II.11.7. Problem regarding the qualification of health care practice instructor

Our sector possesses a health care educational officer vocational qualification under serial number 55720 01. This supplementary education regarding the specialities of the sector was realized with state aid, with the budget of a tender framework, as there was no accessible teacher qualification in this sector for a long period of time. With this vocational qualification, there was a possibility for performing practical educational tasks so far. However, health care educational officers cannot perform educational tasks without a higher educational pedagogy qualification, according to the 2011. CLXXXVII. act on vocational education, which may result in severe problems regarding the education due to the lack of professionals. Although in case of colleges, who have completed the education, a change of perspective can be noticed and they are able to transfer their high-level professional knowledge to students participating in health care education with the utilization of suitable pedagogical methods.

II.11.8. Problems regarding social care carer and nurse education

The title „nurse” can be obtained within the frames of education, which is outside the health sector education and our sector and the Chamber of Hungarian Health Care Professionals have no substantial control over it. The nurse title is misleading as it does not comply with the provisions of the relevant EU directive on nursing education, nor can it perform the role of nurses, even in the social sphere. In addition, social care carers and nurses are entitled to use the nurse title with some scope of practices (e.g. medication, intramuscular injection), with a 3-year-long education for which they do not need the high school leaving certificate, with those in the health sector it is only possible to obtain general nursing and health care assistant qualification (so the nurse title cannot be used!), moreover by completing a 4-year-long education and with a high school diploma.

II.11.9. Anomalies resulting from the non-regulation of the professional tasks within the sector

In order to maintain and restore professionalism, the sector’s due relevancy within the determination of developmental processes (pl. vocational education, framework curriculum, Vocational- and Exam Requirements, scope of practice order) and criteria is especially important. We suggest the exclusion of organizations unqualified for the profession (e.g. Hungarian Chamber of Commerce and Industry) from fields requiring special professional expertise and the knowledge of sectoral frameworks during establishment of legal regulations regarding the health care vocational educational programs. A separate expert’s community of the National Healthcare Services Center/Hungarian Health Care Professional Chamber/Hungarian Chamber of Commerce and Industry is not justified. The coordinated sectoral verification of the experts’ person is due and justified.

According to the current regulation, it is often noticeable that experts working in the development of one professional field work independently from each other, they are not aware of the problems within the given professional field. In several cases, the determination of the expert’s community is the decisive factor instead of the professional experience and practice of the given field; the relationship between the expert and the client is emphasized, and whether he/she is able to perform the task under a short period of time (even 24, 48 hours), thus the task is handed to an expert who is able to complete the task within the framework determined by the developer, by only utilizing the earlier material. The coordinated sectoral verification of the experts’ person is due and justified. The selection of the expert’s person through tenders is regulated by the 31/2004. (XI. 13.) Ministry of Education order, in which the change of the tender requirements is necessary regarding the solutions of the problems stated above.

II.11.10. Anomalies regarding the performance of tasks by the chairman- and members of the examination board

The regulation of the tender for the chairman of the examination board is determined regarding every sector, thus the specialty of the given sector cannot apply and also, there is unfortunately no suitable upper age limit set for the performance of the task. Currently, the function can be fulfilled by a person with a higher educational qualification not related to the given education, or even without a higher educational health care qualification or operating license, or without any practical knowledge on the given field. Unfortunately, some of the chairmen of the examination board are not aware of the relevant legislation and the requirements of the given qualification, they are not aware of the changes.

In case of the examination board members, the relevant legal framework determines the requirements in a general manner, the specific regulation is conducted by the Educational, Continuous Development and Sciences Committee of the Hungarian Health Care Professional Chamber (including the concerned Professional Department). It can be stated that the selection of a suitable person is a daily problem. Hence the number of qualified professionals is unsuitable regarding certain profession groups, there are no professionals either suitable for- or willing to fulfill the position, thus often the same person is appointed several times within the profession group during the appointment/proposal, and still in several cases, and no suitable examination board member can be provided. Another problem is the fact that examination board members, chairmen of the examination board or experts cannot receive a scheme for part-time working, thus, in several cases, they can only fulfill the task at the expense of their own holiday period. Regarding this fact, the chairmen of the examination board, experts and the examination board members working under retirement are emphasized. We hereby suggest the regulation of the scheme for part-time working on a legislative level, so the expert concerned can utilize an annual maximum of 3 to 6 days (this is at least 2 exams). In addition, it is necessary to amend Government Decree 315/2013 (VIII.28.) regarding the incompatibility of the members of the examination committee, eg. family members and relatives are excluded from the examination committee.

II.11.11. Anomalies regarding the conduct of vocational exams

II.11.11.1. Main problems regarding vocational exam organizers

In some cases, the exam organizer does not compile the documentation of the examination candidates according to law during the preparation for the vocational exam, the exam organizer institution validates the exam candidate based on partially incomplete documentation (unsuitable entrance competence/prior vocational education; valid medical certification; valid practical certification, etc.). Therefore, several exam candidates may not begin their vocational exam (or they begin it illegally), as they are unsuitable for the entrance requirements of the vocational education, which becomes apparent before the vocational exam.

The exam organizer institution does not always contact the entire examination board, thus the chairman of the examination board approves the conduct and task list of the practical exam activity under his or her own scope of practice without the inclusion of the members. Therefore, the examination board members cannot always fulfill their vocational tasks as required by law. Consequently, the location of the practical exam activity and the practical exam task list is unsuitable for the determined vocational- and exam requirements of the vocational qualification. During vocational exams, the vocational chambers and the examination board members delegated by the vocational organizations often find themselves in a situation, where the requirements deductible from the vocational- and exam requirements and vocational criteria are partially- or not valid. In order to remedy this, the government offices/district offices appoint persons for the verification of the exam organizers, however, it often occurs that the persons appointed for conducting verification are also not experienced in the given professional field and/or the verification only extends to the possession and legal validity of the documents required by law, while – due to the lack of a professional expert – the verification of the professional documentation compiled by the exam organizer (module exam, compliance of the practical vocational exam tasks to the Vocational- and Exam Requirements) is not conducted. In order to make professional guarantees enforceable during the exam verification, we have initiated a proposal for revised legislation; its basis is currently present within the act on vocational education. The aim of the proposal is having the sectoral management order one of the professional experts during the verification procedure of the complex vocational exam, in order to validate the professional aspects.

