Nursing education and

practice from diploma to

bachelor in Spain

Adelaida Zabalegui, RN, PhD, FEANS

November 30th , 2017

• Background

• Nursing education from

diploma to degree

• Nursing practice from

diploma to degree

• The Future of nursing

• Conclusions

OUTLINE

HEALTH CARE CHALLENGES

• Population aging and chronicity

• Immigration

• Technology growth

• Economic and sociopolitical globalization

• Increased level of patient’s knowledge and decision making

• Policies of health cost maintenance and reduction

• New health care procedures, quality improvement

• Evidence-based practice and advances in health science

06/12/2017 4

Healthcare expenditure, 2014

De media Europa dedica 8% de su PIB para sanidad, mientras

que España dedica 6,1% (Eurostat, 2007)

http://ec.europa.eu/eurostat/statistics-explained/index.php/

Physician & Nurse Ratios in EU

MD RN

Based on 2016 OECD/Eurostat/WHO-Europe Joint

7

RN ratio & mortality

8Aiken et al., The Lancet, 2014

SPAIN RESULTS (N = 5654 RN)

26% would like to move to another hospital

45% were moderately dissatisfied

48% had unfavorable/poor work environment

22% had high level of burnout

Lack of time to:

40% comfort the patient

46% update care plan

49% patient / family education

21% document the care

21% monitor the patient

20% mobilize the patient

9Fuentelsaz-Gallego, Consorcio RN4CAST-España. 2013. [Work setting, satisfaction and burnout of the nurses in critical

care units and hospitalization units. RN4CAST-Spain project]. Enferm Intensiva, 24(3):104-12

Nursing Education

in Spain

From Diploma to Degree

06/12/2017 11

LEGISLATIONEurope:

European directive 2005/36/CE, Nursing education requirements 4,600hrs (2,300 hrs of clinical practice).

Spain:

Law 44/2003, LOPS (Law on the organization of the health

professions)

Royal Decree 450/2005, Nursing Specialties approved

BOE 157/2006, Postgraduate Education Programs

Royal Decree 1393/2007, Degree Programs

BOE 2134/2008, General requirements to be a Registered

Nurse

BOE 1837/2008: Nursing Degree Objectives, 240 Credits,

Competencies, ....

“Nurses are responsible for the direction,

evaluation and provision of nursing care aimed

at the promotion, maintenance and recovery of

health, as well as the prevention of diseases and

disabilities”

LOPS (LEY DE ORDENACIÓN DE LAS PROFESIONES

SANITARIAS). Law 44/2003

Pre-Bolognia academic system

1st cycle 2nd cycle 3rd cycle

2 - 3 years 4 - 6 years

Diploma

Bachelor

Doctor

2 years

POST-BOLONIA system

Degree240 ECTS

Master60-120ECTS

Doctorate

L

L

L

Clinicaldevelopment

22 years old

SpecificPofessionalCompetencies

24 years old

Postdoctorate

30 years

Academic

development28 years

4 years + 1- 2 years +

Basic Professional Competencies

4 years

Nursing Specialty

By Residency

2 years

60 ECTS: Sciences, humanities, social, behavioral sciences,

technology, computer sciences, foreign languages, etc.

120 ECTS common for all universities:

- 15 ECTS: Anatomy and physiology, pharmacology,

microbiology.

- 105 ECTS of Nursing sciences: Fundamentals of nursing (10),

Clinical nursing (40), Psychosocial and mental health nursing

(9), Community nursing (20 ECTS), Nursing along the life cycle

(15), ethics, legislation and administration (5), and other nursing

related subjects (6 ECTS) such as bioethics or communication.

60 ECTS Clinical practicum.

Nursing Degree (240 ECTS)

Clinical Practice

Student nursing clinical practice

is performed with different

structures and protocols and not

all emplacements are

perceived as a powerful

learning environment for

students.

Nurses perceive lack of time

and sometimes knowledge in

front of the formative role.

05/31/2017Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A radical call for transformation.

Bennett, M., & McGowan, B. (2014). Assessment matters-mentors need support in their role. British journal of nursing, 23(9), 454-458.

