NURSING AND MIIFERY COUNCIL OF ZAMBIA

(Nurses and Midwives Act, 2019)

2024

PROFESSIONAL REGULATORY
FRAMEWORK
 NURSING AND MIDWIFERY COUNCIL OF ZAMBIA
(Nurses and Midwives Act No.10 of 2019)

PROFESSIONAL REGULATORY FRAMEWORK

Review of this document was made possible through financial support provided
by the United Nations Population Fund (UNFPA) and technical support from the
Ministry of Health (MoH).

©2023
 TABLE OF CONTENTS
FOREWORD ................................................................................................................................................ iiii
ACKNOWLEDGEMENTS ........................................................................................................................... v
ACRONYMS ................................................................................................................................................. vii
Glossary of terms ..................................................................................................................................... vii
1 BACKGROUND AND CONTEXT .................................................................................................... 1
1.1 Professional Regulatory Framework Review process ............................................. 2
2 REGULATORY FRAMEWORK ....................................................................................................... 3
2.1 Introduction .............................................................................................................................. 3
2.2 Target Audience ...................................................................................................................... 3
2.3 Elements of the PRF ............................................................................................................... 4
3 Scope of nursing and midwifery education and training .................................................. 4
3.1 DOMAIN ONE: GOVERNANCE AND ADMINISTRATION .......................................... 5
3.1.1 Standard 1: Governance ................................................................................................. 5
3.1.2 Standard 2: Administration .......................................................................................... 6
3.2 DOMAIN TWO: INFRASTRUCTURE ................................................................................. 7
3.2.1 Standard 1: Teaching and Learning Resources ...................................................... 7
3.3 DOMAIN THREE: CURRICULUM ....................................................................................... 7
Curriculum in nursing and midwifery education is crucial for shaping healthcare
professionals. It involves designing, implementing, and evaluating curricula to
ensure students achieve proficiencies and programme outcomes. .................................. 7
3.3.1 Standard 1: Curriculum design ..................................................................................... 7
3.3.2 Standard 2: Curriculum Implementation ................................................................. 8
3.3.3 Standard 3: Assessment of Students .......................................................................... 9
3.4 DOMAIN FOUR: EDUCATORS ............................................................................................. 9
3.4.1 Standard 1: Faculty........................................................................................................... 9
3.4.2 Standard 2: Clinical faculty ........................................................................................... 10
3.4.3 Standard 3: Professional Development of Faculty .............................................. 10
3.5 DOMAIN FIVE: STUDENT EMPOWERMENT .............................................................. 11
3.5.1 Standard 1: Student welfare ....................................................................................... 11
3.6 DOMAIN SIX: PROGRAMME ADMISSION.................................................................... 13
3.6.1 Standard 1: Admission Policy and Selection ........................................................ 13

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4 Scope of Nursing Practice............................................................................................................ 13
4.1 Introduction ............................................................................................................................ 14
4.2 Standards ................................................................................................................................. 14
4.2.1 Domain One: Professional, Ethics & Legal Practice ............................................ 14
4.2.2 Domain Two: Care Provision and Management.................................................. 14
4.2.3 Domain Three: Professional Development and Quality Management ........ 14
5 Scope of Midwifery Practice ....................................................................................................... 14
5.1 Introduction ............................................................................................................................ 14
5.2 Standards ................................................................................................................................. 19
5.2.1 Domain One: Professional, Ethical, and Legal Practice ..................................... 20
5.2.2 Domain Two: Care Provision and Management ................................................... 20
5.2.3 Domain Three: Professional Development and Quality Management ........ 20
SUMMARY ................................................................................................................................................... 22
References .................................................................................................................................................. 23
List of Contributors Annex I ......................................................................................................... 24

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FOREWORD
The Nursing and Midwifery Council of Zambia (NMCZ) is mandated by the Nurses and
Midwives Act No. 10 of 2019 to regulate the nursing and midwifery profession,
protect and promote the health and safety of the public based on the highest
standards.

One of the regulatory documents that the Council uses to achieve this mandate is the
Professional Regulatory Framework (PRF) which is periodically reviewed in order to
incorporate the new trends to ensure quality improvements in nursing and midwifery
education and practice. The PRF describes the minimum acceptable parameters
within which professional nursing and midwifery is practiced. The minimum
competencies expected from nurses and midwives provide a yardstick not only for
evaluating the quality of care provided in different settings including homes,
workplaces, schools, public and private health facilities and the community; but also
enhance the contributions of nursing and midwifery to performance, goals and
objectives in the provision of health services in Zambia.

The review of this PRF was necessitated by the ever-increasing disease burden, old
and emerging communicable and non-communicable diseases particularly
hypertension, heart disease, diabetes and cancer, including tropical diseases like
malaria and others. Furthermore, maternal and infant morbidity and mortality
continues to threaten the lives of mothers and children.
The review also serves to strengthen nursing and midwifery education, evidence-
based practice, management, leadership and research. The PRF review is an
important milestone in the advancement of nursing and midwifery education and
practice in Zambia whose process involved a review of current literature and a
consultative process by different stakeholders.

