European strategic directions for strengthening nursing and … · 2015-08-31 · European...

European strategic directionsfor strengthening nursing

and midwifery towardsHealth 2020 goals

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AbstrAct

The European strategic directions for strengthening nursing and midwifery towards Health 2020 goals is a technical guide for Member States, supported by the WHO Regional Office for Europe to enable and enhance the contribution of nurses and midwives to achieve the Health 2020 goals. The docu-ment provides a strategic framework for action – the first of its kind in the WHO European Region. It identifies 12 objectives, four priority action areas and four enabling mechanisms that align policy and practice with the Health 2020 vision, and helps Member States to strengthen nursing and midwifery within the context of their own country plans.

KeywordsEUROPE

HEALTH POLICYHEALTH SERVICES

MIDWIFE NURSE

European strategic directions for strengthening nursing and midwifery towards Health 2020 goals

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contents

FOREWORD ....................................................................................................................................................4

1. INtRODUCtION ......................................................................................................................................5

2. HEAltH tRENDS AND CHAllENgES IN tHE REgION ...........................................................5

3. tOWARDS A NEW ERA .........................................................................................................................63.1 Health 2020 .........................................................................................................................................63.2 Moving forward in the spirit of the Munich Declaration.............................................................7

4. EUROPEAN StRAtEgIC DIRECtIONS FOR NURSINg AND MIDWIFERy ...........................84.1 Priority action areas .........................................................................................................................10

4.1.1 Scaling up and transforming education and training ..................................................114.1.2 Workforce planning and optimizing skill mix ..............................................................114.1.3 Ensuring positive work environments .......................................................................... 124.1.4 Promoting evidence-based practice and innovation.....................................................14

4.2 Enabling mechanisms .....................................................................................................................154.2.1 Regulation ....................................................................................................................... 154.2.2 Research ........................................................................................................................... 154.2.3 Partnerships .....................................................................................................................164.2.4 Management and leadership ..........................................................................................17

5. IMPlEMENtINg AND MONItORINg tHE FRAMEWORK .....................................................18

REFERENCES ................................................................................................................................................19

ANNEx 1. PRIORIty ACtION AREAS AND PROPOSED ACtION lINES ............................. 22

ANNEx 2. ENAblINg MECHANISMS AND PROPOSED ACtION lINES ..............................31


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Foreword

Health 2020, the policy framework for health and well-being in the WHO European Region, highlights the key and increasingly important role that nurses and midwives play in society’s efforts to tackle today’s pub-lic health challenges in ensuring the continuity of care and addressing people’s rights and changing health needs. Nurses and midwives collectively form the largest component of the health workforce, and have close contact with many people across the age continuum and in all health-service areas. to ensure the full poten-tial of this large and important resource is realized, as service needs and population health demands change, so must the knowledge, skills and service delivery models employed by nurses and midwives.

Work led by the WHO Regional Office for Europe has shown that much good work is underway that demon-strates how nursing and midwifery practices are evolving across the Region. Excellent examples are available of nurses and midwives applying advanced skills in their practice and often being the lead health profes-sionals in service delivery. A key concept underpinning the strengthening of health systems in Health 2020 is the utilization of a people-centred approach to service delivery, which means services are comprehen-sive, continuous, ethical, safe and sustainable, and that they meet the individual’s needs. Evidence suggests that initiatives for service change that employ nurses and midwives with enhanced or advanced skills are addressing many serious issues, such as unclear or misaligned patient pathways, fragmented professional roles, compromised access and discontinuity of care and inadequate cross-sector work. A growing body of evidence shows these new models for services and nursing and midwifery practice are leading to cost-effective, people-centred services with better patient outcomes. Education has significantly improved, with more nurses and midwives receiving initial preparation at degree level and having the opportunity for con-tinuing professional development that continues to build their knowledge and skills to ensure they remain fit for purpose. Progress across the Region is patchy, however, and much clearly remains to be done to fully mobilize the contribution of these two professional groups.

This document on strategic directions resulted from much debate, consultation and discussion with senior nursing and midwifery leaders in the Region; it is a technical document setting out agreed actions to be taken to support the implementation of Health 2020 by the nursing and midwifery professions. While the document focuses on nursing and midwifery practice, it fully recognizes that these practitioners work in complex health systems, alongside many other workers delivering health and social care. Multidisciplinary and interprofessional models for education and service delivery are key to providing fully integrated, people-centred care.

The staff of the Regional Office are committed to supporting work at the country and regional levels to ensure the continued development and redesign of the health workforce, underpinned by research and evi-dence, and will continue to support activities that promote, disseminate and implement innovative practices that result in benefits to patients and populations.

Dr Zsuzsanna JakabWHO Regional Director for Europe


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1. IntroductIon

Nurses and midwives have key and increasingly important roles to play in society’s efforts to tackle public health challenges and in delivering safe, high-quality, effective and efficient health services. These profes-sions are vital to protecting and improving health by supporting people to manage their own health, and ensuring access and continuity of care when patients need it. This dual approach is central to meeting changing health care needs.

This document aims to guide Member States in enabling and enhancing the contribution of nurses and mid-wives to achieving the Health 2020 goals of improving the health and well-being of populations, reducing health inequalities, strengthening public health and ensuring sustainable, people-centred health systems. It builds on the values and principles endorsed in Health 2020: a European policy framework and strategy for the 21st century (1) and outlined in the global Strategic Directions for Strengthening Nursing and Midwifery Services 2011–2015 (2).

This is a framework to strategize action – the first of its kind in the WHO European Region. It sets out how to maximize nursing and midwifery potential, and enables their full contributions for supporting Health 2020 implementation with clear action lines. It identifies 12 objectives, four priority action areas and four enabling mechanisms that align policy and practice with the Health 2020 vision, and helps Member States to strengthen nursing and midwifery within the context of their own country plans (see Section 4). Annexes 1 and 2 present a suggested plan of work by which Member States and stakeholders can work with the WHO Regional Office for Europe in implementing the actions needed to deliver these objectives.

2. HeAltH trends And cHAllenges In tHe regIon

Wide variations exist in the patterns of health and disease in the 53 Member States of the Region. While positive health gains were reported in the last 20 years, not all countries have benefited to the same extent. Health-related inequities exist between and within countries and populations according to ethnicity, gen-der, socioeconomic status, educational level and geographical area. In 2012, the infant mortality rate in the poorest countries in the Region was nine times higher than that in the richest. While wider determinants of health, e.g. social factors and education, are the biggest factors affecting health outcomes and inequalities, health care and thus supply of health care professionals are significant contributors (3). Health workforce maldistribution and shortages are clearly associated with poor health outcomes (4). This situation is exac-erbated by the growing problem of health workforce mobility and migration in many countries across the world, including many European countries, which can lead to a strain on services.

Noncommunicable diseases are the leading causes of mortality and morbidity in the Region and account for 86% of deaths and 77% of the disease burden (5). Cardiovascular diseases and cancer are the main killers, with disadvantaged populations displaying the highest prevalence and mortality. Mental health disorders are also on the rise and are among the most common contributors to chronic conditions in Europe. The current number of older people and predictions for their increased numbers are particular challenges for the health and social sectors, requiring governments to support people in remaining as healthy and independ-ent as possible. Furthermore, preventing communicable diseases such as tuberculosis and HIV/AIDS and outbreaks of pandemics continue to be priority areas.

Primary health care remains a cornerstone of health systems in the 21st century. Recognizing patients as partners in their own care, and extending supported self-care and community-based solutions require re-


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newed emphasis on the need for effective primary health care. Primary care innovations need to include extending the use of technologies for communication, decision support, and remote health and care support (for example, patients with chronic illness monitoring their own conditions and discussing results and ac-tions with nurses online). Integrated care is important, providing the best quality care for patients and the best value. Interprofessional collaboration in education, practice and research is a priority and a means of fostering team work and mitigating the health workforce imbalances and shortages (6). WHO recognizes that interprofessional education in particular enables effective collaborative practice, which is key in opti-mizing the skills of team members, case management and in the provision of better health services, which leads to improved health outcomes.

The next decade is likely to be challenging for Member States due to the consequences of the international financial and economic crisis and the continued problems of social exclusion, and health inequality. Accord-ing to research on recent previous economic downturns, the main impacts tend to be on health and social issues, with poorer areas taking longer to return to previous levels (7).

3. towArds A new erA

3.1 Health 2020

Health 2020 is the European policy framework for health and well-being, adopted by the 53 Member States of the Region in September 2012. It aims to support action across government and society to “significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality” (1). Health 2020 builds on the previous Health for All policies including Health 21 (8), the tallinn Charter: Health Systems for Health and Wealth (9) and the United Nations Millennium Development goals (10). Fig. 1 presents four priority action areas of Health 2020; one of which is strengthening people-centred health systems and public health. The policy framework is also inextricably linked with the renewed emphasis on primary health care set out in The World Health Report 2008. Primary Health Care – Now More Than Ever (11). The European action plan Strengthening public health services and capacity (12) focuses on this action area, as do people-centred health systems (13), which presents operational products and services under the programmes of the Regional Office.

Health 2020 supports integrated whole-of-government and whole-of-society approaches, as well as a global partnership in order to successfully address the disease burden, and enable people to improve their health by tackling the determinants of health. good health benefits all sectors through increased productivity and healthier ageing. Fostering collaboration with civil society and communities ensures that health systems are person centred, comprehensive, accessible and integrated and that primary health care is strengthened. Health 2020 highlights nurses and midwives as having key roles to play in society’s efforts to tackle public health challenges and in ensuring access to health services and continuity of care, as well as addressing peo-ple’s rights and changing needs.


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Fig. 1. Health 2020 policy framework

3.2 Moving forward in the spirit of the Munich declaration

The Munich Declaration: Nurses and Midwives: A Force for Health, 2000 (14) was only the second WHO policy statement on nursing and midwifery in the Region endorsed by ministers of health. The first, the Vienna Declaration on Nursing in Support of the European Targets for Health for All, 1998 (15), focused on nurses’ and midwives’ roles in achieving the Health for All targets.

