Case Study on the European Professional Mobility Card for Nurses

CASE STUDY ON THE EUROPEAN PROFESSIONAL MOBILITY CARD FOR NURSES

The European Federation of Nurses Associations (EFN), as member of the Steering Group on the European Professional Card (EPC), has developed this draft consolidated case study on the possible introduction of a European Professional Mobility Card (e-certificate) only for nurses wanting to move within the EU as facilitated by the European Directive on Mutual Recognition of Professional Qualifications. The competent authorities from the UK, Portugal, Poland, Denmark, Spain and France- volunteered to participate and to further develop this case study. The members of the nurse subgroup of the Steering Group are as follows: Paul DE RAEVE (European Federation of Nurses Associations, lead), Ana GIMENEZ (ES Ministry of Health and co-lead), Grzegorz MAZURCZAK (PL Ministry of Health and co-lead), Tatjana MILCEVIC (DK coordinator for the Professional Qualification Directive), HansSebastian PEREZ (FR Ministry of Health), David HUBERT (UK Nursing and Midwifery Council), Raul FERNANDES (PT Ordem dos Enfermeiros) and Prof. KOUTROBAS (FEPI/CEPLIS). The members of the subgroup are grateful to Mr Francesco PROSCIA (Federation of Veterinaries of Europe) and Mr Patrick FORTUIT (Ordre National des Pharmaciens de France) who have followed the work in the nurses subgroup as observers and provided valuable comments. At the teleconference of 16 June 2011 with the members of the subgroup and the European Commission it was agreed that the case study will take into consideration the following working assumptions which were discussed in great detail at the meetings of the Steering Group: The professional card should entail low costs, even no additional cost for the individual nurse; A short-term solution should be developed; Any solution should be closely linked to IMI; The card should be issued by the competent authorities; A solution requires amendments to the EU Professional Qualifications Directive.

VALUE ADDED AND LEGAL EFFECTS OF THE EUROPEAN PROFESSIONAL MOBILITY CARD This case study analyses how the European Professional Mobility Card (EPMC) could facilitate the recognition process for a nurse who either moves on a temporary basis or wishes to work on a permanent basis in another EU Member State. The subgroup agreed that a two stage approach for the introduction of the EPMC for nurses is needed. At the first exploratory phase, the scope of the card should be piloted for nurses responsible for general care falling under the automatic recognition system. After evaluating the experiences of this exploratory phase and also evaluating whether the IMI developments have successfully worked out in daily practice, the members of the sub-group of the Steering Committee will then reconsider whether it is sensible to extend the scope of the EPMC to nurses falling under the general system. The rationale behind is that the recognition procedure for the cases of automatic recognition is comparatively straightforward and offers a stable starting point to test the durability and effectiveness of the EPMC. The general system is significantly more complex, it is especially challenging to

Case Study on the European Professional Mobility Card for Nurses

compare the migrating nurse's training completed in the home Member State with the training requirements of the host Member State and to determine whether compensation measures are required. Consequently, when assessing the possible extension of the EPMC's scope to nurses falling under the general system it should be clarified how many nurses are applying under the general system, the profile of these applicants and an overview of the compensation measures needed. The Steering Group has discussed different scenarios for the use of the EPMC. The subgroup of the nurses has decided to take forward for this case study the following two scenarios (one regarding temporary mobility and another concerning permanent establishment): Within temporary mobility the EPMC could substitute all administrative documents supporting a declaration required prior to the first provision of services. The card could enable an accelerated procedure for recognition and could enable reduction of the time necessary for the professional recognition (for example from 3 months to one month). The card could facilitate the recognition procedure by according greater credibility to the credentials indicated by virtue of its issuance by a competent authority in the Member State of departure which has already verified them. IMI could further help to speed up the recognition procedure, for instance by generating, at the moment when a professional requests a card or when a card is issued by a competent authority. A request for recognition addressed to the host Member State by the home Member State competent authority.

Added value for temporary mobility If the professional situation is included on the EPMC and updated via the IMI system, the excessive administrative burden linked to the declaration in case of temporary mobility could be significantly reduced. As such, technology needs to support nurses mobility. This cannot however remove the requirement for health professionals practicing temporarily in another Member State of prior notification and declaration with the relevant Competent Authority (health regulator). Added value for establishment The EPMC, through its link with IMI, should speed up the recognition procedure. For instance, at the moment when a nurse responsible for general care requests a card or when the card is issued by a competent authority, it could generate automatically a request for recognition addressed to the host Member State by the home Member State's competent authority. In order to meet the requirements related to patient safety and quality of care, the issuance of the EPMC by the home Member State should be preceded by a compliance check on the minimum educational/training requirements (Article 31), on compliance with other requirements, such as the authorization to practice in the home Member State, lack of pending disciplinary sanctions, and also on all other necessary documents (as a first step, the documents needed are the current ones to meet the automatic recognition principle). As a positive result through the EPMC and the IMI system both, home and host Member States can communicate and check the process at any time, fostering trust along the recognition process. Another added value for the migrant would be the possibility to contact her/his own competent authority (same language) without having to find the right competent authority in the host Member State. In cases where clarification needs to be given, the applicant would not have to explain the regulation of her/his country of origin as the relevant competent authority would communicate it to the competent authority of the host Member State through the IMI.