The PRF contains the scopes of nursing and midwifery education and practice. The
standards of nursing and midwifery education and practice are arranged in six
domains namely; governance and administration, infrastructure, curriculum,

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educators, student empowerment and programme admission. The nursing and
midwifery practice standards are further arranged according to the professional,
ethics and legal practice; care provision and management; and professional
development and quality management domains.

NMCZ is confident that this document is an invaluable resource for policy makers,
educators, practitioners, students, researchers and other stakeholders in the health
sector. The PRF is an indication of the commitment by Zambian nurses and midwives
to continuous quality improvement in education, practice and research that will in
turn increase public confidence in the healthcare delivery system.

Beauty Siansende Zimba (Mrs.)

Acting Registrar and CEO

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ACKNOWLEDGEMENTS
The review of the Professional Regulatory Framework would not have been possible
without the commitment and support of a number of individuals and organisations.
The Council is grateful to all who individually and collectively contributed to the
review of this document. The names of contributors and resource persons are
indicated in Appendix

The NMCZ also is indebted to the Ministry of Health, UNFPA and other stakeholders
for the financial and technical support rendered during the review process of the PRF.

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LIST OF ACRONYMS

GBV Gender Based Violence

HEA Higher Education Authority
HEI Higher Education Institution
HIV Human Immunodeficiency Virus
ICM International Confederation of Midwives
ICN International Council of Nurses
MoH Ministry of Health
NMCZ Nursing and Midwifery Council of Zambia
PRF Professional Regulatory Framework
UNFPA United Nations Population Fund
WHO World Health Organisation
ZAQA Zambia Qualifications Authority

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GLOSSARY OF TERMS

Accreditation: A process of review and approval by which an institutional

programme or specific service is granted a time-limited recognition of having met
certain established standards.

Attitudes in Nursing and Midwifery: The disposition, feeling or position of the

nurse and midwife which reflects empathy, understanding, compassion and
comforting in the care of clients

Certification: Measures put in place by the Nursing and Midwifery Council of Zambia
to regulate training and practice of the nursing and midwifery profession to protect
the public.

Client: Consumers of nursing and midwifery services which include individual, family,
group or community.

Clinical Instructor: One who demonstrates and teaches patient care in the
classroom and clinical area to nursing and midwifery students, instructs in principles
and application of physical, biological and psychological subjects related to nursing
and midwifery.

Community Setting: Homes, schools, churches and other community institutions

where the nurse and midwife may provide health services.

Competence: The competence knowledge, skills, judgement and attribute required of

the nurse to practice safely and ethically in a designated role and setting (ICN 2021)

Core Competencies: Combined basic or essential knowledge, skills and attitude

demonstrated by nurse or midwife

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Cultural competence: Awareness of culture and inter-group differences.

Curriculum: All the learning activities, processes and materials that are planned,
implemented, monitored and evaluated to prepare learners to meet the expected
competencies. The learning activities are intended to achieve specified educational
objectives within a specified time.

Entry level of practice: The point of registration or licensure for the beginning
practitioner, following graduation from a basic nursing or midwifery education
programme

Health Needs: Clients’ actual or potential health problems which require nursing and
midwifery and other care team members interventions.

Holistic Care: Total care given to an individual, including mental and psycho-social;
aspects rather than just the signs and symptoms of health problems.

Home Based Care: Care that responds to the needs of clients in the home. A family
member, nurse or midwife can provide such care.

Integrated Nursing and Midwifery Education: Combines general nursing and

midwifery curriculum and instruction in one programme.

Lecturer: A member of the faculty of a college or university usually having qualified

status without rank or tenure.

Manager: A person who is delegated responsibility and authority by an organization

to coordinate individual efforts of self and other health care team members to achieve
organizational goals and objectives.

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Manage Care: Assuming responsibility and accountability for care which includes
independent care consultation and referral to other providers as appropriate.

Mentor: A nurse or midwife who demonstrates competence in practice and guides

learners who are acquiring clinical competence as part of recognized programme of
training.

Midwife: Midwife means a person registered as a midwife in

accordance with the Nurses and Midwives Act No.10 of 2019

Midwifery: Is the profession with a unique body of knowledge, skills and professional
attitudes drawn from disciplines shared by other health professions such as science
and sociology, but practiced by midwives within a professional framework of
autonomy, partnership, ethics and accountability. (ICM, 2017)

Nurse: A person who has completed a programme of basic, general nursing education
and is authorized by the Nursing and Midwifery Council of Zambia to practice nursing
in Zambia in accordance with the Nurses and Midwives Act No.10 of 2019

Nurse/Midwife Educator: A person trained to give intellectual, moral and social

instruction in the field of nursing or midwifery in a formal process.

