The impact of the economic crisis on nursing and health systems and subsequent challenges that the European Union faces, are highlighting areas where greater policy making and political decisions are needed.
The updating of the Directive 2005/36/EC could politically be a step back to the Seventies if decisions are taken without considering existing evidence. The health sector is recognised as being a key driver to increasing growth and economic sustainability, yet the lack of investment in the education of the EU health workforce is seen as a major barrier by most governments. We know that making our society healthier will help increase productivity and employment, also helping society to better cope with the challenges of an ageing population. This could entail moving from traditional hospital care to nursing in community settings. In order to make that change possible European health strategies, as designed by WHO and DG Sanco policymakers, need to take into consideration the development of a highly educated health workforce.
Only when nurses are properly educated according to the minimum requirements as set out in DIR 2005/36/EC, can nurses lead and support the necessary changes to prepare, empower and support EU citizens in the management of their own health and well-being.
In the context of the modernisation of the Professional Qualifications Directive, the Commission proposed upgraded requirements for the recognition of qualifications, taking into account the evolution of the nursing profession in the last 40 years and the increasing responsibilities that nurses have in their daily working environment. However, what the Commission crucially picked up on has been immediately criticised by German MEPs and politicians, followed by those MEPS who see shortages of nurses as a matter to be solved by downgrading their education. Furthermore, the upgrade of the admission requirements (10 to 12 years of general education) for nurses is seen by some German MEPS as “making nurses academics” and they wrongly believe that this will lead to an increased shortage.
Instead, the evidence shows that increasing the entry requirement for nursing education has in fact led to better recruitment rates, major attractiveness of the profession and last, but certainly not least, better patient outcomes (EFN Evidence Report, 2011). Although the Hungarian government wants to reduce the entry threshold now, the evidence shows that even if there are different educational systems, the vast majority of Member States currently fulfil the requirement of 12 years training. Despite the Hungarian government’s determination to reduce nursing education to ten years, research shows that most Hungarian nursing candidates prefer in fact to study for a bachelor in nursing, equivalent to 16 years education.
MEP Mario Pirillo (ENVI shadow) and Bernadette Vergnaud (IMCO rapporteur), together with EFN, organised a European Parliament roundtable to share this evidence with MEPs, the Commission and the Council and to hear the views of other stakeholders. The meeting was attended by a large and wide-ranging audience. EFN President Unni Hembre presented the results of the largest European study on the nursing workforce showing the benefits of a higher level of education on patient outcomes: “Every 10% increase in nurses that have studied for a bachelor is associated with a 7% reduction in the chances of patients dying, showing that higher education of nurses correlates with lower mortality” (results from RN4CAST, Linda Aiken et al, 2012).
Acknowledging the different education systems around Europe and the importance of having in-depth training, as a precondition to acquiring vital nursing skills in an increasingly complex health care system Ms Monika Kosinska, EPHA Secretary General, echoed the importance of nurses’ education on patient safety and its impact on the position of women in society. Quality of health care is hampered by the enormous societal challenges and, more than ever, we need to make sure that European health systems are built on a highly educated nursing workforce to ensure that quality and safety remains at the centre of patient care. Furthermore, the need to invest in one single level of nurses, a highly qualified one, was stressed. Huge differences in education across EU member states could result in further implications for patient safety and equity in quality of care. If we leave the minimum requirements of the directive as they were prior to the modernisation process, we would move backwards as nursing is one of the most mobile professions. It is crucial that high educational components are the key drivers in the modernisation of the minimum requirements for nurses to boost the single market act. Bearing in mind the evidence, politicians should think twice when deciding on future requirements for the recognition of nurses’ qualifications in the EU. From a patient safety perspective, Europe cannot forget their vital role in ensuring EU citizens’ rights to safe and high quality health care across Member States.
By Paul De Raeve, Secretary General of the European Federation of Nurses Associations (EFN); Silvia Gomez Recio, EFN’s Policy Advisor and Alessia Clocchiatti, EFN’s Intern.