Guest editorial: Nursing has got stuck in ‘the system’, so let’s CHANGE THE SYSTEM!

Abstract

When I started to work as a community health nurse in 1986 in a small village in the Netherlands, I thought I had found the most perfect job I could have. I had my own responsibilities, decided autonomously what patients needed, made the schedules together with my colleagues, and worked closely together with general practitioners (GPs), social workers, midwives, social care, occupational therapists (OTs), physical therapists (PTs) and volunteers. The team included priests and policemen when necessary. I had 'my own' neighbourhood, providing preventive programmes and care from the cradle to the grave. And, very importantly, we didn't have separate management. We had a local voluntary board that recruited new nurses and determined budgets. Every year we held an evaluation at the local Chinese restaurant and discussed the problems we had to deal with, if there were any.For eight years I worked this way and I'm sure it was the most effective and productive way of community health nursing I could and can imagine. During this time, we developed standards for different patient groups, we had high professional standards and the educational level throughout the country was the same; only with a post-registration higher level education could you become a community health nurse. In the 'hierarchy' of nursing, the community health nurse had a high status, if not the highest. Patients were happy, GPs were happy and nurses were happy. So, why didn't we keep it this way?The management paradigmIn 1993 there was growing pressure from politicians and policy makers to create 'professional' organizations. Regional reorganisation meant that community health organisations had to merge with social care, nursing homes and residential care facilities, and sometimes even hospitals. Every year a new management layer emerged and patient needs were redefined as 'products'. We had 10 different products: nursing care, nursing care special, nursing care extra, personal care, personal care special and personal care extra, guidance and guidance extra, etc. The health care service became a real industry.

Perspectives: The Nurse Associate: an asset to supplement the NHS workforce or a cheaper substitute for the registered nurse?

“…High-quality care requires an initial investment and the Buurtzorg model of community nursing in the Netherlands is an excellent example of this. Despite having higher costs per hour because the majority of care is delivered by RNs, the Buurtzorg model has resulted in an overall reduction in care costs of between 30% and 40%, yet an increase in both patient satisfaction and the quality of care provided (De Blok, 2015; KPMG International, 2014). Based on these findings and the knowledge that it is the number of RNs that improves patient safety (Krueger et al., 2013), we should be advocating for ourselves and not a cheaper imitation.…”