THE EEC DIRECTIVES
Implications for Nurse Educators
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SHEILA Q U N N Sheila Quinn, CBE, B . S C , FRCN, FHA, S R N , ‘ S C M , S T D , is Regional Nursing Officer, Wessex Regional Health Authority, Highcroft, Romsey Road, Winchester, UK. She was elected the first President of the EEC Advisory Committee on Training in Nursing and is a member of the Standing Committee of Nurses of the EEC.
T h e Nursing Qualifications (EEC Recognition) Order 1979 became law on 1 January 1980. T h e theoretical content of the training programme in the Nursing Directives should not cause any difficulty in the UK. It is the organization of practical experience for learners that is producing problems. Learners must now obtain clinical experience i n maternity care, community care, mental health care and psychiatry, and care of the old as well as in medicine, surgery and paediatrics. Clinical teachers will have to be reallocated from acute areas to these specialist areas, with appropriate retraining. More attention will have to be paid to the basic teaching course for nurse teachers and to continuing education. The likely effects on nurse training and practice of the implementation of the EEC Directives on the Activities of the Nurse Responsible f o r General Care have been the subject of considerable controversy. However, important though the Directives are, the educational proposals they contain are, in fact, just a small part of the whole canvas of change in nurse education taking shape in the United Kingdom. Thus, while legislation was awaited, the General Nursing Councils (GNCs) were themselves considering ways of improving education. In addition, the Central Midwives Board proposed the extension of midwifery training to 18 months for registered nurses (this was agreed in December, 1979); and on the advice of the Panel of Assessors for District Nurse Training, training to work as a nurse in the community is to become mandatory. Requirements of the EEC Directives The Directives state that, before qualification, the student nurse must have: 1. Adequate knowledge of the sciences on which general nursing is based, including sufficient understanding of the structure, physiological functions and behaviour of
88
healthy and sick persons, and the relationship between the state of health and the physical and social environment of the human being. 2. Sufficient knowledge of the nature and ethics of the profession and of the general principles of health and nursing. 3. Adequate clinical experience: such experience, which should be selected for its training value, should be gained under the supervision of qualified nursing staff and in places where the number of qualified staff and equipment are appropriate for the nursing care of the patients. 4. The ability to participate in the practical training of health personnel and experience of working with such personnel. 5. Experience of working with members of other professions in the health sector. Theoretical and technical work must be coordinated with clinical experience in all of the following areas: 1. General and specialist medicine. 2. General and specialist surgery. 3. Child care and paediatrics. 4. Maternity care. 5. Mental health and psychiatry. 6. Care of the old and geriatrics. 7. Home nursing. Educational Policy of the GNC for England and Wales The views of the GNC for England and Wales are incorporated in the Statement of Educational Policy (July 1977). This was drawn up in the knowledge that the EEC Directives were almost ready for signature and with a clear appreciation of their general content. The GNC was concerned about the delay in expected legislation based on the recommendations of the Committee on Nursing, chaired by Professor Asa Briggs. However, it felt that it could no longer hold back in giving advice as to the
Medical Teacher V o l 2 No 2 1980.
Med Teach Downloaded from informahealthcare.com by York University Libraries on 11/14/14 For personal use only.
