After 40 years of intensely lived professional life, as a nurse and educator, with an eye always aimed at the “rest of the world” and not only at my beloved country, I cannot fail to speak about the future health structure, not just thinking about the region Lombardy.
I agree with all the points presented by Professor Vittadini in his latest editorial because I’ve lived them on my skin all these years. I therefore react, in particular, to what I read in previous contributions that appeared in your newspaper in recent days (Marco Magri e Callisto Bravi and others) which saddened me to say the least.
Knowing the international health and welfare realities and having maintained contact with former students who are currently working and have continued their studies in other countries, my instinctive reaction was: “No! But are we still at this point? It is still too little! It’s an old thought! If we miss this opportunity too – sadly brought to light by Covid-19 – health care in Italy will not make the leap that is urgent more than ever “.
Despite being in line with several points presented by the authors, I am amazed to see that it is never possible to go beyond the “already known”. Precisely because (I quote the article of January 28) “The pandemic shows that no one can solve health issues alone”, how do you think that the approach we have been talking about for thirty years is still sufficient? Do you really believe that adequate locations with “functional primary care teams (Mmg + nurse + secretary)” are enough? In 2021, are we still thinking of teams led by “Mmg and their staff”? While in other countries advanced nursing practice has been a reality for more than twenty years and, where there was a delay, the pandemic has finally made the full professional practice of nurses take off, in Italy we remain anchored to obsolete logics.
There is no room for many examples, but at least a hint to make people understand what I mean by “radical change” is a must. In other countries it is normal to go, for any health problem and as a first choice, to the office of a properly trained and certified nurse, able to independently manage not only the basic health needs of citizens, but to prescribe drugs or to refer the patient to the general practitioner or, again, to send him to the most suitable specialist until requesting a possible hospitalization.
And not only that: the district or family or community nurse has been the central pivot around which most of the health services around the world have developed. It is these nurses who operate in the preventive field, in the promotion of health and health education, in order to avoid hospital admissions as much as possible as well as to keep the population healthy.
This was the intent of the impetus given to Primary Health Care by the Who since the eighties of the last century. All this cultural movement in Italy has been translated (and reduced) to primary care, managed exclusively by doctors who, without the contribution or enhancement of other professional figures (and therefore not even their competence as doctors!), Found themselves at operate alone with an increasingly severe workload.
With all the esteem for the authors, I invite you to make an extra effort and – finally – to let yourself be “contaminated” by new ideas and proposals. The bibliography is really extensive and the data unequivocally document where to direct efforts and resources (for example, the Crea and Oecd data of 2021 speak for themselves). If in Italy we have 0.4 doctors per 1,000 inhabitants and 6.7 nurses per thousand inhabitants against the data of other European countries – 3.7 doctors per 1,000 and 9.4 nurses per 1,000 inhabitants – will also mean something. In our hospital operating units, only one nurse can assist 9, 10 or 12 patients with increasingly complex pathologies and problems.
A colleague told me that in Oxford, in the hospital where she serves, they have – as studies conducted around the world recommend – a maximum of 6 patients in general wards and 1: 1 in intensive care (they reach a maximum of one nurses for every two patients). By now there are also Italian studies that show dramatic mortality data associated with the low number of nurses (RN4Cast Italy, University of Genoa); we have not yet seen any kind of social or economic recognition (in recent months the nurses have gone from “heroes” to “greasers”); not only have not been increased places for access to degree courses, but the resources allocated to the training of future nurses continue to be reduced.
Is anyone realizing that we will close hospitals and health facilities due to a lack of nurses? Someone is reflecting on the fact that, especially after this dramatic period, there will be a further flight of nurses from hospitals to the territory, to a well-paid and career-developing job in other countries, not to mention a real exodus from profession?
If we associate this situation with the increase in the average age and chronic diseases, and the fearful denatality in our country, we can only combine our energies and, finally think out of the box!
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