Paradigms of Practice: a dilemma for nurse educators

Reforming the Swiss nurse education system: A policy review

BACKGROUND

Western Europe has been swept in the last three decades by ongoing reforms within the nurse education systems. Within the Western European region, Switzerland is one of the last countries initiating the integration of nursing programs into higher education institutions.

OBJECTIVES

This article examines the nurse education reforms recently enacted in Switzerland. The specific aims of the analysis were to: (a) examine modes of reform implementation and the current status of the Swiss nurse education system; (b) compare between two new Swiss nurse education models developed in the various linguistic regions.

METHOD

A documentary search for policy documents, reports and studies related to the implementation processes of reforms was conducted through websites of various legal institutions and the Swiss university library system.

FINDINGS

The analysis indicated that although a fit between environmental pressures and the reform agenda exists, the implementation of the nursing reform varied considerably between the various Swiss linguistic regions. This variation resulted in two newly created models of nurse education programs revealing a high level of variability and inconsistency. As such, the development of a unified system of nurse education, which was set as the primary goal of the reformed system, was not achieved.

CONCLUSIONS

Overall, Switzerland is contributing to the widening heterogeneity rather than to the aspired homogeneity across Western European countries.

Education commissioning by consortia: some theoretical and practical issues relating to qualitative aspects of British nurse education

In 1995 the British National Health Service (NHS) Executive published details of a new framework for planning and commissioning education and training in the NHS. Among the central elements of these new arrangements are consortia of representatives from health care provider organizations and purchasing authorities among others, who will in due course take on responsibility for the commissioning of non-medical education and training (NMET). This NMET market is clearly distinct from the larger 'internal market' for health care provision by virtue of its separate funding, and different supply and demand side components. This paper includes an analysis of the new arrangements in terms of quasi-market theory and articulates a key role for consortia in harmonising the distinct markets for health services and NMET. A primary purpose of the paper is to examine the extent to which the new arrangements generally, and consortia in particular, can ensure that NMET contributes to NHS reform. Evidence from consortium development work in the South Thames Regional Health Authority, England, is discussed and it is argued that consortia will only perform effectively if they receive devolved real powers to an extent that persuades members to genuinely commit themselves to the proper development of consortia and the responsibilities of NMET commissioning. Finally a tendency to become preoccupied with education and training operations and processes rather than outputs is described and identified as a threat both to consortium effectiveness and educational innovation.

British National Health Service trust chief executives on nurse education: corporate instrumentalism and doubts on quasi-market structure

The funding of nurse education through Working Paper 10 arrangements is susceptible to analysis as a 'quasi-market' in which regional purchasers (in England) commission education and training services on behalf of National Health Service (NHS) trusts. In this context, some regions have developed ways of managing the demand side of the market in such a way as to enable NHS trust involvement in purchasing decisions, sometimes through consortium configurations. This paper reports the findings of an empirical study of the views of NHS trust chief executives on nurse education. The investigation was conducted to provide the information base for a consortium development reported earlier in the Journal of Advanced Nursing. The consensus views of chief executives revealed an ideological stance, referred to as corporate instrumentalism. This was shown to be derived from the position of trusts as newly corporate organizations undergoing considerable change in a volatile and competitive environment. Education was seen as potentially capable of contributing significantly to both health service quality and organizational change. Chief executives described an ideal of collaboration in which college providers are highly responsive to their needs, but doubted that the current quasi-market arrangements can in fact deliver this. A comparison of chief executive and senior executive nurse views revealed some significant differences of emphasis, and a mechanism is provisionally suggested by which educational innovation could be suppressed. Finally the education quasi-market was analysed in terms of both its implications for the professional status of nurses and its potential to facilitate NHS reform.