EFN Report on Covid-19 crisis management at national level - November 2020

EFN – European Federation of Nurses Associations

The following are areas of expenditure in the Swedish Government's and the Co-operation
Parties' budget bill for 2021 that may at least partially affect the conditions for health care
during the pandemic.
The government will allocate SEK 10 billion in general government grants to municipalities
and regions in 2021. These will be used to strengthen welfare. The investment that is
presented is in addition to the permanent increase of SEK 12.5 billion that the government
and the co-operation parties have previously decided on. How the general state subsidy is
used is up to municipalities and regions, but the intention is to strengthen the long-term
conditions for developing welfare based on local needs.
Furthermore, the municipalities receive SEK 4 billion per year (2021-2023) to strengthen care
for the elderly. 1.7 billion is also set aside for the municipalities' elderly care to provide staff
with the opportunity to train as a care assistant or assistant nurse during paid working hours.
When more people are trained in elderly care, care for the elderly becomes safer and working
conditions for the employees better, as more people can get permanent employment and
the number of temporary substitutes can decrease.
More money for health care. In the spring, the health service needed to adjust to cope with
the corona pandemic. Many planned doctor visits and surgeries were postponed when health
care resources were needed to provide emergency care to people who fell ill with covid-19.
Now the health service must be able to quickly provide the non-emergency care that has had
to wait. At the same time, healthcare must continue to provide care to those who become ill
with covid-19. The pandemic is not over. Therefore, the government proposes that the
regions receive SEK 4 billion in 2021 and 2022.
The government allocates 105 million for increased social justice, some of which will go to a
recovery bonus for healthcare staff.

4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Experiences from critical care in Sweden during the covid pandemic.
Throughout the work with the covid pandemic, it has been clear that both the nurse's nursing
competence and a functioning interprofessional collaboration have been a prerequisite for being
able to save lives. Specialist nurses in intensive care have been involved in several ways, through
different positions and at different levels (macro-meso-micro) in healthcare. By planning, leading,
implementing and evaluating activities, conditions have been created for caring for a large number
of seriously ill intensive care patients in Sweden.
Meso level / unit level (nurse managers, nurses with special assignments):
• Responsibility for planning and implementing training of new staff, mainly consisting of
nurses and nurses’ assistants from the perioperative units and surgical wards, to
supplement the regular intensive care staff
• Relocation of existing units and construction of new intensive care units with focus on
patient safety and a safe working environment
• Design, implement and evaluate new guidelines, working methods, routines
• Prepare and carry out research and quality improvement

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• Ensure adequate and sufficient staffing, distribution of skills, planning of schedules
• Present leadership for employees, ensure emotional support.
The challenges have consisted of the need for quick but well-founded decisions, limited resources
and difficulties in reaching out with information. It has periodically been particularly complex with
skills supply and staffing as many employees have been ill. The work has been facilitated by short
decision paths, recognition of nurses' autonomy and mandate and the use of interprofessional
competence. In several hospitals, external resources were gradually available, such as scheduling
and crisis support.
Micro level / bed-side nursing:
• Lead, organize, prioritize and coordinate the nursing care in the new nursing teams
• Carry out a care plan based on an analysis of the patient's condition
• Prevention of complications such as intensive care delirium, pressure ulcers and healthcare-

associated infections.
At this level, the most common challenges have been a high workload and different working
conditions, which has periodically meant that the usual care has not been able to be performed.
In many cases, this has led to ethical stress and exhaustion among staff. The ban on visits from
family members has also caused great strain. The opportunity for video conversations with
relatives was introduced in some hospitals after a couple of months and was perceived as very
positive by patients, relatives and staff. For the specialist nurse the collaboration with new
members of the nursing team has meant a double responsibility; to act as a supervisor and be
ultimately responsible for the patient due to the highest competence. To be able to handle this
responsibility it requires trust from the specialist nurse, both in the other team members and in
the own competence.

SWITZERLAND

1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?

