II.12.1. Mandatory continuing education programs

According to practical experience, the Hungarian system for continuous development courses did not provide an optimal framework for the rectification of deficiencies due to the natural forgetting of professional knowledge and the continuous expansion, development and changes of such professional knowledge. There are several reasons for this, e.g. the professionals were (are) able to acquire the scores necessary for the continuous developmental period by participating in conferences and with points due for the years in practice in a decisive rate, further factors: the content of a portion of continuing education courses with an “A”, the scope of experts conducting continuous development courses, the determining of the continuous development course subjects, and the lack of scope of practice for qualification levels. Compared to this, the 63/2011. (XI.29.) National Ministry of Human Resources order on the regulations of the continuous development of professionals is an improvement; according to the order, the mandatory continuous development courses may exclusively be conducted by faculties of health sciences in case of college/university-level professionals, while, in case of vocational-qualified professionals, continuous development courses may be conducted by the faculties of health sciences, the National Healthcare Services Center, accredited health care institutions and institutions conducting formal health care vocational education. However, there are anomalies regarding the system, summarized below.

Health care professionals need to collect 150 points in five years (theory: 50 points, practice: 100 points) for acquiring validation. From these, it is mandatory to acquire 30 theoretical points within the framework of a further education in a profession group (Community Framework for State aid), which may be completed by even one further education (however, 10 points can be acquired by the professional participating in the education of a different profession group and failing the exam). A problem regarding optional mandatory continuing education courses for certain profession groups is that the given profession group includes several vocational qualifications on different levels (different vocational levels, Bachelor, Master), and acquired on different fields (e.g.: 1. vocational group includes health care teacher-, nursing assistant-, health improvement assistant- and Bachelor/Master’s qualifications as well.), i.e. a health care professional with a qualification acquired on a different level of education and/or different field within the profession group, while the scope of practice of the professionals may significantly differ in the given subject (e.g.: for “The modern treatment of urinary- and fecal incontinence”, a general health care assistant is only competent for the preparatory stage. A similar situation emerged regarding e.g.: the “prolonged analgesia”, „nursing aspects of ostomy therapy”). In certain cases, continuous development is conducted for several profession groups (e.g.: regarding “parenteral nutrition”, aside from the adult nursing and care profession group, the dietitian; APN pediatric nursing and treatment profession groups are included, thus the following professions receive equivalent content within this education: pediatric nursing home nurse; patient guide; Master level nurse; paramedic or a Master Level Nutritionist, whereas their competencies and prior knowledge are not comparable on the field.

The update of the classification of vocational qualifications in profession groups has not been conducted for years, thus new vocational qualifications and specialized continuing education courses are not indicated in the system. The Hungarian Health Care Professional Chamber made an effort to monitor the new vocational qualifications at the departmental classification stage, and added them to the department. The differences between the departmental entries of the mandatory profession group registry and the departmental entries of the Hungarian Health Care Professional Chamber are due to this fact, although the unification of the two would facilitate transparency and professional work.

Recommendations for solutions

It is important to establish mandatory continuing education courses by qualification levels and specializations in a manner that the health care professionals would be able to complete certification educational programs necessary for the servicing of practice-expanding activities, currently performed in manner which is legally unsolved. Aside from that, point q) of par. 3 of the 1997. CLIV act on health care is required to be changed, regarding the fact that the term “specialized vocational qualification” acquired within the specialized further education is currently not listed in the terminology.

II.12.2. Optional continuing education courses

Following the certification of the program submitted by the organizer for certification, the National Healthcare Services Center certifies the organizing of the continuing education program in the form of a decision. In several cases, the following problem occurs: the actual organizing of the continuing course significantly deviates from the certified program submitted by the organizer for certification (e.g. location, date, a different lecturer instead of the renowned lecturer, a multiple-day program conducted by a main lecturer, etc.). In several cases, the program submitted by the organizer contains the content of one of each module program of certain vocational qualifications; therefore it does not qualify as a continuing education course. A reason for this may be that the organizer wishes to organize a program as a continuous development course – even for a significant 150000 HUF fee/participant –, which significantly exceeds the framework of an optional continuous development course, avoiding, for example, the accreditation process of the specialized continuous development course. Several optional continuing education courses are identified as educational scope “B” or “D”, according to the 2013. LXXVII. Act on adult education, and several continuing education courses are organized coupled with “B” or “D” scope programs.

