Nursing Colleges Function Shift Annual Nursing Education Conference 04 September 2015 Hannelie van Rensburg Director: University Academic Planning, Monitoring and Evaluation 1
Presentation Content 1. Joint Submission to the Minister of Health and the Minister of Higher Education and Training 2. Matters to be considered 3. Feasibility Study currently underway 4. What happens after the feasibility study? 2
Joint Submission to the Minister of Health and the Minister of Higher Education and Training (Heading) JOINT SUBMISSION BETWEEN NDOH AND DHET TO BOTH MINISTERS OF HEALTH AND OF HIGHER EDUCATION AND TRAINING ON A SUGGESTED MIGRATION STRATEGY FOR PROVINCIAL PUBLIC NURSING COLLEGES TO A NATIONAL COMPETENCY UNDER THE NATIONAL DEPARTMENT OF HEALTH First Draft: 30 September 2014 Revised: 20 March 2015 Final: 23 April 2015 3
Joint Submission to the Minister of Health and the Minister of Higher Education and Training (3) - Background Summit in 2011 that culminated into a Nursing Compact Minister of Health appointed a Task Team on Nurse Education and Training Recommendations in Joint Submission based on assertion that the primary aim of nursing education and training is to provide adequate numbers of competent, service oriented and career focussed nurses to meet the health needs of the country. One of the strongest and most urgent recommendations: NCs to be declared higher education institutions, in compliance with the provisions of the Higher Education Act (Act 101 of 1997 as amended in 2008) 4
Joint Submission to the Minister of Health and the Minister of Higher Education and Training (3) - Background Failure to do so will result in: NCs being unable to continue offering nursing education and training at NQF Level-5 and higher beyond 30 June 2018 (it was 2013, then 2015 SANC Deadlines) 5
Joint Submission to the Minister of Health and the Minister of Higher Education and Training (4) - Background MTT recommended that Nursing Education and Training be regarded as a national competency accounting directly to the Director General of Health. Recommendation would have addressed: provincial inequalities, decrease fragmentation improve clinical training, enhance social accountability, eliminate fly by night nursing training institutions and improve quality, through setting of national norms and standards for nursing education This approach informed by sections 51and 52 of the National Health Act, 61 of 2003, that enables the National Minister of Health to establish educational institutions to educate and train health care personnel NB: In terms of the Constitution the overall mandate for HET is with the Minister: DHET. 6
Initiatives taken to address options and preferences Meeting of delegates representing the NDoH, SANC and the DHET: 08 Sept 2014. Purpose of meeting: Development of strategy for migration of PNCs from provincial to a national competency under the NDoH. Intention of Joint Submission: (a) To initiate a process to reach an agreement between the two Ministers on the migration strategy. 7
Intention of Joint Submission-continued (b) Explore other options/ arrangements between the NDoH and the DHET besides incorporation of NCs into the HE sector. In effect NCs remain the primary production platform of nurses in SA, support is sought from the two Ministers to approve that NCs as a national competency be mandated under the NDoH in collaboration with universities under the DHET. 8
DISCUSSION The future of nursing education offered at PNCs unclear since 2002 when the National WG recommended their incorporation into UoTs or universities. The recommendation was not acted uponnegative impact on the development of NCs. Currently, a NC is a relatively autonomous entity under the jurisdiction of a PDoH. 9
Discussion-continued NCs buildings, strategically positioned adjacent to hospitals to facilitate WIL/ clinical practice are the property of the DoH funded by a PDoH. In 2009 the NDoH commissioned an audit of all PNCs to inform HR planning and financial investment to improve infrastructural requirements for nursing education. 10
NATURE AND TOTAL NUMBER OF NURSING EDUCATION INSTITUTIONS: Source: 2014 SANC Statistics NATURE OF NURSING EDUCATION INSTITUTION Higher Education institutions TOTAL NUMBER 22+1 Private Higher Education institution. Active Public Nursing Inst. Incl. 3 Military Hospitals. 135 Private Nursing Education Institutions 101 Inactive Sub-campuses 84 TOTAL 343 sites Active: 259 Non-Active: 84 11
Discussion continued Based on the recommendations of the Van Wyk Commission Report of 1986 (as quoted from the Strategy) education programmes offered by the NEIs include: o 4-year programme- registration with SANC as a PN o Currently this could be a 4-year Diploma or a Degree Main difference between the two is the focus of preparation. 12
The diploma focuses on technical skills and the degree on science, art and research. Challenge: Policy directives ito of the HEQSF: 4- year diploma no longer exist as a qual type. o Other nursing quals include a 2-year Diploma in Nursing-registration as Enrolled Nurse. o One year Certificate in Nursing- registration as an Auxiliary Nurse o One year Midwifery Certificate- reg. as a Midwife 13
