Nursing education has undergone a quiet revolution. Things have changed somewhat since Florence Nightingale, the founder of modern nursing, set up the first battlefield hospital to care for wounded Crimean War soldiers nearly 150 years ago. The hospital-based training system for nurses, in place for more than a century, and based in large part on the precepts and techniques developed by Florence Nightingale, is finally giving way to a college-based educational programme.
Since the mid-1990s, student nurses have followed a three-year diploma programme, linked to a college or university. They took social and biological science classes in college, but the rest of their time was spent on the wards. After they qualified, they could do a one-year, part-time course to get a degree. From next year, however, nursing will be a four-year degree programme. Admission will be through the Central Applications Office (CAO), as is the case with most other third-level courses.
Student nurses, regardless of whether they are doing general, psychiatric or mental handicap nursing, will spend their first three years on campus, with limited hospital-based clinical practice each year. Their final year will be spent entirely in the hospital. "Nurse training is being turned on its head," says Seamus Cowman, professor of nursing in the Faculty of Nursing and Midwifery at the RCSI. "For the first time, nurses will be graduates and will have graduate status," he says. "We'll be the envy of Europe. This is a huge investment in nursing."
The move to a four-year degree programme was one of the recommendations of the 1998 Commission on Nursing report - A Blueprint for the Future. This highlighted the need to upgrade the nursing profession in terms of professional career pathways, education and pay - a need that has become all the more pressing with the current shortage of nurses in the healthcare system.
In the 1980s, there were 20 applicants for every available place in the nursing school, says Prof Cowman. Today, nurses are either emigrating in search of better pay, conditions and career prospects or switching careers, while young people are opting for less onerous and more lucrative career choices. The result is that many hospitals have been forced to import nurses from the Philippines and elsewhere.
Giving degree status to nursing education is seen as one option to reverse the nursing shortage. Another is the establishment of clinical career pathways for nurses, such as the creation of advanced nurse practitioners posts, something which was also recommended in the report. Trained to masters degree level, these practitioners will have advanced clinical skills and even prescribing powers. "They will be independent and autonomous practitioners," says Prof Cowman. "For instance, in Accident and Emergency, they may run their own clinics, admitting and discharging patients. Or they may run specialist clinics such as asthma clinics."
In response to the coming changes, the RCSI, which has been providing nursing education for 26 years, is planning a new undergraduate school of nursing. It is also developing an advanced nursing practitioner programme in neonatology (care of the newborn) in association with the National Maternity Hospital in Holles Street.
AMONG the college's existing programmes are three part-time BSc degrees in nursing, nursing management and practice development, as well as 16 higher diplomas - run in conjunction with various hospitals and approved through the National University of Ireland - in everything from coronary care to gerontological nursing.
With Letterkenny General Hospital, for instance, the college runs higher diplomas on intensive care, coronary care and theatre nursing. Lectures are beamed live via a video conferencing link from the RCSI's base in Dublin to the hospital in Letterkenny. Students then access PowerPoint lecture presentations, online journals and various databases via the college intranet.
Last year, the college developed a number of new programmes including an MSc in nursing, an MSc in midwifery, and higher diplomas in practice nursing, wound management, tissue viability and infection control. In addition, it registered its first two PhD nursing students.
Research will become increasingly important to the profession, says Prof Cowman, both to underpin best practice in nursing care and to get nurses more involved in policy-making: "In traditional nursing, we learned by doing the same things again and again. Now, we have moved to more efficient learning. We are learning why, not just how, to do something, and understanding the rationale behind it. We are looking at patients as individuals and what is best for them."
He is adamant that the new degree and the focus on further academic and professional education will not give rise to a two-tier nursing system. Nurses who went through the traditional training route are being given the opportunity to do the part-time degree course, with the Department of Health paying their fees, he says. Older nurses, who are being lured back into the profession in response to the nursing shortage, are also being given the option to upgrade their skills.
"It's their choice whether to go for it, but this is the way the whole profession is going. The half-life of knowledge is only 2.5 years. Education is the way forward," he says.
"This is a hugely exciting time for nursing. And yet, if you go into a hospital and look at patients on trolleys in corridors, or you read the newspapers and the negative image of nursing, you would be very depressed at the state of nursing. But, with the things to be implemented, it is exciting - if we can just hold on till we get there."
