The future structure of nurse education: an appraisal of policy options at the local level

This paper describes the evaluation of investment options in nurse human capital and examines how managers can identify the costs and benefits of alternative arrangements. This study followed a request from four health districts on Humberside (East Yorkshire, Grimsby, Hull and Scunthorpe) where managers wished, following proposals from Yorkshire RHA, to make more effective use of resources for nurse training in face of a reduced supply of manpower and pressures to improve the quality of nurse training. The appraisal was carried out in consultation with nurse teachers, managers and the ENB. A framework of objectives and constraints was established within which options could be assessed. These included educational objectives, such as whether an option made it easier to develop post basic courses and to manage manpower constraints such as the retention of basic RGN education in the 3 districts where it was currently carried out. The educational criteria also covered curriculum development, the sharing of resources with universities and polytechnics and career attractions for teaching staff. Options were also assessed in relation to their timing, ease of implementation, flexibility and cost. Four detailed options were assessed and the third, that of establishing a jointly funded and organised college responsible for all nurse training across all four authorities, attained the highest score. This option involved the maintenance of self-contained basic, general nurse training circuits where they exist at present and will permit the development of post basic education. The study identifies significant incentives for cooperation between districts and outline a plan for the creation of a new College. The College would operate on a contractual basis offering courses which the health authorities would take up and pay for on an annual or bi-annual full cost basis. The College would also be able to sell courses to an outside market, for example on occupation health on Humberside, and it would aim to mobilise both NHS and other resources and to compete with outside educational bodies. There has been much discussion of change at the national level in nurse education. This paper examines how changes such as Project 2000 can be managed at the local level to ensure a more effective use of scarce resources. It provides a methodology for similar studies in other nurse labour markets.