Cook Islands

Background Information

Introduction
Cook Islands is a self governing country with free association with New Zealand. It consist of 15 islands and atolls spread over 2 million sq. km of the South Pacific Ocean. The Islands are divided into two groups, the Northern and, the Southern Group of which the Main Island of Rarotonga is the Administrative centre. The total land area of the islands is 237 sq. km. Thirteen of these islands are inhabited. According to the last Census in 2001, the population was 18,027. However in the last quarter statistics of March 2006, the resident population has decreased to 11,800 mainly due to migration overseas.

Health System
Cook Islands provides health care at Primary Prevention and Secondary. The Government is the main provider of health care under a user pay system with fees for consultations and hospital admissions charged for people aged between 6 up to 60 years. Private health service is provided through Private GPs, but hospital services are limited to Government owned smaller hospitals in some islands, and the main base hospital in Rarotonga which is the only referral hospital. There are 108 nurses in the Cook Islands (this includes unregulated care workers) and 25 doctors.

Registration Status

Registration - Legislation
Registered Nurses are registered under the Nurses Act (1985) which is administered by the Cook Islands Nursing Council. An amendment to the Act has been proposed and submitted to Crown Law Office to incorporate the Midwives, Nurse Practitioners and Enrolled Nurses, and is currently awaiting for it to go to Parliament.

Responsibility for Registration
The Cook Islands Nursing Council (CINC) with the Director of Nursing as Chairperson is responsible for nurse registration. The Nursing Council Registrar keeps the record of all nurses registered. Even nurses who practice in private practices must be registered and licensed with the Nursing Council before they can practice.

Licensing and Renewal
Licensing is mandatory and annual renewal is required. The Council does not have mandatory continuing education although the Ministry of Health through the Nursing Division encourages inservice and continuing education.

Eligibility requirements for registration
The CINC is only responsible for registration of nurses trained in the Cook Islands. Successful completion of the required examinations set and marked by the CINC, and payment of fees for both registration and practice license is necessary. A character reference, from the nursing school is required before a nurse is eligible to sit the final examinations.

Categories of Nurses and Midwives
Registered Nurse, Registered Nurse Midwife, Public Health Nurse, Nurse Practitioners, Registered Enrolled Nurses, Nurse Aide, Compassionate Nurse.

Workforce Planning

Barriers to Movement within Country
There is no barrier to movement within the country as there is only one government nurse training school. The Ministry of Health, through the Division of Nursing is responsible for ensuring that all islands have adequate nurses to provide health services. It can be difficult to get nurses and doctors to work in the smaller isolated islands, hence special salary packages are offered as an incentive to attract staff to these communities. Nurses who wish to work in the private sector are free to move as long as they renew their Annual Practicing license.

Mutual Recognition
The Cook Islands recognises nurses trained in New Zealand, Australia, Canada, UK, USA, Fiji, Samoa and other Pacific Countries. However, there is no signedagreement with any of these countries, but any nurse who wishes to register and work in the Cook islands must apply as stipulated under Overseas Registration.

Regulation of Foreign-Qualified Nurses
Those wanting to work as a nurse in the Cook Islands must apply to the CINC for registration. If approved, a registration fee is required. To be eligible for registration e following documents are required:
(i) Transcript of basic Nursing Training Program/Curriculum indicating the theoretical and clinical hours covered by the nurse.
(ii) Copies of Basic and Post Graduate nursing qualifications, current registration and practice license from her/his country, and any other relevant nursing or health related qualification that may be relevant to the application.
(iii) Curriculum Vitae of past work experience, including name and contact address, email or telephone of two referees for character reference and qualification verification.
If or when her application is approved, a payment is required before being issued with Registration Certificate and Practicing License.

Educational Standards-Nursing

Education Standard Required to Enter Pre-Registration Programs
The minimum qualifications are completion of New Zealand School Certificate or Year 11 of NCEA education program, with good grades in the subjects of English, Math's, Human Biology and Science.

Accrediting Pre-Registration Programs
CINC is responsible for confirming the training program.

Basic Qualification for Nursing Practice
Diploma in Nursing after 3 years of training.

Programs Provided by Education or Health Systems
Cook Islands School of Nursing under the Ministry of Health. The curriculum was reviewed in 2001 by WHO and the program updated from certificate to diploma.

Length of Pre-Registration Program
Three years.

Involvement of regulatory body with curriculum development
Yes

Measurement of Nurse Education Standards and quality
Nursing competencies are being developed which will assist with this process.

Educational Standards-Midwifery

Education Standard Required to Enter Midwifery Programs
Nurses are sent to Fiji for midwifery training. Must be registered nurse for 2 or more years.

