Nursing in Denmark. Title The field of activity of nursing Registration requirements. EC rules. Introduction. Regulated Activity

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1 Nursing in Denmark Introduction Regulated Activity Title The field of activity of nursing Registration requirements Types of Nurse in Denmark Training EC rules Appendix 1 Specialised training

2 Introduction Denmark treats nurses uniformly across its territory. There are 21 nursing schools taking in roughly 2,400 students a year on a selective basis. Nursing in Denmark is traditionally a public sector activity. Roughly 1/3 rd of nurses (13,500) are employed in the Community with 2/3 rd being employed in hospitals. About 2% of nurses are nurse teachers. 1 In hospitals a hierarchy of nurses is established running from: Director of Nursing Service to Deputy Director of Nursing services to Head Nurse to Ward sister to Senior staff nurse to staff nurse. All nurses must be Sygeplejerske 2 and each grade of nurse (above) requires the appropriate educational qualification. When working in the community as a health visitor 3 a diploma in health visiting is always required. 4 1 Kirsten Stallnecht Denmark in Quinn & Russell Nursing the European Dimension (Scutari Press 1993) p See footnote Error! Bookmark not defined. and accompanying text. 3 The Danish health visitor (Sygeplejefaglig Diplomeksamen som sunhedsplejerske) works primarily with children, and is mostly employed by municipalities. 4 Sygeplejefaglig Diplomeksamen som sunhedsplejerske.

3 Regulated Activity Title In Denmark, only those authorised by the National Board of Health under the Nurses Act 5 have the right to practice as nurses in Denmark. The title Sygeplejerske (certified nurse) is a reserved title. 6 All nurses in Denmark practice under this title (and have responsibilities laid down in the Nurse s Act) even those with specialist qualifications. There are no legally protected specialist nurse titles. The title of specialist nurse, according to the circulars on specialist education, may only be used by sygeplejersker, who have undergone specialist education. Normally it is the employment market that determines the use of a specialist nurse, except in the case of the Sundhedsplejerske (Sygeplejefaglig Diplomeksamen som sunhedsplejerske) (the health visitor) where the law 7 requires a special qualification in order to hold the post. The field of activity of nursing In Denmark the law does not define a particular scope of activity for particular nurses. Registration requirements Authorisation from the National Board of Health is required in order to practice as a nurse. Registration is granted to those qualified on payment of a fee. 5 Nurses Act No. 127 of 25 May 1956 as amended. 6 The Act on Certified Nurses 1933 established this rule. It is now replaced by that mentioned in footnote Error! Bookmark not defined.. Generally see Kirsten Stallnecht Denmark in Quinn & Russell Nursing the European Dimension (Scutari Press 1993). Holding oneself out as a nurse is a penal offence if one is not registered with the National Board of Nursing. 7 Order Nr. 438 of May 14, 1995 on preventive health schemes for children and youth.

4 Types of Nurse in Denmark All nurses are general nurses in order to be able to practice in Denmark. There are no direct entry branch nurses in Denmark. However there are qualifying specialist nursing studies organised in following areas: anaesthesia nursing (SPECIALUDDANNET SYGEPLEJERSKE I ANÆSTESIOLOGISK SYGEPLEJE (ANÆSTESISYGEPLEJERSKE)) intensive care nursing (SPECIALUDDANNET SYGEPLEJERSKE I INTENSIV SYGEPLEJE) psychiatric nursing (SPECIALUDDANNET SYGEPLEJERSKE I PSYKIATRISK SYGEPLEJE) infection control nursing 8 (HYGIEJNESYGEPLEJERSKE) These nurses have the advantage of their speciality in the employment market but no reserved area of activity nor a special title which is legally protected. Additionally there are public health nurses (health visitors) that do have reserved areas of practice. 9 Training, as nurse specialised in anaesthesia, intensive care and psychiatry is organised at county level. The course in infection control is organised at the State Serum Institute and requires as prerequisite a course of advanced nursing studies. 10 Those undertaking these studies will have access to employment in nursing positions requiring special advanced 8 No courses have been run on this topic since 1990 and the curriculum is currently under review 9 See above. 10 EC Commission Doc. No II/D/1176/83 (October 1998)

