Beijing to Launch Multi-Site Nursing Practice Policy Starting Next Month
In the nursing community, there is a saying: “Thirty percent treatment, seventy percent care; medicine and nursing are inseparable.” As policies on physicians’ multi-site practice have gradually been relaxed, the issue of nurses engaging in multi-site practice has naturally come to the fore.
Recently, VCBeat (WeChat ID: vcbeat) learned that the Beijing Municipal Health and Family Planning Commission has released the “Notice on Implementing Regional Registration for Nurses” (hereinafter referred to as the “Notice”). Starting August 1, regional registration for nurses will be implemented in Beijing.
# Regional Nurse RegistrationRegional nurse registration refers to the adjustment of a nurse’s practice registration location from a single medical and health institution to the entire municipal administrative area. Once registered to practice at any medical and health institution within the city’s administrative area, the nurse’s registration is valid citywide, allowing them to practice simultaneously at multiple medical and health institutions within the same municipal administrative area.
The concept of “multi-site practice” is arguably unique to China, as most countries and regions worldwide do not have an equivalent notion. So-called multi-site practice does not merely mean that healthcare professionals may practice at multiple medical institutions; rather, it specifically refers to “the practice whereby licensed physicians who meet the requisite conditions, after being registered with the health administrative authorities, are employed to provide services at two or more medical institutions.”
What Impact Will This Notification Have on the Nursing Industry? VCBeat Attempts to Interpret the Policy by Examining the Current Status of Nurses’ Multi-Site Practice and Comparing Domestic and International Practices.
Currently, there is substantial demand at the primary care level for home-based nursing services and elderly care nursing services. However, a significant gap remains between the primary care nursing service model, which is dominated by community health service institutions, and the public’s growing nursing needs. Therefore, in the process of promoting privately run medical institutions and home-based nursing care, calls are intensifying to lift restrictions on the number of practice locations for nurses and to guide high-quality nursing resources toward the grassroots level.
As can be seen from the main content of the notice, the current policy relaxes restrictions on nurses’ practice locations, primarily by implementing stringent reviews of practicing institutions and standardizing procedures for multi-site practice, thereby addressing prior concerns regarding “safety.”
Following the implementation of multi-site practice for nurses, the "Practice Location" field on the Nurse Practicing Certificate for nurses registered in this city shall be recorded as "Beijing Municipality."Nurses who change their practicing institutions within the administrative area of this city are not required to submit an application for modification of registration. Meanwhile, nurses practicing in medical and health institutions within this city shall designate one medical institution as their primary practicing institution and file a record of all their practicing institutions with the health and family planning administrative department. No filing is required for nurses undertaking tasks such as health support, consultations, advanced studies, academic exchanges, and matters assigned by the government, as approved by their primary practicing institution, participating in free clinics approved by the health and family planning administrative department, or practicing in institutions that have signed assistance or trusteeship agreements.
According to the notice, nurses from secondary and tertiary hospitals are encouraged to practice in primary healthcare institutions, medical-nursing combined facilities, and privately-run medical institutions, so as to provide scarce nursing services such as transitional care, long-term care, and home-based care for discharged patients, patients with chronic diseases, the elderly, and other groups.
Meanwhile, the notice explicitly stipulates that all practicing institutions shall fully safeguard the legitimate rights and interests of nurses. In accordance with relevant laws, regulations, and employment (labor) contracts or other written agreements, these institutions shall clearly define with nurses their job responsibilities, work schedules, task assignments, compensation and benefits, and related insurance coverage, so as to ensure the fundamental rights and interests of nurses.
The introduction of this new policy can effectively address the current shortcomings in community-based home nursing care, further improve the home nursing service model, and encourage social capital to enter the resource-scarce nursing service sector, thereby serving as an effective supplement to the existing medical service system. Furthermore, it can expand the scope of nursing services by extending them from institutions to communities and households, promoting the standardized, specialized, and systematic development of nursing practice.
However, this is not the first time that policy news regarding nurses’ multi-site practice has emerged. Rumors had already circulated in regions such as Guangdong, but they ultimately amounted to “all thunder and no rain.”
In May 2016, the Health and Family Planning Commission of Guangdong Province issued the "Key Work Plan for Continuously Improving Nursing Services in Guangdong Province," encouraging specialist nurses from tertiary hospitals to establish specialist nursing clinics at the primary care level. Following the liberalization of multi-site practice for physicians, the commission also encouraged regions with appropriate conditions to explore multi-site practice for nurses and widely solicited public opinions on the implementation of this policy.Originally, this was a good opportunity for nurses to increase their income, but the “well-intentioned move” by the Guangdong Provincial Health and Family Planning Commission was met with a cold reception from nursing management departments in medical institutions.