The performance of tasks as well as the advance payment of travel expenses by the board is not uniform following the conduct of the vocational exam. The task, accommodation and travel expenses depend on the exam organizing institution, which can often lead to problems (we know cases, where the travel expenses and the management fee were not paid in six months/one year).

II.11.11.2. Main problems regarding the functioning of the vocational examination board

The Pest Count Government Agency appoints and publishes a member of the vocational examination board, which is public for the individuals participating in the exam, according to the proposal of the National Healthcare Services Center and the Hungarian Health Care Professional Chamber, according to the legal requirements, (due to the reception of the delayed letter of commission). In several cases, the publishing is obstructed, which complicates, and in some cases renders contact between examination board members impossible, which is only conducted within the MINERVA system with closure. The exam organizer cannot adhere to his or her legal requirements due to the lack of background documentation which delays the rightful material and other legislative services for the board members. We hereby recommend the guarantee of a systemic IT background and the publishing of the decision within 10 days following the proposal. The members of the board cannot substantially contact each other, as the letter of commission is not always sent before the commencement of the exam (first exam activity). Therefore - due to the lack of information - the composition of the examination board remains unknown, and in several cases, the vocational exam-organizing institution does not contact the entire examination board until the vocational exam underwent closure in the MINERVA system.

Members of the vocational examination board cannot always exercise their rights and obligations according to the 315/2013. (VIII. 28.) Gov. Order, as the organization and conduct of the vocational exam is not uniform. His results in the following problem: the documents to be released by the board (letter of commission, certificates validating qualification, degrees; documentation necessary for the accounting of travel expenses, invoices, vehicle documents; payment supporting documents; etc.), and the possibility of requesting accommodation is not conducted under uniform criteria.

II.11.11.3. Problems regarding the issuing of vocational exam organizing certificates

The issuing of vocational exam organizing certificates is conducted by the regional government office, its criteria is outside the scope of practice of the Hungarian Health Care Professional Chamber. According to the laws in effect, in case the exam-organizer institution already possesses a sectoral exam-organizing certificate, the procedure is conducted in the form of simplified administration.

In several cases, only a cooperation agreement is signed for the conduct of the exam activity, which does not guarantee that the organizer is suitable for the conduct of the exam activity determined in the exam requirements of the given vocational qualification (e.g. insufficient technical requirements), therefore the requirements stated in point 6. (tool- and equipment registry) of the Vocational- and Exam Requirements of the profession, or there is no specific exam location. In several cases, there is no possibility set in the written conduct order - dependent on the exam organizer – or on the exam location for the following: the conduct of the exam activity in a professionally suitable manner in a circumstance related to the situation (e.g. on a patient), and the possibility for an objective determination of manual/interaction capabilities within the professional skills.

II.11.11.4. Problems regarding validation of the vocational exam

The validation of the vocational exam is paper-based, conducted through an electronic system. The location of the practical exam is often not a health care institution, but the location of the exam-organizer institution, therefore the location of the practical exam activity remains unknown. Currently, the requirements of the practical exam activities are not uniform – e.g. whether the exam organizer possesses a demonstration room, where the tools determined in the vocational- and exam requirements are available, whether point 5.3.1. of the vocational- and exam requirements required for the practical exam conduct is guaranteed, and whether the patients and the up-to-date imitation tools (nursing torsos, mulages, nursing simulation phantoms) are available in suitable quality and quantity for the number of exam candidates. We hereby propose the central publishing of the practical task list - aside from the preparation time/number of education hours for the complex vocational exam, completely covering the competences of the given vocational qualification, determined by qualification – and the related evaluation criteria (by determining the necessary technical conditions). With this, the unprofessional and pedagogically improper formulation of practical tasks can be avoided. By contrast to the current system, the proposition provides protection for the examination board members and for the exam organizer as well, furthermore – regardless of the exam organizer –, it provides equal opportunities for the exam candidate regarding the exam tasks. Examinations based on professionally unsuitable practical task lists and confrontations between examination board members and the exam organizer regarding the approval of the practical task list can be avoided. It is also recommended to compile an examination material (guide, procedure, etc.), which describes in detail the activities related to the organization of exams. This would facilitate the unified implementation even if it is not fixed by law.

II.11.11.5. Problems regarding the management of the vocational exam

Following the vocational exam, the members of the board have an obligation to report. A feedback appears on an interface for both the chairman of the exam and the examination board members, highlighting the closed question and a scale from 1 to 10, aside from that, it provides an opportunity for comments and for the answering of essay questions. Aside from the identification data, the professional content inquires the legal conformity, the organization method and the performance of the exam candidates. The high authority processes the data according to experiences from the previous years, however, the Hungarian Health Care Professional Chamber has no overview on the processed results. The content of the reports needs to be rendered accessible for the participants by means of sectoral intervention, as this may form the background regarding the development of objective information. Furthermore, comments and experiences of the chairman and members of the examination board must be evaluated and taken into account in the developments, feedbacks should be given to the exam organizer as well if it is necessary, because there are practically no consequences of the problematic operation.

Recommendations for solutions

Establishment of a ministerial background institution on sectoral level, with the following responsibilities: