European Federation of Nurses Associations
EFN
The European Federation of Nurses Associations represents three million nurses to influence health and social policy.
Lobbying Activity
Meeting with Ruggero Razza (Member of the European Parliament, Rapporteur)
25 Sept 2025 · INI EMPL-SANT report - EU health workforce crisis plan
Meeting with Ruggero Razza (Member of the European Parliament, Rapporteur) and Standing Committee of European Doctors
15 Jul 2025 · INI EMPL-SANT report - EU health workforce crisis plan
Meeting with Margarita De La Pisa Carrión (Member of the European Parliament)
3 Jun 2025 · EU Health Workforce
Meeting with Dirk Van Den Steen (Acting Head of Unit Health and Food Safety) and Standing Committee of European Doctors and Pharmaceutical Group of the European Union
2 Jun 2025 · Health workforce actions at EU level
Meeting with Veronika Cifrová Ostrihoňová (Member of the European Parliament, Shadow rapporteur)
14 May 2025 · Shortages of nurses and other medical workforces in the EU
Meeting with Grégory Allione (Member of the European Parliament)
30 Apr 2025 · Intergroup on Resilience, Disaster Management, and Civil Protection
Meeting with Annukka Ojala (Cabinet of Executive Vice-President Roxana Mînzatu)
6 Mar 2025 · Challenges facing nurses
Meeting with András Tivadar Kulja (Member of the European Parliament)
2 Dec 2024 · European health policy
Meeting with Tilly Metz (Member of the European Parliament)
21 Nov 2024 · Healthcare workforce
Meeting with Catarina Martins (Member of the European Parliament)
21 Nov 2024 · nurses working conditions
Meeting with Olivier Chastel (Member of the European Parliament)
19 Nov 2024 · Politique de santé de l Union européenne
Meeting with Adam Jarubas (Member of the European Parliament, Committee chair)
24 Oct 2024 · European Federation of Nurses Associations (EFN) on future Own Initiative Report on the EU Health Workforce
18 Jan 2024
As mentioned in the European Pillar of Social Rights principle 1 Education, training and lifelong learning, everyone has the right to quality and inclusive education, training and life-long learning in order to maintain and acquire skills that enable them to participate fully in society and manage successfully transitions in the labour market. For EFN, representing 3 million nurses in the EU, it is crucial to have high qualified nurses, to guarantee the quality of care and patient safety in the EU and Europe. The EU Directive 2005/36/EC on Mutual Recognition of Professional Qualifications (amended by Directive 2013/55/EU) is key to any future EU policy development on EU workforce for health. Therefore, the publication of the updated annexe V through a delegated act, to which the EFN members largely contributed, is more than welcome. EFN members endorsed the SPARK study outcomes which are now reflected in the Delegated Act. The proposed generally acknowledged scientific and technical advancements in education/training programmes in EU Member States and EFTA States are key to update the current minimum training requirements of Directive 2005/36/EC & Directive 2013/55/EU. EFN members believe that empowering citizens/patients, building on person centered care theories, strengthening evidence-based practice, a stronger focus on quality and safety, digitalisation skills to boost continuity of care (e-Health), multi-disciplinarity/mentorship, and technical innovations related to healthcare and nursing methods are essential updates in the Annexe V of the Delegated Act to complement Art 31 Directive 2013/55/EU. This is important for the curriculum for nursing within each Member State and will be particularly important in a post-Covid19 working environment, and the enormous shortage of nurses due to the pandemic and underinvestment in the nursing workforce for many years since the financial crisis which hit us hard in 2010. Furthermore, it is essential that all nursing schools interpret the eight competencies mentioned in Art. 31 in the same way. We need to make sure the education of nurses willing to move within the EU, based on Mutual Recognition of Professional Qualifications, is in compliance with article 31 and Annexe V of the Directive 36/55 (ref: EFN Competency Framework which describes the competences required to nurses responsible for general care - https://efn.eu/wp-content/uploads/2022/03/EFN-Competency-Framework-19-05-2015.pdf). This will not only build trust between the competent authorities signing off Mutual Recognition of Professional Qualifications requests, but also build trust in the healthcare systems in the EU and Europe (WHO, 2023 Tallin). In this context, the EFN Workforce Matrix 3+1 (https://efn.eu/wp-content/uploads/2023/08/EFN-Workforce-Matrix-31-Final-Oct.2016-REV-July-2023.pdf) is a very important policy document that complements the Directive and Annexe V, as it includes information on education, qualifications and competences for each category of nursing care (general care nurse, specialist nurse and advanced practice nurse).
