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History notes.The unforgettable years

The unforgettable years 

1955 – The birth of the Colleges   

It is 1955 and Italians are trying to forget their memories of the war and even if they were still unaware of it, they were getting ready for the booming years. It is in this climate that the Colleges of the professional nurses, the children’s nurses and the assistant health visitors, are established by the Governmental Decree of October 1954. The Colleges were established above all thanks to those ladies who worked in the health sector who became aware that they had become precious, but were still not professionally recognized, because the 1946 Decree on health professions only aimed at re-establishing the registers for medical doctors, veterinarians and pharmacists and established the Colleges for Midwives.

However, from then on, the Colleges and the IPASVI Federation have continuously developed, recording all the stages of their growth and changes where nursing has been the main protagonist. The first important step was to convince nurses, children’s nurses, assistant health visitors, religious and lay people to register in their respective Colleges: according to the data gathered in 1959, on the occasion of the national census of the healthcare service providers, showed that good results had been achieved, but there were still some difficulties.  

1965 – Nurses meet for their Congress  
Now there was more wealth and more freedom of movement, thanks to the fact that more and more people could afford to buy a car. So, at last the Federation of the IPASVI Colleges was able to organize its first National Congress, held in Rome between 31st May and 2ndJune 1965.

The venue chosen for the opening ceremony was the Palazzo degli Uffici, in the most modern district of Rome, called EUR, where all the “top religious, military and civil authorities” were present, as the papers in those days reported.

Even if the photographs seem to show a very rigid and formal reality, the opening speech of the President of the time, Laura Sterbini Gaviglio, was by no means ritual: thinking back to the stages of the ten years of life of the Collegi, she underlined all the difficulties nurses had faced, from the lack of public and free training schools, the problems of contractual engagement, up to the more general defence of the dignity of nursing, concluding with the statement that it is now time “to achieve a system of social security”.  

1971 – Make way to men!
“Extension to male staff of the practice of the nursing profession”: these are the words of the law n. 124 of 25th February 1971 that ratifies a real revolution in the world of nursing. Until now, the history of nursing had exclusively belonged to women: a female saint to protect them, the matron Fabiola who dedicated herself to others in ancient Rome, a woman as an ideal paragon, Florence Nightingale, and then many other women in hospitals, for hygiene controls in the poorest parts of the Country, in caring for infants. Nurses’ work, considered as “auxiliary” and “vocational”, was judged to be particularly adapted for women and above all for women of religious orders, who for many years accounted for the majority of the nurses.

It was a situation that produced, as a consequence that perhaps was not deliberate, the curious “anticipation” of females desiring to be in the limelight, by covering top-level posts, just like the two nursing representatives who by right were asked to become members of the Higher Council of Health in 1957. However, the development of the society steadily leads to a radical transformation of the role of nurses, who gain more and more professional competence and autonomy. So, even for a question of social equity, men could no longer be excluded from this profession, who in any case were allowed to become general nurses (as a matter of fact, it is precisely on the distinction between professional nurses and general nurse that a harsh debate bursts out between legislators, parties interested in enrolling staff and the IPASVI Colleges, who did their best to protect the professionalism until then gained through many years of hard work). The introduction of men into nursing would have also contributed to speeding up the change of the educational curricula, starting from the boarding schools that had to give up boarding for the new students.  

1973 – European standard education  
Italy accepts the European Agreement on the education and training of professional nurses (Law of 15th November 1973, n. 795). It is an important stage in the history of nursing: this document will then become the point of reference for the entire process of legislation reorganization that shall develop from the Sixties to nowadays. As a matter of fact, the Strasbourg Agreement outlines the essential points that will allow to review the teaching programs and defines the educational role of the practical apprenticeship of the students. In order to conform to the European directions, which include 4600 hours of teaching, new study curricula are drawn up and therefore an extra year is added to the courses, so that their duration passes from two to three years. The aim is twofold: to improve the quality of education and offer nurses the chance to go and work in the other Countries who signed this agreement.

1974 – The tasks are renewed   
In 1974, the DPR 225 defines the nurses’ sphere of activity and competence, with the so-called “Mansionario” (Job Description), which changes the previous regulatory rules for the profession that dated back to the 1940. In 1978, with the passage of the Law 833, we have the reform of the Healthcare Services, which was preceded by a preparatory period to reorder the activities of the health professionals. On the whole, the “new” job description is positively welcomes by the representative bodies of nursing who, when it was issued, considered it as an important stage of the evolution of nursing, even though they did notice some contradictions.

The text tends to establish a different approach towards the recipients, who are no longer considered to be just a sick person with clinical problems, but as a person with psychic, physical and social needs. With this new approach, the relational aspects of nursing become of fundamental importance, thus enhancing the functions of nurses, as well as the wording in the DPR highlights. For instance, the word “carrying out”, used in the previous law, is nearly always substituted by the words “planning” and “promoting... initiatives”; furthermore, the word “coordinating” is introduced and the word “depending” is removed.

