Senior Lecturer, University of Malta Visiting Researcher, Tuning Academy

■ Registered Nurse

■ Professional Interests : -Nurse education (curriculum development and evaluation)

-Regulation of the nursing profession

-Policy development and co-ordination

(health and social care)

-Internationalisation in higher education

Email: Maria.Cassar@um.edu.mt Skype:maria.e.cassar Phone:+356 23401139

NURSE REFUGEES WITHOUT VERIFIABLE

QUALIFICATIONS

Does TUNING offer a way forward?

THE SEA........

Authorisation use of images: Roberto Runza

RobetrtoRunza Photography

robertorunza@gmail.com

Asylum seekers and refugees…… Past reality? Prevalent reality? Future reality?

Some of the many thousands are qualified nurses Many others hold various other qualifications Problematic realities:

Unverifiable documents

Missing Document/s

Difficulties to search, access , reconstruct or

retrieve missing documents

Facts

In the period from 2004 to 2014, in Norway alone, almost 1000 individuals were refused recognition of their claimed profession on the grounds of non-verifiable or missing documents

1

Without proper documentation of qualifications, displaced persons and refugees are at a serious disadvantage both within the labour market and if they wish to pursue further studies

2

Undocumented persons vary in need and moreover they vary across the (1) possibility and (2) willingness of having authorities in country/region of origin contacted by an reviewing/ evaluation body of a host country.

3

Various countries and entities have developed systems and initiatives to address these realities 4 examples……..

Germany

■ "Prototyping Transfer" project

If applicants are unable to produce written evidence in the process of having their foreign professional qualifications recognised, they can have their competences assessed by way of a so-called qualification analysis, in order to gain recognition

The Federal Recognition Act simplifies and standardises procedures for the evaluation of foreign professional or vocational qualifications governed by Federal Law and opens up such procedures to target groups not previously entitled to pursue such a route.

April 2012

Norway

NOKUT, the Norwegian Agency for Quality Assurance in

Education, provides that academic assessments of

applications of persons without verifiable qualifications

are carried out by expert committees commissioned

and appointed by NOKUT.

Article 14 BQFG (Federal Recognition Act) (1) If the applicant cannot submit all or part of the documents required for the establishment or assessment of equivalence in accordance with section 5 subsections 1, 4 and 5 or section 12 subsections 1, 4 and 5 for reasons beyond his or her control or if submission of relevant documents involves an unreasonable expenditure of time and effort, the competent body shall apply other suitable procedures to establish the applicant's professional skills, knowledge and abilities required for comparison with corresponding German professional training. The applicant must substantiate the reasons for not submitting relevant documents. ………….

(2) Other suitable procedures to ascertain professional skills, knowledge

and abilities as specified in subsection 1 include in particular work

samples, interviews, practical and theoretical examinations and expert

opinions.

Interview with Marina

Malgina, Director NOKUT

9.3.2018

- The outcome of Nokut's work with refugees without verifiable documents is the determination of the quality and level of academic studies pursued by an applicant, not the determination of the content of a programme of studies or training that an applicant claims to have pursued.

- Nokut does not seek to establish the fitness to practice of an applicant within a profession/ or a specific subject area.

- The "passport" which Nokut establishes enables an applicant to seek admission to higher education, or to seek employment, or to seek entry to a professional register but does not actually guarantee any of the three.

-The exercise which Nokut carries out with applicants largely comprises an interview with an applicant, which in turn involves the review of any documents that an applicant may have and tracking down contacts related to an applicant's education. Subject area experts are drawn into the interviewing process accordingly.

-The availability of a framework which may guide the contribution of subject area experts would be favourable. It would provide consistency and enhance homogeneity across different countries. Such framework may be available and used across different European countries but the actual registration of a nurse in any one country should be the decision of that specific country

.

- Despite the availability of a (universal) framework which may guide the evaluation process of an applicant's actual qualification/ training . education, the process of establishing the education / training/ qualification received by an applicant needs to, nevertheless, adopt a case by case approach.

Various countries and entities have developed systems and initiatives to address these realities

Greece

■ European Qualifications passport for Refugees

■ The European Qualifications Passport for Refugees is a document providing an assessment of the higher education qualifications based on available documentation and a structured interview. It also presents information on the applicant’s work experience and language proficiency.

