Report of the Post-registration Nursing and Midwifery Education Review Group

Transcription

1 Report of the Post-registration Nursing and Midwifery Education Review Group Item type Authors Rights Report Health Service Executive (HSE) Health Service Executive Downloaded 19-Jul :33:39 Link to item Find this and similar works at -

2 Report of the Post-registration Nursing and Midwifery Education Review Group Changing practice to support service delivery Office of the Nursing Services Director

3 ISBN Health Service Executive May 2008 Office of the Nursing Services Director Human Resources Directorate Health Service Executive Dr Steevens Hospital Dublin 8 Ireland telephone: nursing.services@hse.ie

4 Table of Contents Preface 4 Executive Summary 5 CHAPTER 1: Recommendations of the Nursing and Midwifery Post-registration Education Review Group Introduction Context and background to the review Health Reform Educational Reform Nursing and Midwifery Reform The review group and its mandate Scope of the review Vision Consultation and communication process Development of Recommendations 18 CHAPTER 2: Literature Review Summary Background Overview of Literature Evaluation of Studies Other relevant points from the literature Reasons for undertaking post- registration and postgraduate courses Benefits of undertaking post registration and postgraduate courses Barriers, constraints and concerns National and international post registration and postgraduate courses Issues around course provision and educational methods and approaches Training needs analysis and purchasing/contracting for education Discussion Conclusions 28 CHAPTER 3: Current provision of post-registration nursing and midwifery education Introduction Aims of the survey Methodology Findings Courses offered and courses delivered Course categories Courses offered Uptake of courses Numbers of nurses and midwives enrolled in post-registration nursing and midwifery education 32 1

5 3.4.6 NQAI levels Areas of Practice (excluding Doctoral programmes) Single Module Registration Course fees Course characteristics Generic programmes Diplomas, Higher Diplomas, Post-graduate Diplomas, Graduate Diplomas, Graduate Certificates Programmes leading to registration with An Bord Altranais Courses preparing for an area of specialist practice not leading to registration with An Bord Altranais Masters Programmes Doctoral Programmes Summary Conclusion 43 CHAPTER 4: The Consultative Process Introduction Methodology Eight principles that should underpin the Framework The 13 key requirements for future post-registration nursing and midwifery education A Strategic Approach Educational Needs Analysis Recognition for prior learning New models of education provision Scholarship Support Value for money New methods of financing education New methods of procuring education Evaluation of Education Professional Regulation Removal of entry barriers to accessing post-registration education Increase specific registration courses A greater research focus 51 2

6 CHAPTER 5: The Strategic Framework Introduction Aims and principles of the framework HSE Nursing and midwifery education governance and finance infrastructure Framework Processes Stocktaking- Educational needs analysis Forecasting- Educational needs Planning Education Commissioning and procurement Monitoring Evaluation Process levels Factors impacting on the post-registration education process External factors Internal Factors Service factors Organisational and Professional Factors Equity and access Current and new educational processes Conclusion 62 REFERENCES 63 APPENDIX 1: Post-registration Nursing and Midwifery Education Review Group Membership 70 APPENDIX 2: Review of Post Registration Nursing and Midwifery Education Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis 71 APPENDIX 3: Post Registration Nursing and Midwifery Education Review Communication & Consultation Plan 73 APPENDIX 4: Barr et al s (1999) conceptual framework for the evaluation of education and training 76 APPENDIX 5: An example of the questionnaire sent to higher education institutions 77 APPENDIX 6: Consultation Workshop Schedule and Agency Presentations 84 3

7 Preface On behalf of the Health Service Executive (HSE) and the Post-registration Nursing and Midwifery Education Review Group, I am pleased to present this review of post-registration nursing and midwifery education. This review was established by the Health Service Executive in the context of radical reform in both healthcare services and nursing and midwifery education in Ireland. The main impetus for the review arises from the urgent need to create a structure and processes that are designed to deliver a strategic approach to development, delivery and evaluation of nursing and midwifery post-registration education nationally. Nursing and midwifery educational reform has been shaped by the changes in healthcare and also by the implementation of the Commission on Nursing (1998) which advocated that nursing became a graduate profession. Both nursing and midwifery are now graduate professions. In addition, the Commission on Nursing (1998) recommended the establishment of a number of career pathways. The establishment of management and clinical career pathways has necessitated the development of many post-registration nursing and midwifery educational programmes to meet the educational requirements to prepare practitioners for specialist and advanced practice and management roles. These reforms have enabled nursing and midwifery to respond to the changing healthcare needs of those in their care. The review group established by the HSE comprised various stakeholders from within nursing and midwifery, with representatives from service providers, the Department of Health and Children, the Higher Education Authority, higher education institutes, regulatory and professional bodies, and staff associations. This report presents the work of that review group and provides a comprehensive, strategic framework for the future development, delivery and evaluation of post-registration nursing and midwifery education in Ireland. I wish to thank the many individuals and organisations who contributed to this report including those who responded to the survey, attended the consultation workshops and made written submissions to the review group. Particular thanks are extended to the members of the review group, Dr Siobhan O Halloran, Nursing Services Director, Ms. Mary Wynne, Project Officer, Mr Hugh ONeill, Administrative Support, HSE, and Dr Harry Gijbels, Ms Caroline Dalton-O Connor, Ms Rhona O Connell, Ms Moira O Donovan, University College Cork who undertook the literature review. Professor Tom Collins Chairperson Post-Registration Nursing and Midwifery Education Review Group 4

8 Executive Summary This report outlines the work undertaken by the Nursing and Midwifery Post registration Education Review Group, which was established by the Health Service Executive in January Its aim was to prepare a comprehensive, strategic framework for the future development, delivery and evaluation of post-registration nursing and midwifery education in Ireland. The group was made up of various stakeholders from within nursing and midwifery, with representatives from service providers, the Department of Health and Children, the Higher Education Authority, higher education institutes, regulatory and professional bodies, and staff associations. The review group employed three main techniques to inform the development of the strategy, including an extensive consultation and communication process, a review of national and international literature, and a baseline survey of the current provision of post-registration nursing and midwifery education. The review also examined the need for post-registration programmes for registration with An Bord Altranais. This review was undertaken in climate of radical reform both in healthcare delivery and in the educational preparation of the professionals who deliver care. It took cognisance of the priorities set out in the Transformation Programme of 2007 and followed a period of educational and professional development reform within nursing and midwifery as recommended in the Commission on Nursing in Reform ensured that nursing became a graduate profession in 2006, while the establishment of clinical and management career pathways lead to an increase in the number and variety of postregistration education programmes offered by higher education institutions. The main focus of this report is the review group s strategic framework for the future development of nursing and midwifery post-registration education, presented in Chapter 5, with the 23 recommendations for its implementation. The framework was developed and agreed upon following detailed examination of the findings arising from the literature review, baseline study and consultation process. It is hoped that the framework and the recommendations will ensure the efficient and effective provision of quality post-registration education for nurses and midwives which is responsive and appropriate to patient and client need. Finally, the Post-registration Nursing and Midwifery Education Review Group believes that implementation of its recommendations is dependent upon the continuing collaboration and partnership between all stakeholders. With this in mind, the group recommends that an advisory committee is established to oversee the implementation of the recommendations proposed in this report. 5

9 Recommendations of the Nursing and Midwifery Post-registration Education Review Group Principles RECOMMENDATION 1 Future post-registration education should be guided by the principles of equity of access, flexibility, standardisation, quality, partnership, sustainability, value for money and also be service-driven and clinical/ patient care-focused. Governance & Finance RECOMMENDATION 2 A nursing and midwifery education function will be established within the Office of the Nursing Services Director at the Health Service Executive. This education function should have an appropriate skill mix of staff, as it will have overall responsibility for the strategic planning, development, procurement, monitoring and evaluation of post-registration nursing and midwifery education, in alignment with pre-registration education and continuing professional development on behalf of the Health Service Executive. In particular, it will: prepare and submit estimates for post-registration nursing and midwifery education; act with overall responsibility to coordinate the management of funding assigned to postregistration nursing and midwifery education; develop, disseminate and review policies regarding post-registration nursing and midwifery education within the Health Service Executive; ensure a national, cohesive approach to the development of post-registration nursing and midwifery education which reflects the changing needs of the health service, patients and clients; ensure that external agencies funded directly by the Health Service Executive for postregistration nursing and midwifery education are accountable for delivering agreed educational outcomes and value for money, and are subject to audit, evaluation and conformity with best practice; develop key internal and external relationships at national and international level; and ensure that nursing and midwifery planning and development units will assume responsibility in their administrative areas for post-registration nursing and midwifery education, under the auspices of the Health Service Executive education unit and in line with its policy. This will involve working in partnership with the Directors of Nursing and Midwifery, centres of nursing and midwifery education and higher education institutions. 6

10 RECOMMENDATION 3 - Post registration education funding will be managed in the following way Funding allocated by the Department of Health and Children for the development of all Nurse Education and Research will be identified within the overall HSE budget and ring fenced for continued availability for Nurse Education Development and Research. Overall responsibility for the allocation, management and accounting for funds allocated for nurse education and development will be assigned to the Office of the Nursing Services Director. The Office of the Nursing Services Director will be provided with the appropriate resources, including accounting resources and administrative support to adequately discharge this responsibility. In managing the overall allocation management and accounting of funds allocated for Nurse Education and Development, funds shall be distributed on a devolved management basis to area nurse and midwifery planning and development functions and individual hospitals areas having regard to the development and putting in place of appropriate administrative and accounting systems and reporting arrangements. Funding provided as part of the HSE vote to support the Undergraduate Nursing Education and Training will in the first instance be assigned to the Office of the Nursing Services Director in respect of funding allocated for Undergraduate Nursing Education in General, Mental Health, Intellectual Disability, Midwifery and Integrated Children s and General Nursing and Postgraduate Diploma Programmes in Midwifery and Children s Nursing. Existing arrangements in respect of the funding of the Third Level Sector by way direct funding relationship between the HSE and the individual colleges should continue. Detailed reporting arrangements shall be agreed between the Third Level colleges and the HSE. Furthermore it is also recommended that the HSE enter into discussions with Third Level colleges and the Higher Education Authority in relation to agreement in respect of the annual fee for all Nurse Education Programmes and payment arrangements including arrangements where the numbers admitted to individual programmes either exceed or are less than the agreed number of places contracted with the individual college. These discussions shall have regard to the need to maintain a steady output at the contracted number of places throughout the sector. While at the same time that numbers admitted to these programmes are consistent with the capability of the HSE to provide clinical placements. 7

11 The HSE shall, in partnership with the individual third level college, undertake a detailed review of the cost/financing of all registration courses provided. This review shall be carried out on a regular basis and no longer than five yearly intervals. It is acknowledged that the Department of Health and Children will be undertaking a review of the undergraduate nursing degree programme. Funding arrangements and responsibility in respect of the funding of the clinical intern period as part of the Undergraduate BSc Programmes in Nursing and Midwifery shall be transferred to the Office of the Director of Nursing, including the transfer of the existing base budgets of participating hospitals in this element of the Programmes. Verification and calculation of fees and payments in respect of rostered payments shall be managed by the Office of the Nursing Services Director. Arrangements for and funding of ongoing expenses in relation to uniform, travel and other allowances shall be devolved to the Area Nursing and Midwifery Planning and Development functions at area level. Funding currently provided at a local hospital/area basis in respect of Postgraduate Education, Training and Development should be retained for management, administrative and accounting purposes at local area level and shall be ring fenced accordingly. Generic, administrative and accounting codes should be developed by the Office of the Nursing Services Director for implementation at hospital and local area level to ensure consistency in the administration coding and reporting of expenditure in respect of Post Registration funding. Funding held at central level for Post Registration Nurse Education Development should be distributed on an area/hospital basis having regard to existing base funding and the need to provide for equity and funding availability and having regard to the number of nurses employed in a particular area hospital, specialty distribution etc. This funding should be allocated at the commencement of each service/accounting year on the preparation of an agreed service level provision in respect of such funding. The group recommends that the HSE should prepare and implement a value for money programme in relation to the purchase and delivery of nurse education/development programmes. Circulars: Currently a number of circulars set out requirements and provisions in respect of access, funding/other supports and service commitment requirements in relation to nursing and midwifery education programmes. There is need to review these circulars to ensure consistency in relation to access, supports etc. having regard to resources available, service needs etc. 8

12 RECOMMENDATION 4 An Interim Education Advisory Committee should be established to inform and advise on the implementation of the post-registration review report. This committee should represent the relevant stakeholders in post-registration nursing and midwifery education. It is envisaged that this committee will, in the first instance, be set up on an interim basis to support the implementation process. This will be reviewed on an ongoing basis. RECOMMENDATION 5 The Health Service Executive should develop an equitable, standardised system for the funding allocation for post-registration education with suitable governance and accountability structures that take into account quality and value for money. RECOMMENDATION 6 The Health Service Executive should examine procurement options, including but not limited to a tendering process, that will ensure the commissioning of quality post-registration education. Due regard should be taken in relation to issues of service need, quality, access, sustainability, value for money and the Health Service Executive procurement policy. RECOMMENDATION 7 The Health Service Executive should examine options for devolved procurement and fund management, coupled with a clear policy framework to support the procurement process. RECOMMENDATION 8 The Health Service Executive should develop key indicators of educational quality that will inform the tendering, monitoring and evaluation process. Integration of Health Services and Education RECOMMENDATION 9 The Health Service Executive should develop structured systems for stocktaking and forecasting educational needs at national, area and local level. These systems should take account of workforce planning analysis and the emerging needs of the Health Service Executive Transformation Programme. They will be underpinned by the development of a post-registration education minimum dataset for the nursing and midwifery resource. RECOMMENDATION 10 The Health Service Executive should ensure that post-registration nursing and midwifery education is responsive to the needs of the health service by delivering the appropriate number of nurses and midwives, educated in the necessary areas of practice and to the required level of competence. 9

13 RECOMMENDATION 11 The Health Service Executive in consultation with the Department of Health and Children should develop a policy in relation to the need for the re-introduction of postregistration programmes (conversion programmes) leading to additional registration on An Bord Altranais registers, giving priority to psychiatric and intellectual disability nursing. RECOMMENDATION 12 The Health Service Executive in partnership with the relevant bodies of nursing and midwifery, should undertake the development of a nationally-consistent framework for the categorisation of specialties with a view to assisting educational planning, workforce planning and policy development. Professional and Regulatory Requirements RECOMMENDATION 13 The Department of Health and Children should request An Bord Altranais to regulate all clinical post-registration programmes. RECOMMENDATION 14 Future Health Service Executive national, area and local structures with responsibility for post-registration education incorporate nursing and midwifery research development and application to practice in their remit, thus maximising the impact of education. Systems and Structures RECOMMENDATION 15 The Health Service Executive following consultation with relevant bodies, should put in place an appropriate structure e.g. a specific function within the Health Service Executive which would develop and review a standardised system of scholarship support, which is equitable, transparent and aligned to service need. RECOMMENDATION 16 The Health Service Executive following consultation with relevant bodies, should ensure that a formal system of career advice is established that is consistent with Health Service Executive systems. RECOMMENDATION 17 - The Health Service Executive should establish a single point of information, such as web-based knowledge centre, whereby nurses and midwives can access all relevant information about post-registration programmes including the scholarship support available. Educational Processes RECOMMENDATION 18 The Health Service Executive should replicate existing structures to facilitate partnership arrangements between the service and education sectors, such as local joint working groups, professional advisory groups and memoranda of agreement to support postregistration education. RECOMMENDATION 19 The Health Service Executive in consultation with relevant bodies, and with due regard to systems already in place, should further develop systems for the recognition of prior learning 10

14 RECOMMENDATION 20 The Health Service Executive in partnership with higher educational institutions, nursing and midwifery planning and development functions, centres for nursing and midwifery education and the professional and regulatory bodies, should develop programmes and models of delivery which incorporate inter-professional education and e-learning. RECOMMENDATION 21 The Health Service Executive should seek that a high quality information and communication technology infrastructure be available to support all aspects of postregistration education provision, including the electronic delivery of programmes or modules. RECOMMENDATION 22 The Health Service Executive in partnership with higher educational institutions, nursing and midwifery planning and development functions, centres for nursing and midwifery education and the professional and regulatory bodies, should develop programmes of education within the parameters of the National Framework of Qualifications established by the National Qualifications Authority of Ireland. RECOMMENDATION 23 Centres of nursing and midwifery education have a key role at local level in the implementation of post-registration education and should work towards becoming Registered Providers of the Further Education and Training Awards Council (FETAC) and Higher Education and Training Awards Council. 11

