David Benton, CEO of the International Council of Nurses spoke with faculty and graduate students at the University of North Carolina at Chapel Hill during his visit on April 20-22, 2010. In answer to a question about why the U.K. requires all practicing nurses to have a minimum of a baccalaureate degree in nursing, Benton explained that this is a European Union general systems directive that allows nurses to move freely among member states. Qualifications are standard to provide flexibility of movement. Nursing programs, in fact, must provide a minimum of three years of education with 2,300 practice hours and 2,300 theory hours. In 2005, the professional services directive was updated to focus on competence measures.
Wales moved to an all graduate RN level requirement after this. Scotland undertook to examine the profession of nursing and compare it to educational requirements for entry-level practice of medicine and law. They determined that the work that nurses did was of equal or greater value and required equal or greater competence than medicine and law. Yet, the educational qualifications were lower, which they concluded, reflected the role of women and how they are valued in society. These are political decisions, says Benton.
At the diploma level, the Scottish evaluation concluded that nursing required a much higher level of competence than the medical degree, yet the educational requirements were not commensurate. Benton asks, are we undervaluing what we already have? What are we asking the RN to do? We must award educational degrees that value nursing competency. There is an advantage to students undertaking an advanced diploma because it centers around quality of care. There are quality issues around failure to rescue when students are not educated at the BSN level. The data is powerful around quality and patient impact.
The politics of nursing is powerful. Benton gave the example of the African country of Botswana that imported a U.S. degree program for advanced practice. In the U.S., students were awarded the MSN after completing the program. In Botswana, they were awarded the BSN program. He raises the question of undervaluing the profession based upon politics and culture.
RNs can work in a variety of job arenas, but acute care hospitals are highly specialized environments. Employers expect expertise. There must be a close dialog between the educators and those providing the service to debate how to design the best system. We need exemplary role models and we need to promote and provide more education to the people who demonstrate competency.
In the U.K., women have been disadvantaged. Benton has practiced with highly qualified nurses who could not afford a university education and were not able to get a baccalaureate education. If we can link educational opportunities through technology to combine resources and strengths, we will be better able as health care professionals, to sustain communities in remote and rural areas, he concludes.
And, there is a big concern as our population ages about whether we will get enough students to fill the need. In the U.K. people are coming into nursing for second, third and even fourth careers. We need to make nursing education accessible, affordable, and high quality. Do we need to create alternative or hybrid educational models? How can a student do scholarly work, for example, if their nursing degree program is not university-based?