The future of Swedish healthcare is a constantly topical issue. In terms of the supply of skills for healthcare, the medical and healthcare education programs at the country's universities have a large role in the debate. The university chancellor's office has recently taken a closer look at nursing education in Sweden, here the SFS quality committee (SQC) comments on the results of the review.
During the autumn, SFS had special reason to get involved in questions about medical and nursing education. Representatives from SFS have, among other things participated in a meeting with the National Care Competence Council and the National Board of Health and Welfare to strengthen future competence in primary care. This in turn has resulted in a final report which SFS has commented. SFS representatives have also had a dialogue with the University Chancellor's Office (UKÄ) about the ongoing evaluations that are carried out in the nursing education sector, including the thematic evaluation of Swedish nursing education.
In addition to that, SFS has also contributed consultation response on the state investigation Safer in the healthcare profession - a review of certain issues in training for nurses and midwives (SOU 2022:35). Finally, SFS has also met with Hans Wiklund, the national VFU coordinator appointed by the government, who is tasked with investigating how more VFU places can be created for the nursing courses.
The quality assurance system
A thematic evaluation is one of four components in UKÄ's national quality assurance system for the country's higher education institutions. The purpose of the thematic evaluations is to contribute to important knowledge and the possibility of national comparison in a certain issue. Unlike other components of the system, for example educational evaluations, the thematic evaluation does not lead to any sanctions for the higher education institutions.
The thematic evaluation Skill and ability in nursing education
UKÄ's previous thematic evaluations have focused on university-wide issues such as sustainable development and expanded recruitment. The starting point has been to follow up changes in the Higher Education Act. The thematic evaluation of the nursing program was instead initiated as a follow-up to UKÄ's education evaluation that was carried out in 2014. In that evaluation, all the universities that participated were approved, but UKÄ noted a need for a deeper analysis of students' prerequisites for clinical skills training. In consultation with representatives from higher education institutions with nursing education and students, a method was developed that would evaluate the students' conditions for achieving the graduation goals under skill and ability.
A discussion in the university council that has been in the past is that the thematic evaluations are at risk of having a political character because they look at values from the Higher Education Act that do not necessarily have a natural connection to quality in education. In a evaluation of its own quality system that UKÄ ordered there are voices that the previously reviewed areas, sustainable development and expanded recruitment, are part of the higher education institutions' social responsibility and not necessarily a quality aspect of the education. The same evaluation also points out that several actors in the higher education sector have highlighted that the thematic evaluations are at risk of being subject to political control. In this thematic evaluation, however, we think that there is a clear quality focus and a learning perspective that favors the development of the education. It is welcome that UKÄ develops its methods and looks after the needs of the business in these matters.
The result from the evaluation
In the thematic evaluation, among other things, the goal "show ability to work in a team and cooperate with other professional groups" was evaluated, which concerns interprofessional aspects of the education. It emerges in the assessment group's reflection that a number of higher education institutions find it difficult to offer skills training with student groups from other nursing educations. Instead, students are sometimes offered digital seminars and in other cases the skills training is referred entirely to the work-based part of the education, where the student can encounter fully trained healthcare personnel in another profession.
Students who study at universities where nursing education is the only care education may possibly ask themselves whether they are offered the same conditions to achieve the degree goal when compared to a student who studies at a university that has a broader educational environment in health, care and medicine.
Good supervision is a necessity in the clinical skills training. Despite this, according to the thematic evaluation, there is a lack of a national definition for what a supervisor's training should contain. Currently, higher education institutions' education varies both in scope and collaboration with the specific program. Due to the work situation, however, it is difficult for healthcare personnel to participate in the training offered to supervisors. There is also no requirement for supervisor training, something that both we and the assessment group believe must be regulated more clearly. The assessment group establishes several proposals regarding supervisor training.
- national education
- supervisor training as part of competence development
- implementation of action plans for new nurses who lack supervisor training
- inclusion of students in the work with supervisor training
- flexible forms of education
- inclusion of peer-learning
As part of the analysis of the clinical placements, the assessment group has drawn attention to a lack of cooperation with healthcare providers in the distribution of VFU places. The previous supply of clinical placements within inpatient care is decreasing as care becomes more specialized and new forms may be needed to offer enough places for all students. As regional and municipal VFU places are regulated by their respective guidelines, national differences have been noted in the ordering procedure. We want to draw attention to the potential risks of negotiating VFU places based on supply and demand, as it risks contributing to lower requirements for high quality.
Good clinical connection in theoretical parts of the education requires teachers with up-to-date clinical competence. Despite this, it appears in the assessment group's reflection that several institutions of higher education have difficulty recruiting teachers with that competence. It also appears that there is a lack of a plan for continued research links in the education. Here we want to highlight the need for more combined services for nurses as a step on the career ladder.
The political situation regarding the supply of healthcare competences
It has been pointed out in several places that a national shortage of nurses in healthcare has contributed to several regions being forced to close care places. As part of the problem, there is a need for the proportion of training places for nurses to increase and thus also the need for VFU places. In order to coordinate distribution and strengthen the quality of clinical education, the previous government appointed a national coordinator, Hans Wiklund, who took office in the summer of 2022. The assignment must be reported in December 2023.
Our hope is that the results from the thematic evaluation can be used for an overall analysis of today's nursing education in order to be able to conduct high-quality education in Sweden where the nursing staff of the future are given the opportunity to handle the challenges that the professional role entails.
In summary, the assessment group's reflection has contributed to a national overview of common shortcomings and strengths for Swedish nursing education. We hope that the basis is used for quality development purposes and believe that the results can also be used by student unions in their work with strengthened cooperation.
In order for higher education to be able to contribute to the supply of skills in healthcare, we hope that the conditions for healthcare education will improve. More employees in care must be prepared to supervise students in the future and a national supervision model should be developed that covers certain basic parts of supervision that can all be applied across the country.
Jacob Färnert and Tilda Jalakas, SFS Quality Committee (SQC)