direction in which nurse education should be moving, and in recommending modifications to the current syllabus in order to continue the steady improvement achieved over recent years. The Statement describes the characteristics of a satisfactory learning/training setting and emphasizes the need for sufficient clinical experience with adequate supervision by trained staff and a learner/tutor ratio of not more than 25 to one and preferably 15 to one. It also sets out the Syllabus and A-actical Experiences Required f o r Admission to the General Part of the Regziter-this section including the most important changes for nurse trainers. In particular, this section states that the seven areas of clinical experience considered essential include the seven areas spelt out in the Directives. The Statement also indicates that the maximum time spent on night duty should be not more than 24 weeks during the training period. This statement of Educational Policy arrived on people’s desks at about the same time as the news of the agreement on the EEC Directives, thus linking the two events. Points which the General Nursing Council indicated were goals to be achieved, such as the reduction of night duty for student nurses, have been seen as a requirement of the EEC. In addition, guidance on the length of modules of experience in specialist clinical areas, such as psychiatric nursing, has been taken as the minimum laid down by the Directives. The latter do not make any such quantitative requirements and they make no requirements at all as regards night duty. However, as we have seen, the Second Directive does state the need for a correct balance of theoretical and technical training with clinical training. Since it is first impressions that are the most lasting, the nursing profession will no doubt remain convinced that the Nursing Directives were negotiated in such a way that considerable extra and unnecessary cost was laid on a service already under the pressure of public expenditure cuts and cash limits. Similarities Between Two European Documents As long ago as 1961, the Royal College of Nursing, as the member association of the International Council of Nurses (ICN), agreed to the proposed ICN definition of Basic Nursing Education as “a planned educational programme which provides a broad and sound foundation for the effective practice of nursing and a basis for advanced nursing education”. This became an internationally accepted definition, used by the World Health Organization, and was kept in mind throughout the discussionsleading to the Council of Europe Agreement on the Instruction and Education of nurses (Council of Europe, 1968), and the later EEC Directives on the Activities of the Nurse Responsible for General Care (Official Journal of the European Communities, July 1977). The first of these documents was agreed in 1967 and the United Kingdom was one of the first signatories. The document was based on the recommendations of a working party, a member of which was the Education Officer of the GNC for England and Wales. Medical Teacher V o l 2 No 2 1980
If one compares the two documents there is a very close correlation in the outline training programme. Both require 4,600 hours of training, which in the Directives is qualified by “or three years”. The Council of Europe document requires at least half those hours to be clinical experience, and at least one third to be theoretical and formal instruction. By comparison, the Directives are much more flexible in requiring only a balance and coordination of theory and practice. However, they also require a review of this clause within five years of signing, to see if the conditions require to be tightened. The two documents are almost identical in both the theoretical parts of the programme and the areas of practical experience, except that ‘home nursing’ has been added to the experience required in the Directives. It is interesting to speculate why the EEC Directives have caused so much concern, when the UK Government had been a signatory of the Council of Europe document some 20 years earlier. The importance of the latter piece of work had, perhaps, not been recognized -although other EEC countries had taken steps to fall into line with its recommendations -and the UK did not appear to take it positively into account in our nurse training programmes. The EEC Directives, on the other hand, came to us with the force of international obligations behind them and a definite time limit for implementation. Educational Implications of the Directives The General Nursing Council for Scotland had been working on a syllabus which requires little change to meet the Directives except in paediatrics. Northern Ireland is in a similar position. The concern therefore rests mainly with the syllabus for general nurse training in England and Wales. In December 1977, having had time to study the content of the Directives, the GNC for England and Wales issued a second paper giving more specific guidance, while stating that no alteration was required to the original policy document. Points to note are that learners should spend a minimum of 60 hours in community care which should be integrated into units of experience as appropriate, and that other units of experience should be between eight and 12 weeks. The reduction of night duty was stated as a goal to work towards. Where a training school had difficulties in meeting the required units of practical experience, the Council were prepared to look into the difficulties on an individual basis. A letter from the Chief Nursing Officer of the Department of Health and Social Security on the combined subject of GNC Education Policy Documents and the EEC Nursing Directives emphasizes both these points as well as the flexibility of the Directives. Implementation of the EEC Directives All nurse educators will be aware of the individual discussions which have been held by the GNC inspectors with each school of nursing, and the later joint meetings with officials of the DHSS and the GNC in each Region in 89
