by Elisabetta Caredda and Lucia Conti
The case was raised by the leader of the PD, Gianfranco Ganau who announced a question to the councilor on facebook. But the Dg of the ASL concerned clarifies “the Community Nurse is part of an officially communicated experimental project”. To better understand how things are going, QS has heard from several local representatives and the president of Fnomceo Anelli. Here’s what they said
15 DIC –
The shortage of doctors is creating many problems in the continuity of care service, therefore for the coverage of medical guards, in the communities of the most internal villages of the island. And in this regard, controversy raged yesterday after a Facebook post published by the group leader of the Democratic Party, Gianfranco Ganauwhich goes viral, where the councilor denounces that Aritzo’s medical duty shift was covered by a nurse and that it would seem that the hourly wages recognized to him were far higher than that recognized to doctors.
Shortly afterward, the director general of the Asl 3 of Nuoro replies with a note, Paolo Cannas, who explains: “In reference to the recent interventions posted on social media, following the “experimental” launch of the community nurse (as per Ministerial Decree n. 77) in the district area of Sorgono, the Directorate of the ASL n . 3 of Nuoro communicates that the Continuity of Care Service must certainly be guaranteed and on this the ASL is continuing to invest time and resources in order to implement the medical staff “.
“Another thing, on the other hand, is the experimentation – wanted and agreed with the Regional Health Department – of the Community Nurse. Experimentation of a figure also foreseen by the DM 77, which – together with Teleassistance and Telemedicine – is part of a project that provides for the global taking charge of the patient in the proximity medicine model. This experimental model provides that there are more services in the area, which complete the health offer, namely:
- Teleassistance, i.e. the monitoring of the behavior of “fragile” patients, with assistance to people who live alone and must be constantly monitored and followed in their behavior and lifestyles;
- Telemedicine, which instead remotely monitors the vital parameters of particular categories of patients: in this regard, the Nuoro ASL is starting with 400 patients suffering from heart failure, who will be guaranteed this innovative service, which is also capable of significantly improving the quality of life;
- finally the community nurses, who complete a modern and functional care in the area, and carry out a “triage” necessary to address the patient.
As regards the parameters of the remuneration of nurses, doctors or engineers who deal with this project, they are those regulated by the National Collective Labor Agreement. Yesterday the nurse simply carried out his normal work service, in his shift of activity, today also included in the experimental project that we have activated “, concludes the note from the ASL.
Health newspaper he investigated the matter in depth and heard various interlocutors. The Pd group leader Gianfranco Ganau, who is also a member of the Health Commission, points out: “However, they do not clarify the role of “replacement” in an emergency medical service. In the absence of the doctor, the community nurse can only carry out a triage following which she must necessarily refer the patient to a doctor for diagnosis and appropriate treatment. Unless you don’t take on your own responsibilities that border on the abuse of the medical profession. If so, what kind of answers can it give to patients who turn to a territorial continuity service whose aim is to replace the general practitioner at night and on holidays? Then, are we sure that those of the nurse have not been recognized as “additional services”?”
The Mayor of Aritzo, Paolo Fontana, he explains: “We knew that in December some days were uncovered, we also tried to look for other available doctors, but to no avail. For example, the situation in Desulo is even more serious. With regard to nurses, the community nurse project has been activated on an experimental basis, which does not replace the emergency doctor, but will enhance services to the community”.
Per Mary Magdalene Job, President OMCeO – Nuoro -: “I had read the news about a month ago on the fact that the Nuoro Local Health Authority had launched the experimental community nurse project, to work on uncovered shifts regarding health care in the countries belonging to the Sorgono area. This was disclosed as an experimental project to make up for the shortage of doctors. Which left me a bit perplexed”.
“The community nurse is doing very well for her care duties – comments the OMCeO president -. But it cannot be said that you make up for the shortage of doctors with the community nurse. Because this is not acceptable. To each their own role! Very well in 2022 the presence of the nursing figure in innovative paths as well as all other professions. Even the doctor is no longer what it was 50 years ago. Skills, technologies, and much more have evolved. So huge steps forward have also been made in the nursing profession. But let’s not confuse the roles. This is important to reiterate. Because if it is said that the community nurse has the task of taking blood samples, medications, detecting vital parameters, infusion therapies, who is it who prescribes these things? He’s the doctor.”
