A reserve army of nurses to help the Netherlands through the next healthcare crisis
It had been thirty years since Kees de Ruijter (65) had worked in a hospital ward. But after an hour of working in the cardiology department of the Albert Schweitzer hospital in Dordrecht, he had it under control again. “The equipment may be a little different, but cardiology patients who are scared or in pain have not changed. And I could also put someone on a pot.”
In daily life Kees de Ruijter is something completely different: he is an alderman (ChristenUnie) in the municipality of Papendrecht. Before that, he worked in healthcare for many years. First as a nurse, later on the ambulance and later in management and policy positions. During the corona pandemic, De Ruijter felt ‘morally obliged’ to assist in his old field. This was not possible at the hospital and the GGD for all sorts of reasons. He was able to get started right away at the National Care Reserve. “I strongly believe in the phenomenon of a reserve. I am also a reservist in the army medical unit – there I saw how it works. I think it would be a good thing to set up something like this for healthcare as well.”
In the meantime, De Ruijter has worked seven shifts at the Albert Schweitzer since May. He loves it. “It’s a bit different from the political world. Here I meet young people with fresh ideas, I am at the heart of society. It feels good to be able to contribute on a modest scale to solving the shortages in healthcare.”
The National Care Reserve is the ‘2.0 version’ of the Extra Hands for Care initiative, which arose in March 2020 in the first phase of the corona crisis. A lot of former healthcare professionals wanted to help, but the hospitals couldn’t organize it themselves in all the hectic – the Extra Hands platform had to form the link. In practice, this turned out not to be very effective: in the second and third wave, only 2,825 healthcare professionals were placed out of the 10,500 registrations.
With the lessons learned then, the Extra ZorgSamen foundation has now set up a more sustainable variant: the National Care Reserve. Again, it concerns a database of former healthcare professionals who can be deployed in times of crisis, but now not only intended for corona. In the future, this may also involve deployment in a department whose staff is struggling with noro – a stomach flu virus – or has to deal with a severe flu wave, as in 2018.
Since last February, 450 people have registered for the Care Reserve and the first testing grounds are in operation: one in a care home and three at hospitals, including the Albert Schweitzer Hospital in Dordrecht. The Ministry of Health, Welfare and Sport is financing the development of the concept of the National Care Reserve; The care organizations pay for the deployment of the care reservists.
What makes this the improved version of Extra Hands? “We no longer think in terms of functions, but in terms of activities,” says Patrick Schrooten, who coordinates the testing grounds from the National Care Reserve. “In the Extra Hands time, healthcare institutions drew up job descriptions: they were looking for someone who could do this and this, and who was available at least three days a week. But someone who hasn’t worked in healthcare for ten years and now has another job can never meet all those job requirements. That’s one of the reasons there were very few matches.”
Now care organizations let them know which activities they need people for: for example helping with washing and dressing for part of the day. They share this task in the Zorgreserve community with reservists from the region, who can then register. Kees de Ruijter, for example, ticks two or three shifts a month, and it is easy to combine with his full-time job. The minimum number of days to work as a reservist has provisionally been set at three per year.
This new system works well for the Albert Schweitzer Hospital, says deputy head of department Mariëtte Grootenboer, also chair of the Nursing Advisory Council. “It is very easy to tick the activities. It doesn’t take much extra time.”
Not with every change
It is a bit more difficult for the HR departments, Schrooten hears. “They have to register the reservists as new employees. That takes time, while the administration should not be a barrier – you don’t have time for that at all in a crisis. We are investigating how we can improve that.”
The National Care Reserve defines a crisis as ‘an unplannable situation that has an impact on regular care provision’. In care jargon, this is about phase 4. In phase 1, the permanent staff works in the regular roster, in phase 2 they work overtime to fill the gaps, in phase 3 extra troops come from an employment agency and in phase 4 the reservists deployed. “Not every time, therefore,” explains Schrooten.
A disadvantage of working with care reservists is that the pool is large and varied, and that the people in it are limited in their employability. Suppose a department asks for one reservist per day, then it is quite possible that someone else will come every time. Grootenboer: „You can be lucky or unlucky with that. If you have a good reservist, it can be a nice relief. But guiding someone who picks it up less easily can actually add extra pressure.”
Jasper Heeren (25) is a nurse in the cardiology department and at the beginning of May had a number of reservists as temporary colleagues. Working with them is like supervising a student nurse, although it is quite different, says Heeren. “The reservists have more experience: in the profession, but also as people. They deal with patients more easily. I can learn a lot from that too.”
The reservists with whom Jasper Heeren worked were very diverse. “Really a bit of everything. So an alderman, but also someone who normally works in IT. And even though some reservists hadn’t done the care activities for a while, they quickly picked up the basics again. Just like with Kees: I gave him a blood pressure pole and he started using it in no time.”
Heeren did not see it as an obstacle to his work. “I did enjoy it. You have a better click with one than with the other, but that is also the case with ordinary colleagues.”
This summer, the reservists were a great help to Albert Schweitzer, says Grootenboer. “We are still dealing with higher absenteeism due to Covid. It was therefore nice for the staff that we could still keep to the regular holiday schedules. It was also nice that we had to close fewer beds.”
Kees de Ruijter will soon be planning two day shifts: he will return to work on Sunday and Monday. When will he come home more tired: after a day as an alderman, or a day in the hospital? “Oh, that’s so different. After a day in the hospital, I plop down on the couch in the evening and do nothing. But a four-hour debate about the framework memorandum for the spring is also very tiring, you know.”