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b. Number of nurses infected with COVID-19?
There are no national statistics on HCW infections. SBK ASI survey resulted in at least 100
infections and around 10 hospitalisations. We suppose that there must be more but we don't
have any evidence.

c. Number of nurses who died from COVID-19?
We are not aware of any nurse who died.

2. Question 2 - Working environments
a. What was put in place to make sure the nurses were protected in the workplace? Was there
sufficient personal protection equipment for the nurses (masks, gloves etc.), and were
nurses prepared to handle COVID-19 patients (protocols, awareness, facilities, etc.)? If NO,
has your national government taken any action to address this? What has been/will be put
in place to avoid this in the future (second wave)?
In many hospitals and nursing homes there was a lack of PPE. The stocks prescribed by the
national pandemic plan were only partly existing.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Not in the beginning, as tests were scarce.
c. Were there enough resources/nurses to handle the COVID-19 patients?
There was big heterogeneity, some hospitals or e.g. psychiatric clinics did not have enough
work, others especially ICUs and turned to 12h-shifts due to lack of qualified personnel during
the 1st wave of COVID-19.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
The number of "all other patients" dramatically decreased, as the government decided that
all non-emergency interventions should be put on hold to have enough capacity for covid-
patients.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Some days in April, about every bed, in a qualified ICU environment was filled. Capacities
stretched to the max. The government and institutions did a lot to add ICU beds, ventilators,
etc. with success. The really critical point was the limited number of specialised nursing
personnel. ASI made a call among its members and nurses who had left the profession, also
ICU nurses were willing to return for the pandemic.

3. Question 3 - Challenges
a. What is the most serious challenge in combating COVID-19 experienced in your country? Is
your national government taking measures to tackle this?
Currently a large proportion of the population does not always follow the rules about social
distancing, wearing masks, etc. Especially young people seem not to care much about
infection, as they don't get severely ill.

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b. Stigmatisation – Were nurses confronted with stigmatisation in your country and if yes,
how was your national government protecting its nurses from stigmatisation and violence
against nurses during the ongoing COVID-19 pandemic? If nothing was done, are they
foreseeing any actions in the future? Which ones?
No, not that I am aware of, there was/is a lot of respect for the nurses in the population.

c. Did your national government/health setting put in place appropriate mechanisms for
psychological support for those nurses who experienced extreme anxiety and stress during
the crisis?
No. some institutions did and ASI had a collaboration with the association of psychologists to
provide free counselling.

d. What are the measures taken by your national government to make sure the health
professionals, in particular nurses, are prepared for the next COVID-19 wave/a future new
pandemic?
Well, we hope, they made big stocks of PPE and can provide enough testing. We also strongly
ask for the nurses to have enough time to rest and take brakes, to have the labour laws
respected.

e. And how is your national government planning to engage with EU/national nurse
representatives to better engage the nursing profession in a future health crisis?
There are two evaluations by the MOH and ASI is invited to participate in these evaluations.

f. Is your national government going to re-arrange already existing budget to support the
nursing frontline during future healthcare crisis? If so, which budget areas, how much, and
what for?
No, not to my knowledge.

4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Some nurses had negative working hours and we had to fight , alongside with the physicians that
they do not have to compensate those working hours.

UK

1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
As of 4th October, 502,978 people have tested positive for Covid-19 in the UK.
2,428 patients are currently in hospital with 368 in ventilator beds.
The total number of patients admitted to hospital is 142,852.
42,350 people have died from Covid-19.

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b. Number of nurses infected with COVID-19?
There is no official, Government published data on this. This is a key concern for the RCN and
part of our lobbying efforts to get official data published.

c. Number of nurses who died from COVID-19?
101 nurses have died from Covid-19 as of 25 May according to ONS. A further 30 nursing
auxiliaries and assistants have died.

