The nursing profession is an important component of the provision of community healthcare, and nearly a third of the nurses in Israel are employed in the community. The role of community nurses has altered significantly in recent years due to the following changes: the aging population and increase in chronic morbidity; activities and changes within the health system including programs of measurement of the quality of medical care, the mental-health reform, and expanded health promotion; expanded opportunities for advanced training for nurses, and academization of the profession.
In light of these changes, this study was designed to provide data for the first time on the following:
In addition, the study also furnishes data on these issues:
The extent of autonomy felt by nurses in their work
The extent of their satisfaction with various aspects of the work
The barriers to the continued development of the role of community nurses.
The study was based on in-depth interviews with some 50 senior medical and nursing professionals, and on a survey of some 700 nurses from the four health plans who provide direct patient care in the community. The role of community nurses in Israel was compared with that in the US and UK by means of a literature review and consultations with experts in these countries.
The study found that nursing leaders, as well as a large majority of the front-line nurses (85%), perceived that the nature of their work had changed substantially in recent years. Key changes included a transition from reactive to initiated work, increased specialization, a shifting of tasks from hospitals to community settings, and greater autonomy. The main areas of current activity include caring for chronically ill patients, health promotion, and routine care. Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them felt that they had autonomy at work to a great or very great extent. Perceived barriers to further role development include traditional attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels.
The study findings are expected to contribute to the efforts to recruit more people to the profession, especially to community nursing; to update the curricula of nursing schools; and to the discussion of health plans when defining nursing tasks and considering budgets and compensation levels. The findings will also help the general public better understand the roles of community nurses and contribute to nurse empowerment.
The study was funded with the aid of a research grant from the Israel National Institute for Health Policy Research.