Opportunities and challenges of opening an independent nursing practice in Serbia - between law, market and professional initiative

  • Nemanja Aritonovic Clinical Hospital Center "Zvezdara", Belgrade, Serbia
  • Ljiljana Jovcic Academy of Applied Studies Belgrade, The College of Health Sciences, Serbia
  • Goran R Stojanovic Visoka zdravstvena skola strukovnih studija u Beogradu
  • negra Terzic Academy of Applied Studies Belgrade, The College of Health Sciences, Serbia
Keywords: independent nursing practice, nurses, legal regulation, professional challenges, healthcare

Abstract


Introduction: In an era marked by increasing challenges in healthcare systems worldwide including aging population, chronic diseases, and a shortage of healthcare professionals, the need to transform the role of nurses has never been greater. A healthcare system in which the nurse is not merely an executor but a holder of independent practice, autonomous, competent, educated, and accountable with their own clinic, patients, and decision-making zone, is a reality in many developed countries. In Serbia, however, this vision is only beginning to emerge, surrounded by legal ambiguities, institutional resistance, and market barriers.

Aim: The aim of this paper is to explore the opportunities and challenges of establishing independent nursing practice in Serbia through the analysis of nurses’ attitudes and perceptions.

Materials and Methods: A descriptive and observational indirect method was used in a survey.
Results: The results indicate that nurses in Serbia recognize numerous obstacles in starting
independent practice, with the main challenges being the unfavorable legal framework, lack of institutional support, and financial barriers . At the same time, the majority of respondents express a high level of motivation and interest in this type of work, particularly in rural areas. There is a clear need for additional education and mentorship programs. When compared to European and global practices, Serbia shows a significant normative lag. Furthermore, a higher level of education positively correlates with greater readiness to initiate independent nursing practice.

Discussion: The research showed that, although there is significant interest and willingness among nurses in Serbia to engage in independent nursing practice, numerous barriers still limit this opportunity in reality. The key barriers identified include an inadequate legal framework, lack of institutional support, low public and professional awareness, as well as the need for further education and financial support.

 

Author Biography

Goran R Stojanovic, Visoka zdravstvena skola strukovnih studija u Beogradu
predavac

References

Jovanović S. Regulatorni izazovi u zdravstvu Srbije. Beograd: Institut za političke studije; 2020.

Hansson A, Carlsson G, Nilsson M. Nursing practices in Sweden and the need for reform in the EU health systems. Nurs Policy. 2018;26(3):102–8. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545729/

Zakon o zdravstvenoj zaštiti. Službeni glasnik RS. 2019;(25).

Zakon o sestrinstvu. Službeni glasnik RS. 2019;(77).

Ministarstvo zdravlja Republike Srbije. Pravilnik o uslovima i načinu osnivanja i rada zdravstvenih ustanova. Službeni glasnik RS. 2010;(72).

Tomić N. Tržište privatnih zdravstvenih usluga u Srbiji. Zdravstvena politika. 2020;15(2):112–9.

Ivanović M. Razvoj privatnih sestrinskih praksi u Srbiji. J Med Econ. 2021;32(4):84–90. Available from: https://www.uzps.rs/wp-content/uploads/2021/12/Zbornik-apstrakata-i-radovaUZPS-2021.pdf

Petrović V. Preporuke za unaprđenje sestrinske profesije u ruralnim područjima. Zdravlje i društvo. 2022;9(1):75–83. Available from: (uzps.rs in Bing)

Jovanović T. Neregulisana konkurencija na tržištu zdravstvenih usluga. Pravni život. 2019;19(5):44–50.

