Notice of the National Health and Wellness Commission on Printing and Distributing the National Nursing Development Plan (2021-2025)
Guo Wei Yi Fa [2022] No.15
Health and Health Committees of all provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps:
In order to promote the high-quality development of China’s nursing industry during the Tenth Five-Year Plan and improve people’s health level, according to the requirements of the 14th Five-Year Plan for People’s Republic of China (PRC)’s National Economic and Social Development and the Outline of the Vision in 2035, the Outline of the Plan for Healthy China 2030, the Opinions of the General Office of the State Council on Promoting the High-quality Development of Public Hospitals, and the Implementation Plan for the Construction of High-quality and Efficient Medical and Health Service System during the Tenth Five-Year Plan, our Committee formulated the National Nursing Industry. It is hereby printed and distributed to you, and all localities should conscientiously implement it.
National Health Commission
April 29, 2022
(Information disclosure form: voluntary disclosure)
National Nursing Development Plan (2021-2025)
Nursing work is an important part of health care, which is of great significance to comprehensively promote the construction of a healthy China and actively respond to the aging population. In order to meet the growing health needs of the people and the new requirements of economic and social development for the development of nursing career, this plan is formulated according to the requirements of the 14th Five-Year Plan for National Economic and Social Development in People’s Republic of China (PRC) and the Outline of the Long-term Goals in 2035, the Outline of the Plan for Healthy China 2030, the Opinions of the General Office of the State Council on Promoting the High-quality Development of Public Hospitals, and the Implementation Plan for the Construction of High-quality and Efficient Medical and Health Service System in the Tenth Five-Year Plan.
I. Planning background
(a) the progress of nursing during the 13th Five-Year Plan period.
During the "Thirteenth Five-Year Plan" period, in the process of fully implementing the major decision-making arrangements of the CPC Central Committee and the State Council on promoting the construction of a healthy China, actively responding to the aging population and continuously deepening the medical reform, the nursing cause has developed rapidly and achieved remarkable results. The team of nurses continued to grow and develop. By the end of 2020, there were more than 4.7 million registered nurses nationwide, an increase of 45% compared with 2015. The number of registered nurses per 1,000 population reached 3.34, and the national doctor-nurse ratio increased to 1:1.15, which further reversed the problem. More than 70% of nurses have college education, and the academic quality of nurses has been further improved. Through the continuous development of high-quality nursing service and the implementation of the project of improving nurses’ service ability, the primary nursing service ability has been significantly improved, the quality of nursing service has been continuously improved, the nursing characteristics of traditional Chinese medicine have become more prominent, and nursing work has become closer to patients, clinic and society. All localities have basically achieved full coverage of high-quality nursing services in secondary and above medical institutions, and some medical institutions have covered non-inpatient departments such as outpatient (emergency) clinics, blood purification centers (rooms), surgery (department) rooms, and catheter rooms, and the people’s sense of obtaining medical treatment has been further enhanced. Through the pilot project of "internet plus Nursing Service", the elderly nursing service development project was implemented, and the elderly home medical nursing service was actively promoted. The nursing service model was innovated and developed, and the nursing service field was continuously extended, covering medical institutions, communities, homes and the whole population. The medical care services provided by nurses for the people are more diversified.It has played an important role in disease prevention, treatment, nursing, rehabilitation and hospice care. The full implementation of electronic registration of nurses makes the practice management of nurses more convenient and efficient. Medical institutions gradually establish a nursing post management system, implement nurse manpower allocation, training and assessment based on nursing posts, and gradually realize the same salary and treatment for nurses in the same post, get more pay for more work, and get excellent grades and rewards, so as to fully mobilize the enthusiasm of nurses.
Compared with the economic and social development and the growing health needs of the people, there are still problems of imbalance and insufficiency in the development of nursing in China. The number of nurses is relatively insufficient and unevenly distributed; There is a certain gap between the supply of nursing service and the diversified and differentiated needs of the masses; The connotation field of nursing service needs to be further enriched and expanded; Relevant institutional mechanisms in the nursing field still need to be improved.
(2) The new situation faced by the development of nursing during the 14th Five-Year Plan period.
