Dr. Simon is Professor and Director, School of Nursing, Nyack College, Nyack, New York. At the time this article was written, Dr. Simon was Assistant Professor, Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, New York.
The author has no financial or proprietary interest in the materials presented herein.
Address correspondence to Elizabeth B. Simon, PhD, RN, CCRN, CEN, ANP, 11 Lynwood Road, Scarsdale, NY 10583; e-mail: firstname.lastname@example.org.
Nurses visiting southern Switzerland usually stop at #3, Place Jean Marteau, Geneva, at the International Council of Nurses (ICN), a group that represents 130 countries. Founded in 1899, the world’s first and widest-reaching international organization for health professionals serves as a hub for the international exchange of ideas, experience, and expertise for the nursing profession (ICN, 2008). The World Health Organization (WHO) and the Swiss Red Cross (SRC) are other health-related sites of interest. In that vicinity, there is another landmark institution that nurses might not visit because it is less known compared with these international organizations—Le Bon Secours (LBS). Founded in 1905 and now known as Haute Ecole de Santé Genève (HEDS), the school is a pioneer in nursing education. Unlike many nursing schools in Switzerland, HEDS, with its history of constant evolution, is moving forward to absorb the nursing education culture of ICN members, especially the United States. The transition from LBS to HEDS was influenced by the vision of its founder, Dr. Marguerite Champendal, the support and strategies of the Rockefeller Foundation, the influence of American nursing education through its past directors, and eventually the European educational reform. Like the ICN, WHO, and SRC, HEDS influences the international community with special projects and internship programs that allow students to get involved in global health and international nursing issues.
This article was prepared on the basis of an interview with the director, observation of the school’s activities, and examination of the school’s documents. The purpose of this article is to introduce HEDS, its remarkable history, and its commitment to excellence in nursing education. The following paragraphs describe the evolution of HEDS, the vision of its founder, and how her vision has been carried out by her successors, who were clearly influenced by her vision and the Rockefeller Foundation, as described in the Francillon (2005). The article highlights the educational strategies that made the school different from other Swiss nursing programs. The effect of the Bologna Declaration in the transformation and the future direction of Swiss nursing education is also discussed. The international vision of this school will inspire nurse academics to initiate similar steps to provide a unique experience for their nursing students. Above all, the introduction of this school to U.S. nursing colleagues will facilitate further exploration and networking.
An Untraditional Nursing School
Champendal started the “Drop of Milk” clinic in 1901 and then realized that she would need a visiting nurse for follow-up home care. In 1905, Champendal met Céline Pélissier, who spent her time visiting the needy in her parish. Champendal became the president of the school preparing volunteer nurses and named it Le Bon Secours (Francillon, 2005). Tuition, room and board, and the uniform cost approximately 2,200 francs, which was approximately two annual salaries for a private home care nurse at that time. Such an amount limited access to wealthy women with secondary educations only. LBS adopted pedagogical strategies different from those of the traditional nursing schools in Switzerland.
A notable strategy was that students learned at their own pace. The theory classes could be briefer or more varied, general culture classes could be included, and the internships could be shortened if the students learned faster because of the solid basic education. Internships were organized with the state Hospital of Geneva. The students worked in different medical and surgical departments under the direction of deaconesses. This internship training could last 1 year or more. After graduation, Champendal asked the nurses and auxiliaries to commit to serving the needy at a specific time of the day of their choosing for a minimum of 2 hours. Service-learning could enhance caring behaviors (Johanson, 2009).
In contrast to other schools, LBS trained its students in a minimum of 18 months, alternating theory and practica, whereas training in schools under the authority of the SRC lasted 3 years. The teaching practiced at LBS encouraged intellectual broadening through diversified approaches, such as discussions, problem solving, music, art, and politics. This flexibility in curriculum and instruction encouraged adaptability and resourcefulness in the students—valuable qualities sought by employers. In essence, such innovations resemble the current trend of accelerated programs in the United States. On October 25, 1928, Dr. Champendal passed away, but her inspiring command to her students to be in “constant evolution” has guided both the enormous number of LBS graduates and the directors who have led the school over the years. The directors of nursing who led the school after Champendal either were educated in the United States or were supported by grants from the Rockefeller Foundation.
