Speech by Minister Varadkar to the Annual Conference of the Irish Association of Advanced Nurse and Midwife Practitioners (IAANMP)

Check against Delivery

Wednesday 22nd April 2015 – Farmleigh House


Good morning. I want to thank Chairperson Karen Brennan, and Vice-Chairperson Bernadette Carpenter, for asking me to address your annual conference. I’m delighted to meet you and learn about the sort of contributions that Advanced Nurse and Midwife Practitioners make across a variety of specialities.

Events like this today are a good opportunity to debate issues of concern and to learn from each other.

From the theme of your conference – Leading in a Time of Challenge: Advanced Practice, Leadership in Action, it’s clear that you already provide leadership nationally through advanced nursing and midwifery practice in health care.  Leadership in the health services is always a challenge, but never more so than at present. A good example of that leadership in action was the decision 11 years ago to set up this association.

Ireland currently has 144 Advanced Nurse Practitioners and 6 Advanced Midwife Practitioners. They play an important role in many areas of practice.
In particular, Emergency Departments and Local Injury Units across the country have benefited by adding Advanced Nurse Practitioners to care teams. This has improved access to services for patients, and helped to ensure that patients receive rapid assessment and treatment.

There are currently 65 Advanced Nurse Practitioners working in the Emergency Care Networks. I am convinced that we could do with more. In fact, Advanced Nurse Practitioners have already demonstrated their value to efficient service delivery across a wide range of areas. However, some areas of practice remain underdeveloped. That’s why the Chief Nursing Officer Siobhan O’Halloran will start a project this year looking at how to build on the existing pathway for advanced and specialist nursing and midwifery practice, and further develop value-based outcomes for patients.

This project will feed directly into future plans for advanced and specialist nursing and midwifery practice, including a look at how these roles can contribute more effectively to health reform. The Department will prepare a policy document to see how advanced and specialist nursing and midwifery practice can be used to improve access to quality care across services. This paper will also look at the how workforce planning, legislation, and credentials can be used to deliver value-based outcomes of care.
I know the CNO’s office will be consulting on this paper and I want to encourage your association to take part.

One of the project’s goals will be to identify appropriate Key Performance Indicators for specialist and advanced nursing and midwifery, which can be used for quality improvement and to measure the contribution made by nursing and midwifery.

Scope of Practice:

Ireland’s nurses have earned their reputation for being very well educated, highly-skilled and motivated. They are a great asset and a cornerstone of the health service. We must ensure that this expertise continues to be fully utilised, and that we get the best possible outcomes for our patients.

It hasn’t always been possible for nurses and midwives to make the best use of their education, and to put their skills into practice, largely because of a range of cultural, regulatory and policy barriers. This situation has got to change.

But it doesn’t make any sense to restrict the scope of what our nurses can and should do.
Highly skilled nurses are too valuable – and too scarce – to restrict them in this manner. We must make every effort to remove any obstacles and allow nurses to expand the scope of their practice, in the best interest of patients, our health service and their own job satisfaction.

Some bold decisions have already been taken. New laws were passed to allow nurses and midwives to prescribe medicinal products and we currently have 783 Registered Nurse Prescribers practicing in Ireland.

By looking again at current practices, we can look again at how we think about how to guarantee quality and safety. Regulation is all about setting standards for consistency and control. But regulation also needs to be proportionate to the end goal, and should strive to reach that goal in the most effective and efficient way possible.

Removing unnecessary or outmoded barriers, and building on past experiences and new developments, helps us to identify new possibilities. That’s why we need to develop champions and agents for change.

And we need to ensure that nurses and midwives make the best use of their education and experience, and make an even bigger contribution to the health service with the support and leadership of your association.


It’s vital for patient safety that all healthcare professionals should continue to maintain their own levels of competence. A recent study found that competence in nursing and midwifery practice is about much more than just skills, tasks and roles. It’s also about knowledge, experience and critical thinking. These competences help nurses or midwives to make safe and appropriate decisions for the patient.

Competence also means letting the nurse or midwife take ownership of their own practice, and engage in new practices. I was delighted to see the results of a new study showing that patient safety is viewed as an important factor by nurses and midwives, when deciding on whether to take on a new role.

I know that nurses and midwives have taken on a lot of new responsibilities in recent years.
These include comprehensive physical and psychosocial assessments, caseload management, nurse-led clinics and nurse-led admission, and discharge practice, as well as prescriptions and x-ray. We must continue to build on these initiatives.

We need to give each nurse and midwife the confidence to develop new competencies, and embrace new ways of working, in the interests of their patients.

I’m conscious that the professional competence element of the Nurses and Midwives Act 2011 has not yet been commenced. I would like to see it implemented as soon as possible. I have made this case to the Nursing and Midwifery Board of Ireland – the NMBI – and hope the necessary schemes will be developed and implemented without undue delay.

I want to take this opportunity to highlight some of the key policy developments being driven by the Chief Nursing Officer and her office in the Department of Health.

Taskforce on Staffing and Skillmix in Nursing:

The 37,000 nurses in Ireland comprise just over a third of the healthcare workforce. The number of nurses has fallen in recent years, in line with the overall reduction in health service staffing. However, I am happy that this situation is being reversed and I hope it will continue to improve, albeit gradually.

Nurse and Midwife recruitment is already underway in some parts of the health service. However, it’s no easy task to decide on the optimal number of nurses. You need a very clear rationale and a rigorous assessment. You need to strike a balance between efficiency and safety, ensure that staffing levels are appropriate, and have the right mix of skills.

The Taskforce on Staffing and Skillmix in Nursing is doing very important work in this area.  It was established to develop a framework to find the best staffing and skill mix in nursing, across a range of major specialities.  Phase 1 of the Taskforce is focused on developing a framework for nurse staffing and skillmix, in general and specialist medical and surgical settings in acute hospitals. It has consulted widely on the framework and I expect to receive the report back in the coming weeks.

Future Direction of Nursing:

Most countries are struggling with the challenge to produce better outcomes for patients, in a more co-ordinated manner across the health service, with reduced or limited resources. In Ireland, one of the options being looked at is the development of new advanced nursing and midwifery roles, and developing interdisciplinary nursing roles.

Some of the roles being developed in other countries include:

1) care co-ordination roles for teams in complex or rapidly changing situations;
2) nursing informatics specialists and tele-health;
3) bringing virtual and face-to-face health care to people where they work and live;
4) and providing care in the community where the patient particularly expects to receive it.

I look forward to seeing how we can further support community-based care as part of the new community healthcare organisations. I expect that my Department will consider these issues in due course.


Health reforms and technological advances are always important in the health service, but they can never replace the care elements of nursing and midwifery best practice. Staff need to focus on care and compassion as much as they do on knowledge and skills and competence.

Incidents of misadventure and poor practice are always deeply regrettable, but when they occur we must address the problem and make every effort to prevent a re-occurrence. We must always reflect and learn from our mistakes.

Care, compassion and competence should be at the heart of everything we do. Leadership at all levels has to be underpinned by the values we live by, and which you apply as professionals.

Concluding remarks:

It’s impossible to underestimate the importance of nurses and midwives to the Irish health service. I think the time is right for advanced practice practitioners to make an even greater contribution to high quality clinical care.
I encourage you to continue your good work and ensure that we develop our practices in the best interests of patients and their safety.

I want to acknowledge the commitment to high standards in both your professions, and the challenges you face on a daily basis. I hope you all enjoy the rest of this interesting conference, and I wish the Irish Association of Advanced Nurse and Midwife Practitioners continued success in the years ahead.