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Sylva Bártlová
EDUCATION AND PROFESSIONALISATION OF NURSES Introduction In majority of countries the nurses form the most numerous group of health care staff, namely both in in-patient and out-patient (especially primary) care. Thus the nurses and the nursing profession play a significant role in the health care system. Recently, Europe has been uniting and this is true also in case of nursing studies. The existence of European standards in all EU countries has undoubtedly led to improvement in education – almost homogenous education of nurses was adopted in Europe. A lot of EU member countries implemented vast educational reforms in 1990s. The new concept of education in nursing represents a profound change in nursing practice and a new way of professional preparation of nurses both for institutionalised and individualised nursing care. In the study which takes at least 4600 hours the theoretical and practical parts are balanced. Also the new EU countries adjusted their educational programmes to it (see Tab. 1). The table shows that in spite of that, even today the education of nurses continues to differ in some important discriminating criteria, i.e.: - admission requirements - level of education - completion of qualification. I. New requirements concerning education of nurses Only a few occupations have undergone such profound changes during a relatively short period like the nursing profession. The role of the nurse not only went through a complicated development in the past but it has been experiencing fundamental changes at present, too. The changes concern the professional, legal and regulatory position of the nurse, as well as education, working conditions, etc. On one hand there is the effort for higher specialisation in the nursing profession, on the other hand for maintaining the holistic approach in nursing. Traditionally, the nurse was regarded to be the team member who provides basic (physical) care to the patients. However, new responsibilities have occurred and are expanding all the time. They are based on the orientation of professional activities of nurses on human health as a whole and founded on the knowledge of social sciences, applied psychology, sociology, nursing ethics, etc. Brought forward are the activities connected with psychological support provided to the patient during management of the disease and coping with it, as well as the activities connected with the role of an educator, because even the simplest treatment may become the source of tension and stress. Worthy of attention are also the activities connected with extension of the professional role of the nurse, i.e., with increasing of quality of therapeutic care, and her participation in the deve-lopment of nursing theory. To be able to achieve and maintain the standard of care the nurses are required to possess new skills which were not required in the past. In many aspects these skills belong to a different category than the previous requirements. A broader spectrum of skills is concerned, especially regarding the social problems related to the disease and health of an individual or a group. It is necessary for the nurses to have also certain knowledge of the research work, if nursing is to be developed as a practice based on research. II. Requirement for professionalisation of nurses In the materials of the World Health Organisation attention has been paid recently to the problems of nursing and the position of nurses within the health care system. In these materials the requirement for professionalisation of the nurse occurs. Also in CR the terms “professional nursing” and “professional nursing care” are frequent. Majority of documents of the World Health Organisation emphasise that the recommendations must be adapted to the status, conditions and possibilities of the individual countries. From the point of view of sociology a profession can be called an occupation, a vocation or vocational training for the desired occupation. The term profession is related especially to the work roles. The main common denominator of the work roles is the restricted and regulated access to their pursuit. For instance, a person can become a doctor only after successful completion of usually six-year university study. This study covers both theoretical and practical components of medical science and includes a commitment to life-long learning. Preparation of nurses in industrially developed countries, as well as in CR (Law No. 96/2004 Coll.), takes usually three years. In CR, the term university education of nurses denominates especially a baccalaureate study leading to acquiring of competence for pursuit of the nursing profession, the extension baccalaureate education for qualified nurses and the follow-up master and doctoral studies. Thus, the university education of nurses is structured, has a certain hierarchy. It requires differentiation in understanding of the individual forms of university education and differences can also be seen in the ratio of generality and specialisation. The higher level of university education, the higher degree of specialisation. It also includes a commitment to life-long learning. The pursuit of professionalisation is thought to be natural and legitimate in the developed industrial countries. In spite of that some social critics are disturbed by too strong emphasis being placed on formal accreditation (certification) by school diplomas. This effort is led especially by the desire to gain prestige, which is closely connected to professionalisation, but also by some other aspects among which an important role is played by the hope to achieve a higher stability of jobs, the opportunity for a real career, the possibility of regular promotion and improvement of financial evaluation of skilled work. III. The development of professionalisation of nursing The most important element in the drive for professionalisation