Identiteitscrisis wijkverpleegkundige

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Door Sander Duindam (partner PlatformVmZ)

‘Wie ben ik?’ Zowel een oud bordspel als een tv-programma waar je moet raden welke persoon je bent. In de wijkverpleging is dit spel in een aangepaste vorm vanaf 2015 op de (zorg)markt gebracht onder de naam: Wat is een wijkverpleegkundige?

Een aantal antwoorden op bovenstaande vraag zijn mogelijk in dit spel: wijkverpleegkundige, indicerend wijkverpleegkundige of indicatiesteller. Het ‘spel-format’ heeft ook wat weg van de kijkcijfer-hit eind 70’s: ‘Wie van de Drie!’

Interessant anno 2019 is wie er op zal staan op de vraag: ‘Kan de echte wijkverpleegkundige nu opstaan?’

Spreken we van ‘huisbezoekende huisartsen’, ‘analyserende onderzoekers’ en ‘intake-afnemende neurologen’? Doorgaans niet omdat het duidelijk is dat deze taken tot de volledige rol van het beroep horen. Waarom is het dan wel zo belangrijk om expliciet één taak (indicatiestellen) van de hele rol te benoemen bij een wijkverpleegkundige?

Sinds 2015 is de rol van de wijkverpleegkundige benoemd in het Normenkader van de V&VN. HBO-V’ers zijn voorbehouden om de rol van wijkverpleegkundige uit te voeren. Dit houdt in: indiceren, monitoren, evalueren en organiseren van zorg. De wijkverpleegkundige moet weer actief zijn in de wijk zodat wijkgericht rondom de burger, zorg en/of ondersteuning georganiseerd kan worden. Met het oog op de toenemende vergrijzing is een belangrijk aandachtspunt preventie. 

De toegang tot wijkverpleegkundige zorg (zorgverzekeringswet) gaat via een wijkverpleegkundige (HBO-V’er). Tot 2015 was dit een taak van het Centrum Indicatiestelling Zorg (CIZ), zij doen dit vanaf 2015 alleen nog voor de zorg in de Wet Langdurige Zorg (Wlz). 

Voor zorginstellingen en zorgverleners die wijkverpleegkundige zorg leveren, is het essentieel voor het declareren van zorg dat er een indicatie gesteld is door een wijkverpleegkundige. Hierdoor is de druk op wijkverpleegkundige om indicaties te stellen erg groot. Daardoor is het logisch dat wijkverpleegkundigen in een identiteitscrisis terecht kunnen komen, zij worden vaak primair gevraagd om een indicatie te stellen en niet voor hun complete rol als wijkverpleegkundige. 

In alle visiedocumenten en beleidsstukken die de afgelopen jaren zijn verschenen over inrichting van de eerstelijnszorg, staat telkens weer hoe belangrijk de rol van een wijkverpleegkundige is als spin in het web. Let wel, het gaat hier dus nogmaals om het vak in de volle breedte en niet een
beperkte invulling van alleen het stellen van indicaties. Het is dan ook belangrijk om consistent te zijn in de communicatie. We kennen dus niet ‘indicerend wijkverpleegkundige’ of ‘indicatiestellers’ in de wijkverpleging, alleen maar wijkverpleegkundigen! 

Door in de uitingen ‘indicerend’ te koppelen aan wijkverpleegkundige impliceert dit dat de rest van de rol niet wordt (hoeft niet te worden) ingevuld. Dit vertraagt de ontwikkeling van de identiteit van de wijkverpleegkundige, met gevolg dat de rol in de wijk zoals bedoeld niet of te langzaam wordt ingevuld. De focus op preventie wordt hierdoor ook niet versneld, waardoor er steeds meer (professionele) zorg geleverd moet worden o.b.v. de gestelde indicaties. Met het oog op de vergrijzing is het geld en het aantal zorgverleners niet toereikend om consumptie van zorg in deze omvang te blijven leveren.

Het is dus belangrijk dat de identiteit van de wijkverpleegkundige heel helder is. Om dit te bereiken is het essentieel dat vanuit de beleidsmakers en uitvoerende instanties dezelfde terminologie en beschrijving wordt gebruikt voor een wijkverpleegkundige. 

Indien de identiteit van de wijkverpleegkundige niet eenduidig en helder is, zullen bij de vraag die ook aan het einde wordt gesteld in het programma ‘Wie van de Drie’, ‘Wil de echte wijkverpleegkundige opstaan?’, alle HBO-V’ers opstaan i.p.v. de wijkverpleegkundige 

die in de wijk de volledig rol invult (indiceren, monitoren, evalueren en organiseren van zorg).

We verwachten dat de identiteitscrisis van de wijkverpleegkundige niet lang meer zal duren. De populaire spellen van vroeger worden geïnnoveerd naar moderne formats door technologische ontwikkelingen. Een parallel die wij ook zien in de ontwikkeling van de wijkverpleegkundige vanaf eind jaren zeventig naar het heden.

PlatformVmZ biedt een compleet digitale werkomgeving voor wijkverpleegkundigen, zodat zij onafhankelijk hun volledige rol kunnen uitvoeren, (digitaal) ondersteund worden in hun dagelijkse werkzaamheden en informatie met elkaar kunnen delen. Wijkverpleegkundige die zich alleen richten op het stellen van indicaties (m.u.v. PGB indicaties), kunnen zich niet aansluiten bij PlatformVmZ.

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