Nursing in Greece. Technological Education Institutes (TEI s) Take up and pursuit of the TEI course leading to nursing

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1 Nursing in Greece Introduction Training Institutions Technological Education Institutes (TEI s) Take up and pursuit of the TEI course leading to nursing University training Take up and pursuit of the university course leading to nursing Specialisation Developments Sub-specialisation courses Training to become a specialist nurse Regulation of Nursing in Greece Registration Title of Nurse Field of Activity EC Law

2 Appendix 1 (detailed training) Specialist Nurse in Surgical Nursing Specialist Nurse in Medical Nursing Specialist Psychiatric Nurse/Specialist Mental Health Nurse Specialist Nurse in Paediatric Nursing Appendix 2 (summary view) Specialist Psychiatric Nurse/Specialist Mental Health Nurse Specialist Nurse in Medical Nursing Specialist Nurse in Surgical Nursing Specialist Nurse in Paediatric Nursing Registered General Nurse Registered General Nurse

3 Introduction In Greece there are the general care nurses (nosileftis) and, currently, four types of recognised specialist nurses (Edikevmenos nosileftis). In addition there are health visitors (episkeptes igias), who, though related to nurses, are now considered to be a separate profession in the public health area. 1 There are also nurse assistants. The training of nurses is undertaken in the institutions that are set out below. There is a move towards making all nursing training take place within university departments. 2 Training Institutions Technological Education Institutes (TEI s) Up to 1970 (and since 1875) all nursing training was hospital based, under the Ministry of Health. The law of established the Centre for Higher Technical Education under the Ministry of Education in Greece. There were five such schools with departments of nursing operational since 1970 but there are now 7 TEIs with nursing departments. The centres titles were changed by the legal change in and they became known as higher 1 Until 1984, when the last group of health visitors graduated, this category were trained as nurses with additional public health training. They are no longer trained as nurses and thus have no nursing licence. They could be considered to be a direct entry branch of a related profession. 2 Lanara, V., Nursing Education in a United Europe: The Greek case (1996) 1 European Nurse 45. Progress is slow and mainly held up over the question of equivalence of engineers from TEIs to university trained engineers. The university-trained engineers resist this equivalence and nurses are caught up in the crossfire. If TEI nurses were equivalent why could not the TEI engineers be so considered? 3 Law 652/1970 Stavroula Papamicrouli Greece in Quinn and Russell Nursing in the European Dimension (Scutari Press, 1993) p Law 576/1977 Papamicrouli id p.102.

4 technical and professional education centres (KATEE). Finally in 1983 these institutions became technical education institutions 5. Since the mid-80 s all training has been undertaken in the new TEIs (Technical Education Institutions). There are now 7 TEIs with nursing departments. The basic nursing course at the TEI lasts four years (eight semesters) of which the eighth semester is dedicated to clinical practice. This forms an internship prior to graduation. Graduates receive a diploma of nursing from the Minister of Education. Take up and pursuit of the TEI course leading to nursing Access to a TEI follows secondary school and national competitive examinations. Candidates must be at least 17 years old and medically fit. University training Take up and pursuit of the university course leading to nursing Candidates enter the Athens university-nursing programme following secondary school and national competitive examinations. 6 Candidates must be at least 17 years old and medically fit. Presidential Decree 184/1979 modified by presidential decree 562/1980 established the first nursing department at the University of Athens, which, since 1983, has been an independent department. 7 The department initially just ran post-graduate courses in nursing fore registered nurses. Since 1987 the department has been training general care nurses. 5 Law 1404/83 Papamicrouli id p Lanara op.cit. p Law 1268/1982 Papamicrouli id p.103. See also University of Athens, Department of Nursing Study Guide (Athens, 1995).

