The Recovery Plan will enable us to adapt the provision of local healthcare services in line with a proximity-based model of healthcare. How should the organisation of nursing work change?
In order to create a network of primary care and community hospital based services one undoubtedly needs to strengthen the provision of nursing work as well. Many regions already offer networks of nursing services that provide home and clinic based support- decentralised in the communities- but there are also many uncovered areas. What we should think about is whether enhancing the nursing asset is a quantitative or qualitative matter. The debate around this often focuses on the fact that the number of nurses should be increased. Every year around 14,000 students enrol in nursing school and 12-13,000 complete their studies and graduate with a nursing degree. Strategies incentivising our young population to enter this profession would enable us to get to a maximum of 16,000 enrolled students so no matter what is done this number cannot get higher than that. However, the truly unresolved matter is not so much the number of nurses but the quality of education offered today. I believe that we should intervene more radically on the quality aspect, starting with organisational models. In Italy the nursing profession is not differentiated based on skills that are specific and tailored to their context of application. We are also not experimenting with organisational models- especially in primary care- that are innovative and aimed at promoting greater accountability.
The truly unresolved matter is not so much the number of nurses but the quality of education offered today.
What future context do you imagine would be needed to prepare a profession for a network of differentiated services?
We should follow the model adopted by English speaking countries whereby there are different levels in the nursing profession hence the provision of different specialised degree courses. The National Federation of the Nursing Professions- the FNOPI- also proposes the introduction of post-graduate specialisation courses to train managers with high-level responsibilities. This would enable us to provide different expertise and skills through local healthcare services that can manage diverse situations and contexts and their varied levels of complexity. Additionally it would also enable us to cover a greater area of intervention and hopefully provide a higher number of services with more autonomy than we have today. We urgently need to reform the roles of the healthcare professions involved in general medicine. In Italy it is already challenging to get to a context where there is one general practitioner (GP) per 1,500 inhabitants. Other countries have a much higher GP/inhabitants ratio. For example in Scotland there is one GP per 3,000/3,500 inhabitants but the system is supported by a network of highly skilled nurses that screen through the series of issues they come across through proximity-based support. Developing a proximity-based system means getting closer to the problems of individual household members as well as providing concrete and fast responses that are tailored to each context. This cannot happen without a nursing profession with different roles and responsibilities- both clinical and managerial ones. It should be noted that, among other things, community hubs are probably going to be managed by nursing staff. Therefore it is necessary to rethink in a modern way the roles- thus also the education- of the new generations of nurses. Nursing managers, just like medical managers, will have to be trained in inter-professional and interdisciplinary management schools.
Developing a proximity-based system means getting closer to the problems of individual household members as well as providing concrete and fast responses that are tailored to each context.
Task shifting is still a very current discussion topic in our country…
The most qualified networks of hospitals and local healthcare services offered in English speaking countries include the specialised figure of the nurse practitioner. This profession covers a series of tasks, including the management of part of the basic diagnostic screening process and the prescription of some treatments in line with the protocol. In Italy this model did yet not take off, or rather, it was not formalised. Nurses are not even allowed to prescribe support equipment meant to support patients. The medical profession still struggles to accept that the role of nurses might develop into a partnership rather than remaining in its current submissive state. This type of resistance is more typical in general medicine rather than hospital based medicine as there is no close contact with nurses in it and the tendency is not to recognise the cultural shift that is impacting healthcare professions in general. The debate around this often focuses only on “GPs and nurses” while we should think about integrating multi-professional teams that, for example, include dieticians and physiotherapists, and coordinate closely with networks of volunteers and freelance professionals.
First of all you need a change in curricula and a cultural shift.
Where should the Recovery Plan money be invested?
We are lacking specialised and diversified capabilities, skills and training. This is the challenge of the future. For this reason I would invest part of the funds to support universities that educate healthcare workers and nurses by offering lab facilities and professional tutors for their courses, and provide specialisation courses with grants in order to train managers. It is not possible to suddenly create a context of proximity-based support when the entire academic and education system is centred on hospitals and the treatment of acute conditions. First of all you need a change in curricula and a cultural shift. This country needs to step up if in ten years from now we want to have a network of proximity based services which is not just made up of individual nurses or general practitioners that provide services going from one home to the other but rather a true network of support services that identifies and manages issues before these require an hospital based intervention.
Edited by Laura Tonon