The Job Description extends the scope of nursing from hospitals to public health services, and includes the areas of prevention, treatment, rehabilitation and healthcare. Also the nurse’s role as educator is recognised with regard to recipients and families, and to other health workers and students.

In short, with the DPR 225 nurses gain their own professional character, more conform to those days, which also means recognition of a certain grade of operational autonomy and precise responsibilities for those activities the legislator described as typical of nursing: however, it was a list of job descriptions that soon became outdated after its impact with the transformations introduced by scientific and technological progress.

1978 – Enough with the workers’ sickness funds, we now have the National Health Service
In 1978, ten days before Christmas, the Premier Giulio Andreotti, the Minister of Health Tina Anselmi, with such a vast parliamentary alliance - that in recent times has only been seen for the elections of Mr. Ciampi as President of the Republic – after years of debates and clashes, approved the establishment of a Public National Health Service, where the only ones voting against were the right wingers of the Movimento Sociale, the Liberal Party and the abstentions of the Republicans (in all, less than 15% of the electors of the time).

Therefore, with a nearly unanimous majority, also Italy entered the club of those countries who had chosen a national system of health protection by placing disease prevention, treatment and rehabilitation as one of the duties of the Republic.

The old worker’s sickness funds, characterised by evident disproportions among the various categories of recipients, gave way to the so-called USL (Local Health Centres), that took upon themselves all the competences relevant to healthcare. The financing of this system is ensured by general taxation (but it will be necessary to wait for nearly twenty years before actually achieving the exemption from the old sickness contributions) and the national health fund is established as part of the specific expense item of the Treasury.

The 1978 reform will undergo a great number of modifications and integrations, thus leading to the first great reform of the reform (of the years 1992/1993) that changed the USLs into “Aziende sanitarie locali” (Local health enterprises), endowed with juridical autonomy and giving way to the so-called company-mindedness of the system and to the “riforma ter” (or better known as the Bindi Reform, after the name of the Minister of Health who prepared it) passed in 1999, but until now largely not put into practice, because of the change of the majority after the political lections in 2001 and due to the current implementation of the federalist reform of the Country, that has strengthened the role of the Regional governments in the management of the health sector.  

1992 – The arrival of the University Diplomas 
The first nursing students who entered university to attend the first university courses for nurses were about one thousand, in the academic year 1992/93 and in 18 Italian universities. The introduction of nursing education in Universities marked the outcome of a decade of battles led by the entire category of nurses in order to adapt the educational programs to the role of great responsibility nurses play in every single structure of the Italian Healthcare System and to become part of Europe by full right.

This need fits perfectly into the overall reform plan of Universities, launched in 1990 that established the bachelor’s degree also in our Country. At the end of 1992, the Legislative Decree 502 (later 517) was issued, which as well as outlining the competences of Universities, Regions and the ASLs of the NHS in the scope of nursing education, it established that only students who had attained a five-year secondary school diploma could have access to university nursing education. The aim of the new reform was to safeguard the patrimony of education experience of the secondary schools, thus accrediting the most suitable schools to the Universities. In 1996/97, the period of transition through to the new educational system ends with the definitive handover of all basic training to universities. Now on the degree certificate, next to the signature of the Director of the Course, you can find that of the Chancellor of the University.  

1994 – A great public demonstration 
On 1st July 1994, along the streets of Rome, 50,000 health workers, mostly nurses, organise a great public demonstration that asked for more attention towards the Public Health System. These were the years when privatisation appeared to be the solution for all the problems. Above all, workers asked for interventions in favour of a better qualification of the health professions, in other words the new professional profiles over which there were many discussions, but no one seemed to be taking the final decision to approve them.

But the long parade of protesters in Rome also represented a key shift for the creation of a new and stronger professional identity: banners, posters and thousands of balloons showed everyone that today’s nurses were far and different from the stereotypes of the past. All the slogans circled around this awareness: “Qualified nurses, protected patients”, “We want to improve, to help and care”, and in an ironic dispute, but not groundless “Doctor I have committed a great crime: I have thought, I have thought!”. And not forgetting the immediate aims: “Costa, Costa we want a reply”. In fact, the reply arrived very quickly, because only a few months later, in September, the then Minister of Health, Raffaele Costa signed the ministerial decree that defined the role and functions of professional nurses.       

1994 – Nurses have a new profile 
The professional profile is a milestone in the professionalization process of nursing. The Ministerial Decree 739/94 recognized that nurses are in charge of general nursing, it provided a detailed description of the nature of nursing interventions, the operative ambits, the methodology of their work, the interactions with other workers, the professional spheres of cultural and practical investigation, the five areas of specialized training /public health, paediatrics, mental health/psychiatry, geriatrics, critical care).

