1. Changes in the education system, i.e. training and retraining:

introduction of a new educational standard;

transition to multilevel nursing education;

· teaching new technologies from the standpoint of the new philosophy of S.D.

2. Changes in the labor sphere:

· increasing the prestige of the profession - the possibility of professional growth;

Motivation of nurses for independent scientific - research work;

Revision of responsibilities, pay scales, workloads, list of positions;

· Implementation of nursing standards.

3. Creation of a regulatory framework for nursing.

AT 1994 year the All-Russian public organization was created Association of Nurses of Russia. President - Sarkisova Valentina Antonovna. The Omsk association is represented by more than 10,000 representatives - one of the largest in the country. President - Zorina Tatyana Alexandrovna.

Association tasks:

· active participation in the state policy in health care;

Support for scientific research in nursing;

development and publication methodological literature;

management of the introduction of new nursing technologies;

implementation of legal protection of nurses;

defending the professional interests of nurses in the health care system;

Improving working conditions and increasing wages;

Expansion of the information space in nursing;

Revival of the traditions of sisterly mercy;

· the international cooperation.

The Russian Nurses Association has been a member of the European Forum of Nursing and Midwifery Associations and WHO for 10 years, and in 2005 was admitted to the International Council of Nurses. Since that moment, the Association has been actively involved both in the formation of global, world policy in the field of nursing, and in the implementation of strategic plans for healthcare policy in Russia.

1998 - The 1st All-Russian Congress of Nursing Workers took place in St. Petersburg, at which the draft State Program for the Development of Nursing in the Russian Federation was approved. Implemented multilevel training of nursing professionals - basic, advanced, higher nursing education (HSO).

The current state of nursing in Russian Federation

Nursing training is currently being carried out in 453 vocational schools. State educational standards new generation. The Doctrine of Secondary Medical and Pharmaceutical Education in the Russian Federation was approved, the Sectoral Development Program of S.D. is being successfully implemented. in RF. It is designed to increase the efficiency and strengthen the role of nursing staff in providing medical care to the population.

Every year the number of experimental sites for the introduction of new nursing technologies is growing: nursing process, perioperative process, etc. .

A network of wards, departments, hospitals for nursing care and palliative care is being developed.

The participation of nursing staff in new organizational forms of out-of-hospital care is expanding: day hospitals, centers for outpatient surgery and medical and social assistance, home care services, in "Schools of patients", etc.

The activity of nursing personnel in conducting health education of the population has increased.

Currently, more than 1,336.1 thousand specialists with secondary medical education work in the healthcare system. Nursing staffing is 69.7%. The doctor-middle medical staff ratio is 1:2.2, which limits the possibilities of aftercare, patronage, and rehabilitation. This is due to objective reasons: low wages, egalitarian approaches to wages, low level of social protection.

The experience of implementing the national project "Health" has shown that nursing staff (in particular, primary care) does not always meet the requirements of the time, and this applies not only to the quality of services provided, but also to the relationship between nurses and patients.

Health care as an industry in last years received powerful financial injections for the development of the material and technical base. This also affected nursing staff: a fund of small-scale mechanization was formed, which expands the possibilities of quality patient care. Regional development programs for S.D. The positions of chief specialists in SD were introduced in the governing bodies. Programs for interaction between medical educational and medical institutions have been developed.

The main problems noted in the Concept: 1. ... The ratio between the number of doctors and nurses in our country is much lower than in most developed countries of the world, which causes an imbalance in the system of medical care, limits the development of post-treatment, patronage, and rehabilitation services.

Educate patients and families Assess the needs of the individual and their family Identify problems that can be addressed through nursing interventions Involve the patient and their immediate environment in prevention and rehabilitation Implementation of nursing care with the inclusion of nursing interventions for prevention for rehabilitation for psychological support of an individual or family Functions of nursing staff (WHO Bureau of Nursing)

The main problems noted in the Concept: 2. Low wages for nursing staff. 3. Equalizing approaches to wages. 4. Low social protection of medical workers with secondary medical education. 5. Low prestige of the profession.

The main problems noted in the Concept: 6. Inconsistency of the Federal State Educational Standard of secondary vocational and higher nursing education with the modern needs of healthcare. 7. Low quality of teaching. 8. Lack of a system of continuing medical education

Low motivation of healthcare workers Low motivation of healthcare workers Insufficient level of remuneration The average salary in healthcare was 8870 rubles, The average salary of nurses was 4546 rubles 38% of healthcare workers have wages below the subsistence level The difference in funding at the level of subjects of the Russian Federation reaches 12 times, and at the level of municipalities - 50 The difference in financing at the level of subjects of the Russian Federation reaches 12 times, and at the level of municipalities

The most important problems in the field of healthcare management are low wages and equalizing approaches to remuneration of nursing staff, low social security and prestige of the profession, discrepancy between the Federal State Educational Standards of secondary medical education and modern health needs, lack of a system of continuing medical education, low awareness of paramedical workers about modern means and methods of patient care, methods of diagnosis, prevention and rehabilitation 12

The main priorities of the Program for the Development of Nursing in Russia until 2020 development of the state and public system development of the state and public system for managing nursing activities, managing nursing activities, creating legal, organizational and economic creation of legal, organizational and economic conditions for the development of nursing in Russia, conditions for development nursing in Russia, improving the quality and accessibility of nursing care, improving the quality and accessibility of nursing care, motivation of the population to preserve and strengthen the motivation of the population to preserve and promote health, the formation of a cult of a healthy lifestyle. health, the formation of a cult of a healthy lifestyle. Slide author I.MISKARYAN 13

