National nursing development plan

I. Planning background

(1) Progress of nursing during the "13th Five-Year Plan" period.

During the "13th Five-Year Plan" period, in the comprehensive implementation of the major decisions and deployments of the Party Central Committee and The State Council on promoting the construction of a healthy China, actively responding to the aging population, and continuously deepening the process of medical reform, the nursing industry has developed rapidly and achieved remarkable results. The number of nurses continues to grow. By the end of 2020, there were more than 4.7 million registered nurses nationwide, an increase of 45% over 2015. The number of registered nurses per 1,000 population reached 3.34, and the national medical and nursing ratio increased to 1:1.15, further reversing the problem of medical and nursing ratio inversion. More than 70% of nurses have a college degree or above, and the educational quality of nurses has further improved. Through the continuous development of high-quality nursing services and the implementation of the nurse service ability improvement project, the primary nursing service ability has been significantly improved, the quality of nursing services has been continuously improved, the characteristics of traditional Chinese medicine nursing are more prominent, and the nursing work is closer to the patients, close to the clinic and close to the society. All regions have basically achieved full coverage of high-quality nursing services in secondary and above medical institutions, and some medical institutions have covered outpatient (emergency) diagnosis, blood purification centers (rooms), surgery (department) rooms, catheterization rooms and other non-inpatient departments, and the public's sense of access to medical treatment has been further enhanced. Through the "Internet + nursing service" pilot work, the implementation of the elderly care service development project, and actively promote the elderly home medical care service, the nursing service model has been innovative development, and the nursing service field has been extended and expanded, covering medical institutions, communities and homes as well as the whole population. Nurses provide more diversified medical care services to the people and play an important role in the fields of disease prevention, treatment, nursing, rehabilitation and hospice care. The full implementation of electronic registration of nurses, nurses practice management more convenient and efficient. Medical institutions will gradually establish a nursing post management system, implement nurse manpower allocation, training and assessment based on nursing posts, and gradually realize the same pay and treatment for nurses, more work and more pay, and fully mobilize the enthusiasm of nurses.

Compared with economic and social development and people's growing health needs, there are still problems of unbalanced and inadequate nursing development in our country. The number of nurses is relatively insufficient and the distribution is uneven. There is a certain gap between the supply of nursing services and the diversified and differentiated needs of the masses. The connotation of nursing service needs to be further enriched and expanded. The relevant system and mechanism in nursing field still need to be perfected.

(2) The new situation facing the development of nursing cause during the "14th Five-Year Plan" period.

The overall promotion of the construction of healthy China in the period of the 14th Five-Year Plan has put forward new requirements for the development of nursing. The CPC Central Committee and The State Council have made important arrangements to comprehensively promote the construction of a healthy China, requiring that the people be the center and provide comprehensive full-cycle health services for the people. Nursing business needs to closely focus on people's health needs, build a comprehensive, high-quality and efficient nursing service system, and constantly meet the differentiated nursing service needs of the masses. To deal with the aging population actively puts forward a new task for the development of nursing career. With the deepening of aging, there is an urgent demand for nursing services, especially elderly care services, and it is necessary to effectively increase the supply of elderly care services. Promoting high-quality development has brought new opportunities for the development of nursing. The main contradiction in the field of nursing is the contradiction between the people's demand for nursing services and the relative shortage of supply. It is necessary to further promote the development of high-quality nursing from the nursing system, service, technology, management, talent and other aspects, and improve the level of nursing homogenization. The rapid development of information technology has created new conditions for nursing. Cloud computing, big data, the Internet of Things, blockchain, the fifth generation of mobile communication (5G) and other new generation of information technology and health services deep integration, new models, new industries, new forms of business in the field of health and health continue to emerge, to promote the innovation of nursing service model, improve the efficiency of nursing services, leading the high-quality development of nursing in China to provide strong support.

Second, the guiding ideology and basic principles of nursing development during the "14th Five-Year Plan" period

(1) Guiding ideology.

 Promote the development of high-quality nursing, and strive to let the people enjoy a full range of full-cycle nursing services.

(2) Basic principles.

1. Be people-centered. We give priority to the protection of people's health in a strategic position, adhere to the nursing work to serve the people's health, take meeting the diverse nursing needs of the people as the starting point and goal, and gradually establish and improve a high-quality and efficient nursing service system covering the whole life cycle and the whole process of health.