15 CHAPTER 1: The Review: Background, Scope and General Overview 1.1 Introduction The Health Service Executive (HSE) established the Post-Registration Nursing and Midwifery Education Review Group in January This report details the work undertaken by the review group and its conclusions and recommendations. The aim of the review group was to prepare a comprehensive strategy for the development, delivery and evaluation of post-registration nursing and midwifery education in Ireland. Its main focus is the development of an overarching framework for the development of future post-registration nursing and midwifery education programmes including a preferred model for procuring and financing the development, delivery and evaluation of these programmes. This strategy and the recommendations therein have been developed with reference to and are compatible with the HSE Board policy objective of a unitary multidisciplinary education, training and research structure within the HSE. This strategy will support the HSE s Transformation Programme (2006), which outlines the mission, vision and transformation priorities from 2007 to 2010, and provides direction and focus for all HSE employees. The report comprises five chapters. Chapter 1 outlines the report structure, the context and background to the review and its terms of reference and scope. In addition, it provides an overview the work undertaken, and the consultation and communication processes employed. The vision of the review group and the principles underpinning its work are described along with the process used to develop the recommendations. Chapter 2 contains a summary of the extensive literature commissioned by the review group. Chapter 3 describes the existing scale and provision of nursing and midwifery post-registration programmes in Ireland in terms of the areas of practice, course types on offer, fees and the number of nurses and midwives enrolled. Chapter 4 presents the methodology employed in analysing all the data gathered in the consultation process. The themes arising from the content analysis are reported under two main headings; the principles that should underpin the strategic framework and its key requirements. Chapter 5 describes the framework and the recommendations required to ensure and support its implementation. 1.2 Context and background to the review The main features of health reform within Ireland are outlined in the next section. This is followed by a brief outline of nursing and midwifery educational reform, and nursing and midwifery reform as it impacts on post-registration nursing and midwifery education. 12

16 1.2.1 Health Reform The context in which health reform in Ireland has occurred reflects global public sector modernisation. Initially the impetus for public sector modernisation was to improve efficiency, to reform management practices and divest public involvement in commercial enterprises. More recently, the concern for efficiency has been overtaken by problems related to governance, strategy, risk management, the ability to adapt to change, collaborative action and the need to understand the impact of policies on society (OECD 2003). In 2001 the Irish Government published its National Health Strategy, Quality and Fairness: A Health System for You (2001) that provided a vision and strategic direction for the development of health and personal social services. The strategy set out key objectives for the health system up to In 2003, the health reform programme announced by the Minster for Health and Children yielded a number of key reports. These included the Audit of Structures and Functions in the Health System (2003), Report of the Commission on Financial Management and Control Systems in the Health Service (2003) and the Report of the National Task Force on Medical Staffing (2003). The reform programme required a separation of executive and non-executive functions of the Department of Health and Children. The Health Service Executive (HSE) was established with the enactment of the Health Act 2004, and from 1 January 2005 it became the sole body with executive responsibility for the management and delivery of health and personal social services in Ireland. Previously these services were delivered by a complex structure consisting of seven regional health boards, the Eastern Regional Health Authority and three area health boards. Within the HSE, nurses and midwives comprise the largest professional group, with 46,220 (35, whole time equivalents) currently employed (HSE 2006), and as such offer the greatest opportunity to effect rapid change and health reform. Demographic changes within the last five years, such as the overall population growth and increased immigration, (Central Statistics Office 2006) are evident in the increasing demand for health services, the culturally diverse HSE workforce and in the multi-cultural populations accessing health care. The most recent reform agenda, the HSE Transformation Programme and its six transformation priorities provide strategic direction for all healthcare activities and as such also informed the work of the review group (HSE 2006). The transformation priorities are to: Develop integrated services across all stages of the care journey Configure Primary, Community and Continuing Care services to deliver optimal and cost effective results Configure hospital services to deliver optimal and cost effective results Implement models for prevention and management of chronic illness Implement standards-based performance measurement Ensure all staff engages in transforming health and social care. 13

17 1.2.2 Educational Reform Nursing and midwifery education in Ireland has undergone radical reform in the last decade. Nursing became a graduate profession in 2006 following the Commission on Nursing (Government of Ireland 1998), the Evaluation of the Pre-registration Diploma in Nursing Programme (Simons et al 1998), the Reports of Nursing Education Forum (Government of Ireland 2000), the National Implementation Committee (2002) and the subsequent commencement of the Bachelor of Science in Nursing in Since 2002, the pre-registration degree programme educates nurses for entry to the general, intellectual disability and psychiatric register of An Bord Altranais. The Report of the Expert Group on Midwifery and Children s Nursing Education (2004) and the National Implementation Group (2007) has culminated in the establishment of two additional Bachelor Programmes commencing in These programmes prepare graduates for entry to the midwifery and children s register and general register, respectively. These changes have required significant expenditure by the Department of Health and Children. In addition, post registration programmes in children s nursing and midwifery provide entry to those registers for nurses whose initial registration is in another division of the register. Both midwifery and children s nursing post-registration education programmes have been revised as part of the work undertaken by the National Implementation Group (2007). All of these developments were informed and influenced by global trends in nursing and midwifery and in particular were subject to European Union (EU) directives and standards Nursing and Midwifery Reform In addition to advocating that nursing became a graduate profession, the Commission on Nursing (1998) also recommended the establishment of structures to support professional development and planning for nursing and midwifery nationally. These structures are the National Council for the Professional Development of Nursing and Midwifery, the Nursing and Midwifery Planning and Development Units. The Commission on Nursing also recommended the establishment of both management and clinical career pathways. The clinical career pathway advocated the development of Clinical Nurse/Midwife Specialist and the Advanced Nurse/Midwife Practitioner roles and recommended levels of post-registration educational preparation for these roles at Diploma and Masters Level respectively. Many post-registration nursing and midwifery educational programmes were developed by higher education institutes in response to educational requirements to prepare practitioners for specialist and advanced practice roles. Since the Commission on Nursing there has been an increase in the number and variety of post-registration programmes now on offer. This review is being undertaken in a climate of radical reform both in healthcare delivery and in the educational preparation of the professionals who deliver care. 14

18 1.3 The review group and its mandate The Post-registration Nursing and Midwifery Education Review Group held its inaugural meeting on the 7 January The group comprised various stakeholders from within nursing and midwifery, with representatives from service providers, the Department of Health and Children, the Higher Education Authority, higher education institutes and regulatory and professional bodies, and staff associations. Membership of the group is detailed in Appendix 1. The review group was given three Terms of Reference and a working definition of post-registration nursing and midwifery education to guide its deliberations. The Terms of Reference were as follows: 1. To prepare a comprehensive strategy for the development, delivery and evaluation of post-registration nursing and midwifery education. Preparation of the strategy will include reference to the following: service requirements; professional requirements; relationship between professional competence and quality of patient care and safety; core principles of the health services reform programme; value for money, including sponsorship arrangements and monitoring service commitments; availability of clinical placements; access; geographical spread of educational provision; modes of delivery; existing partnerships between health service providers and higher education institutions; potential for multi-professional education. existing related national and international legislation, policies and strategies, e.g. NQAI framework; and progression and transferability issues. 2. The strategy will be informed by: a baseline study which clearly details the existing scale of provision of post-registration nursing and midwifery education programmes and takes account of arrangements for and amount of health service funding; and an examination of the need for the provision of post-registration programmes leading to registration with An Bord Altranais. 15

19 3. The strategy will result in the publication of an overarching framework for the development of future post-registration programmes including a preferred model for procuring and financing the development and delivery of these programmes. Post-registration nursing and midwifery education was defined as education including: Higher/post-graduate diplomas in nursing and midwifery, including both registration and nonregistration programmes. This will include public health nursing and midwifery programmes although immediate arrangements for the continuation of the post-registration midwifery programme are being dealt with in a separate working group. Masters and doctoral education. Continuous professional development and education has not been taken into account in the study as the remit for this lies with the Centres of Nurse Education, Centres of Midwifery Education and Nursing and Midwifery Planning and Development Units. During the deliberations of the review group it was considered appropriate that the administrative management of undergraduate and post-graduate programmes should be dealt with as whole. The review group adopted guiding principles to underpin the work of the review. The principles included: responsiveness to service need; educational and professional quality; value for money; integration; and support structures. 1.4 Scope of the review The education programmes which are the main focus of this review are higher diplomas and postgraduate diplomas in nursing and midwifery including both registration and non-registration programmes. This will include public health nursing and midwifery programmes although immediate arrangements for the continuation of the post-registration midwifery programme are being dealt with in a separate working group, the National Implementation Group (2007). It also includes nursingspecific masters and doctoral education. Access Programmes and Bachelors of Nursing Programmes are included in the review. Other non-nursing post-graduate programmes accessed by nurses and midwives in other university departments are excluded from this review. The review excludes short courses provided by higher education institutes, as well continuing professional development courses provided by centres of nursing and midwifery education and nursing and midwifery planning and development units. 16

20 1.5 Vision The strategy is based on the premise that post-registration nursing and midwifery education is vital to the provision of quality patient care. In addition, nursing and midwifery education is a process of lifelong learning that meets the needs of patients, delivers the outcomes of the HSE s Transformation Programme and enables professionals to expand and fulfil their potential. The strategy and the recommendations within it will guide and direct the future development of post-registration nursing and midwifery education to enable excellence in professional practice and service delivery. 1.6 Consultation and communication process The review group developed a consultation and communication plan (see Appendix 3). The purpose of the communication and consultation process was to engage with a variety of key stakeholders with a view to bringing the maximum amount of experience and expertise to bear on the review process and subsequent recommendations. To that end, the review group formally consulted with stakeholders from education, the HSE and its service providers, regulatory bodies and professional organisations, and staff associations such as trade unions. In addition the review group invited written submissions from stakeholders and interested parties. A total of 46 written submissions were received. A Finance and Education Circular Review sub-group was also convened. The sub-group reported back to the steering group with broad strategic recommendations for inclusion in the report following its analysis. It was given its own terms of reference, which included: Review and identify existing nursing and midwifery education funds currently available at corporate and local levels in all publicly-funded health service providers. Identify the expenditure profile per region on each of the main funding schemes for the year ending 31 December Identify and profile related fund management systems at corporate, regional and local level. Make recommendations regarding structures, governance and accountability for the future management of these funds. Review current circulars that relate to post-registration nursing and midwifery education in relation to funding availability; relevance to corporate strategy, workforce planning, training and development and service priorities; standardisation and consistency; and the principles of equity and accessibility. 17

21 The data collected through both the formal consultation and written submissions were analysed. A number of stakeholders were asked to present their views to the review group. These presentations and the themes arising from the consultation process further informed the development of the strategy. A newsletter was prepared and circulated to inform all stakeholders of progress and developments. All communications were coordinated through the Office of the Director Nursing Services, HSE. 1.7 Development of Recommendations A series of recommendations were developed on completion of the consultation process and the data collection and analysis phase. These recommendations were subsequently reviewed and agreed by the review group in accordance with a specifically-designed template, which asked members to assess whether the recommendation was relevant, achievable, and measurable and agreed. The recommendations developed form the basis for the overarching framework for the future development of Nursing and Midwifery post-registration education, which is detailed in Chapter 5. The creation of a unitary system provides unprecedented opportunities for a strategic approach to managing health care and the continuing educational preparation of health professionals within it. 18

22 CHAPTER 2: Literature Review Summary 2.1 Background It is surprising that in the current climate and culture of evidence-based practice, little systematic and coherent work has been undertaken to evaluate the impact of nursing and midwifery graduates skills on either the subsequent care that they provide or on clinical outcomes. Recent policy and consultation documents identify major trends and factors which are likely to impact and influence future changes in health service requirements, and the subsequent need for a nursing and midwifery workforce ready and able to respond to these changes (Heller, Oros & Durney-Crowley 2007). These key trends and factors can be summarised as follows: Demographic changes, including both a general population growth, and a growing older population Changes in the health and social status of the population New health care technologies and interventions New and changing legislation Higher expectations from people who utilise health services, and a greater involvement of the public in decision-making regarding delivery of health services (user involvement) Moves to a population-based model of health care laying greater emphasis on primary health care, prevention and health promotion The increasing cost of health care provision The growing emphasis on collaborative and integrated care, and providing care close to people s homes Ongoing concern about recruitment and retention of health care professionals The impact of the European Working Time Directives on medical manpower Focus on life-long learning. Against this background, the Health Service Executive established the Post Registration Nursing and Midwifery Education Review Group to prepare a comprehensive strategy for the development, delivery and evaluation of future post-registration nursing and midwifery education. This literature review of national and international research of post-registration nursing and midwifery education was commissioned by the review group to inform and aid it in its deliberations in preparing a strategy for the future of post-registration and postgraduate education programmes for nurses and midwives in Ireland. 19

23 2.2 Overview of Literature Exactly 100 studies, including a number of literature reviews and systematic reviews, were examined. The vast majority of these reported on the impact on aspects of practice of single modules, specialist programmes, generic programmes at post-registration and postgraduate level, including masters and doctoral programmes, and interprofessional education programmes. Other studies focused on the impact of different aspects of educational programmes, such as educational methods, clinical practice assessments, training needs analysis and purchasing of education. Most of the studies were of a retrospective, descriptive nature, using either postal questionnaires or interviews, relying mainly on students self reports, with a few providing perspectives from managers, lecturers, patients or carers. Evaluation focused on the immediate impact of courses, with only a few studies providing baseline measures, follow-ups or longitudinal studies. The studies by Pelletier et al (1994, 1998a, 1998b, 1998c, 2003, 2005) and Brooker (1990) and Brooker et al (1992, 1993, 1994, 2002, 2003) are clear examples of the latter. Whyte, Lugton and Fawcett (2000) and Gournay et al (2000) also used follow-up studies, over 10-and 25-year periods, respectively, but as no baseline data were taken, it is difficult to comment on their findings. Only a few studies were of an experimental nature, with even fewer using a control group. The majority of the papers focused on nursing, with a few focusing on nursing and midwifery, and even fewer focusing exclusively on midwifery. There were also very few studies which reported on the impact of doctoral education, whilst no studies were located which evaluated intellectual disabilities nursing programmes. No papers were found which explored the cost-benefit implications or value for money of post-registration and postgraduate education programmes. Evidence of the impact of public health nursing education is also limited. The most rigorous studies have been undertaken in the area of mental health nursing, the only area also where patient measures were taken to evaluate the impact of education. 2.3 Evaluation of Studies Using Barr et al s (1999) six level conceptual framework for the evaluation of training and education (see Appendix 4) for the evaluation of studies, the outcomes can be summarised as follows: Level 1: Learners reactions Various studies have reported learner satisfaction with their respective courses. This ranged from satisfaction of single modules (Williams et al 1999; Mariano 2002), studies at post-registration (McCarthy & Evans 2003) and masters levels (Whyte, Lugton & Fawcett 2000, Spencer 2006), and at specialist level (Rassool & Oyefeso 2007; Gauntlett 2005; Happell 2005), generic and interprofessional levels (Brown 2000, Carpenter et al 2006; Clifton, Dale & Bradshaw 2006). There was also some evidence that some students did not feel well prepared (Nicolson, Burr & Powell 2005). The evidence comes mainly from learners self reports, although there is also evidence from managers reporting satisfaction with courses which their staff had completed. 20

