Notice of the National Health and Wellness Commission on the issuance of the National Nursing Career Development Plan (2021-2025)

Provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps Health and Health Commission:

In order to promote the high-quality development of China's nursing care during the 14th Five-Year Plan period and improve the health of the people, according to the "14th Five-Year Plan for National Economic and Social Development of the People's Republic of China and the Outline of the Vision 2035", "Health China 2030 "Planning Outline" "General Office of the State Council on the promotion of high-quality development of public hospitals," "Fourteen Five" quality and efficient medical and health service system construction implementation plan" and other requirements, the Commission has developed a "national nursing career development plan (2021-2025)". Now issued to you, please conscientiously implement around the implementation.

National Health and Wellness Commission

April 29, 2022

National Nursing Career Development Plan (2021-2025)

护The work of nursing is an important part of health and health care, and is of great significance in comprehensively promoting the construction of a healthy China and actively coping with the aging of the population. In order to meet the growing health needs of the people and the new requirements of economic and social development on the development of nursing, according to the 14th Five-Year Plan of National Economic and Social Development of the People's Republic of China and the Outline of Vision 2035, the Outline of Health China 2030 Plan, the General Office of the State Council on Promoting Public Hospitals 

I. Planning Background

(1) The progress of nursing care during the "13th Five-Year Plan" period.

During the "13th Five-Year Plan" period, in the comprehensive implementation of the Party Central Committee and the State Council on promoting the construction of a healthy China, actively respond to the major decisions and plans of the aging population and continue to deepen the process of medical reform, the rapid development of nursing, with remarkable results. At the end of 2020, there were more than 4.7 million registered nurses nationwide, an increase of 45% over 2015. The number of registered nurses per 1,000 population reached 3.34, and the national medical-to-nursing ratio increased to 1:1.15, further reversing the problem of inversion of medical-to-nursing ratio. The number of nurses with college degrees or above exceeded 70%, and the academic quality of the nursing team was further improved.

Through the continuous development of quality nursing services and the implementation of the nurses' service capacity enhancement project, the capacity of primary nursing services has been significantly improved, the quality of nursing services has been continuously improved, the characteristics of Chinese medicine nursing have become more prominent, and nursing work has become closer to patients, closer to the clinic and closer to society. All localities have basically achieved full coverage of quality nursing services in medical institutions at the second level and above, and some medical institutions have covered outpatient (emergency) clinics, blood purification centers (rooms), operating (department) rooms, catheterization rooms and other ambulatory departments, further enhancing the public's sense of access to medical care.

Through the "Internet + nursing services" pilot work, the implementation of the development of elderly nursing services project, and actively promote the elderly home medical care services, nursing services model has been innovative development, nursing services continue to extend and expand the field, covering medical institutions, community and home and the whole population. Nurses provide more diversified medical care services for the people and play an important role in disease prevention, treatment, nursing, rehabilitation and hospice care. The full implementation of electronic registration of nurses, nurses practice management more convenient and efficient.

Medical institutions have gradually established a nursing position management system, implemented nursing position-based nurse manpower allocation, training and assessment, and gradually realized the same salary and treatment for nurses in the same position, with more work and more pay for better performance, fully mobilizing nurses' enthusiasm.

Compared with the economic and social development and the growing health needs of the people, the development of nursing in China is still unbalanced and inadequate. The number of nurses is relatively insufficient and unevenly distributed; there is a gap between the supply of nursing services and the diversified and differentiated needs of the masses; the connotation field of nursing services needs to be further enriched and expanded; the relevant institutional mechanism in the field of nursing still needs to be improved and perfected, etc.

(2) The new situation facing the development of nursing career in the 14th Five-Year Plan period.

The "14th Five-Year Plan" period to comprehensively promote the construction of a healthy China has put forward new requirements for the development of nursing. The Party Central Committee and the State Council have made important plans to comprehensively promote the construction of a healthy China, requiring that the people be the center of attention and that the people be provided with comprehensive and comprehensive health services. The nursing career needs to focus closely on the people's health needs, build a comprehensive, high-quality and efficient nursing service system, and constantly meet the differentiated nursing service needs of the public. Actively respond to the aging of the population has put forward new tasks for the development of nursing.