2. Adhere to high-quality development. To improve the quality and level of nursing service as the core task, adhere to the new development concept, accelerate the construction of the current level of economic and social development, conducive to strengthening the construction of nurses, improve the efficiency of nursing service resource allocation management system mechanism, promote the innovation of nursing service model, to achieve high-quality nursing development.

3. Stick to the weak points. Adhere to the goal and problem orientation, and strive to solve the problem of unbalanced and inadequate development of nursing services. We will speed up efforts to improve weak areas in the nursing sector, increase the supply of nursing services in women and children, the elderly, rehabilitation, and traditional Chinese medicine, develop community and home nursing, hospice and other services, further improve professional service capabilities, and improve the accessibility of nursing services.

4. Pursue reform, innovation and development. Conform to the new situation and new requirements of the development of nursing, focus on the new expectations of the people in the nursing field, grasp the characteristics of nursing work, innovate nursing service mode, and strive to promote the reform and development of nursing service industry. Strengthen the reform and innovation in the field of nursing, remove the institutional obstacles that restrict the development of nursing, and continue to enhance the momentum of nursing development.

Third, development goals

By 2025, China's nursing development will achieve the following goals:

The total number of nurses in China has reached 5.5 million, with 3.8 registered nurses per 1,000 population. The number of nurses has continued to increase, their structure has been further optimized, and their quality and service capabilities have been significantly improved, basically meeting the needs of economic, social and health development. The overall nursing system of responsibility is effectively implemented, and nursing services are closer to the needs of the masses and society. The connotation and extension of nursing care have been further enriched and expanded, and the supply of elderly, traditional Chinese medicine, community and home nursing services has increased significantly. The level of scientific nursing management has been continuously improved, the quality of nursing services has been continuously improved, and the system mechanism to mobilize the enthusiasm of nurses has been further perfected.

Note: Nursing nurses in short supply include: geriatric nursing, pediatric nursing, intensive care, infectious disease nursing, emergency first aid, rehabilitation nursing, traditional Chinese medicine nursing nurses.

Iv. Main tasks

1. Improving the nursing service system.

1. Optimize the layout of nursing resources. Taking into account the changes in population structure, the characteristics of disease spectrum and the needs of the people for medical and nursing services, we will improve the nursing service system covering acute diagnosis and treatment, chronic rehabilitation, stable periodic care and end-stage care. We will give full play to the leading role of high-quality nursing resources in large hospitals, rely on local tertiary hospitals with strong comprehensive strength and high level of nursing disciplines, and improve the nursing service system with clear positioning and division of labor among different medical institutions through the establishment of urban medical associations, county medical communities, and specialty alliances. Different medical institutions provide professional and standardized nursing services according to the needs of different functional positioning. Tertiary hospitals mainly provide nursing care for difficult and critical patients, strengthen the construction of nursing disciplines and personnel training; Secondary hospitals mainly provide common diseases, frequently-occurring care; Nursing homes, nursing centers, rehabilitation medical centers, hospice centers, and primary medical institutions mainly provide geriatric care, rehabilitation care, long-term care, hospice care and other services.

2. Increase the supply of nursing services. We will promote the utilization of resources in areas rich in medical resources, and transform some level I and II hospitals into nursing homes and nursing centers. Support and guide social forces to set up large-scale and chain nursing homes (stations), nursing centers, hospice centers, etc., to further stimulate market vitality. We will increase the number of beds in primary-level medical institutions providing nursing and hospice care services, encourage qualified medical institutions to develop family beds and home care services in light of actual conditions, and effectively expand the supply of geriatric care, rehabilitation care, home care and other services.

(2) Strengthen the construction of nurses.

3. Continue to increase the number of nurses. Take effective measures to increase the number of nurses, especially those working in geriatric care, paediatric care, traditional Chinese medicine care, community care, infectious disease care and hospice care, as well as those working in primary health care institutions. Medical institutions should scientifically and reasonably allocate nurse manpower according to functional positioning, service radius, bed size, clinical nursing workload and technical elements to meet the needs of clinical nursing services.

