November – December 2017

President message

Dear EFN Members and Colleagues,

I wish to sincerely thank you for electing me as your President at the recent EFN General Assembly in Brussels. I am very humbled by your confidence in me to lead this strategic and important organisation with Dr Paul de Raeve, Secretary General, EFN.

Nursing is central to the delivery of healthcare to the 508 million people in the EU. It is a privilege to witness the extraordinary contribution made every day by nurses across the continent and to see how nurses make a real difference to the lives of those they meet. While nursing plays a key role already, health systems have not fully recognised the potential of nurses and the EFN has been, and will be, pivotal in ensuring that the voice of nursing is at the centre of every discussion around healthcare. I am honoured to have been chosen by you and our member national nursing associations across Europe to lead their great organisation. I will make full use of this privilege to drive forward and strengthen EFNs influence at a political level in the EU so as to support nurses and thereby enhancing the health of the populations in all European Countries.

The EFN General Assembly highlighted the many challenges for national nursing associations and the nursing profession across Europe that requires our collective vision, wisdom and solidarity to deliver safe, effective and quality healthcare for the populations we serve. Our discussions during the General Assembly clearly identified the need to embrace and proactively drive EU legal opportunities to strengthen nurses and nursing as a profession, to achieve the best population health outcomes.

The EFN has strategically used the European legislation, in particular the Directive 2005/36/EC (modernised by Directive 2013/55/EU), to strengthen nursing as a profession. The Directive, which has not yet been implemented by all Member States (Deadline – January 2016), is proving not to be sufficient enough to hold national governments accountable in order to maintain the appropriate level of bachelor nurses replacing them with new and less qualified professions.

Additionally, many national governments are planning, and some already have commenced, downgrading nursing education. This is driven by economic factors rather than the body of evidence which demonstrates that appropriately educated nurses make a significant positive difference to the quality, safety, morbidity and mortality of the individual citizens. This is very much a live issue that is taking place across Europe and requires proactive, sustained and collective action to protect and enhance the care and health service delivered to all. The EFN, through the ENRF, will continue to evolve and develop the evidence to strengthen the case for national nursing associations. Further action is required to ensure that the nurses’ education is in line with the Directive 55. To this purpose, the EFN Competency Framework and EFN Workforce Matrix 3+1 will be guiding tools for EFN members and stakeholders to work towards the right workforce composition, and to provide clarity to the different nurses’ roles and responsibilities.

In the upcoming months, EFN’s efforts will focus on continuing to promote a high-quality nursing profession in Europe. This can only be achieved by the collective strength of national nursing associations engaging and working with the EU Institutions and national governments to drive and deliver positive concrete policy actions to support the nursing profession and thereby enhancing health service effectiveness and efficiently. It is a core principle of EFN that health should be a high priority in the EU agenda, and that the current health challenges still require a European approach to facilitate Member States benefit from the exchange and collaboration at EU level. However, these goals can be achieved only if a European leadership in the field is maintained and improved with innovative solutions and concrete actions. This can be achieved by making nurses’ voice heard and ensuring we are central to the political health debate.

The EFN is the united voice for nurses in the EU and Europe, collectively represent 3 million nurses, our ambition is to grow in size as more nurses’ organisations join EFN, in addition to growing in strength as we position nursing central within the EU healthcare policy arena.

I look forward to working with all of you to make our vision of better healthcare across Europe a reality.

Elizabeth Adams
EFN President

News from EFN

The EFN Members elected new members of the Executive Committee at the EFN General Assembly, in Brussels, October 2017: President – Elizabeth Adams (Ireland), Treasurer – Milka Vasileva (Bulgaria), and two members of the Executive Committee: Roswitha Koch (Switzerland) and Jana Slováková (Slovakia). The General Assembly thanked Marianne Sipilä for her hard work as EFN President in the last 4 years.

106th EFN General Assembly
The EFN Members met on 12-13 October in Brussels to discuss many EU topics, impacting on nurses daily operational environment, throughout the EU and Europe.

