1. National Action Plan for Nursing & Midwifery 2002 – 2010 evaluation

2. Background
The current National Action Plan for Nursing & Midwifery has been developed by MOH for the Period
This year WHO and MOH conduct an evaluation of the current NAP and drafted guidelines for the preparation of the coming one
In 2010 MOH, with the support of WHO will develop the NAP WHO proposes to create a working group on nursing/midwifery to follow that process and work on improving nursing in Vietnam

3. key objectives of NAP 2002-2010:
leadership development;
wage structure;
education system improvement;
holistic care implementation;
standardisation of nursing procedures;
international collaboration/support;
improvement nurses morale and status.

4. The results show improvement for some of the indicators
 but many indicators were not totally under the control of the Nursing Office in MOH for their achievement
The coming action plan should be developed with targets and responsible units/departments within the government and related organizations

5. The indicators for measuring the 2002-2010 national action plan are divided into 3 areas:
organization,
education
practice

6. Organization
 Significant progress in the strengthening of nursing leadership: most of the provinces have appointed a person in-charge of nursing service except 5 of them
 Hospitals are establishing nursing office for nursing management, But 59% of district hospitals still don’t have a nursing office/chief nurse.
 Developments to improve the qualifications of head nurses:
- Provision of management certificate (a 3 month training course provided by 20 medical schools)
- “Leadership for Change” (LFC) program by the International Council of Nurses. (3 LFC training courses were conducted between 2004 and September 2009 for 91 nurse leaders and nurse teachers)

7. Education
 significant progresses made such as the setting up of 2 nursing universities and 7 nursing faculties in medical universities.
 But there is the issue of secondary level nurse training.
there was an upgrading of secondary training to college level, but the number of secondary level programs stay stable (75 in 2002 to 74 in 2009).
The draft of nursing education plan from DST-MOH revealed that the number of secondary graduates will only be reduced from 14,400 in 2009 to 12,600 in 2015 (net reduction of only 1,800 places)
 In 2008 there was a total of 4,169 teachers in the education institutions and only 531 (12.7%) were nurses and of which only 6.6% have obtained post-graduate qualifications (survey from DST-MOH in 2008),
Important for the next action plan to address the problem of nurse education in term of workforce planning and upgrading basic nurses from 2-years trained to 3-years at least.

8. Nurse practice
 Nursing standard in the form of guidelines for nursing care was developed and promulgated to hospitals for implementation in 2002 and 2004.

9. Evaluation survey in hospitals
Survey conducted during May to July 2009 to solicit information from hospitals
The sample:
96 hospitals (92 from public sector, 4 from the private sector) representing about 10% of the total hospitals in Vietnam.
These hospitals were from the national (7), provincial (33) and district (56) levels.
The size of these hospitals ranged from 10 beds to 1800 beds with a median size of 100 beds.
The sample of 96 hospitals of varying size and location can reflect the situation in different areas/regions of Vietnam.

10. Results 1
This sample had a total of 17,420 planned beds whilst the actual bed in use was 20,169  around 16% higher bed usage because of high patient load.
10,112 nurses working of which only 8,847 (or 87.5%) worked in the clinical areas.
7,971 doctors  1.27 nurses to 1 doctor reflecting a level similar to many developing countries.
But when comparing different level the ratios are:
3.0 for national level hospitals,
2.0 for provincial level
0.6 at the district level
 more doctors are providing services at the district level
 To be examined in the coming national action plan to strengthen the number of nurses serving the community

11. Result 2
only 19% of the head nurses have bachelor degree and above qualification and 70% of them have secondary or below level of qualification.
only 5% of the nurses have obtained bachelor or above degree with a majority (91%) have only secondary or below level qualification.
 That issue need to be addressed in the next NAP

12. Result 3
77% of hospitals reported implementation of continuing education and only 40% of them have used evaluation criteria to assess nurses’ competency.
61% reported implementation of holistic care and 74% has steering committee established. A further 11% of hospitals indicated that they will implement holistic care in the coming year.

13. Result 4
For nursing care practice, a majority (56%) claimed to have team nursing model, there were still 16% of the hospitals reported a task oriented nursing and a further 11% reported using primary nursing model.
 It is not possible to judge the actual nursing care being delivered unless there is a mechanism for assessing nursing practice.
75% of hospitals reported implementation of the infection control guidelines, and only 68% of hospitals reported the presence of an infection control team/department.

14. Result 5 Time consuming nursing activities reported by hospital:
nurses spent about 28% of time on nursing care activities
28% was spent on paper work. (+ in the commenting section, 20% of the respondents says that there is a need to reduce paper work for nurses)
There is a need for local management to provide support so that nurses can be better utilized for patient care.
The hospitals also indicated that high patient load (18%), low qualification of nurses (16%), lack of equipment (12%), lack human resources (12%) and low income level (11%) are significant issues faced by nurses.

15. Draft national action plan 2011-2015
Objectives can be grouped into four areas for discussion:
- professional regulation
- training/education
- nursing process
- nursing management

16. Draft national action plan 2011-2015: professional regulation
There is no formal regulation of nurses/midwives in Vietnam at present. This is a fundamental issue which affected all other areas of planning
The issue of the number of levels of nurses and how to implement a system of professional recognition will need to be sorted out:
Establish a national competency standard for nurses and midwives
Determine a system for the initial and continuing recognition of existing nurses for practice

17. Draft national action plan 2011-2015: Education
Urgent need to address the problem of a nursing workforce comprising of 80% of nurses trained at the secondary level.
Set a framework for the recognition and monitoring of basic training course for nurses
Identify areas for nursing specialization with targets number based in the priority needs
Determine the direction and action for future development of specialty nursing education
Establish a plan for the development and training of nurses for specialty nursing
An agreed core competency for nurses is important for both curriculum and practice development.
Pilot the Global Standard for Initial Nursing Education
Adopted a set of agreed national standards for the training of basic nurses after pilot
Establish a framework for the development and monitoring of continuing education of nurses
For education, quantity and quality of nurse teachers, curriculum standard, quality of teaching and variations in quality of graduates.
Determine and set standard for nurse educators nursing education
Establish plan to increase the supply of qualified nurse teachers and improve qualification of existing nurse teachers

18. Draft national action plan 2011-2015: nursing process
The nursing practice issues included staff shortage, unclear nursing role/career structure, ineffective work practice/allocation of staff, lack of specialization, lack of in-service training and outdated practice model.
Specific action required to enhance nursing contribution to patient care
Establish person-centred care practice development units for the quality of nursing practice
Identify problem of holistic patient care implementation and develop action for further implementation
Assess the community nursing roles and competency requirements
Develop training program and training for community health nursing
Plan and implement community nursing practice to advance primary health care
Develop measurement tool and quality assurance system for monitoring of nursing standards for patient care
Agree on the key nursing quality indicators and monitoring mechanism

19. Draft national action plan 2011-2015: nursing management
There is a lack of management system, quality monitoring mechanism, qualification and competency of nurse managers.
Specific action required
Develop and implement nursing management standards
Develop a nursing workload measurement tool for determining nursing needs based on patient dependency
Develop agreed methodology to provide nurse supply and demand projection model
Examine a career structure and progression model for nurses
Address issues relating to the recruitment and retention of nurses
Determine the need and implement manager development programs for nurse managers