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This year, nurses took a small step towards a historic demand: expanding their skills and achieving legal recognition of some of the tasks they already perform. The Ministry of Health has published a guide so that it can prescribe ibuprofen and paracetamol for flu cases. The news was well received by the profession, although they generally consider it more symbolic than practical, since a citizen can now buy these drugs without a prescription (with less active ingredient per pill, yes). It is part of the path they want to take to be able to prescribe without restrictions any drug that falls within the processes they treat (the group usually calls itself female by an overwhelming majority of women), and that contributes to a further ongoing Demand for: Increase His level in administration ranges from A2 to A1, which most graduates achieve with a degree (as in your case) and which, in addition to a better salary, allows access to leadership and management positions.
The guide, published by Health in early January, joins five others covering the treatment of wounds, burns, ostomies, oral anticoagulation, diabetes and high blood pressure. However, this step must be carried out by the autonomous communities, which must validate or adapt them in order for them to come into force. According to the information provided to EL PAÍS by the Federation of Family and Community Nursing Associations (FAEFC), the majority is not yet underway, although the process already began in 2015, since the first guide (the one on wounds) dates back to 2015 2020.
The FAEFC confirms that municipalities such as Madrid and Andalusia have made great progress, but in the words of its president Esther Nieto: “There is a lack of political drive.” “There are many medical lobbies that are trying to delay this work “, he emphasizes. In the case of the guide on the indication of medications for diabetes and hypertension, an appeal was lodged by the Collegiate Medical Organization (OMC), which considers that the version of the guide shows that it is the nurses who are able to begin and termination of treatments, which they believe is the exclusive responsibility of physicians.
Both the FAEFC and the major groups in the sector, such as the Majority Union (Satse) or the General Nursing Council (CGE), are calling for a more radical change that would mean changing the Medicines Act, which only allows the prescription of medicines by doctors, podiatrists and dentists. For this reason, all these guides talk about the “indication” of medications, which, according to Nieto, is just a semantic trap to avoid the word “prescription.”
The Ministry of Health, in turn, tells this newspaper that it is examining how the Medicines Act can be reformulated so that nurses can prescribe within their powers.
In the everyday life of many health centers, nurses already have this responsibility, regardless of whether the guide has been approved or not. José Luis Cobos, third vice president of the CGE, gives the example of oral anticoagulants (the best known is Sintrom): “The doctor makes the diagnosis, we don’t tell the nurse to start treatment. But then we are the ones who do the monitoring, we see the results of the tests to see if the blood has clotted well and adjust the dosages accordingly. Rather, what the guidance does in this case is provide legal certainty to what we have already done.”
Another example would be the treatment of a wound, a process that is clearly integrated into the work of nursing. “Just as I use betadine, sometimes I need an ointment with an antibiotic or a prescription corticosteroid. We demand that the nurse can prescribe it without the need for a protocol or instructions,” says Cobos.
As long as everything is subject to guidelines, care requires applying them and not delaying their implementation, which, in Nieto’s words, is “not very operational.” The hypertension and diabetes guide used by the OCM addresses two issues that fall “within the scope of care” because they involve chronic care. “If small changes need to be made, that can very well be done through care consultations, but we need to have full legal protection. We don’t want to prescribe anything that is outside our area of expertise, we don’t want to prescribe an antibiotic for tonsillitis, but for a wound that falls within my jurisdiction, I have to use my knowledge and practice to decide what type of healing it will be listed “, he adds.
This is already the case in other European countries where nurses have more skills. The most commonly cited example is Ireland and the United Kingdom, which have had the advantage for almost two decades. “There is a multitude of research that shows that it benefits everyone: the patient, because we avoid double visits to the health center, because if the nurse as a finalist is able to solve the whole process, we don’t have to go. “ to consult the doctor. This and the system are relieved. In the countries where they do it, they are happy because they have time for other things,” says the vice president of the CGE.
In a system where there is a lack of general practitioners with comprehensive responsibilities, nurses present this as a contribution to improving health care and optimizing resources. It was no coincidence that the Guide to the indication of antipyretics and antipyretics, the Responding to an October 2023 resolution passed in January, at the height of the respiratory virus peak.
The OMC believes that it is positive for nurses to acquire skills. But in the words of its president, Tomás Cobo, it must have some limits: “The doctor must make the diagnosis as cannot be otherwise and prescribe a treatment that can be supervised by him according to guidelines and in certain circumstances.” Nursing, provided this is not interrupted or suspended without consulting the doctor.”
Cobo is committed to multidisciplinary patient care, involving doctors, nurses, physiotherapists, pharmacy… “But if you don’t understand that this has to be led by a doctor, you haven’t understood anything. And it is not due to a corporatist advantage, but to the time it takes us to acquire knowledge and skills, which is why we study for six years and acquire expertise for four or five years,” he points out.
Category promotion
Another battle nurses face is rising through the ranks. Before the Bologna Plan, the degree was a diploma, so the upper limit in administration was at the A2 level, while bachelor’s degrees could reach A1. Since the new curriculum was applied 15 years ago, it is a four-year degree that offers the possibility of specialization towards a master’s degree. However, this “discrimination”, which affects a few graduates, such as technical architects or technical engineers, due to the inheritance of diplomas, is still recorded in the contracts in administration.
In this context, it would be logical to create a single Category A, which, according to Paloma Repila, includes all members of the Satse union. This should mean a pay increase for the approximately 200,000 nurses employed in the national health system, which is not feasible in the short term but could be implemented gradually depending on the sector. “That doesn’t mean there can’t be additions to the professions with more credits [medicina o farmacia son estudios con dos años más que la mayoría de los grados]but 90%, including nursing, have 240 credits and it makes no sense to have different scales,” protests Repila.
Lower wages are not the only disadvantage of belonging to a lower category. Certain responsible positions are reserved for A1s, such as leadership, management or certain research tasks. José Luis Cobos of the CGE gives the example that a journalist working in the communications department can become a hospital manager, but a nurse with the law cannot.
Although for practical reasons there are some nurses who hold management positions in health centers, this can be considered irregular. A ruling by the Supreme Court of Extremadura in December 2023 banned these positions for medical stations due to the question of professional category.
Health assures that as part of the roadmap for the full development of the skills of nurses, together with the Ministry of Public Functions, it is putting on the table the requalification of professional categories, which would not only affect this profession.
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