Thinking about the future: student nursing and Erasmus

10 October 2017

​By Sheila Cunningham, Associate Professor, Middlesex University

There is a shortage of nurses in most European countries which has created a workforce crisis. The recognition of professional qualifications, laid out in the relatively recent Mutual Recognition of Professional Qualifications (MRPQ) directive, enables free movement of professionals.

And it could be argued that this has contributed to increasing the movement of nurses which can help to fill vacancies. However, the future of the directive is unclear.

In the last ten years or so, the UK has seen an increase in student nurse mobility and expansion of clinical learning  environments. Although this number is significantly lower than many other degree subjects. Student nurse mobility benefits nursing programmes as well as students' professional development. Student nurse mobility could potentially be a positive step towards helping fill the surplus nurse vacancies. Erasmus exchanges enable mobility for nurses and have been a feature of many universities and colleges for years. However, it has not been without organisational, professional and bureaucratic challenges.

A challenge of differences

In Middlesex University, we are fortunate to have exchange credit recognition built into the BSc European Nursing programme, which comes with the same professional recognition as other nursing programmes: professional registration. Nursing programmes in the UK are tightly regulated by the Nursing and Midwifery Council (NMC). The NMC requires monitoring and analysis of placements, clinical mentor support and assessment of experiences. This is challenging enough in the UK, but even more so on overseas placements with different healthcare environments.

Many students at Middlesex University come from a variety of societal backgrounds (widening participation groups) for whom Erasmus funding has made the opportunity to study abroad possible. This is not unique to nursing. What is unique however, is the partnership working, close professional collaboration, mutual exchanges and the opportunities to broaden horizons for nurses.

Good partnership negotiation and communication means the benefits for student nurses undertaking placements abroad are maximised. However, moving forward, the negotiations on the future of Erasmus relationships once the UK leaves the EU could potentially hinder the valuable breadth of provision and the experiential learning opportunities. 

'Nurses' are defined in each country as those meeting the EU definition of trained and licensed nurses according to the MRPQ. It is evident that differences exist with the ongoing evolution of professional workforces. This has been of concern to the NMC for incoming and outgoing (exchange) nursing students and professional nurses. The principles of nursing preparation remain but the monitoring of nursing professionals varies in each country. For students, this has been a challenge in overseas mentor support. The role of mentors and students in clinical areas can vary from non-participant observer to full engaged hands-on caring work. 

The importance of close collaborative working

One year on from the outcome of the EU referendum, the future of the workforce and, importantly from my perspective, the opportunities for nursing students are unclear. It has taken many years to build relationships with European nursing partners. We need these valuable relationships to effectively communicate the needs of nursing students and facilitate exchange programmes.

Furthermore, programme requirements or objectives need careful negotiation and planning. Bilateral agreements to date enable, but are an incomplete picture of this. Comparison of curricula, skills and scope of practice requires precise management. While nursing is, in principle, the same (well, similar) in different countries, it is also different in application, technical skills and position within the healthcare team. From a UK perspective, supporting mentors, assessing students in practice, evaluating and quality assuring clinical learning environments is a challenge that is heavily regulated by the NMC. And we engage with it in what may be considered a UK-centric manner. 

That said, the rigor and confidence nursing students experience in any country is an assured a feature many countries are working towards. This area of collaboration can only benefit all exchange nursing education partners mutually. 

The mutual benefits of student nurse mobility

The benefits of exchange programmes to my students are huge.  In my university, evaluation data for the last three years from students that participated in Erasmus exchanges indicate impacts on professional and social identity, personal growth, resilience and ethnic sensitivity in caring encounters with diverse cultures.  This is only one dimension of impact. Incoming European students contribute to the experiences of those who do not go on exchange. Clinical areas that host international nursing students find the difference refreshing. In many cases they have been so impressed with the quality of work, the students have been offered employment or work opportunities on completion of their placement.

Clearly this is not a recruitment route but it does point to the volume of potential professional opportunities within the UK and across Europe. Ironically, while the UK may be seen as an increasingly unattractive option for EU nurses, growing numbers of UK-trained nurses are seeking new career opportunities abroad. The latest NMC figures point to an immediate change after the EU referendum.  Up to this point, the nursing profession was the most numerous, and increasingly mobile, element of the health workforce. 

Nursing is more diverse in many other countries outside the EU and exchanges with some of these are increasingly popular too. Countries such as Australia, Canada and the U.S.A have long been, and are still, a popular route. However, hands-on experience is variable and funding remains restricted (or non-existent) and may hold more barriers than the European route.  

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