24 Level 2: Modification in attitudes and perceptions Evidence here comes from a wide range of studies, indicating that courses have a positive impact on the students attitudes and perceptions in different areas, such as increased confidence and assertiveness, ability to share their knowledge with others, facilitating the development of research skills, and leading discussions (Burr & Powell 2005; Ellis & Nolan 2005). Other benefits include an improvement in attitude in working with people with long-term mental health problems (Brooker et al 2003; Forrest, Masters & Milne 2004; Lam, Kuipers & Leff 1993), better awareness and appreciation of roles and functions of other health care professionals (Clifton, Dale & Bradshaw 2006), and increased job satisfaction and self-esteem (Pelletier et al, 1994). However, there is also evidence that attitudes did not change as a result of an education programme (Brooker & Butterworth 1993), although the authors point out that the students attitude may already have been positive. Carpenter et al (2006) found little evidence of a change in professional stereotyping amongst students who had completed an interprofessional community mental health course. Level 3: Acquisition of knowledge and skills Here too, there is ample evidence that courses can impact on students acquiring technical, interpersonal, professional, cognitive and academic knowledge and skills of benefit to them in their relevant areas of practice. This evidence is from evaluation of single modules in: pharmacology (Jordan et al 1999), incontinence (Williams et al 1999), health policy (Rains & Carroll 2000), crisis intervention (Mariano 2002), communication skills (Chant et al 2002), courses in critical care oncology (Wyatt 2007), psychosocial interventions (Lam, Kuipers & Leff 1993), generic postregistration and postgraduate programmes (Nolan, Owens & Nolan 1995; Spence 2004) and interprofessional programmes in community mental health (Carpenter et al 2006) and primary care (Pullon & Fry 2005). There was also evidence that postgraduate education impacts positively on collaborative working with patients (Miller 2004). However, some studies show that that no improvement took place. A study found that there was no correlation between specialist education and decision making skills in accident and emergency, but there was a positive correlation between generic post-registration programmes and decision making skills (Considine, Ung & Thomas 2001). Brooker (1990) found that neither students nor managers identified much skill improvement in a number of cohorts who had undertaken a community psychiatric nursing course. Finally, Parsons and Barker (2000) reported that managers felt that students overestimated their level of skill acquisition in report writing and care planning. The evidence then has come through students self reports, reports from managers, comparisons of pre- and post-test results, and through independent ratings from direct observation or rating of audio or videotape recordings of students skills. Most of the evidence presented was gathered shortly after the students completed the programme, so whether knowledge and skills acquired were maintained over time is not clear. 21

25 Level 4: Changes in behaviour There is little evaluative evidence of the impact on the students application of the knowledge and skills they acquired on courses. Again, the evidence has mainly been gathered through self reports, reports from others and independent ratings. Some studies used measures over time. Some changes in behaviour have been reported in relation to practice development initiatives (Happel 2005), improving the knowledge base of the key relative caring for a person with a diagnosis of schizophrenia (Brooker, Barrowclough & Tarrier 1992), spending more time with families (Brooker & Butterworth 1993), using assessment skills (Brooker et al 2003), using psychosocial intervention skills (Forrest, Masters & Milne 2004; Gauntlet 2005; Carpenter et al 2006), using research skills, teaching skills, evidence-based practice (Pelletier et al 1998); Hardwick & Jordan 2002; Nolan et al 2000), improvements in job performance (Brown 2000) collaborative working (Pullon & Fry 2005), enhanced clinical leadership skills (Ellis 2006) and reports of more generic changes in behaviours (McCarthy & Evans 2003). Nolan et al (2000) found that changes in behaviour were more of a professional than a practical nature. Level 5: Changes in organisational practice Evidence of wider changes in the organisation and delivery of care that were attributable to an education programme comes from one systematic review. Barr et al (2005), in their systematic review of interprofessional education, report of changes in the organisation and delivery of services, more in hospital settings than community settings, and more with people with long-term rather than acute conditions, with the participants in these studies mainly being nurses. Level 6: Benefits to patients and carers Finally, benefits for patients and carers, as a direct result of educational programmes, have been reported on in a small number of studies, all of which were in the area of mental health care. The evidence has come through self reports from patients and carers, and through measures taken from patients over time in relation to symptoms, social functioning, and life satisfaction. Improvements in knowledge of aspects of schizophrenia have been reported (Brooker 1992), reduction in symptoms, days spent in hospital, improvements in social functioning (Brooker et al 1994; Lancashire et al 1997), and improvements in social functioning, life satisfaction, life skills, and satisfaction with the nurses knowledge, skills and personal qualities (Carpenter et al 2006). 22

26 2.4 Other relevant points from the literature In the search for relevant literature to inform this review, a number of other aspects were identified as being relevant for the Review Group to consider, such as reasons why students undertake postregistration and postgraduate courses, the positive and negative aspects of courses, data of national and international post-registration and postgraduate course provision, the educational methods adopted in course delivery, and issues around training needs analysis and the purchasing of education by health service providers Reasons for undertaking post- registration and postgraduate courses A number of studies highlighted reasons why students undertake post-registration and postgraduate courses. This ranged from personal development, job satisfaction, improving professional status, improving job and promotional opportunities, improving knowledge and skills (Barriball, While & Norman 1992; Pelletier et al 1998a; Simsen & Holroyd 1997) and gaining broader insights by undertaking an interprofessional education course (Brown, 2000). Interestingly, improving patient care was not identified in any of the above studies Benefits of undertaking post registration and postgraduate courses In addition to the aspects identified under Barr s evaluative framework, a number of other positive aspects have been reported by nurses and midwives undertaking post-registration courses. These include job security and the opportunities for working abroad (Chaboyer et al 2001), support from colleagues, especially if they had undertaken the same course (Brooker et al 2003), staying in practice (Gournay et al 2000), interpersonal and educational benefits, staff recruitment and retention, gaining respect and recognition from medical colleagues, and maintenance of standards of care (Nolan et al 2000), personal satisfaction (Whyte, Lugton & Fawcett 2000), relevance of course to practice, flexibility of access/entry requirements, funding of fees and guarantee to return to relevant practice area (Conteh & Lunn 2005), professional credibility following practice doctorate (Ellis 2006), staying in practice on completion of PhD(Sterling & McNally 1999), and enhancing research capabilities of clinical staff (Berger et al 1999). Personal and professional developments were most frequently mentioned outcomes, rather than practice development (Nolan et al 2000). Colleagues and superiors were seen as the most important and beneficial influence, especially when colleagues study together (Francke, Garssen & Huijer Abu- Saad 1995). In addition, longer university courses were considered more beneficial than short courses, study days and one-day conferences (Wood 1998) Barriers, constraints and concerns A wide range of barriers, constraints and concerns regarding post-registration and postgraduate education have also been reported. These relate to individual students, colleagues, managers and lecturers, and health service and education providers, and can be summarised as follows: Self Heavy work and caseloads Lack of finances/reduction of income as result of attending courses Combining work, study and social and family life (mainly affects women) Personal circumstances being the greatest barrier to a career move 23

27 Resentment, especially when having to undertake courses in own time Ability to change and innovate is linked to position in the organisation Stress of undertaking courses, leading to high attrition rates Implementing research and setting up a research culture Higher expectations of practice doctorate than traditional PhD Tension between research skills and practice skills. Other people Lack of support from colleagues, managers, lecturers Being seen as a threat by colleagues Professional jealousy Resistance to change Considering practice doctorate as a second-class doctorate Health service provider Service pressures Managers pressures on nurses to undertake courses Lack of time, staff, resources, funding, encouragement, study leave and flexibility, especially for night staff, part-time staff, older and lower-grade staff Entrenched attitudes within the organisation, resulting in changes being blocked Lack of an effective team to implement change Lack of opportunities to implement skills due to the organisation not being ready for change Organisation lacking an overall strategy Managers considering courses to be too academic Lack of recognition of post-registration and postgraduate qualification Tension between expectations from managers that staff undertake course in own time, and from staff that they attend courses in work time. 24

28 Educational service provider Lack of access to, and availability of, courses Cost of courses Travelling to and from courses Lack of lecturer involvement in practice Lack of places/too few places Courses not filled and therefore not run, due to lack of uptake Courses considered irrelevant Lack of information on courses MSc lecturers not challenging students enough, and not focusing on care giving, interpersonal care, and academic and intellectual aspirations National and international post registration and postgraduate courses There are currently 14 higher education institutes (HEIs) throughout Ireland that offer a wide variety of nursing and midwifery-specific courses, approximately 285 courses in total. The scale and provision of these courses are presented in Chapter 3. Most relate to general nursing, midwifery, some to mental health nursing and a minority to intellectual disability nursing. This trend is also reflected in courses offered internationally. Some nurses access non-nursing postgraduate nurses in other university departments. Such courses fall outside the remit of this literature review. Nationally and internationally, courses are offered at different levels, such as Graduate Diplomas, Higher Diplomas, and Post Graduate Diplomas. All universities in Ireland offer a masters programme and a PhD by research. Not all institutes of technology offer a masters programme. No practice doctorate programmes are in place. This too is mainly in keeping with courses provided internationally, though universities in Great Britain also provide Postgraduate Certificates and a limited number of practice doctorates. Entry criteria for courses are not uniform, with disparity noted related to length of clinical experience and previous academic qualifications. This trend was also noted internationally. Some courses run by schools of nursing and midwifery in university settings are specifically for nurses and/or midwives, others are multi-professional with nurses and midwives being educated alongside professionals from allied sciences. The provision of multi-professional courses is more evident internationally than nationally. 25

29 Course content is not always explicitly stated on websites, or indeed in some college prospectus. From both a national and international perspective, course content encompasses both core and specialist modules core modules common to a number of pathways and then specialist modules for a particular pathway. Others do not specify whether modules are core or specialist. The number of modules to be undertaken by students varies. Some websites list both modules and the credits attached to each module, others provide either credits or number of modules. This can make it difficult to compare the workload attached to each course, as modules may have different credit ratings. The vast majority included a clinical practice module but the credit weighting given to this varied even for very similar courses. Not all stipulated how many practice hours were required and there was variation in the ones that did. It was difficult to compare and contrast the number of modules and assessments on courses as the details on course structure and modules ranged from minimal information to quite detailed information. Some courses require a dissertation to be submitted, others require clinical portfolios to be completed Issues around course provision and educational methods and approaches Various issues were identified in the literature around course provision. Variations in course content, levels, credits, time spent in practice, assessments, and variation in access, availability, funding, and entry requirements were highlighted. Concerns were expressed about inadequate and irrelevant course content (Gould, Drey & Berridge 2006), fragmentation of provision of courses (Furze & Pearcey 1999), courses having to fit in with rigid academic regulations, lecturers having to fit material in modular structures, with little flexibility. Concern was also expressed in some studies that lecturers were not skilled, knowledgeable and experienced enough to teach the course content (Brooker et al 2002). In Endacott, Scholes and Chellel s (2000) study, managers could not agree whether the academic level had any influence on the competencies acquired. Simsen and Holroyd (1997), focusing on postgraduate programmes in Hong Kong, provided evidence that students wanted access to local, part-time, face-to-face, college-based courses for socioeconomic, professional-educative and employment reasons reasons which reflect some of the concerns identified above. Hardwick and Jordan s (2002) study highlighted that there was too much focus on the development of academic knowledge and skills to the detriment of the development of practical knowledge and skills, especially in the area of directing and leading change. Finally, the tensions between the generic and specialist nature in the provision of masters level courses has also been highlighted (Gardner et al 2006). A small number of studies have looked at the impact of different educational strategies on aspects of practice. Some studies focused on specific teaching and learning strategies, such as problem-based learning and its benefits to increasing awareness of multidisciplinary working (Carey & Whittaker 2002). Dewar & Walker s (1999) study on work-based learning found that students and supervisors had different ideas about this method, which lead to conflict and misunderstandings. Wilkinson et al s (2004) study reported the benefits of web-based learning in terms of flexibility and accessibility, whilst Anderson and Mercer s (2004) study compared web-based learning, classroom learning, and a combination of web-based learning and classroom learning and found that there was no difference in application to practice by the three groups of nurses, suggesting the educational approach has no bearing on the nature of practice. 26

30 A study by Happell, Pinikahana and Roper (2003) reported that the involvement of a newly appointed service user/academic on a programme was seen as positive. Finally, a few studies explored flexible learning. Latter et al (2003) found a student preference for flexible, practice-based, problem solving and work-based learning approaches. Presho s (2006) study found something similar, but it also suggested that students also valued face-to-face contact with fellow students and lecturers. Although these studies made an attempt to define flexibility, Clarke and James (1998) study found that there were many different dimensions and meanings attached to the term flexibility. It is surprising that only a few studies were located which considered competency assessment. Scholes and Endacott (2003) found a range of competency assessment strategies used in critical care, Baulcomb and Watson (2003) tested the internal consistency of a practice assessment grid, Coffey (2005) reported on the benefits of using a portfolio as a means of assessing practice, and Gill, Leslie and Southerland (2006 reported on the development and standardisation of a clinical performance assessment tool in paediatric intensive care and adult critical care Training needs analysis and purchasing/contracting for education A few studies have examined training needs analysis in various areas and considered issues around purchasing education. Timms and Ford (1995) found a wide diversity of views regarding the perceived needs of gerontological nurses, whilst studies by Jones and Lowe (2001) and Jones (2004), about training needs of nurses working in acute psychiatric services, and child and adolescent services respectively, found that training needs varied depending on the career trajectory of nurses, and where nurses were working in the service. Both studies reported a current lack of appropriate and/or accessible post-registration and postgraduate programmes to address the needs of the respective services. An Irish study by Conteh and Lunn (2005) found support for a proposed postgraduate framework, but that the decision to pursue a course was influenced by the relevance of the course, flexibility of access, entry and delivery of course, funding of fees, guarantee to return to relevant practice areas, replacement costs and flexibility to release staff. Gould et al (2004) offered a model which could be used to evaluate the effectiveness of the process and outcomes of future training needs analysis initiatives, informed by their literature review on the impact of training needs analysis and its potential to influence the organisation of service delivery. In relation to purchasing education, Walters and Clark (1993) found that health service managers had little understanding of the financial issues involved, and that they demonstrated a considerable variation regarding their views on purpose, type and academic level of post-registration education. Cost was the determining factor in determining purchase. Most post-registration education programmes for health professionals in England are provided by the universities and commissioned on behalf of NHS employers by the Workforce Development Confederations. Shields (2002) survey of contracting arrangements found that these did not easily allow the purchasers of education to measure value for money. 27

31 2.5 Discussion There is evidence from mainly descriptive studies that students benefit from post-registration and postgraduate courses in relation to changes in attitudes, perceptions, and knowledge and skill acquisition. There is some evidence of improved application of knowledge and skills acquisition, and of benefits to patients and carers. Many studies provided evidence of barriers, constraints and difficulties along the continuum of beginning a course to implementing newly acquired knowledge and skills. It is disappointing that there is hardly any evidence which demonstrates the direct impact of educational programmes on organisations and delivery of service changes. There was little relevant research evidence on public health nursing, midwifery and intellectual disability nursing. Most of the evidence came from students through self report, but managers, colleagues, lecturers, and patients and carers were also involved in evaluating the impact of programmes on elements of practice. The evaluations were devoid from any conceptual model or framework. As such, these were stand-alone evaluations, undertaken mainly internally, with often little information provided on details of the programme, the design or the sample. 2.6 Conclusions Although it is clear that post-registration and postgraduate nursing and midwifery education programmes have been evaluated in Ireland and elsewhere, comprehensive studies in relation to the impact of that education seem in its infancy, both nationally and internationally. In this literature review, post-registration and postgraduate nursing and midwifery education programmes have been evaluated from a nurse, midwife, patient, and health and educational service perspective. There is evidence in the literature of the ongoing development of post-registration and postgraduate nursing and midwifery education programmes, although the relevance of some of the current programmes has been questioned. Some evidence has been presented on the range of educational models utilised, and the relationship between types of educational delivery and health outcomes. Issues around support systems for students and the links between the higher education institutes and the health services were identified in a number of studies, as were other issues, in particular the variation relating to the academic levels of the programmes. Finally, no evidence was found which evaluated whether post-registration programmes for nurses and midwives offered value for money. It can be concluded then that although there are many studies which demonstrate benefits at various levels, the impact of post registration and postgraduate nursing and midwifery education has yet to be fully explored. 28

32 CHAPTER 3: Current provision of post-registration nursing and midwifery education 3.1 Introduction The terms of reference required the group to undertake a survey of the current provision of nursing and midwifery post-registration education. This section outlines the aims, methodology and findings of the baseline study undertaken in February Aims of the survey The aims of the survey were to: Identify the existing scale and provision of post-registration nursing and midwifery postgraduate education Identify the numbers of nurses and midwives currently participating in post-registration nursing and midwifery education. Identify the fees accruing to post-registration nursing and midwifery education programmes. Identify the need for the provision of post-registration programmes leading to registration with An Bord Altranais. 3.3 Methodology A survey methodology was employed. A questionnaire to be sent to higher education institutions was developed and approved by the review group following expert review and a pilot study within the higher education and service sector. The questionnaire sought data in relation to course type and title, course length, NQAI level, start date, credits awarded, numbers enrolled, availability of single module registration and fees charged. A copy of the questionnaire can be found in Appendix 5. Given that the focus of the review was post-registration nursing and midwifery-specific programmes, the questionnaire was distributed to the 14 higher education institutes that comprise the main providers of post-registration nursing and midwifery education. Key information such as the Terms of Reference and membership of the review group was circulated to the 14 Heads of Nursing Departments prior to the distribution of the questionnaires. Each higher education institute received a bespoke questionnaire based on the prospectus of their nursing department with the facility to make additions to course descriptors where necessary. Fourteen questionnaires were returned, giving a 100 per cent response rate. In addition, a key contact person was identified for the purposes of clarification of the data received should the need arise. All data received was coded and each higher education institute was assigned an identification code. The Statistical Package for Social Services (SPSS) Version 14.0.was used for data entry and analysis of responses. Frequency and descriptive statistics were employed for this analysis. 29

