Future Direction of Nursing Development in Hong Kong

The Honorable Michael Mak Kwok-fung, Legislative Counsellor
Honorary Advisor, Hong Kong Society for Nursing Education

(A Speech at the Scientific Meeting of the 17th AGM on 28 March 2003)

First, I would like to express my heart-felt appreciation to all our fellow health care workers for their great contributions to our community in the battle with SARS.

Regarding the future direction of nursing development in Hong Kong, I think we should go for professional autonomy and independence. Autonomy means non-invasion by other professions, whereas, independence means being independent in our professional practice. Nursing is a profession in many senses. What is a profession? Professionals always strive for excellence in their performance and demonstrate a sense of ethics and responsibility in their practice. Clearly, professionals are autonomous in their decision-making and accountable for their actions. How can we attain autonomy and independence? To make decision independently, one must be equipped with the knowledge and skills required for meeting challenges and demands. Professional education is of prime importance to professionalisation. For over a century, nursing education in Hong Kong has been conducted in hospital-based nursing schools through an apprenticeship system. In 1990, nursing education in Hong Kong started to move away from hospital-based diploma programmes to university degree level education. In May 2002, there were 32,000 nurses, including Registered Nurses and Enrolled Nurses, holding practicing certificates issued by the Nursing Council of Hong Kong. Among them, at least 7,000 hold a bachelor's degree in nursing, 650, a postgraduate diploma, 600, a master's degree, and 20, a doctoral degree. This year, we should have more nurses with a doctoral degree.

At the moment, there are three local universities, including the Polytechnic University of Hong Kong, The Chinese University of Hong Kong, and The University of Hong Kong offering pre-registration nursing degree programmes. It is definitely a milestone of professional nursing development. Indeed, many members of the local nursing community wish that in the very near future, all nurses of Hong Kong will have a degree in nursing before they become registered.

Why do we need a bachelor's degree in nursing? What is the difference in nursing competence among nurses with diploma qualification and those with an associated degree or a bachelor's degree? The answer is a simple one. Hong Kong has always been recognised as an international city with many great achievements. The demand of the community of Hong Kong is escalating, and the professional standard of many health care disciplines e.g. medicine and many paramedics have been maintained at a very high level, and their professional education is well founded with a bachelor's degree programme. I do not see any reason why basic nursing education in Hong Kong is to be kept at a diploma level. Degree education becomes essential for nursing to keep up with other health care colleagues, and to meet the increasing needs of the society. Hamilton (1997) defined professional education as a process by which the occupation develops the characteristic of a profession. So, how to make a profession to be recognized as a profession? I regard autonomy and independence in practice, continuing education, and evidence-based practice as the most important elements. In Hong Kong, nursing research has gradually been recognised as an important part of professional development. Many specialty nurses and nurse academics have been gaining more and more research experience. The knowledge gained from their research work becomes a valuable asset for the local nursing practice. However, I still consider that more effort should be paid in promoting nursing research. I hope that schools of nursing in the universities, nursing associations, the Hospital Authority and Department of Health could do more in this respect.

On the other hand, we are all aware of the importance of continuing education for the development of a professional. Last year, my office did a survey among members of the Health Services Sector which consists of mainly nurses. 95% of the respondents supported the need for continuing profession education, although the majority maintained that it should be taken on a voluntary basis. For the growth of our profession, continuing education is essential. We need to have realistic and effective plans for our colleagues to take part in continuing education.

Moreover, political forces are having great influence on the development of nursing. Have you ever thought of the potent effect of participating in political activities? Our bargaining power will certainly increase if we work together striving for our rights. Klan (1987) said, 'If nurses become involved in and participate in political decision-making through nursing organisations and political parties, I believe they will be an unbeatable force for change.' Politics is indeed an essential matter of life. Taking part in politics helps to develop links with political parties and policy-makers. I regret to see that many nurses in Hong Kong are not that keen to be associated with politics, and are apprehensive in participating in political activities.

As an elected legislative counsellor of the Health Services Sector, I will safeguard your interests as well as those of the public. But, I do urge you to become more politically sensitive and active. It is high time that we unite and gather our forces. A recent survey shows that nursing is ranked the fourth among the ten most respectable occupations in Hong Kong. We only come after university professors, medical doctors, and engineers. It is encouraging, isn't it? Nevertheless, we must not be complacent with this. We may have been too focused in nursing services and not used to participating in public affairs. Actually we could make better use of our professional knowledge to help those who are less fortunate. The public would learn more about our professional contribution. We could also self-actualise and lead a more positive life. I hope to see more nurses participate in volunteer work and community affairs in the capacity of a nurse.

Another issue is a bit sensitive. It is the medical dominance, which is an undeniable feature in the health care services, be it international or local. In Hong Kong, many key policy makers, hospital chiefs, and many powerful people in our society are all from the medical profession. Medical dominance is shown by the unfair allocation of resources and power, and even legislation. For example, in Chapter 359 of the Supplementary Medical Profession Ordinance, it is stipulated that the chairman of the Supplementary Medical Profession Council must be a register medical practitioner. Nursing, like many other health care disciplines, is in many ways being controlled by the powerful medical profession. Nurses need to get rid of their traditions of being passive and submissive. Today, nurses need to demonstrate their professional competence and sound knowledge with confidence and courage. They need to position themselves that they practice independently, as well as interdependently with a good working relationship with other health care disciplines. I would think that all professions are sharing a common goal, that it, to provide the community with quality services. I have a dream that nurses in Hong Kong have their private practice with clients referred by other health care professional. I believe that this dream would come true soon if we work harder. Please keep well and live professionally. Thank you.