Coping with New and Complex Caring Demands: Health Workforce Policies and Practices in Norwegian Care Services

Like in many countries, also the resource - rich, Norwegian health care services face challenges regarding both the supply and distribution of competent staff. Recent health care reforms aimed at redistributing tasks between state and local government have increased local demands for skilled health workers to cope with more complex tasks. The use of skill mix strategies in primary health care has so far been limited. A range of other strategies are, however, suggested by central and local government and tried out in services to meet the demands of higher skills and more integrated services.

This paper explores the recent national policies regarding reinforcing professional competencies in primary health care for the elderly, as well as the local policies of seven Norwegian municipalities of different size and geographical location. The analysis is based on a study of national and local health workforce policies and plans, as well as interviews with managers at different levels in the local care services.

How are the main challenges defined on different levels and in various local settings, and what kind of competence and professionalism are asked for? What are the central measures for coping with the changing demands?

New roles for nurses and new divisions of labor between nurses and other health care staff are key elements of the new health workforce strategies. Our analysis suggests that policies and recruitment practices on the one hand asks for broader competencies and interprofessional skills, in order to strengthen the integration of services for patients with increasingly complex needs. On the other hand, there is a strong tendency for the larger municipalities in our study to aim at recruiting specialized health care professionals, in particular nurses with special education, in order to cope with the new responsibilities for complex health care tasks in primary health services.