33 3.4 Findings The findings of the survey presented a summary of all the courses offered by the 14 higher education institutes in Ireland, including a breakdown of number and types of courses offered, and the uptake of courses in Autumn 2006 and Spring The numbers of nurses and midwives enrolled per higher education institute are also outlined in the results detailed in this section and the 14 course titles found are further categorised into five major course categories for the purposes of description. The number of nurses and midwives enrolled are presented by major course category. All courses delivered in Autumn 2006 and Spring 2007 are described in terms of NQAI level. The number of nurses enrolled by area of specialist practice is also described, as is the availability of single module registration, and module and course and fees by major course category Courses offered and courses delivered A total of 286 nursing and midwifery specific post-registration courses were offered by the 14 higher education institutes in the Autumn of 2006 and the Spring A total of 173 (61%) courses on offer had an intake, while 113 (39%) of courses were not delivered. The reasons for non-delivery of programmes was not ascertained. Table 1: Courses offered, delivered and not run in Autumn 2006 & Spring 2007 No. Courses offered No. Courses delivered No. Courses not run Certificate 1 1 Diploma 1 1 Access Ordinary Degree 3 3 Honours Degree Higher Diploma Graduate Diploma Post-graduate Diploma Stand alone Pathway Modules Professional /Practice development Module Higher Certificate 2 2 Graduate Certificate 3 3 Masters PhD Total

34 3.4.2 Course categories For the purposes of description and analysis, the courses surveyed have been divided into five major course categories. It was evident from the responses received that course titles applied within the higher education institutes were not standard and NQAI level 9 courses were variously described as Graduate Diplomas, Post-Graduate Diplomas and Graduate Certificates. Similarly, NQAI level 8 programmes were titled both Diploma and Higher Diploma programmes. The five major course categories are: 1. Access/ Certificate and Higher Certificate (NQAI level 6 and level 7 Programmes) and stand alone and professional / practice development modules (NQAI Level 8) 2. Degree Programmes (NQAI Level 7 and Level 8 programmes) 3. Diplomas, Higher Diplomas (NQAI Level 8) and Graduate Diplomas, Post-Graduate Diplomas and Graduate Certificates (NQAI Level 9 programmes) 4. Masters Programmes (NQAI level 9 programmes) 5. Doctoral PhD programmes (NQAI level 10 programmes) Figure 1: Number of courses offered and number of courses not delivered in Autumn 2006 and Spring Number of courses (n=286) Certificate/ Diplomas/ Access/ Modules 23 0 Degrees Higher Diplomas/ Masters Post-graduate Programmes Diplomas/ Higher Certificates/ Graduate Certificates Major Course Category 7 1 PhD Programmes Number of courses offered Number of courses not delivered 31

35 3.4.3 Courses offered Within the five course categories the following courses were offered nationally: A total of 32 courses were on offer in the category of Access/Certificate and Higher Certificate (NQAI level 6 and level 7 Programmes) and stand alone and professional/practice development modules (NQAI Level 8) courses. A total 23 degree programmes were on offer. A total 145 courses were offered nationally within the course category of Diplomas, Higher Diplomas (NQAI Level 8) and Graduate Diplomas, Post-Graduate Diplomas and Graduate Certificates (NQAI Level 9 programmes) There were 79 Masters programmes on offer There were 7 Doctoral programmes on offer Uptake of courses Within the five major course categories surveyed, the degree programme category was the only category where all courses were run. Within the remaining categories the percentage of courses not run varied from 58 per cent in masters programmes to 14 per cent in PhD programmes (one out seven PhD programmes nationally). (Figure1) Numbers of nurses and midwives enrolled in post-registration nursing and midwifery education. A total of 2,643 nurses and midwives enrolled in post-registration nursing and midwifery education in the Autumn of 2006 and Spring This represents 6.2 per cent of the total nursing and midwifery workforce within the HSE. This number underestimates the total number engaged on post-registration education as nurses and midwives also enrol in post-graduate programmes within other disciplines, for example management and business studies, human resource studies and legal and ethical studies (which were outside the remit of this review). The review also did not take into account the number of nurses and midwives already enrolled prior to Autumn The number of nurses and midwives enrolled in any one higher education institute ranged from a maximum 459 to a minimum of 27. For the 173 courses that had an intake, the numbers enrolled on any one course ranged from one to 200, with an average of 15 students per course. The most frequently occurring number of students on a course was six. The highest uptake was in the Higher Diploma, Post-graduate diploma course category where 1,161 (44%) of the total number nurses and midwives were enrolled. Degree programmes accounted for 878 (33%) of enrolments, while masters programmes had an uptake of 289 (11%), and the certificate, higher certificate and access group had an uptake of 269 (10%). Two percent (46) nurses and midwives enrolled in Doctoral programmes. 32

36 3.4.6 NQAI levels Of the 173 courses run in the Autumn 2006 and Spring 2007, the majority 109 (63%) were at NQAI level 9, 47 (27%) were at level 8, and seven (4%) courses were at level 7. Five (3%) of courses were at level 10, and two courses at level 6. Three courses had missing data. Therefore, the majority of courses of the courses attended by nurses and midwives, 156 (90%), were at NQAI level 8 or 9. Figure 2: NQAI levels of courses run in Autumn 2006 and Spring 2007 (n=170) Number of courses (n=286) NQAI Level Areas of Practice (excluding Doctoral programmes) Sixty areas of practice were represented in the courses run in Autumn 2006 and Spring 2007 (excluding PhDs). A total of 2597 nurse and midwives enrolled on these courses, with the remaining 46 enrolled PhD courses. Sixteen areas of practice accounted for 81 per cent (2145) of the total enrolments for all courses, with the remaining 19per cent (498) spread on 50 disparate areas of practice. The generic category accounted for 40 per cent and comprised 1061 students on access to degree programmes. The top 16areas of specialist practice were generic, midwifery, public health nursing, mental health nursing, gerontolgical nursing, children s nursing, oncology, critical and intensive care, accident and emergency, palliative care, nurse prescribing, infection control, peri-operative nursing, wound management and tissue viability, haemovigilance, and education. Three of the programmes lead to registration with An Bord Altranais: midwifery, children s nursing and public health nursing. 33

37 Table 2: Top 16 areas of Practice (excluding PhDs) Top 16 Areas of Practice for courses (excluding PhDs) Uptake number of places 2006 (n=2643) % of total enrolled Generic Midwifery Public Health Nursing Mental Health Nursing 90 3 Gerontological Nursing 89 3 Children s Nursing 73 3 Oncology 65 2 Critical/Intensive Care 55 2 Accident & Emergency 54 2 Palliative Care 53 2 Nurse Prescribing 50 2 Infection Control 50 2 Peri-operative nursing 45 2 Wound Management & Tissue Viability 42 2 Haemovigilance 41 2 Education 39 1 Total Single Module Registration Sixty percent, (103) of the courses delivered did not facilitate students to register on a single module basis, while and 28per cent (49) of courses did and six per cent (11) provided single module registration for repeats only. Missing data and courses where single module registration was deemed not applicable accounted for the remaining six per cent (10) reported. Figure 3: Percentage of courses delivered with single module registration 3 (2%) 7 (4%) 11 (6%) 103 (60%) 49 (28%) Not applicable Yes No Available for repeats only Missing 34

38 3.4.9 Course fees Overall data submitted on course fees reported varied considerably both within and between higher education institutes. Although some higher education institutes exhibited internal consistency within their fee structure, others did not. Course fees across all categories applied to non-eu students were at minimum twice the amount charged to EU students and in some instances three times more costly. The following figures outline the cost of each major course category for EU students and non-eu students. Figure 4: Course fees EU and non-eu students for Certificate, Higher Certificate, Access programmes, Professional Practice and Stand alone Modules Fees (Euro) Mean Mode Range Minimum Maximum Course fee EU students 2006 Course fee non-eu students 2006 Figure 5: Course fees EU and non-eu students Diplomas, Higher Diplomas, Post-graduate Diplomas, Graduate Diplomas, Graduate Certificates (NQAI level 8& 9) (n=110) Fees (Euro) Mean Mode Range Minimum Maximum Course fee EU students 2006 Course fee non-eu students

39 Figure 6: Course fees EU and non-eu students for Degree Programmes (n=12) Fees (Euro) Course fee EU students 2006 Course fee non-eu students Mean Mode Range Minimum Maximum Figure 7: Course fee EU and non-eu Masters Programmes (n=59) Fees (Euro) Mean Mode Range Minimum Maximum Figure 8: Course fees EU and non-eu students Doctoral Programmes (n=5) Fees (Euro) Mean Mode Range Minimum Maximum Course fee EU students 2006 Course fee non-eu students 2006 Course fee EU students 2006 Course fee non-eu students

40 Figure 9: Fee per module Fees (Euro) Mean Mode Range Minimum Maximum 3.5 Course characteristics Information was sought on a variety of course characteristics. These included, length of course, NQAI level, credits awarded, class contact and clinical practice hours. The responses to these questions will be described under the following categories: Generic programmes access programmes, ordinary degree and honours degree programmes. Diplomas, Higher Diplomas, Post-graduate Diplomas, Graduate Diplomas, Graduate Certificates Programmes Masters Programmes Doctoral Programmes. The findings will be presented for each category by course type, NQAI levels, credits awarded and, where applicable, the minimum and maximum requirement for both class contact hours and clinical practice hours Generic programmes This category refers to access programmes, ordinary degree and honours degree programmes. These programmes hold the titles Access to degree programme, and Bachelor of Nursing and Midwifery degree. Access programmes showed variability in all characteristics described. Ordinary degree programmes were consistent in NQAI and credits awarded, but were inconsistent in class contact hours delivered. All honours degree programmes were delivered at NQAI level 8, but showed variability in credits awarded ( credits) and class contact hours ( hours). 37

41 Table 3: Course Characteristics Generic Programmes Generic Programmes Type of course (No. of Programmes) NQAI level Credits awarded Clinical Practice hours Minimum Clinical Practice hours Maximum Class contact hours Minimum Access (5) Level 7 0, 15 and 44 Not applicable Level 8 50 Class contact hours Maximum Ordinary Degree (2) Level 7 60 Not applicable Honours Degree (20) Level Not applicable Within this generic category of courses the responses indicate that there is no clinical practice requirement from the course perspective it is a condition of scholarship support that nurses and midwives are employed within the health service Diplomas, Higher Diplomas, Post-graduate Diplomas, Graduate Diplomas, Graduate Certificates This varied course category includes, but is not limited to, courses that prepare nurses for areas of specialist practice. This category comprises 145 courses. Four of these courses lead to registration with An Bord Altranais (midwifery, children s nursing, public health nursing and nursing and midwifery education programmes). The remainder do not lead to registration. The findings have been broken down into two categories those leading to registration and courses that focus on specialist areas of practice but do not lead to registration. Within the former course category there were many programmes delivered in only one educational institution and for one specialist area of practice - others were delivered in up to eight educational institutions. Two specialist areas of practice have been chosen to illustrate a national view of course provision within these areas of practice. The programmes described illustrate the variability across registration programmes and specialist practice area programmes that are delivered in multiple educational institutes Programmes leading to registration with An Bord Altranais. The three programmes that lead to registration by An Bord Altranais midwifery, children s nursing and public health nursing are detailed below. Midwifery programmes The six midwifery programmes leading to registration in the midwives register of An Bord Altranais are delivered at NQAI level 8 and 9. They also show variability in the credits awarded, clinical practice hours and class contact hours (see Table 4). All of these programmes are two years in length and will be reduced to 1.5 years from Autumn 2007 onwards. 38

42 Table 4: Course characteristics midwifery registration programmes Programmes leading to registration in midwifery (n=6) Type of course NQAI level Credits awarded Higher Diploma in Midwifery (4) Post-graduate Diploma in Midwifery (2) Clinical Practice hours Minimum Clinical Practice hours Maximum Class contact hours Minimum 8 30 for 2 courses and 180 for 1, (1 missing) and Class contact hours Maximum Children s Nursing The three children s nursing programmes are consistently delivered at NQAI level 8 and show some variability in credits awarded, clinical practice and difference in class contact hours (see Table 5). Table 5: Course characteristics Children s Nursing Programmes Programmes leading to registration in children s nursing (n=3) Type of course NQAI level Credits awarded Higher Diploma in Children s Nursing (3) Level 8 60 and 70 (1 missing) Clinical Practice hours Minimum Clinical Practice hours Maximum Class contact hours Minimum Class contact hours Maximum Public Health Nursing All four programmes leading to registration as a Public Health Nurse are delivered at NQAI level 9 and are one year in length. They show variability in credits awarded (60-90), clinical practice hours (592-1,131 hours) and class contact hours ( hours) (see Table 6). 39

43 Table 6: Course characteristics Public Health Nursing programmes Programmes leading to registration in public health nursing (n=4) Type of course NQAI level Credits awarded Post-graduate Diploma/ in Public Health Nursing (3) Graduate Diploma in Public Health Nursing (1) 9 60 for 1 courses and 90 for 2 courses Clinical Practice hours Minimum Clinical Practice hours Maximum Class contact hours Minimum 592 1, Class contact hours Maximum Courses preparing for an area of specialist practice not leading to registration with An Bord Altranais. Two areas of specialist practice programmes peri-operative nursing and accident and emergency are described in the following section.. These programmes are provided by eight and six educational institutions respectively and therefore enable a description of course characteristics across multiple educational providers. Peri-operative nursing programs Eight peri-operative nursing programmes are delivered nationally. They are delivered at NQAI level 8 and 9 and show variability with in terms of the credits awarded (30-90) at Level 9 and 60 credits at Level 8. There is variability in clinical practice hours (975-1,482 hours) and class contact hours ( hours) (see Table 7). All programmes are one year in length. Table 7: Course characteristics of peri-operative nursing programmes Peri-operative nursing programmes (n= 8) Type of course NQAI level Credits awarded Post-graduate Diploma in Peri-operative nursing (4) Graduate Diploma in Peri-operative care (2) Higher Diploma in Science in Peri-operative Nursing (2) 9 60 for 3 courses and 90 for 1 course Clinical Practice hours Minimum Clinical Practice hours Maximum Class contact hours Minimum 1,200 1, and , Class contact hours Maximum 40

44 Accident and Emergency programmes There are six accident and emergency programmes delivered nationally. They are delivered at NQAI level 8 and 9 and show variability within terms of the credits awarded (60-90) at Level 9 and 60 credits at Level 8. There is also variability in clinical practice hours (807-1,200 hours) and class contact hours ( hours). All programmes are one year in length (see Table 8). Table 8: Course characteristics accident and emergency nursing Accident and emergency nursing programmes (n=6) Type of course NQAI level Credits awarded Post-graduate Diploma in Nursing in Emergency Nursing/ Accident and Emergency Nursing (4) Graduate Diploma in Nursing in Emergency Nursing (1) Higher Diploma in Science in Accident and Emergency Nursing (1) 9 60 for 3 courses and 90 for 1 course Clinical Practice hours Minimum Clinical Practice hours Maximum Class contact hours Minimum 1,200 1, Class contact hours Maximum Masters Programmes The Masters programmes category comprises a diverse group of courses. Some Masters programmes require entry at post-graduate level 9 and require entrants to complete a thesis only. Other programmes comprise lectures and theses completion, and where applicable, some require clinical practice hours as well. Masters programmes are consistently delivered at NQAI Level 9. Credits awarded vary from 15 to 120 credits, clinical practice ranges from 75 to 1746 hours (one calendar year), while class contact hours vary from 42 to 500 hours (see Table 9). Length of programmes was reported in calendar years, academic years and semesters and included both part-time and fulltime courses. A total of 42 masters programmes (55%) were offered on a two year, part-time basis. Thirteen courses (17%) were one semester in length, and remaining programmes offered part-time of full-time alternatives of varying length. 41

