Now is the right time to re‐evaluate how we educate and regulate health care professionals

In many parts of the world a focused re-examination of how and where we deliver health care is underway. Importantly, however, we are not simply re-examining how we deliver care, but also how we educate and regulate health care professionals. Some reasons for this include significant economic challenges, health human resource shortages or imbalances, and changing demographics and disease patterns. In the last few years, numerous national, regional and international initiatives have focused specifically on the education and regulation of nurses, or more broadly of all health professionals.1 All of these studies recognize the importance of: ensuring not just a sufficient quantity but also the quality and relevance of health professionals entering the workforce; overhauling education and regulatory systems so that they prepare socially accountable health care professionals able to practice collaboratively; preparing health care professionals to deliver care both in our current complex context of practice as well as locally relevant primary health care. I believe that the current focus on health care professional education and regulation is timely and important. As an ICN Consultant for Nursing and Health Policy, I travel to many regions of the world to participate in discussions of education and regulatory issues. It has become clear through this international dialogue, that in much of the developing world, health professional education is stagnant and poorly resourced, often with minimal or ineffective monitoring. The number of poor quality and poorly monitored private for-profit education programs has increased rapidly (Frenk et al. 2010). Regulation of health professionals is non-existent in some regions, and based on outdated legislation in others. Great variability in levels of education and regulatory oversight exists across the world. This variability presents a significant challenge for regulators dealing with increasing globalisation and a highly mobile health care workforce. Globalisation has also extended to nursing education programmes – students move from country to country seeking international opportunities and entire programmes are being delivered in other countries. Numerous broader factors in the global context influence the need to re-evaluate how we educate and regulate health care professionals. (ICN has produced a number of monographs on nursing education and regulation.2) Such factors include the impact of the economic crisis, aging populations, an aging workforce, greater connectivity and technological advances, the rapid increase in the prevalence of non-communicable diseases, and a more informed public with heightened expectations. Still other factors are the substitution of lesser skilled workers for highly qualified personnel, task shifting, the creation of new roles and categories of health care providers, the recognition that it is essential that health care professionals participate in life-long learning and the promotion of collaborative and interdisciplinary practice. In addition, because of the growing trade in health sector services, more people travel abroad for treatment and more service is provided across borders. We care for patients from many cultures, and work with more diverse nursing and other health professional workforces. Who is responsible for overhauling nursing education and regulation? The scope certainly goes beyond individual educational institutions and regulatory authorities. Nursing education and regulation involves multiple stakeholders which may include: government ministries such as the Ministry of Education, Ministry of Health and often both; ministries of labour and trade; professional associations; donor agencies; and of course, the public itself. All these players need to be engaged in the dialogue to strengthen educational and regulatory systems. Strong linkages between education, regulation and practice are absolutely essential if we are to accomplish the agenda of the future. It is time to re-evaluate the quality and the relevance of all health professional education and regulation globally so as to break down professional silos and align professional competence with changing health care needs. We must start at the beginning, that is, when we first introduce nurses and health care professionals to their future work. We must ensure that they are prepared with the right skill set and able to practice collaboratively. They will need knowledge and skills that are transferable to different roles and settings, and the curriculum must address the local context and include a global perspective. Tomorrow's health workers will need a broad and integrated knowledge base combined with an expanded repertoire of clinical, communication and interpersonal skills, as well as the ability to navigate social and ethical issues arising daily, and in exceptional situations (ICN 2010). Nurses need to be prepared to practice to the full scope of nursing practice. The right regulatory authorities and professional supports must be in place so they can do so. Now is the right time to re-evaluate how we educate future health care professionals and regulatory structures. It is not only timely but also essential if nursing is to lead the world to better health. Jean Barry, RN, MScN is a Consultant for Nursing and Health Policy with the International Council of Nurses. Her portfolio includes addressing nursing regulatory and education issues. Previously she was the Director of Regulatory Policy for the Canadian Nurses Association.

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