5 qualifications. 11 The circulars on the education give the right to a new title. However they are still Sygeplejerske and practice under the title and responsibilities of Sygeplejerske according to the Nurses Act. Training This is set out in the Order on the Education of Nurses for the general care nurse. 12 All specialised training is carried out once achieving the status of Sygeplejerske. Specialist nursing education Orders are given by the Ministry of Health and circulars on the programmes are given by the National Board of Health. There are the nursing specialities set out above and also Advanced Education for Nurses in the following fields. These are run at the University of Aarhus School of Advanced Nursing Studies. These courses give access to particular nursing positions. The Sygeplejefaglig Diplomeksamen som sundhedsplejerske health visitor qualification allows access to Public health visiting health promotion and preventive work in the field. Some work for the counties in a more administrative role (County Public Health Officer). The Sygeplejefaglig Diplomeksamen med speciale i uddannelse og undervisning (Education and Teaching in Nursing) leads to being a nurse teacher in schools in basic social and health training and also a teacher in Nursing schools programmes (clinical mentor and educational coordinator) The Sygeplejefaglig Diplomeksamen med speciale i ledelse (Management/Leadership in Nursing) which leads to management roles in nursing. 11 Op. cit. p Order No. 143 of 2 March 1990 that is appended in English translation.

6 EC rules In Denmark the general nurse is trained at further educational level (admission equivalent to university admission requirements) level. This training complies with the sectoral nursing directives. The activities of Danish nurses are not themselves legally restricted to being undertaken by specialised nurses i.e. any nurse may undertake any functions provided otherwise qualified. 13 They, and their employers would be liable should a nurse undertake functions beyond their competence. Thus they would not be considered to be a different or separate profession. The migrant specialist nurse would thus enter the Danish profession as a general nurse (i.e. using the sectoral nursing directives) and then seek positions in their speciality in market competition with local nurses. Their specialist qualifications are assessed for equivalence by the Regional Councils for anaesthesia nursing, intensive care nursing, psychiatric nursing and infection control nursing, as appropriate. Such equivalence, once granted, would operate within that region only. There is an informal mutual recognition agreement between the regional councils. The Danish specialist nurse qualifications themselves are automatically valid throughout Denmark,. The only specialised nurse that has its own protected scope of activity is the health visitor Sundhedsplejerske (Sygeplejefaglig Diplomeksamen som sundhedsplejerske). They have an advanced diploma from Aarhuus university. Thus they form part of a regulated profession 14 but the question arises as to whether they might be considered as a distinct profession or merely an extension of the existing nursing profession. As they must all belong initially to the Danish nurse profession and they subsequently practise under the general nurse title, they should be viewed as an extension 13 With the exception of the health visitor nurse. 14 C-164/94 Georgios Aranitis v Land Berlin [1996] ECR I-135.

7 of it. On this view access by a migrant nurse would be through the sectoral nursing directives followed by application of the Treaty and case law rules to ensure that their knowledge and experience is recognised by the National Board of Health, and a certificate of equivalence issued. This process is undertaken under the EC Treaty and case law rules.

8 Appendix 1 Specialised training Specialisation in anaesthesia nursing COUNTRY - Denmark NURSE QUALIFICATION/SPECIALITY LEVEL Post-Basic DURATION 1½ Years ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY EXPERIENCE Anaesthesia Nursing 2 years experience as qualified nurse in hospital dept.'s and 6 months in a department of anaesthesia AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 70 weeks (incl. 1-2 h. of theory/week = h.) THEORETICAL - 8 weeks (approx. 200 h.) TECHNICAL - TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY STATUS OF THE TRAINEE Exams Bevis for specialuddannelse for sygeplejersker i anæstesiologisk sygepleje Regional Council for Education of Anaesthesia Nurses EMPLOYEE/ Student Theoretical Education (training) (finalised during the first year) 8 weeks Introduction, tests and exams 18 hours Central nervous system 9 Respiratory and circulatory systems 12 Preoperative assessment 6 Anaesthesia equipment 12 Monitoring 6 Preparing for anaesthesia 3 Pharmacology 18 Fluid and blood-component therapy 6 Clinical anaesthesia 9 Anaesthesia to patients with special medical conditions and pregnant women 12 Anaesthesia to children and older people 8 Anaesthesia in out-patient surgery 4

9 Anaesthesia in retaliation to special procedures 18 Assessment, nursing and treatment during recovery 6 Legal aspects and ethics 12 Acute anaesthetic assistance and patient transportation 9 Documentation and quality development 18 Clinical (Practical) Education (Training) 14 months Systematic clinical education (training) takes place under supervision and guidance in 2 different departments of anaesthesia and in a recovery ward.

