This article discusses reports from seven countries about the coronavirus pandemic, drawing comparisons between them and identifying lessons for next steps
The UDINE-C network is an international group of senior nurses who share country-specific experiences with each other. This article looks at health professionals’ views of the coronavirus pandemic, submitted by nurses from seven of the network’s member countries, which highlight similarities and differences between how the pandemic is being managed across Europe and Russia.
Citation: Butterworth T (2021) Management of the coronavirus pandemic across Europe and Russia. Nursing Times [online]; 117: 5, 56-58.
Author: Tony Butterworth is emeritus professor, University of Lincoln.
Although the UK has formally withdrawn from the European Union – and, therefore, also withdrawn from between-country arrangements afforded by that membership – health professionals from Europe and elsewhere continue to share information and to work together. Formed in 2007, the Understanding Development Issues in Nurse Educator Careers (UDINE–C) network (Box 1) is a high-level, established group of collaborating senior nurses who share country-specific experiences with each other.
Box 1. The UDINE-C network
The UDINE-C network (Bit.ly/UDINECNetwork) was created in Udine, Italy, in November 2007. The founding members were: Professor Tony Butterworth, Dr Christine Jackson and Professor Sara Owen (England); Dr Alvisa Palese (Italy); and Dr Majda Pajnkihar (Slovenia). Since then, many nurses around the world have joined the network and it currently has members from 15 countries. Professor Esther Cabrera (Spain) is the current UDINE chair.
The responses discussed in this article were submitted by: Marie Trešlová (Czech Republic); Árún Sigurðardóttir (Iceland); Alvisa Palese (Italy); Natalia Kasimovskaya (Russia); Sanja Stanisavljević and Devina Kekuš (Serbia); Majda Pajnkihar, Klavdija Cucek Triflovic, Mateja Lorber and Barbera Kegel (Slovenia); and Esther Cabrera, Adelaida Zabalegu and Nuria Fabrellas (Spain).
Throughout the coronavirus pandemic, UDINE-C has reported overwhelming work pressures for health professionals in every member country; additional serious pressures have also been reported in the second wave of the pandemic. Along with this, during the first wave, all member countries reported having problems with both the accessibility, and the suitability, of personal protective equipment; for some, this has unfortunately continued into the second wave.
In December 2020, I provided an English case study for the UDINE-C network and invited members to similarly reflect on the work of nurses in their own countries during the first wave of the pandemic. Each respondent offered views on a range of matters and, although it is always difficult to make meaningful country-to-country comparisons, I have been able to identify some commonalities and differences between the responses. Due to the fact that governments, as well as national and regional health systems, are different between the countries, I have not made direct comparisons between them.
The variances between the individual countries – for example, Russia’s huge geographical and population size versus those of smaller nations such as Iceland – means that they will likely be managing the pandemic in different ways; however, most of the challenges faced are similar. Any countries hoping to boost their nursing workforce through invitations to professionals based who are in other countries should note the shortages that have been mentioned by many of the respondents from different nations.
Despite the fast-moving nature of the current situation, in which data quickly becomes out of date, this article discusses the ways in which the nursing professions in individual countries are managing their very difficult situations; it is hoped that sharing such experiences will prove particularly beneficial in the present climate.
Professional nursing leadership
Nurses and midwives in England may take it for granted that the country has a chief nursing officer (CNO), Ruth May (as do the other UK nations). As well as establishing #teamCNO on Twitter, which allows nurses to form a collective voice that will be heard by leaders and decision makers, she is also currently establishing a CNO’s legacy group to learn lessons from the pandemic. In the UK, nursing leadership is reinforced by a strong team of chief nurses or directors of nursing in local healthcare organisations; critical and expert support is also provided by the Royal College of Nursing and by other healthcare trade unions.
Not all countries have a CNO and, instead, they look elsewhere for professional support. UDINE-C’s Icelandic respondent said the country’s chief community nurse had been particularly helpful throughout the pandemic and that the Icelandic Nurses’ Association offers useful support via its website.