In media interviews, some nursing managers at Guangzhou’s medical institutions stated that there is currently a widespread and significant shortage of nursing talent; virtually no hospital is adequately staffed with nurses, and in some hospitals, the nurse-to-physician ratio is even inverted. Against this backdrop, nurses are already overwhelmed by their primary duties, raising the question: how can they possibly engage in “multi-site practice”?
Some head nurses even stated bluntly, “We are severely understaffed and overwhelmed with work; how could we possibly have the spare time?” He Xiangjun, Head Nurse of the Huichiao Department at Nanfang Hospital in Guangzhou, believes thatMulti-site practice is more suitable for nurses outside the public system, while it is less feasible for nurses in public hospitals.
In their view, the key to improving nursing quality lies in increasing nurse staffing levels rather than encouraging nurses to practice at multiple sites. After all, they are already overwhelmed at their primary places of employment.
In addition to the promulgation of policies, the continuous emergence of apps offering home-visit nursing services in recent years has also sparked heated discussion. In its April report titled “Home-Visit Nursing Industry Report: Global Market Value to Reach $349.8 Billion, While the Chinese Market Remains Untapped,” VCBeat listed 13 apps that provide home-based nursing care. Among them, Hu Daojia is the largest.
In November 2015, Hushi Daojia joined forces with over 1,000 registered nurses on its proprietary platform to establish China’s first nurse group based on mobile internet—the Grade-A Nurse Group. This is the largest nurse group in China built on mobile internet and the first in the country to explore multi-site practice for nurses.
In China, nurse home-visit services primarily target the elderly or disabled populations and are referred to as "caregiving." Yihu Daoyao provides nurse home-visit services to nearby patients, including injections, intravenous infusions, urinary catheterization, nasogastric feeding, and dressing changes.Such a policy on the scope of services neither explicitly permits nor explicitly prohibits it.
This time, Beijing announced the implementation of regional registration for nurses on August 1, which to some extent has provided a “reassurance” for this industry.
In the United States, nurses practicing at multiple sites are referred to as “part-time nurses.” Nurses employed full-time can freely allocate their remaining time beyond the standard 36-hour workweek to take on part-time roles through staffing agencies that help hospitals recruit nursing personnel. These agencies provide benefits such as health insurance and retirement plans, and typically offer compensation that is 20% to 30% higher than full-time hospital salaries. This arrangement represents a highly attractive option for nurses in the U.S.
In fact, Visiting Nurse Service of New York (VNSNY), the largest nonprofit home and community-based healthcare organization in the United States, was established as early as 1944. Currently, the top five organizations by market share in the U.S. are Kindred Healthcare, Amedisys, LHC Group, Almost Family, and Encompass Home Health. Among them, Kindred Healthcare reported revenue of $7.2 billion in 2016.
Furthermore, since the 1970s, Japan has been developing various forms of home-based care services. In 2000, Japan introduced Long-Term Care Insurance, integrating medical care with long-term care and gradually establishing standardized “home medical care” services.
According to statistics from Markets & Markets, the world’s second-largest market research and consulting firm,In 2015, the global home healthcare market was valued at $227.5 billion, and is projected to reach $349.8 billion by 2020.(Regarding market data on overseas home-visit nursing services, VCBeat has previously published a detailed report; see “Report on the Home-Visit Nursing Industry: Global Market Value to Reach $349.8 Billion, While the Chinese Market Remains Untapped》）
Compared with foreign countries, China has a smaller base of nurses and heavier workloads. Many nurses at their primary practice institutions are in a state of "continuous rotation," often working one night shift after another, especially those in Grade 3A hospitals. Therefore, although Beijing took the lead in issuing policies allowing nurses to practice at multiple locations, China’s home-visit medical and nursing care market still has a long way to go compared to the well-established home-care nurse industry abroad.
