New directions for postgraduate education: changes are afoot in the tertiary education sector. To ensure nursing benefits from the changes, leaders in education and nursing must develop strategic alliances.

The Government's tertiary education reforms threaten the quality, relevance and sustainability of current postgraduate nursing education. At the same time, they present an opportunity to enhance the quality, relevance and sustainability of this education. However, the opportunities will not be realised unless the profession and its leaders in practice and education plan for a new future. This paper highlights the current threats and suggests some possible opportunities for postgraduate nursing education.

Postgraduate nursing education was not established in the university sector until Massey and Victoria Universities developed masters level courses in the late 1970s and early 1980s. Since the late 1990s, the number of tertiary institutions providing postgraduate nursing qualifications has dramatically increased. Currently, five universities and two polytechnics provide master of nursing degrees, with an additional three polytechnics providing postgraduate certificates and/or diplomas.

The nature of postgraduate nursing qualifications has also changed. From being largely master's degrees with a significant research component, postgraduate education has changed to clinically focused postgraduate certificates, diplomas and master's degrees. These are primarily taught courses, with a much smaller research component. The only exception is Otago University's clinical master's, which has a full-time equivalent (FTE) research practicum. Consequently, the scope of nursing research projects at master's level tend to be much narrower than in the past. Larger nursing research projects tend only to be done by the relatively small group of nurses completing PhDs or the slowly growing number of nurses with PhDs. The change to clinically focused masters has also created a demand for nurse educators with advanced clinical skills, experience and qualifications.

These changes occurred largely in response to a recommendation in the Report of the Ministerial Taskforce on Nursing that "the postgraduate education framework recommended by the Nursing Council needs to be implemented by tertiary education providers". (1) The focus on the clinical masters programmes approved by the Nursing Council has created new opportunities for nurses wanting to advance their clinical practice. But it has moved the focus away from advanced practice in nursing education, management, policy and research, and arguably limited the postgraduate educational opportunities in those fields.

Since the Nursing Council assumed responsibility for developing competencies for advanced nursing practice and accrediting postgraduate programmes, its expectations, as expressed through its process for auditing education providers, have changed. Providers of clinical master's programmes must demonstrate, not only how students meet the broad competencies for advanced nursing practice, but also how they meet each of the indicators for each competency. This change significantly directs the required course content and assessment, and reduces the flexibility of council-approved postgraduate programmes.

Funding postgraduate education

There has also been a growing tension within all tertiary education providers between research and teaching, with research increasingly becoming the priority. This has happened because of explicit changes to Ministry of Education (MoE) funding as a result of the Performance Based Research Fund (PBRF). Since 2004, the MoE's research top-up funding for taught postgraduate courses has been progressively transferred into the PBRF. When the PBRF is fully implemented in 2007, taught postgraduate courses, undergraduate and non-degree courses will receive the same MoE subsidy. However, the Tertiary Education Commission's Report of the Funding Category Review found the costs of taught postgraduate courses were 11g percent higher than undergraduate courses; the fees for taught postgraduate courses were 15 percent higher; and there was evidence that undergraduate course funding cross subsidised taught postgraduate course costs. (2)

The funding issue in relation to taught postgraduate courses raised in the review was not addressed in last year's budget. The previous Minister of Education [Steve Maharey] was subsequently reported as saying that taught postgraduate course in areas of excellence should be supported by the PBRF and, as a result, there was no need for additional taught postgraduate funding. (3)

However, research components of less than one EFT, such as those in most postgraduate nursing programmes, do not qualify for additional funding under the PBRF. Therefore, to access the funding available through the PBRF, staff teaching in these programmes have to be research active and have high quality research outputs. This requires a different staff skill mix to that required for a clinical master's. Nursing performed poorly in the last round of the PBRF and it will take time, resources and, arguably, changes to the structure of the PBRF, to improve the performance of nursing programmes in the PBRF environment. Collaborative, interdisciplinary research and sharing staff resources between education and nursing service providers has the potential to make more effective use of existing research and clinical expertise. The briefing paper for the incoming Minister of Education [Michael Cullen] identified the need for a fiscally sustainable funding model in the tertiary sector, but made no mention of the sustainability issues associated with taught postgraduate courses. (3) University Vice-Chancellors have expressed continued concerns over the future of new taught postgraduate courses in universities in the wake of the Government's failure to address the issues raised in the TEC review. (4)

The same concern exists in the polytechnic sector, where a number of urban polytechnics offer postgraduate programmes in vocationally oriented areas such as nursing. There is a significant risk that the funding model for taught postgraduate nursing courses is not sustainable, particularly if the quality of such education is to be maintained, and the requirements of the Nursing Council and health service providers are to be met. Likely consequences of the reduced funding are fewer courses, larger class sizes and fewer educational providers. The development of regional and national alliances between educational providers and nursing service providers, and the delivery of courses through multiple modes of delivery (including online) has the potential to ensure nurses' postgraduate educational needs can still be met in the current funding system.

