Nurses and Midwives: A force for health

By: Andreas B?scher Bente Sivertsen Jean White

Nurses and Midwives: A force for health

Survey on the situation of nursing and midwifery in the Member States of the

European Region of the World Health Organization

2009

Nurses and Midwives:

A force for health

Survey on the situation of nursing and midwifery in the Member States of the European Region of the World Health Organization 2009

By: Andreas B?scher Bente Sivertsen Jean White

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Table of contents

Table of contents................................................................................................................................... 3 List of graphs......................................................................................................................................... 4 List of boxes and tables........................................................................................................................ 5 Foreword ................................................................................................................................................ 6 Preface.................................................................................................................................................... 7 Acknowledgements............................................................................................................................... 8 Executive summary............................................................................................................................... 9 1. Introduction...................................................................................................................................... 12 2. Methodological approach ............................................................................................................... 16 3. Political will and commitment ........................................................................................................ 20

New legislation ............................................................................................................................................20 National strategies and action plans ...........................................................................................................21 Statements, agreements and position papers .............................................................................................22 Moves by professional associations to ensure governmental and societal commitment.............................23

4. Public health challenges in the countries of the European Region of WHO ............................ 25 5. Legislation and professional regulation ....................................................................................... 31

Responsibility for legislation and regulation ................................................................................................35 Contents of the legislative framework .........................................................................................................36 Professional self-perception ........................................................................................................................38

6. Initial and continuing education and higher education............................................................... 40 7. Fair rewards, recognition and opportunities for career advancement ...................................... 48 8. Workforce planning strategies....................................................................................................... 51

Workforce policy..........................................................................................................................................54

9. Obstacles for nurses and midwives to work to their full potential ............................................ 57 10. Decision-making at all levels ....................................................................................................... 60 11. Role in public health and community development .................................................................. 62 12. Evaluation and quality of nursing and midwifery services....................................................... 64 13. Information on nursing and midwifery........................................................................................ 67 14. Knowledge and evidence base for nursing and midwifery....................................................... 68 15. International collaboration and guidance from WHO ................................................................ 72 16. Conclusions ................................................................................................................................... 74

Recommendations ......................................................................................................................................78

References ........................................................................................................................................... 79 Appendix 1: .......................................................................................................................................... 81

Questionnaire on the situation of nursing and midwifery in the European Region of WHO ............. 81

Answer ........................................................................................................................................................85 Answer ........................................................................................................................................................90

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List of graphs

Graph 1: Overview of responses

17

Graph 2: Overview of institutional responses

17

Graph 3: Public health challenges and the important role of nurses and midwives

28

Graph 4: How is the role of a nurse or a midwife defined?

32

Graph 5: Scope of professional practice

33

Graph 6: Responsibility for professional regulation

35

Graph 7: Aspects covered by legislative framework

36

Graph 8: Duration of general school education before professional education

40

Graph 9: Duration of general school education before professional education by country

41

Graph 10: Level of professional qualification after initial education

42

Graph 11: Characteristics of educational curricula

43

Graph 12: Changes in nursing and midwifery education

45

Graph 13: Salary level compared to national average

48

Graph 14: Obstacles for nurses and midwives to work to their full potential

57

Graph 15: Number of professional and scientific journals

69

Graph 16: Sources for funding nursing research

70

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List of boxes and tables

Box 1: Munich Declaration: Nurses and Midwives: A force for health

12

Table 1: Overview of responses

18

Table 2: Illustrative examples of regulatory and legislative processes

20

Table 3: Public health challenges

25

Table 4: Public health challenges and the important role of nurses and midwives

29

Table 5: How is the role of a nurse or a midwife defined?