The international presence of the newly transformed and christened HEDS is evident in numerous ways. The school displays pictures of its students completing their community health practicum in different countries, such as India and Albania. There are nursing faculty members from other countries, especially the United Kingdom, spending full semesters in a faculty exchange program in this francophone school. The dean of health sciences and the director of nursing expressed their willingness to expand their connections to nursing faculty in the United States and other anglophone countries. Nurses interested in comparative nursing education and standardization of international nursing competencies can undertake further exploration and involvement in Swiss nursing education. The evolution of LBS is an example of the transformation in Swiss nursing necessitated by the educational reformation in Europe.
The Transformation of Higher Education in Europe
In the late 1990s, Western Europe was envisioning a reformation in its higher education. The major structural change at LBS was influenced by the ongoing reforms in the nursing education system in Western Europe, especially the Bologna Declaration. The Bologna Declaration (1999) was prepared by the Confederation of European Union Rectors’ Conferences and the Association of European Universities. The European process of unification and the fundamental principles laid down in the Magna Charta Universitatum, signed in 1988 (also in Bologna), the Sorbonne Declaration of 1998, and the Bologna Declaration of 1999 are aimed toward reformation of higher education in Europe. The focus of these agreements is the adoption of easily readable, comparable degrees, such as undergraduate and graduate, and the establishment of a system of credits—the European Credit Transfer and Accumulation System (ECTS). ECTS is a standard for comparing the performance of students of higher education across the European Union. The successful completion of 1 academic year corresponds to 60 ECTS credits that are equivalent to 1,500 to 1,800 hours of study (Davies, 2008; Oliver & Sanz, 2007; Reinalda, 2008).
In addition, the following areas are given importance: promotion of mobility, cooperation in quality assurance and promotion of curricular development, inter-institutional cooperation, integrated programs of study, and training and research. The Bologna Declaration (1999), an agreement signed by 29 countries, is intended “to create a European space for higher education in order to enhance the employability and mobility of citizens and to increase the international competitiveness” (p. 4) of the European system of higher education and is “a commitment freely taken by each signatory country to reform its own higher education system or systems in order to create overall convergence at European level” (p. 2). It demands that the signatory countries will meet this goal within the framework of diversity and culture by 2010.
Switzerland was one of the last countries to integrate nursing programs into higher education. However, the Bologna Declaration brought in significant changes for nursing education in Switzerland (Spitzer & Perrenoud, 2007). The major obstacle in quickly adopting the changes was the Swiss culture of different cantons, languages, and related educational practices and vision, which is discussed below.
Swiss Cantons and Education
Spitzer and Perrenoud (2006) studied ongoing nursing education reform in Western European countries, including Switzerland. The last decade saw numerous reforms in the professional education system. These reforms were intended to harmonize professional education and to grant it a status equivalent to university education. Switzerland has four linguistic regions whose residents speak French, German, Romansh, and Italian. It is a confederate of 26 cantons, with 26 parliament and cantonal executives. The confederation divides the policy decisions, regulations, and administration of financial support of post-compulsory education between the confederation and the cantons. The confederation meets one third of the financial obligations and the cantons met the remaining two thirds for higher education.
In Switzerland, post-compulsory education presents a dual model of academic and vocational studies placed in the upper secondary and tertiary levels. The policy reforms led to structural changes in grouping the professional educational institutions into two categories: the advanced training schools and the universities of applied sciences. The admission requirements and the diploma granted are different for each program. For advanced training schools, a federal capacity certificate (a title delivered to the students after undergoing vocational training after obligatory education) is the requirement. The certificate does not meet admission requirements to a university or to universities of applied sciences. On the other hand, universities of applied sciences require the students to complete a maturity certificate (matriculation examination scores).
The cantonal choices were based primarily on cultural differences. For example, in Germany and the Netherlands, professional education culture is embedded in a vocational model rather than an academic setup, which is considered unnecessary by clinicians, educators, and some students themselves in German-speaking cantons of Switzerland. In German, Italian, and Romansh cantons, only 23% of the students have maturity certificates eligible for university education, compared with more than 70% in French-speaking cantons (Spitzer & Perrenoud, 2007).
French Culture and Curriculum
French-speaking cantons unified nursing, social work, and health education programs into an organization of universities of applied sciences of health and social work to attract a large number of potential students. This model, called the HES-2, confirms a diploma equivalent to a baccalaureate in nursing after 4 years of study with 33% clinical practicum. The remaining regions grant a 3-year diploma with 50% clinical practicum. The major difference in these programs is based on the critical-thinking skills and research competencies emphasized in the HES-2. The Swiss nursing curriculum is directed by the Swiss Red Cross and supervised by the Swiss Conference of the Cantonal Ministers of Health. The German and Romansh cantons placed nursing education under the advanced training schools, and the Italian-speaking and French-speaking cantons brought it under the universities of applied sciences, undermining the credibility of the Swiss diploma among other European nations. Financial obligations imposed on cantons in the HES-2 model are another obstacle. The HES-2 model costs approximately 25,000 Swiss francs more than the advanced training schools.
