by Walter De Caro
28 OTT – Dear Director,
I read with interest the draft of the document Models and standards for the development of Territorial Assistance in the National Health Service, meritoriously published by Quotidiano Sanità. This document presents multiple and interesting perspectives, although some aspects are evident that can generate falling points for citizens and a vision of the nursing profession, definitely emerging in particular due to the amount of collaborative multidisciplinary integration activities attributed.
On the other hand, the truly autonomous component of the nursing professional practice and the unlocking of its full potential do not appear clearly explained.
I am referring in particular to the functions of family and community nurses. The risk is that this new graft, which is certainly beneficial for citizens and for the profession, does not, however, lead to that long-awaited change of pace with respect to medical centralism and general practitioners.
Really take courage. From these new physical structures and organizational models, an innovative phase of real change cannot be disconnected: the limits of the professional action of the nursing profession must be developed towards advanced skills and towards prescribing. If not now, when?
Do you really want to achieve the objectives of having a real development of “primary care”? do you really want proximity? do you want to increase prevention and promotion activities? The recipe all over the world, with many examples and unequivocal positive experiences, is only one: to increase the number of nurses and in particular to increase the number of nurses with advanced skills, with prescriptions.
For example, among the objectives of the Community Homes is to limit the use of emergency departments for minor emergencies. Here, we need to decide and get out of the ford: widening the perimeter of autonomous action of the nursing profession is the solution, quickly arriving with suitable selective training courses in advanced nursing care, as referred to in the recent documents of the International Council of Nurses, translated into Italian from CNAI – National Association of Nurse Associations / i.
The draft presents, as mentioned, several ideas that deserve further analysis. Among the many, the part dedicated to the organization of community hospitals. The PNNR clearly speaks of community hospitals with “mainly nursing management”.
AGENAS, however, seems to decline the delicate point differently. Once again a – not simple – directional triad is revealed: the health and hygiene responsibility of the CB is indicated to be placed in the head of a “doctor”, other doctors are responsible for clinical cases and a “nursing coordinator” has the organizational responsibility / welfare.
The writer believes that this model does not go in the right direction: perhaps it is the case to focus more and definitively on the fact that community hospitals are “nursing management” and that nursing staff should be assigned a position of high organization or of leadership. Otherwise, disputes and / or unstable relationships, differentiated according to the operational realities, with the medical staff would already appear on the horizon, as is always known in a “managerial” position,
Really put citizens at the center and nurses really become the key profession, the profession that first meets the citizen and that manages to support them in their care path in different contexts.
Let me give a further concrete example: recently in a public interlocution a well-known Councilor for Health and Hygienist Doctor told of a health episode that took place in a country in Northern Europe of which he was a protagonist and of which he declared himself extremely satisfied. He pointed out that he had been welcomed, managed and well cared for (with independent prescription, administration of painkillers and carrying out instrumental tests) by a nurse, with the doctor intervening in a second phase for a final consultation before discharge.
This is what seems to be missing in the current overall design that is being given to the future of the professions: a new vision of the skills and responsibilities of the various professions. So the AGENAS document is good, but there is a real need for a structured framework on several fronts: the risk of maintaining the status quo must be removed: a further structural slowdown in nursing enhancement – both in clinical and organizational skills – due to fear of not wanting to change the current balance of power, must be immediately removed, as well as the danger of continuing to have reduced nursing staff.
In Italy, universities are notoriously “dominated” numerically and in decision-making positions by doctors: however, now more than ever, it is necessary to invest considerably in the university training of nurses and in the specialized and advanced training of various professionals. The data is very clear: doctors are still more than the OECD average and nurses are at the bottom of the rankings. At the same time there is certainly also a need for a rebalancing of medical specializations and a new clarity on the training path of GPs. In this regard, mechanisms of greater coherence must be introduced in the relations linked to training between Regions / Health Authorities and Universities, and on the data of the staff who can actually be employed, compared to those who continue to maintain enrollment in the orders.
All decision-makers are asked to have the courage to commit themselves to a sustainable and better health service for all citizens, which truly limits the pockets of privilege, bureaucracy, and the influence of groups that limit any evolutionary trend, establishing innovative strategies appropriate planning, with the contribution of free cultural, scientific and civil society associations, which make it possible to improve the structure of this new beginning for health and the Health Service in Italy, in a European and international perspective.
Walter De Caro
National President of CNAI
Executive Board EFNNMA
October 28, 2021
© All rights reserved
Other articles in Letters to the editor