Health 2020 provides an opportunity for the Regional Office and Member States to re-engage with the senti-ments expressed in the Munich Declaration, which recognizes that nurses and midwives are a real force in public health and effective contributors within health systems. Despite the enormous social and economic changes over the past decade, the principles highlighted by the Munich Declaration are just as relevant to-day.

Nurses and midwives deliver the highest proportion of direct patient/client care and have close contact with large numbers of the population. There are therefore clear benefits to nurses and midwives understand-ing the social determinants of health, and being competent in the principles and practice of public health. Throughout the Region, the roles and scope of practice for all nurses and midwives should be focused on supporting optimal health in people of all ages and preventing noncommunicable diseases and/or the com-plications of noncommunicable diseases by means of health promotion; primary, secondary and tertiary prevention; and empowering people in self-care and changing their health behaviours. Some nurses and midwives should also be educated as specialists in public health to work solely in this field alongside other public health specialists.

Nurses and midwives together form the largest group of health professionals in all countries, and they are central to delivering safe, high-quality, effective and efficient health services. A wide variation in the com-


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position of the health workforce, in education, regulation and the scope of practice for nurses and midwives exists between countries.

Health policy priority areas regarding integrating health services and implementing the life-course strat-egy are setting new requirements for advanced nursing and midwifery practices. Nurse- and midwife-led services are being developed to provide equal and improved access and better continuity of care, as well as improved health outcomes. Innovative roles such as the family health nurse (16), launched by the Regional Office, is focused particularly on promoting and protecting people’s health throughout the life-course, and reducing the incidence of and suffering from the most common and preventable diseases and injuries.

Nurses and midwives are recognized as essential members of multidisciplinary teams working to tackle the social determinants of health, give children a healthy start in life, promote health literacy, empower self-care, support healthy ageing and reduce health inequalities through the Health for All approach. Interprofessional learning should be used to create a structured, supportive more nurturing climate for all professions to work in an integrated way for the benefit of patients and the community.

In recent years, several WHO resolutions (17, 18) and progress reports (19, 20) recognized that improving and sustainable health service systems require educated, valued and properly rewarded nurses and mid-wives. The importance of a robust health workforce in the strengthening of health systems was recognized by the Regional Committee in Europe in 2007 and 2009 (21, 22).

A strong interconnection exists between Member States – this has been evident in the current financial crisis and extends to health policy and the impact of health policies across boundaries. This applies particularly to the health workforce, and the ultimate goal is for Member States to have national health workforce sustainability.

Evidence shows that healthy, well-supported, well-educated and motivated staff improves the care experience and health outcomes. Therefore creating positive work environments, career opportunities, professional rec-ognition and rewards for nurses and midwives are important. This reduces sick leave and encourages their active engagement in the workplace and in the delivery of quality health services. building health workforce capacity (23) and reducing the brain drain of qualified health personnel from developing countries are sup-ported by the WHO Global Code of Practice on the International Recruitment of Health Personnel (24). Ad-ditionally health organizations that provide health promoting environments and health professionals with good health and well-being are role models in their communities.

4. europeAn strAtegIc dIrectIons For nursIng And MIdwIFery

The common goal of Health 2020 and this framework is to improve the health and well-being of popula-tions and to reduce health inequalities. This framework could help guide Member States in enhancing the contribution of nurses and midwives in achieving the Health 2020 goals. It aims to support Member States in strengthening and sustaining their nursing and midwifery workforces so these professions can actively contribute to improving health outcomes. This contribution spans from providing care to protecting and promoting health to participating in national health policy implementation and planning. It was created by the Regional Office following extensive consultations from nursing and midwifery experts. It is built on the principles of Health 2020 (1), the global Strategic Directions for Strengthening Nursing and Midwifery Services 2011–2015 (2) and the Munich Declaration (14). The sentiments endorsed by the Sixty-fourth World Health Assembly in resolution WHA647 on strengthening nursing and midwifery in 2011 (18) and the findings of A global survey monitoring progress in nursing and midwifery (20) in 2010 were also taken into account.


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This framework (Fig. 2) outlines four priority action areas and 12 objectives underpinned by four enabling mechanisms to strengthen nursing and midwifery services within the context of each Member State’s own country plans and in collaboration with the Regional Office.

Fig. 2. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals framework

Fig. 2 shows how this framework supports the implementation of Health 2020 through strengthened and sustainable nursing and midwifery workforces and services. The remainder of this section sets out informa-tion and suggested action lines to achieve the 12 objectives and ultimately contribute to the implementation of Health 2020. Each of the objectives aligns with particular priority action areas and enabling mechanisms (table 1), detailed below. Annex 1 shows a suggested framework for implementation between Member States and the Regional Office.


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Table 1. Priority action areas, enabling mechanisms and objectives

Action area or mechanism Objective

Priority action areas

Scaling up and transforming education

1. Standardize the initial education of nurses and midwives at degree level to get the best outcomes for patients and populations.

2: Develop education and regulation that enables and ensures that nurses’ and midwives’ core competencies are in line with the basic principles of Health 2020.

3: Strengthen continuing professional development and career development.

Workforce planning and optimizing skill mix

4: Develop workforce planning strategies and policies to ensure a sufficient and sustainable nursing and midwifery workforce.

5: Ensure that workforce redesign and skill mix provides safe and effective care.

Ensuring positive work environments 6: Promote positive work environments.

Promoting evidence-based practice and innovation

7: Facilitate the culture of evidence-based practice in nursing and midwifery.

8: Develop, transform and adapt the roles of nurses and midwives in line with the goals of Health 2020.

Enabling mechanisms

Regulation 9: Ensure that the definitions of nursing and midwifery are embodied in legislation and that mechanisms are in place to safeguard the public.

Research 10: build nursing, midwifery and multidisciplinary research capacity.

Partnerships11: build interdisciplinary and intersectoral collaboration and partnerships across society to develop and provide person-centred care and improved health outcomes.

Management and leadership

12: Strengthen nurses’ and midwives’ inclusion in health policy and service delivery decision-making at local, government and international levels.

4.1 priority action areas

based on consultations with experts in nursing and midwifery, four priority action areas were identified as necessary for supporting nurses and midwives in contributing effectively to the health of their communi-ties. They are scaling up and transforming education and training, workforce planning and optimizing skill mix, ensuring positive work environments and promoting evidence-based practice and innovation. Each will progress the Munich Declaration and significantly contribute to the realization of Health 2020 goals.


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4.1.1 scaling up and transforming education and training

It is important that initial training of nurses and midwives promotes a commitment to evidence-based prac-tice, and competence development and maintenance through engagement in life-long learning as an integral component of ongoing professional practice (box 1). Such life-long learning is not restricted to the academic setting and can be pursued through innovative learning models, such as virtual education.

Box 1. Scaling up and transforming education and trainingPriority: the education of nurses and midwives is aimed at ensuring that a supply of qualified and competent nurses and midwives is available to meet changing population needs, health technology and health care delivery models.Objective 1: standardize the initial education of nurses and midwives at degree level to get the best outcomes for patients and populations.Objective 2: develop education and regulation that enables and ensures that nurses’ and midwives’ core competencies are in line with the basic principles of Health 2020.Objective 3: strengthen continuing professional development and career development.

Undergraduate and postgraduate curricula for nurses and midwives should provide for graduates who are competent to meet the needs of a variety of patient groups and of changing health services (25). Public health competencies should form part of core requirements in both undergraduate and postgraduate curricula in order to scale up health promotion and disease prevention competencies throughout the life-course. All curricula should address the key determinants of health, specifically a healthy start for all children, man-agement of chronic conditions, long-term care, supporting healthy ageing, as well as people empowerment and self-care. A key concept underpinning health system strengthening in Health 2020 is the utilization of a people-centred approach to service delivery, which means services are comprehensive, continuous, ethical, safe and sustainable and that they meet the needs of the individual. Education programmes should prepare nurses and midwives with the skills to work in people-centred services.

Research indicates that the degree level of a nursing education and the patient to nurse ratio are associated with reduced preventable hospital deaths (26). It is of utmost importance that patient safety, quality of care and the ability to apply evidence-based clinical practice are central to nursing and midwifery professional education.

In order to enhance skills in collaborative teamwork and intersectoral cooperation, undergraduate nursing and midwifery programmes should be guided by the Framework for action on interprofessional education and collaborative practice (6). For example, interdisciplinary education opportunities should be developed around specific health topics such as the management of noncommunicable diseases.

4.1.2 workforce planning and optimizing skill mix

Aligning supply with demand, now and into the future, requires effective workforce planning (box 2). At present, workforce planning methodologies, purposes, approaches and timeframes vary greatly between countries (27). Variations also exist among the professions and sectors included in these processes. Work-force planning should move from traditional unidisciplinary models to multiprofessional integrated work-force planning and ensure all relevant health professions – including nurses and midwives – are part of the


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planning process. National tools and planning processes can be informed and complemented by recent ini-tiatives. Firstly, the WHO action framework for health workforce planning gives access to a range of models and tools (28). Secondly, the European Union Joint Action on Health Workforce Planning and Forecasting provides a platform for information sharing and learning between countries (29). In addition, it is essential that Member States collaborate in contributing to the effective design and implementation of policy sup-port tools such as the human resources for health databases and the WHO global Code of Practice on the International Recruitment of Health Personnel (30). Member States need to use accurate and complete data, appropriate methods and relevant tools to make evidence-based decisions to monitor and plan the nursing and midwifery workforce. This not only informs the assessment of workforce demand, supply and mobility but also guides appropriate matching of skills with changing health needs.

Box 2. Workforce planning and optimizing skill mixPriority: a sufficient supply of nurses and midwives is central for ensuring the sustainability of health care systems, for enabling health systems to respond to the increasing pressure of changing demographics and patterns of disease, and for fully utilizing current and future technologies.Objective 4: develop workforce planning strategies and policies to ensure a sufficient and sustainable nursing and midwifery workforce.Objective 5: ensure that workforce redesign and skill mix provides safe and effective care.