When interpreting the notice, the Beijing Municipal Health and Family Planning Commission outlined five key significances of implementing multi-site practice for nurses:
First, promote the mobility of healthcare professionals and accelerate the decentralization of high-quality nursing resources to rapidly enhance the capacity of primary care nursing services in both quantity and quality, increase the supply of primary care nursing services, and meet the public’s health needs;
Second, it drives the strengthening of grassroots institutions’ foundational networks and capacity building, promotes the coordinated development of primary care nursing and medical services, and ensures the effective implementation of the tiered diagnosis and treatment system;
Third, it addresses the current shortcomings of community-based home nursing services, further refines the home care service model, and encourages private capital to enter the underserved nursing care sector, thereby serving as an effective supplement to the existing healthcare delivery system;
Fourth, further expand the scope of nursing services by extending them from institutions to communities and households, thereby promoting the standardized, specialized, and systematic development of nursing care.
5. Further streamline administration, delegate powers, optimize services, and strengthen oversight by implementing a filing system.
Currently, the registration of nurses in Beijing’s open areas has not yet been formally implemented. After August 1, it remains to be further explored how the industry will respond and how many nurses will embrace the policy by engaging in multi-site practice.
VCBeat will continue to monitor the implementation of these policies and provide further coverage. Stay tuned.
Appendix: Original Text of the Notice
Notice of the Beijing Municipal Health and Family Planning Commission on the Implementation of Regional Registration for Nurses
Jing Wei Yi [2017] No. 127
Municipal Administration of Traditional Chinese Medicine, Municipal Hospital Authority, District Health and Family Planning Commissions, and all types and levels of medical and health institutions:
In accordance with the overall deployment of deepening the reform of the medical and healthcare system and the “decentralization, regulation, and service” initiatives, and pursuant to the approval granted by the National Health and Family Planning Commission for the pilot program of regional nurse registration in the Beijing area, and in light of the actual conditions of medical and healthcare services in this municipality, our Commission has decided to implement regional nurse registration within the administrative jurisdiction of this municipality. The relevant matters are hereby notified as follows:
I. Guiding Principles
In accordance with the overall arrangements for deepening the reform of the medical and healthcare system and advancing the “decentralization, regulation, and service” initiatives, and guided by the spirit of documents such as the Regulations on Nurses and the Notice of the General Office of the Beijing Municipal People’s Government on Forwarding the Implementation Opinions on Promoting the Integration of Medical and Health Services with Elderly Care Services issued by the Municipal Health and Family Planning Commission and other departments (Jing Zheng Ban Fa [2016] No. 54), this policy implements regional registration for nurses to further streamline administration and delegate authority, optimize services, guide the rational flow of talent, leverage high-quality nursing resources, strengthen grassroots nursing service capacity, increase the supply of nursing services, expand the scope of nursing services, and promote the standardized, specialized, and socialized development of the nursing workforce, thereby better meeting the diverse and multi-level health service needs of the public.
II. Job Responsibilities
(1) Implement Regional Nurse Registration
The term “regional registration for nurses” as used in this Notice refers to the adjustment of a nurse’s practice registration location from a single medical and health institution where they practice to the administrative area of Beijing Municipality. That is, once a nurse is registered to practice at any medical and health institution within the municipality’s administrative area, the practice registration shall be valid throughout the entire city, and the nurse may simultaneously practice at multiple medical and health institutions within the municipality’s administrative area.
After the implementation of this Notice, for nurses who complete their practice registration in this city, the “Practice Location” field in their Nurse Practice Certificate shall be registered as “Beijing Municipality.” Nurses who change their practicing institutions within the administrative area of this city are not required to submit an application for change of registration.
(2) Implement Filing for Practicing Medical Institutions
Nurses practicing in medical and health institutions within this city shall designate one medical institution as their primary practice site and file a record of all practice sites with the health and family planning administrative department. If a nurse has only one practice site, it shall be deemed their primary practice site. For nurses who were registered to practice before August 1, 2017, and whose registration remains valid, their place of practice shall be deemed to be Beijing, and their currently registered institution shall be deemed their primary practice site.
Nurses are not required to file for registration when undertaking tasks such as health support, consultations, advanced training, academic exchanges, and government-assigned duties approved by their primary practice institution; participating in free clinics approved by the health and family planning administrative departments; or practicing within institutions that have signed assistance or trusteeship agreements.
III. Work Process
(1) Nurses applying for practice registration in this municipality, including initial registration, renewal of registration, re-registration, cancellation of registration, and change of registration into the province, shall follow the procedures stipulated in the "Measures for the Administration of Nurse Practice Registration in Beijing" (Jing Wei Yi Zi [2013] No. 140). The place of practice registered on the "Nurse Practice Certificate" shall be "Beijing," with the name of the primary practice institution specified.