Recommendations for solutions

Due to the above-mentioned problems, the modification of the optional continuing education course-regulation is necessary as follows:


In Hungary, reviewing the background of the certification regulation concerning professional health care workers, it can be stated that the 15/2010. (IV. 9.) MoHc regulation came into effect in 2010, which was revoked in the same year. Several anomalies were witnessed regarding this regulation; the most significant ones are the following:

Following the revocation of the regulation, additional scope of practice can be provided by a physician’s written mandate, which resulted in several problems. The process of a written mandate differs by institution: in certain institutions, it is bound for “home” education, while in other institutions, the mandate regarding the conduct of a given task is given without this restriction, and the same task is not transferred to the nurses in other institutions. Furthermore, we have no exact information on the number of individuals conducting physician’s activities based on tradition or even oral mandate.

Based on the above, the introduction of a suitably established certification system is justified. The terms certification /registration- education/ continuing education -scope of practice can only be interpreted collectively, and the term “certification” is not a uniformly utilized term internationally. In certain countries (e.g. USA), programs involving state registration and competence-expansion as a requirement for employment are named as certifications, while in the United Kingdom, the term “certification” is not used. In the UK the competence-expansion takes place within Continuing Professional Development course. During the international examination, the question of continuing education (CE) was a common denominator, regarding the examined countries. Regarding the USA, during acquirement of different certifications or specializations (certification) – either under Bachelor, or Master-level – a certification allowing practice is also required for the nurses, which is subject to periodic renewal; one of the foundations of this procedure is the participation in continuing educational programs. Regarding the United Kingdom, participation in continuing educational programs is one of the main conditions of registration renewal. It is important to note regarding both of these countries that by participating in CE programs and completing the exam results in the expansion of the nurses’ scope of practice. Regarding certain specializations or following the acquirement of a qualification, the minimum number of CE classes is also determined, which is then required to be completed by the nurse within subjects of the given specialization field, within a continuous development period. Continuing education courses can be diverse regarding subject or time-period, starting from the 1-2 hour programs all the way to participation in complete programs conducted in universities. Meanwhile in Hungary, there is no unified certification exam as a requirement for employment, and there is no periodically repeated written/practical exam in order to maintain qualification and to further occupy the related position.

In Hungary, the lack of determined scope of practice differentiated by levels of qualification as well as the multiple modifications of competencies attached to certain educational programs and the issues regarding the quality thereof (e.g.: educational programs with unsuitable structure and content; non-formal nurse education; unsuitable functioning of certain educational institutions; etc.) are also fundamental problems, even in the certification system’s regard.

Recommendations for solutions

Based on the international examination and the analysis of national possibilities, we hereby state the following specific proposals:

By revising the nurse educational programs’ curriculum on all educational levels, the establishment of the scope of practice on all qualification levels is also necessary, only then may the introduction of program-based, practice-expanding certifications – established by educational levels, certifying the performing of special interventions – commence.

It is important to establish the scope of mandatory further educational programs by qualification levels and specializations in a manner, which enables professionals to complete competence-expanding certification educational programs as well (this subject was further detailed in point II.12.). These educational programs, completed in the form of mandatory continuing education courses are suitable for having the previously qualified professionals acquire the theoretical- and practical knowledge necessary for the servicing of activities currently conducted by them in a manner which is legally unsolved. The modification of educational programs is also important in order to avoid the introduction of mandatory continuous development courses or certification programs in unnecessary areas, and to enable students to acquire the competence-expanding knowledge integrated into the vocational- and higher educational (Bachelor and Master) educational programs.