The structure of the tertiary education sector

Like the health reforms of the 1990s, the education sector reforms in the 1990s led to significant competition and a blurring of distinctions between various types of tertiary education organisations. The MoE plans to continue reversing those changes by supporting greater differentiation among tertiary education organisations. (3) The PBRF is a funding mechanism designed, in part, to force such differentiation, by increasingly moving funding towards institutions with superior research outputs. The shift in funding has been aimed principally at the universities and has adversely affected the polytechnic sector. This move to greater differentiation between universities and polytechnics could lead to the end of postgraduate education in the polytechnic sector and is also likely to affect undergraduate degrees in polytechnics. This could lead to a differentiation between bachelor of nursing graduates, depending on whether they were educated in a university or polytechnic.

The MoE acknowledges polytechnics are in a worse financial shape than universities. (3) And it indicates relationships between different institutions are important in terms of pathways for students and the potential benefits of strategic alliances. (3) It wants an appropriate national network of tertiary education providers to be developed. Providers of nursing education therefore need to be proactive in developing strategic alliances that ensure continuous educational pathways for nurses.

The Clinical Training Agency (CTA) has provided funding for a significant proportion of nurses doing postgraduate certificates in priority areas such as mental health, child health and emergency nursing. This funding has stimulated the development of postgraduate courses in those specialty areas and greatly reduced the cost barrier for nurses accessing those postgraduate qualifications. However, the CTA is currently reviewing all funding for nurses' post-entry clinical training.

Interdisciplinary learning

The Ministry of Health's vision for the health workforce is for "a well-motivated and skilled workforce able to deal with increasing demand and innovation in service delivery through teamwork, flexible working practices in multidisciplinary teams and the ability to retrain quickly to meet new challenges". (5)

To ensure the health system's capability to deliver this vision, the MOH recommends the incoming Minister of Health [Pete Hodgson] "reward developments in health workforce education that support broader and more flexible pathways into and between health practitioner careers and new health careers". (5) Thus, there is an opportunity to develop more flexible pathways. However, these opportunities may be limited because, white many health disciplines are prepared in universities, nurses, midwives, occupational therapists and radiation technologists are still largely prepared in the polytechnic sector. In addition, the Nursing Council requirements for a nursing disciplinary focus in the clinical masters limit the scope for interdisciplinary learning within such programmes.

Nurses' participation in postgraduate study

The Health Practitioners' Competency Assurance Act (2003) and the subsequent introduction of competency-based practising certificates with their requirement to demonstrate continuing education, is likely to boost the number of nurses starting postgraduate study. Using the Canterbury region as an example, New Zealand Health Information Service data shows that 4784 nurses work within the health sector in Canterbury. (6) The vast majority (4443) work in clinical roles, followed by roles in management (194), education (106), research (22) and policy (19). The clinical settings with the most nurses are continuing care (elderly) (536), mental health (550) and primary health care (536). The remaining clinical nurses work in a wide variety of specialist settings and within the larger groups there are a number of sub-specialties. The CDHB, which employs or funds a large proportion of those nurses, assumes a five to ten percent participation rate in postgraduate level study, (6) equating to approximately 220 to 440 nurses in Canterbury. However, the actual participation rate depends on a variety of factors including retention rates. The actual rate of participation by nurses and midwives in postgraduate (level 8) study in Canterbury in 2004 was 6.6 percent. Forty percent of those (137) were studying towards a postgraduate certificate, a significant proportion of which would have been funded by the CTA.

The CDHB projects stability in its requirements for nurse managers, nurse educators and nurses working in policy research and informatics. (6) The CDHB has no immediate plans in relation to nurse practitioners. However, it projects some growth in cynical nurse specialists and clinical nurse consultants and significant growth in new community-based advanced nursing roles and case managers. (6) Care of older people and their particular health needs has been identified as a major focus for future nursing workforce development within the CDHB.

A relatively small proportion of nurses are undertaking postgraduate education and those nurses are spread across a wide range of clinical specialties. To develop and maintain sustainable specialty courses, a strategic national approach is required. For some sub-specialties, the strategic approach may have to be Australasian.

The environment in which postgraduate nursing education operates presents a number of threats and opportunities. Realising the opportunities will require strategic leadership and cooperation within education and nursing.

(1) Ministerial Taskforce on Nursing. (1998) Report of the Ministerial Task force on Nursing. Wellington: Ministry of Health.

(2) Tertiary Education Commission/Ministry of Education. (2005) Report of the Funding Category Review. Wellington: Author.

(3) New Zealand Vice-Chancellors" Committee. (2005) Taught postgraduate misses out in FCR. Electronic News Bulletin 5:10. www.nzvcc.ac.nz. Retrieved 24/11/05.

(4) Ministry of Education. (2005) Briefing for the incoming Minister of Education. Wellington: Author.

(5) Ministry of Health. (2005) Health and participation an active agenda: Advice to the incoming Minister of Health. Wellington: Author.

(6) Ainge, N. (2005) CDHB Postgraduate Nursing Education Planning 2005-2009. Christchurch: Canterbury District Health Board.

Paul Watson, RN, BA (Hens), PhD Cand, is postgraduate programme leader in nursing at Christchurch Polytechnic Institute of Technology.