Read full responseResponse to Evaluation of the Regulation on serious cross-border threats to health
17 Jan 2024
HERA has a narrow mandate of operation for preparedness, which is a weaknesses. Optimal preparedness for future health crisis in the EU can only be achieved by making sure the EU has the health workforce managing frontline health emergencies, with nurses playing a crucial role in coordination. Health threats need a specific focus on human resources for health, education and training of the frontline nurses and doctors. The growing shortages of doctors and nurses received no attention from HERA or DG Sante. Doctors and nurses are the ones who will enable the most effective and rapid action to be taken, they know the population, they know their environment (community), they know the words for good understanding and trust building in the healthcare system. It is key for optimal preparedness to address this issue in the future HERA mandate as during the COVID-19 pandemic, hospitals not only faced medicine and product shortages but also shortages of nurses and doctors. HERAs preparedness and response activities should include continuity planning for the healthcare delivery system with a specific focus on safe staffing levels as this is key to the response to any health threat. This would allow for a more holistic approach to health threats including EU actions on human resources for health shortages, workforce distribution, education/training, supporting national capacity building for emergency preparedness, resource planning and above all protecting the most vulnerable. EFN believes it is key to develop optimal and diverse ways to deliver public health countermeasures within healthcare systems by distributing not only medical countermeasures but also human resources and frontline staff, to minimise the impact on routine healthcare services. HERA should therefore support for workforce capacity building, distribution, training and upskilling of nurses and doctors. In any health emergency, the resilience and preparedness of European health workforce is vital. Setting a high standard of information and harmonise communications, addressing frontline healthcare professionals, by supporting the development of educational and training materials to address health threats, to ensure consistent messaging and enhance public trust. EFN proposes education and training modules on management, procurement, demand analysis and dispensing of public health countermeasures, as well as on how to communicate with patients in times of crisis. These modules should cover an integrated care system between hospital care and community care to respond better to the unmet citizens needs. Therefore, it is important at the governance level to add experienced frontline nurses to the European Health Security Council, not only physicians and epidemiologists, to advise on the daily management of the health crisis and education/training needed. The coordination of care is essential, with a specific focus on a dialogue between hospital care and community care (including care at home). Nurses must be fully utilised to manage the health crisis. The development of a European strategy on preparedness for health threats, to make sure the efforts of different actors, especially the frontline healthcare professionals, are aligned, and accountability well established, including through the use of relevant targets e.g. in reduction of workforce shortage. All this brings health to the core of EU decision-making and contributes to establishing the European Health Union with the European Health Workforce being a top priority for the upcoming Commission and European Parliament.
Read full responseResponse to Review of the Health Emergency Preparedness and Response Authority (HERA)
9 Jan 2024
Currently, HERA has a rather narrow mandate of operation, which is one of the main weaknesses for the future. HERA focusses currently on a very narrow definition of medical countermeasures, with a main focus on medicines, medical devices and personal protective equipment. Optimal preparedness for future health crisis in the EU can only be achieved by making sure the EU has the health workforce managing health emergencies. Health threats need a comprehensive public health approach, with a specific focus on human resources for health, education and training of the frontline nurses and doctors. The growing shortages of doctors and nurses received no attention from HERA. Doctors and nurses are the ones who will enable the most effective and rapid action to be taken, they know the population, they know their environment, they know the words for good understanding and trust building. It is key for optimal preparedness to address this issue in the future HERA mandate as during the COVID-19 pandemic, hospitals not only faced medicine and product shortages but also shortages of nurses and doctors. Mistakes from the COVID-19 pandemic related to the health workforce should not be repeated. HERAs preparedness and response activities should include continuity planning for the healthcare delivery system with a specific focus on safe staffing levels as this is key to the response to any health threat. This would allow for a more holistic approach to health threats including EU actions on human resources for health shortages, workforce distribution, education/training, supporting national capacity building for emergency preparedness, resource planning and above all protecting the most vulnerable. EFN believes it is key to develop optimal and diverse ways to deliver public health countermeasures within healthcare systems by distributing not only medical countermeasures but also human resources and frontline staff, to minimise the impact on routine healthcare services. HERA should therefore support for workforce planning, distribution, training and upskilling of nurses and doctors. In any health emergency, the resilience and preparedness of Europes health workforce is vital. Setting a high standard of information and harmonise communications, addressing frontline healthcare professionals, by supporting the development of educational and training materials to address health threats, to ensure consistent messaging and enhance public trust. EFN proposes education and training modules on management, procurement, demand analysis and dispensing of public health countermeasures, as well as on how to communicate with patients in times of crisis. These modules should cover an integrated care system between hospital care and community care to respond better to the unmet citizens needs. Therefore, it is important at the governance level to add experienced frontline nurses to the European Health Security Council, not only physicians and epidemiologists, to advise on the daily management of the health crisis and education/training needed. The coordination of care is essential, with a specific focus on a dialogue between hospital care and community care (including care at home). Nurses must be fully utilised to manage the health crisis. The development of a European strategy on preparedness for health threats, to make sure the efforts of different actors, especially the frontline healthcare professionals, are aligned, and accountability well established, including through the use of relevant targets e.g. in reduction of workforce shortage. All this brings health to the core of EU decision-making and contributes to establishing the European Health Union with the European Health Workforce being a top priority for the upcoming Commission and European Parliament.
