Some issues discussed

Some issues discussed Susan Sladden

To wind up the conference report, the issue editor reviews the main themes which emerged from the discussion sessions. The review ends with recommendations for action by professional and educational bodies.

To round off the conference gives a digest from reports

of some of workshop

each workshop

emerged

discussions.

Although

topic selected

there was considerable

topics and conclusions.

ing pages

this paper

which

had a particular

by its members, between

record,

themes

I have

attempted

On

several

cation

sector

nology)

to draw

together

contentious

points

nursing

unanimity.

(universities

were accepted

(though

not

an

education.

profession, goal,

potentially

was virtual

though

exclusive) The

edu-

of tech-

a permanent

role

to

play

in

idea of an all-graduate a realistic

of nursing

option

for

and midwifery

service are thus expected

on the scene indefinitely

alongside

to the

tertiary sector. A greater degree of integration between the two sectors is generally believed to be desirable.

To facilitate

movement

ing into the general education priate recognition of nursing

changes nursing

from nurs-

system, approcertificates as

criteria for entry to the general universally desired. This is likely

vantage

is achieved

for nursing

will continue

in gaining

certi-

to be at a disad-

access to further

and higher

education.

RELATIONS SECTORS Within

system is to involve

BETWEEN

the health

ness prevails viability their

the extent

is threatened These

THE

service colleges some uneasi-

about

functions

sector.

seen by some as an ultimate

Colleges

based in the health remain

higher

and colleges

as having

was not considered

the present.

The

status nurses

overlap

In the follow-

this diverse material. there

academic ficates,

by institutions are seeking

wholesale tertiary It

relatively

service colleges

into tertiary

the scope

Proposals

of nursing recently

for

education

sector no doubt reinforce

is only

their

in both basic and

education.

transfer

in the

to increase

and size of their involvement post-qualifying

to which

by encroachments

the

to the

these feelings.

that

the

health,

have had any rivals in nursing

education at any level; but now they appear to have no significant educational function which is not

being

carried

out

somewhere

in

the

tertiary sector, other than the preparation of pupil nurses for enrolment. It was felt that colleges

of

nursing

had,

or

could

develop,

in the way qualifying examinations in are validated. Until satisfactory

specific expertise in specialised areas of clinical nursing which could not be matched elsewhere.

Susan Sladden BA PhD SRN RMN, Lecturer in Nursing Studies, University of Edinburgh

Through ability to offer such resources to institutions in the tertiary sector, they would have the opportunity to develop reciprocal links

42

NURSE

which

would

Higher

education

tact

with

colleges away

be

beneficial

clinical the

while

(especially

major

both

parties.

need closer

practice,

of nursing from

to

institutions

con-

for staff

the smaller

centres

in

ones

of population)

such links would reduce the risk of professional multiestablishment of isolation. The disciplinary

health

the two sectors,

colleges,

bringing

was recalled

together

as an old idea

country,

may

be unable

courses already

to transfer

credit

a critical

provision,

problem.

an increasing number willing to invest their

In

into the resource

be an

anomaly

of nurses have own time and

equation;

if nurses,

were expected

is

recent

money in degree studies. This introduces factor

for

taken.

necessarily

years been

43

‘I‘ODAY

Cost, and the lack of budgetary not

students,

which deserves a new look.

EDUCA’I‘ION

a new

but it would

unlike

most

other

to bear the whole cost

of their own higher education. Qualified

GRADUATING NURSES Demand

expanding

the

demand

came mainly

researchers

three categories

considered cation;

likely

for

in European

a

and nurse managers.

recent

graduate

courses are designed

(WHO

the impetus

argument

higher WHO

edureport

needs

speaker

in

resources

of the profession

in clinical that

pri-

nurses

in

The

above

thing

in entering positive

higher

discrimination

the necessary

influence

upon

necessary,

protracted

for such nurses

and some form of

in their The

that

to

enrich

the

than

intellectual

and to contribute

to

of nursing knowledge.

favour

process

might

of acquiring financial

leave of absence the

object

of

is the

exercise is lost. Health service conditions of service are not designed to encourage part-time or full-time studies, and there are few incentives to undertake them. It may be impossible to reconcile the demands of shift working with those of attendance at full-time or even at parttime courses. Nursing is a highly mobile occupation; nurses moving to another locality, or

offer

exemplifies

graduate which

nursing

needs. Nursing

is

These

cognitive

the have

some-

special

and

which

individuals

abilities

with

leadership What

flexible, and,

adaptable

above

all,

question-

received

tions; people with problem-solving are

as

well-

as well as interper-

skills; thoughtful,

ing people who will challenge

change

general

nurses

needs were identified

needs

sonal and technical

who

sup-

discussion that

follows. developed

difficulties

entry qualifications,

port and, where so

to increase

nurses in the clinical

a direct

education

not be out of place.

often

in order

of nursing care.

are multiple

to

en-

other

THE GRADUATE NURSE

education

There

in disciplines

areas.

to enter

the quality

should

1985, p. 12).