5 The course lasts four years divided into 8 semesters. Each semester lasts 13 weeks plus 4 weeks of examinations. Graduates receive a degree in nursing from the Minister of Education. Graduates from TEIs are accepted to the second year of the programme through examinations. Nurses graduating from the University may study for a higher degree in teaching, administration, research or clinical nursing. 8 The University of Athens also provides postgraduate training (at master s level) in clinical nursing, nursing administration, Mental health nursing, health informatics, public health and basic sciences. 9 There is also the possibility for any nurse with a master s degree to continue studying for a Ph.D. Graduates from TEIs do not have direct access to this post-graduate training. The university trained nurse has a higher level of academic content in her degree. The higher degrees, mentioned above, give access to, de facto, highly valued qualifications in the employment market which makes it easier for a nurse holding them to be promoted. The qualifications from Greek privately owned educational institutions are not recognised by Greek Ministries. 8 Papamicrouli id. p Ministerial decisions of 1996, 1998 and 1999 set out the courses for these degrees. Ministerial Decision B7/203/ (FEK 306/B/96) amending Ministerial Decision B7/37/ (FEK 248/B/7-4-94) on the organisation of postgraduate studies by the Nursing School, university of Athens. Ministerial Decision B7/234/ (FEK 1085/B/98) on the organisation of interuniversity and interdepartmental postgraduate courses on Organisation and Management of Health Services. Ministerial Decision B7/10/ (FEK 73/B/99) amending Ministerial Decision B7/203/

6 Specialisation Before 1984 three specialisations were acknowledged, training for which lasted one academic year. The specialities included public health nursing, 10 medical surgical nursing 11 and paediatric nursing.). 12 The law of 1579/1985 established the four specialisations known today for graduate general care nurses. These include medical nursing, surgical nursing, paediatric nursing and psychiatric/mental health nursing. Each course lasts one year and is under the responsibility of the Ministry of Health. The courses are studied in medical centres and hospitals. The courses started in fact in December 1989 in Athens. Students are graduate nurses with at least two years clinical practice and receive a full time salary. Existing certificates will be recognised as equal to the new title. 13 The old licences which included specialisation of the old types were transferable to the newly created titles for an initial period now expired. Thus the old-character specialised nurses who did not take advantage of the acquired rights provisions can no longer style themselves as specialist nurses in Greece. Developments The Committee on Nursing Education of the Central Council of Health 14 can also recommend new specialities. In 1994 it was agreed that there should be a Community Health nurse. However this new specialisation is held up by 10 The health visitors mentioned above. 11 Then one speciality- now divided in two. 12. There was also a six month course in psychiatric nursing in a mental hospital in Athens (Dromocaetion) though this was not considered to be a specialisation title Papamicrouli id Papamicrouli id The body that advises the Minister of reform in this area.

7 disagreements regarding the position and role of the health visitors of the new style, mentioned above. 15 Sub-specialisation courses In addition to the four specialisations, mentioned above, the Committee on Nursing Education of the Central Council of Health 16 can also recommend sub-specialisation courses in particular fields. If accepted these can be created by Ministerial Decision. There are such courses in renal nursing and oncology nursing. There are, in addition, unofficial courses, in Intensive care nursing and operating theatre nursing. In late May 1999 the Committee on Nursing Education is likely to recommend that these course become official is addition to courses on diabetes, burns and anaesthesiology. It is also likely to recommend updating of the existing course curricula. Training to become a specialist nurse The relevant requirements for gaining these titles are set out in decision A4/203/83 of the Secretary of State. In this decision article 7 sets out the general scope of duties for the medical specialist nurses. Article 8 sets out the general scope of duties for the surgical nurses. Article 9 sets out the general scope of duties for paediatric nurses and Article 10 establishes the general scope of duties for psychiatric nurses. These are all set out in very general terms. The training requirements are clearer and are given in Appendix The main problem being that they are not trained as nurses. See note Error! Bookmark not defined. above. 16 The body that advises the Minister of reform in this area.

8 Regulation of Nursing in Greece Registration Greek nurses, who have the necessary diploma, apply to the prefecture for a licence to practice. Once granted they are all entered on the register held at the Ministry of Health. A licence from any prefecture permits practice anywhere in Greece. The migrant nurse would apply to the Ministry of Health for her licence to practice in Greece. Migrant nurses also must show sufficient competence in Greek to be able to carry out their nursing duties. 18 Title of Nurse The title of nurse is granted to graduates of the university nursing departments and to graduates of the nursing departments of the TEI s, ex-higher education nursing schools and foreign institutions equivalent to the above. 19 The equivalence mentioned is based on that established by the sectoral nurse directives. 20 Field of Activity Article 5 para. 8 of the Law mentions that a presidential decree will deal with issues regarding the exercise and protection of the nursing profession. The only decree so far relevant is decree 351/79 which sets out the general duties of nurses. The operational principle for their scope of activity is that they can do anything for which they were trained. This applies also to the specialised urses. 21 A new Bill before Parliament would make membership of the Nursing 17 See Error! Reference source not found. at page Error! Bookmark not defined. below. 18 A committee set up by the Ministry of Health assesses their language competence. 19 Law 1579/85 Article 5 para In Greece academic equivalence is assessed by a body called DIKATEA/DIKATSA for universities and ITE for technical diplomas (and diplomas of less than three years duration). 21 A project for a new decree on this is in preparation.