Nurse Specialist: The nurse specialist is a nurse qualified beyond the level of a
registered nurse and authorised to practice as a specialist with advanced expertise in
a branch of the nursing field. Specialist practice includes clinical, teaching,
administration, research and consultant roles

Nursing: Encompasses autonomous and collaborative care of individuals of all ages,

families, groups and communities, sick or well and in all settings. Nursing includes
the promotion of health, prevention of illness, and the care of ill, disabled and dying
people. Advocacy, promotion of a safe environment, research, education and

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participation in shaping health policy and in patient and health system management
are also key nursing roles. (ICN 2002)

Nursing and Midwifery Education: Transfer of nursing and midwifery knowledge

and skills that also facilitates appropriate change in attitudes and values in nurses and
midwives to ensure provision of quality client care.

Nursing and Midwifery Standards: Guiding statements through and by which the
nursing and midwifery profession describes the responsibility for which its
practitioners are accountable. The standard described should be achievable and
measurable and indicate levels of performance.

Palliative Care: Nursing and midwifery interventions that alleviate pain, and other
symptoms, without curing.

Practice of Nursing: Means performing nursing functions to optimize health of

individuals, families and communities who are experiencing changes in their normal
health by promoting health, prevention of illness, restoration of health and
development of their health potential throughout the life cycle.

Preceptor: A professional nurse or midwife who demonstrates nursing or midwifery

practice skills and gives feedback to the learner on his/her performance and evaluates
mastery of clinical learning objectives.

Professional Code of Ethics: Stipulates expected standard of professional conduct

and attitude for nurses and midwives.

Programme approval: Mechanism for evaluating the nursing and midwifery

education programmes against the Standards of Training and Education in
accordance with the Nurses and Midwives Act, 2019.

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Registered Practitioner: A person whose name is placed on the registers of Nurses
or Midwives kept by the Nursing and Midwifery Council of Zambia.

Reproductive Health Services: Health care services provided to men and women
that relate to the functions and processes of human reproduction and reproductive
systems.

Nursing and Midwifery Science: A branch of knowledge specific to nursing and

midwifery education and practice.
Scope of Practice: The range of roles, functions, responsibilities and activities which
a nurse or midwife is authorised to perform or carry out according the Nurses and
Midwives Act, 2019.
Self-regulation: An essential characteristic of a profession in protecting the rights,
obligations, responsibilities and relationships of a nurse or midwife to the client,
society and profession.
Therapeutic Environment: An enabling setting that facilitates the achieving of
optimal health for the client.
Tutor: A person who provides assistance or tutelage to one or more people on certain
subject areas or skills

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1 BACKGROUND AND CONTEXT

Good health is an essential prerequisite for national development as stated in the

National Health Strategic Plan 2022-2026. The attainment of the national and global
health goals, aimed at ensuring equitable access to quality healthcare to all in Zambia,
as close to the family as possible, “Leaving No One Behind” cannot be realised without
the full participation of nurses and midwives. Nurses and midwives practice in a wide
range of settings from the community to tertiary and specialised health facilities
across the lifespan. They are the majority healthcare professionals found even in the
remote parts of the country and are well placed to deliver services through the
Primary Health Care approach in the attainment of Universal Health Coverage. The
challenge to the nursing profession is to produce clinically competent nurses and
midwives with skills in management leadership and research to make primary health
care a reality.

In light of the above, it has become necessary to have an updated Professional

Regulatory Framework (PRF) as one of the tools to guide nursing and midwifery
education and practice. The initial PRF was developed in 2001 and revised in 2011,
making this revision timely and necessary in order to encompass the recent and
emerging developments in nursing and midwifery education and practice.

The profession of nursing and midwifery is autonomous and self-regulating. The PRF
contains standards that guide the Scope of Nursing and Midwifery education and
practice. The PRF strengthens the self-regulation of the nursing and midwifery
profession in Zambia in order to safeguard the interests of clients, nurses’ midwives,
and other health care team members. This framework describes the minimum
acceptable parameters for professional nursing and midwifery practice in home,
workplaces, schools, public and private health facilities and in the community.

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1.1 Professional Regulatory Framework Review process

The framework was developed following a series of activities which included:

(i) Analysis of existing PRF (2011) on the regulation of education and practice of
nursing and midwifery;
(ii) Review of existing literature on the status of regulation, practice and education at
international, regional and national level which included the following:
a) ICN and ICM literature
b) WHO global and regional frameworks
c) WHO strategic directions
d) Publications in nursing and midwifery
e) Ministry of Health and regulatory bodies policy documents

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2 REGULATORY FRAMEWORK

2.1 Introduction

Quality assurance in nursing and midwifery is imperative and requires having a

Professional Regulatory Framework (PRF) that guides the establishment,
implementation and maintenance of standards in the education and practice of nurses
and midwives. Effective and efficient implementation of the PRF depends on the
efforts of individual nurses and midwives and the collective efforts of regulatory
bodies and other stakeholders.