2. Question 2 - Working environments
a. What was put in place to make sure the nurses were protected in the workplace? Was there
sufficient personal protection equipment for the nurses (masks, gloves etc.), and were
nurses prepared to handle COVID-19 patients (protocols, awareness, facilities, etc.)? If NO,
has your national government taken any action to address this? What has been/will be put
in place to avoid this in the future (second wave)?
Throughout the pandemic there have been recognised stock availability and distribution
issues of Personal Protective Equipment (PPE), both within acute hospitals and across the
wider health and care system. This is despite the UK Government and health agencies
knowing that PPE would be required in the weeks before the pandemic took hold. Existing
pandemic stocks of PPE were based on modelling for influenza pandemic and were
insufficient – with incorrect assumptions specifically on the requirement for long sleeved
gowns in early stages.
Due to ongoing issues, PPE continues to be procured locally and therefore lacks government
oversight, and there are known issues of variation in quality and type of PPE being used. We
have had reports of RCN members being required to re-use single use, out of date equipment
or supplies made by public which will not meet health and safety standards. Nurses are also
being forced to use one-size-fits-all equipment, due to PPE not being designed to fit a variety
of face shapes. The shape and design of the masks are too big, causing many female
healthcare professionals to fail the FIT testing process. This insufficient PPE has left our
nurses with heightened worry and anxiety regarding their safety at work.
We conducted two online surveys on PPE with RCN members in April and May. Our first
survey revealed that of those treating possible or confirmed COVID-19 patients in high risk
areas, 51% reported being asked to reuse ‘single use’ PPE. In other settings, 39% said they
were being asked to reuse this equipment. Our second survey revealed that, whilst generally
the situation had improved, it was still a concern for members. This survey also revealed
significant disparities in the experience and safety of Black, Asiana and Minority Ethic (BAME)
members. For example, 43% of BAME respondents working in high-risk environments said
they had enough facial and eye protection, compared to 66% of White British Nursing staff.
In addition, guidance to staff on the effective use of PPE has been insufficient and confusing,
leaving members feeling unsafe. There has been continued discrepancies in Government
guidance on the use of PPE and was late to be expanded to cover all health and care staff
working in community and social care settings. Current guidance continues to focus on
frontline workers an does not apply across the whole sector. A key reason for this is the lack
of consultation with staff and stakeholders in development of the guidance.

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b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
In April, the UK Government announced a new COVID-19 testing process which would allow
health and care workers to use an online system for booking a testing appointment or
ordering a home test kit. Despite increases in the testing capability, the number of tests being
conducted was not reaching the maximum capacity.
In April 2020 we surveyed members to understand access and availability to testing, which
was released just before home testing kits were made available. At this time, 76% of nurses
had not been offered testing and 44% did not know how to access testing. Discrepancies
existed between the offer and accessibility of COVID-19 testing for those working in the NHS
compared to those outside or on temporary contracts.
We continue to call for Government to prioritise health and care workers in testing processes.

c. Were there enough resources/nurses to handle the COVID-19 patients?
Staffing shortages were and continue to be a key concern across the UK. Before the
pandemic, there were over 50,000 registered nurse vacancies across the UK. In response to
this, the UK Government introduced the Coronavirus Bill 2020 - Legislation which, amongst
other things, provided temporary emergency measures to increase the health and social care
workforce. Under this legislation, registered nurses who had retired no more than three
years ago were invited to join the UK regulator, the Nursing and Midwifery Council’s (NMC)
temporary register and return to practice. The NMC also established a temporary register for
overseas applicants yet to complete their registration process in full. As of 10th September,
14,243 people had been added to the temporary register.

d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
During the first wave of the pandemic many non-emergency services were cancelled or
postponed. This has led to a significant backlog of patients waiting for hospital treatment. It
is estimated (Sept 2020) that there are two million people who have been waiting for
treatment for more than 18 weeks. Between April and July there were around 3 million
people waiting for cancer screening. 30,00 fewer cancer treatments took place compared to
normal.

