July-August-September 2019

President message

Dear EFN Members and Colleagues,

It was a real pleasure to host the EFN’s 109th General Assembly last April, and to welcome all of you in Brussels. This meeting was an excellent opportunity to receive your feedback on our work, as well as to reflect on what has been achieved over the preceding months, and the priorities for the upcoming ones.

The summer break ahead of us also gives us an opportunity to look at the work carried out by the EFN during the last three months. We have seen how the Nursing Now campaign is progressing raising awareness across Europe on the importance of the nursing profession for the sustainability of our healthcare systems. Moreover, the issue of vaccination-hesitancy remains high on the political agenda, and the World Health Organisation (WHO) is making progress in this topic, the same as the European Union (EU). Parallel to this, the outgoing European Commission has included value-based healthcare and task-shifting in its agenda and is taking steps forward to promote the reform of healthcare systems across the EU.

That said, I should remind you all that a new college of Commissioners is due to be elected soon, and the newly elected European Parliament is restarting its activities. Hence, we should start again thinking on our political priorities for the EFN to lobby at the European level. Collectively, through the

EFN, we can engage in a dialogue with politicians and policymakers in Brussels to ensure that the voice of the nursing profession is heard and taken into account.

At the same time, digitalisation remains high on the EFN’s agenda. It is key for us to demand that the digitalisation of healthcare of all the new digital health tools that we see these days are implemented to support the nursing workforce on its daily activities, and not to increase their workload. Nurses should be co-designers of these tools, to ensure that they are fit-for-purpose and that they address their needs.

Finally, the EFN keeps making progress in its three EU-funded projects: QualMent (a project aiming at addressing the clinical mentor’s lack in nursing education and develop the clinical mentor’s competence with mentor education for national and international nursing students in line with Directive 2013/55/EU), Smart4Health and InteropEHRate (both of these projects are developing Electronic Health Records that operate across the whole of the EU).

I remain convinced that the nurses, working all together, can and will make a difference for Europe’s citizens.

Elizabeth Adams
EFN President

“Integrated working of acute, community, primary and social care services is critical to reduce the fragmentation within the health and social care systems and deliver improved patient/health outcomes”.

Nurses leading Change in Europe’s fight against Alzheimer’s Disease (By Paul De Raeve, Government Gazette, Volume 1, 2019, pp 90-91, May 2019)

News from EFN

Finnish EU Presidency
On the 1st July 2019, Finland will take over the rotatory presidency of the Council of the EU from Romania, until the end of December. The new presidency’s programme is not yet available, but will soon be published on their website. During June, the EFN has attended a series of events on this upcoming presidency and its political priorities. It is clear that their focus will be on trade and the single market. Health will not be listed among their priorities. Nevertheless, it is expected that they will apply a “health in all policies” approach. The EFN would welcome this. The EFN will follow these developments very closely and will monitor their activities to make sure that health is represented and prioritised the same way it is for Europe’s citizens.

Experts’ opinions on value-based healthcare and task-shifting
The European Commission has given a mandate to the Expert Panel on Effective Ways of Investing in Health (EXPH) to work on the topics of value-based healthcare and task-shifting. During a two-day meeting held in Brussels, the EXPH presented its draft conclusions  to the EU health stakeholders present (including EFN).

When it comes to value-based healthcare, the EFN welcomes the EXPH draft opinion. However, the EFN also recognises that these recommendations presented are insufficient as they do not include a series of concrete steps for stakeholders to take to implement operational value-based healthcare systems. Moreover, the EFN is also calling for a recognition of nurses into this debate, since they are largely responsible for bringing up the “value” in value-based healthcare systems.

When it comes to task-shifting, the EFN welcomes the EXPH recommendations, but task shifting has traditionally been used to overload the nursing workforce schedule, and to promote the hiring of lower-qualified and cheaper healthcare workers, not complying with the EU Directive 2013/55/EU.

To avoid these, the Workforce Matrix 3+1, which includes information on education, qualifications and competences for each category of nursing care (general care nurse, specialist nurse and advanced nurse practitioner), should be adopted by all European countries, next to investing in nursing education to ensure appropriate education, lifelong learning and continuous professional development.

Launch of the Nursing Now Campaign in Ireland and Spain
Aiming to improve health by raising the status of nursing, as well as the recognition of nurses’ contribution to healthcare, gender equality, wider society and improved economies, the Nursing Now Campaign has been launched globally. Linked to the EFN members, the Nursing Now campaign has now also been launched both in Ireland and in Spain, with the EFN being present at both events.

In Ireland, the launching event took place on 25 April 2019, in Dublin, hosted by the Irish Nurses and Midwives Organisation (INMO), a member of EFN.  As President of EFN, and member of the Nursing Now Campaign Board, Ms Elizabeth Adams was invited as keynote speaker. In Spain, the launching event took place on 14 May 2019, in Madrid, organised by the Spanish General Council of Nursing, a member of EFN. It was also attended by international high-level health and nursing stakeholders, including Lord Nigel Crisp, Nursing Now co-chair; Adelaida Zabalegui Yárnoz, Nursing Now Board Member; Tedros Adhanom Ghebreyesus, WHO Director-General; Howard Catton, ICN CEO; and EFN. Both, Elizabeth Adams and Paul De Raeve, made it clear that nurses play a crucial role in health promotion, disease prevention and treatment, and their involvement in the policy debate is fundamental to ensure that policy making in health is fit-for-purpose.

News from the EU

Cross-border healthcare directive
The European Court of Auditors published a report in which it warns that the EU Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare has had too little impact so far. EU patients still face challenges in benefiting from the actions envisaged by the directive, and very few of them have asked for the reimbursement of health treatments received abroad, also due to the fact that only a minority of potential patients are aware of their rights to seek medical care abroad. Moreover, from all the EU countries with operating e-Prescriptions, the exchange of patient’s health data is only done in two: Estonia and Finland.

