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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)?
At the beginning and for the first few weeks no or very little adapted PPE available and very
little knowledge and information on how to handle the disease. Infection control nurses
quickly started in hospital training but nurses in the community had no intel at first and too
much and contradictory information sometimes from health ministry and regional health
authorities.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Yes, depending on the workplace and the area but clearly nurses were priority workforce
group for testing.
c. Were there enough resources/nurses to handle the COVID-19 patients?
From March to June hospitals cancelled all non-urgent hospitalisation (basically anything non
COVID) and nursing workforce were reallocated to COVID + unit Reinforcement from less
infected region were called upon on a voluntary basis to help out especially in intensive care.
Nursing students were requested to work with very little recognition from hospitals.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Cf point C patient weren’t admitted to hospitals or did not have access to GP to follow up on
their chronic disease by fear of contamination.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Some places were under huge strained for a few weeks in the spring but a lot of solidarity
helped to face the crisis Things are a lot more worrying today with a nursing workforce
exhausted and quite fed up as a whole.
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?
In the spring the most serious challenge was the lack of PPE and even if masks seem readily
available today gloves are an issue as well as disposable gowns. Several logistics online
platform has been started to get supply and free supplies have been distributed since April
to hospitals and community nurses. Nowadays human resources is the biggest challenge with
less voluntary/benevolery help and less stuff on wards with normal hospital and clinics
activities on the increase.
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?
A few nurses were asked to leave their flat for fear of contamination by other tenants but it
was mostly supportive attitude we witnessed.
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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?
A couple psychological support on line and phone platforms were set up.
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?
Training sessions are being proposed on handling COVID 19 and wages were raised but no
dedicated plan has been formalised as of yet.
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?
No communication to this effect up to now. Crisis management once again has been largely
focused on medical care.
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?
Wage increase has been implemented but no long-term plans on career enhancement or
continuous education programs.
5. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
We have no official or confirmed data, but it seems quite a few nurses have quit or are thinking of
quitting since the beginning of the COVID 19 crisis.
GERMANY
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Total number of people infected: 246,166 (as of 3rd Sept 2020)
Deaths – total: 11.2/100,000 inhabitants
Hospital admissions: 32,493 patients of 211,454 infected people
b. Number of nurses infected with COVID-19?
Not available
c. Number of nurses who died from COVID-19?
Not available
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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 the beginning lack of masks and other protective equipment in particular in nursing homes.
Government tried to buy equipment worldwide. Nurses are not very confident if in case of a
second wave protective equipment will suffice. Good information about how to deal with
infection, risk etc. form public sources (though frequently changing recommendations, e.g.
regarding usefulness of masks). DBfK (and others) provided condensed Information via
website. Several publishers with online-courses offered online-training free of charge.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
In the beginning only in case of symptoms. Now in most states testing is available for health
professionals on demand.
c. Were there enough resources/nurses to handle the COVID-19 patients?
In hospitals yes, as numbers of patients were much lower than expected. There was never a
shortage of free intensive care beds. The situation was different in nursing homes: There,
because of lack a staff, equipment and knowledge frequently residents were sent to
hospitals. In addition, resident suffered because of restrictions for visiting relatives. For
several weeks, visitors were not allowed. Several nursing homes had a high number of deaths
because of COVID-19 infections.
In home care some patients refused visits of the nurses because of worries about the risk of
infection. Here too, availability of protective equipment was limited for several weeks.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Yes, because elective procedures were postponed and many patients appear to avoid health
care institutions or physicians’ offices. The number of people suffering from strokes or heart
attacks is much lower than on average. This raises concern of long-term effects because of
untreated conditions.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
There is no problem. We have a daily updated register of available ICU-beds. Quite a few
patients from abroad (e.g. France, Italy) were treated in German hospitals
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 the biggest challenge is implementing preventive measures like the use of masks
in public or social distancing.
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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?
Very few cases have been reported. But the majority considers nurses to be heroes.
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, not the government. DBfK Northwest in cooperation with the Federal Chamber of
Psychotherapists established a counselling service for nurses dealing with COVID-19 free of
charge. However, use of the service has been limited.
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?
No specific measures.
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?
No information available.
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. Nurses in long term care and in hospitals will receive a one-time financial bonus of 1,000
EURO plus 500 EURO in most of the states. This bonus is tax free.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
No information provided.
GREECE
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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?
…
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?
…
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?
…
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?
…
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?
…
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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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
HUNGARY
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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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?
…
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?
…
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?
…
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?
…
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?
…
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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
ICELAND
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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?
…
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?
…
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?
…
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?
…
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?
…
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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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
IRELAND
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
As of the 07/09/2020: Infection rates: 29,672 Hospital admissions: 3,427 Deaths: 1,519
b. Number of nurses infected with COVID-19?
2819
c. Number of nurses who died from COVID-19?
HCWs: 8 deaths. No nurses
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)?
National occupational health policies and guidelines were established during the initial
COVID-19 emergency for different areas of the health service. However, there were issues
around how these were interpreted and implemented across the health service. There were
initially difficulties around PPE and this was particularly an issue in the residential care
setting. The use of PPE by nurses was not introduced into healthcare setting until April.
Regular testing is not yet standard across the health service but is routinely done in the
residential care setting.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Routine testing was introduced in the residential care setting during the initial emergency.
However, this was not standard across the health service. Currently, within the public health
service as a healthcare worker, you will be referred for testing if you meet the following
criteria: Have a sudden onset of at least one of the following symptoms: cough, fever,
shortness of breath. OR Sudden onset of loss of sense of smell, loss of sense of taste or
distortion of sense of taste and there is no other reasonable explanation for the sudden
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symptoms. OR You have a respiratory illness and have been in contact with a confirmed or
probable COVID-19 case in the last 14 days before the onset of symptoms. Routine testing of
nursing staff was introduced in the residential care sector.
c. Were there enough resources/nurses to handle the COVID-19 patients?
Extra funding was introduced into the health service, private hospitals were used for extra
capacity. Significant nurse staff redeployment took place to generate capacity for COVID
services. A national campaign was launched to recruit nurses into the system. There was an
increase in the number of nurses working in the health service including nursing students.
However, due to the high infection rates in nurses, the level of staffing was put under
extreme pressure with extreme shortages in many areas.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
During the initial emergency, much of the non-COVID related health care services were
suspended as resources were needed to deal with COVID patients and health services.
Resources and staffing were extremely stretched during this time and as a result there is now
a large backlog. This has impacted on waiting lists and missed care.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Bed capacity remains a concern. The Health Service Executive (HSE) have made an
arrangement with the private hospitals to gain access to extra bed capacity if a second surge
occurs.
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?
During the emergency one of the biggest challenges was in the residential care setting where
many of the COVID related deaths occurred. There were a number of issues including a lack
of statutory oversight, poor IPC practices and lack of PPE as well as poor staffing ratios.
The government launched two investigations into the nursing home sector and made several
recommendations. In the immediate term a number of changes were introduced including
routine testing for staff and patient and appropriate access to PPE.
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?
In a survey carried out of INMO members, several respondents stated that they had trouble
acquiring childcare due to their work as a nurse/midwife during the emergency. There is no
official campaign or actions from government on this issue, although it has been raised in the
Oireachtas (Irish Parliament) by the INMO.
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?
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No, the levels of stress reported to us is very high among members (INMO SURVEY). The Irish
public health service (HSE) provides an Employee Assistance Programme which is a work-
based support service for some staff, but it is not available throughout the country. They also
run regular stress control education programmes and developed guidance on managing
fatigue and mental health. The emphasis of the employer is on counselling and self-help, the
issues causing most anxiety are lack of childcare , when schools closed, and if child sent home
from school due to self-isolation requirements, and the lack of follow on for those suffering
after effects post viral symptoms.
