Obzornik zdravstvene nege, 56(3), pp. 172–175. https://doi.org/10.14528/snr.2022.56.3.3191 For the last two years, nurses have been more than ever before in a very complex and challenging timing. COVID-19 has disrupted society in its entirety. But, of all the different sectors, one that remained working day and night, with incredible shifts and no breaks or holiday, were the nurses, who through their relentless commitment, expertise, professionalism, bravery, care for our most vulnerable, have and continue preserving millions of lives daily and providing comfort and dignified care at end of life. This pandemic has for sure demonstrated the added value of the nursing workforce to the European healthcare ecosystems: working at the frontline of care, at the bedside with the patients, and providing the evidence that nurses' competencies are central to the functioning of healthcare systems in the EU. In the last few months, another reality hit us all hard with the war in Ukraine, and again brought very difficult timings for a whole population - a humanitarian crisis that has been threatening our nurse colleagues and their families, and world peace. More than ever, international cooperation and solidarity have been vital to support nurses, midwives and healthcare professionals at the frontlines. In these difficult times, the European Federation of Nurses Associations (EFN) has been collaborating very closely with international organisations, as the International Council of Nurses (ICN), and with EFN National Nurses Associations from Poland, Slovenia, Hungary and Romania, as well as Moldova, to bring its support to the nurses' colleagues from Ukraine, refugees or still in the country, and to those at the neighbouring countries boarders trying to help as much as they can the refugees flying the country, which for some of them are also nurses and midwives. The EFN is also in close contact with other key EU stakeholders and with the European Commission to collectively support the efforts to support and protect nurses, midwives, health professionals and ensure access to healthcare and promote peace through a unified nursing response. More than ever, nurses have witnessed the devastating suffering of individuals and their families with an enormous impact on their mental and physical health. The COVID-19 pandemic reaffirmed the value of well prepared and educated nurses which leads to lower mortality rates and better patient outcomes. Nurses play an essential role in the provision of safe and quality healthcare. Despite the ongoing challenges they are facing and the difficult and stressful working conditions, nurses continue to tackle the situations with incredible strength and dedication to ensure the smooth functioning of the healthcare systems and the well-being of their patients. From the European Commission perspective, it is acknowledged that a stronger Europe-wide coordination is required in relation to health, with more investment to build the foundations for a more resilient health system and better preparation for possible future health crises. As such, people and their well-being are at the heart of the European Pillar of Social Rights Action Plan (European Commission, 2021) that sets out the common agenda to reinforce social Europe. As the single largest occupational group in healthcare, nurses have a crucial and unique role to play in the efforts to develop effective and efficient health systems able to respond to the challenges they face. This depends to a considerable extent on having a high- quality health workforce of sufficient capacity and with the right skills. The way forward could be simple as we do not need to make things more complicated than they already are. With the very good steps already achieved, we need for sure to build further on all the work done and the outcomes reached so far at national and EU level, building on partnerships with the EU leaders and policymakers, and knowing that a lot is happening at EU level, namely on Digitalisation, Workforce Editorial/Uvodnik Nurses' voice as the key to change Glas medicinskih sester je ključnega pomena za spremembe Paul De Raeve1, * 1 European Federation of Nurses Associations (EFN), Clos du Parnasse 11A, B-1050 Brussels, Belgium * Corresponding author/Korespondenčni avtor: efn@efn.eu Received/Prejeto: 7. 7. 2022 Accepted/Sprejeto: 15. 7. 2022 De Raeve, P. (2022)/Obzornik zdravstvene nege, 56(3), pp. 172–175. 