Does education in Italy produce nurses fit for future healthcare needs?

Does education in Italy produce nurses fit for future healthcare needs? In Italy, a policy-level debate is underway on the future of nursing practice and its ability to address the public’s healthcare needs. New ways of delivering care need to be developed given the demographic changes in the Italian population which, in common with the rest of Europe, is ageing (Eurostat 2016) and that Italian health budgets are limited (Sasso et al. 2016). Naturally, Italy must develop a policy to suit its particular needs. However, a contribution to this debate could be drawn from other countries by seeing how they have addressed similar issues and determining whether the actions they adopted could be appropriate for Italy. Whatever policy is adopted regarding nursing practice, it is likely to have implications for nursing education. But is the present educational framework for nursing education in Italy appropriate for the purpose of producing nurses fit for future health needs? In theory, across Europe, we have the Bologna process (European Commission 2016a) ratified by all European countries, which matches eight different levels of education within the European Qualifications Framework (European Commission 2016b). This provides for bachelor’s (level 6) and master’s degree (level 7) education and, largely, nursing education fits within this model. In most European countries, entry to the nursing register is at the bachelor’s degree level or progress is being made towards that, and the master degree level education is available, but the content and purpose of master’s education differs across Europe. Level 7 education for nurses in the UK is far from uniform, but models exist that deliver education at level 7, develop advanced competencies and are closely linked to practice. Students can exit with specific advanced qualifications and competence only, but have the possibility of adding a year and completing their level 7 education with a master’s degree. Clinical skills delivered at the master’s degree level prepare nurses for higher levels of practice, which may be specialized or advanced, and include nurse prescribing. The boundaries between specialized and advanced practice are blurred, but specialist roles may include a focus on specific aspects of clinical practice where nursing skills are especially needed. These include chronic conditions such as diabetes care and rheumatology where nurses lead clinics in these specialities. Advanced practice encompasses areas such as emergency and critical care, and endoscopy where nurses can assume many of the diagnostic and decision-making functions previously the physician’s preserve and provide extended care to patients from admission to discharge. Nurse prescribing, initially proposed in DHSS (1986) and limited to very few medications (DoH 1999), is now virtually unrestricted (PSNC 2016) provided nurses work and prescribe within their area of competence. There is evidence to support the work of nurses in these areas. While reviews have shown little difference between nurse-led and physician-led clinics in terms of clinical outcomes, patients are always more satisfied with nurse-led clinics (APPG 2016), often because nurses can take more time with each patient. Randomized controlled trials of advanced nurse practice show similar outcomes, for example in nurseversus physician-performed endoscopy (Williams et al. 2009). With regard to nurse prescribing, these are very early days in terms of evaluation, but so far, the evidence of safety and efficacy is good and one thing is clear – in common with all of the above – it is more cost-effective than physician prescribing (APPG 2016; Kroezen et al. 2012) NHS-HENW 2015). In Italy, master’s degrees in nursing totally lack subjects that could enable postgraduate students to gain higher levels of clinical skills and thereby gain more ‘advanced’ knowledge and competence related to clinical skills learned during their bachelor’s programme. Instead, in Italy, master’s degrees in nursing focus only on providing additional methodological, managerial and didactic competencies. There has long been an international (including Europe) debate around the definition of ‘competence’ (Watson et al. 2002). However, some agreement exists with regard to the definition of advanced nursing practice, which includes the following core competencies: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration and ethical decisionmaking (Spross & Larson 2005). It is recommended that