Visiting Researcher, Tuning Academy Registered Nurse - - PowerPoint PPT Presentation

Senior Lecturer, University of Malta Visiting Researcher, Tuning Academy

■ Registered Nurse ■ Professional Interests : -Nurse education (curriculum development and evaluation)

• Regulation of the nursing profession
• Policy development and co-ordination

(health and social care)

• Internationalisation in higher education

Email: Maria.Cassar@um.edu.mt Skype:maria.e.cassar Phone:+356 23401139

NURSE REFUGEES WITHOUT VERIFIABLE QUALIFICATIONS

Do Does es TUNING ING offer er a way y forwar ard? d?

THE SEA........

Authorisation use of images: Roberto Runza RobetrtoRunza Photography robertorunza@gmail.com

Asylum seekers and refugees…… Past reality? Prevalent reality? Future reality?

Some of the many thousands are qualif ified ied nurses Many others hold various other qualifications Problematic realities:

Unverifiable documents Missing Document/s Difficulties to search, access , reconstruct or retrieve missing documents

Facts

In the period from 2004 to 2014, in Norway alone, almost 1000 individuals were refused recognition of their claimed profession on the grounds of non- verifiable or missing documents

1

Without proper documentation of qualifications, displaced persons and refugees are at a serious disadvantage both within the labour market and if they wish to pursue further studies

2

Undocumented persons vary in need and moreover they vary across the (1) possibility and (2) willingness of having authorities in country/region of origin contacted by an reviewing/ evaluation body of a host country.

3

Various

• us coun

untr tries ies and entities tities have e developed eloped syst stems ems and initia tiati tives es to addres ress s these ese realit ities ies 4 examples……..

Germany

■ "Prototyping Transfer" project If applicants are unable to produce written evidence in the process of having their foreign professional qualifications recognised, they can have their competences assessed by way of a so- called qualification analysis, in order to gain recognition The Federal Recognition Act simplifies and standardises procedures for the evaluation of foreign professional or vocational qualifications governed by Federal Law and

• pens

up such procedures to target groups not previously entitled to pursue such a route. April 2012

No Norway

NOKUT, the Norwegian Agency for Quality Assurance in Education, provides that academic assessments of applications of persons without verifiable qualifications are carried out by expert committees commissioned and appointed by NOKUT.

Article icle 14 4 BQFG FG (Fed eder eral Rec ecogn

• gnit

ition ion Act) t) (1) If the applicant cannot submit all or part of the documents required for the establishment or assessment of equivalence in accordance with section 5 subsections 1, 4 and 5 or section 12 subsections 1, 4 and 5 for reasons beyond his or her control or if submission of relevant documents involves an unreasonable expenditure of time and effort, the competent body shall apply other suitable procedures to establish the applicant's professional skills, knowledge and abilities required for comparison with corresponding German professional training. The applicant must substantiate the reasons for not submitting relevant documents. …………. (2) Other suitable procedures to ascertain professional skills, knowledge and abilities as specified in subsection 1 include in particular work samples, interviews, practical and theoretical examinations and expert

• pinions.

Interview with Marina Malgina, Director NOKUT

9.3.2018

• The outcome of Nokut's work with refugees without verifiable documents is the determination of the quality

and level of academic studies pursued by an applicant, not the determination of the content of a programme

• f studies or training that an applicant claims to have pursued.
• Nokut does not seek to establish the fitness to practice of an applicant within a profession/ or a specific

subject area.

• The "passport" which Nokut establishes enables an applicant to seek admission to higher education, or to

seek employment, or to seek entry to a professional register but does not actually guarantee any of the three.

• The exercise which Nokut carries out with applicants largely comprises an interview with an applicant, which

in turn involves the review of any documents that an applicant may have and tracking down contacts related to an applicant's education. Subject area experts are drawn into the interviewing process accordingly.

• Th

The ava vailability ty of a frame mework which may guide the contri ributi ution

• n of subject

ct area experts ts would be favour urabl able. . It would d pro rovide de consistency ncy and enhance ce homogene eneity ty acro ross differ erent ent countries ries. . Such ch framework may be ava vailabl able e and used acro ross differe erent nt Euro ropean an countri tries s but the actual al registr trati ation

• n
• f a n

nurse e in any one countr try should be the decisio sion n of that specific c country

.

• Despite the availability of a (universal) framework which may guide the evaluation process of an applicant's

actual qualification/ training . education, the process of establishing the education / training/ qualification received by an applicant needs to, nevertheless, adopt a case by case approach.