o Two year Diploma in Nursing: Bridging Course to cater for nurses with a 2-year Diploma-reg. as General Nurses (GN), need to take a 1-year Midwifery to register as a GN and Midwife. The graduates from both 4-year programmes have same scope of practice, job descriptions and remuneration. Challenge: Retention of graduates skilled in clinical areas 14
Noted: On average 80% of nursing cadres are produced at PNCs and 20% at universities, annually. The Nursing Education, Training and Practice Strategy (2012-2017) is based on the following integrated framework: 15
Historically there was a dialogue between the Minister of Health and the Minister of Education and the Department of Health A formal decision about the future of college based nursing education was never determined. This decision is more pressing now within the context of the delivery of the new nursing qualifications that falls within the higher education section of the NQF in terms of the HEQSF. 18
New Nursing Qualifications Framework aligned to the HEQSF OLD Qualifications NEW Qualification Qualification Duration SANC Reg. HEQSF Level Qualification Duration SANC Reg. Post-basic Course (Specialisation) 1 Register in area of Specialisation 8 Postgraduate Diploma (120- Credit) Degree 4 GN & Midwife 8 B-degree (480- credit) 1 Register in area of Specialisation 4 PN Diploma 4 GN & Midwife - - - - Midwifery 1 Midwife 7 Adv Dip 1 Midwife Bridging Course Diploma in Nursing Auxiliary Nursing 2 General Nurse 6 Diploma (360C) 3 Years Staff Nurse 2 Enrolled Nurse - - - 1 Auxiliary Nurse 5 Higher Certificate 1 Auxiliary Nurse 19
In terms of Student Enrolments the 259 active NEIs had a total headcount enrolment of 37 810 students in 2012. Headcount enrolments by qualification type in 2012 is as follows with the following split: 18 244 (48%) for the 4-year diploma and degree enrolments leading to registration as General Nurse, with specialization in Psychiatry, Community Nursing and Midwifery; 6 561 (17%) enrolments in the Bridging Course; 3 297 (9 %) enrolments in Enrolled Nursing; 6 290 (17%) in ENA; 1 457 (4%) in the one year Diploma in Midwifery 1 952 (5%) enrolments in post basic courses. 20
SANC has issued a circular indicating the implementation date of the new framework as 2015. NCs affiliated to universities commenced with preparations to offer the higher education programmes through continued collaboration with the universities. This included conducting audits regarding the state of readiness of NCs to offer new qualifications. An infrastructure audit is in place as well as a plan to conduct a profile of nurse educators to ensure that plans are in place for capacity development. 21
In this regard there has been a concerted effort with injection of financial resources from the National Department of Health towards the refurbishment of the infrastructure in the public sector colleges since 2010 22
Matters to be considered The offering of nursing education outside the domain of the DHET has a number of funding implications. These include that the students will not have access to NSFAS; or the Clinical Training Grants Colleges will not be able to benefit from Foundation Provision Grants, Infrastructure Development Grants and Teaching and Learning Development Grants to name but a few funding envelopes provided by the DHET to public providers of higher education. 23
Matters to be considered Implications of the new Qualifications Framework who will QA if under NDoH? Qualifications of staff at NCs If under DHET what is the impact on enrolment planning and block grant funding? 24
A model on how NCs should engage with Higher Education Institution is suggested: NCs will require to have a Memorandum of Understanding (MoU) with a University in order to offer Higher Education Qualifications in Nursing Sciences Education; MoUs should be between the University Council and the Nursing College Council and not with the academic department of Nursing in the University (as it is the case at present); Upon graduating from a programme a graduate will receive a qualification certificate issued by the University, with reference made to, or cobranding with the NC in accordance with the MoU, on the qualification certificate; The NCs will have to adhere to the 19 Criteria of CHE (Programme Accreditation Criteria). It was clarified that CHE accredits programmes and the SANC also accredits the education and training institution; 25
Model Continued Colleges will function as autonomous bodies with their own Legal Boards, as required by the Higher Education Act; Depending on the qualifications of academics in NCs, there may be a need for co-teaching with university staff until the academics in the nursing college meet the requirements and are competent to teach higher education qualifications ; The university will monitor quality of nursing education programmes; As a transitional arrangement NCs should plan to systematically phase out old qualifications and phase in new qualifications so as to not negatively affect the production of nurses; There should be a legal arrangement between the students and the academic institutions regarding the transitional arrangements; 26