Read full responseResponse to European Year of Skills 2023
14 Nov 2022
The COVID-19 pandemic changed all social patterns and strongly changed the way we work. The pandemic made everyone more aware of the essentiality of nurses work and all healthcare professionals to manage and tackle health crises. In a constantly changing labour market that is increasingly globalized, digital, robotic and green, the need to build and acquire new skills has become fundamental. In her State of the European Union Address, Ursula von der Leyen stressed the importance of education and upskilling as well as the need to facilitate the recognition of qualifications a key issue for the nurses and the nursing profession, due to the huge nurses shortage at EU level, and globally. On an EU-wide basis, policies must be developed and rapidly funded and implemented to secure enough nurses to allow progression and expansion of nurses roles that are required in an evolving health service, as well as the safe provision of professional nursing care at every level of health care delivery. During the COVID-19 pandemic years, nurses have demonstrated their vital role in running healthcare with tireless commitment and professionalism, and the health sector was identified as an important industrial ecosystem to partner up with, under the Pact for Skills. Due to the consequences of the COVID-19 crisis on health systems and the strong engagement of health stakeholders and industrial players, as well as the great potential of digital technologies for the sector, the Pact calls on industry, employers, social partners, public authorities, education and training providers, employment agencies, etc. to work together and commit to invest in training for all working age people across the Union. It is time to take this up and make change happen! Upskilling and reskilling our healthcare professionals, especially nurses, is key to create a robust and resilient healthcare ecosystem and to be better prepared for facing future healthcare crisis and challenges. As example, building of capacity and investments in digital skills and digital literacy for citizens, patients and healthcare professionals are key for the digital transformation of healthcare, and nurses have a central role to play in this. General care nurses need digital skills to plan, organise and implement nursing care, to empower individuals, families and groups, to give advice, instruct and support those needing care, evaluate nursing care and analyse the care quality and comprehensively communicate professionally! Based on the requirements within the European Pillar of Social Rights, to secure health care to populations of Europe in a timely and accessible manner, the availability of suitably qualified professional nurses must be prioritised. Therefore, the EU needs to invest in nurses and nursing to get better outcomes. We need to build the resilience of the nursing workforce! Frontline nurses are key to build resilient healthcare systems in the EU. Representing 36 national nurses associations and 3 million nurses in the EU and having principle 1 of the European Pillar of Social Rights Education high on its policy agenda, the EFN looks forward to the 2023 European Year of Skills and key EU developments. The EFN will ensure to position nursing more central to health policy and ensure that nurses can use their skills, education and training to their full capacity. Upscaling skills, LLL/CPD, skills empowerment are key for nurses, especially linked to the Advanced Practice Nursing (APN). Investing in advanced roles for nurses, with special regard to the APN and nurse prescribers, will positively increase access to healthcare services for EU citizens. An advanced role with the appropriate skills-mix, will future proof the design of an effective, responsive, dynamic and sustainable frontline workforce composition, as set out in the EFN Workforce Matrix 3+1 (https://efn.eu/?page_id=8220).
Read full responseEuropean Federation of Nurses urges direct inclusion in digital design
25 Jul 2022
Message — The EFN requests that nurses be involved in the design of digital health systems. They advocate for using standardized nursing terminology to ensure clinical data is accurately captured.12
Why — Standardized digital tools would significantly reduce the administrative workload for frontline nursing staff.3
Impact — Taxpayers and developers lose if digital tools remain theoretical and waste European funding.4
Meeting with Stella Kyriakides (Commissioner) and Standing Committee of European Doctors and
6 Apr 2022 · Meeting with European health professionals’ and paediatric associations to discuss COVID-19 vaccination of adolescents and children
Response to Proposal for a Council Recommendation on long-term care
2 Mar 2022
The provision of long-term care (LTC) services of good quality, in particular home-care and community-based services, is a y priority for the nursing profession, advocating for a paradigm shift in long-term care policies to improve the quality of services and quality of life for long-term care patients. The EFN Members shared best practices from their countries relating to long-term care. Submitted practices were subject to
a standard process of thematic categorisation and narrative synthesis and are presented in the attached report under five key areas of activity: LTC & Workforce; LTC & Quality indicators; LTC & Digitalisation; LTC & Financing; and LTC & Standards. The EFN members are strongly engaged in contributing to deliver long-term care positive outcomes: the extent to which nurses’ roles are relevant in the delivery of community care across Europe and how their contribution becomes central to support the EU long-term care political agenda. It is therefore crucial to co-design with frontline nurses EU policies to make them fit for purpose and as such ensure a sustainable and efficient approach in the development of an EU LTC policy. Based on the nurses’ frontline deployments and experiences of long-term care services provision in different counties in Europe, the EFN Report on best practices for Long-Term Care provides the European institutions, Governments and relevant
health stakeholders with policy recommendations on the five key areas. The EFN Members invite the EU and national policy makers to invest
in a highly-skilled LTC nursing workforce; involve healthcare professionals and patients in the development and implementation of LTC quality indicators; invest in people-centred innovation technology; adopt value-based financing models; and engage end-users in standards design.
Principle 18 of the European Pillar of Social Rights has been identified by EFN Members as a crucial priority to be urgently addressed at EU level. Policy Recommendations: 1. Invest in the basic education of the nursing workforce in order to comply with Directive 2013/55/EU to better anticipate or improve the LTC skills needs of the nursing workforce; 2. Promote strategies to attract and retain nurses to the LTC sectors, focussing on the salaries and working conditions to stay in LTC; 3. Invest in social and health outcomes and more robust social and health
outcomes measurement, including patient experience and nursing-sensitive data; 4. Promote the involvement of patients and HCP in all stages of development and implementation of indicators; 5. Support the end-user co-design of electronic tools that support nurses in their daily work and facilitate the easy and fast collection of relevant data; 6. Invest in people-centred innovation technology, focusing on patient safety and empowerment; 7. Develop payment and reimbursement systems based on pathways, including prevention and LTC, rather than individual and disease specific interventions-user co-design of electronic tools that support nurses in their daily work and facilitate the easy and fast collection of relevant data; 8. Invest in standard design with end-users; 9. Engage patients and health professionals in the development, adoption and
implementation of principles and criteria to define standards.