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 HSE developed a plan for reopening the health service with a promise to reduce capacity
to between 80% or below if required. Access by people who do not need to be in the
healthcare environment (for example, visitors) is strictly controlled and measures to support
distancing and temperature checks are required. However, staff shortages due to COVID sick
leave and self-isolation remain a challenge and this is of particular concern as the winter
season approaches. Although a zero-tolerance approach to overcrowding was announced,
the number of patients on trolleys are increasing daily. Recruitment has not speeded up or
changed, process of recruitment is very slow , agency engagement continues at a high rate
approx. €1.3 m per week for nurses.
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?
Chief nursing officer is now, a member of national advisory team to government, this is only
recently arrived at and allows nursing concern be raised, however contact with UK
government or NI government is not , as far as we are aware taking place re staff mobility
during the crisis. Also, the Irish gov position on categorising COVID 19 as a workplace injury
is not in place and this is at odds to most EU countries.
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 Government announced an extra 2bn for the health service in June. However, there is
not a great amount of detail of how this is to be allocated. €320,000 was to be allocated for
PPE, but there are no official figures relating to frontline staff.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
In Ireland, COVID-19 is not recognised as an occupational disease. The INMO is seeking the
amendment of health and safety regulations to ensure COVID-19 is classified as an occupational
injury/personal injury when acquired at work. Staffing shortages are a major concern as stated.
The INMO is also concerned about the psychological impact of the pandemic and how this will
affect nurses into the future. Preliminary results of an INMO survey has shown that 79% of
respondents believed that their experience of COVID19 has had a negative psychological impact
on them.
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ITALY
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Italy Cumulative Cases:
Cases: 322.751
Median age of cases: 56 years
Males 47.8% %) | Females 52.2%
Deaths (Case-Fatality Rate) - 35,979 (11.4%)
Recovered (Hospitalized): 231.217
Total swaps test: 11.691.391 (7.057.949 cases)
Last 30 days:
Cases in the last 30 days: 41,192
Median age of cases in the last 30 days: 41 years
Cases by sex: Males (%)52.4% | Females (%)47.6% in the last 30 days
Deaths in the last 30 days: 358
Recovered in the last 30 days: 22,691
Home Isolation: 52.064
Hospitalized: 3.205
Intensive Care: 297
(Source: ISS (national institute of health)/Gimbe, 3 october 2020)
b. Number of nurses infected with COVID-19?
Total Cases among healthcare workers: 32,542 (12% of total cases)
Estimated more than 16.00 nurses cases (more than 50% of health care workers)
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In last 30 days, Italy have 1,457 Cases among healthcare workers in the last 30 days, that
represent 3%, respect first wave of Covid-19, that was more than 12% of health care workers
testes as positive. We could affirm that enough PPE and better COVID-19 management
competencies acquired on the field help nurses to work with more safety.
c. Number of nurses who died from COVID-19?
The number of Nurses that died from COVID-19 was 40; of these, 4 committee suicide.
The data show that most of them were in hospital service (55%), followed by 12.5% of the
nurses working nursing homes. A further 22.5% (total 35%) of nurses still engaged in Local
Health agency outpatient network, emergency-urgency in the territory.
(Data estimated, source: Minister of Health, FNOMCEO, FNOPI, ANSA, QS)
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 the first months, there was a general lack of all PPE in Italy and worldwide. As Associations,
and also Unions, we have had lobbying activities a lot for the protection of nurses (in an
interview, CNAI president declare that Some hospitals do have enough Personal Protective
Equipment (PPE), but in most cases, nurses and doctors are forced to wear masks which are
far past their effective use, and in some hospitals in central and southern Italy, staff have no
PPE at all. Colleagues have told me they feel like they are going into battle with paper shields
and toy guns. We need these supplies now, not tomorrow). Now the situation is in line, also
because government ask to our national industry to reconvert some factory for the
production of PPE (before we are totally depended by China and East Europe production)
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
In the first months, there were some confusions, lack of swaps, and no-standard decisions in
different regions. After, some lobbying activities (nursing association, nursing union,
international/European association) Government, in April, decide that all health care workers
could be tested (swaps and serologic test).
c. Were there enough resources/nurses to handle the COVID-19 patients?
There were not enough resources and nurses to handle COVID-19. A shortage of nurse during
these years create serious issue in the first phases. From March to May there were a number
of new recruitments COVID-19 dedicated:
+ 4917 Doctors,
+ 11.144 nurses
+ 5.032 Health care support workers
At same time a national task force of protection civil that helps were is necessary (hospitals,
nursing home and so on) (700 nurses and 700 physicians was recruited for weeks, from
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health care workers in active service, private and public). The accumulated shortage of nurses
and shortages in the area in recent years has created serious problems in the early stages. At
the same time, staffing and preparation problems in nursing homes have increased the
number of infected and deaths.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Most of traditional health care and surgery activities were suspended (except cancer-related,
stroke unit, emergency and traumatology) also due country lock-down for 71 days). Most of
resources were used for COVID-19 Department/Hospitals related utilization. Now, there is a
long line of surgery intervention and other diagnostics exams suspended in the lock down
period.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Due 30 years of disinvestment in health care sector, Italy experienced a serious lack of ICU
beds, especially in some regions in the north, with serious consequences in terms of human
lives lost. The number of ICU beds pass in 2 months (April-May) from 5000 to 11.250. Now
there are about 8.000 beds. During first wave, regional government decide to build hospitals
in a convention centers and in area outside some hospital. Italy experienced also air
transportation to patient in Austria and Germany due to lack of beds.
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?
The greatest challenge was represented by the continuing need to raise awareness of the use
of PPE. Some issue now is related to readiness of some regions in the south of Italy during
2nd wave of Covid-19.
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?
Overall, there has been no stigmatization in Italy about COVID-19 and health professions.
During COVID-19, nurses and other health care workers acquire a new positive visibility (as
modern heroes that fighting for the health for all).
Before COVID-19, due line in emergency area and chronic shortage of health care workers
and beds in hospitals, in some area (especially in the Center and South Italy), a relevant
number of violence episodes happened.
During the summer, new legislation about violence in the health care sector was approved
by Government, that improve protection for health care workers.
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?
There is not a National Italian Plan developed to support mental health for health care
workers – Covid-19 related. About all hospitals and local health agency develop interventions
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useful to help nurses and other health care workers like psychological line numbers or local
support. Italian National Institute for Insurance against Accidents at Work (INAIL) publishes
procedural indications and useful tools for carrying out individual interventions in the
country. This initiative was promoted by this institute in collaboration with the National
Council of the Order of Psychologists (CNOP), with the goal to develop guidelines for stress
and burnout of all health care workers involved in the Coronavirus. A psychological phone
triage assessment was developed to identify how to solve better mental health issues of
Health care workers that contact these services. Ideally, the idea was also to constitute a task
force of psychologist for monitoring and support health care workers.
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?
During this time, about education and training, no specific formal training for COVID-19 was
offered (compulsory) at the national level or regional levels. Some guidelines and some e-
learning general course about COVID-19 was developed. Hospitals and Nursing homes
offered local dedicated training covid-19 related. Some hospitals from these months will be
involved in a European project (Provision of Training on Intensive Care Medicine Skills for
Health Professionals Not Regularly Working on Intensive Care Units OVID-19 Skills
Preparation Course- https://www.esicm.org/covid-19-skills-preparation-course/#Natorg).
