by Claudio Maria Maffei
Without this evolution, the only structural changes such as those relating to the new “buildings” envisaged by the PNRR and the increases in the number of professionals available will not improve the quality of the services provided to citizens much
29 JUNE –
Yesterday on QS the news was given that the Council of State rejected the Nursing Units (UDI) activated by the Perugia Hospital, thus putting an end – it says – to a long legal action initiated in Umbria by the trade unions Cimo and Aaroi.
Certainly other more substantive criticisms will come from representatives of the nursing profession. I limit myself to considerations from the general point of view of those who expect and wish for a cultural and organizational evolution of the National Health Service.
Without this evolution, the only structural changes such as those relating to the new “buildings” envisaged by the PNRR and the increases in the number of professionals available will not improve the quality of the services provided to citizens much.
Among the most significant cultural and organizational changes are those relating to professional roles at various levels. In particular, but not only, the response to chronicity (still the main priority in terms of health problems) requires the redefinition of the roles (and therefore of training) of the various professional figures, a prerequisite for the activation of new organizational models.
I limit myself to some really trivial, but important examples, explicitly provided for by (or in any case consistent with) Ministerial Decree 77:
Each of these organizational paths requires you to think about the relationship between the various professional figures involved: specialist doctors, general practitioners and pediatricians of free choice, nurses and all other professionals.
But the same also applies to the hospital where with the same philosophy (that of multi-professionalism that redefines the boundaries of individual professions) new organizational models can and must be experimented, such as the Nursing-managed Post-Acute Ward Unit.
It is a model whose experimentation began in Rimini in 2002. An article describing this long experience in 2016 concluded: “Today the nursing profession, also through the experience of the Post Acute Operative Unit and all the others reality under nursing management, has demonstrated to possess advanced and scientifically supported theoretical knowledge, a working method and a specific disciplinary language, advanced clinical knowledge and widely validated experiences, which allow to face head-on the new professional challenges that the National Health System and Regionale is facing “.
The Perugia ruling puts the Italian public health calendar back 20 years. And this on the initiative, if I understand correctly, of two medical unions. What strikes me is the systematic way in which the medical world calls into question the organizational innovations that should enhance the specific contribution of each profession, but are experienced as an “erosion” of the typical operation of the doctor.
This happened, for example, for the involvement of nurses in the management of white codes and for ambulances with nurses only.
What strikes me in particular in all these events is that this defense of the professional role of the doctor takes place “regardless” of any consideration of merit. Many of the innovations that this defense counteracts can be assessed on the basis of experiences already conducted in the field.
For example, in the specific case of post-acute care in nursing management, the article I cited reports the data of one year’s activity noting that “the care group has demonstrated, through the care plans, to have achieved the planned results in 94% situations. “
Unfortunately, the sentence seems to reflect a widespread climate in Italy of relaunching the centrality of the doctor and the hospital and of clear opposition to those cultural and organizational changes of which the long-term stay in Perugia is an expression. We should not be surprised or complained that in Italy for the first time in the last 11 years the number of nursing graduates has fallen below 10,000 (see yesterday’s QS).
Claudio Maria Maffei
June 29, 2022
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