Case Study on the European Professional Mobility Card for Nurses

Therefore, the EPMC as the members of the subgroup see it could make the recognition process quicker, safer and reliable due to its contents and mechanism set up in connection with the IMI. The professional card facilitating recognition It is necessary to clarify that in most Member States nurses must be registered with the national competent authority after recognition in order to practice the profession. The case study emphasizes that the EPMC should only be used for the recognition of the professional qualifications as a tool to speed up the process and to make it easier for the individual and the competent authorities involved in it by having updated and accurate information on the professional qualifications and professional status. The EPMC is seen as a tool of communication between competent authorities, assisting in the registration process but not replacing it. Further considerations should be given to the registration procedures in each Member State and whether information is required by the host Member State. At the same time it should be made clear that the issuance of the EPMC does not replace the registration process with the competent authority. Members of the subgroup consider it indispensable to make sure that the professional does not get the impression that once she/he possesses the EPMC, she/he does not need to register with the competent authority of the host Member State or that she/he is allowed to start practising immediately. This would be illegal in many Member States where registration is compulsory. The EPMC should not be actively promoted as a verification tool for patients and employers. This would pose the risk of confusion in some Member States as live registers of accredited professionals already exist. In these countries, adding a second verification tool for employers may lead to confusion and possible abuse. However, some member states may find the verification tool helpful. We therefore suggest that Member States may opt in or out of the verification tool for employers. General remarks on the value added of the EPMC for the nurses The strength of the EPMC is that it can speed up and facilitate the mutual recognition for nurses, wanting to move within the EU based on the mutual recognition of their professional qualifications. The EPMC, as for instance an e-certificate linked to the IMI system, would allow an even quite faster and safer recognition process. An improved communication flow through the IMI would mainly serve to create larger trust between Member States along the process of mutual recognition of professionals qualifications. Administrative procedures would be simplified in the host member state and in perspective lead to the replacement of paper documentation with digital documents. Therefore all EU/EEA Member States must be aligned with the IMI system and its use by competent authorities should become mandatory in the Directive. When issuing the card, the competent authority in the Member State of departure would have to check that applicants hold the correct qualifications and satisfy any other conditions as may be required under the Directive. The use of the IMI system will avoid unnecessary translations of documents for the applicant based on a system of automatic translations, which are currently extremely costly for the nurses wanting to exercise the profession in a Member State other than the one they obtained their qualification. The competent authority issuing the card would be able to store the copy of the documents (qualifications, certificates etc.) which served as a basis for issuing the card and make those documents available to its counterpart in the host Member State through the use of the IMI system. Under this system, competent authorities in charge of recognition must be compulsory identified and linked within IMI. It must be emphasised that the EPMC can only have added value for migrating nurses if it does not entail any financial burden on them in addition to the already existing administrative fees for recognition. This was also set out as a working assumption by the Steering Group members.

Case Study on the European Professional Mobility Card for Nurses

INFORMATION AND CONTENTS OF THE EUROPEAN PROFESSIONAL MOBILITY CARD Information to be presented in the card, considering the option of an e-certificate The EPMC (e-certificate) should have a unique card number, valid for the reference of communication under IMI and to link the storage of necessary documentation. The following information is preliminary considered on the EPMC: Personal data (including physical identification and nationality). Unique card identification Profession: o Information regarding the education (compliance with the harmonised minimum training requirements). o In case, acquired rights that lead to automatic recognition (Article 31 of the Professional Qualifications Directive) o The measure of the level of qualifications (for example, Article 11 or EQF as referred to the legislative proposal). o Competent authority responsible for access to the profession o Educational institution1 to check if this institution is authorised to train and educate nurses at the level required by the Directive. Consider including further information regarding recognition by the host country. And most importantly, the European flag as a symbol of belonging to the European Union.

