7.L. Workshop: New roles and innovative skill-mix in nursing across Europe: trends and lessons for implementation

Abstract   Many countries in Europe are changing the roles and skill-mix of their nursing workforce. A sufficient and well-skilled nursing workforce has shown to be key for population health, most recently demonstrated during the Covid-19 pandemic. An increasing number of countries have introduced Master-level education for nurses to work in advanced practice nursing (APN) roles. These changes in the educational systems have implications on patients, clinical practice, teams and health systems. Moreover, many countries are re-orienting their health services from hospital to primary health care and prevention, driving new roles for nurses. The relevance of high-quality education and upskilling has been exemplified during the Covid-19 pandemic, where nurses had to quickly adapt to new treatment and caregiving situations in challenging work environments. Objectives of the workshop. This workshop will provide an overview of research and policy developments in Europe, drawing on recent research. First, an overview of innovative skill-mix changes in nursing will be presented and evidence on health outcomes, based on a study from the European Observatory on Health Systems and Policies. Second, research from Germany in five innovator hospitals will be presented, a country which is still at an early stage with integrating nurses in advanced roles. The panel discussion will address innovations in APN research, practice and policy lessons in Europe and with in-depth insights from four countries (Netherlands, Finland, Switzerland, Germany). In the Netherlands, the policy instrument “experimental law” has led to full practice authority for Nurse Practitioners, its impact on practice as well as barriers and enablers will be addressed. In Finland, the focus will be on recent evidence on the expanded role of nurse prescribers, the policy process and early evidence on impacts for nurses and patients. In Switzerland, the lack of regulation and reimbursement schemes restrict advanced practice, whereas drivers comprise changes in population needs, education (master and doctoral level) and reduced workforce availability. Developments at the national and cantonal level and the evaluation of innovative care models with APNs will be presented using case examples and recent research (e.g. university hospitals, primary care). The panelists will discuss implications for research, policy and nursing management, also taking into account the Covid-19 pandemic and other unexpected “health shocks” which have shown to impact considerably on nurses’ roles in practice. Lessons will be shared on strategies for a well-qualified and -resourced nursing workforce integrated in systems. The format is ‘regular workshop’ with two presentations and a panel discussion with experts from four countries. Key messages • Multiple innovative nursing skill-mix model exist, with promising outcomes for individuals and population groups if nurses are well trained and equipped. • Implementation of APN roles requires enabling policy contexts, sufficient funding, clinical leadership, teams that are open to innovations, and strong nurses that take on APN roles.

Health promotion and disease prevention programme registries can play an important role in increasing transparency of ''good/ best Practices'' and promoting their implementation. In the EU, there are different approaches to how registries seek to support the implementation of practices. However, there is limited knowledge of the extent to which there are informative differences or overlaps in the mechanisms chosen for accreditation, capacity building and implementation. This presentation focuses on six national registries in the EU (Finland, Germany, Italy, Netherlands, Poland, Slovenia) and the European Public Health Best Practice Portal. Information was obtained through a working group on Good/ Best Practice Portals, established in 2019. Information on the process of adding good/best practices to the registry and on measures that promote implementation was gathered and evaluated through a descriptive case comparison. The comparison suggests that implementation can be promoted through different approaches for capacity building measures and incentives for implementation. The latter included funding resources, titling/ awarding of practice and professional feedback in only a few registries. Registries may be useful not only for transparency of good and best Practices but also for implementation through capacity building and several incentives. The information provided in this presentation may be informative in guiding development of similar resources elsewhere and a starting point for discussion on how to support best the implementation of good/ best practices. In their function as overarching settings, communities have a controlling role and political competence for the development and implementation of healthy living environments in Europe. However, the establishment of health-promoting structures is often hampered by a lack of resources and know-how, and decisions in practice are mostly based on personal experiences or standard procedures, which are often not in line with scientific findings and evidence-informed decision making. In the area of physical activity and older people, a digital planning tool (''Impulsgeber Bewegungsförderung'') compromising tools for needs assessment, interventions and information on physical activity, process management, legal issues and funding is being built to support the implementation of practices by local public health actors. This presentation will introduce the digital planning tool and its process evaluation. A mixedmethod approach was applied to answer the question of whether and how the application can succeed in community settings and which additional needs of local actors exist. Initial steps of the recruited socio-economically disadvantaged model regions were setting up local steering committees and needs assessment using the tool. The model regions confirmed the usefulness of the tool in their day-to-day work, but used it with varying frequency. Among others, the tool helps to raise awareness among key actors, to reflect on their own work, or to identify funding sources. Wider use of the digital tool may lead to more evidence-informed actions in health promotion and prevention. The evaluation of the digital planning tool in a small area of health promotion will provide initial insights into how to support the implementation of activity-promoting living environments on a local level.
pandemic. An increasing number of countries have introduced Master-level education for nurses to work in advanced practice nursing (APN) roles. These changes in the educational systems have implications on patients, clinical practice, teams and health systems. Moreover, many countries are re-orienting their health services from hospital to primary health care and prevention, driving new roles for nurses. The relevance of high-quality education and upskilling has been exemplified during the Covid-19 pandemic, where nurses had to quickly adapt to new treatment and caregiving situations in challenging work environments. Objectives of the workshop. This workshop will provide an overview of research and policy developments in Europe, drawing on recent research. First, an overview of innovative skill-mix changes in nursing will be presented and evidence on health outcomes, based on a study from the European Observatory on Health Systems and Policies. Second, research from Germany in five innovator hospitals will be presented, a country which is still at an early stage with integrating nurses in advanced roles. The panel discussion will address innovations in APN research, practice and policy lessons in Europe and with in-depth insights from four countries (Netherlands, Finland, Switzerland, Germany). In the Netherlands, the policy instrument ''experimental law'' has led to full practice authority for Nurse Practitioners, its impact on practice as well as barriers and enablers will be addressed. In Finland, the focus will be on recent evidence on the expanded role of nurse prescribers, the policy process and early evidence on impacts for nurses and patients. In Switzerland, the lack of regulation and reimbursement schemes restrict advanced practice, whereas drivers comprise changes in population needs, education (master and doctoral level) and reduced workforce availability. Developments at the national and cantonal level and the evaluation of innovative care models with APNs will be presented using case examples and recent research (e.g. university hospitals, primary care). The panelists will discuss implications for research, policy and nursing management, also taking into account the Covid-19 pandemic and other unexpected ''health shocks'' which have shown to impact considerably on nurses' roles in practice. Lessons will be shared on strategies for a well-qualified andresourced nursing workforce integrated in systems. The format is 'regular workshop' with two presentations and a panel discussion with experts from four countries.