4. Strengthen nurse training. Establish a nurse training system with post demand as the orientation and post competence as the core. Strengthen the "three bases and three stricts" training of clinical nurses, adhere to the position based, classified policies, and effectively improve the clinical nursing service ability of nurses. According to the nursing needs of the masses and the development of nursing disciplines, targeted training of nurses in geriatric, pediatric, infectious diseases and other nursing specialties in short supply has been carried out. Strengthen the training of new nurses and nursing managers. Arrange nurses' training scientifically and reasonably, reduce repetitive and burdensome arrangements, and alleviate the contradiction between nurses' work and study.

5. Protect the legitimate rights and interests of nurses. To further implement laws and regulations such as the Law of the People's Republic of China on the Promotion of Basic Medical Care and Health and the Regulations on Nurses, as well as the requirements of the state on caring for and caring for medical personnel, and create good conditions in the aspects of nurse practice environment, salary, training and professional development. Medical institutions shall provide nurses with necessary health protection and medical care measures, effectively prevent and reduce the hazards that nurses may suffer in the professional environment, and effectively safeguard and protect the legitimate rights and interests of nurses.

6. Motivate nurses. Promote medical institutions to establish and improve the nursing post management system, in accordance with the requirements of nurses in the post setting, income distribution, title evaluation, management and use, the establishment of internal and external nurses overall consideration, to realize the transformation of nurses from identity management to post management. Improve the incentive mechanism of the nurse team, implement scientific evaluation and performance assessment of nurses, strengthen clinical orientation, guide nurses to base themselves on nursing posts, deepen clinical nursing practice, and strive to improve their professional level. The results of performance assessment are linked to the employment of nurses, performance distribution, reward and evaluation, etc., and tilted to clinical front-line nurses and grass-roots nurses, with more work and more pay and excellent performance, to fully mobilize the enthusiasm of nurses.

(3) Promoting high-quality nursing development.

7. Continue to deepen quality care. We will continue to expand the coverage of high-quality nursing services, achieve full coverage of high-quality nursing services in secondary and above medical institutions, and significantly increase the proportion of other medical institutions providing high-quality nursing services. Implement the core nursing system, implement the overall nursing system of real responsibility, consolidate the quality of basic nursing, strengthen the humanistic care of nursing, optimize the nursing service process, achieve the expansion and improvement of high-quality nursing services, and effectively improve patients' sense of gain.

8. Innovative nursing service model. In combination with the requirements of graded diagnosis and treatment and the actual needs of the masses, conditional medical institutions are encouraged to innovate and develop diversified nursing services. Expand the pilot coverage of "Internet + nursing services", support medical institutions to actively provide "Internet + nursing services", extended care, home care, etc., extend in-institution nursing services to the community and home, and provide convenient and professional medical and nursing services for discharged patients, terminally ill patients or elderly people with mobility difficulties, frail elderly people, disabled elderly people.

9. Strengthen nursing discipline construction. In order to meet the clinical nursing needs of major diseases and key populations, we should strengthen the construction of nursing disciplines, and drive the training of nursing talents and the improvement of nursing service capabilities with the construction of disciplines. We will continue to improve the quality of nursing care, strive to build a nursing norms and technical standards system based on evidence-based basis and clinical needs, and effectively improve the level of inter-regional and inter-institutional nursing homogenization.

(4) Make up for nursing shortcomings and weaknesses.

10. Accelerate the development of medical care for the elderly. We will encourage all localities to accelerate the implementation of national policies and measures on the development of medical and nursing services for the elderly in light of actual conditions. According to the size and quantity of the elderly population in the jurisdiction, disease characteristics, medical care needs, etc., the number of institutions and beds providing elderly care services should be reasonably increased according to local conditions. Increase the number of nurses engaged in geriatric medical care services, and strengthen personnel training. Explore the establishment and development of a professional team of medical nurses, expand the human resources of medical care for the elderly, and better meet the needs of the aging society. To meet the urgent needs of disabled elderly people, accelerate the development of home medical care services and long-term care, and encourage qualified medical institutions to actively provide home care and day care services for the elderly, especially disabled elderly people.

11. Enhance the capacity of primary care services. Support qualified secondary and above medical institutions and primary medical and health institutions to establish nursing specialist alliances, expert joint teams, etc., effectively play the role of high-quality nursing resources to help drive, through sinking or output management, training, technology, and other ways to help improve the ability of primary care services. Speed up the construction of grass-roots nurses and increase the manpower allocation of grass-roots nurses. "Invite in, send out" and other ways to increase the training of grass-roots nurses, effectively improve their common diseases, frequently-occurring nursing, elderly nursing, rehabilitation nursing and other professional service capabilities.

