Health is an inevitable requirement for the development of all human populations, as it underlies and impacts even the most basic conditions related to economic and social factors. Health is an important symbol of national prosperity and represents a personal concern of every member among a nation’s overall populous, from young to old and rich to poor. A key component of any health care system is the nursing community, which plays an irreplaceable role in maintaining and promoting the people's health.
In the Fifth Plenary Session of the 18th CPC Central Committee, the goal of promoting the construction of a healthy China was put forward. This goal was detailed as objective efforts to provide fair, continuous and systematic health services for the people based on two focus points: the whole population and the whole life cycle. Professional nursing services play important roles in the whole process of human life, with contributions in prevention of disease, assistance in diagnosis and treatment, reducing pain and suffering, and promoting rehabilitation. Therefore, to achieve the goal of a healthy China, development of the nursing profession itself must be accelerated, with care to progress the connotation and extension of nursing so that it effectively addresses and meets the people's health needs while being readily adaptable to further reform that will support continual improvement of health care.
1. Remarkable achievements towards development of the nursing profession in China
The CPC and Chinese government attaches great importance to the construction of an effective nursing team, critical for achieving remarkable advances in health care development. Their collective efforts have included a series of measures, such as the promulgation and implementation of the development of careers in nursing through the 11th Five-Year Plan and the 12th Five-Year Plan, the implementation of Nursing Regulations, the augmentation of training for nurses, the reformation of the clinical nursing mode and strengthening of scientific management, as well as general efforts to promote nurses’ performance of high-quality care.
1.1. Substantial increase in the number of nurses
By the end of 2015, the total number of registered nurses in China had reached 3.241 million, representing increases of 1.9 million since 2005 and 1.2 million more since 2010. The trajectory of increase in number of nurses resulting from the 11th Five-Year Plan and the 12th Five-Year Plan is the fastest that China has ever seen. Specifically, the number of nurses per 1000 people increased from 1.06 in 2005 to 2.36 in 2015. The physician-to-nurse ratio also improved from 1:0.97 in 2005 to 1:1.42 in 2015, resulting in a fundamental reversal of the inverted physician-to-nurse ratio.
1.2. Continuous improvement of the comprehensive quality of the nursing team
In 2015, 62.5% of registered nurses had a college (bachelor’s) degree or above, and among these 14.6% had a bachelor’s degree. This shift in higher education level, from secondary school to college or above, highlights the improvement in the overall quality of nurses. In accordance with the Five-Year Plan requirements, starting in 2005, China’s provinces (autonomous regions and municipalities) initiated standardized training for specialist nurses in the intensive care unit (ICU), emergency treatment, blood purification, tumor care and organ transplantation. These ongoing efforts continue to enhance nurses’ professional ability and technical skills.
1.3. Development of the concept of nursing, the work mode of nursing and the connotation of nursing
The modern medical model and new health concept have a profound impact on the practice of nursing, ultimately enriching the connotation of nursing work. In 2010, the concept of patient-centered holistic nursing care was pursued as a key objective, with the primary aims of ensuring patient safety and treatment efficacy so that clinical nurses can meet the health needs of their patients. Realization of this key objective has involved implementation of high-quality nursing skills, acceptance of the clinical nursing reform mode, understanding and dedication to a responsible nursing system, gaining of substantive attitudes towards care for patients, practicing of professional observation and treatment approaches, recognizing the psychological aspects of nursing (related to both the nurse practitioners and patients under their care) and improving health education. These collective efforts have already begun to achieve improvements in nurses’ abilities to provide full, comprehensive and professional services to patients in the health care setting.
Changing the core of nursing from functional care into holistic, humanistic care will involve modification and edification on many more subtle features that are, at first glance, distant from the daily practice of nursing, such as income from the health department, availability of medicines, and the performance-based salary distribution system. However, there is an undeniable linkage between the affects related to changes in the number of nurses, income, nursing service quality, nursing career fulfillment and patient satisfaction. It is, thus, critical in the upcoming years that development of nursing involve identity management, creation of approaches to support and encourage dedication to the work, and generation of a merit pay scale to promote excellence while respecting equal pay for equal work.
It is paramount that an effective incentive mechanism be established, one that will fully mobilize the enthusiasm and creativity of nurses in the workplace. Implementation of such a mechanism will, in turn, promote greater quality care and significantly increase the satisfaction of patients and improve the degree of fulfillment that the nurses obtain through their work. Meanwhile, improvements in the edification and application of medical science and technology for diagnosis and treatment services performed by nurses will improve the technical level of clinical nursing professionals overall, ultimately improving their abilities to treat critically ill patients and cases with more complex and challenging features.
