setting the european and international scene for the …...setting the european and international...
TRANSCRIPT
Setting the European and
International scene for the future
of nursing
Prof. Walter SERMEUSLeuven Institute For Healthcare Policy KU Leuven
Belgium
Overview
• Understanding 40 years in nursing education in Europe
• Where are we now
• Preparing the future
Developments in European Professional
Qualifications Directive
1977
9 countries
2005
25 countries
2013
27 countries
Directive 77/452/EEC
Aim: free movement of
People
How: mutual recognition
of formal qualifications of
nurses responsible for
general care
Directive 77/452/EEC – June 27, 1977
• Deriving from Treaty of Rome (1957) – 6 countries
o Free movement of people
• Directives 77/452-453-454/EEC
o Mutual recognition of formal qualifications of nurses responsible for
general care
o Minimum education and training
• 3 years – 4600 hrs practice & theory, entry after 10y of general
education
o Advisory committee on Training in nursing
• Directive 89/595/EEC
o Minimum content of the programme
• Theoretical instruction: 1/3
• Clinical instruction: 1/2
Developments in European Professional
Qualifications Directive
1977
9 countries
2005
25 countries
2013
27 countries
Directive 77/452/EEC
Aim: free movement of
People
How: mutual recognition
of formal qualifications of
nurses responsible for
general care
Directive 2005/36/EC
Bologna Declaration 1999
+ Aim: Harmonization
How: from practice discipline
To a profession
WHO Munich Declaration 2000
ILO – ISCO 88 to 08
Bologna declaration – June 19,1999
• Action lines – 46 European countries involved:
o The adoption of a system of easily readable and comparable degrees
for each discipline.
o The adoption of a system essentially based on two cycles:
undergraduate (Degree or Bachelor) and postgraduate (Master and
Doctorate).
o The establishment of a system of credits (European Credit Transfer
System [ECTS]) based on student workload
o The adoption of a Diploma Supplement
o The promotion of mobility of educators and students
o The promotion of an education quality control system
• Tuning project:
o Tuning of Educational Structures and Programs on the basis of
Diversity and Autonomy
Change in the (perception & definition) of the
of nurses
• A lot of support from WHO
o Munich Declaration (2000): 48 Health Ministers signed
their intent to improve the position of nursing and
midwifery within Europe
o WHO LEMON LEarning Material On Nursing
• Support from member states
o Bulgaria (FR, BE), Poland (UK, SE, IE, FR), Croatia
(FI), Lithuania (DK), Latvia (SE, NO, FI), Hungary (CA)
o Implementation of the Bologna Process
http://apps.who.int/iris/handle/10665/108181
ISCO-88: International Standard Classification
of Occupations - ILO Code 223
• Nursing and midwifery professionals apply medical
concepts and principles relating to the delivery of babies
and to nursing of the ill, injured or disabled, and of mothers
and their newborn babies.
• Tasks performed usually include: helping medical doctors
in the practical application of preventive and curative
measures and dealing with emergencies in their absence;
providing professional nursing services, care and advice
for the sick, injured, physically and mentally disabled and
others in need of such care, and directing auxiliary nursing
staff; delivering or assisting in the delivery of babies, and
instructing mothers in baby care. Supervision of other
workers may be included
Source: http://www.ilo.org
ISCO-08: International Standard Classification
of Occupations - ILO Code 222
• Nursing and midwifery professionals provide treatment and
care services for people who are physically or mentally ill,
disabled or infirm, and others in need of care due to
potential risks to health including before, during and after
childbirth. They assume responsibility for the planning,
management and evaluation of the care of patients,
including the supervision of other health care workers,
working autonomously or in teams with medical doctors
and others in the practical application of preventive and
curative measures.
• Tasks performed usually include: assessing, planning,
providing and evaluating nursing and midwifery care …
Source: http://www.ilo.org
Developments in European Professional
Qualifications Directive
1977
9 countries
2005
25 countries
2013
27 countries
Directive 77/452/EEC
Aim: free movement of
People
How: mutual recognition
of formal qualifications of
nurses responsible for
general care
Directive 2005/36/EC
Bologna Declaration 1999
+ Aim: Harmonization
How: from practice discipline
To a profession
WHO Munich Declaration 2000
ILO – ISCO 88 to 08
Directive 2013/55/EU
+ Aim: Quality & Patient
Safety
Directive 2013/55/EU
• Free movement - minimal requirements
o Higher education Institutions - completion of general
education of 12 year
• vocational training programme - general education of at least 10
years
• Harmonisation - Integration of Bologna into the directive
o More convergence & common understanding
o …. than standardisation & uniformity
• Quality and patient safety
o Introduction of a list of competencies
o Professional card
o Language requirements
Directive 2013/55/EU on the recognition of
professional qualifications
• Art. 31 Admission to training for nurses responsible for general care
shall be contingent upon either:
o completion of general education of 12 years, as attested by a
diploma, certificate … and giving access to universities or to higher
education institutions of a level recognised as equivalent;
o or(b)completion of general education of at least 10 years, as
attested by a diploma, certificate ... and giving access to a
vocational school or vocational training programme for nursing.’;
• At least 3Y of study; at least 4 600 hours of theoretical and clinical
