by Marcello Bozzi
The overtaking took place in the last two years and understanding why is important for finding concrete solutions to the growing shortage of nurses. And the reason lies essentially in the invariance of organizations with respect to training developments, in inadequate contractualization; in the few possibilities of career paths and the fact that the paths (clinical and organizational) towards the management find many obstacles in their implementation. Basically, the nursing profession has no “appeal”
29 LUG –
Up to now many words about the “enhancement of nurses and health and socio-health professions” and many “slaps on the back” … but few facts.
The matter is complicated and complex. Too many have been afraid of facing issues and problems that many have posed over the years, which have remained unsolved, with the need for strong, urgent and “courageous” interventions.
The reality is that the job market is unable to find Nurses … and even foreign channels are struggling to meet real needs.
The table and graph below show the comparison of graduates in medicine and surgery and in nursing from 2011 to 2021.
In the last 2 years there has been an overtaking of medical graduates compared to nursing graduates.
Table 1 and Figure 1
One would think of a serious programming error … but the reality is different and the following table shows that in recent years the number of places on the Nursing Degree Courses has steadily increased (and also the estimates of graduates compared to the places in the call, before the “overtaking” they were correct).
The problem is that the open positions are often not filled, even in the presence of a number of applications higher than the places available, therefore it is not a problem of lack of positions but a problem of “appeal” of the nursing profession.
The following table allows both the comparison of the data of recent years (bids and questions), and some reflection on the number of health professions in our country (there are too many, with too many overlaps, with the absolute need to rethink the training system .
Table 2
The reasons for the poor “appeal” of the nursing profession can be sought:
- in the invariance of the organizations with respect to the educational developments that have affected nurses (CL I and II level, masters, doctorates, etc.);
- in contractualization (salaries inadequate with respect to role and responsibility, far from the levels of other European countries);
- in the few possibilities of career paths (specializations are foreseen but not developed and not contractual);
- the paths (clinical and organizational) towards the management, even if contractually foreseen, find many obstacles in the implementation, either for cultural aspects (ignorance – in the sense of lack of knowledge) or for “conservative actions” by too many who have remained anchored in 1969! (despite the presence of 20,000 nurses with LM pathway).
Now it’s time to think about the possible solutions for a quick resolution of the problem, taking into account that:
- at the moment the number of graduates hardly compensates for pension turnover (table 3 – source Min.Sal);
- the number of nurses in service, the (pure) terminations in 2017/2019, and the age classes of the staff in service, highlight a further criticality in the next 10 years (table 4 – source Min Sal);
- the shortages of the staff, which have always been reported, remained unresolved;
- it is not known whether the 23,260 nurses foreseen by the DL 34/2020 (COVID) 1 and 2 (10,500 nurses for the structural implementation of 3,500 pl of IT, 3,168 nurses for the requalification of 4,225 pl of SI, of which 50 % structural, 9,600 Nurses for the activation of the Community and Family Nurse – 8 inf. every 50,000 inhab.) were hired for the activation of the structures and services mentioned above or to deal with chronic staff shortages;
- The PNRR (Ministerial Decree 77/2022) mainly concerns the reorganization of territorial services and it would be advisable, before defining what is needed, to check what already exists and then make the necessary adjustments (number and type of resources). In a “spannometric” way (without data it is difficult), excluding the IFC, referred to in the previous point, for the functioning of COT, CdC and Community H it is reasonable to hypothesize the need for about 25,000 Nurses;
it is necessary to define reference standards (uniform throughout the national territory, with the overcoming of the “minutes”, in favor of an analysis of the present assistance complexity) for the determination of real needs.
It is time to review the organizations, staffing and skill-mixes, also enhancing other professions (Social and Healthcare Operators), also taking into account the training developments that have also affected that profession.
It is not a solution to the lack of nurses but a (belated) response to the new needs of the population and to the new needs for the functioning of the structures (public private agreements and private ones as well).
It is an opportunity to rethink the system, with the overcoming of boundaries and fences, favoring integration and inter-professionalism (interdependence in the task), respecting the roles and responsibilities of each one.
In this regard, the decision of the Lombardy Region (resolution 6724 of 25 July 2022) can be seen in a very positive way, which activated the Complementary Training course of the OSS (already envisaged since 2003), with a parallel training course for the adaptation of knowledge for nurses, given the consequent need to review organizations and systems of care and assistance.
The hope is that the project will maintain the characteristic of “experimentation” and that in the meantime the ministerial levels and the State Regions Conference will approve a new professional profile and a new training course for the OSS, in line with the new needs.
In this regard, it is striking that the aforementioned Resolution, in relation to the Course Coordinator, specifies as a required curricular requirement “Professional with a degree in health professions or in the social or socio-psycho-pedagogical area and certified experience of at least three years in professional and didactic practice“. Probably it was a “typo” because, if the specificity is assistance, the required curricular requirement can only be a Master’s Degree in Class 1 – Nursing-midwifery. Otherwise it would be like providing a Chemist (with all due respect to this professional figure) at the Direction of a Thoracic Surgery!
You can’t waste any more time and you need to give answers right away!
Marcello Bozzi
ANDPROSAN Secretary – COSMED Associate
July 29, 2022
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