It's interesting note that CME education was totally suspended for this year, also due to
nurses’ shortage in Italy (estimated more than 50.000 nurses).
A number of government initiative and regional:
- Italian and regional task forces of nurses and physician for community covid-19 care
- Family and community nurses
- new military nurses and physicians
- newly graduated nurses, anticipating Thesis and nurses abilitation sessions.
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?
In these months, the minister of health, government, and regional government involve – not
in a stable form – nurses in some task force COVID-19 related. An Italian Nurse (CNAI
member) participate as CNO to triad meeting OMS – ICN – ICM. CNAI maintain some
informal-formal contact with some countries CNO, with International and European
Organization and with WHO Europe. Until now, there is not an official
representative/Department/position at Health Minister or Protection Civil level or at
Regional Level, lead by a nurse.
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?
Government have decided with a decree (Relaunch Degree) to improve everyone's health
and safety and strengthen our Health System and Civil Protection Force continues with an
initial investment of €5.5 billion: the reorganization of the hospital network, with a structural
expansion of 3,500 new intensive care beds, the strengthening of local and home care and
the recruitment of around 9,000 nurses, dedicated to community area (Family and
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community nurses) and the refinancing of the National Emergency Fund for Civil Protection
activities. Other health initiatives are underway, most of these related to community and
territorial area improvement. Other health projects supported by the ministry of health
relate to the Next generation EU funds that will arrive in Italy next year, with particular
attention to health digitization.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
In Italy, some issue persist regarding the governance of the health workforce are not only related
to the number of nurses or other health care workers; there is a more general and complicated
quantitative (how many) and qualitative (what specialties, what roles) and a serious problems of
low salary. At the same time problem with planning as well as disputes about hospital-centered
vision vs community-centered vision. At the same time, the medical dominance (in government,
in minister of health, Regions, Orders, University) is a real problem for have in our country a
complete full scope of practice (advanced nursing and so on) and the roles of Chief Nursing officer
at different levels. Some issue is related to ethics aspect. During first wave, due shortage of
intensive care beds, some older people was not selected for resuscitation. Its ’a real dramatic for
our nation which believed it to be at the top in terms of health service. Assisting people dying
without being able to do anything more for lack of facilities and resources, always makes you think
about how to do better.
LATVIA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
2,765 - total cases, death - 40, hospital admissions - 247 (for during 7 months).
b. Number of nurses infected with COVID-19?
Until 15.09. – 129 heath care workers
c. Number of nurses who died from COVID-19?
0
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)?
March – May was problems with PPE.
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b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Health care workers tested for free.
c. Were there enough resources/nurses to handle the COVID-19 patients?
Sufficient resources
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Sufficient resources
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Enough.
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?
Very good to work epidemiology team.
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
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, because we hasn’t be actual.
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 government controlled Covid-19 prevalence.
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?
National government to support reform of nurse professions.
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?
Yes, nurses’ salaries will increase by 25% in 2021.
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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LITHUANIA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
56,3 cases per 100 000 inhabitants (5758 Covid-19 cases in total)
139 hospitalized patients (October, 8th )
103 deaths in total (October, 8th)
b. Number of nurses infected with COVID-19?
No data available.
c. Number of nurses who died from COVID-19?
No data available.
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 the beginning of Covid-19 outbreak in Lithuania healthcare institutions experienced
significant shortage of personal protection equipment for working staff. Trade unions of
medical workers wrote a letter to Ministry of health with request to ensure safe work
conditions for medical workers, to provide adequate numbers of personal safety equipment
and to provide proper training about safety rules working with potential covid-19 risk. It took
some time for Ministry of health to purchase adequate numbers of personal protection
equipment for nurses and doctors. Also, voluntary donations of masks and other items were
accepted. Online training courses were organised for all administrative and medical staff
about safety rules and requirements at workplaces. Facilities were prepared and all hospitals
were trained how to arrange admissions of patients. Government states there is enough
stock of personal safety equipment for the future.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Yes, nurses and all medical workers were mandatory tested in all heath institutions locally in
their workplaces regardless of symptoms or exposure. During quarantine it was an obligation
of national centre to carry out tests. Later all heath institutions were obliged to test their
staff members and admitted patients by themselves.
c. Were there enough resources/nurses to handle the COVID-19 patients?
There were adequate numbers of staff to work with covid-19 patients. Some of nurses
disagreed to work in such units e.g. because of elderly age or pregnancy. The other nurses
were replaced from other less loaded units to covid-19 units. Also, medical workers had an
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exposure to covid-19 patients and had to undergo self-isolation period – some hospitals had
deal with a shortage of staff.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Most of the planned medical interventions in the hospitals were cancelled or decreased to a
minimum and postponed during quarantine. Only urgent help was available for the patients.
Most of health services in outpatient clinics were provided remotely like phone
consultations. After quarantine heath services were increased gradually. The situation was
not accepted well by patients because of many of them did not receive necessary services.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Such problem was not declared officially in our country. Government increased number of
ICU beds and purchased equipment for oxygen therapy. Also, Government applied strict
quarantine rules trying to avoid a large number of covid-19 patients. As we see from statistic
data, we still have some reserve of free hospital beds and other equipment. Unfortunately
there are several hot spots in the regions, like in elderly home, where almost every staff
member had as exposition to covid-19 infection or were tested covid-19 positive and some
of these institutions felt severe shortage of staff. Government try to attract nurses and
doctors from the other cities to help to deal with the situation.
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?
The most serious challenge was covid-19 outbreaks among patients and staff members in
health care institutions. Government try to control the situation, performs tests but still such
situations occur in different regions.
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?
Yes, nurses and doctors confronted stigmatisation in the beginning of outbreak. Government
decided to protect all workers by not sharing the information about the profession or any
other private data of the covid patients announcing just a numbers of new registered covid
cases.
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?
Yes, some help was available. Psychologists’ community offered voluntary online
consultations for medical workers free of charge during quarantine. Now people can find
phone numbers of support teams and contact psychologists by phone. All information is
available in national web page of covid-19 control.
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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?
Medical staff is equipped with personal safety equipment and some reserves are collected.
Work safety rules are implemented in work places and staff is educated how to act during
the outbreaks.
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?
In the beginning of covid-19 outbreak some actions were coordinated with medical trade
unions. Examples are protection of the medical workers, education of staff, changes in work
shifts. Not sure about the future while we do have an election to national parliament at this
period and we probably will have a new government.
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 information about the current plans.
But some extra funding was allocated by government during quarantine months. The
allocated finances from State sick funds were transferred for all health institutions even they
did not provide full amount of health serviced during quarantine. All medical workers
received salaries as usually. Also, medical staff received 100 percent of sick leave payment if
being on self-isolation because of exposure to covid 19. Staff members who worked with
covid-19 patients and provided covid-19 testing in hot spots in addition to salary received
extra payments (up to 100 percent of common salary). But these payments were paid only
during quarantine months. Finances were allocated from reserve funds.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
No information provided.
LUXEMBOURG
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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?
…
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?
…
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?
…
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?
…
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?
…
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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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
MALTA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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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?
…
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?
…
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?
…
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?
…
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?