3 rounds of applications completed to date

enic-naric website

The site is a joint initiative of the European Commission, the Council of Europe and UNESCO

Guide for credential evaluators who seek to recognise qualifications held by refugees

Nokut UNHCR

Council of

Europe

Ministry of

Education

Greece

https://www.coe.int/en/web/education/documentary-on-

project-european-qualifications-passport-for-refugees

What has been reported regarding the initiative rolling out in Greece:

“The availability of a framework which may guide the contribution of subject area experts would be favourable. It would provide consistency and enhance homogeneity across different countries. Such framework may be available and used across different European countries but the actual registration of a nurse in any one country should be the decision of that specific country” Marina Malgina, NOKUT Director

“We need to be able to assess the qualifications that one may have. This assessment is to be valid not only when the refugee first arrives but where the refugee may move to” Sjur Bergan, Head of the education Department, Council of Europe

“ We need some simple way to assess the education and qualification which they may have and to enable them to get into the higher education and employment systems of a country” Curt Rice, Oslo and Akenhaus University College of Applied Sciences (HiOA), Norway

“Refugees are part of a solution and they have qualificatons and skills . We need to find a way to identify these specifically“ Passa Polyioni, UNHCR representative, Greece

THE CONVENTION ON THE RECOGNITION OF QUALIFICATIONS CONCERNING

HIGHER EDUCATION IN THE EUROPEAN REGION WAS DEVELOPED BY THE

COUNCIL OF EUROPE AND UNESCO AND ADOPTED AT A MEETING OF NATIONAL

REPRESENTATIVES IN LISBON ON 8 - 11 APRIL 1997.

THE CONVENTION ON THE RECOGNITION

OF QUALIFICATIONS CONCERNING HIGHER EDUCATION IN THE EUROPEAN REGION, OTHERWISE KNOWN AS THE

LISBON RECOGNITION CONVENTION, IS THE KEY LEGAL INSTRUMENT FOR RECOGNITION OF QUALIFICATIONS

ACROSS UNESCO'S EUROPE AND NORTH AMERICA REGION.

IN 2014, 55 COUNTRIES SIGNED THE

CONVENTION AND 53 RATIFIED IT

SECTION VII - RECOGNITION OF QUALIFICATIONS HELD BY REFUGEES, DISPLACED

PERSONS AND PERSONS IN A REFUGEE - LIKE SITUATION

Article VII

Each Party shall take all feasible and reasonable steps within the

framework of its education system and in conformity with its constitutional,

legal, and regulatory provisions to develop procedures designed to

assess fairly and expeditiously whether refugees, displaced persons and

persons in a refugee-like situation fulfill the relevant requirements for

access to higher education, to further higher education programmes or to

employment activities,

even in cases in which the qualifications obtained in one of the Parties

cannot be proven through documentary evidence.

What is common across the 4 initiatives?

Assessment component

Credential evaluators

Subject specific mechanism not

available

(eg Nursing)

Nurse refugees : Missing

Documents

1. Definitions

2. True stories Interviews Feb 2018 with

Hafsa, Kimete, Ayman, Yordanas, Kamara

3 Implications

4. Options for way forward

5. Invitation + Discussion

Refugee status implies “forced” mobility

YORDANOS ASSEFAW, FEMALE, AGED 48, THREE CHILDREN :

TRAINING PROGRAM IN PRIMARY HEALTH CARE NURSING BY THE MINISTRY OF HEALTH, ERITREA 1996

IN NURSING , ASMARA ERITREA SCHOOL OF NURSING, 2001

CERTIFICATE OF REGISTRATION OF HEALTH PROFESSIONALS: REGISTERED AS AN ASSOCIATE NURSE BY THE MINISTRY OF HEALTH, ERITREA: ISSUED ON 01/10/2002

TRAINING IN NUTRITION SURVEY, MINISTRY OF HEALTH, ERITREA IN COLLABORATION WITH

EUROPEAN COMMISSION - HUMANITARIAN AID & CIVIL PROTECTION (ECHO) AND COORDINAMENTO DELLE ORGANIZZAZIONI PER IL SERVIZIO VOLONTARIO (COSV), 2001

COURSE ATTENDANCE IN INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) CASE

MANAGEMENT, TESSENEY HOSPITAL, ERITREA IN COLLABORATION WITH USAID, 2004

TRAINING WORKSHOP IN NUTRITION EMERGENCY PREPAREDNESS BY SAVE THE CHILDREN UK, ASMARA ERITREA, 2007

SHE HAS 22 YEARS EXPERIENCE AS A NURSE IN THE HEALTH CARE SYSTEM IN ERITREA.

NO DOCUMENTS IN HAND

IN MALTA, SHE HAS BEEN WORKING AT A RESIDENTIAL HOME, FOR THE ELDERLY, RUN BY THE CATHOLIC CHURCH AS A CARER, NOT A NURSE, FOR 3 YEARS !!!!