10 Infection control nursing COUNTRY - Denmark NURSE Infection Control Nurses QUALIFICATION/SPECIALITY LEVEL Post Basic DURATION 3 months ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY EXPERIENCE 3 year as qualified nurse including teaching and administrative experience. Preferably done Advanced Nursing Education (diploma) in Education or Nursing Management AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 25 hours THEORETICAL hours TECHNICAL - 60 hours Exams TITLE OF THE AWARD e.g. Certificate/Diploma etc. Bevis for specialuddannelse til hygiejnesjeplejerske TITLE AWARDED BY Infection Control Nurses Educational Board STATUS OF THE TRAINEE Student The theoretical side lasts at least 215 hours Orientation Microbiology Hospital Infections Epidemiology 10 hours 50 hours 50 hours 55 hours Prevention of hospital infections 45 hours Organisation of preventive infection work 5 hours Exercises, group work etc. 20 hours (The clinical studies take place in hospitals with) Exercise and demonstration in a microbiology laboratory 40 hours (Demonstration [delete]) clinical studies and visits to relevant departments 25 hours

11 Specialisation in intensive care nursing COUNTRY - Denmark NURSE Intensive Care Nursing QUALIFICATION/SPECIALITY LEVEL Post Basic DURATION 1½ years ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY EXPERIENCE 2 year experience as qualified nurse in hospital dept.'s and 6 months in an intensive care dept. AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 70 weeks (incl. 1-2 h. of theory/week = h.) THEORETICAL - 8 weeks (approx. 200 h.) TECHNICAL - Exams TITLE OF THE AWARD e.g. Certificate/Diploma etc. Bevis for specialuddannelse for sygeplejersker i intensiv sygepleje TITLE AWARDED BY Regional Council for Education of Intensive Care Nurses STATUS OF THE TRAINEE Employee/student Theoretical Education 8 weeks Introduction, tests and exams 15 hours Respiratory failure and ventilation strategies 22 Haemodynamic and cardio-vascular failure 22 Shock types 6 Gastroenterological illness 8 Kidney insufficiency and failure 6 Neurological illness and accidents 11 Metabolism 16 Haematology and immunology 12 Multitrauma 9 Infections 6 Obstetrics 4 Endocrinology 6 Children 16 Documentation and quality development 18 Recovery patients 14 Sedation, relaxation, pain treatment 6 Equipment and troubleshooting 8 Clinical Education 14 months Systematic clinical education takes place under supervision and guidance in 2 different departments of intensive care and in a recovery ward.

12 Specialisation in psychiatric nursing COUNTRY - Denmark NURSE Psychiatric Nursing QUALIFICATION/SPECIALITY LEVEL Post Basic DURATION 1 year (incl. 7 weeks holidays) ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY EXPERIENCE 2 year experience as qualified nurse in psychiatric nursing AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL 55% = 925 hours THEORETICAL - 45% = 740 hours TECHNICAL - Exams TITLE OF THE AWARD e.g. Certificate/Diploma etc. Bevis for specialuddannelse for sygeplejersker i psykiatrisk sygepleje TITLE AWARDED BY Regional Council for Education of Psychiatric Nurses STATUS OF THE TRAINEE Employee/student Theoretical Education 20 units/weeks Clinical psychiatric nursing Quality development, teaching and guidance Co-ordinating, interdisciplinary trans-sectorial Clinical Education 25 units/weeks approx.60% approx.15% approx.15% Systematic clinical education takes place under supervision and guidance in minimum 3 different placements of which at least 2 are in general psychiatry (incl. sheltered admission ward).

