Samhandlingsreformen

Abstract

How well equipped are the municipality-based health care services to provide for the increased number of patients discharged earlier from hospitals after the implementation of the Coordination Reform? The Coordination Reform implemented in January 2012 aims to ensure that patients receive proper treatment – at the right place and right time. In this report, we have studied municipality health care nurses’ experiences associated with earlier hospital discharge of patients that resulted from this reform by asking nurses working in nursing homes and/or home health care to respond to a web-based questionnaire. Six qualitative interviews formed the basis for the questionnaire. Altogether 2372 nurses responded to our survey during May 2013, and around 82 percent of Norwegian municipalities were represented. The vast majority of nurses were female (94 %), and their mean age was 42 years. Around half the respondents were employed in nursing homes, whereas the remainders worked within home health care. Around 82 percent had been employed at the same work place both before and after the Coordination Reform. All respondents were asked how they experience the situation today. In addition, those that had remained employed at the same place both before and after the reform were asked questions about changes resulting from the reform. Around 70 percent of the respondents said that there has been an increase in the number of patients that are discharged to their services after the Coordination Reform. Many more home health care nurses stated this compared to nursing home nurses (78 % vs 59 %). Nearly 60 percent stated that readmission rates to hospitals have increased after the reform, and readmissions were more frequently reported by home health care nurses compared to nursing home nurses (70% vs 48 %). Almost all, i.e. 91 percent of all nurses, reported that the nursing tasks have become more complex, that the tasks are too numerous (67 %), that there is less time for care work and psychological support (77 %), and that the administrative burden has increased (76 %). At the same time, 74 percent reported that their work has become more varied and interesting. On the downside, 86 percent reported that the work load has increased markedly after the reform, and 73 percent reported that they have unmet needs for education and guidance. Taken together, these reports suggest that the municipality nurses are more pressured for time after the Coordination Reform. This has resulted in more limited services to existing user groups, in particular elderly living at home. An important aim of the Coordination Reform is to improve the collaborations between hospitals and municipality health care services. As such it is somewhat disappointing that only 26 percent of the nurses reported that the overall services to patients have become more integral and coordinated. Only 27 percent agreed with the statement that the patient transfer processes between hospitals and municipalities have improved, and as many as 36 percent disagreed. Four out of ten stated that the collaboration with hospitals has improved, whereas 24 percent said that it has become more strained. To conclude, the municipality-based health care services receive an increased number of poorly functioning patients from hospitals after the Coordination Reform. The majority of nurses express that this has resulted in more varied and challenging work tasks, but they are nevertheless struggling because resources in terms of time, education, equipment and information are lacking. The nurses ask for educational measures to increase their competency, as well as additional medical equipment to satisfactorily provide the warranted care. They also point to the need for an increase in the number of qualified nurses at their work place. Various challenges in collaboration processes with hospitals are pointed to, and many of these relate to rushed discharge processes from hospitals, rendering the municipalities less able to facilitate and put in place the warranted care services in a timely manner. The latter appears to be particularly challenging to handle for home health care nurses.

I denne rapporten belyses hvilke erfaringer sykepleiere som jobber i sykehjem og hjemmesykepleien, har med samhandlingsreformen som trådte i kraft 1. januar 2012. Fokus er satt på eventuelle endringer i tjenestene forårsaket av økt utskrivning av pasienter fra sykehus. I undersøkelse kommer det fram at et flertall av sykepleierne opplever at de har fått mer varierte og spennende oppgaver, samtidig som at de opplever det som vanskelig at det følger for lite ressurser med de økte oppgavene. Økt tidspress og nye mer kompliserte oppgaver ser ut til å gå ut over kvaliteten på tjenestene noen steder. Halvparten oppgir at hjemmeboende eldre har fått et redusert tjenestetilbud etter reformen. Ni av ti svarer at de opplever at arbeidsbelastningen har økt etter reformen. Det kan se ut som at både hjemmesykepleien og sykehjem har behov for flere ansatte og kompetansehevende tiltak for å klare å utføre nye og økte oppgaver som følger med samhandlingsreformen.