Lee K, Singh S, Jones M. Nurses’ roles in primary care and the market for independent nursing practices in the U.S. J Nurs Manag. 2020;28(2):120–9. doi:10.1111/jonm.12931

Gajić M. Etika i profesionalni izazovi u sestrinskoj praksi. Nurs Ethics. 2021;28(3):200–10. doi:10.1177/0969733020955802

Stefanović N. Stručna edukacija i profesionalni razvoj sestara. Nurs Educ Today. 2022;45:105111. doi:10.1016/j.nedt.2021.105111

Smith J, Clark D, Paterson G. Professional development and support for nurses in independent practice: Insights from the UK. J Nurs Manag. 2021;29(6):1124–32. doi:10.1111/jonm.13342

Blok J, Kimble M. Buurtzorg: Revolutionising home care in the Netherlands. Centre for Public Impact. 2016. Available from: (centreforpublicimpact.org in Bing)

Gray B, Sarnak DO, Burgers J. Home care by self-governing nursing teams: The Netherlands’ Buurtzorg model. The Commonwealth Fund. 2015 May 21. Available from: (commonwealthfund.org in Bing)

Monsen KA, de Blok J. Buurtzorg Nederland: A global model of social innovation, care integration, and nurse-led community care. Int J Integr Care. 2014;14:e034. doi:10.5334/ijic.1804

Laurant MGH, Hermens RPMG, Braspenning JCC, Sibbald B, Grol RPTM. Impact of nurse practitioners on workload of general practitioners: randomised controlled trial. BMJ. 2004;328(7445):927. doi:10.1136/bmj.38041.493519.EE

Weiland SA. Reflections on nurse practitioner autonomy. J Am Assoc Nurse Pract. 2020;32(2):113–9. doi:10.1097/JXX.0000000000000312

Jakimowicz S, Williams D, Stankiewicz G. A systematic review of experiences of advanced practice nursing in general practice. BMC Nurs. 2017;16:6. doi:10.1186/s12912-017-0219-2

Paunović I, Apostolopoulos S, Miljković IB, Stojanović M. Sustainable Rural Healthcare Entrepreneurship: A Case Study of Serbia. Sustainability. 2024; 16(3):1143. https://doi.org/10.3390/su16031143

American Association of Nurse Practitioners (AANP). State practice environment. Available from: https://www.aanp.org/advocacy/state/state-practice-environment

Drennan VM, Rechel B. Nurse retention and recruitment: developing a motivated workforce. WHO Health Evidence Network Synthesis Report 43. Copenhagen: WHO Regional Office for Europe; 2018. doi:10.1787/6e2ee313-en

Kroezen M, Francke AL, Groenewegen PP, van Dijk L, Ruwaard D, Delnoij D, et al. Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review. BMC Health Serv Res. 2011;11:127. doi:10.1186/1472-6963-11-127

Lewis M, Hale C, Quinn H, Ryan S, Emery P, et al. The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial. Ann Rheum Dis. 2014;73(11):1975–82. doi:10.1136/annrheumdis-2013-203403

Suzuki Y, Tanaka M, Yamamoto S, Kido A, Nishida A. Barriers to the implementation of nurse practitioner roles in Japan: A cross-sectional study. Int Nurs Rev. 2024;71(1):23–30. doi:10.1111/inr.12945

Duncan SM, Sheppard C. Nurse practitioner regulation in the United States: A fragmented system. J Nurs Regul. 2023;14(2):5–12. doi:10.1016/S2155-8256(23)00040-1

Li H, Zhao X, Wang Y, Chen Z. Development of the nurse practitioner role in China: Challenges and opportunities. Int J Nurs Sci. 2024;11(1):14–22. doi:10.1016/j.ijnss.2023.10.004

Busca P, Gómez-González C, Romero-Collado A, Tomás-Sábado J. Perceptions of advanced nursing practice in Spain: A Delphi study. Int J Nurs Pract. 2023;29(2):e13170. doi:10.1111/ijn.13170

Smith T, Bucknall T, Moxham L, Brown J. Nurse practitioner models in rural Australia: Challenges and enablers. Aust J Rural Health. 2019;27(1):23–9. doi:10.1111/ajr.12456

Oshodi TO, Bruneau B, Crockett R, Kinchington F, Nayar S, West E. The role of autonomy and supportive leadership in nurse retention: A cross-sectional study of UK hospital nurses. Int J Nurs Stud. 2019;91:45–54. doi:10.1016/j.ijnurstu.2018.11.005

Published
2026/03/16
Section
Original Scientific Paper