Planejamento da Força de Trabalho (Portuguese Edition)

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This is perceived as a prerequisite to building mutual trust and developing informed policy making, a critical condition for the acceptance of the expansion of roles of nurses, and eventually of other professionals. Workshop with key informants. A technical workshop was organized on 10 February with the objective of obtaining initial responses from stakeholders, to the preliminary results of the study. The meeting was held under "Chatham House", whereby a report of the meeting was written, but all discussion was non attributable.

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There were 19 participants including managers of health services, officials of nursing and medical councils, and researchers. Much of the discussion concerned the contents of any expansion of roles of nurses. This question reflects on what would be the most appropriate skills-mix in health services to guarantee the quality of services and to better respond to demand, namely in terms of more efficient utilization of existing resources.

It was argued that this discussion should take into account the specificities of the Portuguese health sector, e. It was also deemed important to ensure that expanding the roles of nurses or of any other group would not have collateral negative effects on other professional groups. Regarding the feasibility of expanding nurses' roles at present in Portugal, the consensus was that "the road is still long" before this may become fully possible.

Among nurses and physicians there are very differing views, with some much in favor and others much against and all sorts of nuances in between. However there was a clearer consensus in saying that the current economic and financial crisis offered an opportunity to open the discussion on how services are delivered and how professionals can be used more efficiently.

One important obstacle was mentioned, that of the current relatively low nurse: physician ratio in Portugal which makes it difficult to convince nurses to accept new responsibilities in addition to an already heavy workload. The issue of the potential for nurses to have the right to prescribe was the most hotly debated. The consensus was that this needed to be regulated and that in principle, nurses should be able to prescribe medicines and order examinations and tests in the areas in which they are authorized to practice.

All assumed that training would have to be adjusted in accordance to the knowledge requirements of these new activities. Finally, participants remarked that using evidence on successful international experiences was helpful, but that it was insufficient in itself. Evidence from national research in Portugal, which is in rather short supply at present, was also needed. The workshop showed that there was a need for clarification of the language used to discuss role expansion. Terms such as substitution, delegation, teams of peers, complementarity, role, tasks, competencies, scope of practice, come in the discussion, but they are not always used to describe the same issue, or understood in the same manner by all.

To add to the confusion, there is no clear and operational definition of what is a medical task or a nursing task in the Portuguese legislation. Participants added that at ground level, professionals themselves had no clear understanding of what "belonged" to each professional group. Without such definitions, it may be more difficult to be precise about the contents of an expanded role, or which tasks could be delegated. The policy context for nurses in advanced roles. The international review had highlighted that different countries are at different stages of development in terms of their use of nurses in advanced roles.

The various elements of the study conducted in Portugal showed that there is no clear consensus on if, or how, any developments in advanced roles for nurses should be taken forward in the country. In this regard, the history of the introduction of nurse practitioners in the USA is of relevance. US was one of the first countries to develop such roles, almost 50 years ago.

This chronology highlights the significance in the US of government funding as "pump priming" in the s and s, and the ongoing process of gaining legislative support through the s, s and s Different countries will have different timetables and drivers.

The key points that any country should consider in looking at the potential for using nurses in advanced roles will have to include 7 :.

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First, there is a need for stakeholders to agree on the need for advanced practice nurses. Key stakeholders will include representatives of the nursing and medical professions, ministries of health and education, employers and regulators. Several commentators noted the need to base this approach on mutual respect, and on developing a collaborative model of health care delivery.


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  4. Second, where principles of need have been agreed, there is then a requirement to ensure that the advanced role s have been defined, and the associated educational requirements have been identified. Third, issues of certification and regulation have to be determined. As summarised in this report, different countries have adopted different approaches.

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    Fourth, the career structure and payment system for advanced nurses has to be established, and the potential impacts on other professions, the organization and accessibility of services has to be assessed. Portugal is at the first stage of this possible process.


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    8. As described in this report, there is a limited evidence base in the country about the potential impact of developing nurses in advanced roles. However, well documented international experience shows that this can be done effectively, whilst maintaining quality of care and with benefits for them and for providers as well.

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      The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal which looks at local experience with deploying health professionals in innovative and effective roles would assist in informing policy direction. Most importantly, there is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal, which can explore in a structured and objective manner what is best for healthcare in the country, in terms of the overall health workforce profile.

      Brussels; Dussault G, Fronteira I. Human resources for health HRH plan component of national health plan Portugal. Barros PP. Substitution at the margin: physicians vs nurses. Selected response from: Angela Halat Brazil Local time: Bruno Rossi. Angela Halat.

      Rafael Sousa Brazlate. Danik Rita Arantes P. Fonseca United States. Danik Brazil. Rafael Sousa Brazlate Brazil. Peer comments on this answer and responses from the answerer agree. Paulinho Fonseca. Login to enter a peer comment or grade. Danik Brazil Native speaker of: German, Portuguese.



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