45 Table 9: Course characteristics of masters programmes Masters programmes (n=79) Type of course Masters Programmes (79) NQAI level Credits awarded No. of courses Clinical Practice hours Minimum* *10 missing cases (Not applicable 42 courses) 75 hours Clinical Practice hours Maximum 1746* *calendar year Class contact hours Minimum Class contact hours Maximum Doctoral Programmes There are seven doctoral programmes on offer nationally and they were all designated at level 10. Where credits were awarded they varied from 60 to 180. The individual nature of doctoral programmes was evident in the responses to clinical practice and class contact hours per programme. The length of doctoral programmes ranged from three years full-time to up to seven years part-time (see Table 10) Table 10: Course characteristics of doctoral programmes Doctoral Programmes (n=7) Type of course NQAI level Credits awarded Doctoral Programme 10 for 6 courses ECTS do not apply for 1 course 60 for 2 courses 180 for 1 course No credits awarded 1 course * 3 missing Clinical Practice hours Not applicable for 3 courses As required for 2 courses * 2 missing Class contact hours Not applicable Negotiable Continuous supervision As required * 3 missing 42

46 3.6 Summary The findings of the survey show that 2,643 nurses and midwives enrolled in post-registration education in the Autumn of 2006 and Spring This represents 6.2 per cent of the total nursing and midwifery workforce. It is important to note that this underestimates the number of nurses and midwives engaging in post-registration education in that the data was sought in relation to nursing and midwifery specific programmes only (other courses were outside the remit of this survey). In addition, nurses and midwives enrolled in Year Two of programmes were not captured. There were 283 courses on offer, of which 173 had an intake. It appeared that there was an over provision of courses in certain areas, in that 39 per cent of courses were not delivered. Forty-four areas of practice were represented in the courses that were provided, with 11 areas of practice accounting for 85 per cent of the uptake. The majority (63%) of the courses run were at NQAI level 9, along with 27per cent at level 8, accounting for 90per cent of the courses delivered. Course fees varied both within and between higher education institutes. Course fees for non-eu nurses and midwives were on average at least twice and in some cases three times the EU fee charged. Sixty percent (103) of the courses on offer did not allow single module registration, 28% did and 11% provided single module registration for repeats only. There was variation within course categories in terms of the course characteristics such NQAI level, credits awarded, clinical practice hours and class contact hours. Course length was varied, and there was also variability in the application of course titles, particularly courses at NQAI level 8 and Conclusion The diversity and variety of courses on offer in terms of course type, course characteristics, area of practice, and the disparity of fees accruing to students highlight the requirement for a standard approach to post-registration nursing and midwifery education. The fact that 39 per cent of courses on offer were not delivered would indicate a potential over supply of programmes. The average number of students on programmes was 15, with six being the most frequently occurring number. This raises the issue of economies of scale, and potential opportunities for collaboration and synergy in the delivery of programmes. The non-availability of single module registration in 60 per cent of the courses necessitates that students undertake entire programmes where perhaps it might not be appropriate or necessary. The range of class contact hours, credits awarded and length of programmes underscores the need for standardisation and professional regulation. These findings give an overview of current provision of nursing and midwifery post-registration programmes nationally and highlight both educational opportunities available and the need for standardisation, and rationalisation of the postregistration education process. 43

47 CHAPTER 4: The Consultative Process 4.1 Introduction This chapter outlines in detail the consultation process, the methodology employed for analysis of the data collected, and themes arising within the data. At its inaugural meeting, the review group agreed on a communication strategy to engage with a variety of key stakeholders. The aim was to bring the maximum amount of experience and intelligence to bear on the review process and subsequent recommendations. It was proposed to formally consult with the education sector, the HSE and its service providers, regulatory bodies and professional organisations and staff associations and trade unions. It was also agreed that the consultation process should consist of two phases: An active consultation phase consisting of a series of workshops to take place across the country, and A request for formal written submissions. In preparation for this process, Lime Tree Consulting was engaged to determine the format of the proposed workshops and to generate a list of questions and topics for group work that would be used as a guide for discussion at all the meetings. Representatives from the review group and from the Nursing and Midwifery Planning and Development Units (NMPDUs) agreed to facilitate the workshops. The questions for discussion were piloted and revised by this group of facilitators with the assistance of Lime Tree Consulting. A series of 14 consultation workshops was held over the month of June The larger workshops (consulting with the health sector) were coordinated locally by staff of the NMPDUs in each of their areas. The health service sector workshops were well attended, with more than 330 representatives from general nursing, psychiatric nursing, intellectual disability nursing, midwifery, community and public health, and centres of nurse education. The education workshops were attended by 34 nursing and midwifery educators from the 14 higher education institutes. Staff associations, regulatory and professional nursing and midwifery bodies were also formally consulted, with 12 representatives attending the workshops. (A schedule of these workshops is set out in Appendix 6) In addition, a number of agencies made presentations that informed the work of the group. These presentations aided a series of broad-ranging discussions, as points were clarified or new directions for the work of the group emerged (see Appendix 6) To facilitate individuals and organisations that were unable to attend the workshops requests were issued for written submissions. Letters inviting submissions were sent directly to educational institutes, regulatory bodies and staff associations and were circulated nationally to service providers through the NMPDU. The content of both the workshops and the individual submissions has been analysed and are presented in this chapter. 44

48 4.2 Methodology Analysis was conducted upon the data gathered from the consultation workshops and the written submissions. Five key questions were asked of all respondents (see Appendix 3), and they formed the basis of the content analysis. Proceedings from the workshops were transcribed and the responses to each question were analysed. Question 1 related to the principles that the HSE should adopt in developing a framework for post registration for nursing and midwifery education. Questions 2 to 5 focused primarily on the approach the HSE should adopt in the planning and development of future post-registration nursing and midwifery education, including potential structures and processes that should be employed to strengthen the relationship between service provision and the educational development of nursing and midwifery. Within the formal consultation workshops, three groups were formed to help distil and prioritise the feedback received from the five questions. Each group focused on a particular area, including: Service and professional practice requirements for post-registration nursing and midwifery education Education and academic requirements for post-registration nursing and midwifery education Management and policy requirements for post-registration nursing and midwifery education The information gathered was then broken up into two working headings, which were: the principles that should underpin future post-registration nursing and midwifery education the key requirements for a framework for the future development of post-registration education. The potential approaches / activities / actions suggested by those consulted as a means of ensuring the delivery of the points are also reported. The analysis revealed that there was considerable overlap between the stakeholders consulted in relation to the key requirements expressed for service and professional practice, for education and academic requirements, and management and policy requirements. There were differences only in terms of emphasis placed by each stakeholder group on specific elements. The principles that should underpin a framework for post-registration for nursing and midwifery education are outlined in the following sections. This is followed by the thematic analysis from the group work on the key requirements for service and professional practice, education and academic quality, and the management and policy requirements for post-registration nursing and midwifery education. The adoption of these principles and key requirements will necessitate a strategic system-wide approach, the establishment of new structures and the development of policy and processes to ensure that post-registration education development is appropriate and responsive to the needs of patients, practitioners and the HSE. 45

49 4.3 Eight principles that should underpin the Framework Eight key principles emerged from the data. These were: Service driven It was clearly and repeatedly expressed in consultation with all groups (service, education, professional bodies and regulatory bodies) that service and patient needs should underpin the framework for post-registration for nursing and midwifery education. Equity of access Common themes here were equity of access to education for nurses and midwives as well as equity of patient access to skilled professionals with particular but not exclusive emphasis on nursing disciplines, such as intellectual disability and mental health nursing and their respective vulnerable client /patient groups. Flexibility The means by which equity of access to education can be achieved was articulated by all groups. A requirement for a flexible approach to the education provision process, such as a modular approach to delivery, the facilitation of recognition for prior learning, and the accumulation of credits that have the same academic currency across higher education institutions, were common across all groups consulted. Clinical focus The need for a clinical focus for post-registration education was expressed in all groups. Within the service group in particular there was a strong emphasis on the need to have a clinical focus in educational curricula. The view was expressed that nursing is a practice-based profession and that curricula should better reflect the practice element of nursing and midwifery. Standardisation The need for national consistency in the development and delivery of post-registration nursing and midwifery education was expressed in all groups. The means of achieving standardisation included the development of national standards and requirements and the requirement for professional regulation as essential for approval for funding. All groups supported the adoption of standard systems for the recognition for prior learning for both academic and experiential learning such as the National Framework of Qualifications established by the National Qualifications Authority of Ireland. Quality The key indicators of quality suggested were level of expertise and competency of the graduate, impact on the quality of service and patient care, as well as measures of health and social gain. In addition nurses and midwives fitness for purpose upon exiting from education was agreed as a key determinant of quality. Partnership The principle of working in partnership was proposed by all groups. The need for partnership at strategic and policy levels as well as inter-organisational and operational levels was articulated throughout the consultation process by all groups. Sustainability Sustainability was seen as essential to all consulted, albeit from different perspectives. The focus within the education sector was primarily on the viability and sustainability of programmes, whereas the focus of the service sector was on sustaining the expertise and enabling transferability of learning to patient care. 46

50 4.4 The 13 key requirements for future post-registration nursing and midwifery education A total of 13 key requirements arose from the group work. Some requirements elicited more broad-ranging discussion than others, while others were held to be self-evident such as value for money. Where groups discussed advantages and disadvantages, these are reported under the specific requirement A Strategic Approach The predominant theme arising in the all group work was the requirement by the HSE to employ a strategic approach in the future development of nursing and midwifery post-registration education. The advantages of a strategic approach would: be the alignment of education with corporate plans such the Transformation Programme, and regional and local service development plans. ensure that education provision that is both appropriate and responsive to service and individual practitioner needs require the creation of structures and processes at national, regional and local levels to support a strategic approach with due regard to existing structures such joint working groups and nursing and midwifery planning and development units provide greater potential to achieve, economies of scale and value for money facilitate greater accountability at all levels within the HSE Educational Needs Analysis All groups articulated the requirement to develop a national educational needs analysis process. The advantages of a national approach that would: ensure education provision would be informed by service requirements, manpower /workforce planning, as well as organisational and professional considerations support equity of access, standardisation of education provision and scholarship support for all nurses and midwives Recognition for prior learning Within all groups, the requirement for the development of a system for recognition for learning and exemption from course material already studied arose. This system should: accredit experiential learning accrue incremental credit facilitate the transferability of academic credits across higher education institutes both in Ireland and internationally incorporate professional development portfolios as a potential mechanism for accreditation for prior learning and for aligning education with service requirements. 47

51 4.4.4 New models of education provision The drive for integrative working across care settings within a team structure will require nurses and midwives to attain diverse and transferable skills and competencies to deliver integrated services along with other healthcare professionals. New models of education delivery should incorporate: single module registration e-learning and distance education as potential modes of delivery. foundation programmes in areas of specialty as a means of improving engagement in education and increasing skills and competencies. opportunity to engage in post-registration at an educational level already attained (where as the need for students to progress to increasingly higher levels of academic attainment was questioned). inter-professional and multi-disciplinary education in the context of health reform and the move towards team-working within the HSE, for example sharing of education between nursing disciplines and also between nursing and other healthcare professionals the potential for joint delivery between higher education institutes and the service sector (through centres of nurse education). individual nurses and midwives selecting modules to create their own programmes for their own career needs cross-institutional (both educational and health service) collaboration the provision of one national programme for some specialties. Within the service sector the view that current models of education provision do not meet service requirements well enough was repeatedly expressed. This was mirrored within the education sector, and the professional and registration bodies. The examples given of what needed to be addressed included: geographic lack of access rigidity in terms of modes of delivery the non-availability of education registration programmes for specific groups such as intellectual disability and mental health the non-availability of courses supporting areas of specialist practice the tension between educating nurses and midwives for specialist practice and educating them for expanding scope within general roles such as medical and surgical nursing the fact that the educational level of programmes at level 9 was perceived to be a deterrent for students in engaging in education. 48

52 The current inflexibility of education provision and the focus of programmes on areas of specialist practice have done little to serve the educational needs of the generalist nurse. Two of the 14 higher education institutes have responded to this by developing professional practice modules and standalone modules level (8 NQAI) for nurses who are required to have expertise in multiple areas. It was suggested that nurses and midwives should have the opportunity to select from a menu of modules that would best fit with their patient / client group needs Scholarship Support The requirement to continue to provide support for scholarship within the HSE was seen as vital for creating a culture of innovation and change, and a dynamic health service responsive to patient/client needs. The view was repeatedly expressed that without this support at base, organisations would not benefit sufficiently from their investment in post-registration education. Examples of student support comprised the following themes: funding of fees and replacement costs study leave employing service posts such as clinical course facilitators/preceptors joint appointments providing support and resources at base to implement change and disseminate new knowledge on completion of programmes. Capacity of clinical sites to provide clinical supervision for student competence Additional supports suggested were: A formal system of advice on career planning and career pathways within the HSE to help align engagement in education and professional development with service requirements. A single point of information provision, such as a web-based knowledge centre, whereby nurses and midwives could access all relevant general and specialist information about postregistration programmes (including the scholarship support available) Value for money The requirement for the investment in post-registration nursing and midwifery education to provide value for money was stressed within the consultation groups. The term value for money was further clarified as incorporating evaluation of a wide range of outcomes reflecting the quality of the education not just the bottom line for fees paid. 49

53 4.4.7 New methods of financing education Within all groups there was broad agreement that providing financial support for nurses and midwives undertaking post-registration education should continue. The majority of those consulted regarded 100 percent fee payment as desirable, while a minority supported part-payment by the student. There was strong support for the following views: National funding for nurse and midwifery post-registration education should be red circled and linked to service plans. Funding should be streamlined, as multiple streams of funding for nursing and midwifery education were confusing and cumbersome. The fees charged to non-eu nurses are prohibitive for both the student and the HSE perspective and should be same as for EU nurses. Funding should be focused and prioritised with reference to an overall three to five-year plan Funding for post-registration education programmes at level 8 and 9 should be separate from funding for continuing professional development. A transparent process for the allocation of funding is required. The decision as to whether or not courses were appropriate for funding support should be informed by Directors of Nursing in partnership with the nursing and midwifery planning and development units. There is a need for timely and clear information in relation to the budgets for education. Alternative means of external financial support should also be considered, such as bursaries and scholarships, with due reference to the ethical implications involved. Fees should follow modules not courses New methods of procuring education Within all groups consulted the HSE was seen as the customer in the procurement process. A purchaserprovider relationship between the HSE and the higher education institutes was seen as key to the future procurement of education. The tendering process was discussed within the groups as a potential method of procurement. The predominant view was that competition could be a positive force. The advantages of a tendering process were seen as enabling: A coordinated national approach to financing education in tandem with a regional (administrative area) approach to course procurement and provision. The opportunity to relate procurement to workforce planning. The adoption of service level agreements between the HSE and the higher education institutes The tendering process was seen as a potential threat to issues of quality, access and sustainability, the potential to develop centres of excellence and to the responsiveness of education to service need (due to the length of the tendering process). 50

