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Nursing competence in municipalities requires improvement

Norwegian municipalities lack highly qualified nurses. This is revealed in a new study on the quality at municipal institutions.

Photo of Torunn in front of a wall for nurses
“The lack of specialist nurses is a major challenge for the quality of services in municipalities,” says Torunn Kitty Vatnøy, a researcher and associate professor at UiA.

“There is a critical shortage of nurses with a master's degree or additional training in emergency nursing, geriatrics, and mental health within the municipal in-patient acute care services in this country,” says Torunn Kitty Vatnøy. She is a researcher and associate professor at the University of Agder (UiA) and is affiliated with UiA's Centre for Care Research.

She recently defended her doctoral dissertation, in which she analysed the competence levels in the municipal 24-hour acute care service across the country and identified the need for higher nursing competence.

The doctoral thesis is based, in part, on in-depth interviews with eight nurses and two physicians. She also distributed a questionnaire to the municipalities, receiving a 92 per cent response rate.

“My thesis demonstrates that nurses require expertise in clinical assessments and advanced nursing competence to make sound clinical decisions in acute situations,” says Vatnøy.

Torunn Kitty Vatnøy er forskar og førstelektor ved Universitetet i Agder (UiA) og knytt til UiAs Senter for omsorgsforsking.

Torunn Kitty Vatnøy is a researcher and associate professor at the University of Agder (UiA) and is affiliated with UiA's Centre for Care Research.

New needs following healthcare reform

The need for highly competent nursing staff in municipalities has increased since the introduction of the Coordination Reform in 2012. The reform aimed to strengthen cooperation between the municipal health service and the specialist health service, namely municipalities and hospitals.

One of the primary initiatives of the reform was the establishment of 24-hour municipal in-patient acute care services. From 2016, all municipalities have been required to provide round-the-clock care and observation for patients with acute needs.

“Municipal acute care beds are intended to alleviate the burden on hospitals, offering healthcare for individuals who are not sick enough to be in a hospital but too ill to be treated at home. While the service offers many benefits, it demands a high level of competence,” says Vatnøy.

Unspecified competence requirements 

It is widely agreed that older and vulnerable patients require highly qualified healthcare personnel. However, the nursing competence requirements at the acute care services are inadequately defined by the health authorities.

“In the Coordination Reform, it is specified that doctors and nurses should be present at the acute care units, but there is nothing mentioned about the need for advanced nursing competence among nurses,” says Vatnøy.

She explains that advanced nursing skills at the master's level encompass knowledge and the ability to take responsibility, along with the capability to handle uncertain events and complex disease patterns.

Needing urgent medical attention

Vatnøy refers to an example where an elderly patient requests a warmer duvet when they actually require immediate medical treatment. The patient feels cold due to a rapidly rising fever, and their condition could quickly escalate into a life-threatening infection (sepsis) if the nurse fails to interpret the situation correctly.

“Sepsis progresses rapidly and is life-threatening. It is imperative that a doctor is contacted and critical treatment is promptly initiated in such situations,” emphasises Vatnøy.

According to Vatnøy, having nurses with advanced education, preferably at the master's level, is a great advantage in accurately assessing such situations.

Municipalities do not prioritise education

“The lack of specialist nurses is a major challenge for the quality of services in the municipalities,” says Vatnøy. There are educational opportunities for nurses who want to enhance their skills and knowledge, but many of these programmes have vacant spots.

“It's not surprising. The target group is working nurses; they have jobs and income. One cannot expect them to quit their jobs and give up their income to pursue further education. I find it more surprising that these programmes have applicants at all,” says Vatnøy.

At the same time, she points to a tendency among municipalities to prioritise staffing over further education due to the general shortage of nurses.

“However, municipalities must recognise the need for higher competence and facilitate opportunities for employees to pursue further education,” she says.

Underutilised capacity

Municipalities in this country are only utilising 41 per cent of the capacity in their acute care units. The likely reason is that doctors prefer to send patients to hospitals rather than the municipal acute care units.

“Doctors lack confidence that the municipal emergency 24-hour centres have sufficient competence to manage patients, and this is very worrying. It also underscores what my study shows about insufficient competence in the municipal health services,” says Vatnøy.