1.4. Continuous development and expansion of nursing services
In order to meet the health needs of China, nursing care services need to extend from the patient to the family and their community. The services themselves need to expand to encompass the range from disease prevention to treatment, including services to manage chronic disease and the elderly patient population, as well as provision of long-term care, rehabilitation care and hospice care. In this way, nurses will provide a wide variety of health care services to benefit the entire population of China.
1.5. Continuous improvements in nursing scientific management
Across the country, China has more than 100,000 hospital nursing management staff, who serve to strengthen the overall management of the hospital and its nurses in particular. These staff aim to improve the hospital’s organization, security and standards of care. Innovation is the key feature of all of these efforts. Starting from the focused point of nursing management, they develop new mechanisms to improve the overall clinical practice and health care operation of the hospital. The efforts thus far have included human resource scientific management, scientific performance appraisal and salary distribution, and have achieved positive results.
2. Opportunities and challenges for effective development of the nursing profession
In his August 2016 presentation at the National Health Conference, President Xi Jinping stressed that without universal health there is no comprehensive well-off society. He emphasized the importance that we must put on human health, making it a national priority to develop a strategic position that will ultimately promote healthy living, optimize the nation’s health services, improve the construction of a healthy environment, and promote development of the health care industry so as to ensure accomplishment of all-round, full cycle health for all of the nation’s peoples. As China’s economy continues to develop and the Chinese standard of living continues to improve, the related factors that may influence human health and health services need to be identified and included in the overall efforts to achieve the universal health that President Xi Jinping spoke of.
2.1. Rapid development of a medical system that meets the medical needs of China today
In 2015, efforts began to improve the basic medical insurances available for urban workers and residents, and the rural-cooperative medical service was initiated. These efforts are ongoing and will gradually encompass all urban and rural residents; to date, however, the level of protection of urban and rural residents has improved steadily, with reductions in the burden of medical expenses already realized. It is critical to continue these efforts as the demand for medical care will only continue to increase. Meanwhile, as the unceasing enhancement of China's economic and social development has allowed for the basic material needs of its people to be meet, they are able to now pay more attention to health and a collective desire to further improve quality of life has arisen. Thus, there are greater requirements placed on the health care system and its practitioners to develop and implement diversified and multi-level mechanisms for providing high-quality medical services.
2.2. Increasing burden of disease accompanying the industrialization and urbanization of China, and the accelerating aging population
At the end of 2015, Chinese nationals of ages 60 and above accounted for 14% of the total population, representing approximately 222 million individuals. China's aging population is increasing rapidly, and shows an uneven regional development, with urban and rural populations affected differently. Moreover, nearly 150 million of the elderly population suffer from chronic diseases and nearly 40 million suffer from some form of disability. The current and upcoming surge in demand for elderly care will require significant adjustments to the medical and health care systems, ensuring enhanced service capacity with focused service mode. First, though, the connotation and skills of nursing service must be modified to be able to meet this particular need. These modifications will involve several and various aspects of the nursing profession, ranging from those related to the medical center in which nurses work to the services applied to the patients for disease prevention, treatment and rehabilitation.
Public health-related fields are also shouldering a large portion of the health care responsibilities towards the elderly population, and play an irreplaceable role in the continuously improvements of China’s medical service system as a whole. Efforts to further strengthen nurses should not only engage clinical nursing work carried out in hospitals, but also that carried out in the community at large. Such grassroots efforts, from the hospital to the community, will improve health care along all lines, from preventive approaches that target large social groups down to individual families. This approach will remain crucial as long as there are people in need of health care, and it should be reflected in the nursing work that impacts these people.
2.3. Influences of change in disease spectrum
Infectious diseases, HIV/AIDS, tuberculosis, hepatitis and other diseases represent current threats to Chinese health. Newly emerging infectious diseases are also arising within China, all while the historically common infectious diseases, such as bacterial dysentery and measles, are continuing to pose great challenges to our health care system. In addition, there has been a great rise in chronic non-infectious diseases, such as cardiovascular disease, cancer, diabetes and chronic obstructive pulmonary disease. These challenges all impart increased burdens on China’s populations, notwithstanding through increased medical expenses.