of nursing was the introduction of the “new system of nursing” in 1980s. This system was partially based on the changes in the way in which the nurses are educated. In majority of the developed western countries radically changed syllabus for nurses who apply for state registration was introduced. By the end of 1990s basically all education of nurses was transferred into universities. Some authors, for instance Freidson, claim that the decisive criteria of a profession are autonomy and dominance. He says: The leaders of aspiring occupations, including nursing ... insist that their occupations do provide prolonged training in a set of special skills, including training in theory or abstract knowledge ... but their meaning is suspect because the content and length of training of an occupation, including abstract knowledge and theory, is frequently a product of the deliberate action of those who are trying to show that their occupation is a profession and should therefore be given autonomy (Freidson, 1988: 79–80). He thinks that the problem of nursing lies in the fact that it started too obviously organise its education with the only intention of gaining a higher position in society. It is sure that nursing has improved its occupational status, and that it continues to do so. The attempt of nurses to gain autonomy and dominate a certain area of work is negatively affected by pressures to provide cost-effective health care services with higher turnover of patients. Today most patients, as a consequence of medical developments, do not – or should not – spend enough time in hospital for the principles of new nursing to be administered. Meeting the patient’s biological, psychological, social and spiritual needs is proble-matic when the patient stays in hospital for only a few hours. Discovering of the patient’s needs may not even be possible during his/her short stay in a modern hospital, where there is quick patient turnover, or during the community visit. Freidson (1988) argues that nursing can never be anything other than a semi-profession because the knowledge base of nursing remains within the remit of the medical model. The doctors are responsible for the diagnosis, therapy, admission and discharge of “their” patients in majority of clinical situations, and therefore they have a great influence over nursing practice. According to Freidson (1988) but also other authors, e.g., Smith (1993), Dingwall (1986), Rafferty (1996), in its essence nursing is a subordinate profession. The medical profession can be regarded as remaining powerful. On the other hand, nursing represents a so far relatively powerless profession. Like all social organisations also professions are subject to changes that are the consequences of major developments in a global, national and regional scope. The nursing profession in its fight for a certain autonomy confronts the medical profession which has been already operating in this zone. Thus it impinges the needs, interests and competence of the doctors and produces counter pressure. It would be an unhappy solution if during the effort to find the position of nurses the confrontation between nurses and doctors occurred, because the result of the confrontation usually is one winner and one loser. On the other hand, co-operation could possibly mean profit to all actors. The requirements for performance and education of doctors and nurses are still very different. In spite of that a certain convergence of status of both the professions can be seen during the last decade. The convergence of the status of these two health care professions – the doctors and the nurses – can increase sensitivity in mutual nurse – doctor relations. Conclusion New conception of education of nurses in the Czech Republic according to Law No. 96/2004 Coll. is in accordance with EU strategy and takes into account the global trends. But it is connected with certain requirements for the transformation of the whole hierarchy of the health care system. This system which accentuates university education of nurses is directed to restructuring of the roles which are to be fulfilled by a doctor, a qualified nurse and other health care staff. As table I shows also other EU countries are still faced with a number of tasks in the area of education of nurses. In case of non-medical professions regulated by EU it requires in the first place harmonisation of legislation which includes standardisation at a national level. The standards include among others also the standard of education. Increa-sing stress has been laid on improvement of the quality of the programmes of nursing education, which will give the nurses the possibility of free movement and comparability, e.g., within the European Union. [TABLE I: AVAILABLE ONLY FROM PRINTED VERSION] REFERENCES 1. Dingwall R.: Anatomy of a profession: training for a varied career, Nursing Times 1986, 82(13), 27–28. 2. Freidson E.: The profession of Medicíně: A study of the Applied Sociology of Knowledge – With a New Afterword, IL: University of Chicago Press, Chicago 1988. 3. Rafferty A.M.: The Politics of Nursing Knowledge, Routledge, London 1996. 4. Smith P.: Nursing as an occupation, [in:] Taylor S., Field D. (eds): Sociology of Health and Health Care, Blackwell, Oxford: 1993, chap. 12, pp. 205–233. 5. Stöcker G.: Es ist noch viel zu tun…., Heilberufe 2004, 5 (56), 14–15.
Acknowledgement: The research was supported by Grant Agency of the Ministry of Health of CR, grant task No. NR/7960-3, which is kindly reported.
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Professionalism and Responsibility
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Aby cytować ten artykuł/To cite this article: Bártlová, S., Education and professionalisation of nurses in the Czech Republic (Comparison with the other EU countries) , [in:] Niebrój L., Kosińska M., Health Care: Professionalism and Responsibility, Katowice: Wyd. ŚAM 2005, p. 17-22 |
