redistribution of tasks in health care in finland new roles of nurses and nursing personnel marjukka...
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REDISTRIBUTION OF TASKS IN HEALTH CARE
IN FINLAND
New roles of nurses and nursing personnel
Marjukka Vallimies-Patomäki
Ministerial Adviser, Ph.D.
Ministry of Social Affairs and Health
Finland
2 10/04/23 M.Vallimies-Patomäki
Adopted by the Government in January 2008
Based on the Act on Planning and Government Grants for
Social Welfare and Health Care (733/1992)
Defines development objectives and main measures
for municipal social and health care in 2008-2011 Prevention and early intervention Ensuring the sufficiency of staff and strengthening skills Services functioning as an integral whole,
effective models of operation
Government grants: annually 25 M€ in 2008-2011
for municipal development activities
National Development Plan for Social and Health Care Services
KASTE Programme 2008-2011
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ADVANCED ROLES OF NURSESBASED ON THE RENEWED DIVISION OF WORK
Family Physician – Family Nurse working in pairs
Nurse´s consultation for acute health problems and NCDs
Nurse´s consultation supported by the physician´se- consultation
Nurse´s consultations
at out patient clinics
Advanced roles e.g.
in operating rooms
M.Vallimies-Patomäki
Primary health care Specialised medical care
Nurse facilitated model of
heart patients follow-up
Nurse telephone consultations,
triage & nurse consultation in
emergency care
Specialised medical care &
Primary health care
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INCREASING THE EFFECTIVENESS AND ATTRACTION OF
NURSING CARE BY MEANS OF MANAGEMENT
National action plan 2009-2011
www.stm.fi
Based on the KASTE Programme
The Ministry of Social Affairs and Health allocated 2,7 M€ as state grants for the regional implementation of the action plan
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EXPERTISE IN EVIDENCE BASED NURSING
Nurses, practical nurses in clinical care
Specialised nurses, practical nurses in clinical care
Expert nursesin clinical care
Experts in nursing science
Competencies in development and research, in provision and dissemination of EBN
Competencies in clinical nursing and care,in implementation of EBN
Implementation of EBPs
Implementation of EBPs in specialised care Support for the implementation of EBPs in the unit
Harmonising EBPs at the regional level Development, dissemination & monitoring
EB guidelines Research & development National & international collaboration
Rol
esC
ompe
tenc
ies
Ac t
ion
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HOW PATIENTS AND PHYSICIANSEXPERIENCED
THE ADVANCED ROLES OF NURSES?
Patients Physicians
+ Improved access to care
+ Better continuity of care
+ Improved patient education
+ Improved self care
+ The majority of the patients
were satisfied
- 14 % of the patients
in hospital care had negative
attitudes towards task shifting
+ More time for the patient
+ Improved flexibility
+ Uniform guidelines for care
+ Improved multiprofessional
co-operation
- More demanding cases
- Consultations by the nurse
increased the physician´s
workload in the early stages
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NEXT STEPS The Parliament adopted the legislation on Nurse Prescribing
in April 2010
The aims are to suppot: better access to care better exploitation of nursing knowledge and skills in patient care functioning and flexibity of services in primary health care
settings Improved productivity in PHC
A national list of medicines and nationally defined postgraduate education will be regulated by decrees
Implications for education:
Strengthening clinical competencies in nursing education
Establishment of post-graduate studies for specialisation
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ENSURING PATIENT SAFEY IN ADVANCED ROLES OF NURSES AND
NURSE PRESCRIBING Requirements for nurse prescribing:
1. Employment relationship with a municipal health centre2. Work experience of 3 years and regulated post-graduate studies
for nurse prescribing: 45 ECTS Polytecnics and universities / the medical faculty
3. Authorisation from the physician-in-charge
Registered: The National Register for Health Care Professionals
Identification number: The The National Supervisory Authority for Welfare and Health
The propriety of the nurse´s decision making:EB guidelines and consultation of the physician
Monitoring adverse events: Responsibility of health centres
CPD: Regulated by legisltation
A national steering group: To be set up by the Ministry