BSN Degree is Baseline for Practice in Europe

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?

David Benton, International Council of Nurses CEO, Talks About What We Can Learn From Asia

Asia cannot be defined as one entity.  It is comprised of hugely diverse cultures with many different languages spoken.  We can learn many things from Japan, China, Korea and Thailand, for example.  There are big differences between these countries.  Benton has noticed that Japanese and Korean colleagues have the ability to stop, think through an issue, have a reasoned discussion, make a dceision and then mobile for action.  There is first a lot of debate and discussion, and then there is movement to get something done.   Benton compares this with nursing in the U.S. and the U.K. where he observes that as a profession we are not aligned.  He says we must be able to mobilze nursing around a set of principles to bring influence to bear on the system.  A fluent Spanish-speaker, he has spent a lot of time in Central and Latin America, where he also says that debate is important to the change process.

International Nursing Expert Talks About Quality and Patient Safety

David Benton, CEO of the International Council of Nursing, came to Chapel Hill tis week to discuss nursing in the global health arena.  Benton’s education and practice is U.K. based.  He served as executive director of nursing at a London health authority, as senior civil servant in Northern and Yorkshire regions, as CEO of a Scotland nurse regulatory body, and nuyrse director of a University Trust Health System.  Benton was presented with a 2001 Fellowship of the Florence Nightengale Foundation, and in 2003 was awarded a Fellowshio of the Royal College of Nursing for his work in health and nursing policy.

David Benton is a vocal advocate for identifying and promoting nurses who serve as role models for their peers and new nurses.  Quality is based on having enough time in a health system for people to learn from each other, he states.  Health care systems, he goes on to say, are streamlining to reduce overlap and costs and the opportunities to teach and learn are reduced.  We need to expose our peers to excellence in practice.  If you haven’t seen it, how can you emulate it?, he asks.  The Registered Nurse needs the time to spend with the patient group and we must celebrate the success of each nurse to excels, putting them front and center so people can see what they are doing, sharing their story, promoting their example.  Quality in health care depends upon the information flow and the physical layout, and it also requires champions.  We must put the same emphasis on clinical governance as we do on financial governance, and always ask the question, How can we do better?

International Council of Nurses CEO David Benton at UNC Chapel Hill

Global nursing education and practice are an important focus for the UNC Chapel Hill School of Nursing.  In addition to exchange relationships with nursing schools and faculty in Thailand, Japan, China and Macau, the School enjoys an interchange with King’s College London School of Nursing.  That is why we were pleased to welcome Dr. David Benton to speak to faculty, students and administrators about “Nursing in the Global Health Arena: Education, Policy and Migration.”

Today, a smaller group gathered for a “Conversation with David Benton” to explore some of the ideas he discussed yesterday and to raise some new questions about what it means to be a nurse in today’s economy and political environment.

Moderated by Dr. Gail Mazzocco, director of statewide AHEC for the School of Nursing, the conversation touched on health care policy and reform in the U.S., how our U.S. forays into health care reform are seen by professionals in the United Kingdom, what have we learned from our counterparts in Asia, what about the Malawi brain-drain migration of nurses to work in England, why does the U.K. have minimum qualifications for baccalaureate degree nursing education to practice when we don’t in the U.S. and what can we learn from this, and how does the quality and safety movement influence how we educate and reward excellent nursing.

Benton started out by addressing the migration of Malawi nurses to big cities in England to meet the nursing shortage, especially supplying London hospitals and clinics.  It’s a political issue, he says.  Nurses move to where the shortages are and there was a profitable industry built up around this.  Nelson Mandela wrote a letter to then Prime Minister Tony Blair telling him that England was stripping out the people he needed to rebuild South Africa.  The counterpoint is that the Malawi and South African nurse has the right to do better for him/herself as they wish.  Environmental and economic factors influence nurses’ decisions to move and practice in safe environments.  There is a huge need for services and as populations age worldwide, the economic pressure will increase to provide access to cost-effective, quality care.  The brain drain has to do with the economics of the home and host country.  Countries have stopped importing nurses because we are in an economic downturn.  Retired nurses have come back to work and part-time nurses are returning to full-time employment.  Nurse strategists and leaders must ensure that there are adequate systems in place to plan for the economic variables, that include workforce shortages, gluts, supply and demand.

United Kingdom Health Care Leader David Benton to Speak

You are invited!

Visiting global scholar David Benton will present a public lecture,
“Nursing in the Global Health Arena: Education, Policy, and Migration,”
on April 19, 3:30-4:30 p.m., in the Fox Auditorium.  This presentation
is open to the university community. No RSVP is needed.

PLUS:
In collaboration with the SON Global Nursing Advisory Committee and
Advancement Office, interested faculty, students, alumni and friends are
invited to join us the following day for …

A Conversation with David Benton
April 20, 3:00-4:30 p.m., Room 1100

*Please RSVP by April 15 for the April 20 session to Talat_Qazi@unc.edu
or 919-966-4619*

This smaller group, roundtable conversation will be moderated by Gail
Mazzocco, EdD, RN, who is familiar with the U.K. health care system.
She has made presentations to the Royal College of Nursing and recently
participated with us on the SON spring break trip to London to compare
the U.K. health care system (National Health Service)with U.S. practices.

This will be a focused discussion about health care policy and issues
relevant to nursing.

David Benton has served as Executive Director of Nursing at a health
authority in London; he is a senior civil servant in Northern and
Yorkshire regions; CEO of a nurse regulatory body in Scotland; as a
nurse director of a University Trust Health System.  He was presented
with a Fellowship of the Florence Nightingale Foundation in 2001 and
awarded a Fellowship of the Royal College of Nursing in 2003 for his
contribution to health and nursing policy.

Participation for the smaller group conversation is limited to 25 people.

Questions?  Ask Norma_Hawthorne@unc.edu or Melissa Monroe monroe@unc.edu

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