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England and Wales to establish the cost to the NHS of implementation of the Directives. At the time of writing virtually all schools have commenced their new programmes; indeed, many had started some months before the agreed date. The officers of the GNC have kept in close contact with those few that have had considerable difficulty in providing all the practical experience, so for purposes of this article, general implementation is assumed and the implications for nurse educators are discussed in this context. The cost of implementing the EEC Directives is largely due to the way the General Nursing Councils have interpreted them in the United Kingdom. Named by the Government as the competent authorities, they have thus been given responsibility for interpretation and for the decision whether or not training schools comply with the requirements. We look to statutory bodies to safeguard standards of nursing education, and there can be no professional disagreement with their decision to implement the requirements in such a way as to continue the improvement of training programmes. Nevertheless, this is a national decision, and not inherent in the text of the EEC Directives. The cost of implementation is largely a service factor. Because student numbers will be reduced in acute areas, they will have to be replaced by other nursing personnel. There will be a plus factor in other areas, such as geriatric and psychiatric nursing care where students will spend more time. Even if this does not allow any reduction in other nursing staff, it should have a positive effect on patient care and give the students another insight into the needs of these groups of patients. There are also some costs which will have to be met out of the specific budget of the school of nursing, especially in increased travel to obtain experience, but this should be met through the budget of the Regional Nurse Training Committee. Those Districts that have a particularly high percentage of students in their nursing establishments, such as some of the undergraduate medical teaching hospitals, will be particularly affected in acute areas and there could be considerable problems in making all the essential experience available to all learners. If, as seems likely, such Districts decide they must cut student numbers to match these to available experience, there could be a considerable shortage of trained nurses in future, because these undergraduate teaching hospitals train a very high proportion of the country’s nursing force. This will be compounded if other areas of the country which are traditionally ‘importers’ of trained nurses are not able to increase their own flow. It is, therefore, vital to carry out effective manpower planning at national level and, controversial though this topic may be, to utilize some system such as the University Central Council on Admissions to process applications for entry to nurse training schools. The essential message is that any change in nursing education will have manpower implications and will cost money. So long as nurses in this country are counted as employees and tied to the NHS budget, so the argument will continue and a similar battle will be joined every time 90
a change is required in nursing education. Implications for Nurse Teachers Under the Directives, the overall length of the training programme for general nurses is to be 4,600 hours, or three years. The full basic student nurse training will not be affected. However, experimental courses must also meet this minimum, especially shortened courses for students with a degree. Unless the degree is relevant to the training programme, a reduction will not be acceptable. The same can apply to shortened courses for post-registration students, such as nurses on the psychiatric register taking a shortened course for general training. Here, the relevant experience in the original training and the post -registration experience will have to be carefully calculated with this requirement in mind. In addition to the hours clause, such students must also complete the seven areas of clinical experience. The theoretical content of the programme in the Nursing Directives should not cause any difficulty. It is the organization of practical experience that produces the problems. All schools of nursing, large or small, urban or rural, will have to provide clinical experience in community care, geriatrics, psychiatric illness and maternity care in addition to medical and surgical nursing and child care. It is probably in the field of psychiatric experience that most difficulties will be experienced: extra travel or residential changes will be necessary where the only available experience is some‘ distance from the school. Maternity care produces a different situation again in that a review of learners’ needs was carried out by the GNC and the Central Midwives Board. The result is units of experience of between four and eight weeks. Because of the numbers of students involved, many schools have opted for the shorter period. This will mean careful planning and supervision to give learners a meaningful experience, and they will obviously be supernumary in the ward and clinic areas. There is a secondary implication for intending health visitor students, who are required either to have undergone midwifery training or to have completed a period of obstetric experience. The shortened modules available for student nurses are unacceptable, both from the point of view of the unchanged programme content, and the shortening of the module from 12 weeks to eight weeks to as little as four weeks. This means that special courses for intending health visitors students will have to be organized in a number of centres, something which must have cost implications and which will present organizational problems in slotting students into programmes at the right time. There is also the question of who bears the cost if the training programme is outside the area of the seconding authority. For the nurse teachers, programme changes are nothing new, as schools are constantly reviewing and evaluating their methods of implementing a national syllabus. There are considerable adjustments to be made now, one of which will be changes in student nurse allocation to the senice areas, and another an increase in
Medical Teacher V o l 2 No 2 1980
clinical teachers in the specialist areas named. As the Regional Nurse Training Committee budgets are very restricted and subject to cash limits, this will probably involve reallocation of teachers from the acute areas and retraining to enable the clinical teachers to respond to new student needs. More attention will have to be paid to the basic teaching course for nurse teachers and to continuing education. When finances permit, it is hoped that the present five-yearly refresher courses will be held at more frequent intervals.