The PRF is a step towards improving the level of education for nurses and midwives
including the development of curricula which are responsive to national health needs.
It is also designed to assist policy and decision makers, educators and employers to
utilize the established regulatory elements to contribute to the production of safe,
competent and regulated professionals who can deliver quality and safe health
services.

The framework outlines seven key regulatory elements which have been identified
as having the potential to promote a common approach to regulation, educational
preparation and practice of nurses and midwives (WHO, 2016). If the PRF is well
implemented, the seven identified regulatory elements would significantly contribute
to improved quality of nursing and midwifery services and health outcomes of the
population. Weak or complete lack of regulatory structures and mechanisms for
reinforcing the regulatory elements can make it difficult to scale up relevant quality
education and practice reforms in a sustained manner, such as the implementation of
competence-based curriculum and harmonization of such curricula across the region

2.2 Target Audience

The framework is intended as a reference document for nursing and midwifery

professional associations, regulatory bodies, government decision-makers, managers,
educators, other health professional groups, the public, and individual nurses and

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midwives. It is therefore prudent that professional nurses and midwives who are
leaders in their various capacities (education, practice, research and health policy)
and who have the influence in determining the pace and direction of nursing and
midwifery development have a strong and broad foundation of what governs nursing
and midwifery education and practice. The PRF should be used hand-in-hand with the
nursing and midwifery practice and education standards.

2.3 Elements of the PRF

The seven regulatory elements describe the minimum parameters of desired

professional behaviours and educational standards within which nursing and
midwifery education are provided and practiced.

The regulatory elements presented in this document are as follows:

1. Scope of practice for practicing nursing and midwifery

2. Standards for basic nursing and midwifery education
3. Core competencies for entry into practice for nursing and midwifery
4. Standards of practice for nursing and midwifery
5. Codes of conduct for nurses and midwives, and
6. Career development and progression in the nursing and midwifery professions

3 Scope of nursing and midwifery education and training

The scope of practice defines the range of roles, functions, responsibilities and
activities, which a qualified registered nurse and midwife is educated for, competent
in, and is authorised to perform. It defines the accountabilities and limits of practice.

The scope of nursing and midwifery education and training promotes a common
approach to educational preparation and practice through the use of commonly
developed and agreed upon competencies, educational and practice standards for
nursing and midwifery. A well-trained and regulated nursing and midwifery
workforce is key to effective delivery of quality services.

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The scopes of nursing and midwifery education and training provides the established
regulatory elements as a reference point for monitoring and evaluating quality
improvements in nursing practice through the introduction and use of developed
standards and competencies. The scopes of nursing and midwifery education and
training act as a rallying point to advocate for improved nursing and midwifery
services and protection of the public from unsafe practices through the use and
application of developed standards.

The Nursing and Midwifery education and practice standards are arranged in the
following domains:
1. Governance and administration
2. Infrastructure
3. Curriculum
4. Educators
5. Student empowerment
6. Programme Admission

3.1 DOMAIN ONE: GOVERNANCE AND ADMINISTRATION

Domain, one focuses on Governance and Administration in nursing and midwifery

education, highlighting their crucial role in shaping effective programs.

3.1.1 Standard 1: Governance

The governance structure promotes autonomy and complies with all legal, regulatory,
professional and educational requirements in accordance with the vision, mission and
goals of the institution.

3.1.1.1 Quality criteria

1. A governing body with representation from key stakeholders, academic and
administrative staff and the student body sets strategic directions and
institutional policies, provides oversight with respect to the fiscal and
administrative management of the institution, and accepts accountability for
decisions made.

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 2. Academic and professional leadership is provided by nurses and midwives
with the required professional education, graduate academic qualifications,
and proven leadership and management skills.
3. The HEI and educational programmes are accredited by recognised national
academic and professional regulatory bodies to ensure external quality
assurance.
4. The HEI shall comply with all standards and requirements in accordance with
the NMCZ/HEA/MOH/ZAQA standards for education and training.

3.1.2 Standard 2: Administration

An administrative structure exists with responsibility for carrying out the policies of
the HEI in accordance with the vision, mission, goal and objectives of the institutions.

3.1.2.1 Quality criteria

1. Vision, mission and institutional goals are visibly posted and understood by
academic, administrative and support staff and students.
2. Institutional structures with responsibilities related to the administration of
the institution, implementation and monitoring of programmes are in place
and are performing their functions effectively.
3. Policies related to core functions (e.g., personnel, budget, student admissions,
graduation, student termination, student assessment, programme evaluation,
records) are current, adhered to and periodically updated.
4. A programme for continual quality improvement is in place through:
a) Continuous systematic monitoring and auditing of institutional and
programme performance, and

b) Regular internal and external review of the institution and programmes.

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3.2 DOMAIN TWO: INFRASTRUCTURE

This domain covers the importance of infrastructure and teaching resources.

3.2.1 Standard 1: Teaching and Learning Resources

The teaching and learning resources must be sufficient to enable fulfilment of

institutional and programme goals.