(2) After legally registering to practice in this city, if a nurse intends to change their primary practice institution or add other practice institutions within the city during the validity period of their practice registration, they shall file a record with the district-level health and family planning administrative department where the practice institution is located; if they intend to cancel other practice institutions, they shall apply to the original health and family planning administrative department where the record was filed to cancel the record.
The submitted materials are as follows:
1. One original and one photocopy of the applicant’s ID card (the original will be returned after on-site verification);
2. “Beijing Nurse Practice Institution Information Registration Form” (see the attached sample form);
3. Original copy of the "Nurse Practicing Certificate" (for those intending to change their primary practicing institution).
Upon receipt of the filing materials, the district-level health and family planning administrative department shall process the filing immediately and provide the applicant with a receipt acknowledging the acceptance of the filing materials. In the event of a change in the primary practice institution, the updated information on the primary practice institution must be printed in the registration change column of the Nurse Practice Certificate.
Health and family planning administrative departments at all levels and medical and health institutions may query the practice registration and filing information of nurses within their respective jurisdictions or institutions through the Nurse Registration Information System.
IV. Other Matters
(1) The municipal health and family planning administrative department is responsible for the regional registration management of nurses in this city, while the district-level health and family planning administrative departments are responsible for the filing and supervisory management of nurses’ practice information in their respective districts.
(2) Nurses practicing across multiple institutions shall adhere to the fundamental principles of ensuring medical quality and safety, enhancing service capabilities, increasing the supply of nursing services, and promoting the development of the nursing profession. Nurses from secondary and tertiary hospitals are encouraged to practice in primary healthcare institutions, integrated medical and elderly care facilities, and privately run medical institutions, so as to provide scarce nursing services such as transitional care, long-term care, and home-based care for discharged patients, patients with chronic diseases, and the elderly, thereby facilitating tiered diagnosis and treatment, integration of medical and elderly care, and the development of privately run medical institutions.
(3) All medical and healthcare institutions shall improve nurse position management and the employment system for full-time and part-time nurses, standardize nursing practice behaviors, and ensure the quality and safety of nursing care. The primary practicing institution shall support nurses in practicing at multiple institutions. Each practicing institution shall fully safeguard the legitimate rights and interests of nurses, and clearly define with nurses their job responsibilities, work schedules, work tasks, compensation and benefits, and relevant insurance coverage, in accordance with applicable laws and regulations and the employment (labor) contract or other written agreements.
Nurses practicing across multiple institutions shall reasonably allocate their working hours at each institution in accordance with the agreements signed with the respective institutions, strictly conduct nursing activities in compliance with technical standards for diagnosis and treatment, and ensure the quality and quantity of work tasks are completed.
(4) Nurses practicing at multiple institutions shall be subject to the supervision and administration of each practicing institution and the local health and family planning administrative department. In the event of nursing adverse events or disputes involving a nurse practicing at multiple institutions, the medical and health institution where the adverse event or dispute occurred shall handle the matter in accordance with relevant regulations; in the event of illegal acts, the district-level health and family planning administrative department where the illegal act occurred shall impose penalties in accordance with the law; if the nurse is legally sanctioned with a suspension of practice activities, their practice activities at all medical and health institutions shall be suspended during the period of suspension.
The district health and family planning administrative department shall enter the nurse penalty information into the Nurse Registration Information System within five working days after making the penalty decision.
If a medical or health institution allows nurses who have not completed registration filing as required by this Notice to engage in nursing practice at the institution, it shall be handled in accordance with the relevant provisions of the Interim Measures for the Point-Based Management of Adverse Practice Behaviors by Medical Institutions in Beijing. Nurses who fail to complete registration filing as required by this Notice and carry out professional activities at institutions where they are not registered shall have such adverse practice records entered into the Nurse Registration Information System.
(5) Nurses practicing at multiple institutions shall comply with the deployment by their primary practice institution for public health emergencies and medical rescue operations, and other practice institutions shall provide support.
(6) When nurses practice at institutions other than their primary practicing institution, they shall not be counted as “personnel” for the purposes of verification and accreditation standards of those other institutions.
(7) Upon expiration of the registration information with the nurse’s primary practice institution, the original filing information with other practice institutions shall automatically become invalid.
(VIII) This Notice shall come into effect as of August 1, 2017. In the event of any inconsistency between prior provisions and this Notice, this Notice shall prevail.
Attachment: Beijing Nurse Practice Institution Information Registration Form (Sample)
Beijing Municipal Health and Family Planning Commission
July 7, 2017