training; at least 1/3 theoretical training; at least 2300h of clinical
training
Eight core competenciesa) competence to independently diagnose the nursing care
b) competence to work together effectively with other actors in the health
sector
c) competence to empower individuals, families and groups towards
healthy lifestyles and self-care
d) competence to independently initiate life-preserving immediate
measures and to carry out measures in crises and disaster situations
e) competence to independently give advice to, instruct and support
persons needing care;
f) competence to independently assure the quality of, and to evaluate,
nursing care
g) competence to comprehensively communicate professionally and to
cooperate with members of other professions in the health sector
h) competence to analyse the care quality to improve his own
professional practice as a nurse responsible for general care.’;
RN4CAST: Effect of nurse staffing on
patient mortality
14
Aiken et al. 2014 The Lancet
MEAN EUROPE: 1.3%, RANGE: 0.0%-7.2%, N=300
MEAN ONE COUNTRY: 1.2%, RANGE: 0.3%-3,0%, N=59
0,00%
1,00%
2,00%
3,00%
4,00%
5,00%
6,00%
7,00%
8,00%
1 7
13
19
25
31
37
43
49
55
61
67
73
79
85
91
97
10
3
10
9
11
5
12
1
12
7
13
3
13
9
14
5
15
1
15
7
16
3
16
9
17
5
18
1
18
7
19
3
19
9
20
5
21
1
21
7
22
3
22
9
23
5
24
1
24
7
25
3
25
9
26
5
27
1
27
7
28
3
28
9
29
5
30-day inpatient general surgery mortality per hospital Nh = 300 Hospitals, Np=422730 patients
(9 European countries: BE, UK, FI, IE, NL, NO, ES, SE, CH)“One country” hospitals are marked in red
Aiken LH et al…. Sermeus W, Nurse staffing and education and hospital mortality in nine European countries:
a retrospective observational study, The Lancet 26 February 2014
Lowest staffing
BE hospital
Ave staffing
BE hospitalHighest staffing
BE hospital
9/1000 deaths difference
Lowest QL
BE hospital
ave
BE hospital
highest
BE hospital
5,5/1000 deaths difference
Overview
• Understanding 40 years in nursing education in Europe
• Where are we now
• Preparing the future
Nursing Education Level in EU/EEA 2016
Requirements for entry into the profession
University Training
U/HE Training
HE / Vocational Training
(Own compilation of data)
9
22
Safe nurse staffing ratios in Europe
Advanced Practice Nursing Roles
• Nurse Practitioners or other Advanced Practice Nurses
(NP/APN), working at the interface of the nursing and
medical profession
• Expanding Scope of Practice:
o Task-shifting (a concept referred to as ‘substitution’)
whereby nurses take up activities formerly in the domain
of physicians to alleviate shortages and/or improve
access;
o New clinical areas (‘supplementation’) that have been
largely unexplored, such as new roles as case managers,
liaison roles, eHealth monitoring and lifestyle advice.
Task shifting from MD to RN (NP/APN)
Maier C., Aiken L. European Journal of Public Healh, 2015
Extent of task shifting from physicians to nurses by seven
clinical activities and educational requirements
Maier C., Aiken L. European Journal of Public Healh, 2015
Overview
• Understanding 40 years in nursing education in Europe
• Where are we now
• Preparing the future
Overall strategies on nursing education
• The IOM future of nursing Report USA (2010)
o Future of nursing : education (2010)
o Progress report 2013
o Progress report 2015
The Future of Nursing (2010)
• Remove scope-of-practice barriers
• expand opportunities for nurses to lead and diffuse
collaborative improvement efforts
• Implement nurse residency programs
• Increase the proportion of nurses with a baccalaureate
degree to 80 percent by 2020
• double the number of nurses with a doctorate by 2020
• ensure that nurses engage in lifelong learning
• prepare and enable nurses to lead change to advance health
• Build an infrastructure for the collection and analysis of inter-
professional health care workforce data
2006
2015
0
5
10
15
20
25
30
0 10 20 30 40 50 60 70 80 90
% BSNs in Hospitals
2006
2015
Moving Toward 80% BSNs
Hospital Workforce
Source: Center for Health Outcomes and Policy Research, University of Pennsylvania
%
Ho
sp
ita
ls
Overall strategies on nursing education
• The IOM future of nursing Report USA (2010)
o Future of nursing : education (2010)
o Progress report 2013
o Progress report 2015
• WHO-Europe: European strategic directions for
strengthening nursing and midwifery towards Health
2020 goals (Sept 2015)
o Scaling up and transforming education and training
o Workforce planning and optimizing skill mix
o Ensuring positive work environments
o Promoting evidence-based practice and innovation
WHO-Europe – strategy
Scaling up and transforming education
1. Standardize the initial education of nurses and midwives
at degree level to get the best outcomes for patients and
populations.
2. Develop education and regulation that enables and
ensures that nurses’ and midwives’ core competencies
are in line with the basic principles of Health 2020.
3. Strengthen continuing professional development and
career development.
Overall strategy for Education Health
Professionals
Flexner-report 1910 Lancet-report 2010 (Frenk et al.)
Recommentations from the Lancet report (1)
o Transformative learning
Lancet-report 2010
(Frenk et al.)
Recommentations from the Lancet report (2)
o Interdependence in education
Lancet-report 2010
(Frenk et al.)
Conclusions
• There is a general shift to free movement to quality and
patient safety
• The dominant model is a Bachelor degree as the minimum
requirement for entry into the profession in line with the
changing perception of nurses
• There is no “European nurse”: convergence & common
understanding rather than standardisation & uniformity
• Investments in Advanced Practice Nursing Roles (on
master level) and doctoral training (leadership, teaching,
research)
Thank you for your
attention