[A national survey on the activities performed by nurses and aids in Italian outpatients' services].
In Italy, the National Health System (SSN) grants healthcare to the citizens; its realization is up to the Government, the Regions and local institutions, with the participation of citizens. The Health Ministry determines the essential levels of care, and dictates the general guidelines for the activities of the SSN. On the whole national territory, a network of Local Healthcare Units (ASL) is present; such institutions, although belonging to the SSN, have local autonomy. Their activity is based upon principles of efficacy and efficiency; each one includes one or more Districts, which usually group a minimum of 60,000 citizens. Until 1999, Italian nurses have based their activity on a law that enumerated their tasks (DPR 225/74); nowadays, they work according to the indications of a professional profile (DM 739/94), a code of deontology, a law (L. 42/99) that has eliminated the old DPR, and university programmes. Apart from nurses, both in public and private healthcare facilities it is possible to find aids called OSS; their education consists of a twelve months programme, for which the regional institutions are responsible. Specific laws define their field of activity. For all these reasons, and also because of a major nursing shortage, in Italy it is not possible to talk about tasks delegations from doctors to nurses; we can, however, think about this process from nurses to aids and employees. Italy has the highest number of doctors in the world, with more than 6 every 1000 citizens in 2005 (approximately 370,000 units); nurses suffer from the opposite problem; nurses were 348,415 in 2005 and 360,874 in 2007, that is to say 5.4 nurses each 1000 citizens. This means a shortage of 60,000 nurses.


OBJECTIVE
Our research is aimed at: Studying the activities deployed by nurses in outpatients' facilities, that could be assigned to aids,; Identifying the tasks currently deployed by nurses, that are beyond their competence; Estimating how much time nurses could save, if they were not busy with activities that could be assigned to others.


METHODS
Our study sample included only of manager nurses, who were responsible of nursing offices in ASLs which included outpatients. facilities on the whole territory ofl Italy. We choose to make a convenience sampling, choosing a manager nurse for each regional chief town. Our study is an observational, non-experimental quantitative research. To collect our data we used an anonymous questionnaire, based on a reference model, which had already been used in older studies. The model allowed a classification of the tasks performed by nurses in three categories: Nursing activities without chances of delegation; Nursing activities that could be assigned to aids; Activities beyond the competence of nurses. The questionnaire was articulated in 7 categories (general situation, booking, acceptation, preparation of patients' units, nursing care, tasks usually performed in outpatients' services, rearrangement of patients' units). We made a comparison between our data and the reference model. In the studied outpatients' services, nurses take in charge a high percentage of tasks (39%) that should be performed by others. More precisely, there are activities that should be carried out by aids (17%) or employees (22%). For example, in the category "Rearrangement of the patient's units", nurses perform approximately 70% of the tasks. Our study revealed that not employing aids at their fullest affects the problem; overall, our data show that 45% of nurses' everyday working time could be regained, if it were possible to assign to aids and employees all the activities that are not nurses' competence. This would produce a series of positive consequences, such as bringing out of the competences acquired by nurses, a better qualification and a real identification of the contribution given by nurses to the citizenship, other than an adequate employment and usage of human resources.
Destrebecq
A
A
Chercheur en Soins infirmiers, Université de Milan.
Lusignani
M
M
Terzoni
S
S
D000554:Ambulatory Care Facilities; D032022:Delegation, Professional; D006801:Humans; D007558:Italy; D009726:Nurses; D009728:Nursing Assistants; D010561:Personnel Staffing and Scheduling; D012494:Sampling Studies; D011795:Surveys and Questionnaires