Family and community nurse: the Coronavirus is giving the final blow to something born lame, bringing out all the difficulties of an indefinite profile in fact.
Family and community nurse: an element that projects the whole professional family into the future of healthcare thanks also to fresh shades of renewal.
But is this really in fact?
The reports come from voices belonging to various Italian companies that have officially incorporated and developed the family nurse among their ranks. And these rumors all tell the same truth.
The family nurse is receiving the coup de grace from the Coronavirus emergency, finger in the sore of a project born beautiful but never really realized.
But let’s take a step back.
Who is the family and community nurse?
In 1998 the WHO Europe introduced the figure in the document “Healt 21” and since then the long ordeal of the recognition of this professional novelty has begun.
After a journey during which anyone who has had a microphone or a pen has tried to have their say, the first resolutions arrive that recognize the role and its importance (examples are Tuscany, with the resolution of 597/2018 but also Piedmont with 32-5173 / 2017).
The national consecration arrives on May 13, when in Relaunch Decree the sentence “In order to strengthen nursing services, also with the introduction of the family or community nurse […]“.
The law is clear: this nurse is busy, all over Italy!
Happy ending? I miss it for a dream.
Problem one: who becomes a family and community nurse?
The dynamics of establishing the profile in the field disappoint and raise questions.
The first major problem encountered is the identification of colleagues to invest in the role.
There are 1st level Masters (online and face-to-face) but the formats are very few and often they are not employees of the Companies.
The legislation says that the Regions can provide for the acquisition of self-employed personnel (VAT numbers) to be allocated to the task. But it is a half solution conditioned by the usual dilemma: is it really useful to train and make a personal expert on a fixed-term basis?
An important dilemma, especially in light of the delicacy of the role in question.
In most cases, we then proceeded with the reassignment of the colleagues of the territorial services who in a very short time and with very little training (statements deriving from their direct testimony), found themselves changing the name of the o.o. on the shirt.
Problem two: what does the Family and Community Nurse do?
A true and precise stance is missing and it shows. FNOPI has developed a document which hypothesizes the functions of the figure but in the end each regional resolution indicates some activities that belong to him.
Although this could be discussed, the Relaunch Decree itself determines the regional competence on identification and organization.
Problem three: the system is not ready.
At this point we have the family nurses. Thanks to their professionalism, experience and spirit of adaptation, they are able to withstand the impact of “re-destination”.
However, a serious problem arises. The family and community nurse is a central element in organizing the care of patients’ needs and, therefore, must interface with the other elements of the health system.
However, in most cases, they are not ready for this type of interchange. The reasons reported by colleagues are mainly attributable to:
- Lack of knowledge of the competences of the family and community nurse by other services;
- Lack of authority of the figure in other services.
It therefore happens that the Nurse finds himself singing them and playing them by himself, without in most cases taking into account what is presented by the professional.
The citizen’s need is therefore re-evaluated by 0 by the “landing” service.
Problem four (zonal): economic problem and fake freelance.
In some situations (Lombardy in particular) the employment of freelance personnel is creating a complex problem.
At the dawn of the establishment of the service, the news emerged that the family and community nurse would be hired as a freelance professional and that the hourly wage would be very attractive: 30 euros / h.
In addition, the professional was promised to compete in the newborn role that exalted the nursing figure.
These reasons have led some public employees to take leave and open the VAT number.
In their calculations, the earnings would have been huge in the face of a nice sacrifice spent in important working hours.
The joke came because the skills not only those expected over 140-150 hours it is not possible to work.
And the servant’s account must be subtracted from taxes, social security contributions and other expenses (for example, the accountant), about 60%.
If the Coronavirus kills the Family and Community Nurse.
The Coronavirus removes any problem, that is, it distances the Family and Community Nurse so much from his natural skills to bypass these difficulties.
The fault is partly attributable to the epidemic (disproportionate increase in needs and slowdown in performance due to restrictive hygiene measures) and partly to the Relaunch Decree itself which had indicated the new path.
Because the above paragraph continues: “In order to strengthen nursing services, including the introduction of the family or community nurse, to enhance the care in the territory of subjects infected with SARS-CoV-2 identified COVID-19, also by supporting the Special Continuity Care Units and the services offered by primary care […]“.
How does this translate into facts?
Dozens of family and community nurses who end up replenishing the ranks of USCA (Special Care Continuity Units) and primary care services.
In short, they end up working as unskilled workers: doing tampons, doing home services, doing outpatient services.
Coup de grace?
Although these realities are motivated by the state of emergency which is unquestionably real and concrete, the only hope is that this status quo is strictly momentary and does not represent the coup de grace to a dream that never really came true.
Also because this is unacceptable for both colleagues and the entire professional family.
We were unskilled workers and we will return, while those who celebrated on the wagon of the relaunch decree now feel and see very little.
(PS. I recommend reading the profile document prepared by AIFeC – Association of Family and Community Nurses).
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