Replica | Let’s focus on the “how” of nurse education

In response to the reply of the CEO of the Fédération des cégeps, Bernard Tremblay, to Stéphanie Grammond’s editorial on the training of nurses, published on May 17 and 12.

Nicole Ricard
Retired nurse, professor emeritus at the University of Montreal

Stéphanie Grammond’s editorial on nursing education was excellent¹ and I believe that Bernard Tremblay was disturbed by an argument that he accuses² too inspired by that of the Order of Nurses of Quebec (OIIQ). I believe that, on the contrary, M^me Grammond is sufficiently informed about international needs and trends in nursing education and able to make a sound analysis of the current situation.

Through his arguments, Mr. Tremblay fuels the perception that the OIIQ is against CEGEPs. How does the fact of justifying and asking for the enhancement of a profession, which has more and more responsibilities in the face of increasingly complex health problems, become a charge against CEGEPs? We must put an end to this polarization which leads nowhere, examine the research evidence and the best way to evolve the education of nurses so that it responds to the enormous needs and challenges of our health care system.

Mr. Tremblay accuses the OIIQ of having orchestrated the Estates General. Estates General on the nursing profession had not taken place since 1996 and many groups of nurses were asking for it. Let’s not forget that the OIIQ has a mandate to protect the public and that it was urgent to take stock of the situation and that is what was done in a completely rigorous manner. An independent process was carried out through multiple consultation activities, inquiries and public hearings. In particular, a citizens’ forum was organized and conducted by the Institut du Nouveau Monde.

Disturbing findings

After consultations and deliberations, this citizen forum produced an opinion based on fundamental principles, including, among other things, the enhancement of initial training as an essential condition for maximizing the role of nurses in the provision of care. The findings that emerge from the report of the Estates General are disturbing in particular because there emerges a consensus on the urgency of solving the problem of the dual path of access to entry into the profession.

As described in the editorial by M^me Grammond, this is indeed an anomaly: no other profession in Quebec opts for this double access path with all the problems that ensue. This report of the Estates General is disturbing because it reflects a rigorous process resulting from a broad consultation with diverse audiences by identifying the various obstacles to the optimization of nursing practice in Quebec, including that of the double access from entry standard to practice.

This report is disturbing because it refers to research data, best practices and national and international studies on the benefits of better training for nurses.

However, Mr. Tremblay’s argument on the absence of serious studies carried out in Quebec to demonstrate the benefits of a university education is rather appalling. It is as if we were saying that what is not demonstrated in Quebec is not serious and necessarily has no value. This means that the Fédération des cégeps does not recognize the legitimacy of several scientific studies carried out nationally and internationally on the beneficial effects of better training of nurses on the shortage, attraction, retention at work and pursuit of career.

Furthermore, Mr. Tremblay refers to the report of the National Task Force on the Nursing Workforce to justify his position because this report does not rule on university education as a solution to the problems of the nursing workforce.

However, what Mr. Tremblay omits to say is that the task force recognizes the international trend from the point of view of the university education of nurses, but that this task force does not comment, because it considers that this position is a decision of the Ministry of Education. A good way to pass the buck so as not to make a decision!

We remain skeptical of the position of this working group made up of many nursing experts and deplore the fact that despite the data in favor of a university education, another report watered down by the officials once again ignores the application of best practices.

So what is Mr. Tremblay’s real motivation for opposing better training for all nurses in Quebec? Considering that there will be a transition plan that respects the achievements of nurses already trained at CEGEP and the fact that college training will not disappear for people who wish to begin their training at college and then continue their training, we must concert to move towards the how to make this transition than to return unnecessarily to the why.