A multi-annual plan to make nursing care more attractive in Belgium (2008-2011)

1. A multi-annual plan to make nursing care more attractive in Belgium (2008-2011)

2. ► 4 areas for action Easing workload and stress for the nursing staff Qualifications Remuneration Social recognition and participation in decision-making ► 3 sectors Hospitals Nursing and residential homes for older people Home care ► 2 objectives Enhancing the attractiveness of the nursing profession Providing professionals able to meet patients’ nursing needs and changes An ambitious plan

3. Action 1: easing workload and stress • In progress: • 1. Implementing the 2005-2010 Social Agreement► 1 extra FTE nurses or auxiliary per 30 hospital beds can be used by hospitals to create a moving team (2009-2011) • 2. Relaunching“Training project 600”► auxiliary nurses know the nurse job, are motivated to do it, need help to study • ► auxiliary nurse salaries is given to employer to liberate her to go back nursing school and engage someone else for the auxiliary nurse's job (a lot on labour market !) • ► Target group: 350 FTE every year (= 536 person in 2009) =19 million €/year • 3. Digitalising nursing information in patient records ► Nurses have to care, not to collect data, ND-HMDS (used for financial or health statistics) must be automatically extracted from nursing files (from 2009 : 16,3 million €/year) • Planned : • Extra non-nursing jobs : providing administrative and logistic assistance to care units • Stimulating ergonomic investments (study in progress about recommendations) • Ensuring a better match between funding and nursing needs (study in progress) • Providing finance for the promotion of care that helps to maintain or recover residents’ independence + support and counsel from a nurse specialized in geriatric care

4. ► The EU fringe Belgium about nursing qualifications and EU36 directive (2 levels, great autonomy for schools, sometimes not enough hours…) : an opportunity to take a new model ? ► Continuous training is necessary to guarantee that qualifications are matched by needs Hospitals : gradually increase the funding (1 million € in 2009 = + 7,5%) Nursing and residential homes for older people / home care services: implementing an accreditation scheme which provides for a higher reimbursement rate for some services on the condition that a continuous training programme is attested (home care services: 1,75 million € in 2010, others : system in study) ►"Different patient patterns mean different nursing needs - Different qualifications mean different functions". This differentiation will occur as follows: Further investigation on differentiating functions on the basis of patient patterns and Studies on the nursing contents of the Hospital Minimum Data Set (ND-HMDS) ► Imposing a growing number of specialized nurses by means of existing standards A gradual recognition process, in a coherent framework, having regard to priority care needs 2008 : geriatric specialization and expertise, 2009 oncology specialization (2010 : paediatric, diabetology ?) ► Stimulating Master’s degrees in nursing and obstetrical care ► Considering how to legally extend autonomous practices and care prescriptions. Action 2: qualifications (proposals)

5. 1. Upgrading irregular services ► Continuity of care means a high number of working hours restricting family and social activities and leading to additional costs. ► Bonus per hour for services in the early morning or evening (6 a.m. - 7 a.m. / 7 p.m. – 10 p.m.) ► 63 millions € for 2010 2. Increasing financial value of basic specialties and special competences ► officially recognized expertise and specialization + Practice in the relevant sector is compulsory ► between 5 and 10 % of the current pay scale : 27 millions € for 2010 3. Nursing executives ► Further improving the value of executive tasks, first by extending the so-called complément fonctionnel (extra bonus for managerial activities) and afterwards by granting a pay level compatible with relevant legal training requirements (from 2009 : 800€ net/year/head nurse) 4. Home care – in study ► Differentiating functions, tasks and responsibilities = adapting the health care reimbursement scheme ► Supporting and upgrading nursing consulting ► Upgrading treatments by specialised nurses ► Upgrading group practices (including between self-employed nurses) ► Supporting inter-professional co-operation and alternatives to hospitalisation Action 3: remuneration

6. Proposals: ► Consolidating the positioning in health care establishments: - In hospitals: head of the nursing department and nurse managers - In nursing and residential homes for older people: further staff structuring ► GETTING BETTER KNOWN by launching a publicity campaign in the spring of 2009 with nurses ambasadors ► Improving participation in decision-making processes at all levels : In the KCE: adding 2 members to the BD, nominated by professional organisations Multi-partite Structure for Hospital Policy-Making:- ensuring nursing representation as such- setting up a section (still to be determined) with nurse representatives At the INAMI (National Institute for Health and Disability Insurance): reviewing the composition of the “Commissions de convention” (Agreement Committees) At the “Conseil fédéral pour la qualité de l’activité infirmière” (Federal Council for Nursing Quality): adding and financing nursing peer groups (1 for each basic specialty) as part of the Federal Council In hospitals: mapping out the tasks and functioning of the Nursing Council by ensuring the participation of nurses from baseline ► With regard to ethical matters, the creation of a National Order for Nursing must be discuted ► Structural funding for nursing professional organisations: the INAMI will grant funds for the UGIB. Action 4: social recognition and participation in decision-making