is now coming

was made

of graduate

by one be

nursing,

assumption

the proportion

in a suggestion

to graduate order

Part-time

or day-release

nurses

couraged

should be positively encouraged

field who can exercise

in modular

qualified

the development

to their own

or format.

was interest

that

clinical practice higher

content

are required

form. There

to

for new entrants

and are not adapted

in either

variants

wish

but find that most under-

of these cadres

from nurses practising

A strong

the only ones

from

to the education countries

In Britain

In earlier credentials

later extend-

are often

to benefit

example,

gives priority

marily

academic

from nurse teachers,

ing to aspiring These

very rapidly. for

often

in nursing,

to nursing,

from nurses for studies at degree level

is currently years

STUDIES FOR

practitioners

graduate

who

assump-

capabilities,

and

eager

will

for

provide

for innovation. evidence

is there

that graduates

have

these qualities in greater measure than nurses trained within the health service system? It was generally

admitted

that such evidence

as exists

is purely anecdotal. The effectiveness and costeffectiveness of the graduate nurse has yet to be demonstrated.

demonstration

should

scarcely be necessary; yet, in today’s stances, it would be welcome.

Such

a

circum-

44

NURSE

EDUCATION

Graduates and

in nursing are a scarce commodity,

concern

was

clear policies assumed

felt

graduates

or inevitably

ship positions.

There

for the idea that career

about

certain

management

different

It cannot

be

complicated

as

bution

emerge

however,

cation

functions

have a special

goals.

Where

be

made

a prerequisite

but leadership clinical

formidable

reluctance

is needed

nurse

be enabled

bution

innovator

How

to make

to clinical

practice?

need to intervene

positively

onment

graduate

as they

in which are

expected

and

can

of nursing to the

edu-

this proposition ational

goals

is that individual

in principle

mains

an

pragmatic

open basis

other rationale

as-

development.

achieve

more,

sistance

and

working

in isolation.

support,

through

than

mutual

the same

number

market

velopment between

CONTINUING NURSING Continuing

education

in all its forms,

respective contributions health service education in some because

depth

and

of the tertiary and systems, were discussed

detail.

the term is applied

Ambiguities

arose

to a wide variety of

educational activities. For example, members of one group were found to use it in the following senses: in-service, of formats

etc. post-basic clinical courses higher education aimed at developing advanced professional skills useful to the health service higher education

in its broadest

tion, i.e. for personal

development.

interpreta-

some develappeal

especially

in the

sector, to course planning present

deplored

actual

educa-

it a sauce of unnecessary

involved

at the present

continuing

lected area. Everyone’s

in

nursing

preoccupation continuing publication

this

debate

The are

time and must underlie buzz

of activity

in

education

is still a neg-

attention

is focused upon

the earlier years of nursing of basic

and

the de-

or potential,

service and tertiary

thinking

values

Scotland,

period

on a

whether

and consumer

any resolution. In spite of a certain

trated job-related training, in a variety - occasional, day-release, modular

or

re-

continuing

and waste of time and resources.

familiar

and the

and It

such as product

of competition,

political

EDUCATION FOR

now)

being applied,

the health

friction

whether

research

Those

tion sectors,

to co-exist.

should be distributed (as

concepts

higher education

to

question

exclusive,

should be adopted.

Commercial are increasingly

able

always

functions

opment,

and organis-

are not mutually

ought

education

may

of in-

with

be

association

the framework

benefits would accrue higher

of graduates

in

are

trouble

may

not

and

the

an envirbehave

on aims

sector should be used. The

to distribute graduates randomly enough throughout the health services: groups or cells working

within

individual,

is probably

a

edu-

goal, studies should take place in

cation

contri-

can

be based

primarily

and

distrithat

to the organisation

also at

Management

It

colleges

could

benefits

the were

of continuing

It is at

the graduate

to create

distribution

the principal

of

was suggested

Where

confronts

an optimal

rational

remit institution

in the current

It

service education.

ritualism

nurses

to.

for

research

involvement.

obstacles:

to change.

for them.

proper

by anomalies

of activities.

was no support,

more

the

of educational

to leader-

this level that the would-be most

identify

types

be appointed

posts in teaching,

the level of direct

to

of

will simply

nurses should

might

senior

Efforts

absence

path - a ‘fast lane’ - reserved

A degree

the

the

for their utilisation.

that

leaders,

TODAY

careers.

education

is the

of the moment.

The reform over-riding

Development

of

education in Scotland since the of the Auld Report has concen-

on professional following

initial

studies

courses

qualification.

for the Higher

education institutions are considered by some to concentrate too much on basic nurse education programmes. Too little is being thought, and done, about the education and development of nurses throughout the working life. It was felt that the tertiary institutions should be opening up opportunities for postbasic education in unconventional and flexible

NURSE

004

using

format, learning

modular

packages,

mural

structures,

colleges

of nursing

tutorial

support

colleges

of nursing,

resources

to

ing

the

use

The offer

could in

terms

Lack

and

education

The begun

on

16

tinued,

not only in the columns

in many

anxieties

cation

to be assessed is

to avoid

was widely

wasteful

of effort and inappropriate

of resources.

