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Coming to grips with nursing education funding: money for post-registration nursing education comes from a range of sources. Understanding the web of funding can be a challenge.

Understanding the funding streams for nursing education can be daunting. Funding comes from a variety of sources, meaning confusion over who funds what, and what criteria need to be met in order to secure the necessary monies. The current phase-in of the Performance Based Research Fund (PBRF) for the tertiary sector, under the auspices of the Tertiary Education Commission (TEC), has caused a shift in the distribution of funding between teaching and research activities, with the tatter gaining more emphasis and a (seemingly) higher priority. This shift is significant for nursing where there has been a move to clinically-focused postgraduate qualifications as nurses pursue nurse practitioner (NP) status. Shifts in funding have already seen Otago Polytechnic's nursing school axe its clinically-focused postgraduate courses. (1) Added to this repositioning is the fact postgraduate programmes must demonstrate how they meet Nursing Council competencies for advanced nursing practice. Education funding streams place emphasis on research, white regulatory bodies emphasise the need for taught (as compared with research) programmes to meet the competencies. These two competing drivers are creating new issues that must be resolved if nursing education is to meet its evolving needs. Funding for nursing education is not limited to the education sector. The Clinical Training Agency (CTA), now part of the Ministry of Health, is responsible for post-entry clinical training that has a minimum of 30 percent clinical component in any course/paper. The CTA was established to fund post-entry continuing education on a national basis following the 1992 "unbundling" of clinical education costs within the health sector. (2) In 1996, 90 percent of the initial $44 million budget was used for medical post-entry programmes, with a bare ten percent being allocated to programmes for nursing and awed health professions. (2) A decade later, this ratio remain similar.

The CTA's aim is to predict and prevent workforce shortages where they relate to a lack of post-entry training. However, the CTA is currently reviewing all funding for post-entry clinical training of nurses. (3) The CTA, in outlining its 10-year plan from 2003, states that "all CTA nursing funds will be channeled into first year of clinical practice and 800-level programmes focused on priority scopes of practice". (4)

The CTA has three streams of funding for nurse training. The first is the "deficit switch" project, from 1998, where funding was based on the amount of clinical training hospitals reported they were providing for nurses. Similar amounts of funding have been directed back to individual hospitals, regardless of need. These ex-deficit funds are used to access mainly academic programmes at a mixture of 700 and 800 levels in district health boards (DHB) only. The second stream is the base CTA budget, with purchasing focused on national, post-entry clinical training programmes; and lastly the ex-Mason funding, with two programmes purchased in mental health nursing. It is understood aspects of these funding streams are being reviewed. With the development of the NP role and its educational requirements, funding may need to be transferred from the ex-deficit programmes to nationally specified programmes that enable nurses to better meet health demographics.

Nursing entry-to-practice programme

The pilot first year of practice programmes were evaluated in 2003 and, overall, were found to be effective. A national programme, the nursing entry-to-practice programme, has now been set up, with funding for up to several hundred places earmarked in the CTA budget. The total number of places will be capped if funding is not adequate for all those who apply. The CTA's funding of $6000 per new graduate subsidises each DHB's costs. Additional funding has been set aside to assist with education delivery of the programme, and for the work required to establish it. The programme will cost around $12,000 per graduate, although each DHB's costs may vary. The new graduate mental health nursing programme will continue as usual This programme offers a postgraduate certificate at level 8, which can be credited toward further academic and clinical study, including the NP pathway.

The CTA also purchases and funds post-entry clinical training (PECT) programmes for mental health nurses who have been in mental health and/or its specialist areas for at least two years. These programmes provide nurses with advanced skills and knowledge and prepare them to practise at an advanced level However, there has been considerable variation in the strategies reported within the DHB and non-governmental organisation (NGO) sectors to enable uptake of PECT programmes. These range from nurses being encouraged and well supported, to nurses being unaware of the availability of the programmes. (5) As well, the shortage of nurses and high workloads make it difficult to release nurses for study days. This particularly applies to the specialty areas of liaison psychiatry, maternal mental health and community mental health services, including Pacific services. (5)

There is overwhelming support for CTA-funded new graduate and advanced programmes for mental health nurses. Suggestions have been made for future purchasing that could mean greater access and availability of PECT programmes. (5)

CTA-funded programmes could be used as a recruitment strategy for new graduates, to attract registered nurses working in other areas into mental health and to draw back those who are no longer practising as nurses. They are a valuable recruitment and retention strategy, as they provide an extended and funded education pathway, and have positive implications for patient outcomes.

Hopefully there will be a more transparent process of CTA and TEC funding following the current reviews, and a recognition that balanced development of competencies is every bit as important as research.

References

(1) Nurse assistant course to start while postgraduate courses end. Kai Tiaki Nursing New Zealand; 12: 6. Wellington: NZNO.

(2) Jacobs, S. (2005) Advanced nursing practice end the nurse practitioner: New Zealand nursing's professional project in the late 20th century. (Unpublished thesis in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing.) Hawke's Bay: The Author.

(3) Watson, P. (2006) New directions for postgraduate education. Kai Tiaki Nursing New Zealand; 12: 5. Wellington: NZNO.

(4) Ministry of Health (2004) Clinical Training Agency Strategic Intentions 2004-2023. Wellington: Ministry of Health.

(5) Ministry of Health. (2006) Mental Health Nursing and its Future: a discussion framework. Report from the Expert Reference Group to the Deputy Director-General Mental Health, Dr. Janice Wilson. Wellington: Ministry of Health.

By professional nursing adviser Anne Brinkman
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Title Annotation:funds for nursing courses
Author:Brinkman, Anne
Publication:Kai Tiaki: Nursing New Zealand
Date:Aug 1, 2006
Words:1050
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