December 9th –
Dear Director,
the data of the OECD Health at Glance 2022 Report published on QS show even more clearly the dramatic situation of the health personnel and the general underfunding of the system. However, this situation seems not to be perceived, as demonstrated by the levels of funding planned for the health service and the amendments currently approved in the budget relating to pharmacies only and the two-year increase in the retirement age for doctors and university teachers only. sign of a conservative logic, already widely seen and used in the past.
At the same time, it is sad to note that the FNOMCEO, in its interesting media action for medical personnel, prefers to refer mainly to the data of the medical trade unions to demonstrate the theses of medical shortages proposed, rather than sources from independent institutions that really put I compare the situation with other international countries.
In fact, in its data, the OECD indicates, in addition to the absolute – no shortage – of doctors compared to the European average, that the Italian salaries of doctors are not at the bottom of the European rankings, with the use of the indicator chosen by the OECD. Doctors have an income 2.9 times higher when compared to the average salary of full-time employees in all sectors and there are 17 countries with this indicator of income lower than Italian doctors.
For nurses however, the situation is so dramatic as to predict the generalized collapse of the system in the event of further underestimation/inaction. With the presence of around 350,000 active nurses, there would be at least 120,000 nurses short of the European average. Looking at the nurse/doctor ratio, we are at the bottom of the rankings (1.6 – EU average 2.2), compared to around 3 in Germany and France or over 4 in Switzerland: data show that other countries have up to double our nurses current, compared to the number of doctors.
This situation can make it clear how already now the lack of nursing (and not just medical) interventions translates into delays or missed treatments for citizens, with dramatic health outcomes. Added to this is the improper and rampant attribution of nursing functions to other operators, as appears in progress in the structures of long-term care and in various Regions, also used to mask the contraction in spending.
For the salary part, for nurses the indicator is equal to 1 (compared to 2.9 for doctors), ie comparable to the general average salary. This essentially puts us at the bottom of the ranking of countries by salary, as graduate personnel, with a lower salary than equivalent categories.
There are 15 countries with higher incomes for nurses than the specific indicator. This is certainly one of the aspects that contributes to the lack of attractiveness towards the new generations and has already led over 20,000 nurses to work abroad.
The above is to reiterate that with system measures, the salary, training and organizational situation should be enhanced especially for nurses, not just for doctors. And above all, the possibility of regulated extra-professional practice for nurses should be unlocked immediately, while at the same time providing for better use of freelance nurses, in the context of regional health services.
In consideration of the failure of the current organization and governance models, if we want to safeguard universal health coverage in Italy, the Government and the Regions cannot continue to postpone an overall reform of the system, of the models of professional action and of the sustainability of services .
If, as it appears clear, do a medical examination or a diagnostic test in out-of-pocket (expenditure in constant growth) appears to be decidedly rapid, the same cannot be said for the same services within the NHS/SSR. It can be hypothesized that it is therefore not just a question of a shortage of doctors (if not in limited areas and specializations, beyond a disruptive media force), but of incorrect distribution, organization, and contractual management methods of personnel.
At the same time, if the Emergency Departments continue to overflow with patients, in many cases not congruous, it is also partly due to the current model of general practice in the communities and the delay in implementing the planned reforms for the territorial area, from review according to the new evidence of this period, starting with the broader nursing valorisation.
It is the case, for example, of accelerating, strengthening – immediately and for real – the nursing functions in the primary healthcare sector and in minor/emergency emergencies. It is necessary to unlock its potential and to staff increasing numbers of specialist practice and advanced nursing practice, with prescription. We are, as indicated in the OECD Report, one of the very few countries that has not expanded the skills of the nursing workforce.
In Canada, in recent months, in line with many other nations, also to make up for system shortcomings, numerous territorial health structures have been activated, with total nursing management, to relieve pressure in the area and in the emergency departments. Canadian advanced practice nurses (master’s degree level) treat, autonomously and in absolute safety for citizens, a consistent series of pathologies, greatly relieving the workload for hospitals that now operate in a more appropriate manner.
In conclusion, the nursing shortage, magnified by the pandemic, is a complex problem that requires a multi-pronged approach. There are not enough nurses, due to a combination of hitherto undervalued political and strategic elements (student attractiveness, salary, organizational well-being, development of specialist and advanced skills, technology, physician-centric organizational models and much more) to all the Organizations that – over the years – have participated – in the decision-making tables.
Responsibilities exist, even if many in the sector continue not to feel their significance and forget them.
The current situation clearly reveals the disconnect between the perception of many institutional decision-makers from the short and long-term challenges and the absolute inconsistency of the strategies implemented so far to respond to the nursing crisis and, consequently, of the health system.
It’s time to act differently and change stride to ensure health through nursing. It’s time to make itself felt with the strength that has not been adequately demonstrated so far.
walter decaro
CNAI National President
Executive Board Member EFNNMA