Effective service delivery requires processes to ensure that sufficient staff will be available at the right time, and with the right skill mix, competencies and flexibility to deliver high-quality health care. Member States would need to determine an appropriate skill mix between professions and occupations as a critical com-ponent of effective service delivery. Skill mix can refer to the mix of occupations, the demarcation of roles among different categories of staff and the combination of skills available or needed (31). because health care is a labour-intensive industry, identifying the most effective mix within available resources is important.

International literature provides a range of methodologies for determining the appropriate skill mix as part of a broader approach of resource planning. Reviewing data on skill mix, such as the mix between physicians and nurses/midwives or the mix between specialist and generalist physicians, can help inform strategies to ensure the most appropriate and cost-effective combination of roles and staff (32).

Since no universal, ideal mix of health personnel exists, skill mix should be determined by identifying the care needs of a specific patient population. It is also important to examine organizational and system con-texts, which define the opportunity for change, such as introducing new roles or developing current roles. For example, evidence suggests that the scope of practice of nurses can be extended in many service systems based on the needs of patients and populations and the delivery of countries’ health reforms (33).

4.1.3 ensuring positive work environments

Evidence exists that healthy, well-supported, well-educated, motivated staff improves the care experience and outcomes for patients. Therefore creating positive work environments, career opportunities, professional recognition and rewards for nurses and midwives are important (box 3). This reduces sick leave and encour-ages their retention and active engagement in the workplace and in the delivery of health care.


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Box 3. Ensuring positive work environmentsPriority: positive work environments have been shown to improve both patient and organizational performance outcomes.Objective 6: promote positive work environments.

Positive work environments for nurses and midwives are defined as practice settings that maximize the health, safety and well-being of health workers and improve and/or sustain their motivation (34). They en-sure that nurses and midwives can conduct their work in ways that are effective, efficient, safe and timely. They impact positively on performance, supporting good patient experience and outcomes and organiza-tional performance indicators, and contribute to wider societal outcomes. Financial benefits to organizations include reductions in: absenteeism, lost productivity, organizational health care costs and costs arising from adverse patient/client outcomes. Additionally, health organizations providing health promoting environ-ments and health professionals with good health and well-being are role models in their communities.

governments are responsible for legislation, e.g. to ensure health and safety in the workplace and nondis-criminatory treatment, to set national policy frameworks that support healthy workplaces and protect em-ployees from bullying and harassment, and to set expectations on staffing for high-quality care.

Organizations are responsible for implementing legislation and developing local plans and policies to meet national expectations and local needs, and promoting health and well-being and good work-life balance for their staff. They are also responsible for ensuring occupational health services and work counselling are in place to assist with the emotionally straining and physically demanding work of nurses and midwives.

Professional staff are responsible for understanding and using policies to keep themselves and their patients safe, for taking responsibility for their own health choices and seeking help and support when needed.

Healthy workplace practice needs to be monitored and evaluated so that information is available to con-tinuously improve working conditions through research and development. The prevention of work-related injuries and the importance of healthy work environments should also be included in basic nursing and midwifery education.

The level of dissatisfaction expressed by nurses with respect to educational opportunities and career ad-vancement is of major concern. Thus developing retention strategies is vitally important to ensure a suf-ficient and sustainable nursing and midwifery workforce. Prioritizing career development that improves patient care and increases participation in the development of health services is essential. The opportunity to contribute as leaders to the overall service delivery decisions promotes a sense of organizational loyalty. This can be achieved by placing organizational structures to enable dispersed leadership and bring together multiple disciplines to share experience in development and governance.

Remuneration, including appropriate salaries and flexible contracts, is a basic requirement to retain the nursing and midwifery workforce.

The nursing and midwifery workforce demographic is ageing. In addition to encouraging new entrants to these professions, retention of the current workforce is a major issue and will require sustainable solutions,


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such as longer work careers and higher retirement ages. This will mean new roles for older nurses and mid-wives, for example, mentoring and different working practices and patterns (35).

4.1.4 promoting evidence-based practice and innovation

Evidence-based practice is every nurse’s and midwife’s concern. It should be enabled by means of education, research, leadership and access to evidence sources. All Member States should strive to enable their nurses and midwives to apply evidence-based practice in their clinical roles (box 4). Applying evidence in decision-making involving patient care requires that nurses and midwives:• use the best available evidence• apply their clinical expertise and professional judgement• recognize and incorporate patients’ needs and values• effectively utilize available resources.

Box 4. Promoting evidence-based practice and innovationPriority: health care should be delivered using the best available evidence to make decisions, which is important to promote the effectiveness of health services.Objective 7: facilitate the culture of evidence-based practice in nursing and midwifery.Objective 8: develop, transform and adapt the roles of nurses and midwives in line with the goals of Health 2020.

The goal is to provide the best possible care for patients and populations based on their needs. Furthermore, evidence-based practice standardizes clinical care and strengthens the nursing and midwifery knowledge base.

Nurses and midwives have varied roles and responsibilities in line with organizational expectations as out-lined in job descriptions/role profiles and in line with scope of practice. Different roles often require different levels of education, competencies and authorized scopes of practice. Health policy-makers and leaders in nursing and midwifery should clearly identify these roles. A framework can be used to explain these roles in terms of their scope of practice, expected competencies, and responsibilities in disseminating, developing, evaluating and supporting the use of evidence-based practice. For example, a nurse with a basic nursing degree and an advanced practice nurse with a doctoral degree working in the same clinical setting will have very different responsibilities.

Changing and advancing roles are particularly relevant in a world where demographic trends and patterns of diseases are challenging health systems to redefine the scope of different health professions (36). Keeping up with community needs and expectations requires commitment and active participation not only from policy-makers but also from all health professional groups, including nursing and midwifery. These roles need to be adjusted or developed in line with Health 2020. For example, roles should be adjusted to accom-modate the transition from institutional to primary health and community-based care settings. Similarly, with additional education, new roles can be developed for nursing and midwifery to improve access to health promotion, treatment, non-invasive care and surgical care. to support service modernization there is a growing need for advanced nursing and midwifery practice, where nurses and midwives extend their spe-cialized knowledge and practice utilizing enhanced clinical judgement and clinical leadership in the delivery of person-centred services. Advanced practice should be seen as a level of practice rather than a specific role and it is not exclusively characterized by the clinical domain but may be also include those working in public health, research, education, and management/leadership roles. These roles should be explored and


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integrated in all relevant WHO technical programmes. It is important that role development occurs in a planned manner within the context of clinical and regulatory standards, giving consideration to required competencies and supports.

4.2 enabling mechanisms

In order to deliver the priority actions and meet the 12 objectives, four specific enabling mechanisms – regu-lation, research, partnerships, and management and leadership – need to be in place. They are linked with one or more specific objectives when there is a direct relationship. The enablers, of course, also underpin other objectives.

4.2.1 regulation

Regulation in nursing and midwifery should be in place for public protection, and needs to encompass entry to practice, scope of practice and professional conduct (box 5). It is essential that Member States define regu-latory frameworks in legislation (e.g. Nursing and Midwifery Act). This should include the establishment and function of regulatory bodies responsible for maintaining professional registers, setting standards of entry to the profession, instituting codes of conduct and making decisions of professional fitness to practice. A professional register is essential as a means to safeguard the public; a code of practice provides profes-sional guidelines and sets public expectations for those in the register. It is also important that the scope and authority of regulatory bodies extends to nurses and midwives working in enhanced roles, as specialists and advanced practitioners.

Box 5. RegulationRegulation is essential to ensure patient safety and quality care.Objective 9: ensure that the definitions of nursing and midwifery are embodied in legislation and that mechanisms are in place to safeguard the public.

guidelines should be available for nurses, midwives and health sector stakeholders to define the standards of practice and disseminate best practice. Countries with guidelines in place have demonstrated improved efficiency of care and health outcomes (37). In order to develop practice guidelines and conduct audits in line with international quality assurance criteria, time and resources need to be devoted to enabling all disci-plines to participate in this process. Nurses and midwives should be fully engaged in the process, providing professional expertise, research skills and leadership.

4.2.2 research

Establishing and developing nursing and midwifery research is an important way of understanding and improving health care delivery. Nurses and midwives need to undertake both research into nursing and midwifery care, and research that brings nursing and midwifery knowledge into understanding wider health care systems (box 6). Depending on the research design, nursing and midwifery research can bring the insights and perspectives of frontline workers and patients to whole-systems redesign. both areas require growth in capacity. Research has the potential to improve and increase community/public confidence in nursing and midwifery care, and also to enhance the entire health system. It generates a richer source for evidence-based practice and a strong tradition of analytical skills.


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Box 6. ResearchNursing- and midwifery-based research is necessary both to develop the scientific knowledge base in the professions and to apply this knowledge to renew the practices in health care.Objective 10: build nursing, midwifery and multidisciplinary research capacity.

It is equally important to promote research that provides a multidisciplinary approach including all health professionals. Practice that applies the best available findings in multidisciplinary research can introduce in-novative ways of improving safety and promote evidence-based health care delivery. Such research can improve continuity of care for patients and ensure comprehensive care, thereby improving health outcomes. Addition-ally nursing and midwifery research should be used at national level to inform health strategy and policy.

As with any sound, knowledge-based discipline, it is important that nurses and midwives are in the posi-tion to lead, participate and inform research. Postgraduate training is necessary to lead. This, therefore, requires universities to develop appropriate programmes, which may require funding from government and health institutions. Academic institutions can help too by providing opportunities for research career paths. Employers need to allocate time and resources, and also establish structures for nurses and midwives to participate and conduct research where appropriate alongside their practice.

Researchers in nursing and midwifery should also be engaged by policy-makers to inform policy and re-search funding decisions. governments should support health care services including community-based services that incorporate partnerships with nursing- and midwifery-based and multidisciplinary research. As nurses participate in diverse areas and directly support delivery of care, nursing researchers can help governments develop targets and indicators on a variety of health issues. Similarly, midwives are integral players in sexual and reproductive health care. Research from both of these disciplines can only expand and enrich evidence for decision-makers in government and nongovernment institutions.