3.2.1.1 Quality criteria

1. The HEI has accessible, current and relevant physical facilities to support
teaching and learning.
2. Policy on maintenance of infrastructure is in place
3. Safety policies, procedures and equipment (e.g., fire, evacuation, security) are
in force and known by all staff and students.

3.3 DOMAIN THREE: CURRICULUM

Curriculum in nursing and midwifery education is crucial for shaping healthcare

professionals. It involves designing, implementing, and evaluating curricula to ensure
students achieve proficiencies and programme outcomes.

3.3.1 Standard 1: Curriculum design

Curricula and assessments are designed, developed, delivered and evaluated to

ensure that students achieve the proficiencies and outcomes for their approved
programme.

3.3.1.1 Quality criteria

1. The HEI delivers NMCZ approved Nursing and Midwifery curricula

2. The curricula must describe the full programme of study, addresses health
priorities, population and community needs, core values, cultural and gender
sensitivity and human rights approaches, the knowledge base and skills of the
profession, and the educational process to be followed

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 3. The curricula should define the program competencies that learners should
attain at the end of training in relation to their subsequent education and
future roles in the health system.
4. The curricula must define content, models, assessment strategies, instructional
methods employed and show evidence that a variety of appropriate classroom
and clinical learning experiences are effective.
5. HEIs engage in systematic and regular evaluations of curricula and clinical
learning, incorporating feedback from faculty, students, clients and other
stakeholders.
6. The curricula demonstrate adaptability to changes in healthcare policies,
technologies, and societal needs, fostering a dynamic and responsive
educational environment

3.3.2 Standard 2: Curriculum Implementation

Nursing or midwifery curricula provide core content that will enable their graduates
to meet the established competencies.

3.3.2.1 Quality Criteria

1. Nursing and midwifery programmes must provide classroom learning

experiences that prepare graduates to provide quality care in diverse settings.
2. Nursing or midwifery programmes must provide supervised, pertinent,
effectively planned, organized, monitored and evaluated clinical learning
experiences that support nursing or midwifery theory.
3. Clinical placement areas and HEIs must demonstrate commitment to
collaborate in providing an adequate clinical placement environment through
establishing written agreements or Memoranda of Understanding in relation to
availability of clinical supervision, safety, legal aspects and resourcing.
4. HEIs use inter-professional teamwork approaches in their classrooms and
clinical learning experiences

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3.3.3 Standard 3: Assessment of Students

3.3.3.1 Quality criteria

1. HEIs assess theoretical and clinical learning, knowledge and skill development
as well as progress throughout their programmes, using a variety of valid,
reliable and approved evaluation methods.
2. Health care providers, educators and clients who use services including
students’ self-reflections contribute to assessment.
3. Assessment is mapped to the curricula and clearly shows how theory and
practice assessments are appropriately weighted in each programme.

3.4 DOMAIN FOUR: EDUCATORS

The quality of nursing and midwifery education is significantly influenced by the

faculty's competence. All educators in Higher Education Institutions must possess
necessary competencies for effective management, teaching, learning, and research.

3.4.1 Standard 1: Faculty

All educators in the HEI have the required competencies to manage and advance
educational programmes, teach and facilitate learning, and carry out relevant
research to improve evidence-based learning and practice.

3.4.1.1 Quality criteria

1. The head of a nursing or midwifery programme is a compliant nurse or
midwife who holds a graduate degree, is educated and experienced in
leadership and administration, and demonstrates knowledge as an educator.
2. The core academic faculty are experienced nurses and midwives who
demonstrate knowledge as educators and have a minimum of a bachelor’s
degree with advanced preparation and clinical competence in their specialty
area.
3. Educator workloads comprising teaching and clinical practice are reasonable,
and expectations are clearly stated and documented as per NMCZ guidelines
(for universities as per available institutional approved workload policies).

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 4. Policies and systems for evaluation of educators’ performance must be in place
with evidence of being well implemented.

3.4.2 Standard 2: Clinical faculty

3.4.2.1 Quality Criteria

1. Clinical faculty comprises nurses and midwives with clinical expertise in the
content area who hold a minimum of a university degree in their specialty
area.
2. Clinical Instructors and Preceptors designated to supervise, teach students and
manage clinical learning should have the relevant knowledge, skills and
experience.
3. Recommended workloads for clinical teaching or mentorship/supervision
must be clear and adhered to in order to ensure maximum clinical learning.

3.4.3 Standard 3: Professional Development of Faculty

3.4.3.1 Quality criteria

1. HEIs must have policies and systems in place that provide faculty with
opportunities for development in teaching, scholarship, practice and external
professional activity.
2. There must be policy, a developed system and time set aside to enable
educators to mentor other educators, conduct and apply research, and
maintain clinical and educator competence.
3. HEIs have a policy and system in place for reward and recognition of staff in
accordance with the requirements for promotion and tenure of the institution.