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Selection of Students Apart from the need for a manpower policy, careful selection of candidates is necessary to ensure that each student has the ability to complete successfully the complex and demanding educational programme. We do not aim to turn out a practised practitioner at the end of 4,600 hours or three years training, but a beginning practitioner who will need supervision in the early days of her practice and a planned programme of continuing education.
EEC Advisory Committee on Training i n Nursing Fears have been expressed in both the UK and the other member states of the EEC about the effects of the Nursing Directives on the standard of patient care. There are built-in safeguards. The Standing Committee of Nurses of the EEC, on which the Royal College of Nursing has the UK nomination, has been in existence since 1971 and by its persistence, both in representation to the EEC Commission and through its individual members to the various governments, it has had a definite influence in modifying some of the original proposals. This committee will continue to exist and its influence as the free voice of the profession will be no less effective than it has been in the past. At the same time as the Nursing Directives were agreed, a decision of the EEC Council of Ministers set up an Advisory Committee on Training in Nursing with a remit to advise the Commission. The terms of reference are such that this Committee could be a very powerful influence on the future of nurse training in Europe. The Committee consists of three members from each country, each with an alternate or deputy who also attends meetings. From the UK the members are as follows: Practising Profession - Miss Sheila Quinn. Alternate -Mrs Marion Ferguson. Establishments providing training in nursing -Miss Sheila Collins. Alternate-Mr J. J. Walsh. Competent Authorities -Mrs Betty Nicolas. Alternate -Miss Margaret Auld. Each of the three groups has its own President. The overall Presidency commenced with the President of the Practising Profession and will rotate annually to the other two groups in turn. As President of the practising profession group, I held the overall presidency for the first year, which passes, in turn, to Marie-Louise Medical Teacher V o l 2 No 2 1980
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Badouaille of France who represents the schools of nursing, and to Joukje von Nordheim of The Netherlands, representing the competent authorities group. Each committee member is appointed by the EEC Council of Ministers for three years as an expert in her own right and not as a representative. Nevertheless, each UK member would welcome comments or opinions which the profession would like to make, and they can be contacted individually by any member of the profession. The Advisory Committee met on two occasions in 1979. At its second meeting it adopted a programme of work for the immediate future, Two working parties were set up, each composed of one member from each of the nine member states. The task of the first working party is to identify the major characteristics of nursing in order to define the objectives of training; to clarify and differentiate between theoretical and technical instruction, and clinical instruction and to comment on the balance between these in relation to the second Directive. The second working party is to consider those basic trainings leading to a diploma as a paediatric or psychiatric nurse, or nurse caring for the mentally handicapped. It will also consider post-basic training in the same specialties and also in public health nursing. The objective of this examination is to consider whether the Advisory Committee should offer advice to the EEC Commission on directives concerning these nurses. Both groups have commenced work and will be reporting to the full committee in the course of the year. The Nursing Qualifications (EEC Recognition) Order 1979 became law on 1 January 1980. When it passed through the House of Lords, Lord Sandys paid tribute to the leading role played by the UK in the negotiation of the Directives. We shall exert all our powers of leadership in Europe, while being mindful of the nursing traditions and successes of our partners in the Economic Community. And we shall continue to work together with the nurses in the other eight member states, to improve nurse education throughout the EEC for the benefit of patient care.
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Council of Europe, European Agreement on the Instruction and Education of Nurses, European Treaty Series No 59, 1968. General Nursing Council for England and Wales, Educational Policy 1977, Document 77/19 plusenclosures 77/19/A-D, London, 1977. Oflicial Journal of the European Communities, 1977, 20, no. L176, Brussels.