4.2.3 partnerships

Health challenges in Europe require new approaches and new relationships across government, and between government and citizens and the wider community. Societies are reassessing the value of health and adopt-ing approaches to support individuals to make healthier choices, thereby leading to more productive socie-ties. Nurses and midwives are important enablers of such approaches through their life-course approach to health promotion, which spans from a healthy start in life to healthy ageing (box 7).

In the health service setting, partnership also exists by way of interdisciplinary collaboration. This involves an ap-proach to patient care that engages multiple professionals with different functions as needed to ensure that various aspects of a patient’s physical, social and psychological needs are integrated and addressed. For this reason, an in-terdisciplinary approach leads to quality patient care, maximizing resources and facilities, and patient satisfaction.

Box 7. PartnershipsEffective partnerships in health should integrate whole-of-government and whole-of-society approaches.Objective 11: build interdisciplinary and intersectoral collaboration and partnerships across society for developing and providing people-centred care and improved health outcomes.


17

For successful interdisciplinary collaboration to occur, team members should understand and respect each other’s credentials, scope of practice and function. The team should prioritize communication and learning between professionals. Interdisciplinary teams also shift leadership responsibilities as a case dictates. leader-ship in an interdisciplinary team should be assigned to the most appropriate professional given the patient’s individual circumstance. This often requires a paradigm shift and involves delegation of responsibility and trust to professionals who traditionally may not have held leadership positions. In this way, interdisciplinary teams are innovative and efficient.

governments and institutions can support an interdisciplinary approach by identifying it as a necessary component when planning health targets and monitoring health service performance. For example, inter-disciplinary education should be prioritized in all health professionals’ initial training and education. The interdisciplinary approach should then be continuously re-enforced in the workplace. In terms of expanding roles and making health care more efficient, interdisciplinary teams can inform the process of identifying the most appropriate roles for nurses and midwives. Wherever possible, institutions should devote research and project efforts to seek out opportunities for an interdisciplinary approach.

4.2.4 Management and leadership

Nursing and midwifery professions need to develop capacities to engage in strong management and clinical leadership in order to perform at their highest standards. This requires adequate educational opportunities, leadership programmes and management structures at all levels (box 8).

Box 8. Management and leadershipLeadership opportunities and management structures that engage nurses and midwives at all levels are essential to realize the full potential of nursing and midwifery workforce.Objective 12: strengthen nurses’ and midwives’ inclusion in health policy and service delivery decision-making at local, government and international levels.

governments play a crucial role in assuring the adequacy of their health workforce through key functions including regulation, education, financing and health policy. Nurses and midwives should be included at this level of decision-making because their expertise is vital for contributing towards the achievement of better health outcomes in their societies. governments can achieve this by appointing chief nurses and midwives. government chief nurses and midwives (gCNMs) can provide leadership for transforming health workforce and health care systems. gCNMs are crucial to improving health for all and decreasing health inequities through the development of nursing, midwifery and health care policy and action plans aligned to national health policy plans.

Organizations – whether academic, public or private – benefit from embedding strong nursing and mid-wifery management and leadership in the organizational culture and management systems. Nurse and midwifery leaders will ensure that nurses and midwives are competent and meet the requirements of safe, high-quality and evidence-based care, as well as contributing to corporate policy and service delivery. Sup-porting nurses and midwives in leadership roles is just as important for the sustainability and retention of these professional groups. Nurses and midwives in leadership roles bring clinical knowledge, experience of frontline care and ongoing connection to frontline staff and patients to organizational decisions promoting high-quality patient care.


18

5. IMpleMentIng And MonItorIng tHe FrAMeworK

Ensuring the successful implementation of this framework is a priority of the Regional Office. The imple-mentation is guided by a plan of work (see Annex 1), consisting of 12 objectives associated with four priority action areas and four enabling mechanisms. Each objective is aligned with proposed activities for Members States and the Regional Office. Activities will be monitored at country and regional level on the basis of defined indicators.

Member States are encouraged to use the plan of work as a guide for strengthening nursing and midwifery services within the context of their own country plans. National nursing and midwifery action plans, co-ordinated by gCNMs, can also be built on the plan of work. This will further guide the development of nursing and midwifery to align it with this framework and Health 2020, thus delivering both high-quality patient care and the best health outcomes for populations.

It is advised that Members States should develop a country profile that reflects the strategic directions set out in this document, identifying actions and priorities appropriate to their political, educational and health system context. During the CNO/EFNNMA/WHO meeting in 2017 each country will be asked to provide a statement on actions in their respective country under the 12 objectives described in the annex. During this meeting the methodology for the five year review to be conducted by the Regional Office in 2020 will be discussed and agreed. It is advisable that Member States update their country profiles on an annual basis and use this information to assess progress.

The Regional Office will share evidence on the contribution and impact of nurses and midwives through the European compendium of good nursing and midwifery practices (2015). Further examples of models of appraisal, supervision, career progression and CPD will be developed and disseminated. Information on the achievements and innovations will be disseminated and shared through learning opportunities, such as WHO workshops and publications.

Furthermore, the plan of work defines mechanisms to engage Member States in this implementation, in partnership with the Regional Office, and to mainstream nursing and midwifery across WHO technical programmes. Engagement of nurses and midwives will be facilitated through the establishment of WHO expert groups for example, to guide developments in education and generating research evidence. Creating a platform that includes gCNMs, the EFNNMA, WHOCC and other experts of nursing and midwifery will provide further opportunities for the Regional Office to request consultation whenever needed. The current biennial meeting of gCNMs, EFNNMA and WHOCC will continue to be supported by the Regional Office to provide a forum to share good practice and discuss contemporary nursing and midwifery professional issues. For mainstreaming, new opportunities for nursing and midwifery leaders representing health policy, education and research should be identified to contribute to the WHO technical programmes.

With the Member States’ support and commitment to implementing this framework, nurses and mid-wives can achieve a greater voice in national health policy and planning, and an enhanced role in im-proving health and well-being and reducing health inequities throughout the Region by 2020.


19

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1 All websites accessed 13 August 2015.


20

14. Munich Declaration: Nurses and Midwives: A Force for Health, 2000. Copenhagen: WHO Regional Office for Europe; 2000 (http://www.euro.who.int/en/publications/policy-documents/munich-decla-ration-nurses-and-midwives-a-force-for-health)

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21

27. Dussault g, buchan J, Sermeus W, Padaiga Z. Assessing future health workforce needs. Copenhagen, World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2010 (Policy summary 2; http://www.euro.who.int/__data/assets/pdf_file/0019/124417/e94295.pdf).

28. Models and tools for health workforce planning and projections. geneva: World Health Organiza-tion; 2010 (Human Resources for Health Observer – Issue No. 3; http://apps.who.int/iris/bitstream/10665/44263/1/9789241599016_eng.pdf).

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33. bourgeault Il, Kuhlmann E, Neiterman E, Wrede S. How can optimal skill mix be effectively imple-mented and why?, Health systems and policy analysis. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2008 (http://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/2008/how-can-optimal-skill-mix-be-effectively-implemented-and-why).

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36. Delamaire M, lafortune g. Nurses in Advanced Roles: A Description and Evaluation of Experi-ences in 12 Developed Countries. OECD Health Working Papers, 2012, No. 54, OECD Publishing. doi:10.1787/5kmbrcfms5g7-en. (http://dx.doi.org/10.1787/5kmbrcfms5g7-en).

37. Sipilä R. Peer facilitation and multifaceted intervention in guideline implementation. Enhancing care of cardiovascular disease in primary care [dissertation]. Helsinki: University of Helsinki; 2012 (https://helda.helsinki.fi/bitstream/handle/10138/33543/Peerfaci.pdf?sequence=1).


22

An

nex

1.

prIo

rIt

y A

ctI

on

Ar

eAs

An

d p

ro

pose

d A

ctI

on

lIn

es

Act

ion

area

1:

scal

ing

up a

nd tr

ansf

orm

ing

educ

atio

n

Obj

ectiv

e 1:

st

anda

rdiz

e th

e in

itial

edu

catio

n of

nur

ses a

nd m

idw

ives

at d

egre

e le

vel t

o ge

t the

bes

t out

com

es fo

r pat

ient

s and

pop

ula-

tions

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•Re

view

and

dev

elop

in li

ne w

ith W

HO

gl

obal

stan

dard

s for

the i

nitia

l edu

catio

n of

pr

ofes

siona

l nur

ses a

nd m

idw

ives

(1) a

n: –

acad

emic

leve

l of i

nitia

l nur

sing

and

mid

wife

ry e

duca

tion

prog

ram

mes

; and

–nu

rsin

g an

d m

idw

ifery

aca

dem

ic

and

clin

ical

facu

lty o

r dep

artm

ent

arra

ngem

ents

.•

Revi

ew a

nd d

evel

op d

egre

e pr

ogra

mm

es

and

arra

ngem

ents

in li

ne w

ith p

rinc

iple

s of

inte

rpro

fess

iona

l edu

catio

n•

Prom

ote

the

utili

zatio

n of

sim

ulat

ion

tech

nolo

gy in

nur

se a

nd m

idw

ifery

ed

ucat

ion

to a

id d

evel

opm

ent o

f saf

e pr

actic

e.

Deg

ree-

leve

l pro

gram

mes

de

velo

ped

for i

nitia

l nur

sing

and

mid

wife

ry e

duca

tion

as o

utlin

ed

in th

e W

HO

glo

bal s

tand

ards

for

the i

nitia

l edu

catio

n of

pro

fess

iona

l nu

rses

and

mid

wiv

es (1

).

Nur

ses a

nd m

idw

ives

exi

t ini

tial

nurs

ing

and

mid

wife

ry e

duca

tion

with

a d

egre

e.

Inte

rpro

fess

iona

l edu

catio

n op

port

uniti

es a

re o

ffere

d du

ring

nu

rsin

g an

d m

idw

ifery

deg

ree

prog

ram

mes

(3).