Henderson, A., & Eaton, E. (2013). Assisting nurses to facilitate student and new graduate learning in practice settings: What 'support' do nurses at the bedside need? Nurse Education

in Practice, 13(3), 197-201

O'Mara, L., McDonald, J., Gillespie, M., Brown, H., & Miles, L. (2014). Challenging clinical learning environments: Experiences of undergraduate nursing students. Nurse Education in

Practice, 14(2), 208-13.

NURSING DEGREE

General Degree Competencies

Associated with professional values and the role of the nurse

Associated with nursing practice and clinical decision making

Ability to properly use a range of skills, interventions and activities

to provide optimal care

Knowledge and cognitive skills

Interpersonal and communication skills

Competencies related to leadership, management, research and

teamwork

06/12/2017 19

NURSING SPECIALTIES, LAW, 2005

Obstetric-gynecological nursing (midwife)

Mental health nursing

Family and community nursing

Geriatric nursing

Pediatric nursing

Work nursing

Medical-surgical nursing

New requirements for Professors

The same requirements for all health care sciences

Professors have to be Accredited by National agencies: ANECA, AQU

Teaching assignment based on

Academic activity

Research activity

Management activity

Impact Index applied: CSI

Peer review

Consequences

Improvement of competencies in:

Problem solving

Knowledge & skills

Evaluation of interventions

Health care/services outcomes

Increase in professional autonomy

Nursing care

From Diploma to Degree

By our Law: Diploma = Degree in Nursing

Time to find the first RN job

3 m 3-12 m +12 m

Source. CIE Spain: In 2017: 247.974 nurses, in 2014: 4,41% unemplyed

EVOLUTION OF FIRST JOB BY CONTEXT

(Hospitalization, primary care & long term care)

Hospital Primary care LTC Others

Degree of satisfaction with work (0 to 10)

Primary care Hospital LTC

Work

description

Possibilities for

profesional

development

Salary Knowledge

application

General

satisfaction

PROFILE OF GRADUATES WITH RESPECT TO DIPLOMATES

Much worst WorstThe

sameBetter Much better

PROFILE OF GRADUATES WITH RESPECT TO DIPLOMATES

Primary care Hospitalization

Much worstWorst

The

same Much betterBetter

Importance of the competencies of new graduates

in Nursing according to employers

The most important competencies

identified were:

• Responsibility at work

• Learning capacity

• Teamwork

The less important competencies

were:

• Leadership

• Creativity

• Foreing languages

QUÈ S’AVALUA?

- 30 -

GenericCompetencies

1. Skills associated with professional, ethical and deontological values.

2. Care process (procedures / protocols, prevention and promotion of health,

empowerment, good practices, EBP).

3. Communication with the user or significant other persons and with the

multidisciplinary team.

4. Teamwork and inter-professional relationship

SpecificCompetencies

5. To be determined by the field of specialization (anesthesia, peri-surgical,

midwives, ICU nurses, emergency nursing, surgical or medical hospitalization

floors, ...).

InstitutionalCommitment

6. Institutional commitment (participation, involvement, adaptation to changes,

etc.)

Teaching and research

7. Accredited training / permanent apprehension competence.

8. Teaching activity

9. Research and innovation activity (publications, participation in congresses,

research projects).

10. Other merits.

PROFESSIONAL DEVELOPMENT

Career Development PathwayProfessional career: Requirements for each level

LEVEL Work experience:

Previous working

years

General and specific

competences

Corporate

commitment Curriculum description Minimal

Credits

Title

1 5 150 - 250 20 - 40 Internal Continuous Professional

Development

5 Clinical Nurse 1

2 5 140 - 250 20 - 40 Continuous Professional Development

Presentation of Poster/talk in a conference

21 Clinical Nurse 2

3 5 130 - 250 20 - 40 Official post-graduate or specialist nursing

MSc

Research partner

Conference presentation/ Talk

60 Advanced

Clinical

Nurse

4 5 110 - 250 30 - 40 MSc

Specialist Nursing Degree

Publication in National Journal as

main author

120 Senior

Clinical

Nurse

5 5 100 - 250 30 - 40

PhD

Research project as PI

Doctorat + IP Expert

Nurse

Historical evolution in the prevalence of nosocomial infection

Implementation and evaluation of Dedicated Educational Units in

Europe

Sandra Martin, MsN; Adelaida Zabalegui, PhD, FEANS;

Mariana Carolino Pereira, PhD; Ewa Dmoch – Gajzlerska,

PhD; Fisun Senuzun, PhD; Working group iDEUs-EU

07/31/2017

Implementation of

Dedicated Education Units

A clinical site that is modified to an optimal teaching

and learning environment.