The goal of the development of nursing is to improve the quality of nursing care through the rational use of the potential of nursing staff, which ensures an increase in the quality and life expectancy of the population, contributing to patient satisfaction with the quality of medical services, their availability and cost-effectiveness. fourteen

Tasks for the development of nursing Care Formation of conditions for improvement Formation of conditions for increasing the efficiency and strengthening the role of nursing personnel in providing medical care to the population by improving the regulatory legal and material and technical base of nursing activities, using modern and economically acceptable organizational forms and resource-saving technologies in the work of nursing personnel, ensuring the quality of medical care, its preventive orientation, increasing the satisfaction of the population with the medical services provided; fifteen

Tasks for the development of nursing; improvement of the management system; improvement of the management system of nursing activities by increasing the efficiency of the use of human and financial resources in health care, information support; improvement of the remuneration system; improvement of the remuneration system for nursing professionals, taking into account the specifics of their work, the level of education, as well as the results of work; 16

Tasks for the development of nursing: improvement of the system of professional improvement of the system of vocational training in accordance with the needs of the individual, with the needs of the labor market in each region, by forming a highly qualified nursing specialist capable of independent decision-making within his competence; ensuring the management of the scientific field; ensuring the management of the field of scientific activity in the field of nursing, coordinating and increasing the volume of activities to create a new generation of methodological literature for nursing professionals; 17

First stage: Preparation of regulatory and legal acts regulating the activities of specialists with different levels of nursing education in the field of healthcare and determining the differentiated workload on nursing personnel, taking into account the contingent of patients, the use of new nursing care technologies and the type of nursing care 18

First stage: completion of the development of professional standards and procedures for the provision of pre-hospital medical care by specialists with secondary medical education, informatization of the activities of nursing staff, introduction of an information system for personalized medical care accounting. 19

First stage: implementation of measures for the transition to a new system of organizing medical care, the formation of an integrative system of continuous training based on a unified personnel policy, the development and implementation of a program of technologies for the prevention, diagnosis and treatment of socially significant diseases by specialists with secondary medical education. twenty

First stage: Continued implementation of the national project "Health" in the following areas: the development of primary health and social care and the improvement of preventive measures, increasing the availability and quality of specialized, high-tech medical care, the formation of motivation for a healthy lifestyle among the population of the Russian Federation, reducing morbidity and mortality from socially significant diseases . 21

Second stage: raising the status of a specialist with a secondary medical education, creating a system social protection nursing personnel, the implementation of a phased transition to a self-regulating system of organization of medical care, the implementation of widespread computerization of workplaces, 22

Second stage: introduction of new technologies developed taking into account the priorities of the innovative development of healthcare in the region, standardization and informatization of the activities of personnel with secondary medical education, ensuring the continuity of the actions of medical services at each level at all stages of treatment to achieve the best result, 23

Second stage: giving priority to preventive work for all categories of personnel with secondary medical education in the primary health care system, development of patronage and rehabilitation medical care, including the creation of a network of institutions for rehabilitation, rehabilitation, medical care, unified equipping of health facilities with equipment in accordance with the standards and procedures for providing medical care. 24

1. Increasing satisfaction of the population with the quality of medical care, including nursing. 2. Preparation of legal acts regulating the differentiated workload for nursing staff, remuneration of nursing professionals depending on the level of education, quality and volume of work performed, as well as labor protection and prevention of occupational diseases of nursing professionals. 1. Increasing satisfaction of the population with the quality of medical care, including nursing. 2. Preparation of legal acts regulating the differentiated workload for nursing staff, remuneration of nursing professionals depending on the level of education, quality and volume of work performed, as well as labor protection and prevention of occupational diseases of nursing professionals. EXPECTED RESULTS AND PERFORMANCE EVALUATION

3. Increasing the prestige of the nursing profession. Consolidation of young specialists with secondary medical and pharmaceutical education in the healthcare system. 4. Formation of a management model for nursing services, which will improve the organization of the activities of nursing staff. 5. Improvement of the current nomenclature of specialties for workers with secondary medical and pharmaceutical education. 3. Increasing the prestige of the nursing profession. Consolidation of young specialists with secondary medical and pharmaceutical education in the healthcare system. 4. Formation of a management model for nursing services, which will improve the organization of the activities of nursing staff. 5. Improvement of the current nomenclature of specialties for workers with secondary medical and pharmaceutical education. EXPECTED RESULTS AND PERFORMANCE EVALUATION

6. Increasing the level of professional responsibility of nursing professionals and expanding the range of nursing services through the rational distribution of participants in the provision of medical care. 7. Create standards professional activity nursing staff with different levels of education, standards for nursing services, standard for equipping workplaces. 6. Increasing the level of professional responsibility of nursing professionals and expanding the range of nursing services through the rational distribution of participants in the provision of medical care. 7. Creation of standards for the professional activity of nursing personnel with different levels of education, standards for nursing services, a standard for equipping workplaces. EXPECTED RESULTS AND PERFORMANCE EVALUATION

8. Formation of the information infrastructure of the industry using systems and technologies, telecommunication networks. 9. Creation of conditions for the development of scientific research in the field of nursing, preventive and clinical medicine. 10. Development of international cooperation in the field of nursing. 8. Formation of the information infrastructure of the industry using systems and technologies, telecommunication networks. 9. Creation of conditions for the development of scientific research in the field of nursing, preventive and clinical medicine. 10. Development of international cooperation in the field of nursing. EXPECTED RESULTS AND PERFORMANCE EVALUATION

1. Changes in the education system, i.e. training and retraining:
   • introduction of a new educational standard;
   • transition to multilevel nursing education;
   • teaching new technologies from the standpoint of the new philosophy of S.D.
2. Changes in the labor sphere:
   • increasing the prestige of the profession - the possibility of professional growth;
   • motivation of nurses for independent research work;
   • revision of duties, pay scales, loads, list of positions;
   • implementation of nursing standards.
3. Creation of a regulatory framework for nursing.

