Alessia Gramuglia and Paul De Raeve, of the European Federation of Nurses Associations, explain why the united voice of three million EU nurses is key to addressing European policies on education, workforce and health outcomes.
EU health and social care systems are facing more pressure due to the need to respect sustainability constraints while delivering better outcomes. Such pressure has a strong impact on three million EU nurses who are required to ‘do more with less’. Therefore, with the prospect of the upcoming European Parliament elections, three million EU nurses call on national and EU politicians to enact concrete support to the nurses to be able to deliver the best outcomes for EU citizens and patients.
Being engaged in modernisation
Knowing that the nursing profession is one of the most mobile, a crucial issue for nurses is their free movement throughout the EU. To ensure the mobility of a sufficient, motivated, highly qualified nursing workforce, the EFN has been engaged in the modernisation of Directive 2005/36/EC on the recognition of professional qualifications modernisation towards Directive 2013/55/EU, leading to the development of Article 31 in the Directive, strengthening the existing minimum requirements for nurses’ education and training.
However, ensuring that the legal modernisations are being transposed into the national legislation is key.
Compliance with Directive 55 is crucial to ensure that nurses coming out of nursing schools are able to practise throughout the EU. If nursing curricula do not comply with the modernised directive, those nurses will not benefit from the mutual recognition of professional qualifications, but will fall under the general system, often leading to them being recognised as healthcare assistants when moving to other Member States.
There are severe consequences of non-compliance with EU directives, and the EFN guide to transpose Article 31 into national legislation is crucial to strengthen health and social care ecosystems and clinical outcomes.
In this sense, a step forward has been made with the adoption of the directive on a proportionality test before adoption of new regulation of professions, aiming to prevent national governments from creating new legislation without engaging the nursing voice. The adopted Proportionality Directive is therefore seen as a new legal tool, together with Directive 2013/55/EU, to strengthen nursing as a profession.
The EU-funded project ENS4Care has shown that nurses and social workers, with the right knowledge and skills, are well placed to add considerable value for innovation, forming an important link between technological innovation, health promotion and better outcomes. The proliferation of e-health tools and technologies requires nurses and social workers to understand the evidence base underpinning the available tools, and to ensure that they are selected and used appropriately, so the right outcomes can be monitored and evaluated.
Technology needs to empower and support nurses in data collection; therefore, involving EU nurses from the start of the co-design process, with specific attention to gender sensitivity, leads to the development of tools able to support women/nurses and allows them to spend more time with patients. This should be our top priority, supported by policymakers, politicians and industry.
Urgent concerns for EU nurses
Finally, when looking at the main challenges faced by the nursing profession, it is clear that one of the most urgent concerns relates to salaries. The 2008 cuts in healthcare system financing in the EU had a negative impact on health outcomes, with nurses, mostly women, expected to provide the same quality of care, if not better, with fewer resources, leading to burn-out and nurses leaving the profession. While practically every Member State needs more nurses to support the unmet needs of their population, little is done to achieve better working conditions that keep nurses in the profession. EFN members are strongly committed to ensuring that, at the EU and national levels, policymakers reverse the trends that nowadays see women overrepresented in lower paid and informal care-giving roles.
EU nurses have been disproportionately affected by HR policies that fail to consider their professional needs in employment contracts, incentives and career advancement opportunities.
Poor salaries, unsatisfactory working conditions and ‘no say’ in decision-making processes, particularly for frontline nurses, often leave women feeling isolated, disempowered and unappreciated.
It is therefore essential to have nurses’ voices shaping the European Pillar for Social Rights. As 92% of the nurses are women, incorporating positive working environments that support work-life balance is one important strategy in retaining a competent, experienced workforce.
Unification for EU nurses is key
The united voice of three million nurses is key to addressing EU policies on education, workforce and health outcomes, and to continue building trust with EU citizens to improve health and social care ecosystems. It is crucial that political decisions taken at the Council, Parliament and Commission better reflect the need for change as experienced by frontline nurses, and that their needs and concerns are part of the political discussion and inform the policymaking process.
Healthy and attractive working environments for all nurses are needed for their development across Europe, with a focus on supporting education, frontline practice and outcomes. Nurses call on politicians to champion an appropriately educated, supported and developed nursing workforce with fair working conditions to deliver person-centred care and promote health in the EU.
This article will appear in issue 7 of Health Europa Quarterly, which will be published in November 2018.