The deepening of aging has put forward urgent demand for nursing services, especially elderly nursing services, and the need to effectively increase the supply of elderly nursing services. Promoting high-quality development has brought new opportunities for the development of nursing career. The main contradiction in the nursing field is expressed as the contradiction between the people's demand for nursing services and the relative shortage of supply, which requires further multi-dimensional coordination of the nursing system, services, technology, management and talents to promote high-quality development of nursing and improve the level of nursing homogenization. The rapid development of information technology has created new conditions for nursing. Cloud computing, big data, Internet of Things, block chain, fifth-generation mobile communication (5G) and other new-generation information technology and health services are deeply integrated, and new models, new industries and new business models in health are emerging, which provide strong support to promote the innovation of nursing service models, improve the efficiency of nursing services and lead the high-quality development of nursing in China.

Second, the "14th Five-Year" period of nursing career development guiding ideology, basic principles

(i) Guiding principles.

Guided by Xi Jinping's thought of socialism with Chinese characteristics in the new era, comprehensively implementing the spirit of the 19th Party Congress and the 19th Plenary Session, focusing on people's health, oriented by the needs of the masses, with the theme of high-quality development and driven by reform and innovation, further strengthening the construction of nurses, enriching the connotation and extension of nursing services, improving the level of nursing management, promoting high-quality nursing development, and striving to let the people enjoy all-round and full-cycle nursing services.

(ii) Basic principles.

1. Adhere to the people as the center. Put the protection of people's health in the strategic position of priority development, adhere to the nursing work to serve the people's health, to meet the people's diversified nursing needs as the starting point and anchor point, and gradually establish and improve the quality and efficient nursing service system covering the whole cycle of life and the whole process of health.

2. Adhere to high-quality development. To improve the quality and level of nursing services as the core task, adhere to the new development concept, accelerate the construction of management system mechanisms that are compatible with the current level of economic and social development, conducive to strengthening the construction of the nursing workforce and improving the efficiency of resource allocation for nursing services, and promote the innovation of the nursing service model to achieve high-quality nursing development.

3. Insist on making up shortcomings and strengthening weaknesses. Adhere to the goal and problem-oriented, and strive to solve the problem of unbalanced and insufficient development of nursing services. Accelerate to make up for the shortcomings and weaknesses in the field of nursing, increase the supply of nursing services in the fields of women and children, the elderly, rehabilitation and Chinese medicine, develop community and home nursing, hospice and other services, further enhance the capacity of professional services, and improve the accessibility of nursing services.

4. Insist on reform and innovative development. Comply with the new situation and new requirements facing the development of nursing career, focus on the new expectations of the people in the field of nursing, grasp the characteristics of nursing work, innovative nursing service model, and focus on promoting the reform and development of the nursing service industry. Increase the reform and innovation in the field of nursing, break the institutional and mechanical barriers that restrict the development of nursing, and continuously enhance the momentum of nursing development.

III. Development Goals

By 2025, the development of nursing in China will reach the following goals.

The total number of nurses in the country reaches 5.5 million, the number of registered nurses per 1,000 population reaches 3.8, the number of nurses continues to increase, the structure is further optimized, the quality and service capacity is significantly improved, and it basically meets the needs of economic, social and health care development. Accountable holistic care is effectively implemented, and nursing services are closer to the needs of the public and society. The connotation and extension of nursing care is further enriched and expanded, and the supply of elderly, Chinese medicine, community and home care services is significantly increased. The level of scientific management of nursing is continuously improved, the quality of nursing services is continuously improved, and the institutional mechanism to mobilize the motivation of the nursing team is further improved.

Note: Relevant nursing shortage nurses include: geriatric nursing, pediatric nursing, intensive care, infectious disease nursing, emergency and urgent care, rehabilitation nursing, and Chinese medicine nursing nurses.

