Precios de la referencia “Ladrillo sencillo de primera calidad” Como se observa al comienzo de este capítulo, la referencia “Ladrillo sencillo de primera

There have been significant efforts to adopt common policies for nurse education across the world with respect to entry level qualifications, programme qualifications and advanced education. A good example of this is the Bologna process which was born out of a desire to establish a common higher education area to adapt education and research in Europe to the changing trends and advancing scientific knowledge (European Ministers of Education, 1999). From this initiative, several European nursing organisations and the International Council of Nursing (ICN) recommended in 2008 that basic nursing programmes should be at bachelor level, guarantee the acquisition of required competencies and last for a minimum of three years with a research and skills-based curriculum (Salminen et al, 2010). The implementation of these changes has been challenging for most European countries (Spitzer and Perrenoud, 2006; Sztembis, 2006; Davies, 2008; Bahçecik and Alpar, 2009; Patelarou et al., 2009) and these are not unrelated to the variations in national legislation, culture, healthcare needs, philosophies and economic condition of member countries (Salminen et al., 2010).

In an analysis of the variations in implementation Lahtinen et al (2014) used nursing education system; duration; title of nursing graduate; postgraduate degrees; entry qualification and practical

training; and registration, specialization and tuition, to compare the countries that were signatory to the Bologna Process. They found the following variations:

1. Nursing education system: 68% of nursing programmes were offered at higher education level while up to 32% were still offered at diploma level. 60% of the countries offer a single point of entry (with 74% of these being the bachelor degree), while 29% offer two points of entry (54% of these offer either at the diploma or bachelor degree level while 38% offer two entry points but both leading to a bachelor’s degree).

2. Duration: full-time programme duration ranged from two – four years with 58% lasting for three years and 31% for four years. For the schools within higher education 51% offer three- year programmes while 42% offer four-year programmes.

3. Title of nursing graduate: 82% of the countries offer higher education programmes leading to a bachelor’s or equivalent. But when all the education systems are considered 68% of programmes lead to bachelor’s degree while in 23% of the countries, studies lead to a diploma. The bachelor degrees are generally awarded by universities, colleges, university colleges and universities of applied sciences or polytechnics.

4. Postgraduate degrees: Master’s and doctoral programmes are offered in 60% of the countries while in 27% of the countries postgraduate studies are not yet available. Six of the 45 countries have the master’s degree as the highest level of education for nurses.

5. Entry qualification and practical training: all the countries meet the set directives in terms of minimum number of years of general education required prior to nursing education and the minimum number of practical hours.

6. Registration, specialization and tuition: countries are allowed to determine the registration authority for nurses. In 52% of the countries the title of registered nurse is awarded by government and by a regulatory body in 38% of them. Only five countries (Austria, Germany, Ireland, Malta and the United Kingdom) offer undergraduate specialisation programmes. For tuition fees, 48% of the countries charge tuition fees in state-owned

schools. All the countries that charged tuition fees offered programmes towards the bachelor’s degree except for France which offered diploma level programmes.

The above variations are outstanding because all the countries studied are members of the European Higher Education Area (EHEA) and are supposed to be running a harmonized system of higher education. In the USA inconsistencies are still observed in nurse education. Rich and Nugent (2010) observed that as far back as 1965 the American Nurses Association called for the 4-year baccalaureate (BSN) degree to be the entry into professional practice but by 2007 54% of nursing students were in two-year associate degree programmes, 42% in BSN programmes and 4% in three- year diploma programmes. This shows that the USA still has multiple levels of entry into nurse education. Rich and Nugent (2010) citing the National League of Nursing observed that 57% of all entry-level nursing programmes in the US were the associate degree programmes. It is in recognition of such trends that the IOM (2010) proposed that the US plan to implement measures to increase to 80% the number of nurses with bachelor degrees and double the number of nurses with a doctorate in the US by 2020.

The requirement for training nurse educators is another area that reflects variations even within a harmonized area like the EHEA. Jackson et al (2009) observed that nurse educators should at least have a university degree but the career pathways for this was poorly defined and varied across Europe. In fact there is no consensus on what the minimum qualifications or experience of nurse educators should be (Salminen et al, 2010). They observed that doctoral-level preparation is the desired level for nurse educators in order to ensure that the profession develops its own research leaders for the future. The variation may have an impact on the quality of training and probably the number of nurses that can be trained. In the USA, the American Association of Colleges of Nursing (AACN) in 2005 drew attention to the critical shortage of nurse educators in the US and that it was contributing to the overall nursing shortage (Rich and Nugent, 2010). The shortage of educators was attributed to growing opportunities outside health care, emphasis on long clinical careers before entering academia, low salaries as compared to clinical practice and administration, high cost of required education, high workloads and low salaries for educators, fluctuations in nursing school

enrolment, and lack of funding to recruit educators (Yordy, 2006). These factors add to the complexities already associated with the preparation of nurse educators. Yordy’s (2006) factors may have been based on the US but it is likely that some of the factors might resonate with other countries as well. In such cases countries will adopt different approaches to addressing the issues thus leading to more variation in the educational preparation of nurse educators.

Cameroon’s nursing education system reflects some of the inconsistencies that have been shown in other countries. The variety of pre-registration diploma programmes with varying entry qualifications give people many different entry levels into nursing. The existence of hospital based nursing school diploma programmes, higher education based diploma programmes and university based bachelor’s degree programmes also introduce variations in duration and exit qualifications. Master’s and doctoral programmes have not become common as Cameroon is still to offer its first doctoral programme in nursing. However, Cameroonian nurses had expressed desire for graduate and postgraduate studies many years back. Junang (1996) called for the institution of master’s and doctoral programmes for the nurses arguing that the dynamic nature of care requires constant research which in the case of Cameroon was made difficult by the low level qualifications in nursing education. He saw the advanced programmes as an accessory for health professionals including nurses to advance their professions and improve the quality of care rendered to clients.