Various

• us coun

untr tries ies and entities tities have e developed eloped syst stems ems and initia tiati tives es to addres ress s these ese realit ities ies

Gre reece ece

■ European Qualifications passport for Refugees ■ The European Qualifications Passport for Refugees is a document providing an assessment of the higher education qualifications based on available documentation and a structured interview. It also presents information on the applicant’s work experience and language proficiency. 3 rounds of applications completed to date

enic-naric website

The site is a joint initiative of the European Commission, the Council of Europe and UNESCO Guide for credential evaluators who seek to recognise qualifications held by refugees

Nokut UNHCR Council

• f

Europe

Ministr istry y

• f

Ed Educ ucation ation Greec ece

https://www.coe.int/en/web/education/documentary-on- project-european-qualifications-passport-for-refugees

What t has been en repor

• rted

ed regarding ding the e initiativ iative e rolling ing out ut in Greece ece:

“The ava vailabi ability ty of a frame mework

• rk which may guide

e the contri ributi ution

• n of subjec

ect t area experts ts would be favourabl rable.

• e. It would pro

rovide consistenc ency and enhance ce homogen eneit eity acro ross s different rent countri

• tries. Such

ch framework may y be ava vailabl able e and used acro ross differ erent nt Euro ropean an countri tries es but the actual al registrati tration n of a n nurse e in any one countr try should be the decisio sion n of that specific country” Marina Malgina, NOKUT Director

“We ne

need d to be able e to assess ess the qualif lifica ications tions that t one ne may have. e. This s assessment essment is to be va valid id not not onl nly y when en the refugee fugee first arriv ives es but where the refugee may move to” Sjur Bergan, Head of the education Department, Council of Europe

“ We need

ed so some e si simpl mple e way to ass ssess s the educa cati tion

• n and

d qua ualification ication which ch they may have e and to enable able them m to get et into

• the higher

her educ ucat ation ion and empl mployment yment systems ems of a count ntry” Curt Rice, Oslo and

Akenhaus University College of Applied Sciences (HiOA), Norway

“Refugees are part of a solution and they have qualif lificat icatons ns and skills lls . We need d to find d a wa way y to identify entify these se specifically“ Passa Polyioni, UNHCR representative, Greece

THE CONVENTION ON THE RECOGNITION OF QUALIFICATIONS CONCERNING HIGHER EDUCATION IN THE EUROPEAN REGION WAS DEVELOPED BY THE COUNCIL OF EUROPE AND UNESCO AND ADOPTED AT A MEETING OF NATIONAL REPRESENTATIVES IN LISBON SBON ON 8 - 11 AP APRIL IL 1997. THE CONVENTION ON THE RECOGNITION OF QUALIFICATIONS CONCERNING HIGHER EDUCATION IN THE EUROPEAN REGION, OTHERWISE KNOWN AS THE LISBON SBON REC ECOGNI GNITION TION CONV NVENTI NTION, ON, IS THE KEY LEGAL INSTRUMENT FOR RECOGNITION OF QUALIFICATIONS ACROSS UNESCO'S EUROPE AND NORTH AMERICA REGION. IN 2014, 4, 55 COUNTRIES NTRIES SIGNE GNED D THE E CONV NVENTI NTION ON AN AND 53 RATIF IFIE IED D IT

SECTI TION VII - RECO COGNITI GNITION OF QUALI ALIFI FICA CATION TIONS S HELD BY REFUGEES UGEES, DISP SPLACED CED PERSON ONS AND PERSON ONS IN A REFUGE UGEE E - LI LIKE SITU TUATION TION

Article VII Each Party shall take all feasible and reasonable steps within the framework of its education system and in conformity with its constitutional, legal, and regulatory provisions to develop procedures designed to assess fairly and expeditiously whether refugees, displaced persons and persons in a refugee-like situation fulfill the relevant requirements for access to higher education, to further higher education programmes or to employment activities, even in cases in which the qualifications obtained in one of the Parties cannot be proven through documentary evidence.

What is common across the 4 initiatives?