Sim

ulat

ion

tech

nolo

gy is

util

ized

du

ring

nur

sing

and

mid

wife

ry

prog

ram

mes

•N

umbe

r and

per

cent

age

of in

stitu

tions

th

at o

ffer i

nitia

l nur

sing

and

mid

wife

ry

educ

atio

n: –

at d

egre

e le

vel

–w

ith n

ursin

g an

d m

idw

ifery

aca

dem

ic

and

clin

ical

facu

lty o

r dep

artm

ent

arra

ngem

ents

–w

ith in

terp

rofe

ssio

nal e

duca

tion

oppo

rtun

ities

–w

ith si

mul

atio

n le

arni

ng te

chno

logy

•Pe

rcen

tage

of a

ll ne

wly

gra

duat

ing

nurs

es

and

mid

wiv

es e

xitin

g an

nual

ly w

ith a

deg

ree

leve

l edu

catio

n in

the

coun

try.

WH

O

•Es

tabl

ish a

n ex

pert

gro

up o

f sel

ecte

d go

vern

men

t chi

ef n

urse

s and

mid

wiv

es,

colla

bora

ting

cent

res f

or n

ursin

g an

d m

idw

ifery

, nur

sing

and

mid

wife

ry e

xper

ts

and

educ

ator

s in

orde

r to

guid

e ed

ucat

ion

deve

lopm

ents

.•

Prov

ide

info

rmat

ion

and

guid

ance

on

WH

O

glob

al st

anda

rds f

or th

e ini

tial e

duca

tion

of

prof

essio

nal n

urse

s and

mid

wiv

es a

nd W

HO

Fr

amew

ork

for a

ctio

n on

inte

rpro

fess

iona

l ed

ucat

ion

and

colla

bora

tive p

ract

ice (

2)

to su

ppor

t act

iviti

es in

Mem

ber S

tate

s as

need

ed.

•W

orki

ng g

roup

est

ablis

hed

with

men

tione

d pa

rtie

s.•

Con

sulta

tions

initi

ated

, fol

low

ed u

p/ev

alua

ted

and

repo

rted

on

by th

e W

HO

Re

gion

al O

ffice

for E

urop

e.

•W

orks

hops

and

stud

y vi

sit o

ppor

tuni

ties

orga

nize

d to

shar

e nu

rsin

g an

d m

idw

ifery

ed

ucat

ion

stra

tegi

es a

nd e

xper

ienc

es in

the

WH

O E

urop

ean

Regi

on.


23

Obj

ectiv

e 2:

de

velo

p ed

ucat

ion

and

regu

latio

n th

at en

able

s and

ensu

res t

hat n

urse

s’ an

d m

idw

ives

’ cor

e co

mpe

tenc

ies a

re in

line

with

th

e ba

sic p

rinc

iple

s of H

ealth

202

0.Th

e pr

inci

ples

of H

ealth

202

0 ar

e:•healthpromotion,dise

asepreventio

n,patientedu

catio

nandem

powermento

fpeople

•managem

ento

fchron

icco

ndition

sand

long-te

rmcare

•applying

evidence-basedandsafepractice

•workinginmultid

isciplin

arya

ndintersectoralcollaboratio

ninlinewith

prim

aryh

ealth

carereform

andprincip

lesofpeople-centredservices(4

).

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•En

sure

that

und

ergr

adua

te a

nd p

ostg

radu

ate

nurs

ing

and

mid

wife

ry c

urric

ula

refle

ct

the

Hea

lth 2

020

com

pone

nts o

utlin

ed in

ob

ject

ive

2 (a

s app

licab

le to

the

know

ledg

e an

d sk

ill d

omai

n); s

uppo

rted

by

regu

lato

ry

stan

dard

s.•

Iden

tify

the

met

hods

for e

valu

atio

n of

co

nten

t and

indi

vidu

al’s

com

pete

ncy

in

resp

ect o

f the

pri

ncip

les o

utlin

ed in

obj

ectiv

e 2.

Und

ergr

adua

te a

nd p

ostg

radu

ate

curr

icul

a re

view

ed a

nd a

ppra

ised

in te

rms o

f Hea

lth 2

020

prin

cipl

es,

resp

ondi

ng to

pop

ulat

ion

need

s, sa

tisfy

ing

prof

essio

nal

requ

irem

ents

and

enab

ling

peop

le-

cent

red

serv

ices

.

•C

urric

ula

incl

ude

core

con

tent

in li

ne w

ith

prin

cipl

es o

f Hea

lth 2

020

- out

lined

in

obje

ctiv

e 2

(as a

pplic

able

to th

e kn

owle

dge

and

skill

dom

ain)

; sup

port

ed b

y re

gula

tory

st

anda

rds.

•M

etho

ds id

entifi

ed to

eva

luat

e co

re c

onte

nt

and

indi

vidu

al c

ompe

tenc

e in

resp

ect o

f the

pr

inci

ples

out

lined

in o

bjec

tive

2.

WH

O

•In

col

labo

ratio

n w

ith th

e w

orki

ng g

roup

on

educ

atio

n de

velo

pmen

ts:

–up

date

Reg

iona

l Offi

ce c

urric

ula

for

cont

inui

ng e

duca

tion

for n

urse

s and

m

idw

ives

(3) i

n lin

e w

ith H

ealth

202

0 (4

); an

d –

com

pile

and

diss

emin

ate

exam

ples

of

stre

ngth

ened

com

pete

ncie

s in

nurs

ing

and

mid

wife

ry e

duca

tion.

•U

pdat

ed R

egio

nal O

ffice

cur

ricul

a fo

r co

ntin

uing

edu

catio

n fo

r nur

ses a

nd

mid

wiv

es a

vaila

ble

as a

dig

ital v

ersio

n /

form

at (3

).•

Adv

ice

prov

ided

for M

embe

r Sta

tes o

n ar

eas o

f com

pete

ncy

deve

lopm

ent b

ased

on

less

ons l

earn

t fro

m th

e Eu

rope

an

com

pend

ium

.


24

Obj

ectiv

e 3:

st

reng

then

cont

inui

ng p

rofe

ssio

nal d

evel

opm

ent a

nd ca

reer

dev

elop

men

t

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•Re

view

and

dev

elop

: –

care

er p

rogr

essio

n ar

rang

emen

ts in

hea

lth

care

sett

ings

; inc

ludi

ng g

uida

nce

on

adva

nced

pra

ctic

e ro

le.

–co

untr

y/ su

bcou

ntry

or i

nstit

utio

nal

perf

orm

ance

app

raisa

l sys

tem

s tha

t id

entif

y in

divi

dual

dev

elop

men

t nee

ds.

–co

ntin

uing

pro

fess

iona

l dev

elop

men

t (C

PD) o

ppor

tuni

ties a

nd m

aint

ain

them

in h

ealth

car

e se

ttin

gs; c

onsid

er

accr

edita

tion

syst

ems t

o al

low

tran

sfer/

reco

gniti

on fo

r aca

dem

ic aw

ards

. –

clin

ical

or p

eer s

uper

visio

n of

nur

ses a

nd

mid

wiv

es.

Stre

ngth

ened

cul

ture

of

appr

aisa

l, su

perv

ision

, car

eer

prog

ress

ion

arra

ngem

ents

and

C

PD o

ppor

tuni

ties f

or n

urse

s and

m

idw

ives

.

•Fr

amew

orks

are

in p

lace

out

linin

g ca

reer

pr

ogre

ssio

n ar

rang

emen

ts w

ith e

xplic

it re

fere

nce

to a

dvan

ced

prac

tice

role

s.•

Ann

ual p

erce

ntag

e of

nur

ses a

nd

mid

wiv

es w

ho re

ceiv

e pe

rfor

man

ce

appr

aisa

l to

info

rm th

eir p

ract

ice

and

CPD

re

quire

men

ts.

•A

nnua

l per

cent

age

of n

urse

s and

mid

wiv

es

who

hav

e co

mpl

eted

CPD

act

ivity

.•

Fram

ewor

ks fo

r clin

ical

or p

eer s

uper

visio

n ar

e in

pla

ce.

WH

O

•C

ompi

le e

xam

ples

and

diss

emin

ate

info

rmat

ion

on a

ppra

isal,

supe

rvisi

on,

care

er p

rogr

essio

n ar

rang

emen

ts a

nd C

PD

oppo

rtun

ities

in c

olla

bora

tion

with

the

wor

king

gro

ups.

•Pu

blic

atio

n of

a E

urop

ean

com

pend

ium

of

exa

mpl

es o

f app

raisa

l, su

perv

ision

, ca

reer

pro

gres

sion

arra

ngem

ents

and

CPD

op

port

uniti

es c

ompi

led

and

avai

labl

e as

a

digi

tal v

ersio

n / f

orm

at.

•W

orks

hops

, pub

licat

ions

or o

ther

ac

tiviti

es o

rgan

ized

to sh

are

stra

tegi

es a

nd

expe

rienc

es in

the

WH

O E

urop

ean

Regi

on.


25

Act

ion

area

2:

wor

kfor

ce p

lann

ing

and

opti

miz

ing

skill

mix

Obj

ectiv

e 4:

de

velo

p w

orkf

orce

pla

nnin

g st

rate

gies

and

pol

icie

s to

ensu

re a

suffi

cien

t and

sust

aina

ble

nurs

ing

and

mid

wife

ry w

orkf

orce

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•Re

view

and

dev

elop

arr

ange

men

ts fo

r he

alth

wor

kfor

ce fo

reca

stin

g, p

lann

ing

and

mon

itori

ng b

ased

on

natio

nal a

nd

inte

rnat

iona

l req

uire

men

ts.

•Re

view

and

inte

grat

e di

strib

utio

n an

d re

tent

ion

polic

ies a

s par

t of w

orkf

orce

st

rate

gies

at a

ll le

vels

of g

over

nmen

t and

in

stitu

tions

.•

Revi

ew im

plem

enta

tion

of th

e W

HO

G

loba

l Cod

e of P

ract

ice o

n th

e Int

erna

tiona

l Re

crui

tmen

t of H

ealth

Per

sonn

el w

here

it

pert

ains

to n

ursin

g an

d m

idw

ifery

(5).

Nur

sing

and

mid

wife

ry

dist

ribut

ion,

shor

tage

s and

mob

ility

ac

cura

tely

mon

itore

d an

d ac

tivel

y ad

dres

sed.