13 Advanced nursing studies (Public) Health Visitor (nursing) diploma COUNTRY - NURSE QUALIFICATION/SPECIALITY Denmark Health Visitor LEVEL Advanced Post-basic DURATION 10 months (1 academic year) ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY EXPERIENCE 1 year experience as qualified nurse incl. - 8 months of paediatric nursing - 4 months of home nursing (within 5 years of starting the programme) AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) CLINICAL FOR QUALIFICATION THEORETICAL - TECHNICAL - 4 compulsory papers and 2 exams TITLE OF THE AWARD e.g. Certificate/Diploma etc. Sygeplejefaglig Diplomeksamen som sunhedsplejerske Nursing Diploma TITLE AWARDED BY School of Advanced Nursing Education at Aarhus University STATUS OF THE TRAINEE STUDENT The education for the Sygeplejefaglig Diplomeksamen som sunhedsplejerske includes at least 1520 hours 480 of which are contact hours : History of Nursing: approx.40 hours Conceptual and theoretical development in nursing approx.130 hours Selected scientifically based methods within the nursing profession approx.30 hours Nursing research as a means of developing the knowledge base of the nursing profession approx.40 hours The work of the Health Visitor approx.100 hours Organisation and administration of the work of the Health Visitor approx.80 hours Educational theory in the field of nursing approx.60 hours The clinical education (not training) is divided as follows: Health Visitors functions: General 16 hours Families with small children 5 days School children 4 days Groups in the local community 4 days Family studies 2 days

14 Advanced nursing studies Education and Teaching in Nursing diploma COUNTRY - Denmark NURSE QUALIFICATION/SPECIALITY Education and Teaching in Nursing LEVEL Advanced Post-Basic DURATION 10 months (1 academic year) ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY 1 year experience as qualified nurse EXPERIENCE AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL THEORETICAL - TECHNICAL - TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY STATUS OF THE TRAINEE 4 compulsory papers and 2 exams Sygeplejefaglig Diplomeksamen med speciale i uddannelse og undervisning (Nursing Diploma) School of Advanced Nursing Education at Aarhus University STUDENT The education for the Sygeplejefaglig Diplomeksamen med speciale i uddannelse og undervisning includes at least 1520 hours 480 of which are contact hours : History of Nursing: Conceptual and theoretical development in Nursing Selected scientifically based methods within the nursing profession Nursing research as a means of developing the knowledge base of the nursing profession Educational planning Educational theory Practical teaching methods approx.40 hours approx.130 hours approx.30 hours approx.40 hours approx.115 hours approx.75 hours approx.50 hours The teaching experience is set in authentic environment, mainly in schools.

15 Advanced nursing studies Management/Leadership in Nursing diploma COUNTRY - Denmark NURSE QUALIFICATION/SPECIALITY Management/Leadership in Nursing LEVEL Advanced Post-Basic DURATION 10 months (1 academic year) ENTRY QUALIFICATIONS Nurse (RN) ENTRY REQUIREMENTS & ENTRY 1 year experience as qualified nurse EXPERIENCE AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL THEORETICAL - TECHNICAL - 4 compulsory papers and 2 exams TITLE OF THE AWARD e.g. Certificate/Diploma etc. Sygeplejefaglig Diplomeksamen med speciale i ledelse (Nursing Diploma) TITLE AWARDED BY School of Advanced Nursing Education at Aarhus university STATUS OF THE TRAINEE STUDENT The education for the Sygeplejefaglig Diplomeksamen med speciale i uddannelse og undervisning includes at least 1520 hours 480 of which are contact hours : History of Nursing: Conceptual and theoretical development in Nursing Selected scientifically based methods within the nursing profession Nursing research as a means of developing the knowledge base of the nursing profession Management, organisation and administration Personnel management and development Educational theory (Teaching in Nursing) approx.40 hours approx.130 hours approx.30 hours approx.40 hours approx 170 hours approx 70 hours

16 Finally there are the degree awarding courses Masters in Nursing Science COUNTRY - Denmark NURSE QUALIFICATION/SPECIALITY Post Graduate Nursing Education in Denmark Masters in Nursing Science LEVEL Advanced Post-Basic DURATION ENTRY QUALIFICATIONS ENTRY REQUIREMENTS & ENTRY EXPERIENCE 2 years and 6 months Nurse (RN) (Nursing Education and authorisation [delete] 12 years of school (1 year of experience in clinical nursing [delete] 1 year experience as qualified nurse [insert] AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL THEORETICAL - TECHNICAL - 4 exams + Dissertation TITLE OF THE AWARD e.g. Certificate/Diploma etc. Cand.cur. (Master in Nursing Science) TITLE AWARDED BY Danmarks Sygeplejerskehøjskole School of Advanced Nursing Education at Aarhus University STATUS OF THE TRAINEE STUDENT And lastly Ph.D. study which lasts three years at post-graduate level. The entry qualification is Candidate (Masters) in Nursing or other health allied subject with a good research proposal. There is a theoretical course of roughly 120 hours. The title of the award is Ph.D. in Nursing awarded by the Faculty of Health Sciences, Aarhus University