Assessment component Credential evaluators Subject specific mechanism not available (eg Nursing)

Nurse refugees : Missing Documents

• 1. Definitions
• 2. True stories Interviews Feb 2018 with

Hafsa, Kimete, Ayman, Yordanas, Kamara 3 Implications

• 4. Options for way forward
• 5. Invitation + Discussion

Refugee status implies “forced” mobility

YORDANOS ASSEFAW, FEMALE, AGED 48, THREE CHILDREN :

TRAINING PROGRAM IN PRIMARY HEALTH CARE NURSING BY THE MINISTRY OF HEALTH, ERITREA 1996 IN NURSING , ASMARA ERITREA SCHOOL OF NURSING, 2001 CERTIFICATE OF REGISTRATION OF HEALTH PROFESSIONALS: REGISTERED AS AN ASSOCIATE NURSE BY THE MINISTRY OF HEALTH, ERITREA: ISSUED ON 01/10/2002 TRAINING IN NUTRITION SURVEY, MINISTRY OF HEALTH, ERITREA IN COLLABORATION WITH EUROPEA EAN N COMMISSI ISSION ON - HUMANITARIAN AID & CIVIL PROTECTION (ECHO) AND COORDINAMENTO DELLE ORGANIZZAZIONI PER IL SERVIZIO VOLONTARIO (COSV), 2001 COURSE ATTENDANCE IN INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) CASE MANAGEMENT, TESSENEY HOSPITAL, ERITREA IN COLLABORATION WITH USAID, 2004 TRAINING WORKSHOP IN NUTRITION EMERGENCY PREPAREDNESS BY SAVE THE CHILDREN EN UK UK, ASMARA ERITREA, 2007 SHE HAS 22 YEARS EXPERIENCE AS A NURSE IN THE HEALTH CARE SYSTEM IN ERITREA. NO DOCUMENTS IN HAND IN MALTA, SHE HAS BEEN WORKING AT A RESIDENTIAL HOME, FOR THE ELDERLY, RUN BY THE CATHOLIC CHURCH AS A CARER, NOT A NURSE, FOR 3 YEARS !!!!

Interview May 2017

Hafsa Haydar

28 years old graduate with a Bachelor’s degree in Nursing Mogadishu University, Somalia in 2013 Works on product manufacturing line in a private pharmaceutical company Documents in hand but are unverifiable . Denied registration. Interview February 2018

KIMETE METE KIMI, MI, ALBANIAN REFUGEE IN MALTA IN EARLY 1990S, 50 YEARS, FEMALE

"We e are e not t simpl ply y ref efuge ugees. es. We c e came e her ere e to work rk. . We are nurses”

MAR ARY KAM AMAR ARA,

, 55 YEAR ARS FEMA MALE LE FROM SIERRA LEON

Arrived in Malta in 2000 without documents. Had to undergo full training nursing programme again in Malta. English as medium of instruction and service delivery worked fine. Moved to Holland shortly after graduating where her inability to speak the language there landed her once again out of a nursing role and nurse register

• f the country.

She returned to Malta and now works as a fulltime registered nurse after working for 5 years as a carer in Holland gaining eligibility for EU passport.

Dr Ayman Mostafa

DR AYMAN MOSTAFA IS ONE OF 212 SURVIVORS OUT OF 450 SYRIAN AND PALESTINIAN REFUGEES WHO PERISHED IN OUR SEAS ON 11 OCTOBER 2013.

HE NOW WORKS FULLTIME AS A REGISTERED SURGEON WITHIN THE PUBLIC HEALTH CARE SYSTEM OF MALTA FOLLOWING A PERIOD OF SUPERVISED PRACTICE . THE QUALIFICATION DOCUMENTS HE HAD AT HAND WERE INADEQUATE FOR REGISTRATION

Fatama and Joud

Inter ervie iew w with h Mr Ayman n Mosta tafa a Febru bruar ary 2017

■ The availability of a framework will allow a more objective and formal approach towards the verification of training and this is advantageous since such an approach will hind nder er the e pe perce cepti tion

• n
• f having

ing any favou

• ur

r or spe peci cial al trea eatm tment ent given to any one ne app pplicant/ ant/ pe perso son n by the e authori horiti ties es of a host t coun untr try. ■ The opportunity for conditional registration, that is the opportunity to practise under supervision for a period of time until one's competencies and skills are verified by someone in the host country, is favourable because it gives an applicant to ch chance ce to pr prove e what at he/ / she e claims s is true.

• ue. The proposed framework can be used to verify this.

■ Giving someone his/ her professional registration involves giving that someone a very big important part of life, po possibly sibly the e onl nly y pa part t that t wa was not not lost t in th n the e transit nsit from rom one ne coun untr try y to another nother. . Therefore all efforts to restore the professional recognition/ qualification of a person should be done. One goes from being a professional to being just a number and then to being a professional again. The changes in status are dramatically big.