Mem

ber S

tate

s hav

e a

sust

aina

ble

nurs

ing

and

mid

wife

ry w

orkf

orce

•A

ccur

ate

info

rmat

ion

avai

labl

e on

dem

and,

su

pply,

stoc

ks a

nd m

obili

ty o

f nur

ses a

nd

mid

wiv

es a

t cou

ntry

and

subc

ount

ry le

vels.

•D

istrib

utio

n an

d re

tent

ion

polic

ies r

egar

ding

nu

rsin

g an

d m

idw

ifery

wor

kfor

ce a

dopt

ed a

t al

l lev

els o

f gov

ernm

ent a

nd in

stitu

tions

.•

The

WH

O G

loba

l Cod

e of P

ract

ice o

n th

e Int

erna

tiona

l Rec

ruitm

ent o

f Hea

lth

Pers

onne

l (5)

impl

emen

ted

and

revi

ewed

on

an o

ngoi

ng b

asis.

•Ev

iden

ce o

f int

erna

l mob

ility

of n

urse

s and

m

idw

ives

rath

er th

an e

xter

nal m

igra

tion.

WH

O

•W

ork

with

Mem

ber S

tate

s, th

e Eu

rope

an

Uni

on (E

U),

and

Org

anisa

tion

for E

cono

mic

C

o-op

erat

ion

and

Dev

elop

men

t to

deve

lop

met

hodo

logy

, ind

icat

ors,

tool

s and

stra

tegi

es

for w

orkf

orce

fore

cast

ing,

pla

nnin

g an

d m

onito

ring

.•

Diss

emin

ate

the

WH

O to

ols a

nd g

uide

lines

fo

r hum

an re

sour

ces f

or h

ealth

(6).

•A

ccur

ate

info

rmat

ion

avai

labl

e on

stoc

ks,

and

mob

ility

thro

ugh

the

hum

an re

sour

ces

for h

ealth

dat

abas

es.

•W

orks

hops

, pub

licat

ions

or o

ther

act

iviti

es

orga

nize

d to

diss

emin

ate

info

rmat

ion

on

WH

O to

ols a

nd g

uide

lines

(6).


26

Obj

ectiv

e 5:

en

sure

that

wor

kfor

ce re

desi

gn a

nd sk

ill m

ix p

rovi

des s

afe

and

effec

tive

care

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•Es

tabl

ish c

ount

ry/su

bcou

ntry

or

inst

itutio

nal f

ram

ewor

ks b

ased

on

the

peop

le-c

entr

ed a

ppro

ach

that

defi

nes a

nd

dete

rmin

es th

e op

timal

mix

of h

ealth

pe

rson

nel w

ithin

the

heal

th sy

stem

, in

clud

ing

publ

ic h

ealth

.•

Ensu

re a

nd m

onito

r tha

t the

re e

xist

s a

bala

nce

betw

een

nurs

es, m

idw

ives

and

oth

er

heal

th p

rofe

ssio

nals

as d

icta

ted

by p

atie

nt

need

s and

con

text

ual f

acto

rs.

A p

eopl

e-ce

ntre

d ap

proa

ch to

he

alth

serv

ice

deliv

ery

with

the

appr

opri

ate m

ix o

f hea

lth p

erso

nnel

as

defi

ned

by p

atie

nt n

eeds

and

co

ntex

tual

fact

ors.

A w

orkf

orce

with

skill

s to

supp

ort

prev

entio

n he

alth

pro

mot

ion

and

self-

care

.

•Fr

amew

orks

bas

ed o

n th

e pe

ople

-cen

tred

ap

proa

ch d

escr

ibin

g th

e m

etho

ds a

nd

para

met

ers f

or a

sses

sing

and

mon

itori

ng th

e op

timal

mix

of h

ealth

per

sonn

el h

ave

been

es

tabl

ished

.•

Regu

lar m

onito

ring

and

cor

rect

ive

actio

n in

resp

ect o

f wor

kfor

ce sk

ill m

ix

and

avai

labi

lity

base

d on

pop

ulat

ion

heal

th n

eeds

at c

ount

ry/ s

ubco

untr

y or

in

stitu

tiona

l lev

el is

evi

dent

.

WH

O

•W

ork

with

Mem

ber S

tate

s and

EU

to

deve

lop

met

hods

and

par

amet

ers f

or

asse

ssin

g sk

ill m

ix.

•Pr

ovid

e op

port

uniti

es fo

r diss

emin

atin

g in

form

atio

n an

d sh

arin

g ex

perie

nce

betw

een

the

coun

trie

s and

WH

O te

chni

cal

prog

ram

mes

.

•A

ccur

ate

info

rmat

ion

avai

labl

e on

mix

of

heal

th p

erso

nnel

in M

embe

r Sta

tes t

hrou

gh

hum

an re

sour

ces f

or h

ealth

dat

abas

es.

•W

orks

hops

, pub

licat

ions

and

a ro

ster

of

expe

rts o

rgan

ized

to sh

are e

xper

ienc

es in

the

Regi

on.


27

Act

ion

area

3:

ensu

ring

pos

itiv

e w

ork

envi

ronm

ents

Obj

ectiv

e 6:

pro

mot

e po

sitiv

e w

ork

envi

ronm

ents

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•A

pply

the p

rinc

iple

s set

out

in th

e ILO

Nur

sing P

erso

nnel

Co

nven

tion

No.

149

(8).

•En

sure

info

rmat

ion

is av

aila

ble

that

des

crib

es w

ork

envi

ronm

ents

in th

e in

tere

st o

f con

tinuo

usly

impr

ovin

g w

orki

ng c

ondi

tions

thro

ugh

rese

arch

and

dev

elop

men

t.•

Wor

k w

ith p

rofe

ssio

nal a

ssoc

iatio

ns a

nd tr

ade

unio

ns to

en

sure

the

expe

rienc

e of

fron

t lin

e nu

rses

and

mid

wiv

es

info

rm d

evel

opm

ents

that

pro

mot

e po

sitiv

e w

orki

ng

envi

ronm

ents

.•

Ensu

re n

ursin

g an

d m

idw

ifery

und

ergr

adua

te a

nd

post

grad

uate

edu

catio

n in

tegr

ates

hea

lthy

wor

k en

viro

nmen

ts.

•C

onsid

er a

ctio

ns to

be

take

n na

tiona

lly th

at p

rom

ote

prof

essio

nal r

ecog

nitio

n an

d st

atus

of n

urse

s and

m

idw

ives

. Rev

iew

and

dev

elop

act

ion

plan

s to

impr

ove

wor

king

con

ditio

ns, p

artic

ular

ly in

term

s of:

–st

affing

and

wor

kloa

d ba

lanc

e –

wag

es –

secu

rity

and

flexi

bilit

y of

empl

oym

ent

–sa

fety

of t

he w

orkp

lace

s –

wel

l-bei

ng a

t wor

k –

occu

patio

nal h

azar

ds –

viol

ence

in th

e w

orkp

lace

–ag

e m

anag

emen

t

Ensu

re p

ositi

ve w

ork

envi

ronm

ent a

nd jo

b sa

tisfa

ctio

n m

axim

izin

g th

e he

alth

and

wel

l-be

ing

of n

urse

s and

m

idw

ives

whi

le a

lso

impr

ovin

g he

alth

out

com

es

and

orga

niza

tiona

l pe

rfor

man

ce.

•Ra

tifica

tion

of th

e IL

O N

ursin

g Pe

rson

nel C

onve

ntio

n N

o. 14

9 (8

).•

Prog

ress

on

plan

s to

impr

ove

wor

king

co

nditi

ons a

dopt

ed a

t all

adm

inist

rativ

e le

vels.

•A

ccur

ate

info

rmat

ion

avai

labl

e,

incl

udin

g in

dig

ital f

orm

at, o

n po

sitiv

e w

orki

ng en

viro

nmen

ts b

y al

l hea

lth

serv

ices

.•

Perc

enta

ge o

f und

ergr

adua

te a

nd

post

grad

uate

nur

sing

and

mid

wife

ry

curr

icul

a th

at in

clud

e ed

ucat

ion

on

deve

lopi

ng a

nd m

aint

aini

ng p

ositi

ve

wor

k en

viro

nmen

ts.

WH

O

•Pr

ovid

e te

chni

cal s

uppo

rt a

nd d

issem

inat

e in

form

atio

n re

gard

ing

legi

slatio

n an

d m

echa

nism

s in

rela

tion

to

nurs

ing

and

mid

wife

ry w

here

requ

este

d, in

clud

ing

the

ILO

Nur

sing P

erso

nnel

Con

vent

ion

149

(8).

•D

issem

inat

e W

HO

doc

umen

ts p

erta

inin

g to

hea

lthy

wor

king

envi

ronm

ents

.

•A

ctiv

ities

des

crib

ing

tech

nica

l as

sista

nce

to c

ount

ries i

nclu

ded

in th

e an

nual

repo

rt to

the

Regi

onal

Offi

ce.

•W

orks

hops

, pub

licat

ions

and

oth

er

activ

ities

org

aniz

ed to

diss

emin

ate

info

rmat

ion

abou

t hea

lthy

wor

king

en

viro

nmen

ts.


28

Act

ion

area

4:

prom

otin

g ev

iden

ce-b

ased

pra

ctic

e an

d in

nova

tion

Obj

ectiv

e 7:

fa

cilit

ate

the

cultu

re o

f evi

denc

e-ba

sed

prac

tice

in n

ursi

ng a

nd m

idw

ifery

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•D

efine

and

dev

elop

mec

hani

sms w

ithin

re

sear

ch, e

duca

tion,

and

man

agem

ent o

f he

alth

serv

ices

to fa

cilit

ate

evid

ence

bas

ed

nurs

ing

and

mid

wife

ry p

ract

ice.

•g

ener

ate

evid

ence

and

key

indi

cato

rs to

m

easu

re th

e im

pact

of e

vide

nce-

base

d ca

re

by n

urse

s and

mid

wiv

es o

n he

alth

and

pe

rfor

man

ce o

utco

mes

, thu

s dem

onst

ratin

g th

e re

turn

on

inve

stm

ent i

n th

e nu

rsin

g an

d m

idw

ifery

wor

kfor

ce.