Nurses play a fundamental and indispensable role in the provision of health and social care, in particular in prevention and long-term care.
LINK to EFN file: https://efn.eu/wp-content/uploads/EFN-Report-on-Best-Nursing-Care-Practices-in-Long-Term-Care-with-Upscaling-Potential-Dec.2018-compressed.pdf
Read full responseResponse to Recommendation for strengthened actions against antimicrobial resistance
25 Feb 2022
As nurses have closer and more frequent contact with patients and carers and undertake the role of care coordinator, they are ideally placed to lead antimicrobial resistance reduction and antimicrobial stewardship (AS) programmes. Nurses’ impact on AMR is immediately visible in their role as link nurses and advanced practice nurses (APN), that let them acquire a better overview of all the treatments of the patient, which is of special importance in elderly care, when patients are often prescribed too many different medications. As nurses are getting more active in medication prescribing, they can influence clinical decision making related to medication compliance, monitoring prescription decisions, reducing prescribing errors and most importantly taking up medication reconciliation actions.
Antimicrobial prescribing and management choices involve a multidimensional decision-making process based on a fundamental understanding of the key principles of microbiology and the ramifications of inappropriate antibiotic use . Nurse involvement in antibiotic ward rounds could strengthen of teamwork of nurses, physicians and pharmacists, and foster dialogue on the antimicrobial treatment, indication, and duration, thus further enhancing the multidisciplinary management of antimicrobial stewardship programmes to reinforce best practice.
For nurses to truly impact on AMR and HCAIs through increasing their profile in antimicrobial stewardship, barriers and facilitators to adopting this enhanced role must be contextualised in the implementation of any initiative . The importance of recognising the role nurses play in combatting antibiotic resistance through traditional roles as well as advancing roles such as nurse prescribing is crucial, together with acknowledging the importance of a team approach to address antimicrobial resistance and promoting the prudent use of antibiotics.
Link Nurses and Infection Prevention and Control (IPC) Nurses are a key nursing workforce combatting AMR. However, as new and more complex cases of AMR occur, there will be greater demand for IPC nurses to tackle and control these new bacteria, and to stop the spread of infection. Similarly with AMR, the more complex the HCAI, the more IPC nurse time could be needed to monitor and prevent the acquisition and spread of infection throughout the organisation and to other settings. Factors that could influence demand for IPC nurses especially relate to the services provision incorporated in AMR Strategies developed by EU Member States, resulting in a greater need for IPC nurses to implement the agreed actions. Most strategies build on the proactive approach of IPC teams to slow the development and spread of AMR. This includes moves to: improve knowledge and understanding of AMR; conserve and steward the effectiveness of existing treatments; and stimulate the development of new antibiotics, diagnostics and novel therapies.
The main objective of the nurse Prescribing is to improve patient and drug safety and to make prescribing and dispensing of medicines easier and more efficient, slowing down the rise in demand for physicians. EFN developed EU guidelines on eHealth Services in nursing and social care with specific attention to e-prescribing. A wide range of evidence is available on the content, planning and delivery of nurse prescribing education, which must be considered by the EU and Member States when combatting AMR. EFN members show clear evidence for the benefits that nurse prescribing can bring for patients, nurses, the wider health service and other health care professionals. The benefits attributed to patients include timely treatment, reduced waiting times and continuity of care with patients generally being in favour of nurse prescribing. There is also evidence for nurse prescribing leading to improved nurse-patient relationships, longer consultations, improved quality of care and increased patient choice.
Read full responseResponse to Social and labour aspects of the climate transition
19 Nov 2021
The European Federation of Nurses Associations (EFN) is the independent voice of the nursing profession representing 3 million EU nurses over 36 National Nurses Associations at European Level.
The ecological disruption caused by the unsustainable socio-economic systems can threaten the foundation of the health systems and withdraw decades of health progress. This is what the COVID-19 pandemic and its consequences have shown to the EU, Europe and the world. Health is not a cost, it is an investment in the sustainability and resilience of our European human systems.
EFN acknowledges the direct attribute of human activity to climate change, and the urgent threat climate change poses to global health. Climate change is only one of the global environmental change issues which are threatening the sustainability, the safety and the health of our societies. Other issues include the biodiversity collapse (linked to the increased pandemic risk), and the global pollution (air, water and soil). Policies to tackle global environmental changes, also called planetary change, and understood as a climate and ecological emergency, are gaining an important momentum in the design of COVID-19 recovery policies and the Green Deal in the EU.
Planetary health, an emerging environmental public health approach, provides a relevant framework to understand and tackle the interconnection of causes and consequences between health and these changes. (Buse et al., 2018) Nurses have a key role to play in the co-design and implementation of planetary health solutions. The European Union decision-makers should therefore facilitate and support the contribution of nurses in the mitigation of and adaptation to both local and global environmental changes. The prevention and communication of nurses about hazards to the population will be key. Nurses are in a privileged position to communicate with citizens on lifestyle change and prevention. Based on a long tradition of informing the public about diseases and promoting health, it is evident that nurses take on an important role as change agents in a variety of planetary health activities.