12. Accelerate the development of hospice care. To encourage all localities to increase the number of hospice centers and beds providing hospice services in accordance with the Basic Standards and Management Norms for hospice Centers (Trial), combined with the requirements of graded diagnosis and treatment and the urgent needs of the people in their jurisdictions. The Guidelines for Hospice Practice (Trial) and related technical standards have been revised to continuously regulate the practice behavior of practitioners. To accelerate the training of professionals engaged in hospice care services, and effectively improve the quality of hospice care for terminally ill patients.

(5) Strengthen the construction of nursing information.

Make full use of cloud computing, big data, Internet of Things, blockchain and mobile Internet and other information technologies, combined with the development of smart hospitals and "Internet + medical health" and other requirements, focus on strengthening the construction of nursing information. The use of information means, innovative nursing service model, to provide patients with convenient and efficient nursing services. Optimize the nursing service process, improve the efficiency of clinical nursing work and reduce the unnecessary work load of nurses. Establish a nursing management system based on problems and needs, with nurse manpower deployment, post training, performance assessment, quality improvement, discipline construction and other functions, and gradually realize the modernization, science and refinement of nursing management.

(6) Promoting the development of TCM nursing.

Improve traditional Chinese medicine nursing routine, program and technical operation standards. We should actively carry out syndrome-differentiation care and TCM specialty nursing, continuously improve the quality of TCM nursing services, innovate TCM nursing service models, give play to the important role of TCM nursing in disease prevention, treatment, rehabilitation, etc., and promote TCM nursing to further expand to the grassroots and families, and extend to the fields of elderly care and chronic disease nursing. Strengthen the training of TCM nursing personnel, and effectively improve the ability of TCM nursing service.

(7) Strengthen nursing exchanges and cooperation.

To carry out in-depth cooperation and exchanges in the field of nursing with international and Hong Kong, Macao and Taiwan regions, and strengthen exchanges and cooperation in nursing management, system policies, personnel training, nursing technology and other aspects. Drawing on advanced ideas and practical experience, combining with our national conditions, the relevant policies of nursing high-quality development will be perfected.

V. Safeguard measures

1. Strengthen organizational leadership.

Health administrative departments at all levels (including the competent departments of traditional Chinese medicine, the same below) should fully understand the importance and necessity of promoting high-quality development of nursing during the "14th Five-Year Plan" period, effectively incorporate nursing work into the overall plan of comprehensively promoting the construction of a healthy China in the region, actively responding to the aging population and continuously deepening medical reform, make overall arrangements and deployment, and promote implementation simultaneously. Provincial health administrative departments should formulate the "14th Five-Year Plan" nursing development plan in accordance with the actual situation in the region, refine the implementation measures, strengthen organizational leadership, and conscientiously implement.

2. Strengthening monitoring and evaluation.

The provincial health administrative departments should formulate and improve the monitoring and evaluation plan for the development of nursing undertakings during the "14th Five-Year Plan" period in the region, and do a good job in the dynamic monitoring and mid-term evaluation of the implementation of the plan. Regular monitoring and evaluation of work progress, timely identification of problems and solutions. In 2023, the NHC will conduct a mid-term assessment of the implementation of the plan by the provincial health administration departments, organize a final assessment in 2025, and timely inform the local implementation.

(3) Timely summary and promotion.

Health administrative departments at all levels shall, in accordance with the requirements of this plan, implement key tasks according to local conditions, conduct in-depth investigations and studies, and have the courage to try first. In the process of promoting implementation, focus on summing up experience and promoting implementation step by step. The National Health Commission will exchange and promote typical experience in local innovation, and promote the development of nursing industry to achieve new results.

4. Pay attention to publicity and guidance.

Health administrative departments and medical institutions at all levels should make full use of radio, television, newspapers, the Internet and other forms of news media to do a good job in the "14th Five-Year Plan" nursing development planning policy interpretation and public opinion guidance. Fully respect the local initiative, pay attention to the publicity of typical experience, play a leading role in demonstration, and create a good atmosphere for the whole society to care for and support the development of nursing.