Prin

cipl

es o

f evi

denc

e-ba

sed

care

in

tegr

ated

and

mon

itore

d ac

ross

al

l nur

sing

and

mid

wife

ry p

ract

ice

ther

eby

ensu

ring

hig

h-qu

ality

, saf

e an

d eff

ectiv

e he

alth

car

e.

•Po

licie

s, gu

idel

ines

and

serv

ice

impr

ovem

ents

pro

gram

mes

that

supp

ort t

he

deve

lopm

ent,

appl

icat

ion

and

diss

emin

atio

n of

evi

denc

e ba

sed

nurs

ing

and

mid

wife

ry

prac

tice

(may

be

expl

icit

part

of w

ider

m

ulitp

rofe

ssio

nal p

ract

ice

appr

oach

) are

in

plac

e.•

Perf

orm

ance

mea

sure

s (m

etric

s) a

re

deve

lope

d th

at c

orre

late

evi

denc

e ba

sed

nurs

e an

d m

idw

ifery

pra

ctic

e w

ith

indi

vidu

als’

and

popu

latio

n he

alth

out

com

es•

Perc

enta

ge o

f hea

lth c

are

inst

itutio

ns

with

qua

lity

man

agem

ent p

rogr

amm

es

and

syst

ems f

or m

onito

ring

safe

ty a

nd

effec

tiven

ess o

f nur

sing

and

mid

wife

ry

prac

tice.

WH

O

•D

evel

op a

nd in

clud

e in

dica

tors

in th

e W

HO

Eu

rope

an h

ealth

for a

ll da

taba

se (9

), w

hich

re

flect

the

rela

tions

hip

betw

een

nurs

ing

and

mid

wife

ry c

ontr

ibut

ions

and

hea

lth a

nd

perf

orm

ance

out

com

es.

•W

orks

hops

, pub

licat

ions

and

oth

er a

ctiv

ities

or

gani

zed

to sh

are

info

rmat

ion

and

expe

rienc

es in

the

WH

O E

urop

ean

Regi

on.

•In

dica

tors

ava

ilabl

e in

the

WH

O E

urop

ean

heal

th fo

r all

data

base

(9).


29

Obj

ectiv

e 8:

de

velo

p, tr

ansf

orm

and

ada

pt th

e ro

les o

f nur

ses a

nd m

idw

ives

in li

ne w

ith th

e go

als o

f Hea

lth 2

020

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•D

evel

op sk

ills a

cros

s the

nur

sing

and

mid

wife

ry w

orkf

orce

for 2

1st c

entu

ry

prac

tice

incl

udin

g po

pula

tion

heal

th a

nd

heal

th te

chno

logi

es

•Re

view

and

defi

ne a

fram

ewor

k fo

r the

di

ffere

nt ro

les o

f nur

ses a

nd m

idw

ives

in

clud

ing

the

role

s of a

dvan

ced

prac

tice

nurs

es a

nd m

idw

ives

and

clin

ical

spec

ialis

ts.

•En

sure

that

regu

latio

ns, a

nd if

app

licab

le

legi

slatio

n, a

re in

pla

ce to

pro

tect

thes

e di

ffere

nt ro

les.

•D

evel

op a

ppro

pria

te e

duca

tion

in li

ne w

ith

thes

e ro

les.

Expa

ndin

g th

e sc

ope

of p

ract

ice

for

nurs

es a

nd m

idw

ives

in li

ne w

ith

popu

latio

n ne

eds,

the

life-

cour

se

appr

oach

and

hea

lth re

form

s.

•Fr

amew

orks

defi

ning

diff

eren

t nur

sing

and

mid

wife

ry ro

les w

hich

refle

cts c

ount

ry n

eeds

ar

e in

pla

ce.

•Re

gula

tions

, and

whe

re a

ppro

pria

te

legi

slatio

n, a

re in

pla

ce to

pro

tect

spec

ific

role

s.•

Ther

e ar

e a

rang

e of

eas

ily

avai

labl

e/ac

cess

ible

edu

catio

n pr

ogra

mm

es

that

supp

ort n

urse

s and

mid

wiv

es to

hav

e up

to

dat

e sk

ills a

ppro

pria

te to

mee

t pop

ulat

ion

heal

th n

eeds

, inc

ludi

ng: p

opul

atio

n he

alth

, he

alth

tech

nolo

gies

, clin

ical

spec

ialis

t and

ad

vanc

ed le

vel p

ract

ice

role

s.

WH

O

•Pr

ovid

e te

chni

cal s

uppo

rt a

nd d

issem

inat

e in

form

atio

n on

diff

eren

t rol

es fo

r nur

ses a

nd

mid

wiv

es in

col

labo

ratio

n w

ith th

e w

orki

ng

grou

ps.

•Fa

cilit

ate

the

inte

grat

ion

of re

leva

nt n

ursin

g an

d m

idw

ifery

role

s int

o W

HO

tech

nica

l pr

ogra

mm

es.

•Ex

ampl

es o

f diff

eren

t rol

es fo

r nur

ses a

nd

mid

wiv

es d

issem

inat

ed in

the

Euro

pean

co

mpe

ndiu

m o

f nur

sing

and

mid

wife

ry

prac

tice

and

avai

labl

e a

s a d

igita

l ve

rsio

n/fo

rmat

.•

Wor

ksho

ps, p

ublic

atio

ns a

nd o

ther

act

iviti

es

orga

nize

d to

shar

e in

form

atio

n an

d ex

perie

nces

in th

e W

HO

Eur

opea

n Re

gion

.


30

reFerences to Annex 1

1. global standards for the initial education of professional nurses and midwives. geneva: World Health Organization; 2009 (http://whqlibdoc.who.int/hq/2009/WHO_HRH_HPN_08.6_eng.pdf, accessed 15 July 2015).

2. Framework for action on interprofessional education and collaborative practice. geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf, accessed 15 July 2015).

3. Other nursing specializations. In: WHO Regional Office for Europe [website]. Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/en/what-we-do/health-topics/Health-systems/nursing-and-midwifery/activities/education/other-nursing-specializations, accessed 15 July 2015).

4. Health 2020: a European policy framework and strategy for the 21st century. Copenhagen: WHO Re-gional Office for Europe; 2013 (EUR/RC62/8; http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being/publications/2013/health-2020-a-euro-pean-policy-framework-and-strategy-for-the-21st-century, accessed 15 July 2015).

5. Resolution WHA63.16. WHO global Code of Practice on the International Recruitment of Health Per-sonnel. In: Sixty-third World Health Assembly, geneva 17–21 May 2010. geneva: World Health Organi-zation; 2010 (http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R16-en.pdf, accessed 15 July 2015).

6. tools and guidelines for human resources for health. In: World Health Organization [website]. geneva: World Health Organization; 2014 (http://www.who.int/hrh/tools/en/index.html, accessed 15 July 2015).

7. IlO Nursing Personnel Convention No. 149. geneva: International labour Office; 2005 (http://www.who.int/hrh/nursing_midwifery/nursing_convention_C149.pdf, accessed 15 July 2015).

8. European health for all database [online database]. Copenhagen: WHO Regional Office for Europe; 2014 update (http://www.euro.who.int/hfadb, accessed 15 July 2015).

http://whqlibdoc.who.int/hq/2009/WHO_HRH_HPN_08.6_eng.pdf

http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf

http://www.euro.who.int/en/what-we-do/health-topics/Health-systems/nursing-and-midwifery/activities/education/other-nursing-specializations

http://www.euro.who.int/en/what-we-do/health-topics/Health-systems/nursing-and-midwifery/activities/education/other-nursing-specializations

http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being/publications/2013/health-2020-a-european-policy-framework-and-strategy-for-the-21st-century



http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R16-en.pdf

http://www.who.int/hrh/tools/en/index.html

http://www.who.int/hrh/nursing_midwifery/nursing_convention_C149.pdf

http://www.who.int/hrh/nursing_midwifery/nursing_convention_C149.pdf

http://www.euro.who.int/hfadb


31

An

nex

2.

enA

blI

ng

Mec

HA

nIs

Ms

An

d p

ro

pose

d A

ctI

on

lIn

es

regu

lati

on

Obj

ectiv

e 9:

en

sure

that

the

defin

ition

s of n

ursi

ng a

nd m

idw

ifery

are

embo

died

in le

gisl

atio

n an

d th

at m

echa

nism

s are

in p

lace

to sa

fe-

guar

d th

e pu

blic

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•En

sure

: –

a re

gist

er e

xist

s of n

urse

s and

mid

wiv

es

who

hav

e ac

hiev

ed th

e re

quire

d le

vel o

f co

mpe

tenc

y to

pra

ctise

safe

ly;

–le

gisla

tion

is in

pla

ce to

defi

ne a

nd

regu

late

pra

ctic

e an

d co

nduc

t of n

urse

s an

d m

idw

ives

; –

a su

perv

isory

aut

horit

y is

in p

lace

to

ove

rsee

the

safe

ty, q

ualit

y an

d pr

ofes

siona

l pra

ctic

e in

nur

sing

and

mid

wife

ry; a

nd –

guid

elin

es a

re d

evel

oped

to d

efine

st

anda

rds o

f pra

ctic

e an

d be

st p

ract

ice.

Prof

essio

nal a

ct(s)

, reg

ister

s, su

perv

isory

aut

horit

ies a

nd

guid

elin

es to

ensu

re p

atie

nt sa

fety

in

rela

tion

to n

urse

s and

mid

wiv

es.

•Re

gist

er o

f nur

ses a

nd m

idw

ives

acc

essib

le

by em

ploy

ers a

nd th

e pu

blic

to v

erify

nur

ses’

and

mid

wiv

es’ c

rede

ntia

ls.•

legi

slatio

n to

defi

ne a

nd re

gula

te p

ract

ice

and

cond

uct o

f nur

ses a

nd m

idw

ives

.•

Supe

rviso

ry a

utho

rity

to o

vers

ee th

e sa

fety

, qu

ality

and

pro

fess

iona

l pra

ctic

e in

nur

sing

and

mid

wife

ry.