The profile, outlined by the decree, is that of a scholarly professional, skilled, autonomous and responsible. The same type of definition of the activities will later be established also for paediatric nurses (Min. Decree 70/97) and for another 20 professional profiles, among which that of the health inspector, the midwife, the physiotherapist, the laboratory technician, etc. The activation of the profile becomes a testing bench to check the compliance between nurses’ aspirations and their potential, who are expected to take – also formally – the responsibility of autonomously managing the healthcare process, from the moment they take a decision, up to the implementation, the evaluation and the confrontation.  

1999 – Never again “assistants” 
No more an “auxiliary healthcare profession”: at last, a law of the State permanently cancels this anachronistic and improper definition used to describe nurses. The Law 42/99 (Provisions on healthcare professions) ratifies that the typical field of the activities and responsibilities of nursing is determined by the contents of the decree that establishes the profile, by the teaching programs of the respective university courses and post-graduate education, as well as the deontological codes the profession sets for itself.  

2000 – The Master’s Degree and management 
The Law 251/2000 (Regulation of the nursing, technical, rehabilitation and midwifery health professions) sets the final stages of the reorganization process of nursing. This law establishes that those nurses who have certificates issued according to the previous regulations may also access to the Master’s Degree in Nursing.

Therefore, after a long battle of the IPASVI Federation, the principle of equipollence of the qualifications passes, so that these nurses may have the chance to continue their studies. However, the relevance of the Law 251 mainly consists in the “official” recognition of the managerial role: this opens the doors to nurses who wish to access to a new unique qualification as directors of healthcare personnel. As we wait for the specific competition regulation to enter full capacity, provisional regulations set forth that health organizations may however proceed to nominate the directors of nursing and midwifery services by means of an appropriate procedure of selection among candidates who possess the requirements of experience and predetermined professional qualification”. These directors have the responsibility to run the nursing activities and all the relevant assignments, as well as labour reorganization, encouraging specially tailored healthcare models. 

2001 – Degrees in harmony with Europe  
The Decrees of the 2nd April 2001 that set out the various classes of the degrees of the health profession, are part of the general process of the reform of the Universities, aiming at lining up with the rest of the European scenario: therefore, the university diploma courses for nurses were changed into three-year degrees and now the masters degree in Nursing and Midwifery Sciences appears on the horizon, to which it will be possible to access according to the number credits attained during basic training.

In the specific degree class, including the nursing and midwifery healthcare professions, also the profiles of nurses, midwives and paediatric nurses are found.

2002 – A law to stem the emergency 
The year 2002 starts off with the issue of a law regarding nurses, the Law n.1 of 8th January (Changed into law, with modifications of the decree law of 12th November 2001, n.402, including urgent provisions with regard to health personnel. The provision, generated by the push of the nursing emergency, actually sets out some wider principles:

-         it recognises to nurses employed by the NHS the possibility to carry out private practice within the premises of the Administrations they already belong to, in order to guarantee through “additional services... the healthcare standards in wards and in the operating theatres”;

-         it includes the possibility to re-employ nurses who had retired on their own free will and stipulate contracts for a limited period of time;

-         it outlines the tasks of the social healthcare worker, underlining that these workers carry out their activities “under the directions or the supervision of the nurse or midwife in charge”;

-         it values subsidiary training, such as Masters and post-basic training and the respective certificates can be considered as valuable qualifications for the career.

2004 - The Masters degrees start off! 
With the decree of 9th July 2004, the Ministry of Education, University and Research (MUIR) sets the conditions and the contents for the admission tests to access to the masters degree in Nursing Sciences and with the decree of 27th July, it establishes the number of places available for the students. On 1st October, with another decree, MUIR accepts “making an exception to the need of passing the admission test” those nurses who already have qualifications issued by Special Schools and those who have been, for at least two years, Directors of Nursing Services or directors or coordinators of degree courses.

Therefore, in the academic year 2004-2005, the Masters Decree at last becomes a concrete reality and these courses start off in 15 Italian Universities.

This has been an objective that the IPASVI Federation and Colleges have pursued with tenacity, in order to offer nurses the chance to embark on increasingly articulate and differentiated educational curricula that render them active and competent protagonists in a healthcare universe in constant progress.

The Masters Decree is not compulsory, but it is an opportunity for nurses who wish to achieve a professional level necessary to perform specific tasks in the fields of advanced clinical and healthcare practice, management, education and research.

2006 - The first PhD Courses in Nursing  
The first PhDs in Nursing begin: this is the step that completes the nurses’ academic education in Italy.
The achievement of this important goal was made possible thanks to the sensitivity of some prestigious universities, but also to the support of the National Federation of Nursing Colleges in the finale stage, by funding some scholarships.
The very first call to be published was that of the University of Rome “Tor Vergata”, immediately followed by the University of Florence.


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