Back Copies of Medical Teacher 1979 issues of Medical Teacher are available at 22.50 ($6) each. All chequedpostal orders should be made payable to Update Publications Ltd and sent to: The Circulation Manager, Update Publications Ltd. (Medical Teacher), 33/34 Alfred Place, London WC1, England. Prepaid orders only. Medical Teacher V o l 2 No 2 1980
Implications for Nurse Educators
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SHEILA Q U N N Sheila Quinn, CBE, B . S C , FRCN, FHA, S R N , ‘ S C M , S T D , is Regional Nursing Officer, Wessex Regional Health Authority, Highcroft, Romsey Road, Winchester, UK. She was elected the first President of the EEC Advisory Committee on Training in Nursing and is a member of the Standing Committee of Nurses of the EEC.
T h e Nursing Qualifications (EEC Recognition) Order 1979 became law on 1 January 1980. T h e theoretical content of the training programme in the Nursing Directives should not cause any difficulty in the UK. It is the organization of practical experience for learners that is producing problems. Learners must now obtain clinical experience i n maternity care, community care, mental health care and psychiatry, and care of the old as well as in medicine, surgery and paediatrics. Clinical teachers will have to be reallocated from acute areas to these specialist areas, with appropriate retraining. More attention will have to be paid to the basic teaching course for nurse teachers and to continuing education. The likely effects on nurse training and practice of the implementation of the EEC Directives on the Activities of the Nurse Responsible f o r General Care have been the subject of considerable controversy. However, important though the Directives are, the educational proposals they contain are, in fact, just a small part of the whole canvas of change in nurse education taking shape in the United Kingdom. Thus, while legislation was awaited, the General Nursing Councils (GNCs) were themselves considering ways of improving education. In addition, the Central Midwives Board proposed the extension of midwifery training to 18 months for registered nurses (this was agreed in December, 1979); and on the advice of the Panel of Assessors for District Nurse Training, training to work as a nurse in the community is to become mandatory. Requirements of the EEC Directives The Directives state that, before qualification, the student nurse must have: 1. Adequate knowledge of the sciences on which general nursing is based, including sufficient understanding of the structure, physiological functions and behaviour of
88
healthy and sick persons, and the relationship between the state of health and the physical and social environment of the human being. 2. Sufficient knowledge of the nature and ethics of the profession and of the general principles of health and nursing. 3. Adequate clinical experience: such experience, which should be selected for its training value, should be gained under the supervision of qualified nursing staff and in places where the number of qualified staff and equipment are appropriate for the nursing care of the patients. 4. The ability to participate in the practical training of health personnel and experience of working with such personnel. 5. Experience of working with members of other professions in the health sector. Theoretical and technical work must be coordinated with clinical experience in all of the following areas: 1. General and specialist medicine. 2. General and specialist surgery. 3. Child care and paediatrics. 4. Maternity care. 5. Mental health and psychiatry. 6. Care of the old and geriatrics. 7. Home nursing. Educational Policy of the GNC for England and Wales The views of the GNC for England and Wales are incorporated in the Statement of Educational Policy (July 1977). This was drawn up in the knowledge that the EEC Directives were almost ready for signature and with a clear appreciation of their general content. The GNC was concerned about the delay in expected legislation based on the recommendations of the Committee on Nursing, chaired by Professor Asa Briggs. However, it felt that it could no longer hold back in giving advice as to the
Medical Teacher V o l 2 No 2 1980.
Med Teach Downloaded from informahealthcare.com by York University Libraries on 11/14/14 For personal use only.