• The feeling of gratefulness is immense and surely it is the most dominant feeling after

having my professional licence and opportunity to practise as a professional was returned to me. …………. Kno nowi wing ng that t this s came me through ugh the sens nsit itivi vity ty and nd good

• d app

pproa

• ach

h and nd decisions cisions of ind ndividua viduals ls and nd official cials s in th n the e system in M n Malta does es not not bothe

• ther me, but having

ing a forma rmal pr process

• cess in

n pl place would uld have e been en more re favourabl

• urable

e and nd would uld be bett tter er for r ot

• ther

hers s in n similar situations. ………… Since my circumstances are not uncommon, and the numbers of persons having to escape is big, a formal system for processing the request of persons like is needed.

Implications

■ The need to address the rights ts and requests uests of undocumented health care professionals ■ The opportunity to enable host countries to tap into unused resources amongst refugees – this is accentuated in the context of staff shortages + staff migration/ mobility ■ The obligation to safeguard patients’ safety and interests ■ The need to live up to the expectations from health (caring) professions ! ■ Political will and commitment

Local cal challenge = Local solution/ approach? Europe

• pe

wide challenge= Europe wide solution approach? Global

• bal

challenge= Multi- regional approach? Can Tuning Provide a feasible and effective avenue

Why may Tuning………

(1) Tuning projects have proved to be powerful instruments for promoti ting ng understandi standing ng and cooperation ration bet etween insti tituti tutions,

• ns, countri

tries es and regions

• ns across the

world

1

(2) Tuning projects focus on student dent- centredn redness ess, , compet eten ence ce-based sed criteria eria

2

(3) The main strengths

• f Tuning projects are

(a) openness ess to the different erent cultura ural l contexts xts in which academics and students work, and (b) the active quest for a mutuall ally underst stood

• od

disc scou

• urse

se and developing that is not fed in ‘top-down’, but negotiated across projects

3

(4) In Tuning projects exper erienced ienced and knowledg wledgeable eable recognised gnised exper erts s in specific subjects , in collectively, develop competence frameworks in a subject area

4

How w may y Tuning……… Wha hat t did the he Tuning ing lead eader ers s say….. Exp xplora

• rator
• ry

y exer ercise cise not t a a re resear search ch st study dy

Statement ent: : The

e TUNING ING compe peten ences ces frame mework k may be us used d to map the e trainin ning g and educa cati tion

• n of nur

urse se refugee gees witho hout ut un unveri rifia iable ble qua ualificat cation/ ion/s s in a host st or recei ceiving ving coun untr try.

The list below presents the five competence domains which TUNING Europe

• determined. These echo in TUNING South America, and TUNING-MEDA
• 1. Professional values and the role of the nurse

2.Nursing practice and clinical decision making 3.Knowledge and cognition 4.Communication and interpersonal skills (including technology ) 5.Leadership, management and team working.

What

at are your r views ws about ut this s stat atement ement please? ease? Kindly y share are though ughts s about ut (1) ) the he feasib sibility ty of the propos

• sal

al not

• ted

ed in the stat atement ement and about ut (2) the chall allenges enges which may be associ sociat ated ed with th this s propos

• sal,

al, pleas ase. e.

Clari rifica catio tion: n: The statement refers to nurses who have been assigned refugee status by the respective authority in a host European country, and how do not have documents in hand and minimal possibility to verify of the nurse qualification / training which one claims to have. Resour urce ce -http://tuningacademy.org/wp- content/uploads/2014/02/RefNursing_EU_EN.pdf

Interviews with Key Informants regarding Tuning (nursing)

■ Mary Gobbi (UK) ■ Marja Kaunonen (Finland) ■ Ingrid Kallok (Germany) ■ Grace Jaccarini ( Malta) ■ Sandor Hallos ( Hungary)

Snapshot of replies

“These competences maybe used as the framework of the acknowle wledg dgin ing g th the knowle ledg dge and d skil ills ls of

• f th

the refugee nurse se/he heal alth th profess

• fessio

ional nal wit ithou

• ut

t of

• ffic

icia ial l do docu cume menta tati tion

• n.” Marja

Kaunonen 3.2.2018

“The id idea of

• f gett

ttin ing refugees es wit ith edu duca cati tion

• n bu

but t la lackin ing th the do docu cume menta tati tion

• n ba

back to w

• work
• rkforc
• rce

e is is very im impor

• rtan

tant…….In n my

• p
• pin

inio ion th the Tunin ing co competenc nces es all llow to

• verif

ify y th the quali lific icatio tion

• f
• f a perso

son wit ith refugee sta tatus tus and d no d

• doc
• cume

ments ts, , who cla

• claim

ims to be a nurse.” Ingrid Kollak 5.3.1018 “The approach won’t work be becu cuase of the EU directive. ………... Also Tuning is graduate level….” Mary Gobbi 2.3.2018

