The Slovenská komora sestier a pôrodných asistentiek together with nursing experts call on the deputies of the NR SR to reject at the next sitting of the National Council of the Slovak Republic the draft law amending and supplementing Act No. 578/2004 Z.z. on providers of health care, health care workers, self-governing professional organisations in health care and on the amendment and supplementation of certain laws. In this open letter, we address the deputies of the NR SR on behalf of almost 38,000 nurses and midwives, citizens of this state, who welcomed with hope the commitment in the Government’s Program Statement 2020, where it declares the intent to return the title practical nurse from 2018 to healthcare assistant.
Currently, the opposite is happening, which again signals to us that Slovak nursing, as well as Slovak nurses, are not accepted as experts or as partners, and this is one of the reasons why we have a shortage of nurses. This is because experts in this area were not consulted, or their views were ignored. Unfortunately, those directly affected by this issue—the healthcare assistants themselves and nurses—never requested this change, were not invited to draft this proposal, and are rightly disillusioned and angry that representatives of hospitals, healthcare schools, and business people—who do not know nursing issues and whose only goal is to seek short-term and simple solutions to the shortage of workers in healthcare—are deciding on their professions.
The proponents of the proposal repeatedly attempt to convince deputies that changing the title of healthcare assistant to practical nurse assistant will increase interest in the profession. We therefore state several reasons why this legal proposal must be rejected:
1. The alleged increase in interest in studying practical nursing at secondary health schools does not mean there will be interest in practicing it. Modern human-resources approaches can simply explain the reasons for a lack of interest in practising this profession. Any quality manager knows that interest in studying in secondary health schools will certainly not be driven by a title of a healthcare profession, but by its prestige, wage conditions, attractiveness of the work environment, opportunities for personal growth, qualifications, room for the realization of personal and family life, etc. It is a false and misleading notion that only increases tension in nursing teams, contributes to worsening relationships, and creates chaos in nursing professions. It relies on an unverified claim by the Association of Secondary Health Schools that this factor alone increased the number of students by 40%. SKSaPA, nor any other entity, knows the methodology or the way the Association reached this conclusion, and therefore has well-founded doubts about its objectivity.
2. The proposed designation practical nurse-assistant is a confusing designation
primarily for the patient themselves, the central subject of interest in legal relationships regulated by Act No. 578/2004 Z.z. It is confusing mainly because it presents the term (practical) nurse, which may give the patient the impression of a nurse with higher qualification, and on the other hand the term assistant, derived from the verb to assist. The purpose of renaming healthcare assistants to practical nurse-assistants is only to mislead patients, who orient themselves very poorly in the classification of healthcare workers, while the term nurse is already familiar to them. The patient will therefore wrongly assume they are being provided care by a nurse, when in fact it will be a less qualified healthcare assistant.
3. No healthcare profession should include the term nurse in its designation if the people practising that profession do not meet the qualification requirements for its performance. The proposed legal amendment is contrary to Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. Under Article 31(3) of this Directive, professional preparation of nurses responsible for general care amounts to at least three years of study, which can also be expressed as ECTS credits and which includes at least 4,600 hours of theoretical and clinical professional preparation, of which theoretical professional preparation represents at least one third and clinical professional preparation at least half of the duration of professional preparation. Training of healthcare assistants (2,400 hours) does not satisfy the above requirement, which is set for obtaining qualification for the regulated profession of nurse.
4. SKSaPA is entitled to refer to a proposal of the European Federation of Nurses based on modern nursing science in Europe, adopted by all EU countries. EFN recommends a 4-level model of nursing (Matrix 3+1), which does not violate EU directives and was developed on the basis of evidence-based practice.
In this model there are three categories of nurses:
1. category “general nurse or registered nurse” – General Care Nurse (RN),
2. category “specialist nurse” – Specialist Nurse (SN),
3. category “nurse with advanced practice” – Advanced Nurse Practitioner (ANP), where a true practical nurse with higher education level II is also included.
The position of “healthcare assistant” – Healthcare Assistant (HCA), who may perform activities only in cooperation with a nurse, is listed as part of the nursing team as “+1” in the 3+1 matrix.
5. The presented proposal cannot be assessed otherwise than as a reduction in the quality of healthcare provided. The purpose of the proposal is to make the nursing profession performable by demonstrably less qualified practical nurse-assistants. Lower qualification logically means lower quality care, because care is provided by a health worker who has completed shorter theoretical and practical training. We draw attention to the study: Nurse staffing end education and hospital mortality in nine European countries: a retrospective observational study (Linda H. Aiken & co. for the RN4CAST consortium ) https://pubmed.ncbi.nlm.nih.gov/24581683/
6. At the same time, we point out the need for an unambiguous separation of competencies for performed activities depending on achieved education; in simpler terms, it must be excluded that the competencies of nurses and healthcare assistants (practical nurses) are identical, or nearly identical. Nursing activities can and will continue after the proposed change of Act No. 578/2004 Z.z. to be performed only by nurses, in no case by practical nurses. These will be authorized to perform only those activities currently assigned to healthcare assistants in Decree No. 321/2005 Z.z. We consider these competencies excessively broad and apparently contrary to the directive. We therefore point out, for example, that two activities entrusted to healthcare assistants in the Czech Republic (administration of medicinal products by intramuscular injection and venous blood sampling) were assessed there as activities that a healthcare assistant cannot perform because they conflict with Directive No. 2005/36/EC. (the legal opinion of the Government Office lawyers of the Czech Republic, who pointed out this fact, despite this it remained retained in the decree). In Slovakia, these activities are also assigned to healthcare assistants in conflict with the directive.
7. The idea that Slovakia will build a strong corps of practical nurse-assistants who will not be authorized to perform the regulated nursing profession in EU countries, and therefore will stay working in Slovakia, is false. Graduates of secondary health schools make up the largest group of students at faculties of nursing precisely with the goal of obtaining a qualification enabling migration to more favorable economic conditions. Keeping them in the Slovak health care system will be possible only by creating competitive conditions compared with other EU countries.
Source: Slovenská komora sestier a pôrodných asistentiek Slovenská komora sestier a pôrodných asistentiek (SK SaPA) is a self-governing professional organization of nationwide scope, with its seat in Bratislava, uniting 38,000 nurses and midwives. The primary task of SK SaPA is to defend the professional, economic and social interests of chamber members in healthcare, social, educational and other institutions.