IV. Main tasks

(A) improve the nursing service system.

1. Optimize the layout of nursing resources. Combining demographic changes, disease spectrum characteristics and public demand for medical care services, improve the nursing service system covering acute treatment, chronic rehabilitation, stable care and end-of-life care. We will give full play to the leading role of high-quality nursing resources in large hospitals, rely on local tertiary hospitals with strong comprehensive strength and high level of nursing disciplines, and improve the nursing service system with clear positioning and division of labor among different medical institutions through the formation of urban medical associations, county medical communities and specialty alliances. Different medical institutions provide professional and standardized nursing services in combination with their functional positioning and classification as needed. Tertiary hospitals mainly provide care for patients with difficult, acute and critical illnesses, and strengthen the construction of nursing disciplines and personnel training; secondary hospitals mainly provide care for common diseases and multiple illnesses; nursing homes, nursing centers, rehabilitation medical centers, hospice centers, primary medical institutions, etc. mainly provide elderly care, rehabilitation care, long-term care, hospice care and other services.

2. Increase the supply of nursing services. Promote the revitalization of resources in areas rich in medical resources, the transformation of some primary and secondary hospitals into nursing homes, nursing centers, etc.. Support and guide social forces to organize large-scale, chain nursing homes (stations), nursing centers, hospice centers, etc., to further stimulate market vitality. Increase the number of beds in primary medical institutions to provide nursing care, hospice and other services, and encourage medical institutions with the conditions to carry out family beds, home care services, effectively expanding the supply of elderly care, rehabilitation care, home care and other services.

(ii) Strengthen the construction of nurses.

3. Continuously increase the number of nurses. Take effective measures to increase the number of nurses, especially the number of nurses engaged in geriatric nursing, pediatric nursing, Chinese medicine nursing, community nursing, infectious disease nursing and hospice care, as well as the number of nurses working in primary care institutions. Medical institutions should be scientifically and reasonably equipped with nurse manpower according to functional positioning, service radius, bed size, clinical nursing workload and technical elements to meet the demand for clinical nursing services.

4. Strengthen the training of nurses. Establish a nurse training system oriented by job requirements and centered on job competency. Strengthen the "three basic and three strict" training of clinical nurses, adhere to the position-based, categorical policy, and effectively improve the clinical nursing service capacity of nurses. In conjunction with the nursing needs of the masses and the development of nursing disciplines, the training of nurses in geriatric, pediatric, infectious disease and other nursing specialties in short supply is carried out in a targeted manner. Strengthen the training of new nurses and nursing managers. Arrange nurse training scientifically and reasonably, reduce repetitive and burdensome arrangements, and ease the contradiction between nurses' engineering.

5. Protect the legitimate rights and interests of nurses. Further implement the "Law of the People's Republic of China on Basic Medical Care and Health Promotion", "Regulations for Nurses" and other laws and regulations, as well as national requirements on care and concern for medical and nursing personnel, to create good conditions in the practice environment, remuneration, training and professional development of nurses. Medical institutions provide nurses with the necessary health protection and health care measures to effectively prevent and reduce the hazards that nurses may be exposed to in the occupational environment, and effectively safeguard and protect the legitimate rights and interests of nurses.

6. Mobilize the enthusiasm of nurses. Promote medical institutions to establish and improve the nursing position management system, in accordance with the requirements of the nurses in the establishment of positions, income distribution, title assessment, management use, etc., the establishment of nurses inside and outside the integrated consideration, to achieve the transformation of nurses from identity management to position management. We will improve the incentive mechanism of the nursing team, implement scientific evaluation and performance assessment of nurses, strengthen clinical orientation, guide nurses to base on nursing positions, deepen clinical nursing practice and strive to improve their business level. The results of performance assessment are linked to the employment of nurses, performance allocation, reward and merit, etc., tilted to clinical front-line nurses and grass-roots nurses, with more work and more pay for better performance, so as to fully mobilize nurses' enthusiasm.