2.4. Challenges facing the medical service system in China
Unfortunately, there exists and unequal allocation of the existing medical service resources throughout China. There is an excessive concentration of resources in city hospitals, and shortages (accompanied by slow development) in community primary health care centers. the majority of demand on medical and social resources has been increasingly inclined towards the large hospitals, while the primary health care institutions remain limited in their facility conditions and technical level, even though they are proximal and convenient for the local community. Although the overall population of nurses has grown rapidly over recent years, only 600,000 of all nursing staff work at the grassroots level, accounting for less than 20% of the total. Meanwhile, the existing medical service system mode remains relatively simple and the public health service demand is not consistent with the current diversification spectrum.
3. Development goals and priorities
To further accelerate development of the nursing profession it is of equal importance to build a healthy China, promote the overall national health and well-being, instigate effective economic restructuring, expand social employment and accelerate the development of health services customized to the particular needs of the proximal communities. To promote the development of health and health reform, and meet the goals set forth in the “China 2030 Plan”, the nursing profession must be carefully developed with respect to people's health at its core, so that the reforms and innovative approaches generated will be oriented to the needs of each community. The strategic deployment of a healthy China will ultimately meet the health needs of people for their whole life cycle, adopting and adapting the most progressive medical technology that best supports the clinical services necessary.
3.1. Further strengthening the construction of effective nursing teams
To support effective implementation of new “nursing regulations”, adequate human resources, remuneration and occupation safety programs must be in place. These features will safeguard the legitimate rights and interests of nurses. Ultimately, such a comprehensive approach to nursing staffing will help to further increase the amount of registered nurses and nurses with specialized skills, which is necessary in order to meet the current and upcoming demands of clinical work. Other aims in this regard are continuous improvements in defining the stratifications for nurse level management, in establishing clear developmental paths for the nursing occupation, generating fair and comprehensive nurse grading systems, providing sufficient and convenient training for professional and technical aspects of nursing, instilling dedication to job responsibility, defining professional rank and salary distribution, implementing management mechanisms to stabilize the nursing team as a whole, and broadening the developmental space for the nursing occupation.
3.2. Making efforts to improve the quality of nursing service and expand the field of nursing services
Achievement of high-quality nursing service should be met with the current objective of creating a nursing field that is centered around holistic care. When the patient is at the center of nursing care, nurses will strive to provide professional care, meaningful patient observation, substantive health guidance, and effective rehabilitation, psychological support and other skilled services – all of which are the underpinnings of humanistic care of patients. However, while developing this type of nursing, it is key to also strengthen the quality of nursing with scientific management, so as to improve the efficacy and safety of the practices applied. Increased access to high-quality training and education programs and incentive policies and measures is also imperative to improving the level of nursing skills in both urban and rural medical centers.
We must also encourage the development of at-home nurses and grassroots medical initiatives and facilities. These will help in our efforts to expand the field of nursing services as needed in the modern day, specifically as related to nursing care for the elderly, and will gradually establish a mechanism for medical support within rural communities, which are more likely to rely on a home-based elderly care service system. The integration of comprehensive health care services for the elderly – during periods of treatment, rehabilitation, stable health/general aging, and hospice care – will also be supported by this approach.
3.3. Towards strengthening of nursing management
Scientific management of nurses implements measures that promote people-oriented strategies in nursing care. In this manner, the patient is at the center of the service and the aim becomes to provide safe, high-quality, standardized, continuous and personalized professional services; this is in contrast to the traditional approach, in which the clinical nurses are at the center, which has the benefit of focusing on human resources, occupational safety protection, job training, remuneration and promotion. The benefits of the latter must not be lost during the shift to a patient-focused approach to care. The new development of nursing in China, ultimately, must fully encourage the enthusiasm of nurses and stimulate their initiative.
3.3.1. Towards further strengthening of nursing education in according with clinical development
The need exists to establish nursing personnel training programs that are in line with industry needs and based upon a core of skilled competency. Such programs will encompass college-level education and graduate education, and provide access to supplemental training outside of the formalized education. Such education will not only aid in the desired transformation of nursing research to clinical nursing practice but will also provide empirical and technical support for the improvement of clinical nursing.
The development of Chinese nursing goes hand-in-hand with the construction of a healthy China. The development speed must match that of China’s society and economy, exploiting the most recent advances in medical science and respecting the particular health needs of the people in various communities across the nation. In this way, nursing professionals will be able to improve human health in our nation for the full range of the life cycle.
Footnotes
Peer review under responsibility of Chinese Nursing Association.