Because it is difficult to establish the positive outcomes of the high-cost nursing education embraced by the French-speaking cantons, the rest of the cantons are reluctant to get full integration into universities of applied sciences (Spitzer & Perrenoud, 2007). However, the Swiss Conference of the Cantonal Ministers of Health has promoted universities of applied sciences education in German-speaking cantons for nursing graduates to pursue careers in management and education. For example, the University of Basel offered the first combined bachelor’s and master’s education in nursing science since 2000 (von Klitzing & Kesselring, 2006).
The first phase of the European reforms standardized the entry requirements and the level of basic nursing programs in most of the countries. However, the second phase of reform aimed at integrating nursing education into higher education resulted in significant variations in levels and period and the degrees awarded. The purpose of this reform is mainly to attract qualified nurses into the practice setting. LBS transformed to HEDS to accomplish this goal and to be in continuous experiments and evolution that give the school its significance in Swiss nursing education.
The Final Destination
The current director did an intensive preparation for the entry of LBS into the French-speaking specialized school (HES-2) (Francillon, 2005). This task required the reconfiguration of the totality of training programs for the health and social service professions in Geneva. In 2002, there were 343 students comprising the first year of HEDS. They were beginning their education as dietitians, nurses, physical therapists, radiology technicians, and midwives in HEDS specialized school. Currently, there are 701 students in HEDS, which is affiliated with the Geneva University of Applied Sciences (HEDS, 2004). It was a historical moment, part of a vast European movement affecting public education.
In Switzerland, it was a result of the federal law on specialized schools, broadened to include health sciences, social services, and arts. The working groups given the task of implementing the law decided to give Geneva a School for Social Work and a School of Health, which grouped the different specialized school tracks around LBS. A month of mobility was initiated this year for all third-semester and fourth-semester health care and education students in francophone Switzerland, offering them the opportunity of developing professional competencies in a variety of sites (Tables 1 and 2).
Table 1: Academic Preparation for the Haute Ecole de Santé Genève Nursing Program
Table 2: HEDS Nursing Program Overview
In partnership with the Adult Education Institute of Geneva, students were able to take classes in English for professionals. During 2003 and 2004, HEDS expanded to include graduate training programs: Specialization in Community Health and Care Networks, Specialization in Maternal and Infant Health, Specialist Training in Care to the Elderly, and Specialization in Oncology and Palliative Care. Further progress was made in e-learning; establishing a fall and fractures prevention program for the elderly; teaching interns from management schools in France; expanding library services, making HEDS a document center; renovating the media center; and offering international internships abroad. The most visible international project is the Albania Project.
The Albania Project
In 1993, LBS launched a new intercultural community health project that had three goals: training trainers, training nurse managers, and opening a site for internships abroad for LBS students in Albania. The long isolation of Albania and the lack of funds available for its public health care sector had resulted in stagnation of the quality of its education and inability to cope with the minimum European standards. In 1995, LBS organized a new basic training curriculum to help Albanian nursing education. “Since then, a new generation of young nurses and midwives has accomplished modern health education, thus building a personnel pool with skills compatible with European standards” (Swiss Agency for Cooperation and Development, 2007, p. 1). The goal of the training was to make staff members autonomous so they could identify what the problems were for themselves and respond according to their own criteria and cultural norms. The World Bank invested in the construction of a nursing and midwifery school at the hospital of Tirana. The relationship and supervision still continue with Françoise Bonvallat, the current director of HEDS. Evidently, HEDS is making a difference; it has a clear focus on the future development of nursing science.
The Future Focus
Dassen and Kottner (2007) argued that the nursing profession in these Western European countries needs to refocus on the content of nursing science, with more doctoral programs that promote discovery. The knowledge derived from nursing science is related to nursing diagnoses, interventions, and outcomes. Study courses and research programs in clinical nursing are needed for the development of nursing science. In Europe, the programs of study in nursing management and nursing education are referred to as programs of nursing science even when their priorities are different. One issue that limits the expansion of nursing science in Switzerland is the lack of a nationwide health policy and research agenda. This void has led to poor coordination of nursing research in the past. Nevertheless, in 2007 the Swiss Research Agenda for Nursing developed an agenda for clinical nursing research that recommended seven research priorities (Imhof et al., 2008), and the effectiveness of nursing intervention is first on the list. An action plan to develop nursing research is the next step in this process. I believe that development of strategies and an action plan to implement those priorities will greatly influence nursing education in both French-speaking and German-speaking cantons of Switzerland and that HEDS is positioned as a leader in reaching this goal. The vision of its founder, Dr. Marguerite Champendal, is kept alive in innovative teaching strategies, serving the needy, and being in constant evolution.
- Bologna Declaration. (1999). The Bologna Declaration on the European space for higher education: An explanation. Retrieved from http://ec.europa.eu/education/policies/educ/bologna/bologna.pdf
- Dassen, T. & Kottner, J. (2007). Nursing science in the German-speaking countries: A position statement. Pflege, 60, 96–100.
- Davies, R. (2008). The Bologna Process: The quiet revolution in nursing higher education. Nurse Education Today, 28, 935–942. doi:10.1016/j.nedt.2008.05.008 [CrossRef]
- Francillon, D. (2005). Le Bon Secours: Quand le passé announce l’avenir. Geneva, Switzerland: Georg Editeur, M&H Department livre.
- Haute Ecole de Santé Genève. (2004). Dossier de formation: Filiere de formation des infirmieres et infirmier. [File of training: Course of study of training for the Nurses]. Geneva, Switzerland: Author.
- Imhof, L., Abderhalden, C., Cignacoco, E., Eicher, M., Maher-Imhof, R. & Schubert, M. et al. (2008). Swiss Research Agenda for Nursing (SRAN): The development of an agenda for clinical nursing research in Switzerland. Pflege, 21, 252–261.
- International Council of Nurses. (2008). ICN mission. Retrieved from http://www.icn.ch
- Johanson, L.S. (2009). Service learning: Deepening students’ commitment to serve. Journal of Christian Nursing, 26, 95–98.
- Oliver, R. & Sanz, M. (2007). The Bologna Process and health science education: Times are changing. Medical Education, 41, 309–317. doi:10.1111/j.1365-2929.2006.02650.x [CrossRef]
- Reinalda, B. (2008). The Bologna Process and its achievements in Europe 1999–2007. Journal of Political Science Education, 4, 463–476. doi:10.1080/15512160802414012 [CrossRef]
- Spitzer, A. & Perrenoud, B. (2006). Reforms in nursing education across Western Europe: Implementation processes and current status. Journal of Professional Nursing, 22, 162–171. doi:10.1016/j.profnurs.2006.03.011 [CrossRef]
- Spitzer, A. & Perrenoud, B. (2007). Reforming the Swiss nurse education system: A policy review. International Journal of Nursing Studies, 44, 624–634. doi:10.1016/j.ijnurstu.2006.04.003 [CrossRef]
- Swiss Agency for Cooperation and Development. (2007). Development programme for nurses and midwives. Retrieved from http://www.swisscooperation-albania.ch/ressources/resource_en_63256.pdf
- von Klitzing, W. & Kesselring, A. (2006). Nursing science courses at the University of Basel/Switzerland: Concept, guidelines, curriculum and evaluation of study results. Gesundheitswesen, 68, 780–786. doi:10.1055/s-2006-927281 [CrossRef]
Academic Preparation for the Haute Ecole de Santé Genève Nursing Program
|General baccalaureate||50%: 30% candidates from Switzerland, 20% principally from Europe and Africa|
|After 1 year of the preparatory program for candidates with a general educational certificate||40%|
|Directly for candidates with a vocational baccalaureate||3%|
|Directly for candidates with a specialized baccalaureate||7%|
HEDS Nursing Program Overview
|Preparatory Program||Professional Sequence||European Regulations|
|Theoretical training, 22 weeks||6 clinical training periods (1 per semester)||180 ECTS and 3 years, 2,900 hours|
|Clinical training, 11 weeks||Theoretical training, 60%; clinical training, 40%||6 semesters of 30 ECTS|
|Seminars or examinations||Nursing professional competencies: 9||1 semester = 16 weeks = 4 theoretical modules and 1 clinical module|
|Pedagogy by a reference system of 6 professional competencies (total of 1,520 hours)||International and national mobility possible during the fourth semester||1 module = between 5 and 10 ECTS with 1 possibility to redo|