How can a country learn from the experience of another? Expanding nurses’ scope of practice in Portugal: Lessons from England

doi:10.1016/j.healthpol.2014.12.005

Health Policy

Volume 119, Issue 4, April 2015, Pages 475-487

https://doi.org/10.1016/j.healthpol.2014.12.005 Get rights and content

Highlights

•
The Portuguese healthcare system uses an inefficient combination of nurses and doctors.
•
Britain's example of enhancing nurses’ roles as a possible source of policy learning.
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Potential ingredients for a successful strategy for Portugal were identified.
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The study provided an explicit framework of questions to explore in formulating such policy changes.

Abstract

Introduction

The composition of the Portuguese health workforce suggests an inefficient combination of nurses and physicians. Evidence indicates that, under specific circumstances, nurses can provide equivalent care to that delivered by physicians. England has a broader experience in developing policy-led initiatives in this field from which Portugal can learn. The study explores this issue, aiming to assist in informing policy formulation.

Methods

The study analysed English policies which led to the enhancement of nurses’ roles between 2000 and 2010. A literature review and interviews with selected informants were carried out.

Results

In 2000, the British government adopted a new policy for the health sector. A “working differently” strategy was subsequently developed. An increase in demand as well as the failure to improve access, efficiency and quality of service were the drivers for change. The strategy was fostered by the idea of building roles around patients and several tools were developed in order to trigger change, in which different stakeholders performed a central role. In spite of the registered progress, by the end of 2010, some issues remained unresolved, namely the lack of a specific framework to regulate nurses’ expanded functions.

Conclusion

This study provides Portuguese policy-makers with useful knowledge for defining a strategy to expand nurses’ scope of practice, by proposing a general framework of key aspects to be taken into account.

Section snippets

Materials and methods

The research was developed following a single case study methodology, as our aim was to obtain an in-depth understanding (a descriptive and explanatory comprehension) of the English policies for expanding the nurses’ scope of practice, set in their context (relevance of the circumstantial conditions to the phenomenon under study) [29]. Time, e.g. the 10-year period after The NHS Plan of 2000, and type of actions, e.g. the policies commissioned by the national health officials, were used as

Findings from the literature review

First, we outlined the current profile of the nursing profession in England. Search criteria allowed the identification of 20 policy documents which, step by step, led to the recognition of advanced nursing over the 10 year period. Table 1 lists these documents. Cross reference and key informants’ suggestions resulted in the subsequent addition of other six documents [35], [36], [37], [38], [39], [40].

Discussion

This study is based on a single case study, limiting the generalizability of its findings, which in any case was not the objective. The analysis of other countries’ experience in drawing lessons from England would be useful to prevent uninformed transferability [3], [4].

The study design was built on a lesson-drawing approach and it might be affected by an inadequate consideration of contextual factors of the country from which lessons were drawn, e.g. its institutional and structural

Conclusion

In this study we aimed at gathering knowledge from the England's experience of scaling up the nurses’ roles in order to advise a similar type of policy in Portugal, as we assumed that an inefficient skill mix between nurses and doctors was responsible, at least in part, for the non-optimal performance of the Portuguese health care system.

Contextual constraints and facilitators for technical and political feasibility were assessed with the intention to prevent inappropriate transference [4]. We

Author contributions

MT conceived the study, performed the literature review, the interviews, as well as its content analysis, and drafted the manuscript. GD took part in the study design, critically revised the research and coordinated the draft of the manuscript. Both authors read and approved the final manuscript.

Conflict of interest

The authors declare that they have no competing interests.

Acknowledgements

We thank the key informants and AP Portugal who provided the interviews transcription.

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¹: These authors contributed equally to this work.

View full text

How can a country learn from the experience of another? Expanding nurses’ scope of practice in Portugal: Lessons from England

Highlights

Abstract

Introduction

Methods

Results

Conclusion

Section snippets

Materials and methods

Findings from the literature review

Discussion

Conclusion

Author contributions

Conflict of interest

Acknowledgements

Revista Portuguesa de Saúde Pública

Handbook of public policy analysis. Theory, politics and methods

What is lesson-drawing?

Journal of Public Policy

Learning from abroad: the role of policy transfer in contemporary policy-making

Governance

Health in Portugal a challenge for the future. Background paper

Human resources development: the challenge of health sector reform

Human resources for health in Europe. European observatory on health systems and policies series

Monitorização mensal da actividade assistencial Julho 2013

Os Recursos Humanos da Saúde

40 Anos da Saúde em Abril

Skill-mix and policy change in the health workforce: nurses in advanced roles

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Nurses in advanced roles. A description and evaluation of experiences in 12 developed countries

Portugal health system review 2011

15 Propostas para melhorar a eficiência no Serviço Nacional de Saúde

How can optimal skill mix be effectively implemented and why? Policy brief. Health systems and policy analysis

Nurses in advanced roles: a review of acceptability in Portugal

Revista Latino-Americana de Enfermagem

United Kingdom (England) health system review 2011

Case study research: design and methods

A Arte da Investigação com Estudos de Caso