1. REDISTRIBUTION OF TASKS IN HEALTH CARE IN FINLAND New roles of nurses and nursing personnel
Marjukka Vallimies-Patomäki
Ministerial Adviser, Ph.D.
Ministry of Social Affairs and Health
Finland

2. Defines development objectives and main measures
National Development Plan for Social and Health Care Services KASTE Programme
Adopted by the Government in January 2008
Based on the Act on Planning and Government Grants for
Social Welfare and Health Care (733/1992)
Defines development objectives and main measures
for municipal social and health care in
Prevention and early intervention
Ensuring the sufficiency of staff and strengthening skills
Services functioning as an integral whole,
effective models of operation
Government grants: annually 25 M€ in
for municipal development activities
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3. ADVANCED ROLES OF NURSES BASED ON THE RENEWED DIVISION OF WORK
Primary health care
Specialised medical care
Family Physician –
Family Nurse
working in pairs
Nurse´s consultation for
acute health problems and NCDs
Nurse´s consultation supported by the physician´s
e- consultation
Nurse´s consultations
at out patient clinics
Advanced roles e.g.
in operating rooms
Specialised medical care &
Primary health care
Nurse facilitated model of
heart patients follow-up
Nurse telephone consultations,
triage & nurse consultation in
emergency care
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M.Vallimies-Patomäki

4. INCREASING THE EFFECTIVENESS
AND ATTRACTION OF
NURSING CARE
BY MEANS OF MANAGEMENT
National action plan
Based on the KASTE Programme
The Ministry of Social Affairs and Health
allocated 2,7 M€ as state grants for
the regional implementation of
the action plan
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5. EXPERTISE IN EVIDENCE BASED NURSING
Nurses,
practical nurses
in clinical care
Specialised nurses,
practical nurses
in clinical care
Expert
nurses
in clinical care
Experts
in nursing
science
Roles
Competencies in development and research,
in provision and dissemination of EBN
Competencies
Competencies in clinical nursing and care,
in implementation of EBN
Implementation
of EBPs
Implementation
of EBPs in
specialised care
Support for the
implementation of
EBPs in the unit
Harmonising
EBPs at the
regional level
Development,
dissemination
& monitoring
EB guidelines
Research &
development
National &
international
collaboration
Action
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6. HOW PATIENTS AND PHYSICIANS EXPERIENCED THE ADVANCED ROLES OF NURSES?
+ Improved access to care
+ Better continuity of care
+ Improved patient education
+ Improved self care
+ The majority of the patients
were satisfied
- 14 % of the patients
in hospital care had negative
attitudes towards task shifting
+ More time for the patient
+ Improved flexibility
+ Uniform guidelines for care
+ Improved multiprofessional
co-operation
- More demanding cases
- Consultations by the nurse
increased the physician´s
workload in the early stages
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7. NEXT STEPS
The Parliament adopted the legislation on Nurse Prescribing in April 2010
The aims are to suppot:
better access to care
better exploitation of nursing knowledge and skills in patient care
functioning and flexibity of services in primary health care settings
Improved productivity in PHC
A national list of medicines and nationally defined postgraduate education will be regulated by decrees
Implications for education:
Strengthening clinical competencies in nursing education
Establishment of post-graduate studies for specialisation
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8. ENSURING PATIENT SAFEY IN ADVANCED ROLES OF NURSES AND NURSE PRESCRIBING
Requirements for nurse prescribing:
Employment relationship with a municipal health centre
Work experience of 3 years and regulated post-graduate studies for nurse prescribing: 45 ECTS
Polytecnics and universities / the medical faculty
Authorisation from the physician-in-charge
Registered: The National Register for Health Care Professionals
Identification number: The The National Supervisory Authority for Welfare and Health
The propriety of the nurse´s decision making:
EB guidelines and consultation of the physician
Monitoring adverse events: Responsibility of health centres
CPD: Regulated by legisltation
A national steering group: To be set up by the Ministry
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