Paul De Raeve, Secretary General of the European Federation of Nurses Associations provides insight into the EU’s advanced practice nursing in long-term care

The COVID-19 pandemic sharpened the focus on system-critical professions such as nurses and intensified the need to develop a comprehensive EU Care Strategy to improve long-term care quality and safety (LTC). It is clear that nurses’ education/training and working conditions, as a recruitment and retention strategy, must be improved by ensuring the sustainable financing of LTC with advanced practice nursing roles. As such, the EU responds to the challenges of healthy ageing and rising unmet care needs in the EU.

Improve long-term care quality and safety

Ensuring people’s access to high-quality and affordable LTC should be the common aim of the strategy, with the European Pillar of Social Rights and the Pact for Skills facilitating a coordinated effort at the EU level. In a constantly changing and complex society, nurses become central to implementing the European Care Strategy with a specific focus on investing in upgrading and upskilling the nurses’ education towards advanced practice nursing roles. As Commissioner Schmit highlighted at the EFN April 2022 General Assembly, “we have all recognised over the last two years how important the role of nurses is in our healthcare systems and in our society. Nurses have shown terrific commitment beyond sometimes unimaginable situations to maintain the care system and wider health system, through their dedication under unprecedented challenges and extreme stress. Therefore, the upskilling and reskilling of nurses will be key”.

The upskilling and reskilling of nurses will be key

As more effort from the healthcare sector is expected to boost the continuum of long-term care services and the system of payment for those services, the LTC equation should shift towards community care and prevention, supporting patients and citizens in achieving their health goals and, as such, creating a healthier population. APNs are very active in the prevention agenda to achieve accessible, effective, efficient, and affordable pathways with the provision of comprehensive healthcare services addressing the unmet needs of the European population.

eHealth technologies

eHealth technologies can significantly contribute to prevention, especially concerning LTC and non-communicable disease (NCD), and empower citizens to take control of their health. As technological change transforms almost every aspect of life, embracing the digitalisation of the healthcare sector is vital to empower citizens to promote health and well-being. Educating and enabling people to take more responsibility for their own health is essential for LTC.

Nurses with the proper knowledge and skills are often well-placed to add considerable value and form a vital link between technological innovation, health promotion and disease prevention. The proliferation of eHealth tools and technologies requires nurses to understand the evidence base underpinning the available tools and to ensure that they are selected and used appropriately, with behaviour change monitored and evaluated. Therefore, developing and supporting APNs in facilitating citizens/patients’ access to prevention and primary and community care is essential.

Hospital surgery corridor
© Viktor Levi

Healthcare workforce resilience

Unfortunately, the COVID-19 pandemic has hit and damaged the nursing profession heavily, resulting in nurses leaving the nursing profession in massive numbers. Therefore, on an EU-wide basis, EU legislation and workforce policies must be developed, rapidly funded through the European Recovery and Resilience Facility and implemented to secure enough nurses with an expansion of their frontline roles. Furthermore, healthcare workforce resilience can only be achieved if the EU educates and trains enough advanced roles for frontline nurses in sectors such as LTC.

The operationalisation of advanced practice nursing in the EU must comply with Directive 2013/55/EU and build on the eight legislative competencies in Article 6. Notably, the level of education and training required to qualify and practice as an advanced practice nurse must be further harmonised in line with the EFN Workforce Matrix 3+1. Notably, 11 countries reported on the existence of national legislation establishing minimum educational requirements. Based on the European Pillar of Social Rights and the Pact for Skills requirements, efforts to increase the availability of highly qualified professional nurses can secure timely and accessible quality and safe LTC to European populations if adequately prioritised in EU legislative and workforce policy design.

The EU Care Strategy is a critical milestone in progress

Therefore, the EU Care Strategy is a critical milestone in progress. Investment in advanced practice nursing roles to further reduce European labour and skills shortages should be an urgent political and economic priority.

However, a coordinated and systematic effort in the consistency and ongoing development of advanced practice nurses across Europe is urgently needed. Developing APNs is critical to increase the efficiency and efficacy of the existing resources and improve health outcomes by getting the frontline coordination right of the healthcare systems and LTC specifically. These advanced roles, which include prevention and integrating primary and secondary care following the people-centred model of care, are proven to make healthcare services more responsive, safe, effective, and efficient, showing benefits for individuals and their families, as well as for healthcare professionals surviving daily post-COVID 19 pandemic in challenging working environments.

To conclude, more and more EU countries are establishing APN roles within their healthcare ecosystems, with this category of nurses becoming more recognised or regulated throughout the EU. Nurses become central to implementing the European Care Strategy through these advanced roles.

1. Directive 2013/55/EU of the European Parliament and of the Council of 20 November 2013 amending Directive 2005/36/EC on the recognition of professional qualifications and Regulation (EU) No 1024/2012 on administrative cooperation through the Internal Market Information System (‘the IMI Regulation’) EUR-Lex – 32013L0055 – EN – EUR-Lex (
2. EFN Position Statement on Consequences of nurses shortages in public health (EFN GA October 2020)
3. EFN Workforce Matrix 3+1

Contributor Profile

Secretary General, RN, MSc, MStat, PhD, FAAN
European Federation of Nurses Associations (EFN)
Phone: +32 2 512 74 19
Website: Visit Website


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