The nurses perform tasks they call for others. Those who could have done the tasks have been pushed out – by the nurses themselves, the researcher believes.
On Friday, Nettavisen wrote that in Sweden five nurses are needed to staff one intensive care unit – in Norway you need twice as many.
The head of Norwegian intensive care nurses, Paula Lykke, pointed out one significant difference between the two countries in particular, which may be the reason:
– In Norway today, the wards have been organized so that the intensive care nurses do everything from A to Z. This is not the case in Sweden. There you have support functions and a different type of task distribution. You have social workers in intensive care units who take care of all the practicalities, and assistants who do all the incidental work and the like, she told Nettavisen on Friday.
– Could the intensive care nurses in Norway have been used better?
– Yes, I believe that the right person in the right place will make the whole logistics much easier. Today, it is intensive care nurses who have to deal with patients’ bills or a patient’s cat who is left alone at home. A sociologist will be able to handle this much better. We are working on relatives ‘parking… there are lots of tasks that could have been handled by secretaries, external or unskilled, said the leader of the Norwegian Nurses’ Association’s national group of intensive care nurses.
Who is to blame?
One question that remained unanswered after the article was who had ensured that the nurses were in charge of all the work, including in the intensive care units.
In the wake of the article, Nettavisen has received several tips from people who work in various parts of Norwegian health trusts.
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A former head of department, who does not want to be named because of his position, says there is “no doubt that the Norwegian Nurses’ Association has been a driving force for the nurses to be responsible for the staffing” at the hospitals, because it was thought “difficult to separate the work tasks between the occupational groups ».
Several of the tipsters have pointed to what is referred to as The Loen decision, a decision from the Norwegian Nurses’ Association (NSF) in 1989. The nurses decided at the time that they should work so that in the future only nurses, and not health professionals (then called auxiliary nurses), who worked with patient care in Norwegian hospitals.
They have almost succeeded.
– That decision symbolizes in a way the professional struggle that the nurses started.
Håkon Høst, researcher at the Nordic Institute for Studies of Innovation, Research and Education, tells Nettavisen. He has worked a lot with the Norwegian health sector in his long career.
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– Through that decision, the nurses said that in hospitals it should only be the nurses who performed the care, and not any other occupational groups. At that time, the auxiliary nurses were “the other” occupational group, says Høst.
– In 1980, nurses accounted for around 60 per cent of all nurses in hospitals. In 2020, they accounted for 90 percent. The health professionals have gone from 40 to 10 percent, says Høst, and refers to this graph:
– It is a rather dramatic change over the 30 years, says Høst, and adds:
– The nurses have been skilled and successful in their professional struggle, but you can perhaps trace some of the result in the crisis you are seeing now.
Jumps out of education
To become a health professional, you must complete the health worker subject in a vocational subject in upper secondary school. Health professionals work simply explained with basic care and care of patients.
To become a nurse, you must have study qualifications, as well as three years of higher education. Nurses can, among other things, give injections, give medicine and have more responsibility than a health professional.
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The Nurses’ own trade magazine, Sykepleien, completed in 2019 a survey that showed that more than 6 out of 10 nurses daily perform tasks they do not want to define as nursing tasks.
The number is about the same today, says the nurses’ leader, who comments further down in the case.
Nevertheless, the health professionals have been pushed out of the hospitals, according to several sources Nettavisen has spoken to.
Within vocational subjects, health and care is the largest program, and within that, health professional education is the largest direction, says Høst.
– The problem is that most people who take that education choose to drop out to further their education, says Høst to Nettavisen.
– Why do they do it?
– What they themselves state as a reason is that they want higher education, because they see that it is terribly difficult to get a job as a health professional in a hospital, something that especially young people can imagine. It’s terribly difficult to get into.
– A campaign
When Nettavisen mentions the Loen decision for the leader of the Norwegian Nurses’ Association, Lill Sverresdatter Larsen, she says:
– We have pointed out for several years, but also in the pandemic, the need to hire other types of personnel who can free up nursing capacity for what are nursing tasks. One of our top three priority work and goals for a long time has been division of tasks – how to free up nursing capacity. Both physiotherapists, health professionals, social workers or clinical pharmacists can perform tasks that nurses are assigned to do.
It is the Trade Union that represents, among others, health professionals and cleaners in Norwegian hospitals. In their own magazine, Fagbladet, they have several times taken up the Loen decision.
– That the Trade Union is constantly withdrawing the Loen decision, I perceive it simply as a kind of campaign and a professional struggle from the Trade Union, says Sverresdatter Larsen to Nettavisen.