…
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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
MONTENEGRO
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Data as of September 23rd 14:00h CET:
- Infection rate:
1. Overall 2020: 1449 per 100.000 inhabitants
2. Second wave (June – September): 1398 per 100.000 inhabitants
3. Currently active cases: 3618 with the rate 560,21 per 100.000
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- Hospital admissions:
1. Currently hospitalized: 279 cases
2. Current hospitalization rate: 7,7%
- Deaths:
1. Total number of deaths: 151
2. Lethality rate: 1,6% (with significant variations of age specific lethality rates
ranging from 0 to 29% among age group 90+; 11,83% among 80 -89 years of age)
3. Mortality: 23,38 per 100.000 inhabitants
b. Number of nurses infected with COVID-19?
205
c. Number of nurses who died from COVID-19?
2 nurses.
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)?
The Ministry of Health in cooperation with international counterparts made effort to provide
sufficient protective equipment in order to highly protect nurses as extremely important
staff. Although at some point there was lack of protective equipment, government of
Montenegro and Ministry of Health provided sufficient quantity of protective equipment for
healthcare institutions, which are in stock even now. In compliance with the
recommendations of the World Health Organization, there were developed protocols about
functioning healthcare institutions, with special focus on protection of the staff that is in
direct contact with the infected ones, while the data that the COVID-19 infection rate of
healthcare professionals in Montenegro is among the lowest in Europe is the best proof for
it.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Yes
c. Were there enough resources/nurses to handle the COVID-19 patients?
Due to coordinated work of the Ministry of Health, Institute for Public Health of Montenegro
and healthcare institutions, health workforce (including nurses) were deployed based on the
needs of other healthcare institutions, in order to provide smooth operational work and
continuous providing of nursing care to all the patients infected by COVID-19.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Yes
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e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Montenegro reacted on time and sufficient quantity of ICU beds was provided. There are 600
ICU beds for COVID-19 patients in health institutions, with possibility to increase that number
for over 400 in improvised temporary hospitals. It’s assessed that there won’t be need to
increase these capacities, but the Ministry of Health closely monitors the situation and it’s
ready to react in case of additional worsening the situation and of abrupt filling of the stated
capacities. As for the equipment, orders are regularly made and definitely, health
professionals won’t be lacking the equipment, as they need to be able to continuously and
adequately respond to the challenges caused by COVID-19.
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?
The most serious challenge is definitely to save the most vulnerable population and to reduce
mortality to minimum. Montenegro can definitely be praised for that and it’s so good that
corona virus wasn’t spread to elderly population, which means by measures and conscious
behaviour of our citizens we saved elderly population, as well as due to our continuous work,
we prevented virus to get into nursing homes in Montenegro, so we have very low mortality
rate among elderly population.
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?
Through media presence of the Ministry of Health, in cooperation with the Institute for Public
Health and the National Coordination Body, the combat that health care professionals are
having against corona virus has been promoted; therefore, they were given support in
various ways, which resulted with high level of respect and appreciation for their work and
role in this combat. All this was highly supported by general public, the consequence of which
was reduction of stigmatization to minimum.
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?
Health Centers provide every health professional adequate help of psychologist or
psychiatrist, if they ask for it.
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?
Training of health professionals was done through different projects in order to get ready for
second wave of corona virus and to give best response to its challenges.
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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?
Ministry of Health is willing to participate in all the constructive projects which would enable
higher level of readiness and skills of health professionals in combat against corona virus.
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?
Due to heavy workload and merits of health professionals while treating patients infected
with COVID-19, Government of Montenegro enabled bonus of 15% on the top of their
salaries because that way somehow the efforts and work of nurses were awarded, and
certainly there will be such intentions in future, too.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Nurses are important factor in combat against corona virus, and by all means, they face numerous
challenges at work, like getting infected, physical and mental fatigue, neglecting private life, but
also daily problems and obstacles at work. Ministry of Health is dedicated to improving these
conditions in order to enable best possible functioning of health care system, which means work
of all nurses would be easier, but also of other health professionals.
NETHERLANDS
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
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…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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?
…
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?
…
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?
…
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?
…
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?
…
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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
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NORWAY
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Covid-19 infection rate 15 639, Hospital admissions 1150, Deaths 277
b. Number of nurses infected with COVID-19?
We do not have numbers /statistics showing this in Norway.
c. Number of nurses who died from COVID-19?
No nurses have died from Covid-19 in Norway that we know of.
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 March/April there were a serious lack for PPE as well as respirators, especially in the
municipalities, but also in our hospitals. Our government managed to buy PPE from China
and the situation are now much better.
Due to lack of nurses, hospital beds, PPE and respirators the government decided early on a
lockdown – the hospitals and the municipalities could not handle a lot of Covid-19 patients.
Norway went in lockdown March 12. This lock down bought time to recruit nurses, secure
PPE and training for nurses to work with covid-19 patients as well as organise hospital and
municipality to create places to treat and test Covid-19 patients.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Testing and quarantine depends on symptoms, contact with someone with Covid-19 and
travel abroad.
c. Were there enough resources/nurses to handle the COVID-19 patients?
There is a lack of nurses, especially intensive care nurses. Third- year bachelor Nursing
students have been asked to contribute as well as other nurses no longer working in
healthcare.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
No, daycentres and home services shot down for about a month and many elderly patients
and others did not receive any help, assistance or care. When the schools shut down most of
the “school” nurses had to work with infection tracing and covid-19 testing instead of services
to children. In addition, many surgeries where postponed.
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e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Our government are now planning for much greater storage of PPE and more ICU beds and
have also joined the EU on preparedness planning/storage. The hospitals have gotten extra
funding to tackle the crisis. But the government have not done much to tackle the lack of
nurses. They have increased the amount of student places for nursing somewhat, but this
will by no means solve the problems of recruitment and retention.
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?
This is a difficult question, but as NNO sees it – it is the lack of nurses and specialist nurses
both in hospitals and in the municipalities.
In addition, the lag of treatments, all the patients that did not get their treatments and
operations for months in the start of the pandemic. As well as consequences of isolation.
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, people were grateful for the work the frontline workers were doing.
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?
Not that we know of, there might be local variations.
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?
Organising for covid-19 patients, training, storage of PPE, medicine. If there is local outbreak
of covid-19, local authorities will use different lock-down procedures to try to avoid overload
of the health care services/hospitals.
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?
Norway have organised a Corona Commission that will investigate what we can do better in
the future. In this commission the Norwegian Nurses Organisation were unfortunately not
asked to join neither were anybody else representing the nursing profession. Norway have
joined EU in the Coronavirus Global Response Summit and we did show some solidarity and
sent a Norwegian health team, fully equipped to North of Italy. Norway is also a part of EUs
Union Civil Protection Mechanism (UCPM), European Centre for Disease Prevention and
Control (ECDC), European Medicines Agency (EMA) and EU Health Program and others.
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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?
Yes, some to preparedness, some increase for education and allocations to the hospitals. But
noting to nursing homes and social services. The Norwegian Nurses Organisation have
therefore made a demand, together with different patient’s organisations, for a lager
economic package to nursing homes and home services. There is a severe lack of both nurses
and healthcare assistance in the municipalities and we need strong incentives that will insure
a minimum of quality and patient safety in these services. There is also a need to be prepared
for new and even more dangerous pandemics in the future.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Norway has no register of infected nurses and where they may have been infected. We
therefore do not have an overview of long-term effects and occupational injuries among nurses.
This can also lead to burn-out among nurses, especially if we get an increase in cases during the
fall and winter. Especially ICU (intensive care) nurses have said that they are not sure for how much
longer they will manage to stay in their jobs, under these conditions. Many of these nurses are
also older, so they can choose to retire if they like. Ending on a more positive note; the Covid-19
vaccine will be free of charge to everyone in Norway when the vaccine is ready. They will start
vaccination of health personnel and the elderly first.
