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The ENB consultative document on education and training
NURSE EDUCATION TODAY
The EN B consultative document on education and training B E Hume Assistant Director of Nurse Education, Sefton, Liverpool
THE DOCUMENT clearly sets out its proposals for the future, and as such, is to be welcomed. It has, I consider, missed the opportunity to remedy certain deficiencies as I see them at the moment: • the lack of support/guidance/research for educational innovation in nurse training, based on patient needs; • the authoritarian nature of the present structure in nurse education which may well be a factor in the shortage of teachers of nursing; • the emphasis given to the importance of financial planning which dominates the working of the Regional Nurse Training Committees. Very little in this document suggests to me that the changes proposed are likely to improve matters.
The lack of support/guidance/research for educational innovation Basic nurse training as it is currently organised can be as imaginative and fulfilling in the interests of patients as the capabilities of the school and clinical staff are able to make it. The constraints are said to be the need to fulfil service commitments, but often the constraint is a lack of expert advice based on research, eg implementing continuing assessment, and identifying clinical learning objectives, and even the possibilities of allocation to allow for the benefits of a modular scheme of training. The advent of the nursing process concept highlights the deficiencies of the system-that nurses are usually not taught a problem-solving approach to patient care, but rather given information which they are then expected to interpret in problem situations they meet. In my view, any proposed changes should make the needs of patients the foundation on which the whole educational edifice rests. The authoritarian nature of the present structure While it is accepted that there have to be bosses and workers, it seems to me there is a need to democratise the system. Too many decisions are 18
handed down from 'on high' without a built-in system of consultation and discussion at local level: eg curriculum content and allocation of the budget.
The emphasis placed on financial planning While budgeting is a very important factor in nurse education, continuation of the present emphasis in this direction could prevent development of education. When the functions of the proposed Institutes and Colleges are analysed, it is apparent that the proposals for budgeting are clear-cut; most of the other proposals are not, and this could lead to more attention being paid to financial matters. It is interesting to note that despite all the emphasis given to this area of planning to date, it has never been possible to use all the money provided by the government for nurse training, despite glaring deficiencies in post-basic nursing education. While it is understood that the English National Board could not monitor effectively the budgets of all the proposed Colleges, there is a danger in the proposals that once again the prime role of the tier of management between the Colleges and the statutory body will be financial control. I propose that the model shown in Figure 1 should be used for the administration of nursing education. This model was proposed by Gwyn Jones (1975) for the introduction of innovation, and can usefully be applied to the needs of patients and the solving of their needs and problems, and thereby provide a foundation for the nursing educational structure. If this is done, it would change the emphasis of the whole proposed structure which should be about educating nurses to enable them to help solve the problems of patients/clients. In the model (a) represents the client/patient system within which is enclosed another mini-system. This represents the proposed Colleges of Nursing and Midwifery, and the mini-system the actual patient/client area. This system generates needs and problems related to patients which may be resolved within the mini-system (asking a colleague how to solve a problem).
NURSE EDUCATION TODAY Should the needs and problems not be solved within this system, these are then fed to an information disseminating system (b), which I see as the proposed Institutes of Nursing, Midwifery, and Health Visiting. Should the Institutes not be able to solve the problems, these should then be fed up to a knowledge creating system (c), which I see as the National Board, which might well decide to base a researcher for a particular problem within an Institute. The model shows the direction of feedback, with innovation hopefully being the final outcome. The model as originally proposed is about innovation, but I see no reason why it cannot be adapted to include advice and guidance as well, eg in determining adequate staffing levels in a particular clinical situation. Bearing this model in mind, it then becomes clearer what the proposed Institutes and Colleges should be about, together with the National Board, bearing in mind the requirements of the Nurses, Midwives and Health Visitors Act 1979. The National Board The functions of the National Board should be: 1. to provide syllabi for courses of training and conduct examinations to serve the needs of patients/clients, and which meet the requirements of the Central Council; 2. to determine the numbers of Colleges and Institutes required to serve the needs of patients; 3. to determine the numbers of trained nurses required to serve the needs of patients; 4. to determine the numbers of teachers of nursing required to provide tuition in nursing; 5. to determine areas of need in nursing knowledge creation, and make provision where possible for satisfying those needs, eg establishment of research projects, perhaps in association with an institute; 6. to determine the budget required to service the educational provision for providing for patients' needs and problems.