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– I do not know what they are trying to achieve, whether it is to recruit more nurses or to promote themselves is not good to say, but the Loen decision was made in 1989. Then I was 10 years old. I can not take responsibility for a decision from that time.
– But according to researcher Høst, there are fewer health professionals at today’s hospitals precisely because of the Loen decision?
– I understand that, but the problem is that there is a shortage of almost 7,000 nurses and almost 2,000 health professionals, and we are missing them to the greatest extent in the municipalities. We can not just put them all in the hospital. We have to have them out in the municipalities as well.
– When you say missing, what do you mean by then?
– These are NAV’s figures for advertised positions where they do not receive applicants. They are missing.
– A bit ridiculous and comical
Researcher Høst answers that one can not skip the Loen decision, even though it is a little over 30 years ago:
– Following the Loen decision, a large number of auxiliary worker positions were converted to nurse positions in the hospitals. So even though Sverresdatter Larsen was not more than 10 years old when it happened, she should know the story. The health professionals were in many ways displaced to the municipal nursing care. Not that there is anything wrong with being there, but it has a lower status, especially for young people. They would rather work in hospitals, and very, very few health professional positions are advertised in hospitals, he says, and adds:
– That the Trade Union is accused of waging a professional battle against the nurses, it becomes almost a bit ridiculous and comical. They are so few in the hospitals, and in that sense so weak compared to the nurses, that they try to defend themselves and catch up a little … it is a terribly uneven battle.
Høst says that Norwegian hospitals are not managed in the same way as a private company, where the management decides which occupational groups are needed. In Norwegian hospitals, it is to a very large extent professionally controlled which occupational groups one should have there.
– And it clearly has its advantages, but also its disadvantages. One of the disadvantages is that strong professions manage to keep other groups out. This is what has happened, that the nursing profession has managed to monopolize care in total in Norwegian hospitals. If they now want to change it, it is very positive, but then you have to start with a concrete work for it. We have not seen much of that from their side so far, says Høst.
– Positive if you turn around
He emphasizes that this is not an attack on individual nurses in the current situation:
– They do a great job. What I’m pointing out are bigger, structural things. It is about the nurses as a group having succeeded with a professional policy that has meant that they have been left alone in the hospital arena. As a profession, the nurses have been given a little too much as they want, on a number of questions that are about division of labor, staffing and education, says Høst. On the other hand, he believes the state has been similarly weak as to allow this to develop.
– It is positive if the nurses intend to turn this around in practice, but the policy has lasted so long that it is probably true that today it is not so easy to recruit health professionals. The recruitment pattern has changed in total over the last 30 years. There are not several thousand outside the hospitals waiting for positions to become vacant. It is a long process to turn this around.
– This is necessary
Sverresdatter Larsen says that she obviously knows the history of NSF, and that the Loen decision is not quite as Høst presents it. She highlights, among other things, the reasons for the decision, which meant a change in the services:
– As a far more advanced treatment. The nurses could not work all of the inconvenient shifts to ensure the safety and the patients.
She says that there are still around 6 out of 10 nurses who perform tasks on a daily basis that they do not want to define as nursing tasks.
She completely agrees with both the Trade Union and Høst that the division of tasks in Norwegian hospitals could have been better:
– We are completely dependent on getting more people who can work in place, but I do not think there will be better capacity or quality if you hire more health professionals at the expense of the number of nurses. What you have to do is hire health professionals and other personnel in addition to nurses, she says.
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She points a finger at the government, but also at the hospitals and municipalities:
– There are top managements who have not done what they are supposed to in several years, when it comes to the distribution of work tasks. It must be constantly cut and streamlined.
Hearing derogatory comments
The trade union recognizes itself in Høst’s statements about the position of health professionals within Norwegian hospital walls over the past 30 years.
– There has been a purge of health professionals and other occupational groups in the hospitals, and it has had negative consequences for our hospitals and the everyday work of those who work there. Larsen can not dismiss the significance of the Loen decision, says Iren Luther, vocational section leader health and social affairs in the Trade Union to Nettavisen.
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– Even though our main shop stewards say that they cooperate well with the various employee organizations, we hear about comments such as that it should be professionally unjustifiable to hire health professionals. They have been deprived of assignments because they are not considered good enough, but often lack the knowledge of what the various occupational groups can and have education in, Luther adds.
She points, like Sverresdatter Larsen, to the leaders, and comes with a peace pipe:
– We must to a greater extent work interdisciplinary to give patients the best treatment. This is a management responsibility, but we as parties can provide input and work together in the parties’ cooperation. We are very positive about working with NSF on a better division of tasks in the future, Luther concludes.
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