“Feasibility should not be a problem…….I could imagine an assessment situation, in which a person with refugee status and no documents, who claims to be a nurse, is introduced to a patient's case. The person is asked to explain the implications of the case, the nursing process, the diagnoses, the necessary nursing care, her/his own activities, delegation

• f tasks, co-operation and so on” Ingrid Kollak 5.3.2018

My personal opinion next the competencies, you should to take into consideration the CALOHEE NSG Assessment Framework, and I think it is most important, to look after the assessment were used to prove the reported competences ( aspects and methods of assessment) E.g.: clinical capacity was assessed by theoretical exam of patient’s triage, or applicant can prove the capacity in real life environment as well? Sandor Hallos 3.3.2018

However er,

• The EC directive may cause problems for the registration. How would this be approved in EU vs

the directive for nurse education?

• A survey needs to go to the regulators to see what provisions they have
• How does one organise the testing for the competences of the applicants? How may the

competences be operationalised into concrete statements that actually measure the knowledge and skills the nurse needs?

• Who would be responsible to develop this kind of assessment? And Who would be responsible

for the testing and approval of the competences/ registration?

• Would it be valid in all EU countries?
• Would these refugee nurses have the same rights / same registration as the nurses educated in

the country? Is there scope for partial registration or temporary registration or conditional registration?

• Would there be need for some kind of pretesting/ pre-assessment preparation course?
• Should an assessment capture also the language capacity of an applicant and one culture,

attitude, motivation and social background?

Impor mportan tant t fa factor

• rs

s to consider nsider when hen look

• king

ng for the e optima imal ass sses essme ment nt so soluti tion

• n

Sets in at an early stage / fast Cost-effective Accessible Professional Fair / provides equal treatment Provides relevant information Provides feasible system for transition and easy mobility between regions, countries and educational levels

Marina Malgina 2017 EURIE, Eurasia Higher Education Summit, Istanbul

Measuri uring g and Compari paring ng Achievemen ements ts of Learning rning Outcomes

• mes in High

igher er Education ation in Europe

• pe (CALOH

OHEE) EE)

Do students enrolled in higher education around Europe develop the competences they need? Are study programmes delivering their promises? Can we learn to compare student’s achievements in different countries in a meaningful way? The EU funded project CALOHEE will help to find the answers to these questions by developing eloping the infrastructure that will eventually make it possible to test bachelor and master students’ performa mance nce Europe-wi wide de across ss a range e of fields s in a way that t sati tisfi sfies es the needs ds of the various

• us

stakehol holders ers in the Europea ean n higher er educati tion

• n commu

muni nity ty. The project covers five subject areas, representing five significant academic domains: Engineering (Civil Engineering), Health h Care (Nur ursin sing) g), Humanities (History), Natural Sciences (Physics) and Social Sciences (Education). The methodology to be developed should also be applicable for other fields of study. The frameworks to be developed in these fields will use the same methodology, but they will be tailored to the characteristics of each domain or subject area, taking into account the diversity of missions, orientations and profiles of universities in Europe and their various degree programmes

Di Diver erse se opi pinion nions s exi xist st

■ It’s their problem! ■ We have to safeguard the patients! ■ It would encourage irregular migration! ■ We need to be fair with the documented professionals! ■ There is not enough political will! ■ There is political will but inadequate resources to implement will! ■ Others …………………………………………………………………

In progress…… Next steps… Ex Exploring

• ring views

ws of the e Ar Archit itects ects/ / Direct ector

• rs

s of Tun uning ng Ex Exploring

• ring views

ws of the e EU EU/EC EC

• Mr Martin Frohn, Head of Unit in the unit “Free movement
• f Professionals” in DG Internal Market and Services
• Laura Corrado, Head of the Legal Migration and

Integration Unit in DG Migration and Home Affairs. Ex Exploring

• ring view

w of Regulators s in Eu Europe pe Malta and France : Contact made Italy and Portugal : in progress Other EU state : Searching contact ………………………………………………………. Thank you for your attention today ……..and continued co – operation !