The Institutes of Nursing, Midwifery, and Health Visiting The functions of the Institutes should be:
1. to establish courses of training for nurses having already undergone basic training, to include some inservice training for practising nurses; 2. to provide an information-disseminating system in relation to the needs of patients/clients, which would involve links with academic institutions, Regional Boards, and involvement in library provision within the Institute's territory; 3. to identify centres of excellence in the practice of nursing and education, and strategies whereby the policies and practices that have led to these can be disseminated and support provided for their implementation; 4. to determine the general character of Colleges of Nursing and Midwifery, bearing in mind the needs
Fig 1
and problems of patients served by a particular College; 5. to provide local support for research into needs and problems of patients/clients which may have been identified by the National Board, the Institute, or Colleges; 6. to appoint members of staff to the Institute; 7. to approve estimates submitted by Colleges before they are sent to the English National Board, and disburse the money; 8. to monitor the effectiveness of the financial management of the Colleges, which would have autonomy over their budgets with virement; 9. to advise local health authorities on funding students for courses at the Institute and possibly other centres of nursing higher education. If this level of decision-making is to be based on a Region, I would suggest the adoption of the title 'Provincial Board' to avoid confusion with an entity which is a department in a University or Polytechnic. I do not support the idea of coterminosity with regional borders for two reasons: • the confusion which could arise in establishing links with more than one nursing knowledge creating system-University, Polytechnic; • the dominant role that the Regional Board could adopt, which might not serve the needs of nursing education. I would support the suggestion that there should be a larger number of Institutes-between 35 and 40based on a centre of further or higher education, for the following reasons. They would themselves be actively involved in teaching nurses, albeit at the higher level, and this would provide an excellent backbone for the Institute. The Institute would be associated with learners at a higher level in other fields, which would bring benefits, eg a background of validation of degree courses. 19
NURSE EDUCATION TODAY
Fig 2 Institute
+ Board of governors
Principal .... Registrar . . . . . Academic board
1
/
Heads of ..olIII.-- Departmental departments ......--- committees
+
Lecturers
Sub-committees
+
Students (Taken from the proposals of T Weaver for the management of Polytechnics and Colleges of Higher Education)
The support for Colleges of Nursing and Midwifery would be clearly identified, with all that this could mean in terms of improving standards and innovation. The influence of the Regional Board would be reduced. I can see no reason why the expertise contained at regional level cannot be made available to more than one Institute. What expertise?
The Colleges of Nursing and Midwifery The functions of the Colleges should be: 1. to provide courses within their prescribed areas in basic and post-basic nursing and midwifery; 2. to determine the numbers of training places available, bearing in mind the District's need for manpower, and the availability of suitable clinical training areas; 3. to synthesise sound educational objectives for both clinical and educational settings, based on the needs and problems of patients/clients; 4. to appoint members of staff to the College; 5. to select candidates for the courses under their jurisdiction, and monitor their performance; 6. to determine the nature of courses to be offered by the College in association with the Institute; 7. to provide some in-service training for clinical staff and members of staff of the College; 8. to provide a base and support for researchers into the needs and problems of patients/clients, who may be National Board or Institute sponsored; 9. to liaise effectively with service areas in the placement of learners following an educational plan; 10. to formulate budget proposals for submission to the Institute of Nursing, Midwifery, and Health Visiting, and be responsible for disbursing such money. It is suggested that responsibility for 20
virement should be given to Colleges;' ('Virement' is defined as the ability lawfully to switch funds from the category of expenditure to which they were originally allocated to another designated head of expenditure.) The Management of a College of Nursing and Midwifery should be under the control of a Board of Governors, with the Chairman appointed by the English National Board in association with the relevant Institute. This Board would appoint the Principal of the College, and it is suggested that the structure should be as shown in Fig 2. If my proposal for the Institutes to be based on a centre of higher education for nurses were accepted, this would mean that the management structure of the College would be similar to that of the Institute, with all that this would imply in terms of communication: academic board could communicate with academic board. The advantages of the structure outline would be as follows. • There would be a recognised body at which educational matters relating to the College were discussed by those actively concerned. • The board of governors would be able to discuss matters they felt able to discuss without educational matters being neglected. • It would be more democratic, as there would be election to the academic board, which could include students. The disadvantage would be that it is a rather cumbersome structure for the present size of some schools of nursing. I think, however, that the proposed colleges would be bigger than the present schools, particularly as the proposals of the Central Council envisage a considerable expansion in nurse education, requiring many more teachers of nursing to be employed, and a clear structure needs to be provided to allow all teachers and students to be actively involved in formulating learning content based on patients'/clients' needs.
Summary The proposals of the English National Board for a structure for nursing education have been examined and comments made. Proposals are made for a structure based on a model to ensure that the needs and problems of patients/clients form the base on which the educational structure is built. Suggestions are made as to the functions and role of the proposed Institutes and Colleges, and argument provided that Institutes should be based on a centre of higher nursing education rather than Regional Boards.