In 1994, the All-Russian public organization "Association of Nurses of Russia". President - Sarkisova Valentina Antonovna. The Omsk association is represented by more than 10,000 representatives - one of the largest in the country. President - Zorina Tatyana Aleksandrovna.

Association tasks:

• active participation in the State health policy;
• support for scientific research in nursing;
• development and publication of methodological literature;
• managing the introduction of new nursing technologies;
• implementation of legal protection of nurses;
• defending the professional interests of nurses in the health care system;
• improving working conditions and raising wages;
• expanding the information space in nursing;
• the revival of the traditions of sisterly mercy;
• the international cooperation.

The Russian Nurses Association has been a member of the European Forum of Nursing and Midwifery Associations and WHO for 10 years, and in 2005 was admitted to the International Council of Nurses. Since that moment, the Association has been actively involved both in the formation of global, world policy in the field of nursing, and in the implementation of strategic plans for healthcare policy in Russia.

The main directions and events in the process of reforming nursing in the Russian Federation at the present stage.

Nursing is an integral part of the health care system, having human resources and capabilities to meet the needs of the population for affordable and affordable medical care. Of the existing definitions of nursing, the most famous is the definition:

“The unique vocation of the nurse is to assist the individual, sick or well, in all that contributes to health or its restoration (or the onset of a painless death) and which a person could manage without outside help if he were enough strong, motivated, or informed, and to do so in a way that will help him regain his independence as soon as possible.”

Nursing is an art and a science at the same time. It requires the possession of specific skills, knowledge and skills of their practical application, is based on the knowledge and methods of various humanitarian disciplines, as well as sciences that study physical, social, medical and biological laws.

The process of nursing reform is slow and difficult for a number of reasons:

Insufficient activity of the nurses themselves. Being on the sidelines in medicine, nurses often do not want to take the initiative.

Low level of quality of medical care for the population

Low prestige of the profession

Low social status of nurses

Lack of professional growth prospects

Inconsistency of the level of nursing education with the requirements of the time

Shortage of nursing teaching staff

Lack of scientific research in the field of nursing and ignorance of foreign experience.

The reform of nursing in Russian health care has unfolded in several directions:

Conducting scientific research in nursing;

Reforming nursing education;

Reformation practical activities;

Development of international cooperation;

Self-management and consolidation of the nursing profession.

Let us single out the main events in the reform of nursing in Russia.

Opening in 1979 the country's first advanced training school for workers with secondary medical and pharmaceutical education; holding in 1986-1988. seminars and conferences; The certification of paramedical workers, which began in 1987, can be considered the starting points for subsequent changes in nursing, and first of all, in the minds of both doctors and nurses.

In 1988 In Vienna, the I European Conference on Nursing was convened, the final documents of which noted the need for changes in the preparation, practice and management of nursing services.

As part of the practical recommendations adopted in Vienna for 1988-2000, the WHO European Office put forward and implemented the following priority tasks: teaching materials on AIDS for Nurses; creating, translating, locally adapting and distributing a Nursing Education Package (LEMON); development of leadership in nursing; training of teachers and managers; promoting the creation of national plans for the development of nursing, etc.

In 1989. The All-Union Conference of Specialists with Secondary Medical Education discussed the place of nursing personnel in the domestic health care system and adopted recommendations for the implementation of the decisions of the Vienna Conference. This marked the beginning of a process that continues to go on, despite the socio-political upheavals.

In 1997 The Code of Ethics for Russian nurses was adopted, which defines the most important tasks of a nurse's professional activity, the sister's relationship with patients, colleagues, and society. For the first time there was a document relating directly to the activities of nursing staff. For the first time in a document that singled out the activities of a nurse from the total activities of other healthcare professionals, the category of "patient's rights" appeared, thereby defining a qualitatively new, subject-subject, level of relationships in the "nurse-patient" system. Emphasizing the "humanistic human-centeredness" of the profession, the Code defines the ethical norms of a nurse's behavior as professionally important qualities.

Unfortunately, the Concept for the Development of Healthcare and Medical Science in the Russian Federation, adopted in the same 1997, does not contain direct instructions for nursing services, which still indicates an underestimation of the capabilities of nursing staff in reforming the industry, although the state of health care is characterized as approaching the line "followed by the collapse of the entire health care system."

However, the Order of the Ministry of Health of the Russian Federation dated December 31, 1997 No. № 390 “On measures to improve nursing in the Russian Federation”, one of the leading roles in health care reform, ensuring the quality, accessibility and efficiency of the health care system, strengthening the preventive focus, and solving the problems of medical and social assistance assigns specialists with secondary medical education. Therefore, in order to further develop nursing in Russia, to streamline the duties, responsibilities and functions of specialists with secondary medical education, it was decided to develop a State program for the development of nursing in Russia. Also, the order approved the "Regulations on the chief specialist in nursing of the health authorities of the constituent entities of the Russian Federation."

In 1998 The First All-Russian Congress of Nursing Workers took place, which approved the draft State Program for the Development of Nursing in the Russian Federation. The main objectives of the program:

Creation of optimal conditions for the development of nursing;

Development of new organizational forms and technologies of nursing care;

Ensuring the quality of nursing care to the population;

Raising the professional and social status of the nursing profession;

Ensuring the social security of personnel;

Improving the management system of nursing services;

Assistance in the development of professional associations and their involvement in the implementation of state policy in the field of nursing development in Russia.

October 2004 The II All-Russian Congress of Nursing Care Workers “The Quality of Nursing Care – Healthcare Strategy of the 21st Century” was held, the main task of which was to form constructive proposals for the development of nursing, to determine the place and role of nursing personnel in reforming Russian healthcare. The decision of the congress noted the need to create a "Conceptual Model" of nursing in Russia, which should clearly define the place of a nurse in the healthcare system.

http://mybiblioteka.su/4-102939.html

CONCLUSIONS
- The role of nursing staff has increased in the implementation of state guarantees of medical care for citizens of the Russian Federation, which meets the population's need for preventive, diagnostic, treatment, rehabilitation and palliative care.
- A multi-level system for training nursing personnel (initial-basic-advanced-higher) has been created.
- Adopted the philosophy of nursing in Russia; The Code of Ethics for Russian nurses has been developed, which defines both the rights of a nurse and a patient.
- Carry out experimental work on the introduction of modern organizational forms and technologies of nursing activities. Work has been intensified to create professional standards for medical and nursing activities, which makes it possible to ensure the efficiency and quality of medical services.
- The number of public sister organizations continues to grow. Registered and actively working: Russian Association of Nurses, Russian Association of Midwives, Interregional Public Organization of Operating Nurses and others.
- The international cooperation of Russian nurses is expanding both at the all-Russian level and at the local level.
- In the same time fundamental research in the field of nursing are practically non-existent.
- There is no conceptual model of nursing, which allows to determine the boundaries of the competence of nursing staff and their place in today's health care system.

Fundamentals of nursing: a textbook. - M. : GEOTAR-Media, 2008. Ostrovskaya I.V., Shirokova N.V.

The role, functions and organizational forms of activity of nursing staff are changing in accordance with the new challenges facing health care:

Development of primary health care aimed at

disease prevention and health promotion, hygiene education and education of the population;

Restructuring of medical institutions, which determines the optimization of the length of stay in the hospital;

Expanding home care with new care technologies and nursing process;

Improvement of the system, forms and stages of rehabilitation measures;

Formation of hospitals or nursing units;

The development of a system of hospices and the provision of palliative care to the dying, based on the unity of the medical, social systems and spiritual institutions of society.

It is advisable to study foreign experience in the design and maintenance of primary documentation and update the technologies for its maintenance. According to the strategy of the Ministry of Health, in the process of restructuring medical care in rural areas, it is planned to organize nursing care hospitals on the basis of district hospitals that perform medical and social functions.

To implement effective organizational activities of nursing staff, it is necessary to train chief nurses in a modern interpretation - professional managers of nursing services.

Introduction to the nomenclature of positions of a full-time nurse-manager of health care facilities, deputy chief physician for nursing staff, etc. will solve the issue of demand, effective use and decent pay for specialists with higher nursing education.

Cooperation with social services, homes for the disabled, hospitals for war and labor veterans creates the need for practical healthcare in a qualitatively new training of nurses.

There is considerable room for improvement in the quality of health education provided by nurses, feldshers and midwives, who are used in the training of nursing leaders.

Health and nursing policy makers are well aware of the challenges of nursing:

1. Employment of nurses with higher education.

2. The absence of a legislative framework and a narrow range of nursing positions with higher education.

3. Low moral and material interest of nurses in improving professional knowledge and skills.

4. Physically and emotionally hard work.

5. Low level of self-esteem and prestige of the nursing profession.

6. Adaptation of young professionals in the workplace.

7. Syndromes of emotional burnout and chronic fatigue.

8. Lack of load standards, quality standards.

Based on this, the cooperation of public health organizers with creative scientific and pedagogical teams is the way to solve them.

One of the pedagogical tasks is the development of motivation for the creativity of the leader-mentor of nursing.

Public health organizers and educators discuss possible options specializations for nurses with higher education. Specialization in the organization of nursing can be in the following areas:

Nursing Organizer or Management and Economics of Nursing;

Valeology;

Medical and social rehabilitation, etc.

The approval of these specialties will favorably affect the rational employment of nurses with higher education.

To improve the quality and efficiency of medical care, it is necessary to increase legal knowledge and regulatory documentation, office work and computerization of the activities of a nursing supervisor, mastering basic economic knowledge.

The sister leader has a number of advantages that allow him to become a leader of change in the future, an ideologist continuing education nurses. In the preparation of head sisters, the following should be used:

Create conditions for gaining knowledge in leadership, management, leadership using various forms of the educational process;

Provide a psychological learning environment, high culture organization of labor, the use of the material and technical base of the most equipped healthcare institutions, in them to promote the development of traditions of ethics, deontology and respect for the personality of the leader;

Use in educational process teaching social disciplines (sociology, management psychology, political science, etc.), as well as the experience of recognized nursing leaders, which will significantly improve the quality and content of practical classes;

Expand the list of positions for nursing supervisors, which will allow in the foreseeable future to address the issues of their rational employment and motivation.

Supporting nursing initiatives, stimulating leadership, improving the selection system, and applying a variety of forms and levels of training will have a positive impact on the future of nursing.

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3. Lapotnikov V.A. The future of nursing education in the integration of secondary and higher medical schools.

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5. Matveychik T.V. Volchenok V.F. Formation of a program to increase creativity (school of creative growth) Educational and practical guide, ed. BelMAPO-2001.-45p.

6. Rudenko V.P. Reforming health care is an urgent need for both physicians and the entire population //Medicine-2003.-№1(40).-P.4-5.

7. Semina T.V., Burtseva E.M. Personnel policy of health care institutions and higher nursing education // Chief Medical Nurse.-2003.-№4.-p.59-61.

8. Sokolova E.A. Psychological problems leaders and subordinates in the medical team // Modern psychology: state and prospects. Abstracts of the anniversary report scientific conference IP RAS. M.:, 2002.V.2.-S. 235-238.

9. Tishchenko E.M., Zabarovsky G.I., Alekhnovich M.V., Khmelnitskaya E.V. Department of public health and health care in the system of higher nursing education // Nurse at the turn of the XXI century Sat. scientific work. - Grodno, 2002. - P. 112-113.

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One of the world health trends is the increasing role of nursing staff with different levels of training and, in particular, the widespread use of nursing staff in management. The emergence of new specialists - nursing leaders - forces us to reconsider the prevailing stereotypes on the role and function of nurses.

Effective management of nursing staff is one of the priority areas of the "Sectoral Program for the Development of Nursing in the Russian Federation". In modern conditions of a shortage of human and financial resources for the heads of nursing services, one of the main tasks in the development of personnel has been determined - the formation of a nurse of a new formation: a highly qualified specialist who is able to make decisions and has independence within her competence.

The success of nursing management reform is highly dependent on nursing leaders. Sisters-organizers work in the conditions of deep contradictions. On the one hand, they face the “Sectoral program for the development of nursing in the Russian Federation”, promising, new, setting the organizational bar high enough, on the other hand, the predominance in practice of the outdated stereotypical approach to nursing staff, when in medical institutions they see only obedient performers in nurses . Under such conditions, it is not easy to implement reforms; a lot of contradictions have to be overcome.

Over the past 10–15 years, the imperfection of the organization of nursing service management in our country has been revealed. An analysis of the situation that has developed in nursing indicates a number of unresolved problems, including insufficient legal support and the imperfection of the system for managing the activities of nursing personnel, and the inefficient use of personnel in practical healthcare.

The inefficiency of the traditional management system is manifested in the emerging problems of coordinating the activities of nursing structures, dual subordination, etc. At present, the job functions of the organizers of nursing are not clearly regulated. Attention is drawn to the limited rights of the organizers of nursing, and on the other hand, they are entrusted with a huge number of economic duties, as a rule, not systematized in any way.

A negative factor complicating the work of the chief nursing specialists is the freelance nature of their activities in this post, as well as the huge workloads in their main work.

Issues related to the management of nursing staff are raised quite often in the literature. Many publications are devoted to the experience of implementing nursing process technologies. Colleagues from different regions describe the transformations that they managed to carry out in their medical institutions (HCF). All the functions of a nurse manager are listed in sufficient detail.

However, to date, there is practically no developed model of personnel management at the level of a healthcare institution that allows optimizing the activities of not only the heads of the nursing service, but also the entire nursing staff.

Therefore, it is extremely important to analyze, using the example of a specific health facility, whether the heads of nursing services are ready to solve the new tasks assigned to them in the field of reforming nursing. It is necessary to find out whether it is worth optimizing the existing structure of nursing staff management. This prompted us to approach the study of this problem, which was the goal of our study of an innovative change in the model of nursing staff management in healthcare facilities, some of the results of which are presented in the following article prepared for publication.

Around the world, innovation in nursing is seen as the foundation of daily practice aimed at improving the quality of patient care and reducing the cost of health care services. The need for innovative solutions is high as healthcare systems today struggle to provide affordable, safe and effective services while keeping costs down. However, the contribution of nurses to innovation is not always recognized and known both among the nursing community itself and among the general population.

The International Council of Nurses believes that nursing innovation is the main source of development of health systems around the world, as nurses work in all medical institutions, with all types of patients, families, communities, interacting with both health care workers and other professionals. industries. Innovation in nursing practice is most often a process of constantly reviewing, updating and improving results. And although they do not lead to significant achievements, which are “ringing around”, they contribute to the increase in the competence of nursing staff and are central to the provision and improvement of the quality of care.

Introduction
The decisive role in organizing the work of nurses in any medical institution belongs to the head of the nursing service - the head nurse.
A nurse-leader solves important strategic issues, makes decisions in conditions of extreme instability, a constant shortage of all types of resources. To successfully complete these tasks, the manager does not need only knowledge in the field of his narrow professional competence. The most important criterion for the value of a nurse as a leader; becomes its managerial competence, leadership skills, communication skills, optimism, vision of the future and the desire to know tomorrow what you do not know today.
Improving the quality of medical care is currently a priority for healthcare. Reforming the nursing service, first of all, aims to improve the quality of nursing care to the population. An unconditional reserve for improving the quality of medical services to the population is the correct organization of the work of mid-level medical specialists: rational placement of personnel, redistribution of functions between middle and junior medical personnel, work planning, reduction of non-production costs of working time, and so on.
The main role in solving these problems is assigned to the heads of nursing services.
The main goal of the head nurse's work is to: improve the quality of patient care through more efficient use of available resources, as well as through the introduction of nurse practice standards in health care, increasing professional level nursing staff and enhancing the prestige of the profession.

1. Job description head nurse
I. General provisions
1. The head nurse belongs to the category of leaders;
2. A person with a higher medical education without presenting requirements for work experience or secondary medical education and work experience in the profile of at least 5 years.
3. Appointment to the position of chief nurse and dismissal from it is carried out by order of the head of the institution.
4. The head nurse should know:
4.1. Constitution of the Russian Federation.
4.2. Laws of the Russian Federation and other regulatory legal acts on health issues.
4.3. The procedure for scheduling work and placement of middle and junior medical personnel.
4.4. Theoretical basis hygiene and healthcare organization.
4.5. Organization of social and medical rehabilitation of patients.
4.6. Theoretical and organizational foundations of the sanitary and epidemiological service.
4.6. Organization of health education, hygienic education of the population and promotion of a healthy lifestyle.
4.7. Legislation on labor and labor protection of the Russian Federation.
4.8. Rules and norms of labor protection, safety measures, industrial sanitation and fire protection.
5. The head nurse reports directly (to the head of the institution; another official)
6. During the absence of the chief nurse (vacation, illness, etc.), her duties are performed by a person appointed by order of the head of the institution.
II. Job Responsibilities
Chief Nurse:
1. Provides a rational organization of work of middle and junior medical personnel, improving their skills.
2. Carries out timely discharge, distribution and storage of dressings, medicines, etc., including poisonous and narcotic drugs, keeps records of their consumption.
3. Controls: the work of middle and junior medical personnel for the admission and discharge of patients; transportation of patients within hospital departments; performance of medical appointments by paramedical personnel; sanitary and hygienic maintenance of hospital departments, clothes and linen of patients; timeliness and quality of disinfection of the premises where infectious patients were located.

The role of the head nurse in the organization of nursing in health care facilities

In modern conditions, when the healthcare reform in our country has begun, the tasks of the chief nurses of medical institutions to organize the work of nursing staff in accordance with the new complex problems being solved in the reformed healthcare institutions are immeasurably increasing.

Improving the quality and efficiency of the management activities of chief nurses is possible only through the use of modern science about management.

Nursing personnel management is a purposeful activity of the heads of nursing services of medical institutions (HCIs) and their departments, using various management mechanisms and communication channels to ensure well-coordinated, qualified work of nursing personnel to provide patients with nursing care of the appropriate quantity and quality. Thus, in outpatient clinics, the work of nursing staff in newly organized day hospitals, home hospitals, outpatient surgery centers, general practitioner services, etc. should be ensured. rehabilitation treatment, as well as hospitals for the treatment of patients with chronic diseases and hospitals for medical and social care.

In health care facilities, the organizational structure of nursing staff management includes:

subjects of nursing staff management, i.e. those who manage nursing staff;

objects of management, i.e. nursing staff managed by the subjects of management;

management mechanisms - various types of managerial influences, with the help of which the effective management of nursing staff and the fulfillment of the tasks assigned to them are ensured;

All elements of the organizational structure for managing the nursing staff of health facilities closely interact with each other in order to ensure High Quality nursing in an institution.

There should be constant two-way communication between the subjects and objects of management: the subjects of management bring management decisions to the objects of management, and the objects of management send information, reporting and other information about the progress of these decisions to the subjects of management. The most important obligatory feedback channel of control objects with control subjects is control over the progress of management decisions and performance of nursing staff.

The management mechanisms used by the head of nursing services make it possible to determine the goals of management in relation to the work of this health facility, clarify the main directions (functions) of the management activities of chief nurses, carry out management activities based on the most important management principles and widely use organizational, administrative, socio-psychological and economic methods management.

Thus, the organizational structure of the management of nursing personnel of a healthcare facility is a complex, interconnected management system that can successfully function and ensure the high quality of nursing in a healthcare facility only if all the potential capabilities of each of its elements are effectively used.

Let us consider sequentially what each of the elements of the organizational structure of the management of the nursing staff of the healthcare facility is.

The subjects of management of the nursing staff of health facilities are the heads of nursing services of medical institutions:

chief nurses or deputy chief physicians for work with nursing and junior medical personnel, directors of hospitals (houses) of nursing care and hospices.

In recent years, in a number of large medical institutions, the positions of deputy chief physicians for working with nursing and junior medical personnel have been introduced, which has contributed to improving the quality of nursing staff management and raising the authority of the heads of nursing services of medical institutions.

In some institutions located in several large buildings, the positions of chief nurses of medical buildings have been introduced, while maintaining the positions of the chief nurse of the hospital and senior nurses of the medical departments of the buildings.

In the clinics of the Moscow Medical Academy. THEM. Sechenov introduced the positions of chief nurses of clinics while maintaining the position of chief nurse in the management of all clinics, and each individual clinic also provides for the positions of senior nurses.

In accordance with the Nomenclature of positions of medical and pharmaceutical personnel and specialists with higher vocational education in health care institutions, the chief nurse is the head of the institution. Consequently, the head nurse is an official of the institution with all the ensuing rights and responsibilities.

The tariff and qualification characteristics for the chief nurse (Appendix 2 to the Decree of the Ministry of Labor of Russia dated August 27, 1997 N ° 43) stipulate that in order to occupy this position, a higher medical education is required without presenting requirements for work experience or secondary medical education and work experience in the profile is not less than 5 years.

The following basic requirements are imposed on the subjects of nursing personnel management, that is, mainly on the chief nurses.

When appointing chief nurses to the post, it is necessary to take into account their desire to engage in managerial activities and not appoint them to this position against their will.

Candidates for the positions of chief nurses must have a certain set of personal universal qualities, without which it is impossible to manage people.

Managers must have sufficient professional training in accordance with the requirements of the Qualification Characteristics for Nursing Organization Specialists and have detailed information about the activities of the health facility in which they work (or will work).

Chief nurses should have knowledge about the activities of the mandatory health insurance funds (CHI) and especially about the requirements they impose on health facilities.

Effective work of managers is possible only if there is a clearly defined circle official duties, rights, responsibility and subordination. It is especially important to determine the immediate superiors of the chief nurse who have the right to give her orders and instructions. As a rule, it is advisable to limit them to the chief physician, and in his absence - to the person replacing him. As for other heads of health facilities, the head nurse should cooperate with them on an equal footing, that is, on partnership terms.

The circle of persons reporting to the head nurse should be limited to senior nurses (midwives, paramedics, pharmacists).

Mastering the rules for delegating their routine functions to senior nurses and chief specialists should be considered extremely important for chief nurses.

1. In connection with the work begun on reforming healthcare - the structural restructuring of inpatient care, the redistribution of inpatient medical care to the outpatient level, the development of a network of day hospitals, outpatient surgery centers, consultative and diagnostic centers, the creation of a general practitioner service and other areas of development and transformation medical services - it is extremely important to intensify work on organizing and adapting the activities of nursing staff to work in reformed and transformed healthcare facilities.
2. The most important mandatory element of the managerial activity of chief nurses is the systematic monitoring of the work of senior nurses, their performance of their duties in organizing nursing care, implementing standards for the activities of nursing personnel, ensuring high quality nursing care, etc. For this work, the chief nurse must to involve more members of the Council of Nurses.
3. Effective management of the work of nursing staff is possible only if they are constantly taken care of: about their health, labor protection, creating a favorable psychological microclimate in the workforce, optimizing the workload, convenient work schedule, providing those who wish the opportunity to receive additional income, etc.
4. Heads of nursing services must constantly improve their qualifications, study new normative materials, literature on the development of nursing, the experience of leading heads of nursing services and other healthcare facilities, and implement their positive experience in their work.
5. Nursing leaders should seek leadership in their organizations and influence others so that they work effectively to achieve the goals of effective nursing care for patients, while subordinates should know that their efforts will be known to the leader and he will properly evaluate them.
6. When evaluating the effectiveness of the leadership of nursing leaders, it is advisable to use the "management grid modified by Blake and Mouton. This grid uses two main criteria: the degree of consideration for the interests of people and the degree of consideration for the interests of production, while the degree of "concern for the person" and the degree of "concern for production are ranked on a scale from 1 to 9.

The management grid of Blake and Mouton, indicating the middle and four extreme positions, is shown in the following diagram.

Consider the positions indicated on the "grid" as assessed by the heads of nursing services:

1.1 - impoverished management (fear of poverty) - the manager makes minimal efforts just to avoid being fired. Such a style essentially cannot be called leadership, since there is practically no leadership of nursing staff;

9 - management in the spirit of a country house (rest home) - the head almost completely focuses on creating favorable conditions for subordinates, but practically does not care about improving the performance of nursing staff to provide them with full-fledged nursing care;

1 - power - subordination (authority - subordination) - the leader completely ignores the concern for subordinates and is focused on ensuring the effectiveness of the nursing staff, using their authority. This is a very rigid management style;

5 - organizational management (organization) - effectively managing nursing staff and taking care of subordinates, the head of nursing services achieves both an acceptable quality of nursing care for patients and a favorable moral and psychological climate in the work team and satisfaction of subordinates with caring for them;

9.9 - group management (team) - the most effective leadership style, because due to increased attention to subordinates, caring for them and ensuring effective management of nursing staff, the leader ensures that subordinates consciously participate in the implementation of the objectives of the health facility and provide effective nursing care for patients. This leadership style also provides an excellent moral and psychological climate in the work team and satisfaction of subordinates with the constant care of their leaders.

Therefore, every head of nursing should strive for a management style consistent with positions 5.5 and 9.9. At the same time, leadership styles corresponding to positions 1.1, 1.9 and 9.1 are unacceptable for heads of nursing services, which should be taken into account by the first heads of health facilities.

It is advisable to use the indicated criteria for the "management grid" to assess the leadership style of senior nurses.

1. Effective managerial activity of the heads of nursing services of health care facilities is possible only on the condition that the first heads of medical institutions will fully support the chief nurses in their efforts to develop nursing in health care facilities and skillfully adjust their work. It is very important that the heads of nursing staff be provided with optimal working conditions: comfortable working premises, reliable communication with all health care facilities, personal computers and the necessary office equipment, decent wages, etc.

Nursing personnel management objects

The objects of management of nursing and junior medical personnel include positions of paramedical and pharmaceutical personnel, junior medical and pharmaceutical personnel listed in the Nomenclature of positions of medical and pharmaceutical personnel and specialists with higher professional education in healthcare institutions *.

In a number of health facilities, along with the above, new positions have appeared: nurses - consultants for patient care, nurse coordinators, day hospital nurses, etc.

In recent years, special services have been created in health care facilities to analyze and record work with insured persons under compulsory medical insurance, where nurses do a lot of complex work, medical statistics and medical registrars.

Operational departments (dispatch services) have been organized in a number of health facilities, where medical registrars and nurses are successfully working.

Literature:

1.Kheifets A.S. Article " Management activities chief nurses of hospitals to monitor the work of nursing and junior medical personnel. - Chief nurse, 2000, No. 1, p. 29; No. 2, p.7.

2. Articles: L.V. Spirin and G.I. Panasyuk (Chief Nurse, 2000, No. 0, pp. 41-43); N.D. Lada and Zh.V. Yoon (Chief Nurse, 2000 No. 1, pp. 41-43); T.I. Kareva and M.G. Leushina (Chief Nurse, 2000, No. 1, p. 44-47).

Nursing is the most important component of the healthcare system, therefore it cannot develop autonomously, its improvement is possible only together with the reform of the healthcare system as a whole, which, as you know, is aimed at creating qualitatively new forms of medical care focused on the final socially significant result in public health protection.

The history of the development of nursing, starting with N.I. Pirogov, S.P. Botkin testifies to the integration of the activities and educational space of the higher medical school and medical schools. The multi-level system of training nursing professionals that is being formed now creates a real continuity of knowledge and skills according to the level of training. It is used in the practice of postgraduate education of nurses with higher education, who fill the content of the profession with new meaning.

The scope of nursing activities includes the provision of a wide range of services within the framework of primary health care and participation in high-tech scientific research. In a number of states, a similar range of roles for nurses was formed unplanned and unsystematic. This process was driven by the needs of the population, and in some countries by the desire to contain the growth of health care costs. Consequently, it has become more difficult for planners to describe the nature and extent of medical practice and, accordingly, to bring the skills and knowledge of nursing staff to the level of the needs of the population without duplicating services.

In some countries, there are 15 or more additional categories of nursing personnel, which differ in the degree of their professional training. A sister who has completed advanced training is characterized by:

specialization;

Expanded knowledge and improved skills;

Higher education and reinforcement of practice with research;

a significant degree of independence in practical work and independence in decision-making"

The reasons that gave rise to the need to reform nursing in Russia include the low level of quality of medical care for the population, the low prestige of the profession, the low social status of nurses, the lack of prospects for professional growth, the mismatch of the level of nursing education with the requirements of the time, the shortage of nursing teaching staff, the lack of scientific research in the field of nursing and ignorance of foreign experience. If in most European countries the reform of nursing began in the mid-70s, then in our country the need to reorganize the system of providing medical care to the population was truly realized only in the early 90s.

In Russia, the question arose of developing a concept for the further development of healthcare and medical science in the Russian Federation. Such a concept was developed and approved by the Decree of the Government of the Russian Federation of November 15, 1997. In December 1997, the order of the Ministry of Health of the Russian Federation No. 390 "On measures to improve nursing in the Russian Federation" appeared, and in January 2001 - order No. 4 of the Ministry of Health RF "On the sectoral program for the development of nursing in the Russian Federation". During the same period (December 2000), the Ministry of Health of the Russian Federation holds a collegium "On the training of specialists in social work, clinical psychologists, nurses with higher education (managers) in universities of the Ministry of Health of Russia and their employment ", and also issues order No. 440 of December 20, 2000. "On the establishment of the Council of the Ministry of Health of Russia on nursing." Much of what is reflected in these regulatory documents, was prepared in St. Petersburg."It was in our city in 1992 that the first faculty of higher nursing education in Russia was opened on the basis of the Medical Academy named after I. I. Mechnikov, and in 1999 the Department of Nursing was created on the basis of SPbMAPO.

The reform of nursing and education in Russia, the development of medical science, the introduction of intensive medical, pedagogical and information technologies place new demands on nursing staff. Currently being formed modern concept nursing profession. Nursing is an independent branch of medicine.

In the conditions of reforming nursing and the labor market, high demands are placed on a modern nurse, regarding both a good education, possession of manipulative techniques, and the presence of critical thinking, communication and pedagogical skills. Thus, the growth of the effectiveness of medical care with a sufficiently high level of education of the nursing staff makes it possible to differentiate nursing activities, improve the standards of pre-medical care, determine and normalize the patient's needs for medical services, monitor and record medical care and, therefore, rationally and economically use health resources.

Currently, nursing in our country is facing many problems. First of all, it is:

traditionally formed idea of ​​a nurse, only as a doctor's assistant;

· low salaries of nurses;

Performing unskilled labor (a nurse devotes only 15-20% of her working time directly to patient care);

Lack of standards of practice;

· “blurring” and ambiguity of official duties;

Great physical and psychological stress on the nurse (as a rule, there are up to 30 patients per nurse in the therapeutic department);

· constant outflow of qualified nursing personnel from practical health care;

routine and lack of creativity in the work of a nurse;

· shortcomings in the professional training of nurses;

Insufficient scientific approach to the problems of nursing;

Lack of regulatory and legal framework for independent nursing practice, the impossibility of private practice;

It is impossible not to mention the conservatism of doctors and, moreover, even some of the nurses towards reforms in nursing.

The reform of nursing education, “although slowly and often painfully, is moving forward, and using not a revolutionary, but rather a reasonable, pragmatic approach: without destroying the valuable that has been accumulated over the years and using all the advanced foreign experience, but in no case copying it blindly."

The reforms are based on a strategy aimed at the comprehensive development of primary health care, including nursing. The key element of the reform was the turn of medical organizations to the personality of a nurse as a subject of activity, the development of which will inevitably entail the development of the organization itself. The practice required a nursing specialist of a new formation.

Therefore, the reform of nursing in Russian health care has unfolded in several directions:

nursing education;

· Nursing practice;

scientific research in nursing;

self-management and consolidation of the nursing profession;

· the international cooperation.

Thus, the following conclusions can be drawn:

The reforms currently taking place in healthcare are fundamentally designed to transform the system of nursing and education in Russia. The powers of the modern nurse-manager should be much broader than those of her predecessors, who performed purely technical functions of a physician's assistant.

The reform of nursing in Russian health care has developed in several directions: nursing education; nursing practice; scientific research in nursing; self-management and consolidation of the nursing profession; the international cooperation.