Promoting nursing development towards health for all: Overview and prospect of nursing development in China

Prof. Xinjuan WuPresident of the Chinese Nursing Association

The process of population aging, waves of the COVID-19 pandemic and influences of climate and environmental change on human health pose extreme challenges to the global health system. Nursing is an essential part of health care, and nurses play an important role in ensuring people’s health. Nursing is thriving while facing many challenges as well. We should base nursing development on the background and health needs in the current era, clarify the new trends of the nursing development, and formulate the future goals of reform and development.

1. Booming nursing profession in the mainland of China

Since the founding of the People’s Republic of China in 1949, mainly since 2005, the total number of nurses in China has grown by leaps and bounds. By the end of 2021, the total number of nurses in the mainland of China exceeded 5.02 million, accounting for 44% of the total number of health professionals in China, a more than 100-fold increase compared with 1950. By the end of 2021, there were 3.56 nurses per 1,000 population in the mainland of China [1]. Currently, the total number of registered nurses in the mainland of China accounts for about 25% of the global total, and 80% of them have junior college and above degrees.

Regarding higher nursing education, China has formed a three-level education system consisting of junior college, undergraduate and postgraduate. China has accumulated rich experience in higher nursing education and gradually developed a complete training system, which produces well-recognized results by society, and has gradually become an important part of the international nursing education system.

By the end of 2021, more than 700 higher vocational schools and nearly 300 colleges or universities provide nursing education [2]. More than 120 colleges or universities provided education for master’s degrees in nursing, and more than 30 universities offered doctoral education in nursing. The three-step training system covering college education, post-graduation education, and continuing education provides a strong guarantee for implementing multi-level holistic training for nursing talents.

The number of registered nurses with a bachelor’s degree and above has continued to grow for decades, nearly 180,000 in 2010 [3] and 1.36 million in 2020 [4], with an increase of about 7.6-fold. Increasing nursing talents with high education levels drives the development of nursing scientific research. The number of publications of nursing research funded by the National Nature Science Foundation of China showed an increasing trend, which reached more than 500 research papers in 2021, about 5 times that in 2012 [5]. These researches mainly focus on women’s and children’s health care, geriatric health and intervention, chronic disease management, reflecting nurses’ performance in protecting people’s health throughout the life cycle.

As healthcare science advances, nursing was identified as an independent first-level discipline by the Ministry of Education of the People’s Republic of China in 2011, like clinical medicine and dentistry [6]. Specialized nursing has driven faster growth since then. We commenced specialized nurse training in 2002 and launched much more training programs, especially in the past decade. By the end of 2021, the Chinese Nursing Association has performed specialized nurse training in 28 fields, including intensive care, emergency care, geriatric care, perioperative nursing, oncology nursing, diabetes care, etc., covering more than 30,000 specialized nurses. In 2021, about 8,000 specialized nurses participated the training programs of the Chinese Nursing Association. By improving professional skills, nurses can provide better, more efficient, and high-quality healthcare services for people.

2. The critical role of nursing in achieving health for all

Nursing professionals play an essential role in maintaining people’s health in China and have made brilliant achievements, recognized and commended by government leaders and society. On International Nurses Day 2020, Xi Jinping, President of the People’s Republic of China, extended his season’s greetings to nurses nationwide and gave important instructions on nursing work, emphasizing that: “Nursing constitutes an important part of the health cause. The development of the health cause should be based on strengthening the building of nurse teams. Society should understand and support nurses.” The National Health Commission of China also issued a document stressing that: “Nursing is of great significance to promote the construction of Healthy China and improve the health of the whole nation.”

Over the past decade, China has made remarkable achievements in health care, especially in areas of chronic disease management, infectious disease prevention and control, maternal and child healthcare, and geriatric care. By the end of 2021, the China Healthy Lifestyle for All Campaign has covered more than 96% of counties and districts in China [7]; the coverage rate and success rate of antiviral therapy for AIDS reached above 90% [8]. By the end of the first quarter of 2022, the total number of institutions and facilities for the aged reached 360,000, with 8.126 million beds, nearly double the 4.165 million at the end of 2012 [9]. These achievements cannot be gained without the efforts of nurses.

