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Regulations. The historical and legislative phases of the nursing education reform

The historical and legislative phases of the nursing education reform 

In Italy, the regulation of nursing education started in 1925: in fact, the first Schools were established by the Royal Decree of 15th August 1925, n. 1832 (The faculty to establish professional boarding schools for nurses and specialised schools of medicine, public hygiene and social assistance for health visitors). Only those who had an elementary school certificate could access to this school, but it was not compulsory if there were not enough candidates with this certificate.

In 1934, the regulations on nursing education are included in the Single Text of the healthcare laws.

The Strasbourg Agreement of 25th October 1967 sets the minimum requirement to access the Schools of Nursing and the minimum number of hours of lessons, equal to 4600 hours. In 1971, the law 124 abolished the obligation of boarding and the boarding schools are substituted by the “Schools for Professional Nurses”. Moreover, also men have the possibility to access to these schools.

The Law 795 of 15th November 1973 ratifies the text of the European Community and the subsequent DPR 867 of 13th October 1975 and changes the curricula, thus including a curricula of 3 years, that can be accessed by students with a 10-year school attendance (the secondary school biennium).

With the DPR 761 of 20th October 1979, when the nurses’ professional profiles are defined, for the first time the expression “professional worker’s executive” appeared and subsequently, with the examination regulation in 1982, the diploma attained at the University Schools, specially designed for nursing executives and teachers, becomes a compulsory prerequisite for all those who want to take part in the public examination for Teaching Directors and Head of the Auxiliary Health Services.

The law of 19th November 1990, n. 341, on the reform of the university teaching regulations, established the “level 1 university diploma in Nursing Sciences”. According to this law, the new qualification “has the aim of providing students an adequate knowledge of the methods and the cultural and scientific contents in order to achieve the educational level required by the specific professional areas”.

The regulation of the university diploma course in Nursing Sciences is set out in table XXXIX ter, according to the Min. Decree of 2nd December 1991. However, this measure, although it sets out the bases for a deep renewal, it has no effect on the traditional Schools for Professional Nurses. As a matter of fact, the University Diploma Course constitutes a curriculum parallel to that of the Regional Schools, issuing diplomas that preserve their qualifying value, thus allowing nurses to practice the profession.

The Legislative Decree 502 of 1992 and subsequent modifications, sanctions – after a short period of transition (“double track”) – the decisive step towards university education. As a consequence, the 502/92 decree established that only students with a secondary school certificate could access to this university course. The qualification issued at the end of the course is a “University Diploma” signed by the Chancellor of the University and the Director of the School where the nurses are educated. Between 1994 and 1998, the Regions stipulate agreements with Universities, which now become the only means to access the nursing profession.

The Min. Decree of 24th July 1996, outlines the new university teaching regulations and changes once again the name of the qualification, which becomes “university diploma for nurses”.

Another legislative intervention, the Min. Decree 509/99, redefines the structure of the university system, in which nursing education is fully entitled to have its own position.

Important changes occur in the Nineties, even within the regulations on nursing practice, which we cite for their close link with the reform of the educational curricula: the decrees on the nurse’s professional profile (Min. Decree 739/94) and that of the paediatric nurse (Min. Decree 70/97), the law that abolishes the assignment record (42/99) and the law 251/2000 on nursing management.

A first concrete step towards the activation of the Master’s Degree is marked by the MURST Decree of 2nd April 2001, which defines the competences of those who have a Master’s Degree, who must possess “an advanced professional education and be able to intervene with high competences in care processes, management, education and research (...and) have to be capable of putting into practice advanced skills in activities of care, organization, management and research in order to respond to the health priorities of the general population and the quality issues of the services”. Such skills are in line with the process of professionalization, that has been often supported by a diversified educational offer and consistent with the growth of the nurses’ role and functions. Access to this level of education is allowed also to those who qualified under the old regulation, as well as a five-year secondary school certificate (Law 1/2002).

In December 2003, after the State-Region Conference approval of the Agreement between the Ministry of Health, the Regional Governments and the Autonomous Regions on the definition of the needs of the health professions, also the Ministry of University and Research expresses its approval on the activation of the Master’s Degrees and ratifies the decision. The National University Council (NUC) therefore creates a framework educational regulation for each specialized class in order to ensure the education of uniform professional figures throughout Italy.

But for the definition of the modalities and the contents of the admission exams to the Master’s Degree Courses, it is necessary to wait until 2004. With the Decree of 9th July 2004, the MIUR sets the modalities and the contents for the admission exams to the Master’s Degree of the health professions and with the Decrees of 27th July 2004 and 1st October 2004, establishes the number of posts for the respective enrolment of the students.

The Ministry of University, by acknowledging the indications of the Ministry of Health, for the academic year 2004-2005 assigns to the SNT – SPE/1 class (Nursing Sciences and Midwifery) a total of 578 posts (Official Gazette of 4th August 2004, n. 181) and the courses start in 15 Italian Universities.

The contextual Min. Decree 270/04 reforms the university teaching regulations, but does not change the curricula of the classes regarding the health professions “prearranged for the access to the professional activities”. However, it changes the naming from “Specialized Degree Course” to “Master’s Degree”.

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Firenze 31 maggio 2019

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