One-on-one coaching

Duration of at least 6 weeks of internship

Focus on assumption of responsibility and care coordination

Presents the link teacher in the unit

Motivation and support from unit head nurse and team

The joint experience of knowledge, skills and attitudes

among nurses/midwifes, head nurses, students and

faculty.

05/31/2017

Mentoring my future colleagues, What way to go?

Be Dedicated to Education in your Unit!

Do you also lack the time to be well informed?

Do you want to be on the lead track with your medical

organisation?

Do you want to share your experiences and competences with

colleagues?

Just join the DEU society and learn from the best about practical

education in medical care!

Soon find out more at http://www.ideus.ips.pt/

SAVE THE DATE

25th of Mai 2018

Venue: The institute for Ireland in Europe, Leuven

Keynote speakers

Professor Susan Moscato, USA

DEU pioneer

Professor Peter Rosseel, BE

Expert in organisational/cultural change and the learning organisation

EMERGING COLLABORATIVE RESEARCH ON

ROLES OF ADVANCE PRACTICE NURSING

(CRER-APN)

• Understanding how the APN roles emerge

• Analysis of contextual factors at different levels

• Comparison of results between Canada and Catalonia

Context

SPANISH VERSION OF THE MODIFIED ADVANCED PRACTICE ROLE DELINEATION TOOL

68%

36%

51%

28%

34%

CUIDADO INTEGRALAL PACIENTE

SISTEMAS DE APOYOINTERPROFESIONAL

EDUCACIÓNINVESTIGACIÓN

PUBLICACIONES YLIDERAZGO

Interprofessional

Team

work

Leadership

Research Teaching

Integral

Patient care

APN AT HOSPITAL CLÍNIC OF BARCELONA

The Future of Nursing (USA, 2010)

Remove barriers to professional practice

Increase residency and NP / APN programs

Increase the proportion of registered nurses to 80% (2020)

Double the number of doctors in nurses by 2020

Ensuring that nurses are on continuous education (LLL)

Allow nurses to lead the change (improvement of care)

Analyze inter-professional care data

Global Issues in Nursing & Health Care

Outcomes

Structural

Empowerment

Exemplary

Professional

Practice

New Knowledge

Innovation &

Improvement

* American Nurses Credentialing Center

Transformational Leadership

Values of Magnetism

Transformational Leadership: Quality of nursing leadership and management style.

Structural Empowerment: Organizational structure, Personnel policies and programs, Community and the healthcare organization, Image of nursing, and Professional development.

Exemplary Professional Practice: Professional models of care, Consultation and resources, Autonomy, Nurses as teachers, and Interdisciplinary relationships.

New Knowledge, Innovation, & Improvement: Quality improvement.

Empirical Quality Results: Quality of care.

Outcomes: Sources of evidence

Indicators sensitive to nursing care:

Clinical indicators (Falls, UPP, UI, ...)

Patient satisfaction

Nurse satisfaction

Nursing research

Changes in care and work environment

Professional development

Participation in community activities

44

Conclusions Nurses must apply the acquired knowledge to the fullest possible extent

Nurses must achieve higher levels of advanced education

Health care institutions need to invest in nursing care

We need to:

Increase collaboration between university-hospital-community

Identify and assign nursing positions in relation to competencies

acquired and with advanced education

Create joint positions (university-healthcare setting) and

interdisciplinary training

Increase the participation of the nurses from clinical setting in the

design of training programs and the participation of the nursing

professors in healthcare decision making

- 46 -

46¡ Thank you!