A central theme of our discussion was the current challenge that the health systems face in combating the Anti-Microbial Resistance (AMR). During the EFN General Assembly held in Madrid one year ago, the EFN Members endorsed the EFN Position Statement on Nurses Combatting AMR. Since then the European Commission has published an updated “European One Health Action Plan against AMR” in June 2017, but unfortunately without the substantial engagement of the Healthcare Professionals. Nurses’ engagement in the development of AMR National Action Plan is crucial to combat AMR. In this context, the EFN members joined the development of several videos to make the nurses’ voice heard during the ECDC 2017 Awareness Day Campaign. From the debate, many differences emerged on the role that nurses play on AMR in European countries. While it is common understanding that nurses can do more, thanks to their special role in infection control and hygiene, on delivering information about antibiotics use and on training patients and their families, it was pointed out that nurses’ role can be crucial in assisting patients by education to minimise the cultural ideas that medication is the only answer, especially in those countries with a more traditional medical approach (East and South Europe). The EFN regrets that the European Joint Action on Antimicrobial Resistance and HealthCare-Associated Infections (EU-JAMRAI), led by France (French National Institute of Health and Medical Research, Inserm, with the support of the French Ministry of Health), an EU-funded project (€6,963,604, with €4,178,162 from the European Commission) excluded the engagement of the healthcare professionals in the consortium, a new trend in DG Sante. Policies and roadmaps get designed without listening to frontline!

Also, during the EFN General Assembly, much of the political attention went to the Proportionality Directive with the professional associations and regulators supporting the proposal of the Commission. The EFN Members had the chance to hear from DG GROW and positively analyse the benefits that an ex-ante assessment of new/amended national legislation can bring to the nursing profession.

EFN meets Commission.jpeg

The EFN Members agreed that a careful monitoring of the Proportionality principle implementation is required to make sure that patients’ safety, quality of care and CPD are preserved. The EFN believes that the Directive can represent a useful tool to defend the quality of the profession, and that nurses should be concretely involved in the setting of a new benchmarking of health professions.

Next to the AMR, and Proportionality, the EFN members contributed to the financial sustainability of the ENRF!

Finally, the EFN members took the opportunity to share key political issues ongoing in their country. Special attention went to Montenegro where the current government sacked the rector of the University because he defended the nurses’ education on compliance with DIR55! Can you believe, anno 2017!

International Scientific Conference “Polish, European and Worldwide Nursing”
Hosted by the Polish Main Council of Nurses and Midwives (Naczelna Izba Pielęgniarek i Położnych), the International Scientific Conference held on 09-10 October in Warsaw focused on the crucial role that the nursing profession plays in Europe and in the world. The meeting brought together nurses, midwives, academics, nursing and medical managers to share their experiences regarding the challenges and problems of modern nursing and midwives in connection with a systematically ageing Europe.

The meeting also explored new solutions on coordinated primary care, systems solution to ensure health safety to patients and safe working conditions for nurses and midwives. During the conference, the EFN Secretary General, Paul De Raeve, spoke about the importance to work towards a coherent EU-wide approach concerning the categories of nursing to design a nursing workforce ‘fit for purpose’, with skills and competences, including eSkills, that each category has to strengthen growth, mobility and quality and safety. To this regard, he explained the EFN work in developing the ‘EFN Workforce Matrix 3+1’ including the three categories of nursing and future principles for the development of health care assistants (HCA’s). The Matrix includes the leading role nurses have in the development and supervision of HCA’s and defines the three categories as: general care nurse (RN), specialist nurse and the advanced nurse practitioner.

Preparation of Antibiotic Awareness Day 2017
The EFN is preparing its contribution to the European Antibiotic Awareness Day 2017, to be held on 15 November. Following a meeting with the head of the ECDC Antimicrobial Resistance (AMR) and Healthcare-associated Infections Programme, the EFN engaged in the campaign “make Antibiotics work better”. To this purpose, the EFN will present best practices and opportunities on the role of nurses in tackling AMR in different countries. Another opportunity for nurses to prove their added-value to patients!

News from the EU

President Juncker’s State of the Union Speech 2017
On 13 September 2017, the President of the European Commission, Jean-Claude Juncker, delivered his State of the Union address at the European Parliament. He presented his priorities for 2018 as well as his vision for the evolution of the European Union by 2025. Following the presentation in 2015 of the European Pillar of Social Rights (EPSR), during his speech, President Juncker remarked that Member States should agree on the EPSR as soon as possible, if they aim to avoid social fragmentation and social dumping in Europe. He reiterated the importance of adopting the EPRS at the Gothenburg Summit in November 2017. Furthermore, President Juncker stressed the necessity to “agree on a European Social Standards Union in which we have a common understanding of what is socially fair in our single market” even if national social systems remain diverse for a long time. The attention to the EPSR has been recently revamped with the attention given to policy coordination on social issues in the European Semester. But what happened to Health?

