Over the last decades the healthcare system has witnessed major transformations and has become more technologically intensive, consumer focused and quality orientated. In addition, other factors like social change, new patterns of disease and increasing public expectations have considerably influenced the healthcare environment. In this connection, these changes bring forward a strong need for insightful, highly skilled and knowledgeable nursing practice as well as capable leadership. However, an important question that arises is whether the training provided to nurses in the local context is adequate for them to meet those emerging new challenges effectively?

Without apportioning blame, it is worthwhile to look at the present system from a critical and analytical perspective to have a better insight as to where the problem lies. In Mauritius, nursing education has traditionally been conducted through an apprenticeship system, based on the British model. As a branch of paramedical science, nursing education has progressed and expanded at a great pace in the United Kingdom and some African countries like South Africa, Kenya, and Seychelles, just to match the dynamic healthcare environment.

Although there have been considerable changes and improvements at service level, it is a fact that nursing education has not caught up with the pace of change. A closer look at the syllabus reveals some changes but these are merely patchwork regarding the syllabus itself, rather than a complete review of the curriculum which is compatible with the ongoing changes. It can also be argued that it has remained static, as nurses and managers are still being trained as per an old curriculum that dates back 35 years. However, the appropriateness of this form of training to fit an era where knowledge is rapidly changing and becoming outdated is highly questionable. Some may argue that the syllabus has undergone changes but the duration of training, the number of hours for theory and practice, the teaching methodologies, the way the examination is conducted and students are assessed, have virtually remained the same.

Consequently, this remix of the old curriculum has further widened the theory- practice gap. Furthermore, it also appears that the educators have not been provided with necessary support for their continuous professional development. This is apparent when students join the clinical settings. They are usually taken aback when they discover about evidence based care, new products, and latest technologies which have not been taught at school. This is in sharp contrast with the new philosophy of nursing education, which has constantly been evolving. The current trend requires much emphasis on critical thinking, problem solving analysis and other learning skills that can promote a culture of lifelong learning among nurses.

<B>No specialisation courses provided</B>

Despite new specialities like neonatal care, neurosurgery, renal dyalisis; it is still unclear why specialisation courses have not been provided in respective fields, like midwifery or SAMU. However, it also remains poorly understood why policy makers and those responsible for future orientation of nursing, have not been able to come up with a reform plan for nursing education. Logically speaking, we are tempted to ask whether there is close collaboration between the chief nursing officer, the central school of nursing, nursing council and trade unionists regarding educational issues? This leaves us to wonder who really decides about the future orientation of nursing education and who has stifled its professional development so far? A typical example is the withdrawal of the BSc Hons nursing programme that was run jointly by the University of Mauritius and Middlesex University. Unfortunately, it has not been extended to other nurses. This could have been a major turning point to change the direction of nursing in Mauritius. Thus it is regretful to say that somewhere somebody must have misled the outgoing minister on this issue.

Although the Central School of Nursing is responsible for the overall training of nurses and conducting courses for administrative nursing cadres, its physical structure has remained the same with limited teaching and learning resources. Neither it has been able to carry a training needs analysis, to better prepare nurses and answer to the ever more demanding healthcare delivery service. The absence of a well-defined mission statement and clear vision have made it difficult for it to forge ahead as a training institution of excellence. We usually benchmark from other countries but it is worth recalling that the posts of nursing educators are held by graduates and post graduates, contrary to the majority of our nursing educators who simply possess certificates as clinical instructors or a diploma in nursing education.

Highlighting these important points, I believe, will open the door for an in-depth debate, raise awareness and create a sense of reflection among nurses who are really concerned about the future of the profession. Hopefully, it will draw the attention of policy makers as well. Although my line of thought may not necessarily mirror the views of all my colleagues, my analysis being mainly based on my own personal experience as a nurse. May I also stress that in exposing these facts it is not my intention to cast any doubt on the integrity and honesty of the top establishment of nursing. Likewise, the views expressed on education by Professor Betty Kershaw (Dean Faculty of Nursing and Midwifery –University of Sheffield) during her recent visit, clearly justify the urgency for a reform in this field.

<B>Towards a first-class service

Obviously, if the government really wants to be in line with public expectations and aim at a first class service, the answer resides in its political will to bring reform to nursing education. It must be recognized that this will transform services, practice and why not the landscape of clinical settings?

Otherwise, if the current trend is maintained, ritualistic care will always predominate over quality care. Hence, we are at the cross roads and wish that all leaders would stop adopting the ostrich attitude and start thinking outside the box. In this context the following suggestions can be considered.

First and foremost an audit must be carried out within the nursing community to tap the potential resources that can help in the change process. I have in mind here those nurses who hold an Honours degree in nursing, in quality management, in administration, in sociology or any other discipline.

In this era of the knowledge explosion and as we are increasingly geared towards the concept of a knowledge hub, nurses can not lag behind. It is inevitable that we focus on a new approach to training for nurses that can lead to the award of a Diploma in Nursing. This is only achievable if the training falls under the aegis of the University of Mauritius(U.O.M) or the Mauritius institute of health but is subjected to tertiary education commission jurisdiction.

The central school of nursing must play an active role in the promotion of life- long learning, continuous professional development and continuous nursing education. Facilities must be provided to educators in order to meet those demands. Preferably it must be attached to the faculty of health science at the U.O.M, and work in alliance with other foreign institutions to prepare and conduct specialist courses.

Broadly speaking, if reform is initiated in nursing education it will improve quality and efficiency of nursing services at both community and hospital levels. The new generation of nurses or managers will be highly skilled practitioners with a new mindset who will be able to reflect critically, use researched findings to provide evidence- based care, and challenge decisions in practice.

Finally, we must change not only what we practise, but just as importantly how we practise in order to prepare our workforce to evolve in a system in which flexibility, continuous learning and rapid response to change are the hallmarks of effective practice.

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