Iran Journal of Nursing

Background & Aims: Given the clear role of education in the economic development process of countries, the economics of higher education and the move towards realizing costs have been fundamentally changed as one of the pillars of the package of "Moving Towards Third Generation Universities" in the Medical Education Transformation Plan. Estimation and analysis of students’ educational costs can help managers and investors of the education system make more informed decisions by providing information related to the actual performance of activity units. Given the lack of financial resources and budget and the growing increase in costs, the higher education systems have no choice but to adopt new solutions to use resources optimally and manage costs in order to survive and continue favorable activities. In universities of medical sciences affiliated to the ministry of health, a considerable part of students’ education occurs in healthcare centers under the supervision of the universities, which imposes costs on the system. With this background in mind, this study aimed to analyze the educational costs of students of nursing-midwifery school in independent hospitals of Iran University of Medical Sciences.
Materials & Methods: This was a descriptive, cross-sectional research with a retrospective design, which aimed to estimate the direct costs of nursing and midwifery students’ education based on the level of education. The participants were selected by consensus sampling and all educational groups of the nursing and midwifery school of Iran University of Medical Sciences, who had educational activities in independent healthcare training centers of the university, were entered into the study based on the curricula approved by the ministry. The research settings were Shahid Hasheminejad Hospital, Ali Asghar Children Hospital, Iran Psychiatry Hospital, Rasul-e Akram Hospital, Haft Tir Martyrs Hospital, Lolagar Hospital, Shahid Motahari Hospital, Shafa Yahyaian Hospital, Akbarabadi Hospital, Firoozabadi Hospital, and Firoozgar Hospital. The study was carried out in two stages with research, actual and direct cost accounting approach; in the first stage, we conducted a qualitative research to identify the costs of nursing and midwifery students in training hospitals affiliated to Iran University of Medical Sciences. To this end, we interviewed all heads of departments in different fields-grades in the nursing-midwifery school, managers of hospital nursing services, educational supervisors of hospitals, and clinical wards engaged in nursing-midwifery students’ education. After the interviews, the expense headings were determined by applying the content analysis method. Notably, the main variable of the research was the per capita cost of nursing and midwifery students’ training in training hospitals of Iran University of Medical Sciences based on various levels of education. A researcher-made checklist was applied in the second stage to collect information related to hospital expenses. The face validity of the checklist was confirmed by the vice-chancellor for the education of the nursing and midwifery school and educational supervisors of all hospitals. In addition, the reliability of the information collected was confirmed by gathering information related to the consumption of items from two sources, nursing and midwifery students in each degree and clinical head nurses of hospital wards. After collecting data, the kappa coefficient was analyzed to confirm the reliability of the data. In this regard, the kappa coefficient above 0.7 confirmed the reliability of the data in the desired field of study-degree, whereas the coefficients of 0.5-0.7 and below 0.5 were indicative of moderate and low reliability, respectively. A Time-and-motion study was performed to determine the share of students’ use of expense headings. The study tools in the first and second stages were an interview guideline and a checklist, respectively. In addition, since MSc internal-surgical nursing students, MSc emergency nurses, MSc pediatrics nurses, and MSc psychology nurses were obligated to pass internship courses as work shifts in hospitals, the unpaid salaries of these students were considered as implicit hospital income.
Results: In this study, the most important expense heading for training nursing and midwifery students in hospitals was reported to be medical consumables. The highest number of undergraduate students was related to the field of nursing (488) and the master's degree was related to the field of internal surgery nursing (37). In addition, the highest mean age was related to the MSc of neonatal intensive care nursing (36.52) and the highest age standard deviation was related to the MSc of elderly nursing students (17.46). according to the results, the highest per capita cost of student education was related to the field of BSc nursing, whereas the lowest cost was related to BSc midwifery. According to the results, the highest per capita cost of student education in undergraduate midwifery was in Akbarabadi Hospital (1125926) and the lowest level was in undergraduate psychiatric nursing in Ali Asghar Hospital (46154). Moreover, the most important cost heading for students’ education was related to the cost of consumables.
Conclusion: According to the results of the study, the per capita education cost of BSc students was significantly higher than MSc students. Access to the information related to the actual education costs of students in training hospitals can facilitate the analysis of fields and degrees that have a higher cost. By doing so, we can identify the expensive activity centers and reasons for these costs and make proper decisions to decrease the costs. This can help implement a proper cost control procedure. Furthermore, the calculated information can be used for budgeting and planning, especially operational budgeting in the education sector. The information can also create a basis for decision-making about the costs in the future so that the performance of medical universities could be compared based on various educational groups and levels. Given the high education cost of students, it is possible to manage educational costs by creating transparency in educational processes through holding brainstorming sessions between the heads of departments and the officials of the School of Nursing and Midwifery, the educational officials of hospitals and students. According to the managers of educational departments and students, the decreased workload in hospital wards, increase of service providing quality and patient satisfaction due to the presence of students must be considered in the cost calculation. In order to reduce education-related costs, it is recommended that the correct and optimal consumption of consumables as well as insurance laws be taught to students. In addition, it is suggested that briefing sessions be held in addition to clinical discussions in order to heighten awareness about the importance of costs.