9 Association mandatory and give that body a role in regulating nursing as a profession, if it is adopted. It would appear that the law reserves the title of the specialist nurses to graduates: The exercise of a specialist nurse duties require special education and the title of specialist nurse. The latter is granted to graduates of university nursing departments, nursing departments of technological institutes and the higher nursing schools. 22 The specialist titles are relatively new and are not yet subject to any specific rules as regards the scope of permitted activity. There is no registration as a specialist nurse, however it does help in the relative employment markets. Nurses with specialisation do not automatically receive a higher salary. However nurses with a higher degree (Master s or Ph.D.) do receive a higher salary. Article 5(6) of the general law indicates that specialist nurses can undertake general nurse care duties for five years. It was thought initially that there would be a reserved area of practice for the specialist nurse and this provision was designed to cope with the transitional period. However this bit a law is in fact a dead letter, There is a shortage of nurses and this means that nurses with specialised qualifications are still able to perform general nursing activities. Thus nurses with the specialisation mentioned below are often employed still as general care nurses. There are specialised hospitals for the mentally ill and also for children and in these areas the employment prospects and advertisements for nurses often in fact call for nurses who have got a specialisation in the relevant field. In other sectors the rule is not strictly applied (if at all applied). These hospitals are mostly the ones that in fact train such nurses. 22 Law 1579/85 Article 5 para.3

10 In the past (before the mid-1990 s) families could employ private nurses to look after relatives (for example). Some of the costs for these services were reimbursed through the social security regime. However in the mid-1990 s this practice was effectively stopped. The social security regime from then on only accepted receipts from licensed nurses for re-payment. EC Law The four types of specialist nurse have training granted at the level of higher education (in EC law terms). They are all general care nurses prior to receiving their specialised training. It would appear that they are an extension of the nursing profession in general care and do not form separate professions. Thus EC migrants wishing to access these titles would, it seems, need to register as general care nurses under the sectoral directives and thereafter rely of the case-law of the ECJ to gain access to the specialised titles (if they have appropriate knowledge and training). Migrant EC nurses who are (direct entry) branch nurses would not be licensed until they comply with the criteria of general care nurse Thereafter they could seek to have access to the specialised titles using the case-law of the ECJ to have their existing experience and knowledge taken into account.

11 Appendix 1 (detailed training) Specialist Nurse in Surgical Nursing 1 st unit (each unit lasts three months) Hours are per week Current surgical problems Treatment in surgical units of intensive care Physiology and anatomy Surgical Nursing I (principles, pre- and post-surgical treatment) 5h Seminar Clinical teaching and practice (surgical units) 4h 2 nd unit Biophysics and psychosocial treatment First Aid in ER surgery Interpersonal skills Surgical Nursing II (intensive care, high tech machines) 5h Seminar (methodology of teaching) Clinical teaching and practice (ER and intensive care units) 14h 3 rd unit Oncology Chemical pharmacology Research methodology Surgical Nursing III (cancer) 5h Seminar (Moral Issues) Clinical teaching and practice (oncological units) 14h 4 th unit Social medical science Issues of biophysics and biochemistry English medical terminology Surgical Nursing IV (treatment of patients with multiple tumours) 5h Seminar Clinical teaching and practice (choice between intensive care unit, Surgery, cardiosurgery, neurosurgery) 24h

12 Specialist Nurse in Medical Nursing 1 st unit Current issues of pathology Intensive care units, cardiological units, respiratory units, transplant kidney units Anatomy and physiology Medical Nursing I (principles of biophycosocial nursing, collective Responsibility in medical profession) 5h Seminar Clinical teaching and practice (in units with patients with short-term Needs, diabetical units and physiotherapy units) 14h 2 nd unit: Patients in serious/critical condition Biophysics and psychosocial issues First aid in cases of urgency Medical Nursing II 5h Interpersonal relation in medical nursing Clinical teaching and practice (in ER units) 14h 3 rd unit Medical nursing of long illnesses Special pharmacology Research methodology, Medical Nursing III (cancer, perspirational problems, cardiological and neurological problems, arthritis) 5h Seminar Clinical teaching and practice (oncological, neurological, cardiological, geriatric units) 14h 4 th unit Social medicine Issues of biophysics and biochemistry English medical terms Medical nursing IV (nephrology, medical treatment) 4h Seminar Clinical teaching and practice (choice between intensive care cardiological unit, transplant kidney unit, oncological nursing, diabetical unit) 14h