Promoting the construction of healthy China in an all-round way during the "14th Five-Year Plan" period puts 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, demanding that people be the center and provide people with all-round and full-cycle health services. Nursing needs to closely focus on people’s health needs, build a comprehensive, whole-process, high-quality and efficient nursing service system, and constantly meet the differentiated nursing service needs of the masses. Actively coping with the aging population has put forward new tasks for the development of nursing career. With the deepening of aging, there is an urgent need for nursing services, especially for the elderly, and it is necessary to effectively increase the supply of nursing services for the elderly. Promoting high-quality development has brought new opportunities for the development of nursing. The main contradiction in the nursing field is the contradiction between the people’s demand for nursing service and the relative shortage of supply. It is necessary to further promote the high-quality development of nursing from the perspectives of nursing system, service, technology, management and talents, and improve the level of nursing homogenization. The rapid development of information technology has created new conditions for nursing. Cloud computing, big data, Internet of Things, blockchain, fifth-generation mobile communication (5G) and other new generation information technologies are deeply integrated with health care services, and new models, industries and formats in the field of health care are constantly emerging, which provides strong support for promoting the innovation of nursing service mode, improving the efficiency of nursing service and leading the high-quality development of nursing in China.
Second, the guiding ideology and basic principles of nursing career development during the "Fourteenth Five-Year Plan" period
(1) Guiding ideology.
Guided by the Supreme Leader’s Socialism with Chinese characteristics Thought in the New Era, we will fully implement the spirit of the 19th National Congress of the Communist Party of China and all previous plenary sessions of the 19th National Congress, take people’s health as the center, take people’s needs as the guide, take high-quality development as the theme, take reform and innovation as the driving force, further strengthen the construction of nurses, enrich the connotation and extension of nursing services, improve the level of nursing management, promote the high-quality development of nursing, and strive to let the people enjoy all-round and full-cycle nursing services.
(2) Basic principles.
1. Adhere to the people as the center. Put the protection of people’s health in the strategic position of priority development, insist that nursing work serves people’s health, take meeting the diverse nursing needs of the people as the starting point and the end result, and gradually establish and improve a high-quality and efficient nursing service system covering the whole life cycle and health process.
2. Adhere to high-quality development. Taking improving the quality and level of nursing service as the core task, adhering to the new development concept, speeding up the construction of a management system and mechanism that is suitable for the current level of economic and social development, is conducive to strengthening the construction of nurses and improving the allocation efficiency of nursing service resources, promoting the innovation of nursing service model and realizing the high-quality development of nursing.
3. Insist on making up the shortcomings. Adhere to the goal and problem orientation, and strive to solve the problem of insufficient imbalance in the development of nursing services. Accelerate the filling of shortcomings and weaknesses in the nursing field, increase the supply of nursing services in the fields of women and children, the elderly, rehabilitation, Chinese medicine, etc., develop community and home care, hospice care and other services, further enhance the professional service capacity and improve the accessibility of nursing services.
4. Adhere to reform, innovation and development. Comply with the new situation and requirements faced by the development of nursing, focus on the new expectations of the people in the nursing field, grasp the characteristics of nursing work, innovate the nursing service model, and strive to promote the reform and development of nursing service industry. Intensify the reform and innovation in the field of nursing, break down the institutional and institutional obstacles that restrict the development of nursing, and continuously enhance the motivation of nursing development.
III. Development Goals
By 2025, the development of nursing in China will achieve the following goals:
The total number of nurses in China has reached 5.5 million, and the number of registered nurses per 1,000 population has reached 3.8. The number of nurses has been continuously increased, the structure has been further optimized, and their quality and service ability have been significantly improved, which basically meets the needs of economic, social and health development. Holistic nursing with responsibility system is effectively implemented, and nursing service is closer to the needs of the masses and society. The connotation and extension of nursing have been further enriched and expanded, and the supply of nursing services for the elderly, Chinese medicine, community and home has increased significantly. The scientific management level of nursing has been continuously improved, the quality of nursing service has been continuously improved, and the system and mechanism for mobilizing the enthusiasm of nurses have been further improved.
Remarks: Related nursing professional nurses in short supply include: geriatric nursing, pediatric nursing, intensive care, infectious disease nursing, emergency first aid, rehabilitation nursing and traditional Chinese medicine nursing.
IV. Main tasks
(1) Improve the nursing service system.
1. Optimize the layout of nursing resources. Combined with demographic changes, disease spectrum characteristics and the needs of medical care services for the masses, we will improve the nursing service system covering acute diagnosis and treatment, chronic rehabilitation, stable care and terminal care. 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 discipline, and improve and perfect the nursing service system with clear positioning and division of labor among different medical institutions through the formation of urban medical associations, county medical associations and specialist alliances. Different medical institutions provide professional and standardized nursing services in combination with functional orientation and classification according to needs. Third-level hospitals mainly provide care for difficult and critical patients, and strengthen the construction of nursing disciplines and personnel training; Secondary hospitals mainly provide nursing care for common diseases and frequently-occurring diseases; Nursing homes, nursing centers, rehabilitation medical centers, hospice care centers, and primary medical institutions mainly provide services such as elderly care, rehabilitation care, long-term care, and hospice care.
