Guideline development,re-licensing, continuing

education and the nursing profession

Dr.Cordula WagnerNIVEL

www.nivel.nl

Content presentation

• (re-) licensing • continuing education• definition guidelines• quality of nursing guidelines• accreditation nursing guidelines• discussion

ENQual workshop II

Nurses in The Netherlands

• 424.418 work as nursing professionals– 329.000 education level 1 – 5– 137.000 no specific education

– 77.037 work in hospitals– 118.297 work in long term care– 142.130 work in home health care organisations

• 135.000 registered nurses – 84% female

Task differentiation

• Nurses– Specialised nurse– Nurse specialist

• Physician assistent (PA)• Nurse practitioner (NP)• Advanced nurse pratitioner (ANP)

Educational levels andLicensing

• RN (level 5) – 4 years higher education• RN (level 4) – 4 years in hospital• Carer (personal care) (level 3) – 3

years• Carer (level 3) – 3 years• Caring help (level 2) – 1 year• Home help (level 1) – couple of month

Re-licensing

• All nurses are registered in a specific register

• Registration gives title protection• Still working on criteria for re-

licensing

Continuing education

• Continuing education is not obliged for nursing professionals

• In most hospitals nursing professionals are stimulated to follow further education

• In nursing homes and home health care carers and helpers have less opportunity to follow further education

Definition Evidencebased guidelines

• systematically developed recommendations to help social workers, nurses, physicians and patients with decisions about suitable care in specific situations (www.agreecollaboration.org )

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Guidelines

• Survey 800 guidelines and protocols– A few national guidelines– A lot of local guidelines– Most guidelines for the cronically ill

• Difference between guidelines (what?) and protocols (How?)

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Guideline development

• General practitioners- 70 national standards; developed by

specialised organisation

• Medical specialists- 50 national guidelines; developed by

specialised organisation

• Nursing profession- 800 guidelines and protocols; developed by

individual health care organisations, - compliance 50%

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Examples guidelines

19952000

• Restricted medical actions 42% 72%

• Patient routing 38% 57%

• Critical moments 40% 50%ENQual workshop II

Poor quality

• aim of the guideline described 57 %

• clarity in sequence of decisions 39 %

• clarity in dealing with patients preferences 8 %

• actual recommendations 69 %

• recommendations for several users 14 %

• situations whereby deviation is allowed 3 %

• relation to other guidelines indicated 13 %ENQual workshop II

Poor quality

• procedure for actualizing 8 %• evaluation of achievement of aims 1 %• criteria for testing compliance 1 %• mentioning who can answer questions 66 %• estimated health costs/gain 0,4 %

Conclusion: 1) guidelines do not comply with criteria

2) need for authority to judge and improve guidelines

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Platform Quality of nursing care

• 1999 feasibility study to investigate the agreement within the profession for a Quality Platform that would authorize guidelines

• about 65 nursing organizations; 51 are a member of the umbrella organization AVVV (Dutch Association of Nurses and Careworkers)

• 2000 - Platform on the Quality of nursing care founded

• Platform consists of representatives of various nursing organizations

• budget for 3 years

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Aim of the Platform

• the development of quality criteria for accreditation;

• accreditation of evidence based guidelines for the nursing profession;

• to stimulate quality improvement of guidelines;

• development of a comprehensive quality policy for the nursing profession.

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Accreditation of nursing guidelines

• Quality criteria based on the AGREE instrument

• Independent testing committee of 5 experts -> positive/negative advice

• Q-Platform decides about Quality Label -> National guideline

• First guidelines were not good enough to get the Quality Label

• Discussion: criteria to difficult to reachENQual workshop II

Conclusion

• Quality of local guidelines is poor -> develop new guideline

• the step-wise approach works, but asks for specific knowledge -> not feasible in every health care organization

• A central specialized organization• What to do with the great amount of

local guidelines? Legal consequences!

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Questions

• Do nurses in your country have national or local guidelines?

• Do they have evidence based guidelines?• Is there a difference between guidelines

and protocols• Do you have quality criteria for guidelines?• Do you have a quality label?• Are nurses obliged to follow further

education?• What are the criteria for re-licensing?

ENQual workshop II