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

Defines development objectives and main measures National Development Plan for Social and Health Care Services KASTE Programme 2008-2011 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 2 22/03/2017 M.Vallimies-Patomäki

ADVANCED ROLES OF NURSES BASED ON THE RENEWED DIVISION OF WORK Primary health care Specialised medical care Family Physician – Family Nurse working in pairs Nurse´s consultation for acute health problems and NCDs Nurse´s consultation supported by the physician´s e- consultation Nurse´s consultations at out patient clinics Advanced roles e.g. in operating rooms Specialised medical care & Primary health care Nurse facilitated model of heart patients follow-up Nurse telephone consultations, triage & nurse consultation in emergency care 3 22/03/2017 M.Vallimies-Patomäki M.Vallimies-Patomäki

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 4 22/03/2017 M.Vallimies-Patomäki

EXPERTISE IN EVIDENCE BASED NURSING Nurses, practical nurses in clinical care Specialised nurses, practical nurses in clinical care Expert nurses in clinical care Experts in nursing science Roles Competencies in development and research, in provision and dissemination of EBN Competencies 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 Action 5 22/03/2017 M.Vallimies-Patomäki

HOW PATIENTS AND PHYSICIANS EXPERIENCED THE ADVANCED ROLES OF NURSES? + 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 6 22/03/2017 M.Vallimies-Patomäki

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 7 22/03/2017 M.Vallimies-Patomäki

ENSURING PATIENT SAFEY IN ADVANCED ROLES OF NURSES AND NURSE PRESCRIBING Requirements for nurse prescribing: Employment relationship with a municipal health centre Work experience of 3 years and regulated post-graduate studies for nurse prescribing: 45 ECTS Polytecnics and universities / the medical faculty 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 8 22/03/2017 M.Vallimies-Patomäki