How can a country learn from the experience of another? Expanding nurses' scope of practice in Portugal: Lessons from England

- The Portuguese healthcare system uses an inefficient combination of nurses and doctors.
- Britain's example of enhancing nurses' roles as a possible source of policy learning.
- Potential ingredients for a successful strategy for Portugal were identified.
- The study provided an explicit framework of questions to explore in formulating such policy changes.

IntroductionThe composition of the Portuguese health workforce suggests an inefficient combination of nurses and physicians. Evidence indicates that, under specific circumstances, nurses can provide equivalent care to that delivered by physicians. England has a broader experience in developing policy-led initiatives in this field from which Portugal can learn. The study explores this issue, aiming to assist in informing policy formulation.MethodsThe study analysed English policies which led to the enhancement of nurses' roles between 2000 and 2010. A literature review and interviews with selected informants were carried out.ResultsIn 2000, the British government adopted a new policy for the health sector. A “working differently” strategy was subsequently developed. An increase in demand as well as the failure to improve access, efficiency and quality of service were the drivers for change. The strategy was fostered by the idea of building roles around patients and several tools were developed in order to trigger change, in which different stakeholders performed a central role. In spite of the registered progress, by the end of 2010, some issues remained unresolved, namely the lack of a specific framework to regulate nurses' expanded functions.ConclusionThis study provides Portuguese policy-makers with useful knowledge for defining a strategy to expand nurses' scope of practice, by proposing a general framework of key aspects to be taken into account.