new operator XX not to be done

Nurses and Oss, Fials: we do not agree on the establishment of a new operator XX

We will remember the spring of 2023 as a season in which interesting regulations emerged which, if confirmed, will certainly have an impact on professional daily life or on the future prospects of professions, professionals and operators in the healthcare sector. The fields of action of these rules, mainly two, are different.

However, there is a common independent variable that defines its purpose: overcome shortages or difficulties in recruiting or retaining physicians and nurses in the system. This fact creates serious difficulties for structures and services committed to providing an appropriate and pertinent response to the health needs and demands that come from citizens as a whole.

Some indications derive from the norms of the DL n.34/23 art. 13 soon to be converted into law, the others are consequent to the contents of the proposal from the Health Commission of the State-Regions Conference on updating the profile of the social and health operator and the establishment of a new operator of health interest.

The art. 13 of Legislative Decree 34/23 concerns the “almost, perhaps, it can be, it is a first step, it is limited, it is true that it is temporary, but then we will continue…” overcoming of the exclusivity constraint for the health professions of the sector.

A rich debate has ignited on this overcoming and many positions have been taken in recent days which mainly bring out the bewilderment, irritation and dissatisfaction with a measure that is seen as an undignified ballet of steps forward and backwards , of wanting but not being able, of small and confused ideas, of poor knowledge of the operative reality.

It is in any case revealing of the existence of some “little hands” referable to various ministerial bodies which, evidently, care little about the expectations of the health sector, the critical issues that make it difficult to provide assistance for integrated processes.

Who think they make up for the severe deficiency or perhaps to the unwillingness of nurses to operate in some care settings through handfuls of free services performed, if they are able to do them, beyond normal working hours but, hopefully, within basic standards of safety, competence and good quality.

This is not exactly what was requested by many and more quarters to overcome the discriminating bond of exclusivity which remains difficult to use only for the healthcare sector. A little big mess, then.

And another little big mess is likely to be there proposal for the establishment of a new Operator of healthcare interest. The Health Commission of the State – Regions Conference intends to update the already existing profile of the OSS and establish a new “Innominata” figure of health interest which is provisionally indicated with the initials “XX”.

The updating of the profile of the Oss with improvements inherent to the professional contents, the operational relationships, the training methods with a reference also to permanent training, the places of operation, arouses a high interest given the ever greater importance of the figure in all care settings and particularly in social health and social care structures and territorial realities.

The emphasis on teamwork, integration and correct inter-professional collaboration in the interest of the patient is positive and it is hoped that it does not imply improper encroachments on the operational field of other professions. Which would diminish the comparison and make the debate on the different positionings slide, minimizing the added value to the shared objective of adapt the figure of the Oss to the new demographic and social challenges.

On the other hand, the proposal to establish a new professional profile of health interest, the unnamed or XX, in fact, raises strong perplexities. The XX was born and developed on the shoulders of the Oss, to which it is inextricably linked, given that the expected 500-hour training course to achieve this status can only be undertaken after having acquired the qualification of Oss and boasting work experience of at least 24 months.

With further training, the necessary knowledge to carry out a series of professional services that we can define as “nursing” would be transferred to XX. In this making it clear that the purpose of the institution of XX is precisely to have activities, currently named and indicated as nursing, carried out by an undoubtedly hybrid figure.

No more Oss, not even remotely a nurse, but something else. However, it is evidently useful to make up for the lack of attractiveness that local residential structures exert on nurses. Structures which, moreover, will have to be activated and implemented even more quickly and widely.

Thus the specific planning competence and the professional and concrete assistance capacity of the nurses are made interchangeable with a repetitive and routine type of activity resting on a thin sheet made up of minimal health and nursing notions which certainly does not resolve the issue of competence and ability closely related to individual situation of the assisted person.

The scheme of the attribution of health-related activities by the nurse is proposed, who will then have to detect, verify, re-plan, redefine… But how many nurses will there actually and constantly be in the Structures to give guarantees to this modus operandi?

But hadn’t they told us that with the overcoming of the exclusivity constraint for the sector’s healthcare providers, the shortage of nurses in residential or similar structures would be mitigated or even resolved? Perhaps there is little concertation between the various Institutions for operations in the NHS and in the private sector and private sector with special agreements. For all this and more, we express many hesitations, barring significant and profound changes, on the proposal to establish the figure defined as XX.

We do not agree on the activation of a new professional profile which has the main objective of assisting (deputy?) the nurse and not assisting the patient.

We do not agree on a figure who is born in the OSS, but who at the same time has his own specific professional profile. It is possible that tensions of different types are produced between the Oss and XX which could distract the nurse from his primary mandate which is direct assistance, the unitary planning of individual assistance plans (PAI) and the various processes of taking charge and of continuity of care.

We do not agree on how the attribution of activities by the nurse to XX is structured both in terms of the way and for the responsibilities in charge of the nurse himself. In our opinion, therefore, an in-depth reflection on what is proposed with regard to the XX is necessary precisely in relation to the professional heritage of nurses and Oss and to the changed conditions of local health and social-health assistance today and in the near future.

Consistent with these reflections, Fials will present its formal observations on the proposals analyzed here.

• Annalisa Silvestro | National responsible for coordination of health and social health professions Fials