Chronic diseases pose a severe threat to human health, and the number of people dying from chronic diseases accounts for 86.6% of the total deaths in China [10]. As the specialized nurse team in China is expanding, they have played an increasingly prominent role in the prevention, treatment, nursing, and management of chronic diseases. Hospitals and community facilities have set up specialist nurse-led nursing clinics, such as wound/ostomy clinics, diabetes clinics, peritoneal dialysis clinics, intravenous therapy clinics, and cardiac rehabilitation clinics, to provide treatment, health counseling, health education and transitional care. In some regions, specialist nurses have been authorized to prescribe drugs for specific diseases, such as hypertension and diabetes, to provide convenient, efficient, and high-quality nursing services for patients with chronic conditions. In addition, China has implemented the family doctor contract system. Community nurses and doctors work together to establish health records for residents in the community, carry out health monitoring, give medication guidance, and conduct health education, standardizing the health management of people with chronic conditions and effectively promoting the overall health of residents.

To popularize health knowledge and relieve the burden of chronic diseases, the Chinese Nursing Association leads various nursing committees and provincial nursing associations to carry out science popularization activities and support grassroots nationwide. First, on International Nurses Day every year, we have carried out distinctive nursing science popularization activities nationwide to benefit tens of millions of people. Second, we have carried out special activities such as the “Popularization of Science Campaign in Rural Areas” to impart health knowledge to people in remote and rural areas. Third, we have set up a Science Popularization Specialist Team to regularly train the backbone force for health knowledge-promoting activities and inspire their creativity. Thousands of backbones for science popularization have been trained. Fourth, we have set up 140 popularizations of nursing science education bases covering 28 provinces and cities in China, and built platforms on new media, such as WeChat posters and online platforms, to provide health knowledge and promote healthy lifestyles for people with long-term conditions, in the sub-health state and healthy status.

In waves of the COVID-19 pandemic, nurses in China have actively devoted themselves to patient treatment and epidemic prevention. They play a leading role in public health education, infection prevention and control, care for patients with critical conditions, management of patients with COVID-19 infection, construction and management of makeshift (Fangcang) hospitals, and throat swab specimen collection for detection of SARS-CoV-2, and so on.

In addition, they also play a key role in the treatment, nursing and management of various other infectious diseases. For example, nurses specialized in HIV care can improve patients’ medication compliance through effective management, give psychological care and support to patients, provide transitional care and direction, and help patients enhance their self-management ability.

Currently, the maternal and child healthcare system in China has increasingly improved and gained remarkable achievements, with an antenatal attendance rate of 97.6% and a coverage of postnatal care visits of 96.0% in China [1]. Nurses play a vital role in the maternal and child healthcare system by performing health education, creating a warm, clean and comfortable treatment environment, collecting healthcare information, and taking healthcare measures for women and children. Nurses also actively promote the development and scientific research of maternal and child nursing, providing an essential guarantee for maternal and child healthcare and the safety of services.

As a country with a large population, China faces an intensifying aging trend. In 2021, nearly 190 million older adults in China suffered from various chronic diseases, and the number of older adults with disability reached about 40 million [11]. Actively coping with the aging population has become a national strategy. Under the overall planning of the Chinese government, we enhance nurses’ role in dealing with the challenges of the aging population by carrying out geriatric care service development projects. Nurses extend nursing services to communities and families to provide diversified nursing services for the aged. In addition, China attaches great importance to the cultivation of urgently-needed nursing talents, especially those in the fields of palliative care, rehabilitation care, and chronic disease management, to meet the health needs brought about by the aging population. As informatization develops rapidly, with the help of the new mode of “Internet plus nursing service,” nurses provide online consultation and door-to-door home nursing services for residents with and without conditions.

3. Strategic planning for nursing development in China from 2021 to 2025

From 2021 to 2025, China will further promote Healthy China’s development and provide citizens with people-centered comprehensive and full-cycle healthcare services. Nursing development must focus on people’s health needs. To satisfy the diversified and different needs of the public, we should build an all-around, whole-process, high-quality and high-efficiency nursing service system.

Since 2005, the National Health Commission has formulated and issued the Nursing Development Plan in China every five years. After summarizing the current status of nursing development in China and analyzing the new trends in nursing, the National Health Commission issued the Nursing Development Plan in China (2021–2025) [12]. It makes top-level planning and strong support to nursing development in China.

By the end of 2025, nursing development in China will achieve the following goals. The total number of nurses in China will reach 5.5 million, and the number of registered nurses per 1,000 population will get 3.8 [12]. As the number of nurses keeps increasing, the nurse team structure will be further optimized and the quality and service capacity will be significantly improved to satisfy the needs of socio-economic and healthcare development. Nursing services are more responsive to the needs of the people and society. The connotation and denotation of nursing will be further enriched and expanded by significantly increasing the supply of care for senior citizens, such as Traditional Chinese Medicine (TCM) nursing, community care and home care services. The level of scientific nursing management and the quality of nursing services will be constantly upgraded, and the systems and mechanisms mobilizing the enthusiasm of nurse teams will be further improved and perfected.