direction in which nurse education should be moving, and in recommending modifications to the current syllabus in order to continue the steady improvement achieved over recent years. The Statement describes the characteristics of a satisfactory learning/training setting and emphasizes the need for sufficient clinical experience with adequate supervision by trained staff and a learner/tutor ratio of not more than 25 to one and preferably 15 to one. It also sets out the Syllabus and A-actical Experiences Required f o r Admission to the General Part of the Regziter-this section including the most important changes for nurse trainers. In particular, this section states that the seven areas of clinical experience considered essential include the seven areas spelt out in the Directives. The Statement also indicates that the maximum time spent on night duty should be not more than 24 weeks during the training period. This statement of Educational Policy arrived on people’s desks at about the same time as the news of the agreement on the EEC Directives, thus linking the two events. Points which the General Nursing Council indicated were goals to be achieved, such as the reduction of night duty for student nurses, have been seen as a requirement of the EEC. In addition, guidance on the length of modules of experience in specialist clinical areas, such as psychiatric nursing, has been taken as the minimum laid down by the Directives. The latter do not make any such quantitative requirements and they make no requirements at all as regards night duty. However, as we have seen, the Second Directive does state the need for a correct balance of theoretical and technical training with clinical training. Since it is first impressions that are the most lasting, the nursing profession will no doubt remain convinced that the Nursing Directives were negotiated in such a way that considerable extra and unnecessary cost was laid on a service already under the pressure of public expenditure cuts and cash limits. Similarities Between Two European Documents As long ago as 1961, the Royal College of Nursing, as the member association of the International Council of Nurses (ICN), agreed to the proposed ICN definition of Basic Nursing Education as “a planned educational programme which provides a broad and sound foundation for the effective practice of nursing and a basis for advanced nursing education”. This became an internationally accepted definition, used by the World Health Organization, and was kept in mind throughout the discussionsleading to the Council of Europe Agreement on the Instruction and Education of nurses (Council of Europe, 1968), and the later EEC Directives on the Activities of the Nurse Responsible for General Care (Official Journal of the European Communities, July 1977). The first of these documents was agreed in 1967 and the United Kingdom was one of the first signatories. The document was based on the recommendations of a working party, a member of which was the Education Officer of the GNC for England and Wales. Medical Teacher V o l 2 No 2 1980
If one compares the two documents there is a very close correlation in the outline training programme. Both require 4,600 hours of training, which in the Directives is qualified by “or three years”. The Council of Europe document requires at least half those hours to be clinical experience, and at least one third to be theoretical and formal instruction. By comparison, the Directives are much more flexible in requiring only a balance and coordination of theory and practice. However, they also require a review of this clause within five years of signing, to see if the conditions require to be tightened. The two documents are almost identical in both the theoretical parts of the programme and the areas of practical experience, except that ‘home nursing’ has been added to the experience required in the Directives. It is interesting to speculate why the EEC Directives have caused so much concern, when the UK Government had been a signatory of the Council of Europe document some 20 years earlier. The importance of the latter piece of work had, perhaps, not been recognized -although other EEC countries had taken steps to fall into line with its recommendations -and the UK did not appear to take it positively into account in our nurse training programmes. The EEC Directives, on the other hand, came to us with the force of international obligations behind them and a definite time limit for implementation. Educational Implications of the Directives The General Nursing Council for Scotland had been working on a syllabus which requires little change to meet the Directives except in paediatrics. Northern Ireland is in a similar position. The concern therefore rests mainly with the syllabus for general nurse training in England and Wales. In December 1977, having had time to study the content of the Directives, the GNC for England and Wales issued a second paper giving more specific guidance, while stating that no alteration was required to the original policy document. Points to note are that learners should spend a minimum of 60 hours in community care which should be integrated into units of experience as appropriate, and that other units of experience should be between eight and 12 weeks. The reduction of night duty was stated as a goal to work towards. Where a training school had difficulties in meeting the required units of practical experience, the Council were prepared to look into the difficulties on an individual basis. A letter from the Chief Nursing Officer of the Department of Health and Social Security on the combined subject of GNC Education Policy Documents and the EEC Nursing Directives emphasizes both these points as well as the flexibility of the Directives. Implementation of the EEC Directives All nurse educators will be aware of the individual discussions which have been held by the GNC inspectors with each school of nursing, and the later joint meetings with officials of the DHSS and the GNC in each Region in 89
