Advanced practice nurse in primary care


In 2021 the Ukrainian-Swiss project “Medical Education Development” conducted a representative study “Role distribution among primary health care providers in Ukraine”. As a result, medical doctors, as well as nurses and management representatives, would like to give more power to nurse as to the service provider at primary care. In particular, 59% of managers and 45% of doctors agree that some of the family doctor’s duties can be delegated to a family nurse. Managers, medical doctors, and nurses also support the idea of ​​expanding the role of the nurse (84%, 65%, and 52% respectively).  

Therefore, the broader involvement of nurses in service provision could facilitate to create significant career opportunities for them.

The Project jointly with the Ministry of Health of Ukraine has selected 8 Ukrainian health care facilities out of 30 applicants to participate in the pilot project “Advance nurse practitioner”. The selection of pilots has been based on open competition. When the pilots have been selected, we conducted a survey among 169 nurses who work in pilots to reveal more details of the existing practice and expectations for change. Please find the survey results below (in the end of this text).

The ‘Advanced nurse practitioner’ sub-project aims to improve the accessibility and efficiency of health care services by strengthening the role of the nurse.

From now on, the nurse, as health care staff, provides a wide range of services: from emergency to primary health care services; works both independently and in a team with a doctor. The responsibilities of a nurse depend on the specialization, but he or she already takes care of the patients, orders tests, diagnoses. Moreover, a nurse can provide consultation of high quality thanks to the continuous professional development via improvisng skills, knowledge and values, attitudes.

For more details, please watch the presentation of our experts, Matviy Khrenov and Ivan Didyk, on the pilot project at the Nurses’ Forum here -> Details of the key survey results of a this ‘Advance nurse practitioner’ project.

The key findings of the survey conducted in 8 selected pilot institutions at the first stage of the project (supported by the infographic below).

  • Time of patients’ admission to the medical doctor: time from the moment of registration (from 4 hours to 5 days) and waiting time in line (from 5 minutes to 2 hours) was taken into account.
  • 81% respondents are satisfied with the nurse’s work, but the biggest concern is the low satisfaction with the level of wages.
  • 74% respondents feel independent in their work as a nurse and in their decision-making. Nurses praised the amount of responsibility in their work, although they noted their low level of involvement in cases discussion with medical doctors.
  • 73% respondents are motivated to work as a nurse. We also registered low level of training opportunities offered, as well as ideas for improving health care delivery.
  • All 100% respondents stated that a separate visits to nurses in institutions is not held. Only in Rivne Center for Primary Health Care there are 2 pre-medical examination rooms. This is a workplace for those nurses, who are not part of the “doctor-nurse” team. They perform the following functions: collect patient complaints, perform electrocardiography, measure blood pressure, perform pulse oximetry, measure visual acuity, height, weight, and perform Rufier’s tests.
  • All 100% respondents representing pilot institutions stated that they do not apply pre-medical questionnaires conducted by a nurse.

One of the indicators that we want reach within “Advanced nurse practitioner” pilot is increasing total patients’ admission in pilot PHC facilities by 10%. This indicator was derived based on statistical reports for 2019-2020 submitted by pilot institutions.

Ukrainian-Swiss project “Medical Education Development” jointly with the relevant consultants has already identified further steps for nurses’ greater involvement in in medical service provision. We plan to:

  • continue development of “Advanced nurse practitioner” initiative in pilot facilities,
  • create and support opportunities for nurses to practice clinical and communication skills,
  • train managers on “advance nurse practitioner” role integration in their facilities,
  • develop and provide algorithms for decision-making and triage to call centers of pilot facilities,
  • continue support of pilot facilities management on human resource development,
  • evaluate the results of the pilot implementation, and in case of success – disseminate the experience of pilot centers further.