Worldwide, the nursing workforce is an important issue. Typically, my go to documents, papers and so on have been UK in origin. However, since I began a national role, knowing what is happening globally has become of greater importance, particularly as the Nursing and Midwifery Council (NMC) progress work on several areas of professional practice. A key priority is considering pre-registration education options after the UK's exit from the EU.
I am a member of the Scottish Government Ministerial Taskforce on Nursing and Midwifery, which aims to recognise and value the contribution of the nursing and midwifery professions in Scotland, by building sustainable and skilled nursing and midwifery workforces. The key topics we have discussed this month are not new, with work in key areas already published. The views of a friend – Professor Aisha Holloway, who has been on a secondment with the World Health Organization (WHO) – expressed during this month's meeting, reminded me of key publications from the WHO when considering the global evidence available to inform our thinking.
The WHO's first State of the World's Nursing report (WHO, 2020), although noting that there was much to celebrate, urged governments to act on investing in the acceleration of nursing education – faculty, infrastructure, and students – to address global needs, and meet domestic demand.
The WHO reported that, for most countries (152 out of 157 responding; 97%), the minimum duration for nurse education is a 3-year programme. To address the workforce shortage by 2030 in all countries, the total number of nurse graduates it was stated, needs to increase by 8% per year on average, alongside an improved capacity to employ and retain them.
The WHO Global Strategic Directions for Nursing and Midwifery report presents both evidence and policy priorities aimed to help countries to ensure that midwives and nurses optimally contribute to achieving universal health coverage and other population health goals (WHO, 2021).
The report focused on four policy areas, education being one of them. The ‘strategic direction’ for education being stated as:
‘Midwife and nurse graduates match or surpass health system demand and have the requisite knowledge, competencies and attitudes to meet national health priorities.’
Within the WHO evidence base, it was noted that across and within countries, there are many different ‘entry level’ education programmes to becoming a midwife or nurse, with a growing call for the minimum education of midwives and nurses to be standardised at the bachelor's degree level.
Internationally, ensuring the quality of nursing and midwifery education programmes and the preparation of qualified faculty remain critical challenges, with availability of quality clinical placement capacity also noted as a global issue. It is noteworthy that the Scottish nursing and midwifery taskforce is ministerially chaired, ensuring that economic issues are considered alongside the actions required to address the issues.
The WHO identified four policy priorities for education:
- Align the levels of nursing and midwifery education with optimised roles within the health and academic systems
- Optimise the domestic production of midwives and nurses to meet or surpass health system demand
- Design education programmes to be competency-based, apply effective learning design, meet quality standards, and align with population health needs
- Ensure that faculty are properly trained in the best pedagogical methods and technologies, with demonstrated clinical expertise in content areas.
The WHO places significant emphasis on the clinical practice education environment and infrastructure, which is an area that I feel needs attention in the UK. The WHO has several key areas of focus:
- Faculty need to be experts in their content areas. It is noted that there is a need to increase the number of faculty, while ensuring their quality. This will require advanced training in educational processes and methods
- Engagement with clinical settings to identify expert clinicians to mentor or supervise students in these settings
- Increased investment in digital technologies and infrastructure and training of faculty in the use of digital technology for remote learning and clinical simulations
- Educators must be able to maintain clinical competence, as well as developing and strengthening clinical and didactic teaching and research skills.
I am confident the NMC approach to our review of pre-registration education is the right one. We will undertake a global comparative review of programmes; we will undertake a candid review of the state of clinical practice education and environments while seeking to act by piloting innovative approaches for future programmes.