POLAND
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
102 thousands infected out of 38 mln citizens.
b. Number of nurses infected with COVID-19?
Since 4th of March until 30th of September – 3276 nurses infected with Covid-19, out of
250 000 in the system.
c. Number of nurses who died from COVID-19?
6 nurses (official data).
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)?
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Health care institutions were supported by central and local governments in providing PPE.
Despite those efforts during first weeks of Covid-19 majority of health care institution were
short of PPE. Since the very first weeks, health care personnel received big support from
society, local communities and NGO. The most difficult workplaces for nurses were local
hospital and small health clinics in March and April. At the beginning no health care
personnel was sufficiently prepared to handle Covid-19. The recommendations were very
general and not relevant for all the areas of health care services. But after two/three weeks
of improvisation, a lot of new recommendations and standards were developed, which was
slowly implemented in all health care settings.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Not for the first months of Covid-19. The situation has changed since the middle of summer.
c. Were there enough resources/nurses to handle the COVID-19 patients?
Poland implemented a strategy of dedicating 16 special hospitals to Covid-19, and later
dedicated special departments in general hospitals. Above institutions received additional
resources ( human, financial and logistic support). The situation proved more difficult in
other health care settings, and social care institution, which had to deal with local Covid-19
infections among patients and health personnel. For the first three months of Covid-19 we
experienced many situations, where some departments or big parts of hospitals were closed
due to epidemic conditions and lack of personnel.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Polish health care system is continuously challenged by shortage of nurses. One of the
consequences of Covid-19 and national lockdown, was a limitation of access to health care
services. And this paradox helped us with dealing with Covid-19, despite the very law human
and nurses resources in our country. Since January Poland 2020 implemented obligatory
standards of E-Health: electronic prescriptions and e-consultations. The above solutions
were very helpful at the time of Covid-19. Polish nurses working in PHC, LTC and ambulatory
specialist clinics are broadly using the forename innovation and new competency.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
In Poland we did not have an issue with the lack of ICU beds, until know. We were short of
nurses and doctors in some institutions, but the Covid-19 law enabled officials to transfer
nurses or doctors on a temporary basis to other working places.
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?
The biggest challenges with Covid-19 are continuously changing:
- at the beginning (March )- it was the new standards and organisation of the health care
services, access to PPE, organization of the self-isolation places for citizens as well as
health care and public services workers, lack of tests for all groups (patients and
personnel)
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- second stage of combating Covid-19 ( April-August) – the issues were relating to shortage
of health care personnel, mostly in the long term or social care institutions and restriction
in access to health care services for other patients ( cardiac, oncology, surgical or general
medicine), permanent changes in the legal conditions and standards of providing
services in the time of Covid-19
- now we are at the beginning of the second wave of epidemic – we are very close to lack
of hospital beds for Covid-19, shortage of nurses and doctors, and likely serious
restrictions for other patients and citizens
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?
Yes, after first weeks of public support, we were confronted with social stigmatizations. After
the initial actions against the virus, our Government focused on the organisation of
Presidential election in the middle of Covid-19. The was neither intention nor a place to
develop an effective strategy to support health care professionals.
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, but such support was organised by nursing organisations. It was initially done by Polish
Nurses Association with cooperation of psychologists from Faculty of Psychology in Warsaw
and Poznań, and later by Polish Nurses Chambers.
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 government implemented a special law, which enabled them to give additional resources
for personnel working with Covid-19 patients. They also plan and promise to provide
immunisation for health care personnel for Influenzas.
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?
It is difficult to answer the question above. Polish Government believes that they already
have all the necessary knowledge on health care policies, and the health care crisis.
Nonetheless we are trying our best to motivate the Government for necessary actions
related to nursing.
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?
Yes, Polish national Government is re-arranging the existing budget and adding resources for
health care. Part of those resources would be spent on nursing personnel as well as PPE for
nurses.
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4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Polish Nurses Association was the first professional organization, to open “7-day national Covid-
19 help line for health personnel”, in the middle of March. This project lasted for 8 weeks. Since
May we are mostly involved in consultation and development of the new recommendations,
standards and regulations related to Covid-19.
PORTUGAL
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Total confirmed cases - 74029
Deaths - 1957
Active cases – 24188
Source – Lusa News Agency – Government Press Conference 28/09/2020
b. Number of nurses infected with COVID-19?
According to government data on September 28, so far 4,970 health professionals have been
infected, including 1,435 nurses (the remaining 1,401 operational assistants, 629 physicians,
166 technical assistants and 167 diagnostic and therapeutic technicians). Of the total number
of infected health professionals, 4,108 are already recovered, which represents a higher
recovery rate of 82%. However, it is warned that daily reports of health professionals infected
with the new SARS-CoV-2 are reported and the overwhelming majority contracted the
infection in the workplace in large hospital centers, but also in primary health care units.
The nurses and operational assistants of the Hospitals of Santo António, in Porto, and Santa
Maria, in Lisbon, were submitted to serological tests to COVID-19 in a partnership between
the Champalimaud Foundation and the Ordem dos Enfermeiros (OE). The results revealed
that, in the case of the hospital in Porto, the number of infected is ten times higher than
previously thought; in the case of Santa Maria, the number is eleven times higher. Serological
screening was performed in May to a total of 657 professionals: 206 nurses and 141
operational assistants in Santo António and 184 nurses and 126 operational assistants in
Santa Maria. The result revealed that, in Porto, 8.4 percent of these professionals, mostly
asymptomatic and never previously identified with COVID-19, were effectively, while the
percentage in Lisbon, under the same circumstances, was 6.5 percent. From this study, the
OE considers that a extrapolation can be made to the entire population of nurses and
operational assistants of these hospitals, thus concluding that the true number of these
infected professionals is much higher than that identified.
c. Number of nurses who died from COVID-19?
There is no record of any nurse who has died with COVID-19.
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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 March 2020, when the first patients with COVID-19 arrived, we had some referral hospitals
to receive infected people. There was a lack of personal protective equipment (EPIs) and
what existed were only the "relics of the last global outbreak of Ebola in 2014". Equipment
was scarce and was not the most appropriate to protect patients and healthcare
professionals. In this way, the Government announced the acquisition of more material to
address existing gaps. It was only a few months later that this material (EPIs, Ventilators
etc...) began to reach health services. Some Portuguese companies, to this end, have also
adapted to new needs in the production of these protective materials. Unofficial figures as
at 21 September 2020 estimated that around €260 million was spent on direct adjustments
to tackle the COVID-19 pandemic. This represented more than 12,000 contracts between
March 18 and September 16. Most of these contracts were to acquire ventilators, masks and
laboratory reagents (tests).
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
No. The guidelines/recommendations for testing health professionals occur when they have
symptoms of COVID-19 or have had a high-risk exposure with patients with COVID 19. Health
professionals are tested on a case-by-case basis. There is no specific time frequency. The new
DGS (Directorate General of Health) Plan for Autumn and Winter, presented on 21
September, will change the health professionals' testing policy which will become "regular
and periodic". The OE considers that this measure is indispensable and cautions that the
operationalisation of this plan needs to be closely monitored, and that this measure must be
applied to all health professionals.
c. Were there enough resources/nurses to handle the COVID-19 patients?
No, the Ordem dos Enfermeiros recognizes that there was and continues to exist a deficit in
the number of nurses per thousand inhabitants (the nurse/inhabitant ratio in Portugal is 6.7%
being much lower than the OECD average of 8.8%), requiring nursing professionals to work
longer working hours in difficult environments with high stress levels, requiring a more
demanding level of attention and care on the part of these professionals.