EESC Opinion on Digital Health
The European Economic and Social Committee (EESC) published recently its Opinion on the Impact of the digital healthcare revolution on health insurance. The Opinion focuses on the consequences that the digital revolution will bring to our lives and to the way in which healthcare is currently provided. It is predictable that in the next years, the healthcare will be based on personalised, participatory and preventive interventions. This radical change will have deep consequences on the work of all the healthcare professionals and on patients. In few years, technology will empower patients in the control of their own health, machines will perform diagnosis, allowing health professionals to focus more on the relationship with their patients. Although this perspective looks like a significant improvement for the health daily practice, the Opinion highlights some potential threats that this digital revolution may cause. First, the risk that technology may exacerbate social differences and widen the digital divide between those who have access to digital health and those who do not.

Another important aspect of the Option concerns the effect of digitalisation on the health insurance system. In effect, private insurances can be affected by a system that ‘predicts’ your health status and would push profit-making insurance companies to personalise someone’s risk profile, on the basis of the likelihood that they will contract an illness predicted by digital tools. Other risks described in the text concern the danger of transferring too much responsibility to patients, and the protection of health-related personal data.

But why do we trust eHealth services so much?
Side effects and resistance need to be discussed and dealt with. We must critically scrutiny eHealth development and initiatives because of the power it has to change health care in every way. Therefore, when US evidence suggests GPs are pulled away from patient care, this is quite worrying. We should prevent this happening to nurses. We need to make sure eHealth services bring nurses closer to the patients, citizens, instead of pulling them away from frontline care. In this context, the EFN developed the EU Guidelines for the deployment of eHealth services in Nursing and Social care.

Primary Care – The Commission taking it serious?
According to a Eurostat recent research, 27.3 million people aged 80 and over were living in the European Union in 2016, 7 million more than ten years ago. The growing share of elderly people in the EU is mostly due to an increasing life expectancy. Compared with 2006, the share of people aged 80 or over rose by 2016 in all Member States, except Sweden. The largest increase was registered in Greece (from 4.1% in 2006 to 6.5% in 2016), whereas all Member States have an over-representation of women among people aged 80 and over. In this context, the EFN believes that the development of an efficient primary care system seems more and more urgent. Elderly people need continuity and personal care that cannot be longer provided by hospitals. More support in terms of workforce planning and training is needed by frontline nurses that are overburden, but still perform everyday their job with passion and care.

The European Commission Expert Panel on Effective Ways of Investing in Health has produced a Draft Opinion on Primary Care. Although the Opinion shows some open windows of opportunities for nurses, are Health Ministers willing to strengthen the nurse as case manager, coordinating the continuity of care? Stating that “nurses are important” is no longer enough. There is an increasing evidence that interventions led by nurses can contribute to an improvement of patient outcomes, particularly linked to the early discharge schemes and to self-management, allowing patients to stay longer at home. To allow nurses to further strengthen their role and to deliver safe and high-quality cost-effective patient care in the future, a change of both mindset and health systems is required. The document has been discussed during a Public Hearing that, once again, showed stakeholders thinking in boxes and try to impact on the recommendations according to their needs. Will this hearing lead to better EU policies?



Eurostat – Health statistics at regional level
The article is part of Eurostat’s annual flagship publication, the Eurostat regional yearbook. It presents recent statistics on health for the regions of the EU, providing information concerning some of the most common causes of death, notably cancer and diseases of the circulatory and respiratory systems. It also explores the status of healthcare services through an analysis of the number of hospital beds and healthcare professionals (physicians) and concludes with a range of statistics relating to health determinants according to the degree of urbanisation: six of the seven biggest risk factors for premature death – blood pressure, cholesterol, obesity and overweight, inadequate fruit and vegetable intake, physical inactivity and alcohol abuse – relate to how we eat, drink and move; the seventh is smoking.

Eurobarometer: impact of digitisation and automation on daily life
The survey has shown that European citizens see digitisation and automation as an opportunity, calling at the same time for investment for better and faster internet services as well as effective public policy to accompany changes, in particular in areas such as employment, privacy and personal health. When it comes to digital health and care more than half of EU citizens want online access to their medical records, and half of the respondents would like online access to their medical and health records. The survey also emphasizes that people are much more willing to share their health and wellbeing data with doctors and healthcare professionals than with companies or with public authorities, even if anonymised.


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