e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
As outlined above, in recognition of the shortage of trained nurses the UK government
introduced emergency legislation which enabled the temporary registration of retired
nurses, and overseas applicants already residing in the UK. Internationally educated staff
including nurses working in our National Health Care system were also given a temporary
extension on visas, however this has now expired (as of October 1, 2020) and the RCN, in
conjunction with other organisations representing international health and care staff have
made representations to the Home Secretary (who holds responsibility for immigration
matters in Government) to raise urgent concerns.
A number of temporary field hospitals were also rapidly set up in order to cater to projected
surge in COVID-19 cases and to alleviate pressure on ICU departments in existing hospitals.
Conference centres and other large buildings out of use during lockdown were transformed

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into critical care hospitals. These field hospitals were taken out of commission but remain
ready to be reactivated in the event of a second-wave.

3. Question 3 - Challenges
a. What is the most serious challenge in combating COVID-19 experienced in your country? Is
your national government taking measures to tackle this?
Supply/access to PPE and COVID-19 staff testing continue to be the two greatest challenges
across the UK.

COVID-19 staff testing
Testing of COVID-19 continues to be a key concern for nursing staff. Testing infrastructure
took too long to roll out across Acute Trusts and the wider system. This meant that nursing
staff took the precaution of self-isolating when presenting with symptoms, unable to take a
test. In early April, some Directors of Nursing in London were reporting staff sickness rates of
over 20%, creating significant staffing challenges and placing greater burdens on our already
overstretched staff. In April, the UK Government announced a new COVID-19 testing process
for health and care workers booking a testing appointment or order a home test kit online.
As outlined above, despite increases in the testing capability, the number of tests being
conducted was not reaching the maximum capacity.

Supply of and access to appropriate PPE
Since the beginning of the UK’s response to the COVID-19 pandemic, nursing staff from all
types of health and care setting have expressed concerns about the supply, distribution and
safety of PPE. PPE has not been getting to the health and care staff who needed it at the right
time which has placed patients, the public and health and care staff at unnecessary levels of
risk. Our second survey on the use and availability of PPE revealed that health and care staff
felt under increasing pressure to care for people without correct PPE and having to reuse
single use items. PPE continues to be procured locally and therefore lacks government
oversight which means that variation in quality and type of PPE being used will continue, and
that lack of access persists.

b. Stigmatisation – Were nurses confronted with stigmatisation in your country and if yes,
how was your national government protecting its nurses from stigmatisation and violence
against nurses during the ongoing COVID-19 pandemic? If nothing was done, are they
foreseeing any actions in the future? Which ones?
Bullying and harassment of nursing staff
Earlier in May we surveyed our members to understand the level of value they feel, and the
impact of working on the frontline during COVID-19. This survey revealed that nearly a
quarter (23%) of BAME respondents had experienced an increase in bullying/harassment,
compared to 15% of those who are white. In addition, our regional offices and member
support services have received anecdotal reports from members of threats, harassment or
intimidation, as well as physical assault in the form of spitting. There have also been media
reports of forced evictions of medical professionals from rental properties due to a perceived
increased risk of contraction.

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COVID-19 and its unequal impact on BAME staff
Across the UK, evidence continues to emerge highlighting the disproportionate impact of
COVID-19 on BAME staff. Our second PPE survey conducted in May revealed stark and
deeply-worrying contrast in experience and safety of BAME respondents. For nursing staff
working in high-risk environments (including intensive and critical care units), only 43% of
respondents from a BAME background said they had enough eye and face protection
equipment. This is in stark contrast to 66% of white British nursing staff. Furthermore, 70%
of BAME respondents said that they had felt pressured to care for a patient without adequate
protection as outlined in the current PPE guidance, almost double the 45% of white British
respondents who had felt this pressure. Nearly a quarter of BAME nursing staff said they had
no confidence that their employer is doing enough to protect them from COVID-19,
compared with only 11% of white British respondents. The most common reason
respondents told us for not reporting concerns was because they did not believe any action
would be taken (68%) and almost a third (29%) were fearful of speaking out.