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
No. The mere fact that the Government has announced the hiring of more health
professionals has underlined the insufficiency of these professionals to treat all other
patients (without COVID-19). This effort only slightly diminished the existing gap in human
resources in health to meet the real needs of the country. This gap of nursing professionals
led to the postponement of surgeries, medical appointments, treatments, etc. Proof of this
is the fact that the Government, through the Minister of Health, stated on 23/09/2020 that,
since 31 December 2019, the Portuguese NHS has hired an additional 5,216 health
professionals - of these 4,406 have been hired to strengthen the fight against COVID-19. Of
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the total number of professionals, 1,527 are nurses, 1,784 are operational assistants and 445
are superior diagnostic and therapeutic technicians.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
There was a lack of beds and equipment, including intensive care unit beds. Thus, hospital
structures were reorganized, and more intensive care and general hospitalization beds were
created. To meet any eventual needs, field hospitals have also been set up. Most of the field
hospitals set up to help fight the COVID-19 pandemic are now empty or have been
decommissioned. The favourable evolution in the number of infected by the new coronavirus
led to the large part of these structures not even being used. The Ministry of Health explained
that the priority is to treat patients in hospitals and the use of temporary structures, such as
field hospitals, will be considered on a case-by-case basis, if justified, depending on the
evolution of the pandemic. On the assembly of field tents in some hospitals in the country,
namely the Curry Cabral Hospital in Lisbon, the Minister of Health said that the facilities are
not field hospitals, but "an extended hospital perimeter to enlarge the responsiveness
capability".
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?
Situations have been reported of a reduced patient access to health care units not only for
fear of COVID-19 contagion, but also because of system limitations, which is a warning sign
of the predictable dangers arising from lack of health care to the population. Regardless of
the epidemic, citizens' health needs did not disappear, so the Government need to make sure
that all citizens have their health care needs provided. Examples include the high number of
medical appointments, examinations and surgeries postponed due to the pandemic. Health
professionals have warned of this situation. We have qualified, competent and dedicated
health professionals. However, many of them are already exhausted due to the burden of
work prior to the pandemic and everything they have now experienced. We maintain a
shortage of human and material resources, organizational, structural deficits. Despite this,
we believe in our professionals, in their skills and know-how resulting from the experience
now lived.
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?
Almost 1,000 cases of violence against health professionals were reported at the end of
September 2019. This number was equivalent to the whole of 2018. The Portuguese
government urged all health professionals and institutions to inform of any cases of assaults
against nurses and other health professionals. The Secretary of State for Health, António
Sales, also condemned "all forms of violence".
To this end, the Minister of Health announced the creation of a new Security Office to
manage these situations. "There are several areas of intervention here, from the outlook of
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preventive aspects, but also aspects of incident monitoring and, aspects of risk identification
of facilities, aspects of training of health professionals, to find alternatives of dialogue for
situations that will reveal themselves as episodes of violence." The Ordem dos Enfermeiros
considered this measure insufficient, also having been received with scepticism by the
medical class. Access to health services is not yet normalised at pre-COVID-19 levels. We can
see that the number of incidents may have decreased during the pandemic because citizens'
access to services is conditioned by the state of emergency in which the country was in.
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?
In order to ensure the strengthening of care activities in the area of mental health and
psychosocial support, it was reinforced the Psychological Support and Crisis Intervention
Center of INEM and the Psychological Counseling of the SNS24, including for health
professionals. Also, in order to respond to the need expressed by several nurses in the face
of the COVID-19 epidemic, the Mental Health Support Line of the OE was created, a
completely free service of nurses for nurses.
This line will be available during the COVID-19 pandemic and will operate on weekdays
between 9:00 a.m. and 6:00 p.m., being operationalized by Nurses Specialized in Mental and
Psychiatric Health Nursing, which have technical and scientific knowledge that allows them
to evaluate, plan and implement psychotherapeutic, sociotherapeutic, psychosocial and
psychoeducational interventions. Other organizations and entities have also set up lines of
support, notably the Order of Psychologists.
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 Government announced on 21 June 2020 that the €504.4 million health boost in the
2020 State Budget will ensure that Portugal has more instruments to continue
investment in the sector. "We anticipate the hiring of more health professionals by
December, as well as the integration of professionals who were hired in the emergency
phase. That is, we will have an increase of 4.5% compared to the Budget approved for
2020.
• On 18 September 2020 Prime Minister António Costa presented the five fundamental
rules for combating COVID-19: wearing the mask, maintaining regular hand hygiene,
respecting the respiratory behaviour, maintaining the physical appropriate distance to
each circumstance, effective use of the Stayaway Covid application (STAYAWAY COVID
is an application for iOS or Android phones that aims to assist the country in tracking
COVID-19. The application allows each of us to be informed about risk exposures to the
disease simply and safely by monitoring recent contacts. The application is for voluntary
use and free of charge and has more than 1,030,824 downloads made) as well as
promoting contact through the SNS 24 line.
• Regarding the strengthening of health professionals in the National Health System (SNS),
the Minister of Health reported on 23 September that since December 31, 2019, the
NHS has hired 5,216 more health professionals — of these 4,406 hired to strengthen the
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fight against Covid-19. Of the total number of professionals, 1,527 are nurses, 1,784 are
operational assistants and 445 are superior diagnostic and therapeutic technicians.
• DGS is preparing a vaccination strategy for the eventuality of a vaccine. Secretary of
State António Lacerda Sales, said that the 6.9 million vaccines that the state announced
corresponds to an amount of 690,000 doses and says that distribution should begin later
this year, reinforcing that "it always depends on the evaluation of the European
Medicines Agency" and the "authorization of the vaccine at European level". The DGS
has already defined who the priority groups are when the vaccine is available, ensuring
that there will be priority for vulnerable groups and health professionals.
• The Health Plan for autumn-winter, released on 21 September by the Directorate-
General for Health, also provides for a review of the criteria for defining suspected
patients and ending isolation or discharge. The DGS document is based on three main
pillars: seasonal risk response including Covid-19, ensuring the non-COVID health
response and a number of specific communication and literacy measures. With regard
to the seasonal risk response, which combines influenza with COVID-19, DGS plans to
strengthen the public health response, especially in outbreak situations; plan
vaccination against influenza and COVID "as soon as the vaccine is available"; and adapt
the national laboratory testing strategy for SARS-CoV-2 in the face of the influenza
epidemic. According to the plan, there will be strengthening of stocks and strategic
reserve of medicines, medical devices, personal protective equipment and laboratory
tests; in addition to "consolidating the intervention plan in residential structures for the
elderly". The plan also plans to define hospital units "COVID-19 free", to avoid "the
degradation of access in situations of significant epidemic growth", as well as to
continue the expansion of home hospitalization.
DGS: https://www.sns.gov.pt/wp-content/uploads/2020/09/PLANO-DA-SA%C3%9ADE-
PARA-O-OUTONO-INVERNO-2020-21.pdf
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?
Since the beginning of the pandemic, the Ordem dos Enfermeiros has been in contact with
the Government, having contributed to the elaboration and close collaboration with the
Ministry of Health. The OE has contributed to the development, counselling and guidance of
standards and measures for both health professionals and the general population. Regarding
influenza virus vaccination, the Ordem dos Enfermeiros, as well as the Order of Pharmacists
and Physicians, joined the Ministry of Health in the development and financial support of a
communication campaign aimed at the identified risk groups that need to be vaccinated this
year. The Ordem dos Enfermeiros has been stressing the urgent need for reinforcement on
the one hand, the number of health professionals in the NHS, in particular the number of
nurses and promoting their valorisation and recognition, and, on the other hand,
strengthening the development and implementation of awareness campaigns of the
population as public health agents in terms of behaviours and precautions with a view to
preventing the dissemination of SARS-CoV-2. It is considered essential to increase investment
in the NHS, particularly in terms of infrastructure and conditions in the work environment to
protect nurses and health professionals.