2. Increase the supply of nursing services. Promote the revitalization of resources in areas rich in medical resources, and transform some first-class and second-class hospitals into nursing homes and nursing centers. Support and guide social forces to organize large-scale and chained nursing homes (stations), nursing centers and hospice care centers to further stimulate market vitality. Increase the number of beds provided by primary medical institutions for nursing and hospice care, encourage qualified medical institutions to carry out family beds and home care services in combination with the actual situation, and effectively expand the supply of services such as elderly care, rehabilitation care and home care.
(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 engaged in aged care, pediatric care, traditional Chinese medicine care, community care, infectious disease care and hospice care, and those working in primary medical institutions. Medical institutions should scientifically and reasonably equip nurses according to functional orientation, service radius, bed size, clinical nursing workload and technical factors to meet the needs of clinical nursing services.
4. Strengthen the training of nurses. Establish a nurse training system with job demand as the guide and job competence as the core. Strengthen the "three basics and three strictness" training for clinical nurses, adhere to the position-based and classified policies, and effectively improve the clinical nursing service ability of nurses. Combined with the nursing needs of the masses and the development of nursing disciplines, the training of nursing professional nurses in short supply such as the elderly, pediatrics and infectious diseases was carried out in a targeted manner. Strengthen the training of new nurses and nursing managers. Arrange nurse training scientifically and reasonably, reduce repetitive and burdensome arrangements, and alleviate the contradiction between nurses and engineering.
5. Protect the legitimate rights and interests of nurses. We will further implement laws and regulations such as the Basic Health Care and Health Promotion Law of People’s Republic of China (PRC), the Nurses’ Regulations, and the requirements of the state on caring for medical staff, and create good conditions for nurses’ practice environment, salary and treatment, training and professional development. Medical institutions provide necessary health protection and medical care measures for nurses, effectively prevent and reduce the harm that nurses may suffer in the occupational environment, and earnestly safeguard and protect the legitimate rights and interests of nurses.
6. arouse the enthusiasm of nurses. Promote medical institutions to establish and improve the nursing post management system, and consider the establishment of internal and external nurses in terms of nurse post setting, income distribution, professional title evaluation, management and use as required, so as to realize the transformation of nurses from identity management to post management. Improve the incentive mechanism of nurses, implement scientific evaluation and performance appraisal 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 appraisal are linked to the employment of nurses, performance distribution, reward and evaluation, etc., and they are inclined to clinical front-line nurses and grassroots nurses, so as to get more for more work and get excellent grades and rewards, and fully mobilize the enthusiasm of nurses.
(3) Promoting the high-quality development of nursing.
7. Continue to deepen quality care. We will continue to expand the coverage of quality nursing services, achieve full coverage of quality nursing services in secondary and above medical institutions, and significantly increase the proportion of quality nursing services in other medical institutions. Implement the nursing core system, do the holistic nursing with the responsibility system, consolidate the quality of basic nursing, strengthen the humanistic care of nursing, optimize the nursing service process, realize the expansion and quality improvement of high-quality nursing service, and effectively enhance the patient’s sense of acquisition.
8. Innovative nursing service mode. Combined with the requirements of graded diagnosis and treatment and the actual needs of the masses, we encourage qualified medical institutions to innovate and develop diversified nursing services. Expand the pilot coverage of "internet plus Nursing Service", support medical institutions to actively provide "internet plus Nursing Service", continuing care, home care, etc., and extend the nursing service in institutions to communities and homes, so as to provide convenient and professional medical care services for discharged patients, patients at the end of their lives or elderly people with mobility difficulties, infirmity and disability and dementia.
9. Strengthen the construction of nursing discipline. In order to meet the clinical nursing needs of major diseases and key populations, we should strengthen the construction of nursing disciplines, and promote the training of nursing talents and the improvement of nursing service ability with discipline construction. Continuously improve the quality of nursing, focus on building a system of nursing norms and technical standards based on evidence-based basis and clinical needs, and effectively improve the level of nursing homogenization between regions and institutions.
(4) fill in the weaknesses of nursing shortcomings.
10. Accelerate the development of medical care for the elderly. Promote all localities to accelerate the implementation of national policies and measures on the development of medical care services for the elderly in light of actual conditions. According to the size and quantity of the elderly population, 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 elderly medical care services and strengthen personnel training. Explore the establishment and development of the professional team of medical nurses, expand the human resources of medical care for the elderly, and better meet the needs of the aging society. Meet the urgent needs of the disabled elderly, 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 the disabled elderly.