This clearly demonstrates that there is a need to enhance the quality of information addressed to patients in order to make them aware about their rights to cross-border healthcare, and that it is essential to work together to realize its full potential and make it a true added value for all citizens and patients living in the EU. The EFN has been following this debate quite closely, since the design of the Directive, lobbying hard for the nurses’ voice to be heard in the entire policy process, knowing that this Directive also impacts on nursing care, and that nurses have a key role to play in this, as patients need to be guided by nurses in selecting the proper information regarding their treatments and care. As European citizens, this means having the right to choose where to receive treatment/care across the EU, and to be reimbursed for it.

All employers must record staff working hours
The Court of Justice of the European Union has published a resolution in which it states that in order to guarantee employees’ rights under the EU’s Working Time Directive and the charter of fundamental rights EU Member States “must require employers to set up an objective, reliable and accessible system enabling the duration of time worked each day by each worker to be measured”. Now, it is up to each Member States to define the system to record those working hours. The right to fair working conditions is set out in the 10th principle of the European Pillar of Social Rights “Healthy, safe and well-adapted work environment and data protection”, and in EU’s Working Time Directive (2003/88/EC). The Court’s ruling has far-reaching consequences for the nursing community in the EU because modern-day working-hours are not clearly defined. This is particularly important in light of the trend across many EU countries of exhausting the nursing workforce with shortages and long working hours. The EFN will follow closely this development.

Protecting nurses from carcinogens and work-related cancer
The European Agency for Safety and Health at Work published an article stating that many exposures to carcinogens at work, including those generated by work processes, are preventable through risk assessment, preventive measures and by following the stringent EU measures already in place. Another article, also published by OSHA-EU, highlights that there is also a gender gap in the exposure to hazardous substances at work: women, particularly those working in healthcare, are much more vulnerable to exposure. Knowing that 7.3 million nurses, of

which 92% are women, and more than 12.7 million health professionals in Europe, are exposed every year to carcinogenic, mutagenic and reprotoxic hazardous drugs, safe workplaces are still needed for the nursing profession. The EU Directive 2004/37/EC does not currently acknowledge the dangers of hazardous drugs in healthcare or detail how they should be prevented. Healthcare institutions need to act to prevent nurses and other healthcare professionals from the deadly risk entailed to activities such as preparing and administrating hazardous drugs.

Global action on patient safety
Being high in the EFN political agenda, patient safety remains an important challenge for all, with the EU Member States striving to achieve Universal Health Coverage and the Sustainable Development Goals. Taking this into account, the 72nd World Health Assembly adopted the WHO’s Report on ‘Patient Safety: Global action on patient safety’, which stresses that patient safety interventions must be aligned with overall health system goals and embedded in all programmes, and form the foundation for the strengthening of health systems. Furthermore, addressing patient safety at primary care level is seen as critical to ensuring trust and to having a functioning, high-performing health system, next to digital technologies for implementing patient safety interventions, and monitoring and measuring their impact. Taking into account that with the current challenges of ageing, chronic diseases, etc. we need, more than ever, a highly qualified workforce to ensure that patient safety and quality of care are maintained. Technology has an important role to play to contribute to enhancing patient safety. The 72nd World Health Assembly also endorsed the establishment of a World Patient Safety Day aiming to bring all stakeholders in the health care system to work together to improve patient safety. This should be organised every year on 17 September.

European Commission reports on digitalisation – boosting Member States performance, but without enough women participating
On 11 June 2019, the European Commission made public the results of the 2019 Digital Economy and Society Index. This index monitors Europe’s overall digital performance and looks at the progress done by each of the EU Member States. It concludes that investment in the digital sector, together with robust digital policies, boosts Member States performances. The same day, the European Commission also published its annual Women in Digital scoreboard, concluding that EU countries need to make a great effort including women in the digital sector. The EFN is a strong supporter of the digitalisation in in health, as it has the potential to ease patients’ access to their health records and simplify and improve the communication with and between health professionals. Taking this further, the EFN is part of two EU-funded projects on Electronic Health Records: InteropEHRate and Smart4Health, providing end-user input, and making sure that these digital solutions are useful for the nursing community.


Tools and methodologies to assess the efficiency of health care services
The EU Expert Group on Health Systems Performance Assessment (HSPA) published a report titled “Tools and methodologies to assess the efficiency of health care services in Europe: an overview of current approaches and opportunities for improvement”, aiming at supporting national health policy-makers in their ongoing efforts to improve their set of tools and methodologies to assess the efficiency of their health care systems, as a means to help them design more effective, evidence-based policy interventions.

European Commission report on the EU Charter of Fundamental Rights
On the 5 June 2019, the European Commission published its annual report on how the EU institutions and Member States have been applying the EU Charter of Fundamental Rights – considering that 2019 marks the 10th anniversary of the Charter.

“Putting social matters at the heart of Europe”
The European Commission launched a new publication highlighting how their policies supported employment, social affairs, skills and labour mobility during the period 2014-2019. One of the key achievements if the European Pillar of Social Rights, which forms the backdrop for all the EC initiatives in the area of employment and social affairs. Being key for the nurses, the EFN members have identified 4 out of the 20 principles as crucial for the EFN to focus on (Principle 1 – Education; Principle 6 – Wages; Principle 16 – Healthcare; Principle 18 – Long-Term Care).

2019 report on equality between women and men in the EU
The European Commission’s Strategic engagement for gender equality 2016-2019 sets the current framework for EU action to gender equality. A report has been published looking at the progress done in each EU Member States, as well as the work that still needs to be done.


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