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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?
To deal with the occurrence of COVID-19 outbreaks in ERPIs and residential homes, and in
view of the request of the Ministry of Labour, Solidarity and Social Security, there was a
reorganization of the Budget, namely incentives for nurses to work in ERPIs. It has also been
announced that health professionals who have been at the forefront in the fight against
Covid-19 will receive a bonus of 50% of their monthly base pay. The proposal, which was
adopted in the Portuguese Parliament and determined that the prize should be awarded to
"all NHS professionals who, in the course of the state of emergency and their renewals,
exercised duties under subordinate work in the NHS and have practised, in this period, in a
continuous and relevant manner, acts directly related to the person of suspects and patients
infected with Covid-19". The OE considered that this “award” is not "fair" because it leaves
out those who do not work in the NHS, and the rear guard also is essential in the treatment
of patients. Although the recognition of nurses' work in the fight against the pandemic is
unanimous, there are still no mechanisms for these professionals to remain in the country.
This award shall be paid only once, and its specific allocation has not yet been
operationalised.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
In terms of challenges for the coming months, the Ordem dos Enfermeiros identifies the possibility
of a wave of cases of COVID-19, associated with the approximation of winter with seasonal
diseases. The return to working life in all sectors of society without constraints, which began in
September, and the possible impact on the increase in the number of cases and in particular the
resumption of the NHS to respond to all the coverage of care that has been suspended.
In addition, the OE is also concerned about the lack of structural conditions in maintaining social
distancing, in large clusters of people, for example, in public transport and the growing number of
cases that have occurred, once again in the residential structures of the elderly, where the elders
live, which are the weakest elements of society and which, due to their previous health problems,
are more sensitive to the adverse hazards of COVID-19.
ROMANIA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
160.461 infections
120515 healed
5 535 people died
651 cases at ATI
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b. Number of nurses infected with COVID-19?
3335 cases of infected medical personnel, including nurses.
c. Number of nurses who died from COVID-19?
35 health workers - 22 medical doctors and nurses, 13 auxiliary personnel.
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)?
At first there was not enough material, equipment, no preparation for the pandemic. Now
there are protective materials, there are work protocols.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Yes
c. Were there enough resources/nurses to handle the COVID-19 patients?
Yes
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Yes
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Our government providing all materials, medication, mobile hospitals.
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?
Emergency situation
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?
There were two cases of nurses, but public opinion was very strong and support nurses.
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?
Yes
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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?
Assurance of protective materials, equipment, and testes. The government has stimulated
health workers with money which working in the covid hospitals.
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?
Don’t know.
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?
Don’t know.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Nurses which work in the hospital Covid are very tired and stressed.
SERBIA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
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EFN – European Federation of Nurses Associations
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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?
…
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?
…
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?
…
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?
…
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?
…
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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
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EFN – European Federation of Nurses Associations
SLOVAKIA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
…
b. Number of nurses infected with COVID-19?
…
c. Number of nurses who died from COVID-19?
…
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)?
…
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
…
c. Were there enough resources/nurses to handle the COVID-19 patients?
…
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
…
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
…
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?
…
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?
…
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EFN – European Federation of Nurses Associations
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?
…
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?
…
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?
…
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?
…
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
…
SLOVENIA
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
March-October 6498 cases (cumulative confirmed data/ 140 deaths
https://ourworldindata.org/coronavirus#cases-of-covid-19
b. Number of nurses infected with COVID-19?
49 (July-September 2020)
c. Number of nurses who died from COVID-19?
None
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)?
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EFN – European Federation of Nurses Associations
In the beginning of epidemia, there was lack of equipment, however according the
information, there is enough protective equipment now. Many recommendations were
prepared together with NMA for different settings. Huge national campaign about protective
measures in all settings (schools, public, work).
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Yes
c. Were there enough resources/nurses to handle the COVID-19 patients?
Yes, however lack of nurses and other health professionals is huge, 30-50%
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
No, we are facing with phenomen of nurses leaving profession.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
The Slovenian government bought additional equipment, such as ventilators. Lack of trained
nurses is also an issue. Plans for recruitment of nurses, which worked in ICU in last 3 years
and left these positions, is prepared.
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?
NMA (together with union) prepared strategy for nurse retention, together with improving
working conditions, salaries, however we are facing lack of governmental support and
cooperation.
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?
Actually, we don’t have information/data about stigmatisation.
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?
YES, there are many governmental and NGO association, which take care and actions for
support, even NMA organise online help/SOS telephone.
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?
- National regional coordinators (nurses, family doctors, epidemiologists) are named for
consultations in elderly homes, hospital and other health/social institution.
- Workshops about use of protective equipment are organised for staff in elderly homes
and long-term care homes by NMA and financial supported by Ministry of Health.
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EFN – European Federation of Nurses Associations
- national guidelines and recommendation were prepared about COVI9 19, together
with NMA.
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?
We don’t have that information.
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?
Yes, they are additional budget money for salary supplement for nurses in ICU, however
there are many other work areas, which are critically exposed (emergency,..).However these
additional payment was realized in time of epidemic (2,5 months). In new ANTICORONA ACT,
additional 30 million euros will be supported for health professionals.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
No information provided.
SPAIN
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Total infected: 888.968 (12/oct/20) (Infection rates=1.902 cases x 100.000 hab.)
Total hospitalized: 157.881 (12/oct/20)
Deaths: 33.124 (12/oct/20)
b. Number of nurses infected with COVID-19?
Health professionals= 64.847 (We do not Know the exact number of nurses)
c. Number of nurses who died from COVID-19?
7 Nurses (3 women and 4 men)
2. Question 2 - Working environments (See answers altogether below as one)
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)?
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
c. Were there enough resources/nurses to handle the COVID-19 patients?
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EFN – European Federation of Nurses Associations
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Answer for all questions:
We learned about the first case in China on 31 December 2019 and the Spanish Government
started to hold different meetings with those responsible for healthcare in our 17 regions
(that is, our regional ministers) in January. At first, experts and spokespeople from the
Ministry minimized the situation sending out the message that we would not have many
cases and everything would be under control in Spain. On 31 January we identified our first
case and we had our first victim on 13 February but the news was made public 20 days after
the patient’s death. On 26 February we had 10 cases and 1 of them had not been abroad,
which marked the beginning of community transmission. On 2 March the Spanish General
Council of Nursing, at the request of the Healthcare Ministry, issued a communique
recommending the suspension of scientific congresses and the celebration of events
gathering large numbers of people. The Spanish General Council of Physicians did the same
thing. However, the Spanish Government did not recommend the suspension of football
matches, mass meetings of political parties or the demonstration in the streets on 8 March.
That same day, 2 May, the Spanish General Council of Nursing gathered 20 Nursing Scientific
Societies with a view to set up working groups to draft protocols and recommendations to
prevent contagion. We also worked with the Ministry to draft the protocols you can see on
their website.
On 9 March, when we already had 1 000 positive cases in Spain and 16 deaths, some regional
governments begun to take measures to prevent transmission like Madrid’s where
educational centres were shut down (universities, schools, etcetera). However, the state of
alert confining people in their homes was not declared in Spain until 14 March when there
were nearly 6 000 cases and 136 deaths. Since that day, rules have been gradually established
to avoid the expansion of the virus.
