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EHMA YAC Blog – Issue 3 – Hello Doc! Is there a Nurse in this Primary healthcare facility?
20 March 2018
Nurses’ role in primary care has recently received substantial scrutiny, as demand for primary care has increased and nurse practitioners have gained traction with the public. Furthermore there is evidence which indicates that primary care services, such as wellness and prevention services, diagnosis and management of many common acute illnesses, and management of chronic diseases such as diabetes can be provided by nurse practitioners as safely and effectively as by physicians.
A nurse practitioner has been defined as “an advanced level clinical nurse who through extra education and training is able to practice autonomously, making clinical decisions and instigating treatment decisions based on those decisions, and is fully accountable for her own practice.”
Nurse practitioners are increasingly used as first points of contact in primary care. The number of trained nurse practitioners is increasing as dedicated training programmes become more accessible. Models of nurse practitioner care, however, are developed in several different ways. There is variation in several aspects of practice for nurse practitioners working with physicians.
The organization of primary care and particularly the way in which doctors operate, differs widely between countries and largely determines the role and activities of nurses; i.eg there is a clear contrast between countries like France where general practitioners for the most part practice alone or in groups with other doctors (Germany, the Netherlands, Italy, Canada), and countries where doctors work in group practices with other health professionals (UK, Sweden, Finland).
The density of doctors seems to be related to the development of the nursing role: in Italy and Germany there is a high density of doctors and a relatively limited nursing role, whereas in the UK and Canada there is a lower proportion of doctors and the nursing role is more extensive. But a moderate density of doctors is not necessarily related to the development of the nursing role in the field of primary care. It would appear that close collaboration between GPs and nurses is not a natural mode of operation in most countries. In fact, where this model does exist, whether in an experimental form (Italy, Ontario, Quebec, the Netherlands, Germany), or more generally (the UK, Sweden, Finland), this is as a result of concerted policy on the part of the state to develop the professions’ traditional modes of working.
An expanded scope of nurse practice and team-based approach has been shown to improve quality and patient satisfaction and reduce costs; i.eg in U.S. Retail clinics, where cost saving has been documented, nurse practitioners provide most of the care. According to calculations, nurse practitioner training is the fastest and least expensive way to address the primary care shortage; between 3 and 12 nurse practitioners can be educated for the price of educating 1 physician, and in less time . Some evidence based studies also suggest that appropriately trained nurses can produce as high quality care as primary care doctors and achieve as good health outcomes for patients. Furthermore, in some cases patients were more satisfied with nurse practitioners compared to doctors. Is it time to embrace Nursing and its expansion in Primary care?
Jonila Gabrani – EHMA YAC, March 2018
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What our Members say
I have been active in EHMA since the first years of the '90s and I have seen its evolution from a small association of members interested in sharing knowledge on health management practices to the current status of reference and advisory key player for EU, health systems and organisations, stakeholders associations, industry and universities. EHMA is now a unique knowledge hub, policy advisor, community of practice and network of best in class organisations involved in health policy and management. A place where health managers can build their competences, policy-makers and stakeholder associations envision how to implement and sustain change through health management, industry leaders understand how to engage more effectively with health organisations and systems. The right place to nurture and grow health management capabilities and capacity for every stakeholder of health systems.
Prof. Federico Lega, University of Milan, Italy
Health management has a crucial function in shaping public health and health system challenges. The Medical University of Varna, Bulgaria had success in collaborating with EHMA on EU-funded projects that has resourced us to create new health management competencies for the future workforce. In addition to all classical definitions, health management is a science dealing with individuals, groups, and society at large. It is an art contributing to the beauty of our lives and an interactive communication process at all levels of institutions and human energy. I have also had the pleasure to chair the South Eastern European Special Interest Group which gives members a space to discuss and tools to address how health systems are managed in our regions.
Prof. Todorka Kostadinova, Medical University of Varna, Bulgaria
I enjoy the high level of interaction and engagement in EHMA’s activities, in particular during the annual conference where the panel discussions are rich and well prepared. As a hospital manager and professor of health management, EHMA motivates and inspires me to be creative. You go back home feeling energised from seeing old friends and making new connections, as well as being convinced of serving as EHMA’s ambassador. It’s a strong feeling of interdisciplinary engagement, but it also feels like being part of family-like community.
Prof. Sandra C. Buttigieg, University of Malta, Malta
EHMA is a pre-eminent organisation for everyone working in planning, managing and delivering health services across Europe. As a long standing member of EHMA I have always been impressed by the vibrant community of managers, researchers and academics it has created and by the many opportunities for sharing knowledge and funding opportunities it has brought to its members. Its international scope is impressive and its impact is often felt in management and research across European and national health systems.
Prof. Axel Kaehne, Edge Hill University, UK
Health workforce has become more essential in operating, managing and maintaining health systems lately, particularly in crisis and emergency situations. European healthcare professions and the workforce need to be high on the agenda of managers and decision makers. The Health Services Management Training Centre, Semmelweis University in Hungary is a longstanding EHMA member, because it connects us with collaborators and experts, with whom we can have complex debates, from whom we can learn and at the end find solutions in various challenging fields of healthcare management.
Dr Eszter Kovács, Health Services Management Training Centre, Semmelweis University, Hungary
As a hospital administrator and health management professor, I see on a daily basis that the healthcare challenges require talented and skilled managers to transform it. the EHMA membership has been beneficial to bring healthcare management research and education to the demanding healthcare services world, promoting healthcare management competencies and knowledge creation.
Dr Alexandre Lourenco, APAH - Association of Portuguese Hospital Managers, Portugal
Many healthcare systems in Europe and beyond are facing similar challenges which require innovative and creative solutions. EHMA’s annual conference, webinars, Programme Directors’ group and other activities and resources provide incredible opportunities for networking, connecting and sharing experiences. A distinct feature of EHMA is the diversity of members with representation from many countries, sectors and different communities of practice – academic, policy-makers, practitioners, managers, leaders and students. The annual conference is a highlight in the calendar year, offering a friendly, fun and learningful environment for emerging and established members to engage, collaborate and meet up with old and new friends. I am proud to be a member of the EHMA Board.
Prof. Ann Mahon, University of Manchester, UK
Society evolution, pandemics and ageing modify health needs. So, health policies and services are to change dramatically. EHMA, through webinars, workshops and annual conference provides an excellent insight to a professional changing world, favouring closeness to management innovation and the protagonists of these changes. As a primary care services’ manager, participating in EHMA activities is really worth it and allows to involve oneself in the innovation processes.
Dr Antoni Peris Grao, Consorci Castelldefels Agents de Salut (CASAP), Spain