•g

uide

lines

to d

efine

stan

dard

s of p

ract

ice

and

best

pra

ctic

e.

WH

O

•Pr

ovid

e te

chni

cal s

uppo

rt a

nd d

issem

inat

e in

form

atio

n re

gard

ing

legi

slatio

n an

d m

echa

nism

s in

rela

tion

to n

ursin

g an

d m

idw

ifery

to M

embe

r Sta

tes w

here

re

ques

ted.

•A

ssist

ance

and

act

iviti

es in

clud

ed in

the

annu

al re

port

s to

the

WH

O R

egio

nal O

ffice

fo

r Eur

ope.

•Ex

ampl

es o

f leg

islat

ion

and

mec

hani

sms i

n re

latio

n to

nur

sing

and

mid

wife

ry c

ompi

led

in a

Eur

opea

n co

mpe

ndiu

m a

nd a

vaila

ble

as

a di

gita

l ver

sion/

form

at.


32

rese

arch

Obj

ectiv

e 10

: bui

ld n

ursi

ng, m

idw

ifery

and

mul

tidis

cipl

inar

y re

sear

ch ca

paci

ty

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

Dev

elop

:•

post

grad

uate

nur

sing

and

mid

wife

ry

prog

ram

mes

, whi

ch a

im to

dev

elop

rese

arch

ca

reer

pat

hs;

•st

ruct

ures

with

in in

stitu

tions

that

allo

w

for n

urse

s and

mid

wiv

es to

par

ticip

ate

and

cond

uct r

esea

rch;

•m

ultid

iscip

linar

y he

alth

rese

arch

initi

ativ

es;

•st

ruct

ures

con

nect

ing

nurs

ing,

mid

wife

ry,

mul

tidisc

iplin

ary

rese

arch

and

hea

lth c

are

serv

ices

; and

•op

port

uniti

es to

enga

ge n

ursin

g, m

idw

ifery

an

d m

ultid

iscip

linar

y re

sear

cher

s in

heal

th

polic

y de

cisio

ns.

Impr

oved

opp

ortu

nitie

s and

ca

paci

ty fo

r nur

sing,

mid

wife

ry a

nd

mul

tidisc

iplin

ary

rese

arch

lead

ing

to g

reat

er in

put i

nto

heal

th p

olic

y de

cisio

ns.

•Pe

rcen

tage

of i

nstit

utio

ns w

ith re

sear

ch-

focu

sed

post

grad

uate

pro

gram

mes

.•

Num

ber o

f res

earc

h pu

blic

atio

ns a

nd

activ

ities

in n

ursin

g, m

idw

ifery

and

m

ultid

iscip

linar

y re

sear

ch.

•In

crea

sing

perc

enta

ge o

f nur

ses a

nd

mid

wiv

es p

artic

ipat

ing

and

purs

uing

re

sear

ch a

ctiv

ities

and

hea

lth p

olic

y w

ork.

•Pa

rtne

rshi

ps b

etw

een

heal

th c

are

serv

ices

and

nur

sing,

mid

wife

ry a

nd/o

r m

ultid

iscip

linar

y re

sear

ch p

rogr

amm

es.

•W

eb-b

ased

por

tals

for a

ll he

alth

car

e pr

ofes

siona

ls to

gui

de e

vide

nce-

base

d pr

actic

e.

WH

O

•Id

entif

y an

d di

ssem

inat

e ev

iden

ce fo

r the

im

pact

of g

ood

prac

tices

and

nur

sing,

m

idw

ifery

and

mul

tidisc

iplin

ary

rese

arch

on

heal

th o

utco

mes

.•

Col

labo

rate

with

WH

O p

artn

ers i

n th

e fie

ld o

f hea

lth sy

stem

s res

earc

h to

add

ress

nu

rsin

g an

d m

idw

ifery

in th

eir w

ork.

•C

ount

ry c

ase

stud

ies r

evie

wed

and

com

pile

d in

a E

urop

ean

com

pend

ium

and

ava

ilabl

e as

a

digi

tal v

ersio

n/fo

rmat

. Num

ber o

f stu

dies

by

WH

O p

artn

er o

rgan

izat

ions

that

add

ress

nu

rsin

g an

d m

idw

ifery

rese

arch

.


33

part

ners

hips

Obj

ectiv

e 11

: bui

ld in

terd

isci

plin

ary

and

inte

rsec

tora

l col

labo

ratio

n an

d pa

rtne

rshi

ps a

cros

s soc

iety

for d

evel

opin

g an

d pr

ovid

ing

peop

le-c

entr

ed ca

re a

nd im

prov

ed h

ealth

out

com

es

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•In

corp

orat

e nu

rses

and

mid

wiv

es in

de

velo

ping

and

pla

nnin

g, m

anag

ing

and

mon

itori

ng, a

nd im

plem

entin

g in

tegr

ated

an

d co

ordi

nate

d pa

tient

-cen

tred

car

e.

Inte

rdisc

iplin

ary

and

inte

rsec

tora

l co

llabo

ratio

n an

d pa

rtne

rshi

ps

ensu

ring

inte

grat

ed a

nd

coor

dina

ted

peop

le-c

entr

ed c

are.

•Ev

iden

ce o

f res

earc

h de

vote

d to

dev

elop

men

t of

new

type

s of p

artn

ersh

ips f

or h

ealth

ac

ross

disc

iplin

es, s

ecto

rs a

nd so

ciet

y.•

Hea

lth ta

rget

s and

hea

lth p

erfo

rman

ce

revi

ews i

nclu

de p

artn

ersh

ip c

riter

ia.

•Po

licie

s and

stru

ctur

es in

pla

ce to

faci

litat

e an

d m

onito

r par

tner

ship

s.•

Serv

ices

incl

ude

inte

rdisc

iplin

ary

team

s for

pr

ovid

ing

peop

le-c

entr

ed c

are.

•In

nova

tive

oppo

rtun

ities

iden

tified

and

im

plem

ente

d to

pro

mot

e le

arni

ng b

etw

een

heal

th p

rofe

ssio

nals.

WH

O

•Pr

ovid

e op

port

uniti

es fo

r nur

sing

and

mid

wife

ry le

ader

s to

cont

ribut

e to

the

deve

lopm

ent o

f edu

catio

n, re

sear

ch a

nd

heal

th p

olic

y at

the

Regi

onal

Offi

ce o

r its

co

untr

y offi

ces.

•W

HO

pro

gram

mes

enga

ging

nur

sing

and

mid

wife

ry e

xper

tise

in e

duca

tion,

rese

arch

an

d he

alth

pol

icy

incl

uded

in th

e an

nual

re

port

to th

e Re

gion

al O

ffice

.


34

Man

agem

ent a

nd le

ader

ship

Obj

ectiv

e 12

: str

engt

hen

nurs

es’ a

nd m

idw

ives

’ inc

lusi

on in

hea

lth p

olic

y an

d se

rvic

e de

liver

y de

cisi

on-m

akin

g at

loca

l, go

vern

men

t and

in

tern

atio

nal l

evel

s

Res

pons

ible

pa

rty

Act

iviti

esEx

pect

ed re

sults

Indi

cato

rs

Mem

ber

Stat

e

•En

sure

all

leve

ls of

gov

ernm

ent a

nd

inst

itutio

ns:

–ap

poin

t chi

ef n

urse

s and

mid

wiv

es;

–pr

omot

e sh

ared

lead

ersh

ip w

ith n

urse

s an

d m

idw

ives

; –

upho

ld th

e co

mpe

tenc

y of

nur

ses a

nd

mid

wiv

es in

gov

ernm

ent a

ctiv

ities

; and

–en

gage

nur

ses a

nd m

idw

ives

in

impl

emen

ting

heal

th p

olic

y in

thei

r wor

k.

Mea

sure

s of s

hare

d le

ader

ship

in

pla

ce to

ensu

re n

urse

s and

m

idw

ives

act

ivel

y pa

rtic

ipat

e in

he

alth

pol

icy

deve

lopm

ent a

nd

serv

ice

deliv

ery.

•A

ppoi

ntm

ent o

f nur

ses a

nd m

idw

ives

in

seni

or m

anag

emen

t pos

ition

s at a

ll le

vels

of

gove

rnm

ent a

nd in

stitu

tions

.•

Agr

eed

crite

ria

on c

oncr

ete

mea

ns o

f pr

omot

ing

shar

ed le

ader

ship

.•

Fina

ncia

l and

edu

catio

n su

ppor

t ava

ilabl

e fo

r nur

ses a

nd m

idw

ives

in th

ese

role

s to

deve

lop

thei

r com

pete

ncie

s in

deci

sion-

mak

ing.

•N

atio

nal n

ursin

g an

d m

idw

ifery

act

ion

plan

s in

plac

e; th

ese

shou

ld b

e co

here

nt w

ith

and

supp

ortiv

e of

nat

iona

l hea

lth p

olic

y ta

rget

s.

WH

O

•Fa

cilit

ate

a bi

enni

al m

eetin

g of

gov

ernm

ent

chie

f nur

ses a

nd m

idw

ives

, EFN

NM

A

and

WH

O c

olla

bora

ting

cent

res t

o ad

vise

the

Regi

onal

Offi

ce in

the

stra

tegi

c de

velo

pmen

t of n

ursin

g an

d m

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The WHO Regional Offi ce for EuropeThe World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Offi ce for Europe is one of six regional offi ces throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.

Member StatesAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandIsraelItalyKazakhstanKyrgyzstanLatviaLithuaniaLuxembourgMaltaMonacoMontenegroNetherlandsNorwayPolandPortugalRepublic of MoldovaRomaniaRussian FederationSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandTajikistanThe former Yugoslav Republic of MacedoniaTurkeyTurkmenistanUkraineUnited KingdomUzbekistan

World Health OrganizationRegional Offi ce for Europe

UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark

Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01

Email: [email protected]

Website: www.euro.who.int

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