Working conditions of healthcare professionals
As we have seen, healthcare authorities have been aware of the magnitude of this epidemic
for two months in our country. However, they have not planned accordingly to provide the
personal protection equipment that healthcare professionals need, so they have been forced
to make their own equipment at home using garbage bags, household material, etcetera.
There are not enough masks, coats, glasses, face protection screens, etcetera.
The Spanish General Council of Nursing has revealed to the media the working conditions of
our healthcare professionals many times. We have also sent letters to the national
Healthcare Minister as well as to the Regional Ministers and to the Prime Minister of Spain
to request that the necessary protection equipment is provided urgently. We know there is
high competition internationally to buy such equipment, but in Spain there has been lack of
foresight because purchases should have begun much earlier.
The Spanish General Council of Nursing and the General Councils of the other healthcare
professions have drafted a joint communique requesting once again protection equipment
for professionals.
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EFN – European Federation of Nurses Associations
On the other hand, there are not enough tests to diagnose the infection in the population
nor in healthcare professionals so we do not know the exact number of infected people
though we suspect it is likely to be way above the official figures.
On the other hand, in terms of human resources, we should keep in mind that Spain is a
country with one of the lowest nurse/patient ratio. The EU average is around 8-9 nurses per
1 000 population whereas in Spain we have 5 nurses per 1 000 population. Considering that
Spain is the country with the highest coronavirus infection rates among healthcare
professionals, who as a result cannot provide healthcare, we are in a very difficult situation
because of the lack of nurses to take care of patients. Hence, we have had to ask professionals
to move between regions, retired professionals have been asked to get back to work and the
Government has implemented a rule by which students in their last year of the Nursing and
Medicine Degrees can have a “Healthcare Help” contract to aid healthcare professionals and
thus accelerate the processes for the recognition of qualifications of nurses from countries
outside the EU.
To that end, I wish to mention the problem we have had to face together with Spanish
universities because students’ practice hours in their last year of Nursing (and other
disciplines) have been suspended and therefore we do not know how they will be able to
conclude their studies this year if they do not complete the total number of practice hours
required by the Directive. Considering this is not the case in Spain only, since I suppose it is
also happening in Italy and other countries, a new agreement should be adopted including
an extraordinary provision so that students do not have any problems to graduate this year
despite not having completed all the practice hours envisaged.
I would also like to mention that due to our large number of patients, additional locations
have been set up to take care of them. Hotels have been converted into hospitals to free up
space in actual hospitals, and in just one week a 5 000-bed hospital has been set up at IFEMA
conference venue, where congresses are usually held, which is as impressive as the hospitals
that were built so quickly in China. All this has been possible thanks to the work of hundreds
of people, even altruistically.
Last but not least, I wish to highlight the situation in elderly homes where many people have
died mainly due to their characteristics and old age but also due to the lack of protection
equipment for professionals to work.
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?
Now, the biggest challenge is containing community transmission.
Health professionals are exhausted. More spaces are needed to expand the number of beds
in intensive care units.
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?
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For a time, some nurses suffered some kind of stigmatization, especially in the months of
March, April and May. From the General Council of Nursing of Spain, together with the police
we have a program to report any type of aggression.
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?
The Government of Spain, together with the Professional Associations of Nursing, medicine,
psychology and other health professionals, launched a free psychological help program for
all health professionals.
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?
No information provided.
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?
No information provided.
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?
Not yet.
4. Question 4 - Please provide any additional information, comments, or challenges nurses are
experiencing in your country due to COVID-19.
Actions carried out by the Spanish General Council of Nursing:
• We have set up a platform called “Nursing Unity” gathering the Nursing Union (SATSE),
Nursing Scientific Societies, the Association of Managers, the Conference of Nursing Deans
of all Universities and the Association of Nursing Students. We have made joint statements
revealing the situations in which our healthcare professionals have to work.
• We are continuously updating our coronavirus action protocols together with the Scientific
Societies.
• The Spanish General Council of Nursing and our Research Institute have prepared posters,
videos and documents with recommendations both for professionals and for the general
public, which are being distributed through the social media and published on our website.
We have been commended for this action by the ministry, as well as by the regional
governments, the media, etcetera.
• We are disseminating all these materials through our communications department together
with press notes and communiques to inform both the public and professionals.
• We have developed urgently a one-hour refreshment course updating coronavirus
knowledge for action aimed at professionals, which has already been taken by nearly 10 000
of them. We published it on our webpage just one week ago.
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• We have written letters to the Spanish Prime Minister, as well as to the Healthcare Minister
and to the Regional Ministers requesting protection equipment for our professionals and
coronavirus diagnostic tests for them
SWEDEN
1. Question 1 - Country Profile
a. COVID-19 Infection rates / hospital admissions / deaths (for comparison)?
Summary figures on the infection situation in Sweden 6 October :
Diseased cases 96,145 people since March. Number who during this period / have / or / still
/ are in intensive care; 2619 people.
Persons who have died with established Covid-19; 5883 persons
b. Number of nurses infected with COVID-19?
1400 nurses have reported in to Swedish authorities. But the figures are very uncertain.
There may be a large numbers of not registered cases.
c. Number of nurses who died from COVID-19?
We do not have any statistics in Sweden on this. On the other hand, we in VF have an ongoing
case about a deceased covid-infected reg nurse
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)?
At the beginning of the pandemic, there was a fear that the equipment would not be enough.
This did not happen in inpatient care. Processing and procurement meant that there was
never an acute shortage. In the care of the elderly, there has been a shortage of masks at the
beginning of the pandemic. We have many member stories about this and also the fear of
being infected.
b. Were nurses at national/local level tested at their workplace, regardless of reported
symptoms or exposure?
Nurses have, later in the spring, had the opportunity to test themselves for both antibody
development and ongoing infection.
c. Were there enough resources/nurses to handle the COVID-19 patients?
We have had a shortage among all staff, but mainly in intensive care. This has led to the
resolution of emergency situations by moving staff around and increasing the number of
hours per work shift. Sometimes up to 12.5 hours.
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EFN – European Federation of Nurses Associations
d. Were there enough resources/nurses to handle all other (NON-COVID) patients?
Sweden handled it by stopping all unnecessary operations and investigations. We are now
entering the autumn with a fairly large so-called care debt, which means all postponed
operations and treatments. There is a fear that the number of cancer cases will increase due
to the missed / delayed sampling or treatment.
e. Some European countries experienced lack of ICU beds, equipment, and trained nurses;
how is your national government planning to tackle this?
Sweden is now reviewing both the number of student places in the nursing program, but also
medical equipment and so-called emergency preparedness stocks. The supply of medicines
is also being reviewed and a clear responsibility plan must be drawn up.
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?
The biggest challenge during the pandemic was the lack of intensive care nurses. That we
managed the spring and summer as well as we did anyway was largely due to the staff's
willingness to show up despite long, heavy work shifts and lack of rest and recovery.
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, we don’t think so.
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?
With regard to the direct assistance to staff in the psychological effects of working within the
conditions required by the pandemic, the state or the government has not made any
resources available. On the other hand, individual employers in different businesses have
perhaps offering such help.
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?
As mentioned before, they work on the basis of assignments from the government and state
authorities in various constellations with the aim of reviewing the efforts made during the
spring.
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?
We don’t know yet.
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?
EFN Report COVID-19 crisis management at national level - October 2020
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