Basic Qualification for Midwifery Practice
Midwifery registration either from Fiji or other countries recognised by the CINC.

Accrediting Midwifery Programs
Fiji Nurses, Midwives and Nurse Practitioner Board.

Programs Provided by Education or Health Systems
Fiji Nurses, Midwives and Nurse Practitioner Board and Ministry of Health.

Length of Pre-Registration Program
One year.

Involvement of regulatory body with curriculum development
Measurement of Midwifery Education Standards and quality

Professional Standards

Ensuring Standards of Professional Conduct
We have no established Code of Ethics, but this is now in the process of being developed.

Mechanisms for Complaint about Nurses and Midwives Practice
Deviation from accepted Professional Standard is dealt with by the immediate supervisor or if necessary referred to Chief Nursing Officer (CNO), and Secretary of Health (SOH). An investigation is undertaken by the CNO to confirm the allegation. If the findings warrants disciplinary action, the matter is then referred to the CINC and Head of MOH.

Sanctions for Unprofessional Conduct
For minor cases of misconduct the nurse receives a verbal warning and for a repeat offence, a written warning is issued by the CNO. A third offence necessitates a referral to the CINC and then SOH.

For major cases of misconduct the following may occur:

Unregulated Care Workers and Scope of Nursing Practice

Unregulated Care Workers
Compassionate Nurses are not registered nurses but are employed mainly to care for elderly clients in the Geriatric ward. They are provided a 12 weeks basic training program with special focus on caring for elderly people.
Nurse Aides are employed to assist RNs in primary health care work mainly in the Outer Islands. Although they have no formal training, they have had on the job training for many years. Therefore they are capable of administering medications and providing nursing care. The future plan is that all nurses will have had some formal training and these 4 Nurse aides will eventually become Registered Enrolled Nurses.

Scope of Nursing Practice
The Practice of Nursing in the Cook Islands is legislated under the Cook Islands Nurses Act .As stated earlier, amendments have been made and are awaiting Parliament to pass the new legislation. As yet there is no Scope of Nursing Practice in place.
However, it is realised that the role and functions of nurses now have expanded to incorporate the changing health environment and in particular the needs and demands of the communities they serve. In order to accommodate these new roles a new cadre of nurses are employed, and these must be based on relevant policies and decisions with nurses input.
For example, the training of Nurse Practitioners requires the nurse and/or midwife to provide care in an extended role to complement
services rendered by other health professionals such as doctor, pharmacists, dentists especially in small but isolated locations.
The Upgrading of the 3 years basic nursing training program now provides graduates with comprehensive skills that enable them to practice in any nursing and medical setting in both primary and secondary sectors of health..

Contact Information

Ms Iokopeta Ngari
Chief Nursing Officer & Chairperson, CINC
Cook Islands Ministry of Health
P.O.Box 109
Rarotonga, COOK ISLANDS
Ph: 682 22664
Fax: 682 22670
Email:i.ngari@health.gov.ck
Web: nursing@health.gov.ck

Mrs Elizabeth Iro
President
Cook Islands Nurses Association
PO Box 109
Rarotonga,
COOK ISLANDS.
Email: e.iro@health.gov.ck;
Web: nursing@health.gov.ck

Mrs Elizabeth Iro
Registrar
Cook Islands Nursing Council
C/o Ministry of Health
P.O.Box 109
Rarotonga, COOK ISLANDS
Ph: 682 22664
Fax: 682 22670
Email: e.iro@health.gov.ck;
Web: nursing@health.gov.ck

Country Updates

The Cook Islands over the past decade have had national economic and health reform, which has in many ways affected nursing and midwifery. The reduction of nurses numbers due to migration has had a significant impact on both the quantity and quality of service provided. At the same time budget reductions following the economic reforms have also affected the education of nurses and influenced the recruitment and retention policies of the ministry. Nevertheless, we have made some progress. Our Ministry of Health now has a National Health Strategic Plan of which Nursing is one of the key components. Similarly, a National Human Resource Plan has also been developed and this will shed some light on nursing developments. We completed the review of our Nursing Standards and Infection Control Standards, and are in the process of completing the Competencies and Code of Ethics. Unfortunately we are still trying to amend the Nurses Act to incorporate other cadres of nurses who are currently practicing nursing and midwifery. The Nurse Practitioners and Compassionate Nurses are a new cadre of nurses. Nurse Practitioners are Registered Nurse Midwives given special post-graduate training to manage the health care system in certain outer islands where a doctor is not warranted.