13 Specialist Psychiatric Nurse/Specialist Mental Health Nurse Introductory course (2 weeks) Seminars on current trends and application of Psychiatric Nursing Analysis of the course 10h Educational visiting in psychiatric units 1 st unit (12 weeks): Psychiatric nursing in a general hospital Neuroanatomy, neurophysiology neurology Psychiatric science I (Description of physical illness and modern treatment) 4h Psychopharmacology and chemotherapy Psychiatric nursing I (general principles) 5h Seminar Clinical teaching and practice in a psychiatric unit of a general hospital 15h 2 nd unit (12 weeks): Psychiatric nursing of children and adolescents General psychology Social psychology Psychiatric science II 4h Psychiatric nursing II 4h Seminar Clinical teaching and practice (in medical unit for children, Paedopsychiatric units of hospitals) 15h 3 rd unit (12 weeks): Psychiatric nursing of adults and gerontopsychiatric nursing Clinical psychology Sociology Psychiatric science III (geronto-psychiatric nursing, alcoholism) 4h Psychiatric nursing III (management of a psychiatric unit of a general hospital) 4h Seminar Clinical teaching and practice (in a psychiatric unit, treatment of drug and alcohol addiction) 15h 4 th unit (12 weeks): Social psychiatric nursing Psychiatric health Preventive Psychiatric nursing Legislation Psychiatric nursing IV (Social issues, caring at home) 5h Seminar Clinical teaching and practice (small psychiatric units, nursing at home) 15h

14 Specialist Nurse in Paediatric Nursing Mandatory Components (hours) for qualification 1 st semester -1 st unit Hospital management Preventive paediatric nursing General paediatric nursing Nutrition Advanced paediatric nursing Sociological issues regarding paediatric nursing Clinical teaching and practice in hospitals (paediatric pathological units) and units for newly born children 26h 1 st semester - 2 nd unit Advanced paediatric nursing Paediatric pharmacology 1h Social paediatric nursing 1h Paediatric psychology and educational issues Legal issues Political and economic issues 1h Psychology 1h Social legislation, administrative and social organisation Clinical teaching and practice in paediatric surgery units and pathological units and units for older children 26h 2 nd semester 1 st unit Nursing of newly born children Clinical biochemistry Clinical microbiology 1h Physiotherapy 1h Organisation and operation of intensive care units/nursing of Children in critical condition 4h Seminars and educational visits Clinical teaching and practice in hospitals (paedopsychiatric units) 26h 2 nd semester 2 nd unit Nursing of newly born children (cont d) 1h Education and communication Cardiosurgery on newly born children 1h Special nursing of children in intensive care Introduction to research on issues of paediatric nursing Seminars and education visits 4h Clinical teaching and research in nursing in intensive care units and surgery 26h

15 Appendix 2 (summary view) POST-BASIC/POST-REGISTRATION NURSE TRAINING WITHIN THE EUROPEAN UNION COUNTRY - NURSE QUALIFICATION/SPECIALITY LEVEL DURATION ENTRY QUALIFICATIONS ENTRY REQUIREMENTS & ENTRY EXPERIENCE Greece Specialist Psychiatric Nurse/Specialist Mental Health Nurse Post-basic 1 Year RN Diploma 2 years experience as qualified nurse AGE MINIMUM MAX 45 MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 1010 (1000) 24 THEORETICAL (500) 25 TECHNICAL - TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY STATUS OF THE TRAINEE Specialist Psychiatric Nurse/Specialist Mental Health Nurse Ministry of Health STUDENT APPRENTICE EMPLOYEE yes (leave of absence for study) 23 This is not a legal minimum but a de facto age. 24 The figure in brackets will by the number of hours should the proposals, to be recommended in late May, be accepted. 25 See note Error! Bookmark not defined. above.

