concept "nursing" in Russia was officially introduced in 1988, when in the nomenclature educational specialties in the field of health care, the place of "nursing" was taken by the specialty "nursing", and in the content basic training nurses a new academic discipline - the foundations of nursing.

Since 1991, along with medical schools, medical colleges and the first faculties of higher medical education began to open in our country. important event in the history of nursing was the creation in 1992 of the Association of Nurses of Russia. It was organized at the initiative of nurses as a non-governmental professional organization.

in 1993, the philosophy of nursing was formulated and adopted.

In 1994 organized Association of Nurses of Russia, which is a member of and takes an active part in the work of the International Council of Nurses.

In 1995, for the first time in Russia, a specialist in nursing G. M. Perfilyeva defended her doctoral dissertation on the topic “Nursing in Russia”. It was on her initiative that faculty of higher nursing education at the Moscow Medical Academy. I. M. Sechenov.

Analysis of changes in nursing during this period shows that the main focus was on reforming education. This is evidenced by fairly frequent revisions. curricula, differing from each other only in number academic disciplines"university" set.
From our point of view, this did not affect the activities of practical sisters in any way. Their professional and social status, determined back in 1927, is largely preserved in Russian healthcare to this day. A conscious attitude to the doctor's prescriptions, even if it is developed, remains unclaimed among the bulk of the sisters: the doctor is responsible.

In recent years, a three-level system for training nursing personnel has developed and is developing:

1) basic level (it is provided by medical schools);

2) advanced level (medical colleges);

3) the highest level (faculties of higher nursing education in higher medical schools).

Nursing positions are introduced into the nomenclature in accordance with the level of education

Among the directions for reforming nursing in Russia, there are clearly those points that were proposed by the WHO back in the 70s and, for unknown reasons, were not accepted in our country:

nursing process,
- multilevel training of specialists,
- management,
- nursing research.

". In recent years, the Ministry of Health of Russia, together with the territorial health authorities, has been doing significant work that contributes to the revival, increasing the social significance and prestige of the nursing profession.
In this regard, in the context of the Concept for the Development of Healthcare and Medical Science in Russian Federation the State Program for the Development of Nursing was developed. The program was developed in accordance with 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". The following directions for the development and improvement of the activities of nursing personnel have been identified:

Primary health care with a focus on preventive work;

Treatment and diagnostic assistance, including the provision of intensive inpatient treatment and care;

Rehabilitation assistance and medical and social assistance to the chronically ill, the elderly and the disabled;

Medico-social assistance to the incurable sick and dying.

The tasks of reforming nursing are determined by the established directions for the development of the profession, namely:

Increasing the role of sisters in the health education of the population in such important areas as the formation of a healthy lifestyle, the prevention of diseases, poisoning, accidents, etc.,

Education of the population in emergency care and methods of patient care,

Expanding the participation of nursing staff in new forms of community care: day hospitals, centers for outpatient surgery and medical and social care, etc.

In connection with the restructuring of the hospital bed fund in terms of the intensity of the treatment and diagnostic process, the profiling of activities and the rational use of nursing staff are becoming important. There is a growing need for personnel who can work with modern medical equipment that monitors the condition of patients, who owns the nursing process, the basics of psychology, and provides comprehensive comprehensive care and rehabilitation of the patient.

The main goals and objectives of the nursing reform
The main goals and objectives of the nursing reform are:

1. Formation of optimal conditions for increasing the efficiency and strengthening the role of paramedical workers, improving the management system.

2. Creation of a new conceptual Russian model of nursing. Each model reflects the basic principles of primary health care (PHC). The medical (traditional) model, authored by F. Nightingale, still operates today. In this model, one of the constituent elements is the role of the nurse as a physician's assistant with extremely limited professional autonomy.

3. The introduction of new technologies in nursing, bioethical, professional approaches that can satisfy the population's need for affordable medical care;

4. Strengthening the preventive focus of health care.

5. Carrying out systemic transformations in nursing - in the field of education, scientific research, practical health care, assistance in the creation and development of professional nursing associations.

6. Raising the status of nursing personnel, both professional and social, ensuring social protection of nursing professionals and much more. The training of nursing professionals and the introduction of the nursing process in medical institutions are among the priorities of health authorities. For rational and effective use of the available human resources, in the current situation, the formation of state policy in the field of nursing and increasing the responsibility of authorities at all levels for its implementation is becoming important.