54 The four administrative areas, hospitals and nursing and midwifery planning and development units were proposed as commissioners in the procurement process. This approach was seen to require: a national governance structure comprising all stakeholders (financial, professional and educational) for nursing and midwifery post-registration education process the establishment of a nursing and midwifery education unit in the HSE the utilisation of current structures such as Nursing and Midwifery Planning and Development Units and Centres of Nursing and Midwifery Education Evaluation of Education The requirement to evaluate post-registration education on an ongoing basis was strongly represented within the consultation groups. The opinions expressed underscored the necessity to develop programmes with clear outcomes that could be audited both from educational and service perspective. Evaluation was proposed as being an integral part of a robust tendering process and service level agreements, whereby evidence for return on investment could be quantified Professional Regulation Professional regulation of all post-registration nursing and midwifery education was seen as essential to achieving quality education. Many consultation groups advocated a stronger role for An Bord Altranais in the regulation of post-registration education. Other groups recommended greater cohesion between the respective roles of An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery vis-à-vis post-registration education Removal of entry barriers to accessing post-registration education Currently, certain post-registration programmes require prior registration in a specific division of the register of An Bord Altranais. For example, nurses registered in the intellectual disability register cannot undertake peri-operative nursing courses. Those consulted recommended that such barriers be removed Increase specific registration courses The non-availability of a post-registration programme that would prepare nurses for entry to register for intellectual disability nursing was repeatedly raised both in the workshops and the written submissions. The requirement for this programme was highlighted by the fact that registered nurses in intellectual disability (RNIDs) now constitute approximately one-third of the nursing positions in the intellectual disability sector (FAS 2005) Similarly nurse managers working in the mental health area of practice, have identified a requirement for a post-registration programme in psychiatric nursing that prepares nurses for entry on to the psychiatric nurse register of An Bord Altranais A greater research focus Within many of the consultative groups the issue of nursing and midwifery research was raised. In particular the view was expressed that there were many lost opportunities to strategically align the nursing and midwifery research agenda with the education process with a view to systematically building a body of knowledge for the professions. Academic work such as literature reviews and research could be better focused, managed and disseminated to contribute better to the improvement of patient care. It was proposed that future national regional and local structures with responsibility for post-registration education should incorporate nursing and midwifery research development and application to practice as an integral part of that remit and thus maximise the impact of education. 51

55 CHAPTER 5: The Strategic Framework 5.1 Introduction This chapter outlines the framework that will underpin a strategic approach to the future development, delivery and evaluation of post-registration nursing and midwifery education, as well as the 23 recommendations for its implementation. It has been informed by the consultation process, baseline study, finance review and literature review, and adheres to the requirement to align education with the HSE s core goals and strategic direction. Cognisance has been taken of the health reform process and its demands, as well as current structures, partnerships and education provision. The framework represents the context in which post-registration education is provided, the factors influencing it, the principles guiding it, and the processes and structures required to achieve quality educational outcomes. Each of these points will be discussed throughout this chapter, as will the aims of the framework, and its underlying principles and governance structure. This chapter will also address organisational processes to direct and guide the implementation of the framework, and factors that impact upon the post-registration education process. The review group s 23 recommendations for the framework s implementation have been introduced under five main sections: governance; integration of health service processes and education management processes; professional regulatory requirements; systems and structures to ensure equity and access; and current and new educational processes. Figure 10: Strategic Framework for the Future Development, Delivery and Evaluation of Post- Registration Nursing and Midwifery Education External factors Educational trends care trends in nursing and midwifery Internal factors - Manpower Monitor Evaluate Principles External Environment Implement Stocktake HSE Internal envirnoment Commission Forecast Plan Governance structures Service & Activity Factors services Organisational & Professional Factors environment development 52

56 5.2 Aims and principles of the framework The strategic framework for the future development, delivery and evaluation of post-registration nursing and midwifery aims to: ensure a strategic approach for the future development, commissioning, delivery and evaluation of post-registration nursing and midwifery education align post-registration nursing and midwifery education with the HSE s core goals and strategic direction incorporating the transformation programme ensure the provision of quality post-registration education that is responsive to patient/client need and provides practitioners with knowledge, skills and competencies to support their scope of practice. ensure that the financing and procurement of education represents value for money and supports patient/client centred nursing and midwifery practice. The framework is guided by the number of principles that were elicited during the consultation process. These principles form the basis for Recommendation 1. RECOMMENDATION 1 Future post-registration education should be guided by the principles of equity of access, flexibility, standardisation, quality, partnership, sustainability, value for money and also be service-driven and clinical/ patient care-focused. 5.3 HSE Nursing and midwifery education governance and finance infrastructure Following from the report of the Commission of Nursing 1998 significant funding has been provided through the Department of Health and Children for continuing development and support of Undergraduate, Postgraduate and Post-registration Nursing and Midwifery Education and Development. Prior to the establishment of the Health Service Executive this funding was provided directly to the statutory area Health Boards and the ERHA in respect of their functional areas. Within the former Health Boards and the ERHA individual arrangements were made for the allocation and management of these funds. These included arrangements whereby in certain circumstances funds were managed centrally on behalf of a Health Board administrative area, Programme or individual hospital, depending on local circumstances and management accounting arrangements. This resulted in differing administrative and accounting arrangements being in place on the establishment of the HSE in respect of these funds. The arrangements for the overall management of funding provided for the development of Undergraduate, Postgraduate and Post-registration Programmes were further complicated following the introduction of the Undergraduate BSc Programmes in 2002 with the Department of Health and Children continuing to exercise executive administrative and accounting responsibility for the direct funding of Undergraduate and Postgraduate training including roster clinical payments to and through individual hospitals throughout the service. 53

57 The existence of these varying arrangements has meant that there is little consistency of the administration, coding and accounting arrangements for funding allocated for nurse education and development throughout the service, making a detailed and comprehensive evaluation of such spending very difficult. The establishment of the HSE and the bringing forward of recommendations on the development of Post-registration education and training provides the opportunity to develop a clear policy statement in relation to arrangements for the funding and accountability for funds allocated for nursing education and development and for achieving a greater transparency in relation to the allocation of this funding and the achievement of greater value for money in respect of the overall spend within the service. Currently, responsibility for the many aspects of post-registration education is dispersed throughout the HSE. The review group s recommendations in relation to governance (Recommendations 2 through 8) form an integral part of the framework. Those recommendations are listed below. RECOMMENDATION 2 A nursing and midwifery education function will be established within the Office of the Nursing Services Director at the Health Service Executive. This education function should have an appropriate skill mix of staff, as it will have overall responsibility for the strategic planning, development, procurement, monitoring and evaluation of post-registration nursing and midwifery education, in alignment with pre-registration education and continuing professional development on behalf of the Health Service Executive. In particular, it will: prepare and submit estimates for post-registration nursing and midwifery education; act with overall responsibility to coordinate the management of funding assigned to postregistration nursing and midwifery education; develop, disseminate and review policies regarding post-registration nursing and midwifery education within the Health Service Executive; ensure a national, cohesive approach to the development of post-registration nursing and midwifery education which reflects the changing needs of the health service, patients and clients; ensure that external agencies funded directly by the Health Service Executive for post-registration nursing and midwifery education are accountable for delivering agreed educational outcomes and value for money, and are subject to audit, evaluation and conformity with best practice; develop key internal and external relationships at national and international level; and ensure that nursing and midwifery planning and development units will assume responsibility in their administrative areas for post-registration nursing and midwifery education, under the auspices of the Health Service Executive education unit and in line with its policy. This will involve working in partnership with the Directors of Nursing and Midwifery, centres of nursing and midwifery education and higher education institutions. 54

58 RECOMMENDATION 3 Post registration education funding will be managed in the following way Funding allocated by the Department of Health and Children for the development of all Nurse Education and Research will be identified within the overall HSE budget and ring fenced for continued availability for Nurse Education Development and Research. Overall responsibility for the allocation, management and accounting for funds allocated for nurse education and development will be assigned to the Office of the Nursing Services Director. The Office of the Nursing Services Director will be provided with the appropriate resources, including accounting resources and administrative support to adequately discharge this responsibility. In managing the overall allocation management and accounting of funds allocated for Nurse Education and Development, funds shall be distributed on a devolved management basis to area nurse and midwifery planning and development functions and individual hospitals areas having regard to the development and putting in place of appropriate administrative and accounting systems and reporting arrangements. Funding provided as part of the HSE vote to support the Undergraduate Nursing Education and Training shall in the first instance be assigned to the Office of the Nursing Services Director in respect of funding allocated for Undergraduate Nursing Education in General, Mental Health, Intellectual Disability, Midwifery and Integrated Children s and General Nursing and Postgraduate Diploma Programmes in Midwifery and Children s Nursing. Existing arrangements in respect of the funding of the Third Level Sector by way direct funding relationship between the HSE and the individual colleges should continue. Detailed reporting arrangements shall be agreed between the Third Level colleges and the HSE. Furthermore it is also recommended that the HSE enter into discussions with Third Level colleges and the Higher Education Authority in relation to agreement in respect of the annual fee for all Nurse Education Programmes and payment arrangements including arrangements where the numbers admitted to individual programmes either exceed or are less than the agreed number of places contracted with the individual college. These discussions shall have regard to the need to maintain a steady output at the contracted number of places throughout the sector. While at the same time that numbers admitted to these programmes are consistent with the capability of the HSE to provide clinical placements. 55

59 The HSE shall, in partnership with the individual third level college, undertake a detailed review of the cost/financing of all registration courses provided. This review shall be carried out on a regular basis and no longer than five yearly intervals. It is acknowledged that the Department of Health and Children will be undertaking a review of the undergraduate nursing degree programme. Funding arrangements and responsibility in respect of the funding of the clinical intern period as part of the Undergraduate BSc Programmes in Nursing and Midwifery shall be transferred to the Office of the Director of Nursing, including the transfer of the existing base budgets of participating hospitals in this element of the Programmes. Verification and calculation of fees and payments in respect of rostered payments shall be managed by the Office of the Nursing Services Director. Arrangements for and funding of ongoing expenses in relation to uniform, travel and other allowances shall be devolved to the Area Nursing and Midwifery Planning and Development functions at area level. Funding currently provided at a local hospital/area basis in respect of Postgraduate Education, Training and Development should be retained for management, administrative and accounting purposes at local area level and shall be ring fenced accordingly. Generic, administrative and accounting codes should be developed by the Office of the Nursing Services Director for implementation at hospital and local area level to ensure consistency in the administration coding and reporting of expenditure in respect of Post Registration funding. Funding held at central level for Post Registration Nurse Education Development should be distributed on an area/hospital basis having regard to existing base funding and the need to provide for equity and funding availability and having regard to the number of nurses employed in a particular area hospital, specialty distribution etc. This funding should be allocated at the commencement of each service/accounting year on the preparation of an agreed service level provision in respect of such funding. The group recommends that the HSE should prepare and implement a value for money programme in relation to the purchase and delivery of nurse education/development programmes. Circulars: Currently a number of circulars set out requirements and provisions in respect of access, funding/other supports and service commitment requirements in relation to nursing and midwifery education programmes. There is need to review these circulars to ensure consistency in relation to access, supports etc. having regard to resources available, service needs etc. 56

60 RECOMMENDATION 4 An Interim Education Advisory Committee should be established to inform and advise on the implementation of the post-registration review report. This committee should represent the relevant stakeholders in post-registration nursing and midwifery education. It is envisaged that this committee will, in the first instance, be set up on a interim basis to support the implementation process. This will be reviewed on an ongoing basis. RECOMMENDATION 5 The Health Service Executive should develop an equitable, standardised system for the funding allocation for post-registration education with suitable governance and accountability structures that take into account quality and value for money. RECOMMENDATION 6 The Health Service Executive should examine procurement options, including but not limited to a tendering process, that will ensure the commissioning of quality post-registration education. Due regard should be taken in relation to issues of service need, quality, access, sustainability, value for money and the Health Service Executive procurement policy. RECOMMENDATION 7 The Health Service Executive should examine options for devolved procurement and fund management, coupled with a clear policy framework to support the procurement process. RECOMMENDATION 8 The Health Service Executive should develop key indicators of educational quality that will inform the tendering, monitoring and evaluation process. 57

61 5.4 Framework Processes The organisational processes within the framework that will direct and guide the future development, delivery and evaluation of post-registration nursing and midwifery education are described in this section Stocktaking- Educational needs analysis This process will enable the HSE to outline the context of the labour market, that is the current as is situation with regard to supply of and the demand for nurses and midwives with specific knowledge skills and competencies. In regard to the workforce, it is important to obtain a current nursing and midwifery workforce profile, including a demographics and skills profile. This includes the potential sources of supply for nurses and midwives, attrition rates, vacancies, career progression and retirement. In relation to organisational, professional and service factors, it is important to obtain knowledge about New technologies New services Reconfiguration of services Emerging services Expanding practice requirements New professional regulatory /requirements The stocktaking process will ensure an accurate overview of the current as is profile of the nursing and midwifery workforce, along with the attendant demands of the service Forecasting- Educational needs This process involves an examination of stocktaking information, with particular reference to identifying the imbalance between the supply of nurses and midwives with specific skills, and the future demand for those skills in the medium and long-term. This gap analysis will inform the planning phase Planning Education The purpose of planning is to deliver education in an efficient and effective way that meets the identified needs of the service and professional practice. The planning for the development and delivery of future education will be informed by the educational needs analysis Commissioning and procurement The processes that will be adopted by the HSE in the commissioning and procurement of postregistration education must provide opportunities to reduce duplication, and achieve economies of scale, value for money, flexibility in the provision of education, as well as to increase access to education that supports practitioners fitness for purpose. The implementation of the education plan will require the replication of key processes at national, regional and local level with an information flow between all three levels. 58

62 5.5.5 Monitoring The requirement for ongoing monitoring of all aspects of the post-registration education process lies with the HSE. A dataset will be required to support the analysis of trends, and future planning Evaluation The ongoing evaluation of the education provided is a key element of governance. Evaluation of postregistration education will be conducted with the purpose of ensuring quality educational outcomes, as well as measuring the impact on the service and professional practice. 5.5 Process levels It is important to note that the processes outlined in the framework will be replicated at three levels: nationally within the HSE Education Function area wide within the NMPDUs locally within services This is necessary to inform continuous strategic planning based on accurate information that will support responsive post-registration education for nurses and midwives in practice. A free flow of information is required between policy and operational levels 5.6 Factors impacting on the post-registration education process A number of factors, both internal and external, including organisational, professional and service factors can potentially impact upon nursing and midwifery post-registration education. External and internal in this context are taken to mean outside the HSE and within the HSE respectively. External factors will be addressed first and this will be followed by an outline internal factors, and service, organisational and professional factors as they relate to post-registration education External factors International developments in healthcare, nursing and midwifery, as well as government policy, legislation, labour market supply and third-level education are the main external factors that have the potential to impact on post-registration education. The employment of nurses within the HSE from other jurisdictions is a particularly relevant example of how government policy and labour market supply have impacted upon the profile of nurses and midwives working in Ireland. The government support for a graduate profession within nursing and midwifery will also change the nature of post-registration education. Within the education sector the trend towards standardisation and transferability of academic currency as outlined in the Bologna Agreement also has implications for post-registration education. The changes to legislation that allow for nurse prescribing provide a recent example of how post-registration education needs to be responsive to service need Internal Factors The predominant internal factors that will impact on post-registration education are those to do with the characteristics of the workforce and the changing nature of service provision. The profile of the current nursing and midwifery workforce will inform the education requirements of the future. Factors such as the number of nurses and midwives employed their skills profile, career progression, retirement, vacancies and attrition will have to be considered when planning education. 59

63 5.6.3 Service factors The key tenets the Transformation Programme will require nurses and midwives to work across and between services sectors. Nurse and midwives will have to respond to new service configurations that are better coordinated and meet patients and clients needs. In addition emerging services and new client groups such as persons with intellectual disability now experiencing chronic illness in older age, patients /clients with dual diagnosis (mental health and addiction or mental health and intellectual disability diagnosis) will require professionals to respond with enhanced practice. These demands will require additional educational preparation. All of the above factors must be taken into consideration at all levels when shaping future nursing and midwifery post-registration education. The following recommendations have been made with a view to greater integration and alignment between education and service provision. RECOMMENDATION 9 The Health Service Executive should develop structured systems for stocktaking and forecasting educational needs at national, area and local level. These systems should take account of workforce planning analysis and the emerging needs of the Health Service Executive Transformation Programme. They will be underpinned by the development of a post-registration education minimum dataset for the nursing and midwifery resource. RECOMMENDATION 10 The Health Service Executive should ensure that post-registration nursing and midwifery education is responsive to the needs of the health service by delivering the appropriate number of nurses and midwives, educated in the necessary areas of practice and to the required level of competence. RECOMMENDATION 11 The Health Service Executive in consultation with the Department of Health and Children should develop a policy in relation to the need for the re-introduction of postregistration programmes (conversion programmes) leading to additional registration on An Bord Altranais registers, giving priority to psychiatric and intellectual disability nursing. RECOMMENDATION 12 The Health Service Executive in partnership with the relevant bodies of nursing and midwifery, should undertake the development of a nationally-consistent framework for the categorisation of specialties with a view to assisting educational planning, workforce planning and policy development Organisational and Professional Factors The environment in which nurses and midwives operate places further demands for skills and competencies, for example the adoption of different technologies to provide and monitor care. The requirement to expand scope of professional practice is ever present with the attendant need for education. In addition the drive for integration of services will require nurses and midwives to work across care settings. The ongoing development of Clinical Nurse/ Midwife Specialist and Advanced Nurse / Midwife Practitioner roles will continue to require specialist education. The requirement to maintain competency is a professional duty. The need to undertake research and to ensure its application to practice are essential to improving patient care. The following recommendations have been made in response to the expressed need for professional regulation for all post-registration education, and the need to enhance the application of research to practice. 60