There are seven main tasks for nursing development in the future [12].

The first task is to improve the nursing service system. The nursing service system is improved mainly from two aspects. First, optimize the allocation of nursing resources. We must set up a robust nursing service system covering diagnosis and treatment in the acute phase, rehabilitation care in the chronic phase, long-term care in the stable phase and hospice care, considering demographic changes and disease spectrum characteristics. We must improve the positioning of medical institutions at different levels and form a cooperative nursing service system. Tertiary hospitals will mainly provide acute care for patients with intractable, emergent, and critical conditions and must strengthen the construction of nursing disciplines and talent training. Secondary hospitals will mostly offer nursing care for patients with common and frequently-occurring diseases. Primary-level medical facilities and nursing homes will mainly offer geriatric, rehabilitation, long-term, and palliative care. Second, increasing the supply of nursing services. We need to integrate nursing resources, e.g., transforming some primary or secondary hospitals into nursing homes and long-term care centers in areas with abundant medical resources. We should support and guide social forces to establish chain nursing centers and palliative care centers to give full play to the role of the market. In addition, we need to add more beds in primary-level medical institutions and expand the supply of geriatric care services.

The second task is to strengthen the construction of the nurse team from four aspects. First, continuously increase the number of nurses, especially those engaged in geriatric care, pediatric care, TCM care, community care, infectious disease care, and palliative care as well as those working in primary-level medical institutions. Second, strengthen nurse training. We need to establish a nurse training system centered on nurses’ clinical nursing service capacity. We need to carry out targeted training for urgently-needed nursing professionals. We also need to strengthen the training of newly enrolled nurses and nurse administrators. Third, protect the legitimate rights and interests of nurses. We must further implement the Nurses Regulation and other laws and regulations, and create favorable conditions for nurses, including the working environment, salary, training, and professional development. Fourth, mobilize nurses’ enthusiasm. Provide more remuneration to front-line clinical and primary-level nurses to mobilize the enthusiasm of nurses and reflect the value of nurses.

The third task is to promote the high-quality development of nursing. We must constantly innovate the nursing service mode and strengthen the construction of the nursing discipline. For example, make efforts to construct an evidence-based, clinical demand-oriented nursing specification and technical standard system, to improve the level of nursing homogenization among regions and institutions.

The fourth task is to make up for drawbacks in nursing. China faces an intensified aging population trend and a shortage of talent in geriatric care. In addition to enrolling more nurses in geriatric care, we need to explore establishing a professional team of nursing assistants who will supplement the nursing workforce. We must improve the nursing service capacity at the primary level and in remote areas, and encourage high-grade hospitals to establish nursing specialist alliances with primary hospitals and expert teams to support the primary healthcare facilities. In addition, we must also continuously improve the service capacity of palliative care and accelerate the training of professionals engaged in palliative care to improve the quality of palliative care for patients at the end of life.

The fifth task is to strengthen the informatization progress of nursing. The 21st century witnesses the fast growth of information technology. New ideas and methods, such as intelligent hospitals and “Internet plus healthcare,” are also growing in this context. We must create new nursing service models based on information technologies to provide patients with convenient and efficient nursing services. We must establish an information-based nursing management system, optimize the service processes and improve work efficiency to gradually realize the modernization, scientificity, and refinement of nursing management.

The sixth task is to promote the development of TCM nursing. As a treasure of our Chinese nation, TCM nursing has unique advantages in solving health problems. In the future, we must continuously improve the TCM nursing program and technical operating standards, innovate the TCM nursing service model, and give full play to the vital role of TCM nursing in disease prevention, treatment, and rehabilitation. We need to strengthen the training of TCM nursing talents to improve TCM nursing service capacity.

The seventh task is to strengthen nursing exchange and cooperation worldwide. We live in an increasingly interdependent world, and no country is an island. We will carry out in-depth cooperation and exchanges globally, strengthen collaboration in nursing management, talent training, and nursing technology, and learn from each other to jointly promote the high-quality development of nursing and cope with health challenges.

In the future, we shall take the opportunity and face the challenges, working together to develop the nursing profession and make new and more significant contributions to improving human healthcare in China and the world.

Declaration of competing interest

None.