Nurses with bachelor's degrees working on the front lines are still rare. At that time, nurses in clinical settings were more focused on executing medical orders—whatever the doctor instructed, they would quickly carry out the assigned tasks.” Li Baohua, Director of Nursing at Peking University Third Hospital, told China Hospital CEO.
Even today, many local hospitals in China still face the same situation described by Director Li. With a lack of professional specialization, nurses' income levels have also failed to rise. The aforementioned survey report shows that only 4.5% of nurses earn more than 8,000 yuan per month; 76.5% earn less than 5,000 yuan, and 37.6% earn less than 3,000 yuan monthly.
With limited career advancement pathways and uncompetitive income, many experienced practitioners leave the nursing profession at a certain age. Fujian Shaxian, which belongs to Sanming City, is also a nationally renowned hub for the catering industry. Zhan Jifu, Deputy Director of the Fujian Provincial Department of Finance, told China Hospital CEO that there have been precedents of experienced nurses leaving hospitals to enter the catering industry.
In fact, these nurses, after long-term clinical practice, are often at their peak of professional competence when they resign. Some nurses with rich clinical experience are even privately sought out by patients for medical advice.
This situation needs to change.
Accelerating Nursing Specialization in Hospitals
As nursing education evolves, hospital nursing specialization is also being explored, with some major hospitals having already developed mature pathways.
“Specialist nurses are certified by the Chinese Nursing Association and the Beijing Nursing Association. For example, intensive care unit specialist nurses need to undergo one month of theoretical training and two months of clinical practice training, and obtain a certificate after passing the assessment. The hospital currently has over 160 specialist nurses in various specialties, and training classes for specialist nurses in different fields are continuously held.” Zhang Yan, Deputy Director of Nursing at Beijing Chaoyang Hospital affiliated with Capital Medical University (hereinafter referred to as “Chaoyang Hospital”), told China Hospital CEO.
Alongside the development of specialist nurses, standardized training for nurses is also progressing. For a long time, standardized training for nursing staff has been primarily organized by hospitals, often conducted after selecting a specialty, with a focus on in-hospital rotations.
In 2016, a new standardized training plan for nurses was introduced, requiring all newly recruited nurses to undergo two years of standardized training to master the basic theories, knowledge, and skills required for clinical nursing work.
The standardized training for hospital nurses will be put on the right track in the future. Training process management needs to be further refined, and training record management should be established: in the future, when assigning positions, hospitals should use training records to understand the standardized training information and arrange work accordingly. Shang Shaomei pointed out that standardized training will ensure the baseline of nurses' technical competence.
“Now nurses have enhanced assessment abilities, with the awareness and capability to actively observe and report on patients' conditions. When assessing neurological patients, nurses might bring a flashlight to check pupil changes to report on the patient's progress, applying much of the knowledge learned in school to clinical practice.” Li Baohua noted.
Supporting Measures
Against the backdrop of enhanced professional skills for nurses, Shang Shaomei believes that the exploration of career advancement pathways for nursing in China can take a step further, such as exploring the delegation of prescription rights on a small scale.
In fact, internationally, the exploration of nurse prescription rights has already taken bigger strides. The United States began exploring the training of Nurse Practitioners (NPs) as early as the 1970s, and by 2017, all states had granted NPs varying degrees of prescription rights. The future direction of reform is to further expand these rights. In Shang Shaomei's view, the long-term goal for the training of the master's students who enrolled in 2017 is to become advanced practice nurses with limited prescription rights. “According to this positioning, the first step is to enable them to meet such requirements through their studies.” However, considering China's reality, she also believes that the eventual implementation of prescription rights for advanced practice nurses will require more mature conditions to “naturally come to fruition.” In the past, hospitals did not have dedicated positions, and the government had not liberalized prescription rights, all of which require a series of changes in the industry environment. Therefore, Shang Shaomei not only needs to coordinate with hospitals to seek collaboration in skills training and position setting, but also actively engage with the government to recommend the liberalization of limited prescription rights.
Nevertheless, the exploration of specialist nurses and nursing clinics has laid a certain foundation, and further in-depth exploration can be pursued along this direction. She hopes that her students will not only be competent as specialist nurses but also advance to become nursing experts, capable of assuming the responsibilities of limited prescription rights in certain disease areas, especially in the selected field of diabetes management.
Moreover, this cautious exploration and breakthrough has not only received support from hospitals and doctors but also recognition from the government. Li Dachuan, Director of the Medical and Nursing Division of the Medical Administration Bureau under the National Health and Family Planning Commission, pointed out at an internal meeting in May this year that pilot projects could be selected in professional fields with strong social demand and a certain foundation.