Florence Nightingale Medal

Medal with the image Florence Nightingale Awarded for special merit to distinguished nurses. On the reverse side of the medal, a Latin inscription in a circle reads: “Pro Vera Misericordia et cara Humanitate Perennis ducor universalis” (“For true mercy and care for people, admirable by all mankind”) and in the middle is the engraved name of the owner. The Florence Nightingale Medal was established in 1912. To date, this medal has been awarded to about 1,000 people, including 46 Russian nurses.
Soon, nursing schools in the United States began to open on her model, and the initiative in the development of nursing gradually shifted from Europe to America.

Once every two years on May 12 (Florence Nightingale's birthday), a medal is awarded to sisters of mercy for rescuing the wounded and injured, caring for the sick in wartime and peacetime, and also in recognition of their exceptional moral and professional qualities.

Modern nursing in this period is undergoing a stage of active reform. The activity of modern nursing service is carried out in certain directions, which are developed and set out in the program for the development of nursing in the Russian Federation. In 1997, in accordance with the Order of the Russian Federation of December 31, 1997 No. 390 "On measures to improve nursing in the Russian Federation", a program for the development of nursing in Russia was drawn up.

Nursing personnel make up the dominant part among health workers. The ongoing reform of nursing education has yielded positive results. In Russia, since 1995, the training of nurses with higher education has been carried out. The development program formulates modern concepts and terms. Nursing is considered as one of the main components of health care. It includes activities to promote health, prevent diseases, provide psychosocial assistance to those in need. Nurses provide medical care in special medical institutions, as well as at home. Nursing staff must have education in the specialties: "Nursing", "Obstetrics", "General Medicine (paramedic)". In the implementation of the nursing development program, 2 stages were identified.

1st stage: from 1998 to 2000: the legal framework and material and technical base for the work of nurses were developed and adopted.

Stage 2: 2000 to 2005: implementation of cost-effective ways of nursing services in the health system.

The program for the development of nursing is provided through funding from the federal budget, funds from the budgets of the constituent entities of the Russian Federation and extra-budgetary sources attracted for its implementation. Quality control during the implementation of this program is carried out directly by the Ministry of Health and Social Development of the Russian Federation.

The program for the development of nursing indicates the objectives of the development of nursing in the Russian Federation.

1. Creation of conditions for the development of nursing and the provision of assistance at the federal level and directly in the subjects of the Federation.

2. Promoting more efficient use of resources in health care.

3. Development of new methods of organization and technologies of nursing care.

4. Improved qualification training of nursing staff.

5. Ensuring high quality nursing care for all segments of the population.

6. Improving the legal framework and management system of nursing service.

7. Raising the status of the nursing profession.

8. Maintaining the social security of nursing staff.

9. Development of nursing associations.

The program for the development of nursing in Russia is based on clear, defined principles.

1. The principle of universality. Medical assistance should be provided to all people in need, regardless of their social affiliation, gender, age, religion.

2. The principle of accessibility. Medical care should be available to everyone, regardless of the place and area of ​​​​residence and other factors.

3. The principle of prevention and timely promotion of the health of each person.

4. The principle of efficient use of labor, material and economic resources.

If earlier the nurse was considered as an assistant to the doctor and was obliged to fulfill all his appointments exactly, then present stage In the development of healthcare, the powers of the nurse have expanded: she has the right to make decisions independently when providing assistance to the population.

The activity of a modern nurse has certain directions and tasks.

1. Provision of primary health care. Implementation of preventive work among the population. The nurse should actively carry out health education of patients: to form a healthy lifestyle for each patient, to carry out primary and secondary prevention of the population. Primary prevention is aimed at preventing the development of the disease in a healthy person. Secondary prevention is interventions to reduce relapses in a person with a chronic disease. The nurse should participate in solving the issues of sexual education of the population, in family planning.

2. Provision of medical and diagnostic assistance to patients, highly qualified patient care. Polyclinics, hospitals, feldsher-obstetric stations for better work should be provided with modern equipment and a sufficient amount of medicines, dressings, injections and other medical products.

3. Provision of rehabilitation and medical and social assistance to those in need: the chronically ill, the disabled, the elderly.

4. Provision of palliative care for cancer patients. Creation of hospices and nursing hospitals for people in need. Establishment of a service for the patronage of patients and their care at home.