Spain has no central CNO, but there is a General Council of Nursing and senior nurse leaders are also available at a local or organisational level. Slovenia also has no CNO; the profession’s main source of support has been the Nurses and Midwives Association of Slovenia, which offers advice and guidance through its website.
In Italy, the National Federation of Nursing Professions created a solidarity fund to provide support for nurses involved with, or affected by, Covid-19, while Russia has a powerful regional network that supports nurses, as well as the national Russian Nurses Association. The Czech Republic does have a CNO, but the UDINE-C representative says they have been “quiet” during the pandemic. However, the Czech Association of Nurses has had a high profile on TV and radio and, possibly as a result of this, during the first wave of the pandemic, some additional funds were made available for nurses.
The countries’ responses suggest that having senior nurses offering advice at an organisational or government level is critical to managing the coronavirus pandemic. However, politicians and senior medical staff often lead national responses to the pandemic; there are few nurses on strategic national committees. This needs to be addressed, as nurses can offer unrivalled expertise through their daily work.
“Having senior nurses at an organisational or government level is critical. However, politicians and senior medical staff often lead national responses; there are few nurses on strategic national committees”
The UDINE-C respondents all said that, over the past year, SARS-CoV-2 infections have overwhelmed community-based care homes and nursing homes. Older people living in these facilities are particularly vulnerable and many have been exposed to additional – and sometimes unacceptable – risks for a variety of reasons. For example, several respondents said that older patients had been discharged from hospital to make space for acutely ill younger people; many said that, although necessary, this had been badly planned in their country.
In England, poor test-and-trace systems have affected the care home sector badly: reports of Covid-19 deaths and infections have been extensively reported in the national press (Triggle et al, 2021). Much is now being done to shield these settings from infection, including, in some cases, care home staff moving into the home to protect themselves, their families and the residents. Although smartphones and touchscreen devices have helped residents stay in contact with people who live outside of the home, isolation remains problematic for many.
There are 116 care homes in Slovenia and there has been a significant rise in resident deaths during the pandemic; one cause is staff rotation between care homes. Other community venues – such as sports centres – have now been used to separate healthy residents from those who are infected, and family visiting has been either stopped or greatly reduced.
Spain has 382,000 care home beds and more than 20,000 residents died during the pandemic’s first wave alone (Allen, 2020). One UDINE-C respondent highlighted that this was due to poor testing and that nurses in the sector have been particularly harried.
There have been outbreaks in some of Iceland’s 73 nursing homes, but the country has an effective test-and-trace system that has helped significantly. Italy’s care homes have been severely affected by the pandemic; visiting regimes have been specially designed for isolated residents who are currently in lockdown. Finally, the Czech Republic has 37,000 care home beds for older people and a further 20,100 for people with dementia. The Czech correspondent highlighted that the pandemic’s second wave had a significant negative effect on these settings, but that government help is now very focused on them.
It appears the care home sector has been hit hard universally by the pandemic. A faulty start by many countries in exposing residents to the virus has been compounded by inadequate test-and-trace systems. The situation appears to be changing, but the sector’s death toll in many countries remains shocking. Steps are being made towards change; however, healthcare planners and governments need the expert help of nurses to make differences that count.
One of the clearest lessons from the pandemic so far is the absolute centrality of the nursing workforce. It must, therefore, be noted that there are both total-workforce shortages and insufficient specialist nurses who are able to work in critical and intensive care (Campbell, 2020). This demonstrates the very poor forward planning of most countries in addressing issues related to workforce shortages. Although nurse education numbers are being increased in many countries, the impact of this will be too late to have a positive impact in the current pandemic.
All UDINE-C countries reported efforts to invite recently retired health professionals back to work with mixed success, and most reported students being brought into the active workforce. All countries described a shortage of intensive care specialists and three said the healthcare awareness in residential care homes was poor, but attention was being given by regional and national governments to improve this.