c. Did your national government/health setting put in place appropriate mechanisms for
psychological support for those nurses who experienced extreme anxiety and stress during
the crisis?
Earlier in May we surveyed our members to understand the level of value they feel, and the
impact of working on the frontline during COVID-19. Half of our members who responded
reported concerns around their own physical and mental health, and 9 in 10 were concerned
about the wellbeing of those in the nursing profession more generally. Our results show that
the psychological impact of COVID-19 on nursing staff is significant. In terms of national
support offered, the NHS launched a national mental health hotline in April to provide staff
with psychological support and advice. The NHS also partnered with leading mental health
charities and organisations to offer a suite of apps to help staff with their mental health, free
of charge.

d. What are the measures taken by your national government to make sure the health
professionals, in particular nurses, are prepared for the next COVID-19 wave/a future new
pandemic?
The UK Government has not published any plans relating to workforce preparedness for
future waves of the COVID-19 pandemic or future pandemics.

e. And how is your national government planning to engage with EU/national nurse
representatives to better engage the nursing profession in a future health crisis?
This information has not been made available by our national Government. The ‘Chief
Nursing Officer’ (CNO) role, unlike its equivalent ‘Chief Medical Officer’ does not sit within
the UK Government, rather in the English National Health Service, meaning that
representations from senior nursing staff are not held on par, or at inter-governmental level.
Although the devolved Governments of Scotland, Wales and Northern Ireland do have CNOs
who work within Government, the UK Government does not operate in the same way.

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f. Is your national government going to re-arrange already existing budget to support the
nursing frontline during future healthcare crisis? If so, which budget areas, how much, and
what for?
The UK Government has released additional funding to the social care sector to bolster
infection control ahead of the winter season and potential second wave which will benefit
frontline nurses working in these settings. This funding for care providers totals £546 million
extra. Local councils were given £3.7 billion in July to undertake testing of staff and residents
and to provide sufficient PPE for frontline staff. The NHS received £6.6 billion in April,
however, there has not been a recent announcement relating to funding for a second wave.

4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
No information provided.

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EFN Members

ALBANIA
Ms Blerina Duka - President & Official Delegate
Albanian Order of Nurses
www.urdhriinfermierit.org

AUSTRIA
Ms Elisabeth Potzmann - President
Austrian Nurses Association (OEGKV)
www.oegkv.at

BELGIUM
Mr Yves Mengal - Delegate (FNIB) | Ms Deniz Avcioglu – Official Delegate (UGIB)
Fédération Nationale des Infirmières de Belgique | General Nursing Union of Belgium
www.fnib.be | www.ugib.be

BULGARIA
Ms Milka Vasileva - President & Official Delegate
Bulgarian Association of Health Professionals in Nursing (BAHPN)
www.nursing-bg.com

CROATIA
Ms Tanja Lupieri - President
Croatian Nurses Association (HUMS)
www.hums.hr

CYPRUS
Mr Ioannis Leontiou - President & Official Delegate
Cyprus Nurses and Midwives Association (CYNMA)
www.cyna.org

CZECH REPUBLIC
Ms Jana Hermanova – Official Delegate
Czech Nurses Association (CNNA)
www.cnna.cz

DENMARK
Ms Anni Pilgaard - Official Delegate
Danish Nurses’ Organisation (DNO)
www.dsr.dk

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ESTONIA
Ms Gerli Liivet - Official Delegate
Estonian Nurses Union (ENU)
www.ena.ee

FINLAND
Ms Nina Hahtela - President & Official Delegate
Finnish Nurses Association
www.sairaanhoitajaliitto.fi

FORMER YUGOSLAV REPUBLIC OF MACEDONIA
Ms Velka Gavrovska Lukic - President & Official Delegate
Macedonian Association of Nurses and Midwives
www.zmstam.org.mk

FRANCE
Mr François Barrière - Official Delegate
Association Nationale Française des Infirmiers & Infirmières Diplômés ou Etudiants (ANFIIDE)
www.anfiide.com

