How the Development of Nursing Will Help Make Health Services More Accessible | VoxUkraine

How the Development of Nursing Will Help Make Health Services More Accessible

Photo: depositphotos / racorn
20 June 2020

In 2017, the government began reforming the health care system and changing its funding  at all levels of health care. If the government consistently implements the reform, health services will become more accessible to patients and of better quality.

For patients to feel this better, transformations in approaches to nursing are needed. It is nurses  who are in frequent contact with patients, organize interaction with them, ensure compliance with the norms of infectious safety of any hospital.

Almost no medical service is provided without the involvement of a nurses. When a person goes to a family doctor or hospital and needs treatment, examination, instrumental research, medical manipulation, care, etc. – he always communicates with the nurse. Moreover, some patients would not need to see a doctor if they had access to quality nursing care.

As of the end of 2019, there were 218,000  female and male  nurses in Ukraine. A total of  296,000  specialists have nursing education. Statistics call them paramedics and include in this category nurses and brothers, paramedics, midwives, paramedics, laboratory technicians, dental technicians, radiologists, and so on. 

In the world, nursing practice is increasingly being formed as a separate type of medical services (Scope of Practice American Nurses Association).

In Ukraine, even though medical care, surveillance, prevention and manipulation services are in practice performed mainly by nurses and brothers, the formal responsibility remains with doctors.

Nurses (both male and female) cannot provide services on their own. Ukrainian legislation does not define or regulate nursing services as a separate activity. The law regulates  the licensing of medical practice, but does not mention nursing practice.

Even palliative care at home can be legally provided by mobile palliative care teams only with a doctor, although in many countries such care can be provided by nurses and siblings. For example, 70% of palliative care teams  in the United States consist of self-practicing nurses ( male and female). In the United States, nursing is seen as the future of palliative care.  The Canadian Hospice and Palliative Care Association, together with the Nursing Association of Canada, emphasizes that nurses   are the main providers of palliative care.

In the absence of legal ways for patients to apply for nursing services, and nurses to provide it themselves, a shadow market for these services has been formed.

Social media communities are full of questions – “Where to find a nurse for home visits?”. The most common answer is: “Look in hospital wards.” In the market of nursing services, “providers” and “clients” mostly meet illegally, without quality control, safety, transparent pricing, taxes, etc.

Due to the lack of proper legal regulation of nursing services outside the hospital, both patients and nurses lose.

What to do? In our opinion, such steps are needed:

Expanding the authorities of the  female and male nurses

International practice shows that the line between the professions of doctor and nurse is shifting towards giving more  to nurses. Significantly longer terms and, accordingly, the cost of training doctors increase the cost of medical services. Therefore, if nurses can provide services on their own where possible, such services become cheaper and more accessible to patients.

It is advisable to divide different levels of authority of nurses. A joint report by the WHO and the WHO Committee on Nursing Practice states that different countries have up to 15 or more categories of nursing positions with different levels of training. Increased educational training combined with practical experience allows the nurse to receive extended authorities in various areas and specializations. The practice of obtaining higher education in the field of “nursing” is becoming more widespread.

It is appropriate to extend the authorities of nurses to the provision of care and patronage services at home or in the hospital for palliative patients and the elderly.

The introduction of nursing support services in the hospital, at home or in specialized institutions allows to make the patient’s life as comfortable as possible. The task of nurses is to provide emotional support to patients and their families, to teach them to live with the disease.

Definition of the concepts of “nursing care” and “nursing practice” at the level of law

A separate definition of “medical care”, “nursing practice” in the legislation (1, 2) will make female and male nurses the subjects of medical care to the patient on a par with the doctor. The practice of Canada, Finland, Australia, Great Britain, Sweden, the USA, Kenya or other countries can be taken as a basis.

In particular,  (the Canada Health Act) introduces nursing care as part of hospital care. Extended nursing services under Canadian law are home nursing services, including  ones for the elderly.

Canadian legislations provides for the existence of so-called community nurses with extended authorities  for those visiting patients at home. Maintaining such nurses is within the power of local budgets, which do not have enough funds for their own hospital.

Providing care by community nurses reduces the burden on the emergency care system.  Australia and Canada  experience  shows that visits by community nurses significantly reduce the number of ambulance calls by patients with emergencies.

Introduction of professional standards and certification of female and male nurses

Professional standards in the nursing profession are needed to ensure the quality of training and skills of nurses with different levels of authority. Professional standards underlie the nursing profession in the vast majority of countries: the UK the USA, Canada, Australia, Hong Kong, Korea, Taiwan, New Zealand, Singapore and others. Different countries may have different levels of authority, content of work and types of nurses, but systems of professional standards and certification exist in almost all countries with a relatively high level of medicine.

Such a system will stimulate lifelong learning and career development in the nursing profession. It will create transparent mechanisms for competition in the labor market of health workers and stimulate the development of educational services for nurses.

Creating a legal market for private nursing services

To ensure proper quality and safety control for patients and appropriate working conditions for nurses, a “white” market for nursing services needs to be created.

Today, a nurse in Ukraine has a profession “in her hands”, but she cannot provide her professional services without intermediaries – doctors and health care institutions. For the majority of the population prices for patronage in hospitals are too high. The illegal  use of nurses’ services  allows unqualified providers on the market and discredits real professionals.

For example, in Australia, in 2010 was passed legislation that allowed family nurses to provide private services. This has expanded access to health care, reduced the number of visits to hospitals and general practitioners. Thus, given the ever-increasing demand for medical care,  this will reduce the burden on the medical system.

Self-governance of the nursing profession


In Ukraine, medical professions are not self-regulating. However, in many countries (1, 2, 3), professional medical associations provide transparent and competitive access to the medical profession. Some countries already have successful experience in introducing self-governance in the nursing profession. In particular, In particular, in come countries institutes of nursing self-governance   create and adapt nursing education standards, rules and procedures for their licensing, maintain registers and databases of licensed nurses, develop nursing professional standards of practice and working conditions, form and implement ethical standards of the profession and more. 

It is expedient for Ukraine to study the possibilities of building such institutions.

Unified electronic register of female  and male nurses


Data is the basis for making informed decisions and developing evidence policy. Today there is no data on the number of nurses with different levels of education, specializations, experience, professional level.

Any further steps to empower nurses, introduce professional standards, and provide opportunities for nursing practice in health care settings and beyond require clear and up-to-date information about these professionals.


To make medical reforms easier and for the government to successfully implement such complex but necessary transformations, female and male nurses  need to be involved in management decisions. Their experience and closeness to the patient can go a long way in developing health policy tools.



The author doesn`t work for, consult to, own shares in or receive funding from any company or organization that would benefit from this article, and have no relevant affiliations