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3.5 DOMAIN FIVE: STUDENT EMPOWERMENT

Student empowerment is crucial and, fosters resilience, care, reflection, and lifelong
commitment. It ensures students have access to resources, accurate information,
diverse learning opportunities, and support in their journey to become competent
healthcare professionals.

3.5.1 Standard 1: Student welfare

Students are provided with a variety of learning opportunities, appropriate resources

and are empowered and supported to achieve proficiencies and programme outcomes
as well as become and be capable of demonstrating the professional behaviours in the
Professional conduct with disciplinary code for nurses and midwives.

3.5.1.1 Quality Criteria

1. Students are provided with timely and accurate information about curricula,
training rules, approaches to teaching, supervision, assessment, practicum
placement sites and other information relevant to their programme and have
access to the resources they need to achieve the proficiencies and programme
outcomes required for their professional role.
2. Students have opportunities throughout their programme to collaborate, work
with and learn from a range of health care providers and peers in order to
prepare them to provide care to clients with diverse needs and develop
supervision and leadership skills.
3. Students are protected from discrimination, harassment and other behaviour
that undermines their performance or confidence and have access to support
services administered by qualified individuals, which include, but are not
limited, to health, counselling, academic advice, career placement and
progression.
4. Students' diverse needs are respected across all learning environments, with
support and adjustments provided in accordance with human rights legislation
and good practice.

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5. Students are provided with opportunities to provide feedback on the quality of
support and supervision, encompassing both theoretical and practical aspects
throughout their program and have direct and adequate representation on
decision-making structures within the institution.
6. Students are supervised and supported in practice learning in accordance with
the NMCZ Standards for student supervision and assessment
7. Students are supervised according to their individual learning needs,
proficiency and confidence at every level of training
8. Students are assigned and have access to a practicum site preceptor for a
practice placement or a series of practice placements for each level of the
education programme
9. Students have the necessary support and information to manage any
interruptions to the study of programmes for any reason
10. Students are provided with timely and accurate information regarding entry to
NMCZ registration and the award of their certificate
11. Students are equipped with the information and assistance needed to
empower them in preparing for independent, reflective, and professional
practice. They are also encouraged to assume responsibility for their mental
and physical health and overall well-being.
12. Students are orientated to prepare themselves for learning in both theory and
practical
13. A qualified academic adviser is available and arranges sessions for students at
least once a term/semester
14. There is a fair and transparent student complaints and appeals process
15. A mechanism is in place to promote positive professional behaviour and a
process for dealing with concerns about students’ profession-related conduct
is functioning
16. Student organisations and activities are encouraged, facilitated and supported
with resources (sports facilities, meeting and activity spaces)

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3.6 DOMAIN SIX: PROGRAMME ADMISSION

Programme admission is essential for nursing and midwifery education. It establishes

admission policies and selection procedures to ensure that candidates meet basic
requirements.

3.6.1 Standard 1: Admission Policy and Selection

The candidates to be enrolled should meet the minimum NMCZ recruitment and
selection guidelines to ensure enrolment of suitable candidates for relevant
programmes

3.6.1.1 Quality Criteria

1. HEIs must have a transparent, non-discriminatory admission policy that
specifies the process of student selection and the minimum acceptance criteria
in accordance with NMCZ recruitment guidelines
2. HEIs have a system and policy in place that takes into account different entry
points of students, recognition of their prior learning, experience and
progression options toward higher education goals
3. The student intake volume is established and reviewed regularly in alignment
with HEIs capacities, considering factors such as classroom size, educator-to-
student ratios, clinical placement capacity, and teaching/learning resources.
4 SCOPE OF NURSING PRACTICE

4.1 Introduction

Strengthened regulatory systems are essential for protecting the public and
facilitating the efficient recruitment of qualified nurses into the active workforce to
increase access to quality health services. Nurses should effectively and safely utilise
their competencies to provide services as close to the family as possible, across all
health settings. When responding to and providing services during emergencies and
disasters, nurses need adequate resources, training and equipment.

Workplace policies must promote decent work environments, which includes

addressing issues of protective clothing, workplace safety, social protection, gender,
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Gender Based Violence (GBV), discrimination, power, hierarchy, and respect. This
enables nurses to effectively contribute to service delivery in multidisciplinary teams.
WHO encourages countries to engage relevant stakeholders to adopt standards that
protect health workers’ rights, decent work and practice environment.

The scope of Nursing practice standards will be described under three (3) domains:
1. Professional, Ethics and legal practice
2. Care provision and management
3. Professional Development and Quality Management

4.2 Standards

4.1.1 Domain One: Professional, Ethics & Legal Practice

4.1.1.1 Standard 1: Professional Practice

The nurse demonstrates autonomy, responsibility, accountability, commitment and
compassion in the delivery of quality care in all settings.

4.1.1.1.1 Areas of Competence

1. Accountability, commitment and responsibility for own practice
2. Responsibility for performance of others under his/her direction.
3. Empathetic, compassion, understanding and sensitive caring attitude
4. Management and leadership
5. Team building

4.1.1.2 Standard 2: Ethical Practice

Nurses must articulate ethical values to uphold the integrity of the profession, and
integrate principles of social justice into nursing practice.

