How to ensure the protection of the status of those who have gone through the training programme that is not compatible with a given regulation in nursing? Dr. Anne-Marie Ryan PhD, RGN, RNT, BNS, MSc FFNMRCSI, Chief Education Officer Nursing and Midwifery Board of Ireland TAIEX Workshop 22 January 2013 AMR1

European Union The internal market of the European Union is a single market in which the free movement of goods, services, capital and persons is ensured and in which European citizens are free to live, work, study and do business. Directive 2005/36/EC applies to all EEA nationals wishing to practise a regulated profession in an EEA State other than that in which they obtained their professional qualifications, on either a self-employed or employed basis. Its intention is to make it easier for qualified professionals to practise their professions in European countries other than their own. Public health and safety and consumer protection are safeguarded through the qualification recognition process TAIEX Workshop 22 January 2013 AMR2

Directive 2005/36/EC  Directive 2005/36 consolidated earlier 15 Directives Aimed to:  Modernise the rules regulating the recognition of the professions and the liberalisation of the provision of services  Ensure flexibility of procedures and mobility of professionals – special rules for General care nurses, midwives, doctors, pharmacists, dentists, veterinary surgeons & architects  All recognition should respect in any case minimum training conditions for certain professions. TAIEX Workshop 22 January 2013 AMR3

Theoretical Components of the Programme a. Nursing: — Nature and ethics of the profession — General principles of health and nursing Nursing principles in relation to: — general and specialist medicine — general and specialist surgery — child care and paediatrics — maternity care — mental health and psychiatry — care of the old and geriatrics b. Basic sciences: — Anatomy and physiology — Pathology — Bacteriology, virology and parasitology — Biophysics, biochemistry and radiology — Pharmacology - Dietetics — Hygiene — preventive medicine — health education c. Social sciences: — Sociology — Psychology — Principles of administration — Principles of teaching — Social and health legislation — Legal aspects of nursing 4TAIEX Workshop 22 January 2013 AMR

B. Clinical instruction Clinical Nursing in relation to: — general and specialist medicine — general and specialist surgery — child care and paediatrics — maternity care — mental health and psychiatry — care of the old and geriatrics — home nursing 5TAIEX Workshop 22 January 2013 AMR

Registering as a Nurse in Ireland EU-Trained Applicants who meet the with the European Directive (EU Directive 2005/36/EC of The European Parliament and the Council) An application for General or Midwifery registration that meets with the European Directive (EU Directive 2005/36/EC of The European Parliament and the Council). Such applications for registration as a nurse must apply to the competent authority for nurses and midwives at and registration is a relatively simple process once all the documentation is completed as required. Completed applications are required to be processed in a period of 3 months from receipt by the Member State. EU-Trained Applicants who do NOT meet the with the European Directive (EU Directive 2005/36/EC of The European Parliament and the Council) and NON-EU Trained Applicants An application for General or Midwifery registration that does not meet with the European Directive (EU Directive 2005/36/EC of The European Parliament and the Council) plus an application for a Division of the Register other than General Nurse or Midwifery will have to have the application undergo a full educational assessment otherwise known as a general systems assessment. 6TAIEX Workshop 22 January 2013 AMR

Assessment by General Systems The general system provides for an assessment, on a case-by-case basis, of the qualifications of an applicant against those required to practise in the host member state. If the activities covered by the profession in the home and the host member state are not comparable, then the qualifications cannot be recognised. If the activities are comparable but deficits in the qualifications are identified, subsequent post-qualification professional experience of the applicant must be considered. If deficits still remain, the host country must offer an applicant a compensation measure i.e. a choice of completing an adaptation period or taking an aptitude test. It is therefore important that you submit full information on all relevant post-qualification work experience. 7TAIEX Workshop 22 January 2013 AMR

