The trend of aging has given rise to a large and rigid demand for professional medical nursing services in society. However, at present, there is still a significant gap in the total number and structural aspects of the nursing workforce in our country.
To alleviate the supply and demand contradiction, the National Health Commission has recently emphasized several times that more medical nursing resources need to be released from both the existing stock and the increment, and the attractiveness of nursing positions should be enhanced. This includes promoting the regional registration system for nurses, strengthening training for grassroots nurses, and formulating and improving policies related to the prescription rights of specialized nurses in a timely manner.
On September 5th, in response to the proposal from a member of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) on "widely implementing the regional registration system for nurses," the National Health Commission stated that the "Nurse Practice Registration Management Measures" clearly stipulate that nurses undertaking tasks approved by the registered practice institution, such as health support, further education, academic exchanges, government-assigned matters, and participating in free clinics approved by the health and health authorities, practicing in medical and health institutions that have signed support or trust agreements, and providing home nursing services dispatched by the practice institution, do not need to go through procedures for changing the place of practice.
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"At present, our commission has carried out pilot work for the regional registration of nurses in Beijing, Tianjin, Shanghai, Zhejiang, and Guangdong, exploring local practices and experiences. The next step will be to continuously study and improve relevant policies based on the summary of relevant experiences," said the National Health Commission.
Nurse regional registration refers to the practice registration location of a nurse being within an administrative region, and the practice registration is valid throughout the entire region during the registration period. If a nurse practices in multiple medical institutions within the same region, they should designate one medical institution as their main practice institution and report other practice institutions to the health and health administrative department.
Industry insiders believe that, similar to the regional registration for doctors, the regional registration for nurses opens up channels for multi-point practice. With the gradual implementation of the multi-point practice policy for doctors, the social call for "multi-point practice for nurses" is becoming increasingly strong.
An industry insider who once served as the dean of a tertiary hospital told Yicai that compared to doctors, grassroots medical institutions have a greater shortage of nurses, especially in the lack of specialized nurses such as geriatric and pediatric nursing. "Our country has insufficient total number of nurses, no stratified use, and due to high work pressure, low salary, and limited career development space, there is also a phenomenon of attrition. These issues urgently need to be solved systematically."
According to the latest data released by the Ministry of Civil Affairs at the end of August, the proportion of the elderly population aged 60 and above in China has exceeded 20%, entering a moderately aged society. Other statistics show that there are more than 180 million elderly people in China suffering from chronic diseases, and about 40 million elderly people are disabled or partially disabled.
In contrast, there is a significant gap in the supply of nursing services. Data from the National Health Commission shows that in the past ten years, the total number of nurses in the country has increased by an average of 8% annually, and by the end of 2022, the total number of registered nurses nationwide exceeded 5.2 million, with a doctor-nurse ratio of 1:1.18. By the end of 2023, the total number of registered nurses nationwide increased by 413,000. That year, there were 3.40 practicing (assistant) physicians per 1,000 people and 4.00 registered nurses per 1,000 people, which is still short of the goal of "gradually reaching a doctor-nurse ratio of about 1:2" for the high-quality development of public hospitals.
Jin Chunlin, director of the Shanghai Health and Healthy Development Research Center, told Yicai that the "nurse regional registration pilot" system design is conducive to better leveraging the role of high-quality nursing resources, encouraging nurses from secondary and tertiary medical institutions to practice in grassroots and social medical institutions, and enhancing the nursing capacity of grassroots hospitals. However, in practice, it may have a reverse effect on the tiered diagnosis and treatment system."The movement of nurses within regions is bidirectional. If nursing personnel from grassroots hospitals flow upwards, it will deviate from the original intention of the policy," said Jin Chunlin.
In Jin Chunlin's view, there are many obstacles to the implementation of multi-site practice for nurses. First, multi-site practice is not the same as free practice; nurses need to sign relevant contracts or agreements with the medical institutions where they practice. Second and third-tier hospitals may "not let go" of personnel due to tight labor resources; second, when nurses practice at multiple sites, if nursing adverse events or medical disputes occur, it is difficult to manage and handle; third, whether the capabilities of nurses practicing at multiple sites match the positions, and whether the compensation is sufficient to match, these issues remain unresolved.
A research article published this year by researchers from the Peking Union Medical College Hospital in the "Journal of Nursing Science" mentioned that currently, there is no unified standard for the qualifications of nurses practicing at multiple sites in our country. Nurses practicing at multiple sites in pilot areas (Guangdong, Shanghai, etc.) show a "three lows" state: young age, low title, and short working years. Based on the fact that nurses in our country have not been granted prescription rights, nurses practicing at multiple sites mostly provide basic nursing services, including home-based basic nursing, chronic disease management, health education, wound care, etc.
"It can be seen that our country urgently needs to improve the qualification certification system for nurses practicing at multiple sites," the article suggested. In combination with the actual development of multi-site practice in our country, multi-site practice and specialty nurse training should be combined. For specialty nurses who meet the qualification requirements and pass the assessment, issue multi-site practice licenses, allowing specialty nurses with rich professional knowledge and skills to engage in multi-site practice.
Jin Chunlin believes that clear charging standards can be established for long-term, specialized nursing services for special groups such as cancer patients after discharge and disabled and demented elderly people in grassroots hospitals, communities, or home settings, to encourage more nurses from second and third-tier hospitals to engage in related work and practice at multiple sites.
In addition, Jin Chunlin also mentioned that encouraging multi-site practice for nurses is to "do articles" on existing resources, and the issue of incremental resources has not changed, and shortages still exist.
To further "do articles" on incremental resources, the National Health Commission said in response to another proposal from a member of the National Committee of the Chinese People's Political Consultative Conference on September 5, that it will guide localities to increase the training of grassroots nurses, and effectively improve their professional service capabilities in nursing for common and frequent diseases, geriatric nursing, rehabilitation nursing, etc. Implement the action to improve geriatric medical nursing, carry out pilot work for geriatric medical nursing services, and effectively increase the supply of geriatric medical nursing services.
To improve the treatment level of nurses, especially specialty nurses, the National Health Commission revealed in its reply to the "suggestion on formulating relevant legal provisions to grant prescription rights to specialty nurses" from a deputy to the National People's Congress in late August, that it will revise relevant regulations in due course and formulate and improve relevant policies on prescription rights for specialty nurses.
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