173 and Education. The nurses' voice is key to change for the better, to make sure that the EU includes health in all policies to tackle the EU, European and global challenges, and enhance nurses' ability to shape and deliver effective and efficient EU policies that impact positively on the EU citizens. A resilient future-proof health ecosystem is urgently needed with the agreement of EU institutions and Member States on the use of the EU Recovery & Resilient Funds. This is necessary to respond to the major healthcare challenges that COVID-19 put boldly on the political table: the resilient health and care workforce, the care left undone, the digitalisation of the healthcare services, planetary health, and last but not least citizens' value recognition to build the future of Europe. Still today, nurses have to face shortage, lack of protection, heavy workload, and low wages. It is time to take real EU actions, to address in a systematic way the recruitment and retention of frontline nurses. Nurses through their relentless commitment, expertise, professionalism, bravery, and heroic actions have saved countless numbers of lives. Despite ongoing challenges they are facing and the difficult and stressful working conditions, nurses continue to tackle the situations with incredible strength and dedication to ensure the smooth functioning of the healthcare systems and the well- being of their patients. The new European Semester Spring Package 2022 (European Commission, 2022, May 23) can be a good tool to look at, next to the implementation of the national recovery and resilience plans (European Commission, 2020) which sets out a coherent package of reforms and public investment projects. In these difficult times, creating resilient healthcare systems is a fundamental starting point to support nurses and healthcare professionals at the frontline. It is time for the EU governments and health systems to invest in nursing education and in a resilient Nursing Workforce to address the growing nursing shortage. Nursing workforce is the backbone of the healthcare ecosystem and the most trusted healthcare professional closer to patients. As such, nurses are the solution to address the world's growing health care needs. Nurses are natural healthcare innovators being at the frontline of care, ready to upscale new digital health tools for the benefit of patients, and as such contribute to address three key elements of the current transformation of health ecosystems: building trust, promoting user-centre innovation and ensuring an appropriate use of data to enable technology. EFN, representing 3 million nurses in the EU and 6 million in Europe, supports the boosts of the digitalisation process and in particular the engagement of nurses in co-creation. The EFN believes that it is necessary to create the right digital instruments which can facilitate and support nurses' daily operational activities/services. Therefore, it is urgent to create digital tools that can really help and facilitate nurses and other healthcare professionals' working life. But this is possible only by engaging nurses in co-creation! Nurses really know what the healthcare eco-system needs are and where digitalisation could be helpful and essential for achieving better health and care outcomes. In this context in which digitalisation is more and more essential in the health systems, the European Health Data Space (EHDS) (European Commission, 2022) plays a key role. Recently launched by the European Commission, it represents a great opportunity for nurses and for all the healthcare professionals to have an easy access to the health data of patients, ensuring protection and high-quality care. For EFN, the central issues in the weeks, months and years ahead will be about public trust and keeping the citizen/patient in the centre of proceedings. The EFN placed and will be placing a lot of focus on the health data space, as demonstrated by the 2 EU projects almost coming to an end in the Health Data Space context: Smart4Health (EFN, 2019) and InteropEHRate (EFN, 2020). Challenges for the healthcare systems all over Europe cannot be underestimated, namely in these very difficult times. The EFN and its Members are committed and determined to ensure that EFN EU policy agenda priorities on education, workforce, quality and safety, remain high on national and EU political agendas, and continue lobbying the national governments and the EU institutions to make sure the nurses' voice is heard and taken into account in any of the key health developments. More than ever, it is crucial for nurses and midwives to engage and proactively influence EU policies that impact on quality and safety of healthcare and contribute to the population's health throughout Europe. Therefore, it is essential to support, to listen, and to encourage each other. It is not about prestige, it is not about who is the best, it is about our collective interests, views, actions, concerns and challenges. As we all know, we cannot change the world on our own. But we can focus and work together, in synergy, on specific actions that can make the difference for the nurses and the citizens of Europe. Slovenian translation/Prevod v slovenščino V zadnjih dveh letih so se medicinske sestre znašle v nadvse kompleksnem in težavnem položaju. Medtem ko je pandemija COVIDA-19 za družbo pomenila popoln prelom z utečenimi