REFERENCE Jones G 1975, D203 Parts 1-5, Open University.
The EN B consultative document on education and training B E Hume Assistant Director of Nurse Education, Sefton, Liverpool
THE DOCUMENT clearly sets out its proposals for the future, and as such, is to be welcomed. It has, I consider, missed the opportunity to remedy certain deficiencies as I see them at the moment: • the lack of support/guidance/research for educational innovation in nurse training, based on patient needs; • the authoritarian nature of the present structure in nurse education which may well be a factor in the shortage of teachers of nursing; • the emphasis given to the importance of financial planning which dominates the working of the Regional Nurse Training Committees. Very little in this document suggests to me that the changes proposed are likely to improve matters.
The lack of support/guidance/research for educational innovation Basic nurse training as it is currently organised can be as imaginative and fulfilling in the interests of patients as the capabilities of the school and clinical staff are able to make it. The constraints are said to be the need to fulfil service commitments, but often the constraint is a lack of expert advice based on research, eg implementing continuing assessment, and identifying clinical learning objectives, and even the possibilities of allocation to allow for the benefits of a modular scheme of training. The advent of the nursing process concept highlights the deficiencies of the system-that nurses are usually not taught a problem-solving approach to patient care, but rather given information which they are then expected to interpret in problem situations they meet. In my view, any proposed changes should make the needs of patients the foundation on which the whole educational edifice rests. The authoritarian nature of the present structure While it is accepted that there have to be bosses and workers, it seems to me there is a need to democratise the system. Too many decisions are 18
handed down from 'on high' without a built-in system of consultation and discussion at local level: eg curriculum content and allocation of the budget.
The emphasis placed on financial planning While budgeting is a very important factor in nurse education, continuation of the present emphasis in this direction could prevent development of education. When the functions of the proposed Institutes and Colleges are analysed, it is apparent that the proposals for budgeting are clear-cut; most of the other proposals are not, and this could lead to more attention being paid to financial matters. It is interesting to note that despite all the emphasis given to this area of planning to date, it has never been possible to use all the money provided by the government for nurse training, despite glaring deficiencies in post-basic nursing education. While it is understood that the English National Board could not monitor effectively the budgets of all the proposed Colleges, there is a danger in the proposals that once again the prime role of the tier of management between the Colleges and the statutory body will be financial control. I propose that the model shown in Figure 1 should be used for the administration of nursing education. This model was proposed by Gwyn Jones (1975) for the introduction of innovation, and can usefully be applied to the needs of patients and the solving of their needs and problems, and thereby provide a foundation for the nursing educational structure. If this is done, it would change the emphasis of the whole proposed structure which should be about educating nurses to enable them to help solve the problems of patients/clients. In the model (a) represents the client/patient system within which is enclosed another mini-system. This represents the proposed Colleges of Nursing and Midwifery, and the mini-system the actual patient/client area. This system generates needs and problems related to patients which may be resolved within the mini-system (asking a colleague how to solve a problem).
NURSE EDUCATION TODAY Should the needs and problems not be solved within this system, these are then fed to an information disseminating system (b), which I see as the proposed Institutes of Nursing, Midwifery, and Health Visiting. Should the Institutes not be able to solve the problems, these should then be fed up to a knowledge creating system (c), which I see as the National Board, which might well decide to base a researcher for a particular problem within an Institute. The model shows the direction of feedback, with innovation hopefully being the final outcome. The model as originally proposed is about innovation, but I see no reason why it cannot be adapted to include advice and guidance as well, eg in determining adequate staffing levels in a particular clinical situation. Bearing this model in mind, it then becomes clearer what the proposed Institutes and Colleges should be about, together with the National Board, bearing in mind the requirements of the Nurses, Midwives and Health Visitors Act 1979. The National Board The functions of the National Board should be: 1. to provide syllabi for courses of training and conduct examinations to serve the needs of patients/clients, and which meet the requirements of the Central Council; 2. to determine the numbers of Colleges and Institutes required to serve the needs of patients; 3. to determine the numbers of trained nurses required to serve the needs of patients; 4. to determine the numbers of teachers of nursing required to provide tuition in nursing; 5. to determine areas of need in nursing knowledge creation, and make provision where possible for satisfying those needs, eg establishment of research projects, perhaps in association with an institute; 6. to determine the budget required to service the educational provision for providing for patients' needs and problems.
