EDUCATION. An amendment to the Higher Education Ordinance for training nurses puts pressure on all nursing programs in Sweden to greatly and rapidly expand clinical training (VFU in Swedish). All universities with nursing programs have now signed a letter to the Ministry of Education asking for more time to complete the expanded requirement for clinical training.
The European Union’s professional qualifications directive already stipulates that nurses should receive at least 4,600 hours of training, at least half of which should be clinical training. However, Sweden has not fully complied with the directive, which the EU has now pointed out. This has led to a change in the Higher Education Ordinance beginning in 2023, which significantly increases the number of clinical training placements. Meeting the new requirements will be a major challenge for all Swedish nursing programs because there is already a shortage of clincial training placements with experienced nurses who can supervise students.
Potential risks
Swedish universities agree that trying to speed up the rapid expansion of clinical training placements poses several significant risks.
“If we have to expand clinical training so much and so quickly, universities may need to reduce the number of placements for new students,” says Inger Jansson, deputy head of education at the Institute of Health and Care Sciences. “As a result, we risk further exacerbating the already constrained situation with a nurse shortage. We also envision a significant risk that the quality of education and goal attainment will deteriorate.”
More time needed
The government has already made amendements in the Higher Education Ordinance, which states that Swedish nursing programs must comply with the EU’s professional qualifications directive for all programs starting this summer, after June 2023. However, all universities offering nursing education consider it impossible to implement the major revisions required on such short notice. For this reason, the universities have sent a joint request to the Ministry of Education and Research to reconsider enacting the regulatory changes so quickly.
“The government must pay fines to the EU when Swedish nursing education fails to meet EU requirements, which accelerated this decision,” says Jansson. “The study that led to the amendment of the Higher Education Ordinance proposed that universities be given an additional two years. We want that schedule to be implemented instead. This would allow the expansion of clinical training placements to be completed for programs that start after June 2025.”
The universities were also able to apply for a one-year exemption to implement the change–for programs starting in the autumn of 2024–which the University of Gothenburg has done.
“This exemption is a prerequisite for being able to adopt a new program syllabus, but this does not allow enough time to implement changes while maintaining quality,” says Jansson.
Earmarked funds
The government has also recently allocated additional funds to the universities that are earmarked for the expansion of clinical training in nursing programs. The University of Gothenburg has received about SEK 2.1 million, which is expected to be paid annually in the future. However, this does not even fully cover the cost increase for the needed placements, which the University pays per placement and per week.
“The increase in clinical training placements will cost more than what it costs for the clinical placements alone, since theory and clinical training need to be integrated. We now need to develop new strategies for meeting the clinical training placement requirement while maintaining the quality of education and patient safety. This is being done in close collaboration with both medical care authorities (regions) and municipalities,” says Jansson. “We already work with different forms of education, where we arrange seminars at clinical training sites, develop educational activities together, and introduce peer learning where two students carry out clinical training together and learn with and from each other. Research has shown this is a good method.”
Work is already underway to develop the new curriculum for the nursing program that is required to expand clinical training.
BY: ELIN LINDSTRÖM