The social climate fund (large-scale investment in reskilling and upskilling) should include investment in nurses’ education and workforce, so nurses can contribute to promoting healthy and sustainable lifestyles and the design of programs and policies to deliver planetary health in Europe: the achievement of the highest attainable standard of health, wellbeing, and equity (just transition leaving no one behind) for EU citizens through judicious attention to the human systems - political, economic, and social - that shape the future of humanity and the Earth’s natural systems that define the safe environmental limits within which our society can flourish.
The EFN members call on EU Institutions to:
1. Prioritize the development of policies and agreements that favor climate solutions and protect public health and global equity.
2. Include health civil society, especially nurses’ associations, in EU and national decision making to ensure climate ambition and strategies are designed to maximally protect health and improve global equity.
3. Commit appropriate levels of funding to finance climate and health research, resilience, adaptation and mitigation, and to enable health sector involvement in climate decision-making and implementation.
4. Increase prevention and health promotion activities and incorporate health literacy in citizens’ empowerment strategies. Prevention is key in personalised healthcare, in contributing to populations’ health, and implies the adoption of citizen-centric approaches. Nurses are uniquely placed to act as a health coach and to help to promote individual emission reduction and healthy lifestyles.
5. Invest in the education of the nursing workforce, Lifelong Learning programmes, to facilitate nurses roles as change agents and their further development of competencies.
Read full responseResponse to Statistics on health care expenditure and financing
20 May 2021
Within whatever system, all Member States struggle to improve efficiency and managing budgetary challenges to keep on delivering equal, safe, efficient and high-quality health and social services to EU citizens. The common denominators of these challenges are the ageing populations, including long-term care, and medical technologies. Furthermore, all financial focus has been going to treatment diseases, cure, while prevention becomes ignored.
Within this context, it is important to collect variables on health care expenditure and financing to ensure the availability of EU-wide data for decisions relating to health and social policy. But we need to keep in mind that the health and social ecosystems in the EU are under pressure due to lower economic growth and growing costs as a result of ageing, rising chronic diseases, and increasing demand for health and social care, including long-term care and technology/digitalisation. And to this already difficult situation, we can add the COVID-19 pandemic, that hit the world so hard. For the nursing profession, this led to loosing 30% of its workforce at EU level. A workforce that was already suffering from a huge shortage before the pandemic.
Thus, policymakers at all levels have no other choice than to address the sustainability of the health and social ecosystems, which means “equal access for all”, as reflected in the European Pillar of Social Rights. As such, policymakers and politicians need to adopt the right financial tools that promote a holistic approach, instead of financing silo’s in the ecosystem. The development and production of European statistics in the area of health care expenditure and financing, is one tool, but finding the right balance between quality and expenditure control in healthcare is an urgent priority among EU Member States, as the need to meet cost-effectiveness requirements and ensure the sustainability of the health system.
To improve health outcomes, the financial models underpinning EU health and social care systems require a shift from the current quantitative financing towards a financing methodology incorporating indicators that capture integrated and continuity of care and patient empowerment alongside quality, safety and cost-effective patient outcomes. The continued cost cutting in the health budget is leading to loss of quality, economic and social capacity, and rising health and social care costs in the medium to long term. These unintended consequences highlight the need for structural reforms of the financing systems. To achieve this objective, it is therefore crucial to strengthen disease prevention measures in public health. It is time to revert the very negative European trend that sees that less than 3% of national health budgets are spent on prevention, while 80% is spent on treating chronic diseases. More efforts are needed to promote and finance prevention and primary care, in which nurses can greatly contribute thanks to their coaching roles to empower individuals and families, as well as in promoting health literacy and changes in health behaviour throughout the life-course of people.
Collecting data on health care expenditure and financing are a good starting point. But we also need to know about the outcomes that matter from a patient’s point of view if we are to strengthen the capacity of clinicians and policymakers to provide health services shaped around patients’ needs. As the value-driven health systems developments (mainly led by Industry) have a very economic approach, it is of key importance to have the measurement of “outcomes” through PROMS (Patient related outcome measures) and PREMS (Patient-reported experience measures) co-designed from a nursing perspective to make healthcare systems sustainable and more people centred, and to include prevention and long-term care into the equation.
Read full responseMeeting with Thierry Breton (Commissioner) and
16 Feb 2021 · Pact for Skills roundtable with the representatives of the health sector
Meeting with Nicolas Schmit (Commissioner) and
16 Feb 2021 · Pact for Skills roundtable with the representatives of the health sector.
Response to European Health Emergency Response Authority
15 Feb 2021
Preparedness is essential to prevent any future crises. Planning and having fit-for-purpose policies and procedures in place will help to ensure that the EU Member States can respond to any upcoming crisis and save lives when emergencies occur. This includes coordination with the EU Member States in sharing information, assessing the needs and ensuring a coherent EU-wide response. This COVID-19 crisis demonstrated once again that “WE ARE NOT PREPARED, UNLESS WE ARE ALL PREPARED”.
Overall, the EU and its Member States have contributed with billions of Euros to fight against COVID-19, but equipment and training for the frontline health professionals involved in managing people with COVID-19 was not consistent, and in some cases totally lacking, despite the fact that according to the EU policy strategies, healthcare professionals are required to be equipped with the right material and to have received adequate and appropriate training, confirmed by the Health Council on the 1st December 2014.
It is also clear that sufficient and appropriate resources were not made available and that the capacity to have an appropriate number of professionals available, as well as the needed protection measures, are important factors that contributes to the safety of healthcare professionals and patients. This is especially important for the nurses and the nursing profession knowing that most of the caring activities for a patient with an IDHC are carried out by nurses.