Background:
Many countries in Europe and worldwide have implemented new professional for nurses or are in the process of implementation, yet, an overview of the evidence on skillmix changes has been missing. This study has analysed skillmix innovations in nursing, evidence on outcomes and lessons for implementation.

Methods:
An overview of systematic reviews, following a protocol plus country case studies, as part of an international study. The literature search was performed in six databases, with search terms covering skill-mix whereby the nursing profession played a key role. Screening was performed by three researchers after high interrater reliability rates were achieved. Analyses were performed for the nursing professions, a typology of skill-mix changes (task-shifting and role expansion) and evidence on outcomes.

Results:
A total of 42 systematic reviews were identified on nurses working in new roles. The roles varied considerably, ranging from nurse prescribing to advanced practice nursing and nurse-led clinics. Nurse-led chronic care programmes were frequently identified, with overall positive outcomes on several health outcomes, e.g., for patients with diabetes or cardiovascular diseases. Nurses were also working in advanced roles in health promotion and prevention, e.g., performing screening programmes, showing equivalent quality of care compared with doctors if adequately trained. Several skill-mix models to enhance care coordination and integration were identified, suggesting that when tailored to the needs of specific population groups, particularly for vulnerable groups, may improve health outcomes or access to services.

Conclusions:
The roles of nurses are increasingly diversifying and expanding internationally. Sharing country experiences on how to effectively educate the workforce to be prepared for these new roles and ensure smooth integration is critical.

Background:
In Germany, the number of Bachelor and Master programs for nurses has increased significantly over the past 20 years but the recommended target of 10%-20% of academically qualified nurses has not yet been reached. In university hospitals, it was 3% in 2018. Major challenges for hospital managers are to attract and retain academically qualified nurses in clinical practice, with some hospitals doing better than others.

Methods:
In 2020, semi-structured interviews (n = 18) were conducted with chief nursing officers, nurse managers, nurses, and physicians working in five innovator hospitals, characterised by a high willingness to change the work environment, improve quality of care, and increase the number of academically qualified nurses. The interviews were recorded, transcribed, and analysed using Atlas.ti. Mayring's qualitative content analysis method was applied.

Results:
Recruiting, retaining, and integrating academically qualified nurses varied in the five hospitals studied but all provided time and/or financial support for nursing students. Those with a longer tradition of attracting academically qualified nurses were following a hospital-wide strategy. CNOs or other leaders motivated nurses to enrol in a degree program, provided close support for clinical projects (e.g., on the ward) and when starting a career (e.g., coaching), and fostered individual career planning. Specialised tasks for nurses with a master's degree were leadership roles or specialised patient care. Taking over additional clinical or scientific activities according to their