Slovenia has an aging nurse workforce: 40% are aged ≥50 years (dean of nursing, University of Maribor, personal correspondence, 2021). Student numbers are now being increased due to funding from healthcare organisations but these individuals will, of course, take time to become qualified. Serbia has seen a continual loss of its nursing workforce to other countries, and a shift to increase the number of nurses working in inpatient care has also led to losses in primary care. However, very welcome news is that the country’s nurse workforce has been offered a 10% salary increase.
To avoid workforce shortages, special arrangements are being made in Spain to help health professionals: local hotels are being used to accommodate staff to prevent them putting their families at risk of infection and, in some instances, annual leave has been cancelled. Spain has also seen increasing numbers of nurses returning to the country after working in the UK, particularly in the wake of Brexit.
The Russian respondent reported problems caused by salary differences for nurses working in cities compared with those in more rural settings; they also said that Russian law has allowed nurses to become redesignated as junior medical professionals during the pandemic.
In the Czech Republic, the nursing workforce was reported to be very stretched, although additional funding has been made available. Sadly, although unsurprisingly, all countries reported high SARS-CoV-2 infection rates and above-average death rates among all healthcare staff.
In general, workforce issues dominated replies from many countries. It is clear that workforce planning has been very poor and attempts to increase nursing numbers – although welcome – are being undertaken too late to address the pandemic.
Having suitable and sufficient clinical settings has been central to countries’ responses to the pandemic. In England, hospitals have expanded their intensive care facilities and several Nightingale hospitals have been established in venues such as conference centres. Initially equipped with the necessary equipment for intensive care, they have been somewhat underused or sometimes repurposed for post-operative recovery. Staff with specialist clinical skills are in short supply, which has doubtless affected the Nightingale hospitals’ more widespread use; staff–patient ratios have been stretched to the maximum in many places (Mitchell, 2020).
In Italy, clinical facilities have been strengthened using both public and private services, and hospitals are being divided into those specifically for patients with Covid-19 and those for non-Covid-19 patients. Regional operational centres have also been created to oversee telemonitoring and telemedicine. Integrated homecare services have been intensified and special community units established to help manage at home those people who have Covid-19 but do not need to be hospitalised.
In each region of the Czech Republic, one hub hospital has been established among several smaller hospitals in the area. Each has allocated specialist Covid-19 units that work in tandem to respond to the pandemic. In Russia, 20 new regional clinics have been established and existing facilities have been extensively repurposed; 50 temporary hospital facilities have been created in Moscow, offering 3,000 beds. Serbia has seen some public institutions repurposed for clinical care and the army has been used to support healthcare facilities. Some services have experienced longstanding underfunding and feel exposed in the present situation.
Iceland has developed an active tracking unit that assesses an individual’s infection risk and whether they need to be hospitalised.
Education and training have also been further developed to help health professionals manage the pandemic. Slovenia has three hospitals with the clinical facilities necessary for patients with Covid-19 and more facility development is under way in the country’s two biggest cities, Ljubljana and Maribor. The Slovenian army has also established and repurposed its own mobile field hospital.
Spain has seen significant changes: primary care work has been reframed as a gatekeeper service during the pandemic and, in some areas, it is now only delivered by telephone. Several conference centres are being used as hospitals, as well as four hotels in Barcelona.
Summary and next steps
Many countries have found creative ways to deliver clinical services during the coronavirus pandemic. Although different geographies and healthcare systems demand different ways of working, it is clear that nurses are at the heart of expert healthcare provision.
All UDINE-C respondents reported that their country’s efforts now need to embrace the extensive and critical vaccination programmes currently under way and the UDINE-C network has agreed to report on the situation again in the first half of 2021. In the meantime, the Twitter account @EuroHealthNet provides continuous, valuable insight into matters relating to the coronavirus pandemic in Europe.
- The UDINE-C network allows nurses from different countries to share experiences
- Inadequate test-and-trace systems means the care sector’s death toll is high in many countries
- Strategies to increase the workforce include deploying retired and student nurses, and increasing salaries
- Countries have increased clinical facilities by developing additional hospitals and restricting primary care
- Members of the group identify that that there are few nurses on strategic national committees