Therefore, it is crucial that the EU institutions, EU national governments, health industry and other health stakeholders, develop health and workforce policies based on the lessons learned from COVID-19:
- Eliminate the bureaucracy of the public procurements procedures while ensuring that the right equipment (e.g., FFP2 masks, mechanical respirators) is accessible to the frontline nurses.
- Allocate the necessary funds to support frontline nurses. The EU population health is dependent on highly qualified and motivated nurses in compliance with Directive 2013/55/EU.
Ensure appropriate mechanisms for psychological care of nurses who are experiencing extreme anxiety and stress during the crisis in addition to protecting against potential post-traumatic stress disorder. There are many ways to address this, including through adequate education and prevention.
- Collect Data! Quantitative and qualitative data is crucial to better understand and address the needs of the frontline staff dealing with an IDHC. Therefore, having the systems in place in advance of any such new crisis for the central collection and monitoring of data such as exposure of healthcare workers will ensure a more proactive and timely evidence base to support responsive EU policy. Mechanisms to provide governments the ability to communicate continuously with each other, to collect information/data in a standardised format to share and translate into best practice to inform policy is essential. It is critical for all European countries to have the best available evidence to combat the infection control measures and save nurses and patients’ lives.
- Work with the nurses. They are the frontline experts: Co-creating and co-designing with frontline nurses ensures fit-for-purpose political decision-making processes and policies for IDHC preparedness. It is vital to invest and consider the valuable expertise and experience of the nursing profession on how to plan and implement for this preparedness.
It is time to move from “patchwork” approach to “EU coordination”. It is vital to go beyond “sharing best practices”, to providing focussed and tangible support to frontline nurses. Transposition to support the COVID-19 crisis response is key to save lives: citizens and healthcare professionals.
Read full responseResponse to A European Health Data Space
13 Jan 2021
The nursing workforce, which is the largest healthcare professional of all, will be key in the deployment of the European health data space in healthcare settings. Its success in Europe will largely depend on end-users providing input to the health data space and using the data to better plan their services. Nurses will only do so when they were involved as co-designers of these technologies, trust the systems and see the added-value for EU citizens.
The cloud-based service that will potentially transform the way current healthcare systems operate and communicate are the interoperable EU Electronic Health Record, building on what Member States have developed already. The Electronic Health Record is the digital file containing citizens/patient’s personal data (name, picture, address, age, etc.) and health history (existing diseases, previous surgeries, allergies, blood type, allergies, vaccinations, etc.) that nurses needs to provide high quality and safe services.
It is key for EFN, representing 3 million EU nurses and 6 million European nurses, that frontline nurses are able to use the collected data to boost the continuity of care (e.g., cross border care). Frontline nurses need to become co-designers of future EU-wide systems of Electronic Health Records (EHR). Innovation in health data governance should empower patients/citizens and frontline nurses, moving towards an integrated care system based on proactive/empowered health-aware patient/citizen summary data, with the use of AI, to get better health outcomes.
Stakeholders should look at the national regulation of the growing volume of data, e.g. patient’s health data. The creation of common data spaces should allow citizens, businesses and organisations to access non-personalized data from countries, pooled across different key sectors. Data protection and competition laws continue to be applied. Strengthening data quality, governance, security and interoperability are key to build that trust with the end-users: the frontline healthcare professionals. It is therefore essential to create fit-for-purpose innovations/solutions for healthcare ecosystems. Requirements and mechanisms co-designed with the end-user are key to ensure the utility and suitability of the developed solutions. It is important in the requirement phase to provide the IT developers with the nurses’ views and expertise in making the solution fit-for-purpose.
Furthermore, an open, standardized and unique European extended-EHR is needed to preserve the European assets and professional ways of working, by addressing the current lack of interoperability and security, defining a set of integrated protocols and conformance criteria for mobile apps/software, supporting secure and portable local storage and backup, released as open specifications.Moreover, this exchange is organised by a superior authority – namely governments or hospitals. The idea is to give data’s control back to the citizens and patients, by empowering them. Different scenarios can be worked out, namely 1) device-to-device, 2) a patient in an emergency situation, and 3) donating data for research; and make these happen, implemented throughout the EU. We need to stop hiding us behind subsidiarity: each citizens/HCP needs to have the data for continuity of care at their fingertips!
In order to ensure that the European health data space is deployed successfully and safely across EU healthcare systems, it is key to:
1. Develop the co-creation of EU health policies.
2. Support the development of national electronic health records and improve the interoperability of health data.
3. Equip the nursing workforce with the necessary skill sets to maximise the positive impact of health data and conduct a comprehensive regulatory assessment of the healthcare professions gearing both the bachelor education and lifelong learning programmes towards digital literacy.