4.1.1.2.1 Areas of Competence

1. Human rights
2. Advocacy
3. Patients Charter

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 4. Professional Code of Conduct and other international Ethical Codes e.g. ICN
Code of Ethics.

4.1.1.3 Standard 3: Legal Practice

The nurse practices in accordance with relevant professional and civil legislation and
regulations.

4.1.1.3.1 Areas of Competence

1. Legislation and regulations related to health

4.1.2 Domain Two: Care Provision and Management

The domain encompasses the key roles of the nurse in health promotion and disease
prevention, provision of care and rehabilitation, leadership and management in the
delivery of nursing services.

4.1.2.1 Standard 1: Health Promotion and Disease Prevention

4.1.2.1.1 Areas of Competence

1. Communicable and non-communicable diseases.

2. Determinants of health and disease prevention
3. Reproductive maternal adolescent child health and rights.
4. Health communication and behaviour change
5. Public health policies and legislations.
6. Networking with collaborating partners.

4.1.2.2 Standard 2: Provision of Care and Rehabilitation

4.1.2.2.1 Areas of competence

1. Knowledge of nursing process
2. Therapeutic communication and relationships
3. Interprofessional collaboration.
4. Management of emergency and disaster situations.
5. Basic and advanced life support.
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 6. Gender and health.

4.1.2.3 Standard 3: Leadership and Management

Nursing practice comprises knowledge, skills and judgments that respond to varying
health needs for the delivery of safe and satisfying care.

4.1.2.3.1 Areas of competence

1. Management of resources.
a) Human
b) Time
c) Financial
d) Logistics
2. Policy implementation
3. Advocacy
4. Entrepreneurship
5. Monitoring and evaluation of services and programmes

4.1.2.4 Standard 4: Environment and equipment

4.1.2.4.1 Areas of Competence

1. Comprehensive occupational health and safety measures

2. Appropriate personal protective equipment
3. Adequate and appropriate equipment to provide care
4. Adequate staffing levels and appropriate workload
5. Mental health support and services
6. Use of appropriate technology
7. Implement gender transformative work environments including zero tolerance
for violence and sexual harassment

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4.1.3 Domain Three: Professional Development and Quality Management

4.1.3.1 Standard 1: Professional Development

Nursing practice is evidence-based and aims at continuously improving and
sustaining the quality of nursing care.

4.1.3.1.1 Areas of Competence

1. Engagement in research
2. Continuing education
3. Advocacy for profession growth

4.1.3.2 Standard 2: Quality Management

Nursing care is evaluated according to established quality assurance standards and
guidelines to ensure continued quality improvements.

4.1.3.2.1 Areas of Competence

1. Nursing audits
2. Monitoring and evaluation
3. Total quality management
4. Documentation

5 SCOPE OF MIDWIFERY PRACTICE

5.1 Introduction

The midwife is recognised as a responsible and accountable professional offering

respectful maternity care to women and their families. A midwife practices in any
setting including the home, community, hospitals, schools, clinics or health units (ICM,
2017). In providing care, the midwife functions as a member of the health care team
within the parameters of the professional responsibilities. In collaboration with
stakeholders the midwife promotes and recognizes the clients’ reproductive health
rights and responsibilities, advocates for accessible, acceptable, affordable and cost-
effective quality midwifery services and takes cognizance of gender disparities in the
provision of midwifery care.
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The midwifery practice standards have been organised in three domains;

1. Professional, ethical and legal practice

2. Care provision and management
3. Professional development and quality management

5.2 Standards

5.1.1 Domain One: Professional, Ethical, and Legal Practice

This domain reflects the Midwives’ professional accountability, ethical and legal
practice towards clients, families, community and society, under Zambian regulations
in relation to professional practice.

5.1.1.1 Standard 1: Professional Practice

Midwifery care is provided by qualified, competent, registered and licensed
practitioners to ensure safety of the client and the working environment. The midwife
is accountable to self, the pregnant woman and her partner, and the profession

5.1.1.1.1 Areas of Competence

1. Legislation and laws related to reproductive health
2. Clients’ reproductive rights
3. Human rights
4. Professional Code of Conduct and other international Ethical Codes e.g.,
ICN/ICM Codes of Ethics.
5. Occupational health and safety
6. Counselling

5.1.1.2 Standard 2: Ethical Practice

The midwife advocates for upholding of the clients’ rights in midwifery reproductive
services aimed at improving the health status of the clients.

5.1.1.2.1 Areas of Competence

1. Human rights
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 2. Advocacy
3. Patients Charter
4. Professional Code of Conduct and other international Ethical Codes e.g., ICN
Code of Ethics.
5. Occupational Health and Safety.

5.1.1.3 Standard 3: Legal Practice

The nurse practices in accordance with relevant professional and civil legislation and
regulations.

