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Hospital Healthcare Europe

EU Nurse Leaders: cross border, cross culture, cross discipline

28 July, 2010  

Leadership in nursing is a key tool for safeguarding excellence in practice, such as ensuring the adequate nutrition of patients

Iris Meyenburg-Altwarg
(President ENDA)
Geibelstrasse 25
30173 Hannover
Email: [email protected]

Developments in the provision of healthcare, together with current social changes, require a new level of cooperation
between the various healthcare professions. Individual healthcare professions need dialogue with the other disciplines because, for the most part, their tasks and problems cannot
be overcome without taking into account other fields of knowledge and areas of experience. In the future, for many people, being sick, injured or having a disease will no longer mean an isolated episode in their life, but will represent a continuous influence in their daily living environment.
The borders will tend to disappear between preventative measures and in- and outpatient treatment. Equally the lines between self-care, care by unqualified care-givers, technology and other related professions at various levels right up to
supra-specialisation will become blurred.

Nursing in Europe
The EU supports the mobility of patients but the regulations differ greatly from country to country and have not yet been harmonised. In order to achieve the desired effect on nursing care in the EU, differences of language and culture must be
understood and overcome too. Nursing professionals are involved in and contribute to every aspect of the healthcare system. They are the most constant presence in the healthcare
environment, providing ’24/7′ care. Nurses provide care and contact in all medical fields, all kinds of situations and for patients (and their relatives) with difference levels of dependence. It is apparent that nursing, in parallel to the medical profession, requires increasing levels of specialisation
and qualification.[1]
Associations of specialist nurses – such as intensive care, psychiatry nurses and oncology – are often organised on a national, European and international level. They collaborate and exchange knowledge and develop professional guidelines.

Nursing managers
The essential tasks of managers include, inter alia, planning, organisation, staffing, directing, coordinating, reporting and budgeting.[2] Nursing managers often have a basic nursing qualification as well as a wide experience in nursing practice
alongside their academic qualification and training in management.[3,4] With their academic background in the social science area added to their diverse medical knowledge and varied operational experience, they are able to bridge the gap between financial needs and the requirements of healthcare provision in order to play their part in creating complete, systemic and realisable concepts for implementation. It seems natural, therefore, to pool these competences and to have them available through networking and partnerships.[5]
Current challenges for the healthcare professionals are demographic changes, the ageing population in Europe, the complexity of health problems and the need for multidisciplinary teamwork. These complex needs, along with the challenges of changing technology and increased expectations of practice, as well as meeting social needs, including cultural diversity, require professionals to have the necessary skills, to adapt to and embrace change.

Leadership in nursing is, above all, one of the key tools for safeguarding excellence in practice for the benefit of patients. Partnership and professionalism generate quality. The European Nurse Directors Association (ENDA) was established in 1995
(and formally registered as an NPO two years ago) in order to support nursing leadership and bring together nurse leaders from all over Europe. ENDA is working closely as a member of a
collective group of specialist nursing organisations (ESNO) within Europe and at the same time as an associate member of the umbrella association of EFN (European Federation of Nursing). The main objectives of the ENDA are:

  • To strengthen the nursing contribution to policymaking in the context of healthcare management in Europe
  • To further the development of the art and science of nursing leadership through research, nursing education, policy and practice development
  • To establish formal links between nurse leaders (and/or other healthcare decisionmakers) and their organisations acrossEurope and, in so doing, create a communication network of experts.

Our organisation has been expanded and our membership base represents nurse leaders from 22 European countries.

Professional Interchange
At a biennial congress of ENDA, which took place in Reykjavik, Iceland in 2007, with the theme ‘Tomorrow’s Nurse –Taking the Lead’, a successful forum was created for colleagues to meet and share experiences, to discuss possibilities and challenges and to exchange ideas. As the title implies, it was an opportunity to develop strategies for the future that relate
directly to the everyday life of nurse leaders as opposed to dealing mainly with ‘fire-fighting’ activities.
Recently (2009) another successful ENDA congress was held in Helsinki, Finland with the theme of ‘Better Health for the Future’. Nurse leaders, scientists and representatives of various
organisations from all over Europe participated, including a delegation from China. The opportunity was taken to exchange ideas and discuss the current state of health in Europe and to develop further ideas for collaboration on a number of proposed cross-border projects.

Networking to Partnership
Under the term networks, one understands the creation and maintenance of a framework of communication among a group of people with common interests and who know each other. The
aim is to exchange information and strengthen the group and, at the same time, promote each other’s progress and provide mutual support. In the medium term, however, this is not
sufficient. In order to meet future challenges in healthcare, we need, on the one hand, a trustful and appreciative interplay of functioning and well developed competence-networks and on the other, the unconditional will and a good element of lateral thinking in order to create cross-border solutions.

Malnutrition to adequate nutrition
ENDA actively supports ensuring the adequate nutrition of patients, whether in the community or in care environments, and it remains a focal point of its attention. Nurse Directors are well placed to work with colleagues towards developing meaningful strategies to address this issue. ENDA remains firmly committed to its partnership with the European Nutrition for Health Alliance (ENHA). ENDA’s president was a co-signatory of the Prague Declaration (2007) ‘A Call for Action to Fight Malnutrition’.

Influencing policy
As part of the European Specialist Nurses Organisation (ESNO) we have been able to influence policy-making at the European level. A particular instance is the involvement of ENDA (as part of ESNO) with nurse educators and TUNING.
In the matter of patient safety, it is of prime importance that nurse directors are aware of the competencies of their workforce. The TUNING project has enabled us to voice our views on the competencies of the future nurse – an empowering process for all.
There have also been several position-papers provided in relation to nursing education in line with the directive 2005/B6/EG and the European qualification framework 04/2008. Responses have been collected from our members from a number of different countries and these have been incorporated into a submission to the following organisations:- World Health Organization (WHO), European Public Health Alliance (EPHA) and EU (Green Papers etc).[6]
Rigorous research and collaboration with experts has led to developing the first edition of the ‘Code of Ethics for Nurse Directors’ (2009).

Networking to partnership
ENDA has shown its leadership in meeting the challenges
and creating the opportunities for the future. ENDA has developed relationships of mutual trust to other specialist organisations in healthcare while enjoying the benefits of “the whole being more than the sum of the individual parts”. We are on the right road from networking to partnership.

1. Schröck, R. Milieu und soziale Kompetenz in der Pflege Psy.Pflege 1997; 4:16-19.
2. Gulick, L. Papers on the Science of Administration, Institute of Public Administration New York 1937.
3. Steppe, H. Die Pflege und ihr gesellschaftspolitischer Auftrag. Pflege 2000; 13: 85-90.
4. Elsbernd, A. Das Pflegemanagement stärken. Pflege aktuell 2001;12: 654-657.
5. Hurrelmann, K. Gesundheitssoziologie. Eine Einführung in sozialwissenschaft-tliche Theorien von Krankheitsprävention
und Gesundheitsförderung. Juventa Verlag: Weinheim 2006.
6. Filkins, J.The snowball effect, 12. Pflegesymposium, Germany 2008.

Further information
Green Paper: