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NIS Nursing: A Revolution in Progress

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Up until a few years ago, limited training and restrictive job responsibilities forced nurses at the Emergency Scientific Medical Center in Yerevan, Armenia to the margins of patient care. They, like many of their NIS counterparts, regularly performed dietary and housekeeping tasks, while patients needing acute care were left to the sole supervision of physicians. But the introduction of a 100-hour basic emergency medical services (EMS) curriculum for physicians and nurses, combined with a 400-hour advanced nursing course, changed all that by giving nurses a chance to improve their clinical skills and polish their professional image at the same time. With the help of partners at Boston University Medical Center in the US, emergency care has become a team effort in Yerevan, involving physician, nurse, feldsher and ambulance driver. Nurses now read electrocardiograms, administer cardiopulmonary resuscitation and perform preliminary physical assessments, and are taking on greater responsibility for admissions, diagnostics and treatment?functions previously performed only by physicians. The hospital?s investment in high-quality training has yielded not only improved skill and stature in its nurses, but has produced more timely diagnosis and treatment of patients as well.

Yerevan's story is not unusual; in fact, examples of nursing achievement can be found in every one of AIHA's NIS and CEE hospital partnerships. Nurses across the former Soviet Union are taking the reins to drive change in their institutions in nursing leadership, education reform and clinical practice. In the process, they have created a Nursing Task Force to give a coherent voice to nursing leaders in the partnerships, organized three annual international nursing conferences, spurred the creation of nursing associations in many NIS nations, held transatlantic nursing teleconferences to share information and provide clinical instruction, and, this year, are opening nursing learning resource centers to support nursing curricula. These accomplishments and many others lie at the heart of nursing's recent ascension in the NIS health care sector.

Creating Nurse Leaders

Empowering nurses to be teachers, leaders and mentors is a primary goal of AIHA's NIS nursing task force. While nurses have steadily taken on more responsibility in individual partnerships, the task force has served as a vehicle for communication and professional support for all NIS nurses. In addition to organizing three annual international nursing conferences, members have produced a leadership skills workbook, which has been distributed to all partnerships to provide basic guidelines on nursing education, professional organizations, budgets and hospital operations, mentoring and leadership skills. And task force members have emerged as leaders in their field; two former chief hospital nurses, for example, now hold positions in the Georgian and Kazak Ministries of Health.

The advent of nursing associations has been perhaps the most visible indicator of how NIS nurses are rising to lead their profession. In Moldova, a 15,000-member association regularly pursues better diagnostic skills training and curriculum reform, while an 800-member local nurses association in Semipalatinsk, Kazakstan sponsors regional conferences to promote the professional role of nurses. A senior nurse at Erebuni Hospital in Yerevan, Armenia serves as the president of the Armenian Nursing Association, and works with colleagues nationwide to develop advanced clinical skills in women's health. And the Georgian Nurses Association offers monthly training-of-trainers courses in nursing leadership, addressing topics like Leadership Theory and Style and Budget Control, Patient Discharge and Quality Improvement.

Similarly, the Society of Educators of Nurses, a multidisciplinary group founded at last year's AIHA nursing conference in Almaty, Kazakstan, is working to advance nursing throughout the NIS. The group hopes to gain health ministry approval of standards for nursing education, develop pan-NIS standards for nursing practice, develop the accreditation and certification process for nurses, and improve education programs for nurse-managers and educators.

Senior nurse leaders have created in-hospital nursing committees as well; one such committee at the Radiation Medical Institute in Minsk, Belarus is responsible for ensuring that nurses meet the hospital?s nursing qualification standards every five years.

Nurses in leadership positions have been able to change the image of nursing in the NIS to portray a more powerful, independent role. And as physicians and patients have come to show greater respect for the nurse's position, nurses have begun to respect themselves and their profession more. This year's international nursing conference in Kiev, Ukraine provides a window on this new-found self-confidence. Thirty-three NIS nurses submitted abstracts for presentation at the conference, reflecting the wide range of responsibilities that nurses have earned for themselves: Transformation of the Role of the Bedside Nurse, Patient Care Standards in Nursing Practice, and Impact of an Infection Control Initiative on Patient Outcomes are just a few examples.