Outcome of an Assessment The outcome of an assessment may be to: a): Register the applicant because he/she meets the EU Directive/ Nursing and Midwifery Board Requirements and Standards b): Refuse Registration because he/she does not meet the EU Directive/NMBI Requirements and Standards c): Require that the applicant must successfully complete a period of adaptation and assessment as a pre-requisite to registration with NMBI d): Require clarification/further information Please note that if there are anomalies or if insufficient information is submitted then clarification/further information will be required, which will significantly delay the processing of an application. The onus is solely on the applicant (except in specific circumstances) to ensure that all documentation is submitted and where necessary to follow-up regarding any clarification or further information required. The outcome of an assessment decision can be appealed to a committee of NMBI. 8TAIEX Workshop 22 January 2013 AMR

Harmonisation In the absence of harmonisation of the minimum training conditions for access to the professions governed by the general systems directive, host member states can impose compensation measures. The measure should be proportionate and in particular take account of the applicant’s professional experience. The migrant can choose between a period of adaptation or an aptitude test. Some countries have imposed a derogation on the aptitude test. The period of adaptation can be up to three years to cover substantial differences in the training. 9TAIEX Workshop 22 January 2013 AMR

Adaptation Period A period of adaptation is: The pursuit of a regulated profession under the responsibility of a qualified member of that profession with the period of supervision being accompanied by further training. The period of supervised practice will be subject of assessment. The rules will be clearly laid down by the Member State. 10TAIEX Workshop 22 January 2013 AMR

Acquired Rights Article 33 Acquired rights specific to nurses responsible for general care Where the general rules of acquired rights apply to nurses responsible for general care, the activities must have included full responsibility for the planning, organisation and administration of nursing care delivered to the patient. This provides for formal evidence of formal qualifications issued by the home Member State with a certificate stating that the holder has effectively and lawfully engaged in the activities in question for at least 3 consecutive years during the 5 years preceding the award of the certificate. The titles used will also be referred to as stated in the Annex of the Directive. 11TAIEX Workshop 22 January 2013 AMR

Acquired Rights Acquired rights also make provision for special recognition circumstances where the Member State did not meet Directive training requirements in advance of accession. One example is that of nurses in Romania. Article 33(a) As regards the Romanian qualification of nurse responsible for general care, only the following acquired rights provisions will apply: In the case of nationals of the Member States whose evidence of formal qualifications as nurse responsible for general care were awarded by, or whose training started in, Romania before the date of accession and which does not satisfy the minimum training requirements laid down in Article 31, Member States shall recognise the evidence of formal qualification as nurse responsible for general care (Certificat de competențe profesionale de asistent medical generalist) with post- secondary education obtained from a școal ă postliceal ă, as being sufficient proof if accompanied by a certificate stating that those Member State nationals have effectively and lawfully been engaged in the activities of a nurse responsible for general care in Romania for a period of at least five consecutive years during the seven years prior to the date of issue of the certificate. The said activities must have included taking full responsibility for the planning, organisation and carrying out of the nursing care of the patient 12TAIEX Workshop 22 January 2013 AMR

Tips for Applying in Ireland Complete Application Form Must be solely completed by the applicant in English. Must be sent directly by the applicant. Name printed & Reference Number must be on the reverse of the photograph. Form must be fully completed must be signed. If there is an issue regarding identity, a satisfactory explanation must be provided in writing. If there is a gap in the work history, an explanation must be given & signed. 13TAIEX Workshop 22 January 2013 AMR

Language Skills in the EU Directive 2005/26/EC requires that persons benefitting from recognition have a knowledge of the language necessary for practising the profession in the Member State Competent authorities can test for national language but only one. Testing can only occur after the qualifications have been recognised. TAIEX Workshop 22 January 2013 AMR14

External Complaints Mechanism - SOLVIT SOLVIT ( is an informal problem-solving network established by the European Commission. It was created to solve problems that EU citizens or businesses may experience with the public administrations of EU Member States. The SOLVIT centres are committed to obtaining a response within ten weeks without prejudice to the right of their clients to pursue other action, including legal action, if they are not satisfied with the response. SOLVIT can be contacted at its office in the applicant’s home countryhttp://ec.europa.eu/solvit/ 15TAIEX Workshop 22 January 2013 AMR

Professional Directions  Standards  Competencies  Scope of practice  Setting standards of education  Practice expectations competencies Education programme Practice expectations Scope of practice standards 16 Patient Safety