Read full responseMeeting with Nicolas Schmit (Commissioner) and
27 Nov 2020 · Meeting on the challenges faced by frontline workers during the Covid-19 crisis.
Response to EU Strategic Framework on Health and Safety at Work [2021-2027]
12 Nov 2020
The EFN welcomes this roadmap and believes that it is comprehensive and detailed. It will surely make a positive impact on the citizens of the EU. However, it fails to address the specificities and needs of the nursing profession, particularly in times of COVID-19. There are about 3 million frontline general care nurses in the EU, making them the largest healthcare profession of all. They work both at clinical and hospital-based facilities, as well as long-term and home care settings. At each of them, their exposure to risks is different, from COVID-19 to chemicals that are part of cancer treatments, or sharp injuries. On the latter, for example, 2020 mark the 10th anniversary of the EU Directive 2010/32/EU – (on the prevention of sharps injuries in the hospital and healthcare sector). A lot of progress has been done at nurses' workplace since the implementation of this Directive, however, a lot more needs to be done that there are 0 sharp injuries reported by the nursing workforce. The EU Agency OSHA should very closely monitor these. Moreover, the EU institutions should monitor and report on the long-term effects of the COVID-19 disease in those nurses who got infected and survived it. I.e., monitoring the transposition of the Biological Agents Directive. The EFN encourages the EU Agency OSHA (European Agency for Safety and Health at Work) to enhance and improve data collection quantifying the number of cases that were infected during the COVID-19 pandemic (whether by just getting infected or by having passed away from COVID-19) - and to report this data back to the EFN. In a similar vein, the EFN welcomes that the European Commission has revised the Carcinogens and Mutagens Directive to set new or revised limit values for three important substances. In addition, a European position is needed on the exposure time as linked to the risk of infection due to fatigue. The EFN has liaised with its Membership on this topic and would like to put forward the following recommendations: 1) Develop a consistent approach across the EU with regard the identification of exposure to COVID-19 as an occupational injury; 2) Consider automatic recognition of frontline nurse exposure to COVID-19 as an occupational injury; 3) Consider compensation where appropriate both for the nurse and their family members where they have been significantly adversely affected; and 4) Develop a consistent approach to compensation across the EU Member States, in recognition of the risk nurses are exposed to when delivering care during the pandemic. On another vein, more action should be taken to protect those nurses working in cancer care settings with chemo and radiotherapies. Finally, in the context of the ongoing pandemic, nurses are at the bedside of the patient, 7 days a week and 24h a day, that makes them more prone to get infected with COVID-19 than their peers in the healthcare sector. For further information, the EFN has published a report on Lessons Learned from the Ebola and Covid-19 crisis (it is accessible here: http://anyflip.com/eumpx/ounw).
Read full responseMeeting with Stella Kyriakides (Commissioner)
8 Oct 2020 · Virtual meeting for exchange of views on health priorities files (cancer, pharma strategy, vaccines, Covid19 lessons learned)
Meeting with Alina-Stefania Ujupan (Cabinet of Executive Vice-President Margrethe Vestager)
25 Aug 2020 · Lessons learned from the Covid-19 pandemic si digitalisation of health care
Meeting with Adela Kabrtova (Cabinet of Commissioner Janez Lenarčič), Matjaž Malgaj (Cabinet of Commissioner Janez Lenarčič)
8 Jul 2020 · The COVID-19 pandemic
Response to EU Action Plan of Gender equality and women’s empowerment in external relations for 2021-2025
11 Mar 2020
Research and innovation coalitions and consortia need to include end-users for better co-creation and co-design, with specific attention to gender. KPIs need to be gender specific. Collecting gender sensitive data for research and innovation with identifying, assessing, and upscaling good clinical practices in health services are key to move research finding towards deployment to close the implementation gap. The expected impact need to be much clearer! Increasing the participation of women in R&I, improvement of their career prospects, especially nurse researchers, are key. Improving the gender balance in decision-making bodies in healthcare and research organisations goes way beyond advisory boards and consultation. All societal challenges can be looked at from a gender dimension in research content and increase in the quality and societal relevance of produced knowledge, technologies and innovations that are fit-for-purpose. But all this means support! It is impossible to ask more and ask more, under the same conditions as before. The EU needs to do more to support women.
As an EU umbrella organisation, the EFN has in membership 36 National Nursing Associations, representing 3 million nurses of which 92% are women. In this context, nurses as end-users are ideally placed to bring in a gender and women perspective to research and innovation. Reducing gender health inequalities between and within Member States by mastering sex and gender in the design of people-centred models is essential to get better health outcomes. Nurses/women are key in the co-design of continuity of care, facilitating the reform of the health and social sector and creating better working conditions. Nurses/women improving nation’s health and well-being, through prevention, tackling a complex mix of factors - including personal choices, the opportunities available, and the resources within their communities, determine the context, process and outcomes. Nurses/women see people—not just at different stages of their lives, but also in all of the different places citizens/patients live—therefore it is crucial to use gender specific data and experiences from frontline to develop fit-for-purpose policies/recommendations. In relation to gender and new technologies, including AI and Robotics in care, eHealth solutions that are user-friendly and tailored to women’s specific roles and responsibilities, with technology empowering women, can help support the implementation of the roadmap. As such, the gender dimension in entrepreneurship (including SMEs and public procurement) is key to get successful and sustainable solutions. Providing concrete gender input in addressing key challenges such as people-centred care, prevention, addressing the SDGs, embracing innovative health technologies, and improving working conditions has a huge EU added value.
Specific EU attention needs to go to the gender equation in te healthcare ecosystems in the EU. In health care, violence is impacted by, among other factors, inappropriate admissions of patients into facilities that are ill-equipped to deal with the patients’ acuity/complexity; short staffing and inappropriate staffing; inadequate or inappropriate security or security measures; inadequate communications protocols/practices with respect to gender violence risks; lack of gender violence-prevention training; isolated work assignments (night shifts, home and community care, long-term care); poorly managed transportation/placement of patients (e.g., lack of secure rooms in emergency) and unrestricted access to health care facilities.
