement of technology, nurses' role must adapt to these changes.

The scope of nursing practice is expanding rapidly in width and depth. The setting of practice has gone far beyond the hospital. Wherever there are people, there is a place for nursing in preventive, primary, tertiary, or supportive roles. With the fast development of nursing knowledge and the extension of boundaries of nursing practice, there is a rapid proliferation of nursing specialties. The development of nursing specialization augments the development of medical specialization.

Specialty nurses practise at an advanced level are being called advanced practice nurse. Places like Australia, New Zealand, Taiwan, the United Sates of America, the United Kingdom, West Africa, etc are developing advanced practice nursing, though at different stages. The development of advanced practice nurse in Hong Kong is line with nursing development internationally.

The International Council of Nurses (lCN) (2004) has an advanced practice nurse as 'a registered nurse who has acquired the expert knowledge base, complex decision-making skill and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master's degree is recommended for entry level.

From 1993, the Hospital Authority, the biggest employer of nurses in Hong Kong, had appointed about 190 nurse specialists working in 38 specialties such as diabetes, geriatric, hospice, psychiatry, obstetric and gynaecology, and stoma. These nurse specialists had gained much recognition from nurses, doctors as well as clients for the quality care that they provided to their clients. Since 2001, the Hospital Authority has appointed about 530 nurses as advanced practice nurses. These nurses function independently and interdependently with other health care team members in the hospital and in community facilities, such as nurse clinics. These advanced practice nurses assume the dual role of expert in specialty as well as the clinical nursing management. Both local and international research evidence consistently support the effectiveness of advanced nursing practice in improving care outcome, reducing health care cost and enhancing client satisfaction (for example: Kirchbaum et al, 2005; Naylor et al 2004; Wong, 1999; Wong, Chung & Chan, 2003). It is envisaged that the development of advanced nursing practice would benefit the society of Hong Kong by providing safe, quality and cost-effective specialist nursing services.

Since 1990s many nursing specialty groups are formed in Hong Kong under the name of nursing specialties, e.g. intensive care nursing, paediatric nursing, gerontological nursing, mental health nursing, etc. These new nurse groups are active in organizing professional development activities and they are also expected to have a stipulated continuing nursing education system. Such development reflects the urgency for establishing a regulatory system which in regulating and promoting advanced nursing practice.

At present there are about 4,000 nurses who have specialist qualifications, with a master degree and with more than seven years post-registration experience. They are experienced specialist nurses whose practice needs to be regulated to ensure care quality. It is also estimated that each year, about 600 nurses will graduate from university first degree programme. Those newly graduated nurses working in the Hospital Authority would go into specialist training three years after their graduation. Their specialist training needs to be regulated to ensure they are of consistent standard.

At present, the legal requirements for nurse specialist training after registration in Hong Kong is inadequate and that an establishment, and improvement of facilities, for nurse specialist training is required as a step towards a specialist register. With regard to a nurse specialist register, it is considered that the mere establishment of specialist register in the absence a governing body in implement and supervise postgraduate specialist training on a continuous basis and govern the registration of nurse specialists would do little to improve the standard of nursing care in Hong Kong.

Thus, it is proposed that a statutory body, namely "The Hong Kong Academy of Nursing" (HKAN) to be set up. The key functions of the HKAN are to regulating the practice and promoting the professional development of advanced practicing nurses in specialty areas. It is envisaged that the HKAN set in Hong Kong will be a model of specialist nursing development for Mainland China and nearby regions.

Hong Kong Academy of Nursing Preparatory Committee (HKANPC) is established since 2006 for the preparatory work of the HKAN. The HKANPC consisted of nursing leaders from 19 major nursing professional bodies, two statutory bodies, employers of nurses and universities in Hong Kong. The membership list is presented at appendix I. A proposal for the establishment of the HKAN is prepared by HKANPC which sets out the views of nursing community in Hong Kong on the need for a formal regulatory body for specialist practice, as well as structure and functions of various parts of the proposed HKAN. The proposal has been widely consulted among nurses Hong Kong and has gained support from the nursing community (appendix II). The proposal has been submitted to Dr. York Chow, the Secretary for Food and Health and gained his strong approval and support.

Five work groups have been formed within the HKANPC to focus on specific work: Work Group for Business Plan, Work Group for Fund Raising, Work Group for Promotion and Public Relation, Work Group for Education and Accreditation, and Work Group for Legislation.

This business plan set out the targets, actions to achieve the targets and timeframe for establishing the HKAN.