32

Table 6: Scope of professional practice

33

Table 7: Responsibility for professional regulation

35

Table 8: Aspects covered by legislative framework

36

Table 9: Level of professional qualification after initial education

42

Table 10: Characteristics of educational curricula

43

Table 11: Changes in nursing and midwifery education

45

Table 12: Desirable and actual percentage of academically prepared nurses and midwives

46

Table 13: Salary level compared to national average

48

Table 14: Overview of total and current number of nurses/midwives

51

Table 15 Current numbers and estimated need for nurses and midwives

52

Table 16: Obstacles for nurses and midwives to work to their full potential

57

Table 17: Number of professional and scientific journals

69

Table 18: Sources for funding nursing research

71

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Foreword

Nurses and midwives make up the largest proportion of the health workforce, providing expert, skilled care to the population of Europe and as such, play a key role in the successful delivery of health services. As Europe heads into the second decade of the 21st century, it is timely to look at how nurses and midwives are developing their professional roles and determine what challenges affect their contribution to health service development and delivery.

Europe, like the rest of the world, is facing many challenges: inequality and social exclusion are still prevalent in society; climate change and urbanization affect living conditions; an ageing population means that more people live with chronic conditions and need long-term care, which has consequences on the workforce as the "Baby Boom" generation retire; and more recently, the implications of the global financial crisis and outbreak of H1N1 influenza. These factors all have health consequences for the population. Against this backdrop, it is well recognized that the WHO European Region is facing serious shortages of well-qualified nurses and midwives. This is part of an international health workforce crisis that is set to increase in severity in the coming decade.

The evidence from the review contained within this report points to the challenges for Member States in the coming years. There is a clear need to establish good health workforce planning processes; provide high-level initial preparation and ongoing staff development; robust yet permissive regulatory frameworks which ensure public protection, but allow role expansion; and appropriate recognition and reward. Steps must be taken to ensure nursing and midwifery is seen by individuals as an attractive career option, to safeguard the future workforce.

Dr Marc A. Danzon Regional Director

Regional Office for Europe World Health Organization

Copenhagen, Denmark

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Preface

This report sets out the findings from the third monitoring review of the situation of nursing and midwifery in Europe, undertaken in the World Health Organization (WHO) European Region during 2008/2009. Thirty-five countries, constituting two-thirds of the Member States, provided information.

The origin of this work is the WHO European Region Munich Declaration (2000), Nurses and Midwives: A force for health. (See pages 12-13 for the text of the Declaration.) The principles described within the Declaration are the basis of the Nursing and Midwifery programme of work, led by the WHO Regional Office for Europe. Regular progress reviews in respect of these principles have been undertaken in the 53 European Member States. Evidence from these reviews assists Member States in determining the actions they need to take to strengthen nursing and midwifery.

In recent years, attention to the important contribution nursing and midwifery makes to health has been a feature of global discussions. The 62nd World Health Assembly held in May, 2009, adopted a resolution committing Member States to the renewal of the principles of Primary Health Care (PHC), including strengthening health systems. The resolution makes specific reference to the nursing and midwifery workforce. The Assembly also received a report on the progress of the health related Millennium Development Goals (MDGs), noting poor progress in some areas such as maternal and child health. Nurses and midwives are well-recognized and essential to providing good health care. This view was reinforced in the International Conference on New Frontiers in Primary Health Care: Role of Nursing and Other Professions, which took place from 4 to 6 February, 2008, in Chiang Mai, Thailand. Representatives from the six WHO regions unanimously endorsed the Chiang Mai Declaration, which recognizes that:

Nursing and midwifery is a vital component of the health workforce and are acknowledged professionals who contribute significantly to the achievements of PHC and the MDGs.

The information from the third monitoring review, contained within this report, is set out in 16 chapters, covering the methodology used for the survey and key aspects such as education, workforce planning, scope of professional practice and the evaluation of the impact of nursing and midwifery practice on the quality of patient care. The report also considers broader factors such as political will and commitment to strengthen nursing and midwifery, legislation and regulatory frameworks and the involvement of nurses and midwives in decision-making on health policy and service development. The report indicates the major public health challenges that need to be addressed across Europe, most significantly the increasing numbers of people living with chronic conditions and needing long-term care. A copy of the questionnaire used to gather the data can be found in the appendix.

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