Together with key stakeholders, end-users, frontline, the EU needs to do more and better to promote equal economic independence for women and men, to close the gender pay gap, to advance gender balance in decision-making (especially the board of the hospital, often only men!) and ending all forms of gender based violence (especially in the healthcare sector).
Read full responseResponse to European Partnership for innovative health
20 Aug 2019
It is key for EFN to foster a co-creation environment: innovation in health should empower patients and frontline nurses, moving towards an integrated care system based on proactive/empowered health-aware patient/citizen. We need to ensure that the innovation tools, and the data revolution supports and facilitates the shift towards a resilient health and social care ecosystem.
It is key for EFN to create fit-for-purpose innovations/solutions in health: requirements and mechanisms co-designed with the end-user are key to ensure the utility and suitability of the developed solutions. It is important in the requirement phase to provide the consortium with the nurses’ views and expertise in making a solution fit-for-purpose; identifying, assessing, and bringing in good practices examples.
It is key for EFN to empower patients and citizens: face key challenges such as patient empowerment, patient safety, chronic disease management, diagnosing, home-care logistics, hospital logistics, skills and independent living. It is key to move towards a system based on needs (unmet needs), safety and quality, including quality of life.
It is key for EFN to build trust: citizen and patient’ trust is a central concept in developing digital tools requiring data sharing, therefore, patients and Healthcare Professionals, in particular nurses, should be more involved in the data sharing governance. Due to the close relation nurses develop with the patients, families and informal carers, nurses are ideally placed to create trust from citizens towards EHR solutions.
It is key for EFN to achieve clinical relevance: The developed solutions need to respond to patients’ needs and support frontline professionals in care delivery. Involving nurses since the start of the co-design process will lead to the development of tools able to support nurses and allow them to spend more time with patients, increasing the direct-patient care time.
It is key for EFN to measure outcomes: it is important to evaluate the state of implementation of the solution from a user’s/end-users point of view and provide a qualitative evaluation and feedback on their state of development and uptake.
Established in 1971, the EFN represents over 36 National Nurses Associations and its work has an effect on the daily work of 3 million nurses throughout the European Union and 6 million in Europe.
Innovation/Digitalisation IS KEY to support frontline HealthCare Professionals & Increase Direct Patient Care!
Methods and resources need to be planned for co-creation and co-design!
Read full responseResponse to European Electronic Health Record (EHR) Exchange Format
7 Dec 2018
The European Federation of Nurses Associations is the independent voice of the nursing profession, representing 36 National Nursing Associations and 3 million nurses in the EU.
The health and social care ecosystem in the EU have been actively working on Electronic Health Records for several years now and is still focusing on making data accessible across and within Member States. We acknowledge it is a huge task to align the different records. But it is important in order to increase patient safety, satisfaction but also to give health professionals the optimal conditions for treating and caring patients. EFN is very positive towards making the health records accessible across EU. Of course the security of data is very important. When working with EHR’s, it is very important to make sure, that data from nurses are included in the EHR. Often it has been a tendency (ERN) to focus mainly on data from doctors, but we believe that the nurses’ records are also important to share, to boost continuity of care and integrated care. Citizens will all benefit from this.
From a nursing perspective, the exchange of format of an Electronic Health Record (EHR) is of paramount importance for a smooth transition between and within the hospital and community care. Nurses are in the unique and privileged position of having direct access to the daily people’s care needs and an in-depth knowledge of the patient's’ experiences and contextual environments that are needed to plan and deliver the best outcomes. As nurses are central in empowering citizens/patients to have access to health and social services, nurses play a significant co-designing and deployment role for EHR, making it all operational and fit-for-purpose.
Therefore, the European Commission Roadmap on European Electronic Health Record (EHR) Exchange Format is key for the daily work of 3 million nurses in the EU. Some issues are particularly important from a nursing perspective:
1. Possible inability of the person to understand terminology used on health records thus unable for correct judgment on the level of access required to give to their own personal records.
2. There is the need to have unanimous technical terminology for saving and sharing health data in order to be understood across Europe, which again can be considered a problem as to who has the authority to have access and translate crucial personal health information.
3. It is important to admit that information shared within this context may not be accepted by the health care facility or personnel due to mistrusting of data given which creates the fear for wrong diagnosis and care, thus requesting the repetition of examinations and or diagnosis given at another health care facility across Europe. This makes the sharing of health care exchange of no use.
4. In cases of emergency health care data may not be able to be accessed due to restrictions by the person for sharing crucial health information creating a mixture of legal issues.
In the same vein as the « roadmap on Electronic Health Records », many EU Member States developed an e-Health action plan since 2013. Although these e-Health plans all differ, we could identify some generic, overarching topics/action points. For instance, for nurses continuity of care, it is key to have the Computerized Patient Record, medication schematics, electronic prescription (nurse prescribing), wound care data,..., especially in home and community care, as health care is increasingly out of hospital. Furthermore, combining health and social care within the EHR would steer a positive systems approach and change.
The EFN and its members are eager to be the end-user co-designers, to make sure roadmaps are deployed.
Read full responseMeeting with Vytenis Andriukaitis (Commissioner) and
26 Feb 2018 · Skills of nurses; Vaccination; Workforce planning