Interview May 2017

Hafsa Haydar 28 years old graduate with a

Bachelor’s degree in Nursing

Mogadishu University, Somalia

in 2013

Works on product manufacturing

line in a private pharmaceutical

company

Documents in hand but are

unverifiable . Denied

registration.

Interview February 2018

KIMETE KIMI, ALBANIAN REFUGEE IN MALTA IN EARLY 1990S, 50 YEARS, FEMALE

"We are not simply refugees.

We came here to work.

We are nurses”

MARY KAMARA, 55 YEARS FEMALE FROM SIERRA LEON

Arrived in Malta in 2000 without documents. Had to undergo full training nursing programme again in Malta. English as

medium of instruction and service delivery worked fine.

Moved to Holland shortly after graduating where her inability to speak the language there landed her once again out of a nursing role and nurse register

of the country.

She returned to Malta and now works as a fulltime registered nurse after working for 5 years as a carer in Holland gaining eligibility for EU passport.

Dr Ayman Mostafa

DR AYMAN MOSTAFA IS ONE OF 212 SURVIVORS OUT OF 450 SYRIAN AND PALESTINIAN REFUGEES WHO

PERISHED IN OUR SEAS ON 11 OCTOBER 2013.

HE NOW WORKS FULLTIME AS A REGISTERED SURGEON WITHIN THE PUBLIC HEALTH CARE SYSTEM OF MALTA FOLLOWING A PERIOD OF

SUPERVISED PRACTICE .

THE QUALIFICATION DOCUMENTS HE HAD AT HAND WERE INADEQUATE FOR REGISTRATION

Fatama and Joud

Interview with Mr Ayman Mostafa February 2017

■ The availability of a framework will allow a more objective and formal approach towards the

verification of training and this is advantageous since such an approach will hinder the perception

of having any favour or special treatment given to any one applicant/ person by the authorities of

a host country.

■ The opportunity for conditional registration, that is the opportunity to practise under supervision

for a period of time until one's competencies and skills are verified by someone in the host

country, is favourable because it gives an applicant to chance to prove what he/ she claims is

true. The proposed framework can be used to verify this.

■ Giving someone his/ her professional registration involves giving that someone a very big

important part of life, possibly the only part that was not lost in the transit from one country to

another. Therefore all efforts to restore the professional recognition/ qualification of a person

should be done. One goes from being a professional to being just a number and then to being a

professional again. The changes in status are dramatically big.

-The feeling of gratefulness is immense and surely it is the most dominant feeling after having my professional licence and opportunity to practise as a professional was returned to me. …………. Knowing that this came through the sensitivity and good approach and decisions of individuals and officials in the system in Malta does not bother me, but having a formal process in place would have been more favourable and would be better for others in similar situations. ………… Since my circumstances are not uncommon, and the numbers of persons having to escape is big, a formal system for processing the request of persons like is needed.

Implications ■ The need to address the rights and requests of undocumented health care

professionals

■ The opportunity to enable host countries to tap into unused resources amongst

refugees – this is accentuated in the context of staff shortages + staff migration/

mobility

■ The obligation to safeguard patients’ safety and interests

■ The need to live up to the expectations from

health (caring) professions !

■ Political will and commitment

Local challenge = Local

solution/ approach?

Europe wide

challenge= Europe

wide solution

approach?

Global challenge=

Multi-regional

approach?

Can Tuning

Provide a feasible

and effective avenue

Why may Tuning………

(1) Tuning projects have proved to be powerful instruments for promoting understanding and cooperation between institutions, countries and regions across the world

1

(2) Tuning projects focus on student-centredness, competence-based criteria

2

(3) The main strengths of Tuning projects are (a) openness to the different cultural contexts in which academics and students work, and (b) the active quest for a mutually understood discourse and developing that is not fed in ‘top-down’, but negotiated across projects

3

(4) In Tuning projects experienced and knowledgeable recognised experts in specific subjects , in collectively, develop competence frameworks in a subject area

4

How may Tuning………

What did the Tuning leaders

say…..

Exploratory exercise not a

research study

Statement: The TUNING competences framework may be used to map the training and education of nurse refugees without unverifiable qualification/s in a host or receiving country.

The list below presents the five competence domains which TUNING Europe determined. These echo in TUNING South America, and TUNING-MEDA

1. Professional values and the role of the nurse

2.Nursing practice and clinical decision making

3.Knowledge and cognition

4.Communication and interpersonal skills (including technology )

5.Leadership, management and team working.

What are your views about this statement please?

Kindly share thoughts about (1) the feasibility of the proposal noted in the statement and about (2) the challenges which may be associated with this proposal, please.