16 POST-BASIC/POST-REGISTRATION NURSE TRAINING WITHIN THE EUROPEAN UNION COUNTRY - NURSE QUALIFICATION/SPECIALITY LEVEL DURATION ENTRY QUALIFICATIONS ENTRY REQUIREMENTS & ENTRY EXPERIENCE Greece Specialist Nurse in Medical Nursing Post-basic 1 Year RN Diploma 2 years experience as qualified nurse AGE MINIMUM MAX 45 MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 700 (1000) 27 THEORETICAL 1200 (500) 28 TECHNICAL - TITLE OF THE AWARD Specialist in Medical Nursing e.g. Certificate/Diploma etc. TITLE AWARDED BY Ministry of Health STATUS OF THE TRAINEE STUDENT APPRENTICE EMPLOYEE yes (leave of absence for study) 26 See note Error! Bookmark not defined. above 27 The figure in brackets will by the number of hours should the proposals, to be recommended in late May, be accepted. 28 See note Error! Bookmark not defined. above

17 POST-BASIC/POST-REGISTRATION NURSE TRAINING WITHIN THE EUROPEAN UNION COUNTRY - NURSE QUALIFICATION/SPECIALITY Greece Specialist Nurse in Surgical Nursing LEVEL Post-basic DURATION 1 Year ENTRY QUALIFICATIONS RN Diploma ENTRY REQUIREMENTS & ENTRY 2 years experience as qualified nurse EXPERIENCE AGE MINIMUM MAX 45 MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 700 (1000) 30 THEORETICAL (500) 31 TECHNICAL - TITLE OF THE AWARD Specialist in Surgical Nursing e.g. Certificate/Diploma etc. TITLE AWARDED BY Ministry of Health STATUS OF THE TRAINEE STUDENT APPRENTICE EMPLOYEE yes (leave of absence for study) 29 See note Error! Bookmark not defined. above. 30 See note Error! Bookmark not defined. above. 31 See note Error! Bookmark not defined. above.

18 POST-BASIC/POST-REGISTRATION NURSE TRAINING WITHIN THE EUROPEAN UNION COUNTRY - NURSE QUALIFICATION/SPECIALITY Greece Specialist Nurse in Paediatric Nursing LEVEL Post basic DURATION 1 Year ENTRY QUALIFICATIONS RN Diploma ENTRY REQUIREMENTS & ENTRY 2 years experience as qualified nurse EXPERIENCE AGE MINIMUM MAX 45 MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 1300 (1000) 33 THEORETICAL 600 (500) 34 TECHNICAL - TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY STATUS OF THE TRAINEE Specialist in Paediatric Nursing Ministry of Health STUDENT APPRENTICE EMPLOYEE yes (leave of absence for study) 32 See note Error! Bookmark not defined. above. 33 See note Error! Bookmark not defined. above. 34 See note Error! Bookmark not defined. above.

19 BASIC NURSE TRAINING WITHIN THE EUROPEAN UNION COUNTRY - Greece NURSE QUALIFICATION SPECIALITY Registered General Nurse LEVEL Basic DURATION 4 years (7 semesters of theoretical and clinical education and one semester of supervised practice) ENTRY QUALIFICATIONS National baccalaureat (12 years of education) apolytirion ENTRY REQUIREMENTS & ENTRY National pan-hellenic examinations EXPERIENCE AGE MINIMUM - 17 MAXIMUM n/a MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY STATUS OF THE TRAINEE CLINICAL 1500 THEORETICAL TECHNICAL Degree of Technological Education Institution Ministry of Education/TEI Registration as nurses by prefectures STUDENT - yes APPRENTICE EU DIRECTIVE EMPLOYEE 77/452/EEC 77/453/EEC

20 BASIC NURSE TRAINING WITHIN THE EUROPEAN UNION COUNTRY - Greece NURSE QUALIFICATION SPECIALITY Registered General Nurse LEVEL Basic DURATION 4 years ENTRY QUALIFICATIONS National baccalaureat (12 years of education) Aploytirion ENTRY REQUIREMENTS & ENTRY National pan-hellenic examinations EXPERIENCE AGE MINIMUM - 17 MAXIMUM n/a MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION TITLE OF THE AWARD TITLE AWARDED BY STATUS OF THE TRAINEE EU DIRECTIVE CLINICAL 1700 THEORETICAL TECHNICAL - at least 300 (optional) Degree University of Athens / Ministry of Education Registration as nurse by prefectures STUDENT - yes APPRENTICE EMPLOYEE 77/452/EEC 77/453/EEC

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