Need for a National Strategy for the development and empowerment of Nurses and Midwives

Invest more. Invest smartly. Invest in Nurses and Midwives.

BY MR IOANNIS LEONTIOU*

Introduction

Several countries in the European Union (EU) are experiencing a health workforce crisis. This crisis is also evident in Cyprus, especially with regard to the lack of nurses and midwives and threatens the performance and resilience of the health system.

The need to strengthen health workers in the European Region has been highlighted by the experiences during the COVID-19 pandemic. Hospitals were operating to deal with the pandemic while maintaining basic health services. Nurses responded promptly to challenges and quickly acquired new skills, adapted to new service requirements and responded to growing health needs. All too often, this meant putting themselves at risk of contracting the virus and dealing with a much heavier workload than normal.

The problem

The relevant report of the World Health Organization (Health and care workforce in Europe: time to act, 2022) records that the European countries affected by the crisis report a lack of workers in the health sector. These deficiencies are a result of:

1) Her pandemic COVID-19which led to the departure of many workers from the health sector.

2) Supply and demand mismatchwith a current example of the serious shortage of nurses and doctors.

3) Absence of planning and anticipation of needs, resulting in skills gaps. These (skills) gaps, especially in education (e.g. digital skills), are felt across Europe.

4) Disputes about the labor market and the legal regulatory framework. In some countries, there have been frictions over the pay and working conditions of health workers.

The root causes of this health workforce (HW) crisis include an aging society that requires more health services and, therefore, more health workers. But the EYD is also aging and the replacement of pensioners cannot be a given.

Fewer and fewer young people are leaving school and moving on to higher education and health training. In many countries, the flow in corresponding education as it is today is not enough and it is not only demographic. Countries are now dealing with past omissions such as:

• Lack of national strategy.
• Inadequate foresight and planning.
• Insufficient investment in training and education.
• Inadequate allocation of resources for needed positions.
• Ineffective lifelong learning mechanisms.
• Mismatch between newly trained health professionals and the skills needed to succeed in health system reforms and new models of care and delivery.

Cyprus does not seem to be an exception to what other, larger countries in the EU and with better economies are facing. The above omissions also have an impact on the nursing and midwifery profession where the phenomenon of lack and, inevitably, understaffing in health service organizations (public and private) is observed.

Any strategy (if and when the relevant ministry and government decide to develop) should aim to retain health workers in each health care facility.

In addition to fair wages, which play an important factor, working conditions should be taken into account. A future strategy, (if and when the relevant ministry and government decide to develop) should also include measures such as making the necessary resources available for physical protection against infectious diseases. It should also include measures to address violence and harassment, which has been shown to be a widespread issue in healthcare facilities (hospitals).

Any future development of a national strategy for the development and retention of health workers, especially nurses and midwives, should take seriously various social interventions such as sick leave, or sick pay, as well as the provision of nurseries and daycare centers in hospitals. In this way, family-friendly working conditions and the improvement of work-life balance will be promoted.

The protection of mental health is prominently emphasized which is also vital, as health workers are very often affected by conditions such as burnout.

Facts/Statistics

The aging of the EYD is a concern across Europe. In 13 of the 44 countries that provided data on this topic, they were found to have a workforce in which 40% of doctors are aged 55 or over.

There is wide variation in the production of EYD between countries. It thus becomes clear that countries with low numbers of graduates may not provide sufficient personnel to replace losses due to retirement and other causes.

For nurses, the number of graduates as a percentage of the size of the ED varies from country to country, from less than 1% to nearly 25%. For doctors, rates range from less than 1% (not enough to replace losses) to 15%.

Germany, Spain and the UK were the main destination countries in absolute terms for overseas-educated doctors and nurses in 2020.

High levels of psychological impact have been reported from many countries, with over 80% of nurses reporting negative psychological impact due to the pandemic. As many as nine out of 10 nurses had indicated an intention to leave their jobs.

Cyprus has only 80 nurses and 4.1 midwives for every 10,000 inhabitants (2020). These disappointing numbers are far below the average of the 53 countries of the European Region of the P.O.Y. Among the 45 countries of the European region of the P.O.Y for which there are data, our country is among the last six (Bulgaria, Montenegro, North Macedonia, Turkmenistan, Georgia) and far below the average, in relation to the number of nursing graduates per 10000 inhabitants.

During the pandemic, front-line workers such as nurses faced heavy workloads, high exposure to infections, stress and burnout, resulting in high absenteeism rates, lower job satisfaction and increasing intentions to quit. work. The levels of violent incidents against EYD increased after the start of the COVID-19 pandemic.

World Health Organization recommendations

This report offers a number of policy options that can strengthen countries’ ESAs. Specifically, it proposes 10 actions.

1. Alignment of education with population needs and health service requirements
2. Reinforcement of continuous professional development in order to provide the necessary supplies (new knowledge and skills) to the EYD.
3. Expanding the use of digital tools that will support the EYD.
4. Developing strategies to attract and retain health workers in rural and remote areas.
5. Creating working conditions that promote a healthy work-life balance.
6. Protection of the health and mental well-being of the EYD.
7. Building leadership capacity for EYD governance and planning.
8. Strengthening health information systems for better data collection and analysis.
9. Increase in public investment in education, and in the development and protection of EYD.
10. Optimizing the use of funds through innovative policies.

Conclusions

To address the crisis, the development of a national health workforce strategy is imperative. This strategy should include aligning the labor market with the goals of the health system.

The creation and establishment of a mechanism that can identify/highlight in time any underproduction of workers in the health sector. It would help address imbalances before deficiencies occur.

At the same time, the strategy should take into account the introduction of new models of care. These innovative models of care may include care integration, digitization, teamwork, community involvement, healthcare delivery approaches such as hospital-at-home services, to name a few. These models are designed to respond to the evolving demographic, social and environmental realities in Europe, while making the most of medical and technological innovations.

Although when we decide that we want a substantive solution to address the challenges that arise, there are a plethora of sources available with recommendations from organizations such as the WHO, OECD, the International Labor Office, the International Council of Nurses and others that we can refer to for development of our own national strategy.

Finally

Nurses inspired everyone during the pandemic. Although they had to deal with COVID-19 with the rest of the population, they feared more than anything that their high exposure to the virus would put their children, parents and loved ones at risk, in addition to themselves.

It is therefore worth placing them at the center of the health policy agenda.

Invest more. Invest smartly. Invest in Nurses and Midwives.

References:

1. Health and care workforce in Europe: time to act. Copenhagen: WHO Regional Office for Europe; 2022. License: CC BY-NC-SA 3.0 IGO.
2. Wismar, M. and Goffin, T., 2023. Tackling the health workforce crisis: Towards a European health workforce strategy. Eurohealth, 29(3).
3. BeWell. BeWell Project Website, 2023. https://bewell-project.eu/
4. World Health Organisation. Bucharest Declaration on health and care workforce. High-level Regional Meeting on Health and Care Workforce in Europe: time to act, 22 – 23 March 2023, Bucharest, Romania. https://www.who.int/europe/publications/i/item/ bucharest-declaration
5. European Commission. EU Global Health Strategy: Better Health for All in a Changing World, 2022. https://health.ec.europa.eu/system/ files/2023-10/international_ghs-report-2022_en.pdf

   *PhD, MA, BSc (Hons), CCN, RN