11. Improve the ability of primary nursing service. Support qualified medical institutions above the second level to establish nursing specialty alliances and expert joint teams with primary medical and health institutions, give full play to the role of high-quality nursing resources, and help improve primary nursing service capabilities by sinking or exporting management, training and technology. Accelerate the construction of grassroots nurses and increase the manpower allocation of grassroots nurses. Take "please come in and send out" and other ways to increase the training of primary nurses, and effectively improve their professional service capabilities such as common and frequently-occurring disease nursing, geriatric nursing and rehabilitation nursing.
12. Accelerate the development of hospice care. Promote all localities to increase the number of beds in hospice care centers and provide hospice care services in accordance with the Basic Standards and Management Specifications for Hospice Care Centers (Trial), combined with the requirements of graded diagnosis and treatment and the urgent needs of the people within their jurisdiction. Formulate and revise the Practice Guide for Hospice Care (Trial) and related technical standards, and constantly standardize the practical behavior of employees. Accelerate the training of professionals engaged in hospice care services, and effectively improve the quality of hospice care for patients at the end of their lives.
(5) Strengthening the construction of nursing informatization.
Make full use of information technologies such as cloud computing, big data, Internet of Things, blockchain and mobile Internet, and combine the requirements of developing smart hospitals and "Internet+medical health" to strengthen the construction of nursing informatization. Using information technology to innovate nursing service mode and provide convenient and efficient nursing service for patients. Optimize the nursing service process, improve the efficiency of clinical nursing and reduce the unnecessary workload of nurses. Establish a nursing management system based on problems and needs, which has the functions of nurse manpower allocation, job training, performance appraisal, quality improvement and discipline construction, and gradually realize the modernization, scientificity and refinement of nursing management.
(6) Promoting the development of TCM nursing.
Improve and perfect the traditional Chinese medicine nursing routine, scheme and technical operation standard. Actively carry out dialectical nursing and TCM specialty nursing, continuously improve the quality of TCM nursing service, innovate TCM nursing service mode, give play to the important role of TCM nursing in disease prevention, treatment and rehabilitation, and promote TCM nursing to further expand to grassroots and families, and extend to the fields of elderly care and chronic disease care. Strengthen the training of nursing talents of traditional Chinese medicine, and effectively improve the nursing service ability of traditional Chinese medicine.
(7) Strengthen nursing communication and cooperation.
Carry out in-depth cooperation and exchanges with international and Hong Kong, Macao and Taiwan regions in the field of nursing, and intensify exchanges and cooperation in nursing management, system and policy, personnel training and nursing technology. Fully draw lessons from advanced concepts and practical experience, combined with China’s national conditions, improve and perfect the relevant policies for high-quality nursing development.
V. Safeguards
(1) Strengthen organizational leadership.
Health administrative departments at all levels (including the competent department of traditional Chinese medicine, the same below) should fully understand the importance and necessity of promoting the high-quality development of nursing during the "Fourteenth Five-Year Plan" period, and effectively incorporate nursing work into the overall planning of comprehensively promoting the construction of a healthy China in the region, actively responding to the aging population and continuously deepening medical reform, and make overall arrangements and simultaneously promote implementation. The provincial health administrative department should formulate the development plan of the "Fourteenth Five-Year Plan" nursing career in this area according to the actual situation, refine the implementation measures, strengthen the organization and leadership, and conscientiously implement them.
(2) Strengthen monitoring and evaluation.
The provincial health administrative departments should formulate and improve the monitoring and evaluation plan for the development of nursing in the "Fourteenth Five-Year Plan" period in this region, and do a good job in dynamic monitoring and mid-term evaluation of the implementation of the plan. Regularly monitor and evaluate the progress of work, find problems in time and solve them. In 2023, the National Health and Wellness Commission will conduct a mid-term evaluation of the implementation of the plan by the provincial health and wellness administrative departments, organize a final evaluation in 2025, and inform the local governments of the implementation in due course.
(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 investigation and study, and be brave enough to try first. In the process of promoting implementation, we should pay attention to summing up experience and promote implementation step by step. The National Health and Wellness Committee will exchange and promote the typical experience of local innovation, so as to promote the development of nursing and 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 news media forms to do a good job in the "Fourteenth Five-Year Plan" nursing career development planning policy interpretation and public opinion guidance. Fully respect the local initiative, pay attention to publicizing 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.