Reforming Nursing Education

In a concerted effort to upgrade nursing education, nurse leaders also are developing core nursing curricula, creating clinical nurse educator positions and promoting clinical skill-building.

The transition to a four-year, management-focused baccalaureate nursing degree from the previously standard two-year degree is one advance that has transformed nursing education in the NIS. At Almaty Medical College in Almaty, Kazakstan, a new four-year curriculum, the first of its kind in Central Asia, has received the support of the Ministry of Health. Twelve other Kazak nursing schools have adopted the program. Of the first 49 four-year graduates, 19 are currently employed in management positions in Almaty; two are chief nurses, five are head nurses and 12 are school nurse organizers and infection control nurses.

At the graduate level, Moscow's Sechenov Nursing School has led NIS nations in offering the region's first master's degree program in nursing, and the school's graduates have reaped similar benefits, they are consistently employed by leading hospitals and research organizations in Moscow.

Partner hospitals have also focused on continuing education for nurses. The Postgraduate Nursing School at the Medical Center of St. Petersburg in the Name of Sokolov offers more than 40 continuing education courses, ranging from two weeks to six months. Nurses must pass examinations every five years to retain their certification, and must take a minimum number of courses to be promoted to advanced nursing positions. The program is recognized as one of the best in the NIS; the Russian Ministry of Health now awards certificates to nurses who have completed Sokolov's advanced course work, and AIHA's two Georgian partner hospitals are developing their own continuing education program based on the Sokolov model.

With the opening of twelve Nursing Learning Resource Centers in NIS partner hospitals in 1996 and 1997, hospital faculty and nursing schools will have additional resources to draw on to support these groundbreaking educational initiatives. The centers will provide an array of textbooks, videotapes and models for nursing students and educators, and will serve as a meeting space for local nursing associations.

Improving Clinical Skills

As nurses create change in their hospitals and new formats for nursing education take hold, nurses' clinical skills are improving accordingly.

The introduction of the clinical nurse educator role, in particular, has paved the way for better peer and patient instruction. For example, nurses at the Institute of Oncology and Radiology and the Institute of Obstetrics and Pediatrics in Bishkek, Kyrgyzstan have worked with their partners at the University of Kansas Medical Center to establish clinical skills laboratories emphasizing techniques such as cardiopulmonary resuscitation and breast examination. Their colleagues at Semipalatinsk Oblast Hospital in Semipalatinsk, Kazakstan have focused on patient education, creating a learning resource center to disseminate information on good nutrition and the dangers of alcohol and tobacco use.

Similar advances can be found across Central Asia. Senior nurses with advanced training in obstetrics and gynecology created the region's first ambulatory care women's clinic at the Second Tashkent Medical Institute in Uzbekistan. And nurse managers at the Medical Consultative Center in the Name of Niyazov in Ashgabat, Turkmenistan helped to create a model renal dialysis center.

Because NIS physicians have lent critical support to the development of nursing skills, a new team approach to clinical care has become accepted practice in many partner hospitals. Central Clinical Hospital in Moscow has hosted several clinical practice conferences, in cardiology and orthopedics, specifically for nurse-physician teams, while 40 physicians and nurses at Emergency Scientific Medical Center in Yerevan recently participated in an infection control case study teleconference with Boston University Medical Center.

NIS and US nurses are continuing to hone their skills through a series of regional nursing teleconferences sponsored by AIHA. The teleconferences have already addressed issues such as communication and teamwork in a hospital setting, and neonatal and emergency care; future link-ups will feature discussions on transfusion therapy, fluid and electrolyte balance, food handling and infection control.
 
The fusion of clinical skill-building, nursing leader development and education reform has proved a powerful force in sparking a revolution in NIS nursing over the last five years. The legacy of the systemic changes that NIS nurses have effected is expected to endure far beyond the partnerships' lifespan. "Our new nursing leaders take pride in their accomplishments within their institutions and beyond," says Sharon Weinstein, RN, CRNI, MS, AIHA nursing liaison. Curriculum reforms have been widely accepted throughout the NIS, and we consistently see a trend toward developing nurses as faculty in nursing education programs. Improvements in clinical skills have had a positive effect on patient outcomes, reducing morbidity and mortality, but the most significant change has occurred in the image of the NIS nurse. Today's nurse is confident, educated and articulate, the abstracts in this publication attest to that.

 



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