The world of nursing education funding.

THE WORLD of nursing education often seems esoteric. It is almost like a club you may or may not belong to, one whose membership criteria are unclear. I realise, however, I need to revise my position and get a grip on the situation. Too much is at stake to feel excluded from this world.

Some recent work on post-entry nursing education has been the catalyst for this change in thinking. The availability and structure of post-entry clinical training (PECT) is an issue of vital importance to nurses. And yet many nurses don't even know what PECT means--let alone how to get involved in discussing it. PECT refers to any post-registration training a nurse might undertake, whether provided by an employer or within a tertiary institution. The fact a document on post-entry clinical training will be released shortly is welcomed. But the question remains--why is it so many nurses feel removed and not part of the debate on the funding and organisation of post entry clinical training?

For one thing there is the language. It's full of acronyms, unfamiliar and very off-putting. I've seen many eyes glaze over and confused looks when acronyms like PECT, EFTS, TEPS and CUAP * (to name just a few) are dropped into conversations and discussions on the topic.

And then it is really hard to understand the linkages and connections. Take funding, for example. There are all sorts of funding streams. Some nursing education funds come from Vote: Education, some from Vote: Health, some from district health boards, some from speciality nursing groups. Many nurses fund their own post registration education. It is really quite difficult for the average policy analyst to get a good grasp on the complex world of nursing education funding--and to understand how and why things are as they are. And there's another complexity: how did funding of post-entry clinical training evolve to its present form?

The present funding basis derives largely from the "unbundling" exercise of the 1990s, which attempted to separate out training costs from hospital costs. The "unbundling" exercise is regarded as a very complicated and imperfect exercise. There have been some extra funding allocations since 1995. Eyes really glaze over when it is stated that the funds increased because of money allocated from the "ex-deficit switch". Put simply, the "ex deficit switch" is a pool of money allocated to the Clinical Training Agency (CTA) to identified areas of under pricing, or where there were more trainees required than funded. I offer this explanation to demonstrate why nurses may not get too excited about the funding of nursing education. It all seems rather obscure.

But it is imperative we are not put off by this complexity and that we become knowledgeable about the funding sources and the organisation of post-entry clinical training. Ownership will only come from nurses taking some time to understand it and piece together the bits we know and find out the bits we don't. I was not surprised to read recently, in a publication from the CTA, this statement: "Funding for post-entry clinical training in nursing is limited. In addition, in the past, the allocation of any funding available has lacked a clear direction because the sector has been fragmented." (1)

I agree. The nursing sector has been fragmented in its position on post-entry clinical training. Though the release of the document is a start, there is a significant way to go before we have acceptable consensus on a strategy. However, it is essential nurses do find common points and agreement and are involved in developing the strategy. Fragmentation in the nursing sector does not serve nursing education well.

The allocation of CTA funding for nursing training shows just how fragmentation has not served us well. Nursing is the largest group of health professionals, yet is allocated only ten percent of the CTA budget. The CTA funds 947 training positions specifically for nurses. On average, this equates to $282 spent on each registered nurse a year. (1)

On the face of it, this seems unfair, but more analyses than these simple facts have to made to make a fair and comprehensive judgement. The CTA, in deciding the allocation of nursing training funds, considers who else provides nursing education, what programmes are already in place and current health priorities.

Nurses have not only been fragmented; they have also been apathetic and left it to a few to make decisions and lead these discussions. This does not ensure fairness, progress or participation. Too much is at stake if rank-and-file nurses don't argue for their right to be involved and question how things are organised. The funding of nursing education is a complex world and decisions are not easy. But that doesn't mean we shouldn't attempt to understand it and debate the issues in accessible language.

Post entry clinical training is a vital good for every health professional and the right of every nurse. By avoiding the issues, we remove some of our power base and our ability to challenge decisions. All nurses need to get a grip on the funding and organisation of post-entry clinical training for their own good, that of their profession and of their patients.

* PECT: post entry clinical training; EFTS: equivalent full-time students; TEPS: tertiary education providers; CUAP: committee of universities academic programme.

REFERENCE

1) Ministry of Health (2001) The Health Workforce. A Training Programme Analysis. Author.