5.1.1.3.1 Areas of Competence

1. Legislation and regulations related to health

5.1.2 Domain Two: Care Provision and Management

This domain encompasses the key principles of Midwives’ role in health promotion,
complication prevention, care provision, leadership and management as well
therapeutic and interpersonal relationships pertaining to clients, families, community
and society utilising the nursing process.

5.1.2.1 Standard 1: Provision of Care

The midwife demonstrates autonomy, responsibility, accountability, commitment and
compassion in the effective and quality management of clients in all settings.

5.1.2.1.1 Areas of Competence

1. Respectful Maternity Care
2. Accountability, commitment, responsibility for own practice and others under
her/his care.
3. Collaboration with other stakeholders
4. Management of Emergency obstetrics and neonatal Care
5. Application of knowledge of health and other relevant policies, and
legislations.
6. Documentation.

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 7. Gender and health.

5.1.2.2 Standard 2: Health Promotion

Midwifery practice comprises knowledge, skills, attitudes and judgements that
respond to varying health needs for the delivery of safe and satisfying care.

5.1.2.2.1 Areas of Competence

1. Communication and Health Promotion in Reproductive Health.

5.1.2.3 Standard 3: Leadership and Management

The midwife mobilises and manages resources effectively.

5.1.2.3.1 Areas of Competence

1. Management of resources.
● Human Resources
● Time
● Logistics
● Financial
2. Policy implementation
3. Advocacy
4. Entrepreneurship
5. Monitoring and evaluation of reproductive health services

5.1.3 Domain Three: Professional Development and Quality Management

Midwives are required to maintain professional standards to provide quality health

care. They have a professional obligation to develop themselves and to support other
midwifery colleagues and health care providers in their professional development.

5.1.3.1 Standard 1: Professional Development

Midwifery practice is evidence-based and aims at continuously improving and

sustaining the quality of midwifery care.

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5.1.3.1.1 Areas of Competence
1. Continued Professional Development
2. Research

5.1.3.2 Standard 2: Quality Management

Midwifery care is evaluated according to established quality assurance standards and
guidelines to ensure continued quality improvements.

5.1.3.2.1 Areas of Competence

1. Midwifery Audits
2. Monitoring and Evaluation
3. Documentation
4. Total Quality Management

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 SUMMARY

The Professional Regulatory Framework document outlines the benchmarks and

expectations for nursing and midwifery education and training and nursing and
midwifery practice. This is to ensure high-quality of education and training of nurses
and midwives is implemented and attained with the highest standards that improve
patient care outcomes. It encompasses guidelines, principles, and performance
criteria that nurses and midwives are expected to adhere to in their professional
roles.

The PRF addresses various aspects of nursing and midwifery education and training,
including governance and administration, infrastructure, curriculum, educators,
student empowerment and programme admission. The nursing and midwifery
practice encompasses various aspects of practice which includes: Professional, ethics
and legal practice, care provision and management, health promotion, leadership and
management, professional development and quality management. This document
serves as a reference for nursing and midwives’ education and training as well as
practice.

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 REFERENCES
International Confederation of Midwives (2017). Strengthening Midwifery Globally.
www.internationalmidwives.org
International Council of Nurse (2002). Definition of Nursing. www.icn.ch/nursing-
policy/nursing-definitions. Accessed on 26 April 2023.
International Confederation of Midwives (2011). ICM Global Standards for
Midwifery Regulations.
The Nurses and Midwives Act No. 10 of 2019. Zambia.
The Zambian Nursing and Midwifery Professional Regulatory Framework (2nd
Edition, 2011)
WHO (2016). The Regional Professional Regulatory Framework for Nursing and
Midwifery; Creating a Common Approach to Regulation, Educational
Preparation and Practice: Future Direction for Nursing & Midwifery
Development in the African Region. Regional Office for Africa.
National Health Strategic Plan 2022-2026
WHO (2021). Global Strategic Directions for Nursing and Midwifery 2021-2025.
ISBN 978-92-4-003386-3.

List of Contributors

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1. Dr Marjorie Makukula Lecturer –UNZA-SoN
2. Ms. Biemba Maliti
3. Col. David Ndhlovu Lecturer- Ministry of Defense
4. Ms. Jane Botha
5. Mr Luka Sakwimba
6. Ms. Angela Mwaba
7. Ms. Maureen Aongola NO-Levy Mwanawasa UTH
8. Ms. Gertrude Kampekete
9. Mr. David Mbewe Ag Director-Regulation and Compliance (NMCZ)
10. Mrs. Gloria Lubumbe Kyanamina SNO-Mukinge Mission Hospital
11. Pelina Phiri Chibanje PNO- Care and standards (Western PHO)
12. Mr. Mwila Kennedy HOD-LAMU
13. Mrs. Fransica Msiska Senior Lecturer-LUCON
14. Mrs. Maureen Mulenga Chishimba Inspector-(NMCZ) Lusaka Office

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