(iii) Promote the development of high-quality nursing.

7. Continuously deepen the quality of care. Continuously expand the coverage of quality nursing services, achieve full coverage of quality nursing services in secondary and higher medical institutions, and significantly increase the proportion of quality nursing services in other medical institutions. Implement the core system of nursing care, make the overall nursing care accountable, consolidate the quality of basic nursing care, strengthen the humanistic care of nursing care, optimize the nursing service process, realize the expansion and quality of quality nursing care services, and effectively enhance patients' sense of access.

8. Innovative nursing service model. Combining the requirements of graded diagnosis and treatment and the actual needs of the public, medical institutions with conditions to encourage the innovative development of diversified nursing services. Expand the coverage of the pilot "Internet + nursing services", support medical institutions to actively provide "Internet + nursing services", extended care, home care, etc., extending institutional nursing services to the community and home, providing convenient and professional medical care for patients discharged from hospitals, patients at the end of life or To provide convenient and professional medical care services for discharged patients, end-of-life patients or elderly people with limited mobility, old age and frailty, disability and dementia.

9. Strengthen the construction of nursing disciplines. Guided by meeting the clinical nursing needs of major diseases and key populations, we will strengthen the construction of nursing disciplines and use discipline construction to drive the training of nursing talents and the enhancement of nursing service capacity. Continuously improve nursing quality, focus on building a nursing specification and technical standard system based on evidence-based and clinical needs, and effectively improve the level of nursing homogenization between regions and institutions.

(iv) To make up for the shortcomings and weaknesses of nursing.

10. Accelerate the development of medical care for the elderly. Promote the actual implementation of the national policies and measures on the development of medical care services for the elderly. According to the size of the number of elderly people in the jurisdiction, disease characteristics, medical care needs, etc., according to local conditions and reasonable increase in the number of institutions and beds to provide elderly care services. Increase the number of nurses engaged in geriatric medical care services and strengthen personnel training. Explore the establishment and development of a professional team of medical caregivers to expand human resources for geriatric medical care and better meet the needs of an aging society. To meet the urgent needs of the disabled elderly, accelerate the development of home medical care services and long-term care, and encourage medical institutions with conditions to actively provide home care and day care services for the elderly, especially the disabled elderly.

11. Improve the capacity of grass-roots nursing services. Support the establishment of nursing specialty alliances and joint teams of experts between qualified medical institutions above the second level and grass-roots medical and health institutions to effectively play the role of helping and driving high-quality nursing resources to help improve the capacity of grass-roots nursing services by sinking or exporting management, training and technology. Accelerate the construction of grassroots nurses and increase the manpower of grassroots nurses. Take "invite in, send out" and other means to increase the training of grass-roots nurses, and effectively improve their professional service capabilities in common and multi-morbidity care, elderly care and rehabilitation care.

12. Accelerate the development of hospice care. Promote all places in accordance with the "Hospice Center basic standards and management norms (for trial implementation)", combined with the requirements of graded treatment and the urgent needs of the masses in the area, and focus on increasing the number of hospice centers and beds to provide hospice services. Develop and revise the "Hospice Practice Guidelines (for Trial Implementation)" and related technical standards to continuously standardize the practice behavior of practitioners. Accelerate the training of professionals engaged in hospice services to effectively improve the quality of hospice care for patients at the end of life.

(v) Strengthen the construction of nursing information technology.

With the full use of cloud computing, big data, Internet of things, block chain and mobile Internet and other information technology, combined with the development of smart hospitals and "Internet + medical health" and other requirements, and focus on strengthening the construction of nursing information. Using information technology, we will innovate the nursing service model and provide convenient and efficient nursing services for patients. Optimize the nursing service process, improve clinical nursing efficiency and reduce unnecessary workload of nurses. Establish a problem- and demand-oriented nursing management system with functions such as nurses' manpower deployment, job training, performance assessment, quality improvement and discipline construction, and gradually realize modernization, scientificization and refinement of nursing management.

Source: National Health Commission official website