Information to be linked to the card Furthermore, more detailed information (and scanned documents) concerning the competent authority responsible for recognition, the profession itself including the scope of practice and a measure of the level of professional qualifications, educational institution, language skills and preferably information on professional experience and continuous professional development and the absence of misconduct could be foreseen to be included in the IMI system. These data could be stored and checked through the unique number of the card linked with the IMI system as a basis with the possibility to include more extensive data of the professional who wants to move. Linked to the EPMC should also be included information regarding the legal status of the cardholder and on potential pending sanctions, temporary withdrawal of registration etc. Validities of the EPMC could trigger the veracity of these data. Therefore, these data should be linked through IMI to speed up the information exchange. In relation to the information linked to the card, the host Member State could be informed by the home competent authority of the content of the professional qualifications, for example on the rights attached to the academic titles and content of the training, scope of practice of the profession, professional experience , etc. The possible process to validate the card The modernisation of the Directive needs to entail the mandatory use of IMI system as the main source for the exchange of information between competent authorities. As presented during the Steering Group meeting last 13th September, the members of the nurses subgroup are in favour of
Ref to Green Paper - to ensure better compliance at national level with the minimum training requirements, Member States to ensure universities and other educational establishments follow the framework set by the Directive in light of continuous reforms.
1

Case Study on the European Professional Mobility Card for Nurses

moving towards the option 1 and 3 presented by the IMI department of the EC and therefore favour the proposed e-certificate. As described these options, competent authorities having access to the IMI system will be the ones that will have the access to the information that should appear on the card and the detailed information included in the IMI concerning the recognition process of an individual nurse. Also, some parts would be accessible by the professional itself, patients, employers and consumer organisations. Importantly, the individual nurse could upload the information into the IMI in the professionals file repository, home competent authority could check data and documents to approve the EPMC and finally, the host competent authority could also check the validity and status of the EPMC and request (when needed) translation of documents.

Taking into account these options issuing the card would therefore be the process that enhances TRUST amongst the competent authorities in terms of professional recognition working as an official document from the home Member State.

CONCRETE USE OF THE EUROPEAN PROFESSIONAL MOBILITY CARD

Who is issuing the EPMC The main issue here is to have clarity on who is responsible for issuing the EPMC and the legal power of it, as this is part of building confidence and trust among Member States. The home Member State competent authority in charge of the recognition process should be the responsible for issuing the EPMC. In order to have a proper cooperation between Member States there should be statutory deadlines for competent authorities to reply questions within the IMI system. Guidelines should be prescribed to ensure a consistent approach amongst competent authorities regarding the issue. The assumption that the EPMC will be issued by the competent authority in the home Member State represents a shift from the terms of the current Directive, placing a greater emphasis on the role of the competent authority in the home Member State. Who is the competent authority responsible of the recognition process in each Member State needs to be clear. In this context it is necessary further to clarify the definition of the competent authority and home Member State term. It is equally necessary to explore the question on the issuing body where the home Member State where the nurse has obtained her/his qualifications and the Member State of establishment are not the same State. The last is in particular relevant for the provision of services (see Article 5 of the Directive).

Case Study on the European Professional Mobility Card for Nurses

It is possible that the new and expanded role of the home competent authorities, especially those of that are traditionally sending countries, and consequent increase in the amount of everyday workload might also bring an increase on costs. Therefore, when implementing the pilot studies the inclusion of a financial impact assessment should be considered. Finally, it is important to take into account the lack of communication flows between the national educational accreditation body - which are for the nursing education mainly based within the Ministry of Education or the Ministry of Health and the competent authority examining the recognition and registration. An improved communication between regulation and accreditation should be achieved for the benefit of the individual nurse, for example in the cases of recognition when the title does not appear in the Annex V. Each MS shall recognise as sufficient proof for MS nationals whose evidence of formal qualifications as a nurse responsible for general care does not correspond to the titles given for that MS in Annex V, point 5.2.2, evidence of formal qualifications issued by those MS accompanied by a certificate issued by the competent authorities or bodies. Such certificate shall state that the evidence of formal qualifications certifies successful completion of training in accordance with Art 31 and is treated by the MS which issued it in the same way as the qualifications whose titles are listed in Annex V). This communication could improve and lead the process into a more secure free movement of nurses. What is the validity of the EPMC The case study envisages no opportunities for a restricted period, since the e-certificate can be validated by its unique number, linked to the IMI. The IMI system is the one that needs to be constantly updated and needs to act as the tool to check the validity and accuracy of the information included in the e-certificate. Is it necessary to foresee a mechanism to renew or update the card? It is necessary to define a mechanism of updating the information in the IMI system, above all to include the alerts on legal status. It is vital that the information supporting the EPMC is current and up to date. The updating of information particularly in relation to professional character must be agreed and prescribed across the Union.

FORMAT OF THE EUROPEAN PROFESSIONAL MOBILITY CARD

Members of the nurses subgroup agreed on an e-certificate. The case study suggests including the European flag in the e-certificate to contribute to the EU-identity of the owners. It is essential to include in the format the unique number for identification of the professional and his/her stored information and recognition process. The possibility of implementing a chip is not considered in this case study, meaning that the unique card number provides access to the IMI professionals file repository. At this stage, a possible link with e-identification systems is not envisaged in this case study. Paul De Raeve EFN Secretary General 16 September 2011