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Enfermero especialista en pediatrĂ­a (Spain)

  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       All of the requirements are non-discriminatory. The concept of professional entitlement, regulation and mandatory registration in professional associations involves a set of knowledge and skills; therefore, the professional exercise requires the integration of all areas of individual professional knowledge, since those are interrelated and affect sensitive matters, so that such exercise must be subjected to professional associations’ control.We understand that the regulations on the nursing profession follow the principles given below: -          Support for the principle of non-discrimination. -          Justification of regulations by overriding reasons of public interest. -          Proportionality in relation to the adequacy between regulations and its objectives, also taking into account the impact of regulations of professions on the user of this service.  The nursing profession has its own specific directive which, under harmonised training, allows direct recognition of diplomas by the means established for this purpose.

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
    • Public health
    • Protection of consumers and recipients of services

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       The free movement of workers is a fundamental principle laid down in Article 45 of the Treaty on the Functioning of the European Union, developed in secondary legislation and European Court of Justice. EU citizens are entitled to:-look for a job in another EU country-work in another country without a work permit-reside in another country while working there-stay in the same when they have stopped working-receive the same treatment as nationals of that country regarding the access to employment, working conditions and social and tax advantages.The requirements ensure these principles.

    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       The nursing profession, which values and scientifically evaluates, is a health profession with autonomy, responsibilities, body of doctrine and its own functions. Their interventions are based on scientific, humanistic and ethical principles, using clinical and technological means in order to ensure the highest quality health care for patients.All Spanish nurses have a liability policy linked to the registration at the regulatory authority (Professional Association). Currently, models of continuing professional development are being designed. These are related to assessment processes, continued competence through certification and periodic recertification. In these models the evaluation of knowledge, skills and attitudes focused on the knowledge and application of ethical and deontological codes of nursing is contemplated.

    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

        Regulated professions provide high added value to the whole of the Spanish economy and to the development of the “knowledge society”. In this regard, we recommend the study entitled "Impact on the Spanish economy regulated professions: A study on production and employment".Whenever there is a well-balanced competition in the subsector of professional services, including health, there are elements of quality and efficiency in generating certainty for consumers and society.There are numerous characteristic profession-related elements that cannot be quantified because of its intangibility. Aspects such as, for example, the relationship of trust established between the professional and the client or the preventive system that articulates their daily exercise. Its complex quantification does not imply that its unmistakable value becomes intangible for society to be recognized.

    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       The duty of the nursing profession in Spain is precisely “to protect the health of individuals and to ensure patient’s safety thanks to a practical nurse with professional ethics and who is independent and competent”.A very particular element in the nursing profession is the fact that training is provided for throughout life by law as a right and obligation. This training, as well as other elements of the continuous professional development, should be evaluated and accredited periodically to ensure the quality and safety of the service provided. These implement mechanisms of self-regulation in the nursing profession, including legitimate and appropriate measures, based on identity, consistency, control and accountability for the independent professional exercise, leading to:superior protection of the publiceffective and efficient mobilitythe adequacy of professional practice tailored to patients’ and society’s needs

    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       Nursing is an entitled, regulated, collective profession that has its own policy and whose area of responsibility has been clearly gathered in the DIRECTIVE 2013/55 / EU, where the following applies:Formal qualifications as a nurse responsible for general care shall provide evidence that the professional in question is able to apply at least the following competences, regardless of whether the training took place at universities, higher education institutions of a level recognised as equivalent or at vocational schools or through vocational training programmes for nursing: - competence to independently diagnose the nursing care required, using current theoretical and clinical knowledge and competence to plan, organise and implement nursing care, when treating patients on the basis of the knowledge and skills acquired in accordance with points (a), (b) and (c) of paragraph 6 in order to improve professional practice; - competence to work effectively together with other actors in the health sector, including participation in the practical training of health personnel on the basis of the knowledge and skills acquired in accordance with points (d) and (e) of paragraph 6; - competence to empower individuals, families and groups towards healthy lifestyles and self-care on the basis of the knowledge and skills acquired in accordance with points (a) and (b) of paragraph 6; - competence to independently initiate life-preserving immediate measures and to carry out measures in crises and disaster situations; - competence to independently give advice to, instruct and support people needing care and their relatives;- competence to independently assure and to evaluate the quality of nursing care;- competence to comprehensively and professionally communicate and cooperate with members of other professions in the health sector; - competence to analyse the care quality to improve one’s own professional practice as a nurse responsible for general care.All are considered minimum competences.

    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       In the framework of the current situation, in which there are evolving concepts that articulate undergraduate and graduate programmes like skills, competence, shared and exclusive powers, professional qualification, accreditation of training and experience, continuous professional development, among others, it is necessary to focus on the idea that a profession will have to have some training enabling to professionally exercise.Spain joined the Bologna Declaration in 1999, favouring international mobility and allowing the momentum of this dimension to universities, to graduates and professional students in Spain, thus responding to one of the fundamental objectives of the Treaty establishing the EEC: the creation of a single, free internal market in which goods, individuals, services and capital could move freely. The regulation of the nursing profession is definitely contributing to that end.

    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?
    • Other, please specify

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       The Spanish nursing profession is self-regulated and well regulated, so it is not necessary to introduce new measures that are not already covered by the existing legislation. Life-long learning is a key element, which is covered by the current law not only as a right but also as a professional duty. It should facilitate and promote this aspect of lifelong learning to prove that nurses are up-to-date and in line with the latest knowledge in the field of health care. The incorporation of new information and communications technology and the development of guidelines and clinical practice care protocols, with standardization of practice are key elements to ensure quality and safety.The incorporation of new information and communication technology, as well as the development of guidelines and clinical practice care protocols with standardisation of practice, are key elements to ensure quality and safety. 

    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Maintain current system

       Explain where relevant:

       The axis around which professional practice and health care revolve is people’s health protection and ensuring patients' safety. These constitute the basic mission of the nursing profession, from which the rights of patients develop. These patients’ rights result in the imposition of legal commitments to ongoing training and regular proof of professional competence, among other things. 

    11. Any other comments?
       The relevance of the functions involved in the registering of Nurses gives technical coverage to the public purposes of all the corporations that make up the professional organisation of the nursing profession.
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