64 RECOMMENDATION 13 The Department of Health and Children should request An Bord Altranais to regulate all clinical post-registration programmes. RECOMMENDATION 14 Future Health Service Executive national, area and local structures with responsibility for post-registration education incorporate nursing and midwifery research development and application to practice in their remit, thus maximising the impact of education. 5.7 Equity and access The following recommendations have been made in response to the need for a national approach to equity and access to post-registration education for all nurses and midwives within the HSE. RECOMMENDATION 15 The Health Service Executive following consultation with relevant bodies, should put in place an appropriate structure e.g. a specific function within the Health Service Executive which would develop and review a standardised system of scholarship support, which is equitable, transparent and aligned to service need. RECOMMENDATION 16 The Health Service Executive following consultation with relevant bodies, should ensure that a formal system of career advice is established that is consistent with Health Service Executive systems. RECOMMENDATION 17 - The Health Service Executive should establish a single point of information, such as web-based knowledge centre, whereby nurses and midwives can access all relevant information about post-registration programmes including the scholarship support available. 5.8 Current and new educational processes The following recommendations have been made in relation to educational processes with due recognition of existing partnership arrangements and current education providers. In forming the recommendations the review group considered the systems for post-registration education delivery and determined that while future delivery models may change in the context of service developments, at this point in time, the current arrangements should continue. In addition, the need for new educational systems such as recognition for prior learning and need to adopt the national qualifications framework are addressed. The key role of information technology to support all aspects education is highlighted. The potential for existing HSE resources such as website to be contribute further to nursing and midwifery education is also recognised. RECOMMENDATION 18 The Health Service Executive should replicate existing structures to facilitate partnership arrangements between the service and education sectors, such as local joint working groups, professional advisory groups and memoranda of agreement to support postregistration education. RECOMMENDATION 19 The Health Service Executive in consultation with relevant bodies, and with due regard to systems already in place, should further develop systems for the recognition of prior learning 61

65 RECOMMENDATION 20 The Health Service Executive in partnership with higher educational institutions, nursing and midwifery planning and development functions, centres for nursing and midwifery education and the professional and regulatory bodies, should develop programmes and models of delivery which incorporate inter-professional education and e-learning. RECOMMENDATION 21 The Health Service Executive should seek that a high quality information and communication technology infrastructure be available to support all aspects of postregistration education provision, including the electronic delivery of programmes or modules. RECOMMENDATION 22 The Health Service Executive in partnership with higher educational institutions, nursing and midwifery planning and development functions, centres for nursing and midwifery education and the professional and regulatory bodies, should develop programmes of education within the parameters of the National Framework of Qualifications established by the National Qualifications Authority of Ireland. RECOMMENDATION 23 Centres of nursing and midwifery education have a key role at local level in the implementation of post-registration education and should work towards becoming Registered Providers of the Further Education and Training Awards Council (FETAC) and Higher Education and Training Awards Council. 5.9 Conclusion This chapter outlines the strategic framework that will underpin the future development of postregistration nursing and midwifery education. The aims of the framework, principles underpinning it and the governance structures required to implement the framework are presented. The processes of stocktaking, forecasting, planning, commissioning, implementing, monitoring and evaluating are explained. The need to replicate these processes at national, area and local levels is explained. External, internal and service factors that impact on post-registration education are explored. Organisational professional and educational process issues are also addressed. The strategic framework and the recommendations proposed by the review group are informed by the literature review, baseline study, formal consultation process and the written submissions. The recommendations were examined and agreed by the review group using the criteria of relevance and as to whether they were achievable and measurable. The implementation of these recommendations is dependent upon a continuing collaborative and a partnership approach between all stakeholders. With this in mind, the Post-registration Nursing and Midwifery Education Review Group recommend the establishment of an advisory committee representative of key stakeholders to oversee the implementation of the recommendations proposed in the report. 62

66 REFERENCES Anderson, ET & Mercer, ZB 2004 Impact of community health content on nurse practitioner practice: a comparison of classroom and web-based teaching. Nursing Education Perspectives, vol. 25 no.4, pp Armstrong D & Adam J The impact of a postgraduate critical care course on nursing practice Nurse Education in Practice, vol.2 no.3 pp Barr, H, Freeth, D, Hammick, M, Koppel, I, & Reeves, S Evaluating inter professional education: A United Kingdom review for health and social care, British Educational Research Association/Centre for the Advancement of Interprofessional Education London. Barr, H, Freeth, D, Hammick, M, Koppel, I, & Reeves S 2005, Effective Interprofessional Education: Argument, Assumption and Evidence, Blackwell, Oxford. Barriball, K L, While, A E, & Norman, I J 1992, Continuing professional education for qualified nurses: a review of the literature, Journal of Advanced Nursing, vol. 17, no. 9, pp Baulcomb, S & Watson, R 2003, The internal consistency and intra-rater reliability of an assessment practice grid for community nurses, Clinical Effectiveness in Nursing, vol. 7, no.3-4, pp Berger, A. Eilers, J, Heermann, J, Warren, J, Franco, T, & Triolo, P 1999, State-of-the-art patient care. The impact of doctorally prepared clinical nurses, Clinical Nurse Specialist, vol. 13, no.5, pp Brooker, C 1990, A Community Psychiatric Nursing: A research perspective, London, Chapman and Hall. Brooker, C, Barrowclough, C, & Tarrier, N 1992, Evaluating the impact of training community psychiatric nurses to educate relatives about schizophrenia, Journal of Clinical Nursing, vol. 1, pp Brooker, C, & Brabban, A 2004, Measured success: A Scoping Review of Evaluated Psychosocial Interventions Training for Work with People with Serious Mental Health Problems, NIMHE/Trent WDC National Institute of Mental Health England/Workforce Development Confederation Trent, Mansfield, Notts, UK. Brooker, C & Butterworth, T 1993, Training in psychosocial intervention: the impact on the role of community psychiatric nurses, Journal of Advanced Nursing, vol. 18, no. 4, pp Brooker, C, Falloon, I, Butterworth, CB, Goldberg, D, Graham-Hole, V, & Hillier, V 1994, The outcome of training community psychiatric nurses to deliver psychosocial intervention, British Journal of Psychiatry, vol. 165, pp Brooker, C, Gournay, K, O Halloran, P, Bailey, D, & Saul, C 2002 Mapping training to support the implementation of the National Service Framework for mental health, Journal of Mental Health, vol. 11, no. 1, pp Brooker, C, Saul, C, Robinson, J, King, J, & Dudley, M 2003, Is training in psychosocial interventions worthwhile? Report of a psychosocial intervention trainee follow-up study, International Journal of Nursing Studies, vol. 40, no. 7, pp

67 Brown, S E 2000, Does a multi-disciplinary health degree provide a satisfactory post-registration course for nurses? A follow-up survey of health science studies graduates, Nurse Education Today, vol. 20, no. 8, pp Carpenter, J, Barnes, D, Dickinson, C, & Wooff, D Outcomes of interprofessional education for community mental health services in England: the longitudinal evaluation of a postgraduate programme, Journal of Interprofessional Care, vol. 20, no. 2, pp Carey, L, & Whittaker, KA 2002, Experiences of problem-based learning: issues for community specialist practitioner students, Nurse Education Today, vol. 22, no. 8, pp Central Statistics Office 2006, Census 2006 Preliminary Report. Stationery Office: Dublin. Chaboyer, W, Dunn, SV, Theobald, K, Aitken, L, & Perrott, J Critical care education: an examination of students perspectives, Nurse Education Today, vol. 21, no. 7, pp Chant, S., Randle, J, Russell, G & Webb, C 2002, Communication skills training in healthcare: a review of the literature, Nurse Education Today, vol. 22, no. 3, pp Clarke, B, & James, C 1998, Flexibility in post-registration nurse education in England, Innovations in Education and Training International, vol. 35, no. 4, pp Clifton, M, Dale, C, & Bradshaw, C 2006, The impact and effectiveness of inter-professional education in primary care: Royal College of Nursing, London. Coffey, A 2005, The clinical learning portfolio: a practice development experience in gerontological nursing, Journal of Clinical Nursing, vol. 14, no. 8b, pp Considine, J. Ung, L, & Thomas, S 2001, Clinical decisions using the National Triage Scale: how important is postgraduate education? Accident & Emergency Nursing, vol. 9 no. 2, pp Conteh, M, & Lunn, C 2005, Postgraduate education needs analysis report, Health Service Executive, Ireland. Department of Health 2006 Modernising Nursing Careers Setting the Direction. Department of Health, London Department of Health and Children 2003, Audit of structures and functions in the health system. Stationery Office, Dublin. Department of Health and Children 2002, Final Report of the National implementation Committee. (Unpublished). Department of Health and Children 2007, National Implementation Group Report for the Report of the Expert Group on Midwifery and Children s Nursing Education (Unpublished). Department of Health and Children 2001, Quality and Fairness: A Health System for You. Stationery Office, Dublin. Department of Health and Children 2003, Report of the Commission on Financial Management and Control Systems in the Health Service, Stationery Office, Dublin. 64

68 Department of Health and Children 2004, Report of the Expert Group on Midwifery and Children s Nursing Education, Stationery Office, Dublin. Department of Health and Children 2003, Report of the National Task Force on Medical Staffing (Hanly Report), Stationery Office, Dublin Department of Health and Children 2006, Sexual Assault Treatment Services: A National Review, Stationery Office, Dublin Dewar, BJ, & Walker, E 1999, Experiential learning: issues for supervision, Journal of Advanced Nursing, vol. 30, no. 6, pp Ellis, L, & Nolan, M 2005, Illuminating continuing professional education: unpacking the black box, International Journal of Nursing Studies, vol. 42, no. 1, pp Ellis, L The professional doctorate for nurses in Australia: Findings of a scoping exercise, Nurse Education Today, vol. 26, no. 6, pp Endacott, R, Scholes, J & Chellel, A 2000, Balancing stakeholder needs: a review of English National Board 100 and 415 courses., Intensive & Critical Care Nursing, vol. 16, no. 1, pp FÁS (2005) Health Care Skills Monitoring Report (2005). FÁS-Training and Employment Authority, Dublin. Forrest, S, Masters, H & Milne, V 2004, Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation - part II, Journal of Psychiatric and Mental Health Nursing, vol. 11, no. 2, pp Francke, AL, Garssen, B & Huijer Abu-Saad, H 1995, Determinants of changes in nurses behaviour after continuing education: a literature review, Journal of Advanced Nursing, vol. 21, no. 2, pp Furze, G & Pearcey, P 1999, Continuing education in nursing: a review of the literature Journal of Advanced Nursing, vol. 29, no. 2, pp Gardner, G, Dunn, S, Carryer, J & Gardner, A 2006, Competency and capability: imperative for nurse practitioner education, Australian Journal of Advanced Nursing, vol. 24, no. 1, pp Gauntlett, A N 2005, Evaluation of a postgraduate training programme for community mental health practitioners, Journal of Psychiatric and Mental Health Nursing, vol. 12, no. 2, pp Gill, F, Leslie, G & Southerland, K 2006, Evaluation of a clinical performance assessment tool (CPAT) within a critical care context, Australian Critical Care, vol. 19, no. 3, pp Gould, D, Kelly, D, White, I & Chidgey, J 2004, Training needs analysis. A literature review and reappraisal, International Journal of Nursing Studies, vol. 41, no. 5, pp Gould, D, Drey, N & Berridge, EJ 2006, Nurses experiences of continuing professional development Nurse Education Today, In Press, Corrected Proof, doi: /j.nedt Gournay, K, Denford, L, Parr, AM & Newell, R 2000, British nurses in behavioural psychotherapy: a 25-year follow-up, Journal of Advanced Nursing, vol. 32, no. (2), pp

69 Government of Ireland Report of the Commission on Nursing : A Blueprint for the Future, Stationery Office, Dublin. Government of Ireland 2000, Nursing Education Forum A Strategy for a Pre-registration Nursing Education Degree Programme, Stationery Office, Dunlin. Happell, B, Pinikahana, J & Roper, C 2003, Changing attitudes: the role of a consumer academic in the education of postgraduate psychiatric nursing students, Archives of Psychiatric Nursing, vol. 17, no. 2, pp Happell, B 2005, Education for life: the evaluation of an innovative approach to facilitate ongoing learning for nurses,. International Journal of Psychiatric Nursing Research, vol. 10, no. 2, pp Hardwick, S, & Jordan S. (2002) The impact of part-time post-registration degrees on practice, Journal of Advanced Nursing, vol. 38, no. 5, pp Government of Ireland (2004) Health Act 2004, Stationery Office, Dublin. Health Service Executive 2006a, National Employment Monitoring Unit Staff Census December 2006 (Unpublished). Health Service Executive 2006b, Transformation Programme , Health Service Executive, Dublin. Heller, B, Oros, M & Durney-Crowley, J 2007, The future of nursing education: ten trends to watch. National League for Nursing, USA Health Service Executive 2007, National Health Services Plan, Health Service Executive, Dublin. Jones, J 2004, The post-registration education and training needs of nurses working with children and young people with mental health problems in the United Kingdom. Royal College of Nursing Institute: Royal College of Nursing London. Jones, J & Lowe, T 2001, The post-registration education and training of mental health nurses working in acute inpatient psychiatric settings, Mental Health Practice, vol. 5, no. 4, pp Jordan, S, Coleman, M, Hardy, B & Hughes, D 1999 Assessing educational effectiveness: the impact of a specialist course on the delivery of care, Journal of Advanced Nursing, vol. 30, no. 4, pp, Lam, D H, Kuipers, L & Leff, J P 1993, Family work with patients suffering from schizophrenia: the impact of training on psychiatric nurses attitude and knowledge,. Journal of Advanced Nursing, vol. 18, no. 2), pp Lancashire, S, Haddock, G, Tarrier, N, Baguley, I, Butterworth, CB & Brooker, C Effects of training in psychosocial interventions for community psychiatric nurses in England, Psychiatric Services, vol. 48, pp

70 Latter, S, Speller, V, Westwood, G & Latchem, S Education for public health capacity in the nursing workforce: findings from a review of education and practice issues, Nurse Education Today, vol. 23, no. 3, pp Mariano, C 2002, Crisis theory and intervention: a critical component of nursing education, Journal of the New York State Nurses Association, vol. 33, no. 1, pp McCarthy, A & Evans, D 2003, A Study on the Impact of Continuing Education for Nurses and Midwives who completed post Registration Courses. Nursing and Midwifery Planning Development Unit, Western Health Board, Ireland. Miller, J 2004, Level of RN educational preparation: its impact on collaboration and the relationship between collaboration and professional identity, Canadian Journal of Nursing Research, vol. 36, no. 2, pp National Qualifications Authority of Ireland 2003, A Framework for the Development, Recognition and Award of Qualifications in Ireland, National Qualifications Authority of Ireland: Dublin. Nicolson P, Burr, J & Powell, J 2005, Becoming an advanced practitioner in neonatal nursing: a psychosocial study of the relationship between educational preparation and role development,. Journal of Clinical Nursing, vol. 14, no. 6, pp Nolan, M, Owens, RG & Nolan, J 1995, Continuing professional education: identifying the characteristics of an effective system, Journal of Advanced Nursing, vol. 21, no. 3, pp Nolan, M, Owen, R, Curran, M & Venables, A 2000, Reconceptualising the outcomes of Continuing Professional Development, International Journal of Nursing Studies, vol. 37, no. 5, pp Organisation for Economic Co-operation and Development 2003, Public Sector Modernisation, Policy Brief. Parsons, S & Barker, P 2000, The Phil Hearne course: an evaluation of a multidisciplinary mental health education programme,. Journal of Psychiatric & Mental Health Nursing, vol. 7, no. 2, pp.101. Pelletier, D, Donoghue, J, & Duffield, C 2003, Australian nurses perception of the impact of their postgraduate studies on their patient care activities, Nurse Education Today, vol. 23, no. 6, pp Pelletier, D, Donoghue, J & Duffield, C 2005, Understanding the nursing workforce: a longitudinal study of Australian nurses six years after graduate study,. Australian Journal of Advanced Nursing, vol. 23, no.1, pp Pelletier, D, Donoghue, J, Duffield, C & Adams, A 1998a, The impact of graduate education on the career paths of nurses,. Australian Journal of Advanced Nursing, vol. 15, no. 3, pp Pelletier, D, Donoghue, J, Duffield, C, & Adams, A 1998b, Nurses perceptions of their professional growth on completion of two years of postgraduate education, Australian Journal of Advanced Nursing, vol. 16, no. 2, pp