praksami, so bile med vsemi storitvenimi sektorji so ravno medicinske sestre tiste, ki so se odpovedale odmorom in počitnicam in ohranile celodnevni delovnik z garaškimi izmenami. Njihova trdna zavezanost, znanje in strokovnost, pogum in skrb za najšibkejše člane družbe so reševali De Raeve, P. (2022)/Obzornik zdravstvene nege, 56(3), pp. 172–175.174 in še naprej dnevno rešujejo na milijone življenj ter pacientom zagotavljajo olajšanje, skrbno nego in dostojnost tudi ob koncu življenja. Pandemija je evropskim zdravstvenim ekosistemom jasno pokazala dodano vrednost delovne sile v zdravstveni negi: delo na prvi liniji nege, ob posteljah pacientov, je dokaz, da so kompetence medicinskih sester osrednjega pomena za delovanje zdravstvenih sistemov v EU. V preteklih mesecih je javnost pretresel izbruh vojne v Ukrajini. Ta grožnja svetovnemu miru in populaciji pomeni humanitarno krizo, ki ogroža tako naše kolege na področju zdravstvene nege kot tudi njihove družine. Sedaj je še posebej pomembno mednarodno sodelovanje in solidarnost v podporo medicinskim sestram, babicam in drugemu zdravstvenemu osebju v prvih bojnih linijah. V teh težavnih časih Evropska federacija združenj medicinskih sester (European Federation of Nurses Associations [EFN]) nudi podporo ukrajinskim zdravstvenim delavcem (tako beguncem kot tistim, ki so ostali v državi, ter tistim iz sosednjih držav, ki nudijo pomoč beguncem, med katerimi so tudi medicinske sestre in babice), pri čemer tesno sodeluje z mednarodnimi organizacijami, kot so Mednarodni svet medicinskih sester (ICN) in nacionalna združenja medicinskih sester znotraj EFN iz Poljske, Slovenije, Madžarske, Romunije in Moldavije. EFN se v okviru enotnega odziva zdravstvene stroke zavzema za mir in zagotavljanje dostopa do zdravstvene nege ter v tesnem sodelovanju z ostalimi ključnimi evropskimi deležniki in Evropsko komisijo nudi podporo in zaščito medicinskim sestram, babicam in drugemu zdravstvenemu osebju. Medicinske sestre so bolj kot kdajkoli prej priča neizmernemu trpljenju posameznikov in njihovih družin, kar močno vpliva na njihovo duševno in fizično zdravje. Pandemija COVIDA-19 je poudarila pomen razpoložljivosti dobro pripravljenih in strokovno podkovanih medicinskih sester, saj ta pripomore k nižji smrtnosti in boljšim rezultatom zdravljenja. Medicinske sestre igrajo ključno vlogo v procesu zagotavljanja varne in kvalitetne zdravstvene nege. Kljub neprestanim izzivom, s katerimi se soočajo, ter težkim in stresnim delovnim pogojem, se medicinske sestre s kriznimi situacijami spopadajo z neverjetno močjo in predanostjo, s čimer omogočajo nemoteno delovanje zdravstvenih sistemov v dobrobit svojih pacientov. Evropska komisija prepoznava potrebo po močnejši vseevropski koordinaciji na področju zdravstva ter naložbah v izgraditev temeljev odpornejšega zdravstvenega sistema in boljše pripravljenosti za primer morebitnih prihodnjih kriznih situacij. Evropski steber socialnih pravic (European Commission, 2021) tako predstavlja skupno strategijo za okrepitev socialne Evrope, v kateri so ljudje in njihova dobrobit v središču pozornosti. Medicinske sestre imajo kot največja poklicna skupina v zdravstvu ključno in edinstveno vlogo v prizadevanjih po razvoju učinkovitih zdravstvenih sistemov, ki se bodo sposobni odzvati na tekoče izzive. To je seveda v veliki meri odvisno od razpoložljivosti zadostnega števila kvalitetnega in ustrezno strokovno podkovanega zdravstvenega osebja. Pravzaprav je pot naprej lahko preprosta. Na podlagi že doseženih premikov, opravljenega dela ter dosedanjih rezultatov na nacionalni in evropski ravni je vsekakor potrebno še naprej graditi na partnerstvih z voditelji in oblikovalci politik EU, obenem pa ohranjati zavedanje, da se na ravni EU že odvijajo ključne spremembe na področju digitalizacije, razvoja delovne sile in izobraževanja. Vendar pa je za potrebne spremembe in vključitev zdravstva v vse politike spoprijemanja z evropskimi in globalnimi izzivi ključnega pomena glas medicinskih sester. Prav tako je nujno potrebno povečati možnosti medicinskih sester po sooblikovanju in uresničevanju učinkovitih in za prebivalstvo pozitivnih evropskih politik. Izgraditi je potrebno odporen zdravstveni ekosistem, ki bo temeljil na sporazumu med institucijami EU in državami članicami o uporabi sredstev Mehanizma EU za okrevanje in odpornost. Na podlagi tega se je potrebno odzvati na ključne zdravstvene izzive, ki jih je pandemija pogumno postavila na politično prizorišče in ki vključujejo potrebo po odporni delovni sili v zdravstvu, neopravljeno zdravstveno nego, digitalizacijo zdravstvenih storitev, planetarno zdravje in nenazadnje tudi pomen gradnje prihodnosti EU s strani njenih prebivalcev. Danes se medicinske sestre še vedno soočajo s pomanjkanjem delovne sile in varnosti, preveliko delovno obremenitvijo ter nizkimi plačami. Čas je, da v EU pride do konkretnih ukrepov, ki bodo sistematično naslovili