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England and Wales to establish the cost to the NHS of implementation of the Directives. At the time of writing virtually all schools have commenced their new programmes; indeed, many had started some months before the agreed date. The officers of the GNC have kept in close contact with those few that have had considerable difficulty in providing all the practical experience, so for purposes of this article, general implementation is assumed and the implications for nurse educators are discussed in this context. The cost of implementing the EEC Directives is largely due to the way the General Nursing Councils have interpreted them in the United Kingdom. Named by the Government as the competent authorities, they have thus been given responsibility for interpretation and for the decision whether or not training schools comply with the requirements. We look to statutory bodies to safeguard standards of nursing education, and there can be no professional disagreement with their decision to implement the requirements in such a way as to continue the improvement of training programmes. Nevertheless, this is a national decision, and not inherent in the text of the EEC Directives. The cost of implementation is largely a service factor. Because student numbers will be reduced in acute areas, they will have to be replaced by other nursing personnel. There will be a plus factor in other areas, such as geriatric and psychiatric nursing care where students will spend more time. Even if this does not allow any reduction in other nursing staff, it should have a positive effect on patient care and give the students another insight into the needs of these groups of patients. There are also some costs which will have to be met out of the specific budget of the school of nursing, especially in increased travel to obtain experience, but this should be met through the budget of the Regional Nurse Training Committee. Those Districts that have a particularly high percentage of students in their nursing establishments, such as some of the undergraduate medical teaching hospitals, will be particularly affected in acute areas and there could be considerable problems in making all the essential experience available to all learners. If, as seems likely, such Districts decide they must cut student numbers to match these to available experience, there could be a considerable shortage of trained nurses in future, because these undergraduate teaching hospitals train a very high proportion of the country’s nursing force. This will be compounded if other areas of the country which are traditionally ‘importers’ of trained nurses are not able to increase their own flow. It is, therefore, vital to carry out effective manpower planning at national level and, controversial though this topic may be, to utilize some system such as the University Central Council on Admissions to process applications for entry to nurse training schools. The essential message is that any change in nursing education will have manpower implications and will cost money. So long as nurses in this country are counted as employees and tied to the NHS budget, so the argument will continue and a similar battle will be joined every time 90
a change is required in nursing education. Implications for Nurse Teachers Under the Directives, the overall length of the training programme for general nurses is to be 4,600 hours, or three years. The full basic student nurse training will not be affected. However, experimental courses must also meet this minimum, especially shortened courses for students with a degree. Unless the degree is relevant to the training programme, a reduction will not be acceptable. The same can apply to shortened courses for post-registration students, such as nurses on the psychiatric register taking a shortened course for general training. Here, the relevant experience in the original training and the post -registration experience will have to be carefully calculated with this requirement in mind. In addition to the hours clause, such students must also complete the seven areas of clinical experience. The theoretical content of the programme in the Nursing Directives should not cause any difficulty. It is the organization of practical experience that produces the problems. All schools of nursing, large or small, urban or rural, will have to provide clinical experience in community care, geriatrics, psychiatric illness and maternity care in addition to medical and surgical nursing and child care. It is probably in the field of psychiatric experience that most difficulties will be experienced: extra travel or residential changes will be necessary where the only available experience is some‘ distance from the school. Maternity care produces a different situation again in that a review of learners’ needs was carried out by the GNC and the Central Midwives Board. The result is units of experience of between four and eight weeks. Because of the numbers of students involved, many schools have opted for the shorter period. This will mean careful planning and supervision to give learners a meaningful experience, and they will obviously be supernumary in the ward and clinic areas. There is a secondary implication for intending health visitor students, who are required either to have undergone midwifery training or to have completed a period of obstetric experience. The shortened modules available for student nurses are unacceptable, both from the point of view of the unchanged programme content, and the shortening of the module from 12 weeks to eight weeks to as little as four weeks. This means that special courses for intending health visitors students will have to be organized in a number of centres, something which must have cost implications and which will present organizational problems in slotting students into programmes at the right time. There is also the question of who bears the cost if the training programme is outside the area of the seconding authority. For the nurse teachers, programme changes are nothing new, as schools are constantly reviewing and evaluating their methods of implementing a national syllabus. There are considerable adjustments to be made now, one of which will be changes in student nurse allocation to the senice areas, and another an increase in
Medical Teacher V o l 2 No 2 1980
clinical teachers in the specialist areas named. As the Regional Nurse Training Committee budgets are very restricted and subject to cash limits, this will probably involve reallocation of teachers from the acute areas and retraining to enable the clinical teachers to respond to new student needs. More attention will have to be paid to the basic teaching course for nurse teachers and to continuing education. When finances permit, it is hoped that the present five-yearly refresher courses will be held at more frequent intervals.
