In response to T. Defloor, A. Van Hecke, S. Verhaeghe, M. Gobert, E. Darras & M. Grypdonck (2006) The clinical nursing competences and their complexity in Belgian general hospitals. Journal of Advanced Nursing56(6), 669–678.

Field: Health Professions (Health Sciences)

With great interest, we read the article by Defloor et al. (2006) about clinical nursing competences and their complexity in Belgian general hospitals, published in JAN. The complexity of nurses’ work and their various functions in clinical practice are, as they describe, well-known phenomena. Nowadays nurses’ work cannot be evaluated as a ‘task-centred’ job because it involves a complex set of caring activities with the client as a whole person. Nursing competences are of interest in Hungarian nursing practice as well. The demands of modern nursing require an adequate educational background with appropriate competences, which include cognitive, affective and psychomotor skills. Service developments have increased the demand for healthcare workers and, at the same time, have increased the new career opportunities open to healthcare professionals (Parkin 1995). The nursing profession in Hungary had not experienced many great changes until, after the societal and political reforms that occurred in 1990, the nursing education system was transformed (Betlehem & Olah 2003). The changes in nursing education involved not only lifting up the level of education from a vocational course to a BSc programme, but also renewing the way in which novice nurses were taught (Illei 1996). Although the basic nursing education programme in health vocational institutions still exists, now – >10 years later – the developments that have taken place, especially in research, teaching and management, have required higher education for nurses and so MSc nursing programmes were established (Mucha et al. 1991, Oláh 2003). Shortly after Hungary joined to the European Union, the implementation of the Bologna agreement (Betlehem 2005) resulted in the establishment of the first Doctoral School of Health Sciences in Hungary. These developments are summarized in Table 1. Although the development of academic education for nurses has achieved its formal aim, the debate of nurses’competences has become a burning issue of the current times. The skill mix in Hungarian hospitals does not mean that more highly qualified nurses (BSc and MSc) can concentrate only on those responsibilities for which they are educated. Specialization in different areas of nursing is not yet well developed. There are some pre-1990 post-registration specialist qualifications (for example, in intensive care nursing), but these are not congruent in content and format with the requirements of newly developed bachelors and masters nursing programmes. Therefore, it is essential to develop new specialized programmes in nursing that are congruent with higher education. In developing these programmes, Defloor et al.’s study might be useful in highlighting the areas of competences – cognitive, affective and psychomotor – that are required for more effective contemporary education of nurses, and for up-to-date patient care. In Hungary, there are nurses with significantly different levels of qualification (including those who undertook vocational training before 1990 and commenced this training at 14 years of age, and those who have undertaken a BSc or MSc degree since 1990 with initial admission to nursing no younger than 18 years of age), and this results in a large educational gap between younger and older members of our profession. This continuing presence of care providers with such different educational backgrounds requires regulation of competency levels in Hungary, and especially in emergency situations and in difficult situations as Defloor et al. concluded in their paper from Belgium.