“Certainly the nurse is not a prescriber – continues Job -. Even if on this point it is necessary to point out another thing, which is gaining momentum. That is, from a recent article I read that only Italy does not have a prescriber nurse. We are almost getting to the prescribing of medicines by nurses. We are arriving at the transfer of skills from one professional figure to another who does not have the same training. The patient cannot go to the doctor’s office and find the nurse. He can find the nurse, but the doctor has to be there. And this is a desirable question, just as it is desirable that in the future there may be a family nurse alongside the general practitioner. This is totally acceptable. We speak of team skills which, as happens in the hospital, complement each other, but certainly one does not replace the other. Everyone has made a professional choice and everyone has been trained for those specific skills, just as among doctors, a specialist in a given discipline cannot replace another specialist with a different medical specialization, concludes the OMCeO president.
We also heard from the president of Fnomceo about the case, Philip Rings, according to which “if there is a serious shortage of doctors and the ASL deems it necessary to open a clinic of this type to give answers to people, it is clearly free to do so”, but “it must be absolutely avoided to implement an overlapping of powers, also contrary to the law”. For Anelli, however, the risk of “opening a question between professions” must also be avoided, because “the shortage of doctors does not depend on the professions, which are rather taking on a difficulty caused by the Regions. The Sardinia Region could have made a precise programming, training more general practitioners to ensure a replacement of professionals “.
“Doctors and nurses have two different jobs – explained the president of Fnomceo -. The optimal thing would be if they could work together, each for their own skills”. On the case of Sardinia, concluded Anelli, “the ASL has a duty to be clear towards the citizens and explain that there it will not be able to receive medical diagnoses and services, but nursing, which are important but are something else”.
Finally, the councilor for health also intervenes on the matter, Charles Doria, “No nurse with all his professionalism can replace a doctor in any organization. Unfortunately, there are realities that I have inherited where we have shortages of medical figures with difficulty in covering on-call shifts in the continuity of care service which must be completely revisited and renewed as anticipated in the last hearing in the health commission with Gianfranco Ganau present “.
“The nurse we are talking about does not want to replace any doctor – continues the Giunta exponent – but represents the first “experiment” of the figure of community nurse present in advanced national and foreign healthcare realities, whose mission is to ” take care” of patients, especially the elderly, by going to their homes to guarantee those services that the patient would otherwise have to seek away from home (e.g. blood sampling, intramuscular and intravenous pharmacological therapies, blood pressure measurement, glycemic sticks, etc.); always on prescription and medical indication”.
“The immediate future, as mentioned in the commission, will have to provide for a profound reorganization of the continuity of care to bring territorial health into the third millennium also enriched by technology (see telemedicine), there is much talk but which no one has put into practice. The energies and enthusiasm of the young USCA colleagues with whom I have already had various meetings will play a very important role in this project and who will gladly enter the project to care for Sardinian citizens”, concludes Doria.
For Marina Fancellu, Sardinian regional secretary of the Italian Doctors Union (Smi), “in the use of the community nurse (or family nurse, if you prefer but not yet institutionalized at the regional level and, according to the managers of the Nuorese ASL, in an experimental form) in the headquarters of the Continuity of Care of Aritzo, in the province of Nuoro, as well as in other locations such as Sedilo, there are several inconsistencies. Starting from the presence of nurses in the same offices and premises used by the Continuity of Care with the same night time schedule “.
For Fancellu “there is a risk of generating confusion in patients who access the service convinced they can find a doctor. Great respect for the professionalism of nurses but the limits between the two professions that have different and very specific tasks must be clear. Nurses cannot have diagnostic and prescriptive tasks, it would go beyond the abuse of the profession. It is clear that we are in the presence of a not entirely clear and transparent communication from the management of the ASL n. 3 of Nuoro”.
“We would like – continues the SMI trade unionist – that the political and administrative authorities responsible for health in the Sardinia Region explain to us why the activities of the nurses are proposed, in this case, at night and not during the day with obvious discomfort for the patients who certainly do not they go to ask for services such as medication or late night blood glucose monitoring. All of this appears as a clumsy attempt to replace the Continuity of Care doctor (former medical guard) and the consequent cancellation of medical services. We would not like – adds Fancellu – that the case of Aritzo’s Continuity of Care was a ploy, the precisely clumsy attempt to make up for the lack of doctors and then apply it if necessary on a larger scale. To respond to the lack of continuity of care and general practitioners, there are two aspects on which a shared solution must urgently be tried: new remuneration policies with clear choices on the rights and protections of the category and go to the origin of this problem which affects all the categories of doctors, i.e. a review of access to the faculty of medicine”.
For the Smi, “the Region of Sardinia, for the Continuity of Care in all offices with similar conditions of discomfort, should have collected the alarm signals that we had already sent as a Union at the time, providing for greater and more realistic incentives for doctors who operate in those areas, in order to attract doctors and thus guarantee medical assistance even in disadvantaged areas”.
Elisabetta Caredda and Lucia Conti
December 15, 2022
© breaking latest news
Other articles in Regions and Asl