In continuing

uncoordinated taking

place

vision

to

policies planning

and joint

institutions implicitly The

and

require

capsulated

resources.

The

believe

that

all the problems

pose, mutual

status,

Coherent

between

the

need for this was

expressed

by all groups. education

of definition,

conditions

enpur-

and limitations

of activity, and competition for students and resources, which exist between the tertiary and health service educational sectors. The call for planning

is a call

for guidelines

in resolving

these problems. At the professional level, responsibility for formulating policies for nursing education Board.

in Scotland

The

Board

lies with

has

many

the National day-to-day

re-

sponsibilities, and its executive structures are necessarily oriented towards these. It was suggested

that

the Board

should

consider

Urgency

and training.

the increasing

become

retention trends,

for the of

more

of

the

pro-

assertive needs

sector.

of The

requires

awareness of concerted action and

open discussions,

positive strategies

is

AVevertheless

education

control

of the

the statutory

recognition higher

over

education

control. that

in

the auto-

control

involvement

there was a suggestion pressing

but issues

I do not myself

fessional

should

con-

is added by

sector in nursing

to professional

be

The

upon

and professional

education

nursing

will

of,journals

circles.

encroachment

bodies

it is hoped,

for the future.

be

for

of continuing

the

pro-

machinery

consultation

or explicitly

discussion

to

of relating

some

and sectors.

especially,

seemed

means

demand

would

dupli-

deployment

education

developments without

are important. about

nurse education

structure

affect

so promisingly

1986

professional

information

in necessary

September

nomy of nursing

base

papers,

the discussions

be seen as such.

PLANNING

considered

of these

that

a threat

of planning

which

sectors of nursing

THE DEBATE

publication

higher

form

in identifying to professional,

will ensure

ventilated

educa-

education

not available.

Some

changes

the various

CONTINUING

to the higher

investment

stance

education.

also

the necessary

social

between

and cost-effectiveness

and should

adequate

hoc

budget-

serious handicap.

Continuing

prospective

45

TODi4Y

make

ad

of specific

continuing

of recourse

is an investment

for

of

learn-

could

sector

a particularly

Unfortunately,

supervision. part,

Boards

But costs are not identified,

to enable

political balance

tertiary

tion sector - not proven.

a more

with

provide

sector

Health

take

future needs and in responding

local

tertiary

for nurse

was considered ~ particularly

extra-

collaborating

clinical

of study.

provision

distance

could

for their

of the

programmes

and utilising

and support for distance

programmes.

more ary

and which

and

clinical facilities

courses

perhaps

EDUCATION

how to

RECOMMENDATIONS The paper concludes fic recommendations shop discussions,

FOR ACTION

with a summary emanating

which

of speci-

from the work-

may act as a stimulus

for further debate. The tertiary education institutions should: -

Revise

entry

and

assessment

criteria

for

nursing studies courses to include interpersonal and psychomotor abilities as well as intellectual - Review

criteria.

current

teaching

methods,

reference to the needs of mature for self-directed learning. ~ Provide adapted

with

students

degree courses in nursing studies to the needs of practising quali-

tied nurses.

NURSE

EDUCATION

Develop

courses

available

by

tance learning Establish of

TODAY

nursing

studies

ment

attendance

or dis-

closer collaboration

in

evening methods.

criteria

the tertiary

for mutual

components

degree

transferability between

UK

between

more

attention

education

needs

particular,

resume

the

London

for

to

the

courses

Diploma

in Nursing.

Institute

collaborative

nurses:

in

-

external -

arrangements

-

Colleges of Nursing.

-

Develop

higher

links

with

and

criteria

Review

validation

Commission

education

nursing

entrance

continuing

collaborative

in

education

to promote

of Nursing

links higher

authorities

qualifications

at relevant

as

levels.

procedures

for

nurse

examinations. an enquiry

into current

vision and future arrangements Colleges of nursing should:

of

institutions

service

Committees

of

qualifying

with

implications

institutions. with

acceptance

of preparation

University

Discuss

on

between health

Colleges

education

post-basic

of practising

and

sectors. - Ask Training

institutions. Give

Departments

education

pro-

for planning

for nurses.

tertiary

institutions; -

Negotiate

with linked institutions

academic

development

to obtain

opportunities

for

I am indebted to the following workshop rapporteurs for their help in compiling this account (for which however I am solely responsible): Elizabeth Edwards, George Findlay, Jean McIntosh, Sylvia Offer, Patricia Peattie, Stanley Walker.

nurse teachers. Health board staff associations should: -

Establish ment

sabbatical

for

teaching

leave staff

as an of

Acknowledgements

entitle-

colleges

of

nursing.

Reference National

Board for Nursing, Midwifery

and Health

Visiting for Scotland should: _ Institute

discussions

with relevant

Govern-

WHO Regional Offtce for Europe 1985 Post-basic and graduate education for nurses. Report on a WHO meeting, Helsinki 4-8 June 1984. EURO Studies 99. WHO, Copenhagen