GERMANY
Mr Franz Wagner - Official Delegate
German Nurses Association (DBFK)
www.dbfk.de

GREECE
Dr Eleni Kyritsi-Koukoulari - President
Hellenic Nurses Association (ESNE)
www.esne.gr

HUNGARY
Ms Tünde Minya - President & Official Delegate
Hungarian Nursing Association
www.apolasiegyesulet.hu

ICELAND
Mr Guðbjörg Pálsdóttir - President & Official Delegate
Icelandic Nurses Association
www.hjukrun.is

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IRELAND
Ms Phil Ni Sheaghdha - Delegate
Irish Nurses and Midwives Organisation (INMO)
www.inmo.ie

ITALY
Ms Stefania Di Mauro – Official Delegate
Consociazione Nazionale delle Associazioni Infermiere - Infermieri (CNAI)
www.cnai.info

LATVIA
Ms Dita Raiska - President & Official Delegate
Latvian Nurses Association
www.masas.lv

LITHUANIA
Ms Danute Margeliene - President & Official Delegate
The Lithuanian Nurses’ Organisation
www.lsso.lt

LUXEMBOURG
Ms Anne-Marie Hanff - President
Association Nationale des Infirmier(e)s Luxembourgeois(es) (ANIL)
www.anil.lu

MALTA
Mr Paul Pace - President & Official Delegate
Official Delegate
Malta Union of Midwives and Nurses (MUMN)
www.mumn.org

MONTENEGRO
Ms Nada Rondovic – President & Official Delegate
Nurses and Midwives Association of Montenegro

NETHERLANDS
Ms Stella Salden – President & Official Delegate
Nieuwe Unie’91 (NU’91)
www.nu91.nl

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NORWAY
Ms Lill Sverresdatter Larsen – President & Official Delegate
Norwegian Nurses Organisation (NNO)
www.sykepleierforbundet.no

POLAND
Ms Grażyna Wójcik – President & Official Delegate
Polish Nurses Association (PNA)
www.ptp.na1.pl

PORTUGAL
Mr Luis Filipe Barreira – Official Delegate
Ordem dos Enfermeiros (OE)
www.ordemenfermeiros.pt

ROMANIA
Ms Ecaterina Gulie - President & Official Delegate
Romanian Nursing Association

SERBIA
Ms Radmila Nešić - President & Official Delegate
Association Health Workers of Serbia
www.szr.org.rs

SLOVAKIA
Ms Iveta Lazorová - President
Slovak Chamber of Nurses and Midwives
www.sksapa.sk

SLOVENIA
Ms Monika Azman – President & Official Delegate
Nurses and Midwives Association of Slovenia
www.zbornica-zveza.si

SPAIN
Mr Florentino Perez – President & Official Delegate
Spanish General Council of Nursing
www.consejogeneralenfermeria.org

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SWEDEN
Ms Sineva Ribeiro – President & Official Delegate
The Swedish Association of Health Professionals
www.vardforbundet.se
SWITZERLAND
Ms Roswitha Koch - Official Delegate
Association Suisse des Infirmières et Infirmiers (SBK-ASI)
www.sbk-asi.ch
UNITED KINGDOM
Dame Donna Kinnair - Delegate
Royal College of Nursing (RCN)
www.rcn.org.uk

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EFN – European Federation of Nurses Associations

The European Federation of Nurses Associations (EFN) was established in 1971 and is the
independent voice of the profession. The EFN consists of National Nurses Associations from 35 EU
Member States, working for the benefit of 6 million nurses throughout the European Union and
Europe. The mission of EFN is to strengthen the status and practice of the profession of nursing for

the benefit of the health of the citizens and the interests of nurses in the EU & Europe.

For further information or copies of this report please contact:
The European Federation of Nurses Associations (EFN)
Registration Number 476.356.013
Clos du Parnasse 11A, 1050 Brussels, Belgium
Tel: +32 2 512 74 19 Fax: +32 2 512 35 50
Email: [email protected] Website: www.efnweb.eu

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