The determination of the scope and subject of certifications possible to complete with either vocational qualification or with exclusively higher educational qualification is also important (the acquirement of Bachelor nurse qualification-based Stoma treatment II.- and the High-level wound treatment certifications for vocational qualification nurses – with suitable professional recommendation providing continuous work as stoma- and wound treatment nurses for the majority in their work schedule for at least 5 years – is also necessary, as a temporary measure between 2019 and 2021). This for example would mean: in the field of stoma and wound treatment there would be a licence for stoma treatment which could be completed with a vocational nursing certificate (stoma treatment I. license, basic wound treatment license, incontinence license) with a specific curriculum and competence, in addition, a stoma treatment license based solely on Bachelor nursing diploma (stoma treatment II license, advanced wound treatment license, incontinence coordinator)with a deeper content of higher education and broader competences. Based on our recommendation the involved nurse colleagues they can be properly educated for all these activities and can carry out all the tasks they are currently providing with vocational stoma, wound treatment, incontinence licenses. At the same time, stoma, wound treatment, incontinence licenses based solely on Bachelor nursing diplomas are an opportunity to legally establish the extension of nursing competences, build on the knowledge and skills of higher-educated colleagues, with more specialized professional knowledge. For example: In line with international practice, providing the prescription competence under a physician’s supervision, in a properly regulated way (prescribing medical assistive devices), to perform defined wound stiching tasks, to give suggestion for a stoma’s place, etc. on a Bachelor nursing level. In this case, we would like a consensus proposal with the professional organizations concerned. It is necessary to periodically renew the certifications (and in most of the cases, the performance of the given intervention within the necessary framework is not sufficient, due to the improvement of professional knowledge). The certification education supposed to be unpaid; the suggested frequency of a repeated education/ exam is 2/3/5 years, according to the activity.

We maintain the principle, that the aim of the vocational nursing certifications is the elimination of deficiencies due to the forgetting of professional knowledge, the expansion, improvement, change of professional knowledge, and the legitimization of activities (e.g. intravenous injection, administering IV fluid, stoma treatment, wound treatment, male patient catheterization) currently conducted on a wide scale, yet not suitably grounded regarding education and regulation (or conducted based on a “mandate system”, which is not sustainable due to quality management- and professional criteria).

On the other hand, the activities transferred from the medical scope of practice (not including the invasive procedures already conducted by nurses, e.g. catheterization, short cannula puncture, intravenous injection, artery cannulation) should be exclusively subjected to Bachelor and/or Master’s qualification, partially integrated into the initial educational program (e.g. emergency airway procedures, high-level wound treatment, transfusion therapy, ordering parenteral nutrition, physical patient examination, prescribing medication under protocols within a determined scope, prescription of medical supplies, gastric lavage, abdominal puncture, wound closure, etc.), partially integrated into the Master’s educational program (e.g. prescription of medication within a determined scope, endotracheal intubation, pleural tap, thoracocentesis, certain forms of central venous access, assisted support of non-invasive mechanical ventilation/breathing or controlled supplementation thereof/assisted wearing from assisted ventilation, the independent prescription of certain medication, modification of therapy, chronic patient care, performing first assistant duties for surgeon, with low-risk patients, during planned surgeries with physician’s supervision, independently performed anesthesia in specific cases determined by a specialist, under medical supervision, etc.). In case of Bachelor/ Master’s nurses, the majority of these activities occurred within the nurse/professional scope of practice preceding the 2017-initiated advanced practice Master’s educational program, as they were identified within the higher-educational specialized continuing education courses (e.g. dialysis nurse, intensive care, surgical nurse, emergency care and triage nurse), approved by the Educational Authority several years ago. Aside from that, the practice-expansion (e.g. intubation, prescription, thoracotomy, etc.) of certain non-medical professions (e.g. paramedic) is noticeable. Meanwhile, the position of insufficiently functioning higher educational specialized continuing education courses was taken over by the advanced practice Master’s educational program, detailed in section II.3. of this study.86

In line with the international literature and representatives of Hungarian organizations, the aim of the authors of this paper is to propose a feasible structure for a Hungarian nursing certification system, determined by levels of qualification, as described in the following figure 12.

Figure 12: Proposal for the establishment of the Hungarian continous educational system separated by educational levels for vocational/Bachelor/Master health professionals