The Institutes of Nursing, Midwifery, and Health Visiting The functions of the Institutes should be:
1. to establish courses of training for nurses having already undergone basic training, to include some inservice training for practising nurses; 2. to provide an information-disseminating system in relation to the needs of patients/clients, which would involve links with academic institutions, Regional Boards, and involvement in library provision within the Institute's territory; 3. to identify centres of excellence in the practice of nursing and education, and strategies whereby the policies and practices that have led to these can be disseminated and support provided for their implementation; 4. to determine the general character of Colleges of Nursing and Midwifery, bearing in mind the needs
Fig 1
and problems of patients served by a particular College; 5. to provide local support for research into needs and problems of patients/clients which may have been identified by the National Board, the Institute, or Colleges; 6. to appoint members of staff to the Institute; 7. to approve estimates submitted by Colleges before they are sent to the English National Board, and disburse the money; 8. to monitor the effectiveness of the financial management of the Colleges, which would have autonomy over their budgets with virement; 9. to advise local health authorities on funding students for courses at the Institute and possibly other centres of nursing higher education. If this level of decision-making is to be based on a Region, I would suggest the adoption of the title 'Provincial Board' to avoid confusion with an entity which is a department in a University or Polytechnic. I do not support the idea of coterminosity with regional borders for two reasons: • the confusion which could arise in establishing links with more than one nursing knowledge creating system-University, Polytechnic; • the dominant role that the Regional Board could adopt, which might not serve the needs of nursing education. I would support the suggestion that there should be a larger number of Institutes-between 35 and 40based on a centre of further or higher education, for the following reasons. They would themselves be actively involved in teaching nurses, albeit at the higher level, and this would provide an excellent backbone for the Institute. The Institute would be associated with learners at a higher level in other fields, which would bring benefits, eg a background of validation of degree courses. 19
NURSE EDUCATION TODAY
Fig 2 Institute
+ Board of governors
Principal .... Registrar . . . . . Academic board
1
/
Heads of ..olIII.-- Departmental departments ......--- committees
+
Lecturers
Sub-committees
+
Students (Taken from the proposals of T Weaver for the management of Polytechnics and Colleges of Higher Education)
The support for Colleges of Nursing and Midwifery would be clearly identified, with all that this could mean in terms of improving standards and innovation. The influence of the Regional Board would be reduced. I can see no reason why the expertise contained at regional level cannot be made available to more than one Institute. What expertise?
The Colleges of Nursing and Midwifery The functions of the Colleges should be: 1. to provide courses within their prescribed areas in basic and post-basic nursing and midwifery; 2. to determine the numbers of training places available, bearing in mind the District's need for manpower, and the availability of suitable clinical training areas; 3. to synthesise sound educational objectives for both clinical and educational settings, based on the needs and problems of patients/clients; 4. to appoint members of staff to the College; 5. to select candidates for the courses under their jurisdiction, and monitor their performance; 6. to determine the nature of courses to be offered by the College in association with the Institute; 7. to provide some in-service training for clinical staff and members of staff of the College; 8. to provide a base and support for researchers into the needs and problems of patients/clients, who may be National Board or Institute sponsored; 9. to liaise effectively with service areas in the placement of learners following an educational plan; 10. to formulate budget proposals for submission to the Institute of Nursing, Midwifery, and Health Visiting, and be responsible for disbursing such money. It is suggested that responsibility for 20
virement should be given to Colleges;' ('Virement' is defined as the ability lawfully to switch funds from the category of expenditure to which they were originally allocated to another designated head of expenditure.) The Management of a College of Nursing and Midwifery should be under the control of a Board of Governors, with the Chairman appointed by the English National Board in association with the relevant Institute. This Board would appoint the Principal of the College, and it is suggested that the structure should be as shown in Fig 2. If my proposal for the Institutes to be based on a centre of higher education for nurses were accepted, this would mean that the management structure of the College would be similar to that of the Institute, with all that this would imply in terms of communication: academic board could communicate with academic board. The advantages of the structure outline would be as follows. • There would be a recognised body at which educational matters relating to the College were discussed by those actively concerned. • The board of governors would be able to discuss matters they felt able to discuss without educational matters being neglected. • It would be more democratic, as there would be election to the academic board, which could include students. The disadvantage would be that it is a rather cumbersome structure for the present size of some schools of nursing. I think, however, that the proposed colleges would be bigger than the present schools, particularly as the proposals of the Central Council envisage a considerable expansion in nurse education, requiring many more teachers of nursing to be employed, and a clear structure needs to be provided to allow all teachers and students to be actively involved in formulating learning content based on patients'/clients' needs.
Summary The proposals of the English National Board for a structure for nursing education have been examined and comments made. Proposals are made for a structure based on a model to ensure that the needs and problems of patients/clients form the base on which the educational structure is built. Suggestions are made as to the functions and role of the proposed Institutes and Colleges, and argument provided that Institutes should be based on a centre of higher nursing education rather than Regional Boards.
REFERENCE Jones G 1975, D203 Parts 1-5, Open University.