1. 1 EU ACCESSION: IMPLEMENTATION OF THE DIRECTIVE 2005/36/EC IN LITHUANIA – EDUCATIONAL IMPLICATIONS Olga Riklikienė, RN, PhD Lithuanian University of Health Sciences Faculty of Nursing, Kaunas, Lithuania Workshop on Harmonisation of Education for Nurses and Midwives, Belgrade, 21-22 January 2013

2. 2 Lithuania Independence since 11th of March, 1990 Parliamentary Republic Capital - Vilnius Total area - 65,300 km² Population – 3222.2 thous. Religion - Roman Catholic Ethnic groups: Lithuanian 80.6%, Russian 8.7%, Polish 7%, Belarusian 1.6%,..... Language - Lithuanian (ancient Indo-European language form)

3. 3 Health Care Professionals (2011) No. of nurses – 22776 or 74,1/10 000 of population Intensive care nurses and anesthetists Operating theater nurses Community nurses Mental health nurses Emergency care nurses No. of midwives 903 or 2.7/10000 of population No. of physicians – 13327 or 38,7/10 000 of population

4. The last developments of Nursing Education in Lithuania 4

5. 5 From the history Long before the Independence nurses were trained during 2-3 years at 6 Medical Schools primarily by medical doctors Curriculum based in biomedicine Role of a nurse – servant to the physician

6. 6 From the history For the first time in the history of Lithuania the Faculty of Nursing was established in Kaunas Medical Academy, September 1, 1990 50 students were enlisted into the training program for University Diploma in Nursing First teachers - nursing positive physicians, visiting professors LUHS, Academy o Medicine – main building

7. 7 National post-secondary education reform In 2000 two levels of higher education (instead of professional schools) with a view to EU qualification system was established: non-university (college) studies university studies

8. Two steps entry level for a nurse: Higher diploma level nursing education (college) University nursing education –an earned BSN degree –further studies at the Master and Doctoral level –a nurse educator’s or nurse researcher’s career

9. Law on Nursing Practice, licenses and registration In 2001 the Law on Nursing Practice and Midwifery Practice passed the Law ensures that only those with diploma in nursing are able to work as a nurse In 2002 the National Nurses’ register, a legal licensure procedure, was started the MoH is competent authority, responsible for registration and the right to practice as a nurse 9

10. 10 Implementation of the Directive 2005/36/EC

11. DIRECTIVE 2005/36/EC DIRECTIVE 2005/36/EC (Sec.3, Article 31.3): The training of nurses responsible for general care shall comprise: –The entrance condition requests 10 years minimum of general school education –At least three years of study or 4 600 hours of theoretical and clinical training where: At least 1/3 is theory (i.e. ~1,600 hours) At leas1/2 is clinical instruction (i.e. 2,300) http://ec.europa/_market/qualifications/index_en.htm DIRECTIVE 2005/36/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 7 September 2005 on the recognition of professional qualifications

12. Nursing Education in Lithuania before TAIEX expertise (2002) 3 Universities - 4 y. Master level - 2 y. DiplomaBachelor of Nursing Doctoral level - 4 y. Clinical nursing Administration Psychology Social care Pedagogy Others Secondary education - 12 y 6 Colleges – 3 y. Nursing

13. 13 18-21 February, 2002 - an evaluation mission (peer review) performed by a team of experts from the EU Member States accompanied by EC officials with the support of TAIEX The subject of the evaluation - to consider if the education and practice of Nurses and other health care professions is in the light of the EU Dir 2005/36/EC Education of Lithuanian Nurses in the light of the EU Sectoral Directives

14. 14 It was concluded: The university program complied with the Directive of General Nurse Training and granted baccalaureate diplomas in nursing education The college program did not meet the standards of this Directive and granted only professional nursing qualification without any degrees

15. 15 Changes in implementation of the EU Sectoral Directive 2005/36/EC College programme of nursing education was revised and course length and design improved: Duration of studies was increased from 3 to 3,5 years Clinical Instruction hours increased from 1,800 to 2,300

16. Nursing Education in Lithuania after expertise 3 Universities - 4 y. Master level - 2 y. DiplomaBachelor of Nursing Doctoral level - 4 y. Clinical nursing Administration Psychology Social care Pedagogy Others Secondary education - 12 y 6 Colleges – 3,5 y. Nursing

17. 17 In University After successful examinations or defense the diploma is awarded and confirms: Professional qualification – A Nurse or A Midwife The qualification degree – Bachelor in Nursing

18. 18 Clinical training of nurses Directive 36/2005 (Sec.3, Article 31.5): In clinical training “the trainee nurse shall learn not only how to work in a team, but also how to lead a team and organise overall nursing care, including health education for individuals and small groups, within the health institute or in the community” “This training shall take place under the responsibility of nursing teachers, in cooperation with and assisted by other qualified nurses“

19. Development of Mentorship in Nursing European projects: ТЕNN, EmpNURS Erasmus teachers exchange Guidelines for nursing education, research and practice Textbooks and other teaching material Research on mentorship in nursing Course on mentorship for Master students Mentorship program for Continuing education of practicing nurses 19

20. 20 Education of Midwives In Lithuania The midwives’ training course of 3 y. was stopped in 1998 (1998-2001) – need for program corrections and low demand of specialists From 2003 diploma study program of 3.5 y. in college: the first graduation of 18 midwives in 2007 From 2010 university study program of 4 y at LUHS: 20-30 students enlisted each year

21. 21 “Bridging” system The legal recognition of credits granted by vocational schools or colleges for the continuation of education at universities Part time studies: 8 weeks per year, 2 or 3 y instead of 4 y (full time) depending on previous learning profile and competencies acquired

22. 22 Impact of mutual recognition and free movement

23. 23 Certification of nationally acquired professional qualification The MoH certifies that a registered nurse in Lithuania has lawfully practiced the profession in question for at least three consecutive years during the last five years prior to the issue of the certificate Free of charge Length of procedure: 2-6 weeks

24. 24 Trends of free movement for nurses No. of certificates were issued: 2004 y. since 1 st of May – 84 2005 y. – 183 (M–7) 2006 y. – 145 (M–9) 2007 y. – 96 (M–8) 2008 y. – 272 (M–7) 2009 y. – 107 (M–10) In the period 01 05 2004 - 2009 05 20: total 887 certificates were issued for nurses 158 nurses declared their departure Nurses make just 0.19 per of all emigrants

25. 25 Outgoing and incoming migration It is minimal. These trends are influenced by: cultural disparities and socialization, sedentary manner of life and profession, insufficient foreign language skills, assumed responsibilities for families…

26. Lithuanian perspective on the Directive 36/2005 The real reason that nursing has been reformed Training of nurses was taken seriously More arguments why nursing should be taught in HE system The program was improved 26

27. 27 Work of the Lithuanian Nurses Organisation The Lithuanian Nurses Organisation - the principal driver for reform of nursing and patient care It has established national networks and international links to ensure that the profession are well informed about progress in and out of Lithuania

28. 28 THANK YOU VERY MUCH FOR YOUR ATTENTION! Olga Riklikiene riklikiene@hotmail.com