Prospects for implementing a new nurse model in capital healthcare: expected effects and possible risks

Increasing the role of nurses is one of the key trends supported by WHO and proven to be effective in many countries. Russia is also moving along this path: the relevant documents have been adopted, an experiment is underway in the pilot regions, and in 2020 further scaling of the new model of the nurse has been announced.

The purpose of the study. Analysis of readiness to expand the functions of a nurse.

Methodology. Content analysis of the information context dedicated to the implementation of the idea of expanding the functions of nurses; studying the experience in pilot regions; sociological research in the form of a mass survey of nurses and doctors, as well as a series of expert interviews.

Results. At the level of an abstract idea, the expansion of the functions of nurses is welcomed by the majority of doctors and experts, but the possibility of its successful implementation in the current conditions raises serious doubts; the same applies to the prospects for achieving the declared goals - increasing the role of nurses and improving the quality of medical care.

Discussion. There is both the noticeable interest of the medical community in this issue and the problems of an informational, organizational, technical, socio-psychological nature that can reduce the effect of the reform. Informational gaps or ambiguity in understanding the essence of the innovation by different groups of medical workers, as well as a range of concerns that exist in both the nursing and medical communities, were identified. The functions that can be transferred to nurses, as well as the conditions necessary for this, are considered.

Conclusion. A serious professional analysis of the opportunities and risks contained in the new reform is required: various areas of medical activity have their specifics, without which the innovation can cause an acute negative response and a noticeable outflow of nursing staff from the capital’s medical organizations.

1. Sherwood G. Perspectives: Nurses’ expanding role in developing safety culture: quality and safety education for nurses – Competencies in action. J. Res. Nurs. 2015; 20(8): 734–40. https://doi.org/10.1177/1744987115621142

2. Chua G.P. Challenges Confronting the Practice of Nursing in Singapore. Asia Pac. J. Oncol. Nurs. 2020; 7(3): 259–65. https://doi.org/10.4103/apjon.apjon_13_20

3. Buerhaus P.I., Auerbach D.I., Staiger D.O. The recent surge in nurse employment: Causes and implications. Health Aff. (Millwood). 2009; 28(4): w657–68. https://doi.org/10.1377/hlthaff.28.4.w657

4. WHO. Working Together for Health: The World Health Report 2006. Available at: https://www.who.int/whr/2006/whr06_en.pdf

5. Xu Y. Strangers in strange lands: A metasynthesis of lived experiences of immigrant Asian nurses working in Western countries. ANS Adv. Nurs. Sci. 2007; 30(3): 246–65. https://doi.org/10.1097/01.ans.0000286623.84763.e0

6. Shorey S., Goh M.L, Ang S.Y., Ang L., Devi M.K., Ang E. The progression and future of nursing in Singapore: A descriptive qualitative study. J. Transcult. Nurs. 2019; 30(5): 512–20. https://doi.org/10.1177/1043659618823909

7. Aiken L.H., Sermeus W., Van den Heede K., Sloane D.M., Busse R., McKee M., et al. Patient safety, satisfaction, and quality of hospital care: Cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ Open. 2012; 344: e1717. https://doi.org/10.1136/bmj.e1717

8. McKee M., Nolte E., DuBois C.A., et al. Human resources for health in Europe. London: Open University Press; 2006. Available at: https://www.euro.who.int/__data/assets/pdf_file/0006/98403/E87923.pdf

9. Kutney-Lee A., McHugh M., Sloane D.M., Cimiotti J.P., Flynn L., Neff D., et al. Nursing: a key to patient satisfaction. Health Affair (Millwood). 2009; 28(4): w669–77. https://doi.org/10.1377/hlthaff.28.4.w669

10. Spence Laschinger H.K., Leiter M.P. The impact of nursing work environments on patient safety outcomes: The mediating role of burnout/engagement. J. Nurs. Adm. 2006; 36(5): 259–67. https://doi.org/10.1097/00005110-200605000-00019

11. Aiken L.H., Clarke S.P., Sloane D.M., Lake E.T., Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J. Nurs. Adm. 2008; 38(5): 223–9. https://doi.org/10.1097/01.nna.0000312773.42352.d7

12. Aiken L.H., Sloane D.M., Ball J., Bruyneel L., Rafferty A.M., Griffiths P. Patient satisfaction with hospital care and nurses in England: an observational study. BMJ Open. 2018; 8(1): e019189. https://doi.org/10.1136/bmjopen-2017-019189

13. Perry S.J., Richter J.P., Beauvais B. The effects of nursing sa­tisfaction and turnover cognitions on patient attitudes and outcomes: a three-level multisource study. Health Serv. Res. 2018; 53(6): 4943–69. https://doi.org/10.1111/1475-6773.12997

14. Gröndahl W., Muurinen H., Katajisto J., Suhonen R., Leino-Kilpi H. Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland. BMJ Open. 2019; 9(4): e023108. https://doi.org/10.1136/bmjopen-2018-023108

15. Adams L.Y. The conundrum of caring in nursing. Int. J. Car. Sci. 2016. Available at: https://pdfs.semanticscholar.org/b428/e8723ef37c6817692d9a2dddd734b28d8947.pdf

16. Lovink M.H., Persoon A., van Vught A.J.A.H., Schoonhoven L., Koopmans R.T., Laurant M.G. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study. BMJ Open. 2017; 7(6): e015134. https://doi.org/10.1136/bmjopen-2016-015134

17. Shorey S., Goh M.L., Ang S.Y., Ang L., Devi M.K., Ang E. The progression and future of nursing in Singapore: A descriptive qualitative study. J. Transcult. Nurs. 2019; 30(5): 512–20. https://doi.org/10.1177/1043659618823909

18. Aleksandrova O.A., Yarasheva A.V., Nenakhova Yu.S. Professional training of nurses for medical organizations in the capital: problems and solutions. Problemy sotsial’noy gigieny, zdravookhraneniya i istorii meditsiny. 2020; 28(S): 680–6. https://doi.org/10.32687/0869-866X-2020-28-s1-680-686 (in Russian)

19. WHO State of the World’s Nursing Report – 2020: Investing in education, jobs and leadership. Available at: https://www.who.int/publications/i/item/9789240007017

20. WHO. Competencies for nurses working in primary health care (2020). Available at: https://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/publications/2020/competencies-for-nurses-working-in-primary-health-care-2020

21. WHO. Year of the Nurse and the Midwife 2020. Available at: https://www.euro.who.int/en/media-centre/events/events/2020/01/year-of-the-nurse-and-the-midwife-2020