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Selection of Students Apart from the need for a manpower policy, careful selection of candidates is necessary to ensure that each student has the ability to complete successfully the complex and demanding educational programme. We do not aim to turn out a practised practitioner at the end of 4,600 hours or three years training, but a beginning practitioner who will need supervision in the early days of her practice and a planned programme of continuing education.
EEC Advisory Committee on Training i n Nursing Fears have been expressed in both the UK and the other member states of the EEC about the effects of the Nursing Directives on the standard of patient care. There are built-in safeguards. The Standing Committee of Nurses of the EEC, on which the Royal College of Nursing has the UK nomination, has been in existence since 1971 and by its persistence, both in representation to the EEC Commission and through its individual members to the various governments, it has had a definite influence in modifying some of the original proposals. This committee will continue to exist and its influence as the free voice of the profession will be no less effective than it has been in the past. At the same time as the Nursing Directives were agreed, a decision of the EEC Council of Ministers set up an Advisory Committee on Training in Nursing with a remit to advise the Commission. The terms of reference are such that this Committee could be a very powerful influence on the future of nurse training in Europe. The Committee consists of three members from each country, each with an alternate or deputy who also attends meetings. From the UK the members are as follows: Practising Profession - Miss Sheila Quinn. Alternate -Mrs Marion Ferguson. Establishments providing training in nursing -Miss Sheila Collins. Alternate-Mr J. J. Walsh. Competent Authorities -Mrs Betty Nicolas. Alternate -Miss Margaret Auld. Each of the three groups has its own President. The overall Presidency commenced with the President of the Practising Profession and will rotate annually to the other two groups in turn. As President of the practising profession group, I held the overall presidency for the first year, which passes, in turn, to Marie-Louise Medical Teacher V o l 2 No 2 1980
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Badouaille of France who represents the schools of nursing, and to Joukje von Nordheim of The Netherlands, representing the competent authorities group. Each committee member is appointed by the EEC Council of Ministers for three years as an expert in her own right and not as a representative. Nevertheless, each UK member would welcome comments or opinions which the profession would like to make, and they can be contacted individually by any member of the profession. The Advisory Committee met on two occasions in 1979. At its second meeting it adopted a programme of work for the immediate future, Two working parties were set up, each composed of one member from each of the nine member states. The task of the first working party is to identify the major characteristics of nursing in order to define the objectives of training; to clarify and differentiate between theoretical and technical instruction, and clinical instruction and to comment on the balance between these in relation to the second Directive. The second working party is to consider those basic trainings leading to a diploma as a paediatric or psychiatric nurse, or nurse caring for the mentally handicapped. It will also consider post-basic training in the same specialties and also in public health nursing. The objective of this examination is to consider whether the Advisory Committee should offer advice to the EEC Commission on directives concerning these nurses. Both groups have commenced work and will be reporting to the full committee in the course of the year. The Nursing Qualifications (EEC Recognition) Order 1979 became law on 1 January 1980. When it passed through the House of Lords, Lord Sandys paid tribute to the leading role played by the UK in the negotiation of the Directives. We shall exert all our powers of leadership in Europe, while being mindful of the nursing traditions and successes of our partners in the Economic Community. And we shall continue to work together with the nurses in the other eight member states, to improve nurse education throughout the EEC for the benefit of patient care.
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Council of Europe, European Agreement on the Instruction and Education of Nurses, European Treaty Series No 59, 1968. General Nursing Council for England and Wales, Educational Policy 1977, Document 77/19 plusenclosures 77/19/A-D, London, 1977. Oflicial Journal of the European Communities, 1977, 20, no. L176, Brussels.
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