Clarification: The statement refers to nurses who have been assigned refugee status by the respective authority in a host European country, and how do not have documents in hand and minimal possibility to verify of the nurse qualification / training which one claims to have.

Resource -http://tuningacademy.org/wp-content/uploads/2014/02/RefNursing_EU_EN.pdf

Interviews with Key Informants regarding Tuning (nursing)

■ Mary Gobbi (UK)

■ Marja Kaunonen (Finland)

■ Ingrid Kallok (Germany)

■ Grace Jaccarini ( Malta)

■ Sandor Hallos ( Hungary)

Snapshot of replies

“These competences maybe used as the framework of the

acknowledging the knowledge and skills of the refugee

nurse/health professional without official documentation.” Marja

Kaunonen 3.2.2018

“The idea of getting refugees with education but lacking the

documentation back to workforce is very important…….In my

opinion the Tuning competences allow to verify the qualification

of a person with refugee status and no documents, who claims

to be a nurse.” Ingrid Kollak 5.3.1018

“The approach won’t work becuase of the EU directive. ………...

Also Tuning is graduate level….” Mary Gobbi 2.3.2018

“Feasibility should not be a problem…….I could imagine an assessment situation, in which a person with refugee status

and no documents, who claims to be a nurse, is introduced to a patient's case. The person is asked to explain the

implications of the case, the nursing process, the diagnoses, the necessary nursing care, her/his own activities, delegation

of tasks, co-operation and so on” Ingrid Kollak 5.3.2018

My personal opinion next the competencies, you should to take into consideration the CALOHEE NSG Assessment

Framework, and I think it is most important, to look after the assessment were used to prove the reported competences ( aspects and methods of assessment) E.g.: clinical capacity

was assessed by theoretical exam of patient’s triage, or applicant can prove the capacity in real life environment as

well?

Sandor Hallos 3.3.2018

However,

-The EC directive may cause problems for the registration. How would this be approved in EU vs

the directive for nurse education?

-A survey needs to go to the regulators to see what provisions they have

-How does one organise the testing for the competences of the applicants? How may the

competences be operationalised into concrete statements that actually measure the knowledge

and skills the nurse needs?

-Who would be responsible to develop this kind of assessment? And Who would be responsible

for the testing and approval of the competences/ registration?

-Would it be valid in all EU countries?

-Would these refugee nurses have the same rights / same registration as the nurses educated in

the country? Is there scope for partial registration or temporary registration or conditional

registration?

-Would there be need for some kind of pretesting/ pre-assessment preparation course?

-Should an assessment capture also the language capacity of an applicant and one culture,

attitude, motivation and social background?

Important factors to consider when looking for the optimal

assessment solution

Sets in at an early stage / fast

Cost-effective

Accessible

Professional

Fair / provides equal treatment

Provides relevant information

Provides feasible system for transition and easy

mobility between regions, countries and

educational levels

Marina Malgina 2017

EURIE, Eurasia Higher Education Summit, Istanbul

Measuring and Comparing Achievements of Learning Outcomes in Higher Education in Europe (CALOHEE) Do students enrolled in higher education around Europe develop the competences they need? Are study programmes delivering their promises? Can we learn to compare student’s achievements in different countries in a meaningful way? The EU funded project CALOHEE will help to find the answers to these questions by developing the infrastructure that will eventually make it possible to test bachelor and master students’ performance Europe-wide across a range of fields in a way that satisfies the needs of the various stakeholders in the European higher education community. The project covers five subject areas, representing five significant academic domains: Engineering (Civil Engineering), Health Care (Nursing), Humanities (History), Natural Sciences (Physics) and Social Sciences (Education). The methodology to be developed should also be applicable for other fields of study. The frameworks to be developed in these fields will use the same methodology, but they will be tailored to the characteristics of each domain or subject area, taking into account the diversity of missions, orientations and profiles of universities in Europe and their various degree programmes

Diverse opinions exist

■ It’s their problem!

■ We have to safeguard the patients!

■ It would encourage irregular migration!

■ We need to be fair with the documented professionals!

■ There is not enough political will!

■ There is political will but inadequate resources to implement will!

■ Others …………………………………………………………………

In progress…… Next steps…

Exploring views of the Architects/ Directors of Tuning

Exploring views of the EU/EC - Mr Martin Frohn, Head of Unit in the unit “Free movement

of Professionals” in DG Internal Market and Services - Laura Corrado, Head of the Legal Migration and

Integration Unit in DG Migration and Home Affairs.

Exploring view of Regulators in Europe Malta and France : Contact made

Italy and Portugal : in progress Other EU state : Searching contact

……………………………………………………….

Thank you for your

attention today ……..and

continued co – operation !