Development of advanced nursing roles in European and non-european countries

Transcription

1 Development of advanced nursing roles in European and non-european countries Gaetan Lafortune, OECD Health Division DG Sanco Working Group on Health Workforce Brussels, 7 February

2 Policy context Concerns about shortages of health workers and access to care (particularly in primary care) Concerns about patient safety and quality of care Concerns about growth in health spending (and how to finance it, given the need to reduce budget deficits) The perfect storm to look at skill mix and a possible re-definition of roles of doctors and nurses 2

3 Nurses outnumber doctors in all countries Practising doctors (per 1000 pop.) Of which: GPs Practising nurses (per 1000 pop.) Of which: Professional nurses Associate professional nurses Number of nurses per doctor Australia Belgium Canada a 1.1 a Cyprus Czech Rep Finland a France a 1.6 a 7.9 a Ireland b 0.6 b 16.2 a Japan Poland United Kingdom United States a Average a) Data include not only doctors/nurses providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. b) Data refer to all doctors licensed to practise. Source: OECD Health Data Data for Cyprus are from the Eurostat database. 3

4 Aims of OECD study on Advanced nursing roles 1) State of development of advanced practice nursing in different countries 2) Evaluations of impact on patient care and cost 3) Barriers/facilitators to development of advanced practice nursing (why some countries are ahead?) 4

5 Process/Method Summer 2009: Invitation to all OECD and EU countries to participate (12 countries chose to do so) Fall 2009: Questionnaire to collect qualitative and quantitative information from national experts February 2010: Experts meeting to discuss draft report (DG Sanco and European Federation of Nurses Associations also participated) July 2010: Final report published as OECD Health Working Paper No. 54 (in English and French) 5

6 Two groups of participating countries More experience Less experience Australia Belgium Canada Cyprus Finland Czech Republic Ireland France United Kingdom Japan United States Poland 6

7 What advanced practice nursing mean? International Council of Nurses (2008): A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master s degree is recommended for entry level. 7 7

8 Titles for Advanced Practice nurses (91 respondents from 32 countries) Source: Pulcini et al., 2010 Frequency % Nurse Practitioner 38 44% Advanced Practice Nurse 15 17% Advanced Nurse Practitioner 9 10% Clinical Nurse Specialist 7 8% Nurse Specialist 4 4% Professional Nurse 2 2% Expert Nurse 1 1% Certified Registered Nurse Practitioner 1 1% Chief Professional Nurse with post-basic training 1 1% in Primary Health Care Nurse Consultant 1 1% Specialist Nurse Practitioner 1 1% Primary Healthcare Nurse 1 1% Advanced nurse in a specialty 1 1% 8

9 What do advanced nurses do? Two broad types of activities Substitution Services formerly provided by doctors Nurse Practitioners Main aims: reduce workload of doctors, improve access to care, and reduce cost? Supplementation New services (e.g., quality improvement) Clinical nurse specialists Main aims: improve services/quality of care, not reduce cost 9

10 Number of advanced practice nurses Country Category Year Number % of all RN Australia Canada Ireland England United States Nurse Practitioners Clinical Nurse Specialists Nurse Practitioners Clinical Nurse Specialists Advanced Nurse Practitioners Nurse Consultants Clinical Nurse Specialists Nurse Practitioners % % % (incl. midwives) 121 (incl. midwives) 3.8% 0.2% % % % 1010

11 What impact on patient care? Access: Advanced practice nurses (e.g., nurse practitioners) can indeed improve access to services and reduce waiting times Quality: They are able to deliver same quality of care as doctors for a range of services (first contact for people with minor illness, routine follow-up of patients with chronic conditions, patient education/counseling) Patient satisfaction: At least equal, if not higher (because of quicker access and longer consultations) 11

12 What impact on cost? (depends on many factors) Substitution of tasks: Earnings differential between doctors/advanced nurses Productivity differential (measured for instance by number of consultations per hour or per day) Differences in prescribing drugs or tests (indirect cost) Differences in training cost between doctors/advanced nurses General finding: cost reduction (or cost neutral) Supplementary tasks: More services mean higher cost in short-term (possible longer-term saving if services avoid complications) 12

13 Main barriers and facilitators to implementing advanced practice nursing Professional interests (opposition from medical profession) Organisation of care and funding mechanisms Legislation and regulation on scope of practice Education and training opportunities 13

14 What can government do to support implementation of advanced nurses? Work with nurse associations and other stakeholders to address/reduce opposition from medical profession Support new modes of care delivery and remuneration methods that promote interprofessional cooperation Review legislation and regulation on scope of practice of nurses (e.g., prescribing rights) Provide financial support for creation of new education/ training programmes for advanced nurses (e.g., Master s level or short-term programmes) 14

15 Links between advanced practice nursing and broader health workforce planning Potential growth of advanced practice nursing may reduce need for doctors (substitution) But high uncertainties concerning the actual growth of such mid-level providers in different countries Need to incorporate these uncertainties in alternative scenarios for health workforce planning ( what if the number of advanced practice nurses doubles over next 10 to 20 years? ) 15

16 For more information

17 This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.