71 Pelletier, D, Donoghue, J, Duffield, C, Adams, A, & Brown, D 1998c. Why undertake higher degrees in nursing?, Journal of Nursing Education vol. 37, no. 9, pp Pelletier, D, Duffield, C, Gallagher, R, Soars, L, Donoghue, J & Adams, A 1994, The effects of graduate nurse education on clinical practice and career paths: a pilot study, Nurse Education Today, vol.14, no. 4, pp Presho, M Earning and learning: Recruitment and retention in post registration nurse education, Nurse Education Today, vol. 26, no. 6, pp Pullon, S & Fry, B 2005, Interprofessional postgraduate education in primary health care: Is it making a difference?, Journal of Interprofessional Care, vol. 19, no. 6, pp Rains, J, & Carroll, K 2000, The effect of health policy education on self-perceived political competence of graduate nursing students,. Journal of Nursing Education, vol. 39, no.1, pp Rassool, GH & Oyefeso, A 2007, Predictors of course satisfaction and perceived course impact of addiction nurses undertaking a postgraduate diploma in addictive behaviour, Nurse Education Today, vol. 27, no. 3, pp Scholes, J & Endacott, R 2003, The practice competency gap: challenges that impede the introduction of national core competencies,. Nursing in Critical Care, vol. 8, no. 2, pp Shields, P 2002, Commissioning post-registration education programmes for health professionals,. Nurse Education Today, vol. 22, no. 4, pp Simons, H, Clarke, JB, Gobbi, M, Long, G, Mountford, M & Wheelhouse, C 1998 Nurse education and training Evaluation in Ireland. Independent External Evaluation. Final Report, University of Southampton, Southhampton. Simsen, BJ & Holroyd, E 1997, Developing a framework for the future: a qualitative perspective on postgraduate nursing education in Hong Kong Nurse Education Today, vol. 17, no. 5, pp Spence, D 2004, Advancing nursing practice through postgraduate education (part two), Nursing Praxis in New Zealand, vol. 20, no. 3, pp Spencer, RL 2006, Nurses, midwives and health visitors perceptions of the impact of higher education on professional practice, Nurse Education Today, vol. 26, no. 1, pp Sterling, Y & McNally, J 1999, Clinical practice of doctorally prepared nurses, Clinical Nurse Specialist, vol. 13, no.6, pp Timms, J & Ford, P 1995, Registered nurses perceptions of gerontological continuing education needs in the United Kingdom and in the USA, Journal of Advanced Nursing, vol. 22, no. 2, pp Walters, G & Clark, JM 1993, Nurse managers perceptions of contracting for nurse education, Part 2: Contracting and post-registration education, Nurse Education Today, vol. 13, no. 6, pp

72 Whyte, DA, Lugton, J & Fawcett, T N 2000., Fit for purpose: the relevance of Masters preparation for the professional practice of nursing. A 10-year follow-up study of postgraduate nursing courses in the University of Edinburgh, Journal of Advanced Nursing, vol. 31, no. 5, pp Wilkinson, A, Forbes, A, Bloomfield, J & Fincham GC 2004, An exploration of four web-based open and flexible learning modules in post-registration nurse education, International Journal of Nursing Studies, vol. 41, no. 4, pp Williams, K, Assassa, R, Smith, N, Shaw, C & Carter, E 1999, Educational preparation: specialist practice in continence care, British Journal of Nursing, vol. 8, no. 18, pp Wood, I 1998, The effects of continuing professional education on the clinical practice of nurses: a review of the literature, International Journal of Nursing Studies, vol. 35, no. 3, pp Wyatt, D 2007, How do participants of a post registration oncology nursing course perceive that the course influences their practice?-a descriptive survey, European Journal of Oncology Nursing, vol. 11, no. 2, pp

73 APPENDIX 1: Post-registration Nursing and Midwifery Education Review Group Membership Prof. Tom Collins Chairperson Head of Department of Education Ms Annette Kennedy (Liam Doran ) Director of Professional Development Centre National University of Ireland Maynooth INO Ms Mary Armstrong* Assistant Secretary Recurrent Grants Higher Education Authority ( also for Department of Education & Science) Ms Mary Boyd* Director of Nursing Cork University Hospital Mr. Colum Bracken* Director of Nursing (PCCC) HSE (PCCC) Mr. Jim Browne* Director Of NMPDU NMPDU HSE North Western Area Mr. Danny Connellan* (for Irish Mental Director of Nursing HSE North West Dublin Health Managers Nurse Managers) Ms Maura Connolly* Professional Development Officer Institute of Community Health Nursing Mr. Liam Doran* General Secretary INO Ms Mary D u ff * Director of Nursing St Vincent s Hospital Ms Patricia Hughes* Director of Midwifery Coombe Women s Hospital Ms Catherine Killilea ( for Jim Browne) Director NMPDU NMPDU HSE South Mr. John Magner* Assistant National Director - Professional Education HR Directorate HSE South Lacken Mr. George Mc Fadden* Head of Nursing and Health Studies Letterkenny Institute of Technology Dr Gary Brown (for George Mc Fadden) Head of Department, Institute of Technology Tralee Nursing and Health Care Studies Prof. Geraldine McCarthy* Head of School of Nursing & University College Cork Midwifery Studies Ms Mary McCarthy* Chief Nursing Officer Department of Health & Children Dr Kathleen McLellan* Head of Professional Development National Council for the Professional Development of Nursing & Midwifery Mr. Gerry O Dwyer* Hospital Network Manager Southern Hospital Network Dr Siobhan O Halloran* Nursing Services Director HR Directorate Ms Ailish Quinlivan* Vice President Finance Irish University Association Dr Anne Marie Ryan* Chief Education Officer An Bord Altranais Ms Sheila Sugrue* Nursing & Midwife Advisor Nursing Department of Health & Children Policy Division Mr. John Scott Senior Executive Officer - Finance HSE Office of Nursing Services Director Dr Paul Tomkins* Head of School of Science Athlone Institute of Technology Ms Sandra Walsh* Assistant Principal, Nursing Department of Health and Children Policy Division Ms Mary Wynne* Project Officer, Nursing and Midwifery Planning and Development Unit Health Service Executive *=Initial review group members 70

74 APPENDIX 2: Review of Post Registration Nursing and Midwifery Education Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis Strengths Core and specialist modules Specialist staff teaching clinical areas Cul-de sac good retention strategy Attracts staff with good national and international recruitment strategy Academic award has international recognition Long experience of programme delivery Geographic spread Choice Funding arrangements Increases quality patient care Access to bridging programmes Access to post-grad programmes in absence of undergrad degree Promotes teamwork and confidence Modularisation, APEL, Flexible approach,working well where in place An Bord Altranais approval NQAI framework Partnerships HSE and 3rd levels Evaluation systems in place - Provides for, development of organizational business cases, additional resources to clinical care areas, increased number students in clinical area, increased profile/ reputations of organizations and increased skill mix. Weaknesses Funding inequity Locum replacement costs Fees funding mechanism Lack of central clearing house Integration of clinical requirements with delivery of academic component Lack of follow through to deliver on service pay-back and recouping of fees Teaching / Learning expertise What constitutes expertise? Lack of standardisation with regard to study leave / exam leave etc Higher education institutes responsiveness to service need requirements Critical mass to justify programme delivery Lack of development of mutual understanding Need for ongoing review of programmes and individual outcomes 71

75 Opportunities Rationalisation of programmes Economies of scale Responsiveness to service need Taking stock of current programmes review of modules increase specialist facilitators Review cost variations Standardise programme delivery Connect service requirements over next 5 years with education provision Run programmes on cost effective basis value for money Incentive for staff personal development Establish tracking mechanism attrition rates etc Develop interdisciplinary education Sharing integration to reflect service delivery Threats Emergence of private sector providers Over specialisation vs. diversity Unsustainability No explicit relationship with service Duplication Non-transferability Funding levels not sustainable at current rate of development Some courses not approved Disparate standards / accreditation / competencies HSE information technology weakness Exploitation of HSE Uni-professional education militates against multi disciplinary work can this one be simplified? Loss of shared knowledge 72

76 APPENDIX 3: Post Registration Nursing and Midwifery Education Review Communication & Consultation Plan Introduction The purpose of the communication and consultation process is to engage with a variety of key stakeholders with a view bringing the maximum amount of experience and intelligence to bear on the review process and subsequent recommendations. To that end it is proposed to formally consult with the following sectors: Education HSE & service providers Regulatory bodies and professional organisations Staff associations (trade unions) It is also proposed to have a call for submissions through the HSE website. This will reflect the questions asked under group work in the formal consultation process. Sector Organisation Workshop Date Education Head of School of Nursing & Midwifery Staff from School of Nursing & Midwifery Registrar s Office Bursar s Office Academic Affairs East (Dublin) DCU, UCD, RCSI. TCD South (Cork) UL, UCC, Tralee IT, WIT North / West (Galway) St Angela s College, GMIT, LKIT, AIT, DKIT, NUIG Health CNE s - Practice Development co-coordinators - CPC - Course facilitators - CNS / AMP - Staff Nurses - General Managers - LHM - Network Managers East & North East NMPDU South & South East NMPDU West & North West NMPDU Midland & Mid West NMPDU 73

77 Regulatory bodies / Professional organisations - An Bord Altranais - National Council Professional development of Nursing and Midwifery Staff Associations INO, PNA, SIPTU (Nursing) IMPACT (Nursing) Include with East & North East NMPDU Dublin Suggested Workshop Format 1. Introduction 2. Overview of Transformation Programme 3. Overview of review process (PowerPoint presentation) 4. Group work Group 1 - Service / practice requirements Group 2 - Education/academic requirements Group 3 - Management/policy requirements 5. Questions & Answers Questions for Group session: Question 1 Identify the top 5 principles that the HSE should adopt in developing a framework for Post Registration for Nursing and Midwifery Education. Question 2 Identify the top 5 operating principles that the HSE should employ in engaging with other relevant parties and stakeholders in Post Registration for Nursing and Midwifery Education. Question 3 Identify structures or processes that should be developed to strengthen the relationship between service provision and educational requirements. Question 4 How should the HSE in partnership with the HEI s identify future educational needs? Question 5 How should the HSE procure and finance the development and delivery of future programmes. 74

78 Note Briefing material to be forwarded in advance of workshop: - Overview of consultation process - Terms of Reference - Membership Communication Methods Method URL / Webpage: Link on Topic section of homepage Links on relevant sites: National Council, An Bord Altranais, INO Tri monthly enewsletter Press Release Health Matters, National Council, An Bord Altranais, INO Target Audience All HSE employees via Intranet 14 HEI s Voluntary Sector 75

79 APPENDIX 4: Barr et al s (1999) conceptual framework for the evaluation of education and training Level 1: Learners reactions this relates to the participants views of their learning experiences and satisfaction with their training and education Level 2: Modification in attitudes and perceptions this relates to changes in attitudes and perceptions towards patients and carers, their problems and needs, circumstances, care and treatment Level 3: Acquisition of knowledge and skills for knowledge this relates to concepts, procedures and principles of working with specific patient groups and their problems. For skills this relates to the acquisition of critical thinking and problem solving, intervention skills, and skills linked to multidisciplinary working Level 4: Changes in behaviour this relates to the implementation of learning from an educational programme in the workplace, prompted by modifications in attitudes and perceptions, or the application of newly acquired knowledge and skills Level 5: Changes in organisational practice this relates to the wider changes in the organisation and delivery of care, attributable to an education programme Level 6: Benefits to patients and carers this level relates to improvements in the health and well being of patients and carers who have used health services as a direct result of an education programme 76

80 APPENDIX 5: An example of the questionnaire sent to higher education institutions Post-registration Nursing and Midwifery Education Review University of Please provide details of the university staff member ( who may be contacted in the event that clarification of survey information is required) Name: Contact details: Phone: Please list below Link Health Service Providers who work in partnership with the university in the provision of nursing / midwifery post-registration education. Link Health Service Provider Address Please completed survey to: postregreview@mailf.hse.ie by 5pm March 9th

81 Name of third level Institute - Access to Degree, Bachelor, Diploma & Higher Diploma Programmes (This section EXCLUDES courses leading to registration) * Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? (Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students Access to degree programme: Bachelor Programmes Bachelor of Science (Honours) Nursing Studies Diploma in Health Sciences in Clinical Teaching Diploma in Health Services Research Higher Diploma in: Health Sciences in Clinical Teaching Applied Science Occupational Health & Hygiene Health Promotion Health Sciences (Primary Care) 78

82 Name of third level Institute - Higher Diploma Programmes (This section EXCLUDES courses leading to registration) * Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? (Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students Higher Diploma in Nursing Studies Accident & Emergency Nursing Education Gerontology Nursing Intensive care Nursing Mental Health Nursing Neonatal Intensive Care Nursing Oncology Nursing 79

83 Name of third level Institute - Higher Diploma Programmes (This section EXCLUDES courses leading to registration) * Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? (Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students Higher Diploma in Nursing Studies Orthopaedic Nursing Palliative Care Nursing Perioperative Nursing Practice Nursing 80

84 Name of third level Institute - Masters Programmes (This section EXCLUDES courses leading to registration) * Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? (Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students Masters Programmes MA in Health Promotion Master in Health Services Research Master of Health Science (Advanced Practice Nursing) Master of Health Science (Nursing & Midwifery) Master of Health Science Occupational Health & Safety & Welfare Master of Health Science (Primary Care) 81

85 Name of third level Institute - Nursing Registration Courses (This section INCLUDES post-registration courses leading to additional registration) * Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? (Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students Higher Diploma in: Midwifery Public Health Nursing Master of Health Sciences (Nursing & Midwifery Education) Name of third level Institute - Doctoral Programmes *Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students 82

86 Name of third level Institute - Other Courses Please provide details of other courses/modules attended by nurses not listed previously *Fee= Registration fee and Tuition fee Total Course Title Programme Start Date Length Credits Awarded to Course Clinical Practice Hours Class Contact Hours Course Level NQAI Can students register on a module basis? (Yes/No) No. of Places on course Uptake 2006 Number Nurses/ Midwives Minimum viable cohort Fee* per Module (if relevant) Course Fee* 2006 ( ) EU students Course Fee* 2006 ( ) Non-EU students Thank You for completing this questionnaire 83

87 APPENDIX 6: Consultation Workshop Schedule and Agency Presentations Workshop date Sector (area) Venue No. of Participants 5th June Education (South) Rochestown, Cork 11 6th June Education (North/West) Galway 11 12th June & Staff Associations (Dublin) Dublin 5 25th July 14th June Health (NMPDU South East) Waterford 20 19th June Health (NMPDU East) Dublin 64 20th June Health (NMPDU North West) Bundoran, Co. Donegal 60 21st June Health (NMPDU Midlands) Tullamore, Co. Offaly 35 25th June Education (East) Dublin 12 25th June Regulatory Bodies (East) Dublin 7 26th June Health (NMPDU South) Cork 42 27th June Health (NMPDU Mid West) Limerick 25 28th June Health (NMPDU West) Claregalway, Co. Galway 48 29th June Health (NMPDU North East) Carrickmacross, Co. Monaghan 40 Presentations Agency presentations to the review group included: Agency The National Qualifications Authority of Ireland An Bord Altranais National Council for the Professional Development of Nursing and Midwifery Dublin City University Foras Áiseanna Saothair - Training & Employment Authority Department of Health and Children An Bord Altranais National Council for the Professional Development of Nursing and Midwifery Title of Presentation The National Framework of Qualifications The Role of An Bord Altranais in Post-registration Education The Role of the National Council for the Professional Development of Nursing and Midwifery in Post Registration Nursing Midwifery Education Postgraduate diploma/registration in mental health nursing National Skills Database Healthcare occupations Post Registration Mental Health Programmes Requirements and Standards for Post-Registration and Continuing Competence Nursing and Midwifery Education Programmes Portfolios and Recognition of Prior Learning 84