Model Continue Nursing students should have the status of a full student (rather than employee) They should receive funding support for tuition, books and study materials, and living costs which should be paid monthly, Tuition fees should be paid directly to NCs. As students cannot receive medical aid and indemnity insurance, these benefits will no longer be available, but may possibly be utilised for funding support through a different envelope. NCs should follow a differentiated approach in offering of HEQSF Aligned programmes based on capacity and regional need. This process is to be facilitated by the NDoH, with the support of the DHET. 27
Model Continued The quality assurance function in terms of nursing as a profession will remain the responsibility of the SANC. Quality assurance of the academic programmes will remain the responsibility of the supporting university in accordance with the criteria and guidelines of the CHE. It follows therefore that the NCs will report to the National Department of Health in terms of governance, regulations and funding. 28
PROPOSED APPROACH 1. Collaboration at a national level between the Department of Higher Education and Training and the National Department of Health through the offices of the respective Deputy Directors-General responsible for nursing and higher education. 2. Collaboration at an institutional level between individual universities and NCs, based on formal Memoranda of Understanding in which the precise role and responsibility of each entity is stipulated. 3. The Provincial Departments of Health remain responsible for the provision and maintenance of the clinical training platforms required for nursing education. 29
Approach continued 4. It was decided that, pending approval from both the Minister of Health and the Minister of Higher Education and Training, the NDOH should: 5. Conduct a capacity audit of all the public NEI currently under Provincial Departments of Health; 6. Determine the state of readiness of NC to meeting national quality assurance standards 7. Conduct a mapping exercise by region of all NCs to inform determination of collaboration with universities based on geographical health needs, programme offerings on the Universities PQMs and availability of clinical training platforms required for Workplace-Based Learning; 30
Approach continued 8. That SANC postpones the final teach-out date of bridging programmes to at least 2018 and communicate this to the sector; 9. That, should the Ministers agree in principle to the content of this submission, a strategic planning session be organised in which the sector s stakeholders will be informed on how to proceed forward. 31
COMMUNICATION IMPLICATIONS In principle agreement to the proposed strategy by the two Ministers will require an official joint communiqué between the NDoH and the DHET to be circulated throughout the sector. Intensive sector liason 32
LEGAL IMPLICATIONS According to Section 21 (1) of the Higher Education Act 101 of 1997 as amended the Minister of Higher Education and Training may, after consultation with the Council on Higher Education (CHE), and by notice in the Gazette, declare any education institution providing higher education as a university, technikon or college, a subdivision of a university, technikon or college. In Subsection 21 (3) (a) (iii) the Higher Education Act states that the Minister of Higher Education and Training must consult with the responsible Minister if the education institution is administered, controlled or funded by an organ of state other than the Department of Higher Education and Training. (DoD; SAPS; DIRCO etc) 33
RECOMMENDATIONS It is recommended that the Minister of Health and the Minister of Higher Education and Training agree in principle to the proposed strategy towards migrating NCs from a Provincial to a National Competency under the Department of Health and to offer HEQSF Aligned nursing programmes in collaboration with selected universities. To obtain in principle approval, the migration of NCs (NC) from a provincial to a national competency under the jurisdiction of the Department of Higher Education and Training if above principal approval in paragraph 46 is not agreed to. 34
Recommendations continued The Ministers engage with each other on the proposed strategy and jurisdiction as a matter of urgency. The Ministers approve that the relevant Deputy Directors-General of the National Department of Health (NDoH) and the Department of Higher Education and Training (DHET) commence with the implementation of the proposed strategy. (JHSEC) 35
Feasibility Study currently underway Minister of Higher Education and Training did not approve the recommendations Reason: Needs a Feasibility Study Being done by DHET AUDIT OF THE CAPACITY OF NURSE EDUCATORS IN PUBLIC NURSING EDUCATION INSTITUTIONS (Draft 2), 2014 AUDIT OF PUBLIC NURSING COLLEGES AND SCHOOLS: A QUANTITATIVE OVERVIEW 20 JUNE 2010 AUDIT OF PRIVATE NURSING EDUCATION INSTITUTION AND NURSING DEPARTMENTS OF UNIVERSITIES (31 May 2010) A further due diligence may have to be conducted other than what's was already covered in the above reports. 36
Thank You Questions? 37