zaposlovanje in obdržanje medicinskih sester na prvih linijah nege. S svojo neomajno predanostjo, znanjem in strokovnostjo, pogumom in herojskimi dejanji so medicinske sestre rešile že nešteto življenj. Kljub nenehnim izzivom ter težavnim in stresnim delovnim pogojem se s situacijami spopadajo z neverjetno močjo in predanostjo, s čimer zagotavljajo nemoteno delovanje zdravstvenih sistemov in dobrobit svojih pacientov. Pri uvajanju potrebnih sprememb se lahko opiramo na novi spomladanski sveženj evropskega semestra za leto 2022 (European Commission, 2022, May 23), obenem pa tudi na nacionalne načrte za okrevanje in odpornost (European Commission, 2020), ki vsebujejo priporočila za reforme in projekte javnih naložb. V teh težavnih časih predstavlja oblikovanje prožnih zdravstvenih sistemov temeljno izhodišče za podporo medicinskim sestram in zdravstvenim delavcem na prvi liniji. Da bi rešili problem pomanjkanja medicinskih sester, morajo vlade in zdravstveni sistemi EU sedaj vlagati v izobraževanje na področju zdravstvene nege in s tem v zagotavljanje odporne delovne sile v zdravstveni negi. Medicinske sestre so kot najbolj zaupanja vreden zdravstveni delavci najbližje pacientom in zato predstavljajo ne le hrbtenico zdravstvenega ekosistema, ampak tudi odgovor na naraščajoče svetovne potrebe po zdravstveni oskrbi. De Raeve, P. (2022)/Obzornik zdravstvene nege, 56(3), pp. 172–175. 175 Medicinske sestre so naravne inovatorke na področju zdravstvenega varstva in so v korist pacientov pripravljene nadgraditi digitalna zdravstvena orodja ter s tem prispevati k naslavljanju treh ključnih elementov preobrazbe zdravstvenih ekosistemov: krepitev zaupanja, spodbujanje inovacij v korist uporabnika in zagotavljanje ustrezne rabe podatkov v podporo tehnološkim rešitvam. EFN, ki zastopa 3 milijone medicinskih sester v EU in 6 milijonov v Evropi, spodbuja pospeševanje digitalizacije in zlasti vključevanje medicinskih sester v njeno soustvarjanje. EFN namreč zagovarja stališče, da je potrebno razviti ustrezna digitalna orodja, ki bodo olajšala in podprla dnevne operativne naloge medicinskih sester. Zato je nujno potrebno razviti digitalna orodja, ki lahko resnično pomagajo in olajšajo poklicno življenje medicinskih sester in drugih zdravstvenih delavcev. Vendar pa je to mogoče le z vključevanjem medicinskih sester v njihov razvoj! Medicinske sestre so dobro seznanjene tako s potrebami zdravstvenega ekosistema kot tudi s koristjo in uporabnostjo digitalizacije za doseganje boljšega zdravja in boljših rezultatov zdravstvene nege. V kontekstu vse večjega pomena digitalizacije v zdravstvenih sistemih ima Evropski zdravstveni podatkovni prostor, ki ga je pred kratkim uvedla European Commission (2022), ključno vlogo. Evropski zdravstveni podatkovni prostor medicinskim sestram in vsem zdravstvenim delavcem omogoča enostaven dostop do zdravstvenih podatkov pacientov, kar pacientu zagotavlja zaščito in kakovostno oskrbo. V prihodnjih tednih, mesecih in letih bosta za EFN osrednjega pomena predvsem vprašanji javnega zaupanja in ohranjanja državljana/pacienta v središču procesov. Da je za EFN zdravstveni podatkovni prostor bistvenega pomena, dokazujeta tudi dva skoraj zaključena projekta EU v kontekstu zdravstvenega podatkovnega prostora: Smart4Health (EFN, 2019) in InteropEHRate (EFN, 2020). V teh težavnih časih resnično ni mogoče podcenjevati izzivov, s katerimi se soočajo zdravstveni sistemi po vsej Evropi. EFN in njeni člani so zato trdno zavezani ohranjanju prednostnih nalog politike EFN EU o izobraževanju, delovni sili, kakovosti in varnosti visoko na nacionalnih in političnih agendah EU. Še naprej bodo intenzivno lobirali pri nacionalnih vladah in institucijah EU in s tem poskrbeli, da se glas medicinskih sester sliši in upošteva pri ključnih premikih na področju zdravstvenega varstva. Zdaj sta bolj kot kdajkoli prej nujno potrebna vključitev in proaktivno delovanje medicinskih sester in babic pri oblikovanju evropskih politik, ki uravnavajo kakovost in varnost zdravstvene nege in prispevajo k zdravju populacije vse Evrope. V teh prizadevanjih je zelo pomembno, da si nudimo podporo, si prisluhnemo in se medsebojno bodrimo. Ne gre za prestiž ali tekmovanje, gre za naše kolektivne interese, poglede, dejanja, skrbi in izzive. Povsem jasno je, da sami ne moremo spremeniti sveta. Lahko pa se osredotočimo na skupni cilj in skozi skladno sodelovanje izboljšamo položaj medicinskih sester in prebivalcev Evrope. Conflict of interest/Nasprotje interesov The author holds a position of General Secretary of the EFN./Avtor opravlja funkcijo glavnega sekretarja EFN. Literature European Federation of Nurses Associations (EFN). (2019). SMART4HEALTH: Citizen-centred EU-EHR exchange for personalised health. 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Nurses' voice as the key to change. Obzornik zdravstvene nege, 56(3), 172–175. https://doi.org/10.14528/snr.2022.56.3.3191