5. The principle of providing quality medical nursing care to the entire population.

6. The principle of involving the population in active participation in solving health issues.

AT modern conditions the requirements for the professional training of nurses are increasing. There is a growing need for nurses who are able to work on modern medical and diagnostic medical equipment: electrocardiograph, X-ray units, physiotherapy devices, resuscitation and patient monitoring devices. In addition, a nurse must know the basics of psychology, know the nursing process and be able to apply knowledge directly in practice. A nurse must know the basics of the legal framework and be able to correctly fill out medical documentation.

An important role in organizing the work of the nursing service belongs to the heads of nursing services at various levels: the head nurse, the head nurse, medicine managers. For more efficient work of the nursing service, there must be close professional communication and cooperation of nurses with doctors, the administrative part, the Ministry of Health and Social Development, other specialists and departments.

Currently, there are many shortcomings and shortcomings in the organization of the work of the nursing service. It is important to further improve its organization and management in the Russian Federation. Development and introduction to the activities of nurses are necessary general principles and approaches to organizing the work of nursing staff. Currently, there is no common, unified management system. This has a negative impact on the work of nurses, and therefore directly on the health of patients. For more effective organization Nursing service needs to organize a multi-level management system. The main thing here is the emergence of nursing specialists in the Ministry of Health and Social Development of the Russian Federation, as well as in the health management bodies of the constituent entities of the Russian Federation.

The head nurse must be proficient in the basics of management and have a higher education in the specialty "Medicine Manager". Better, better organization of the work of the nursing service will ensure the development and implementation of standards in practical work professional activity nurses in outpatient clinics and hospitals. In order for a nurse to perform her work qualitatively and satisfy the needs of the patient (according to Maslow), she must not only clearly and professionally perform the prescribed manipulations. The basis of the professionally performed work of a nurse should be the observance of the culture of deontology, ethical standards, and respect for each patient.

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;

Reforming practices;

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. All-Union Conference of Specialists with Medium 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 critical tasks professional activities of the sister, the relationship of the sister with patients, with colleagues, with 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.
- expandable the international cooperation Russian nurses both at the all-Russian level and at the local level.
- At the same time, fundamental research in the field of nursing is practically absent.
- 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;

Expansion of home care using new technologies of care 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.

The introduction of full-time nurse-manager of health care facilities, deputy chief physician for nursing personnel, etc. into the nomenclature of positions will solve the issue of demand, effective use and worthy payment of 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;

To ensure the psychological atmosphere of learning, a high culture of work organization, the use of the material and technical base of the most equipped healthcare institutions, 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 practical exercises;

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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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 qualities, 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 who has a higher medical education without presenting requirements for work experience or a secondary medical education and work experience in the profile of at least 5 years is appointed to the position of chief nurse.
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; fulfillment 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 of the management of nursing staff of health facilities closely interact with each other to ensure the high quality of nursing in the 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 nursing staff management of the health facility is a complex, interconnected management system that can successfully function and provide high quality nursing in health care facilities 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 the positions of medical and pharmaceutical personnel and specialists with higher professional education in healthcare institutions, the chief nurse belongs to the positions of the heads of the institution. Therefore, the head nurse is official institutions 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 range of duties, rights, responsibilities 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 style of leadership 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 of the 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).

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SAMARA STATE MEDICAL UNIVERSITY

DEPARTMENT OF NURSING

ESSAY

on the topic: “The development of nursing at the present stage”

Completed by: Yulia Yuryevna Barinova

Checked by: Karaseva Larisa Arkadievna

Syzran 2000

Plan

Introduction

1. Nursing program

3. Improving the organization of work of nursing staff

4. Improvement of personnel policy

5. Perfection vocational education and development of scientific research in nursing

6. Development of professional associations, associations and unions

7. Program implementation mechanism

Conclusion

Introduction

In the recent past, nursing was treated as an activity that did not require much special training.

I will consider how the official Soviet ideology interpreted the concepts of "nurse" and "care for the sick." These definitions, on the one hand, demonstrated the attitude of society towards the activities and status of nurses, and, on the other hand, shaped it. So, in the Decree of the People's Commissariat of Health (1927) it was said: "The average health worker should only be an assistant to the doctor, work according to his instructions and under his supervision, must be fully prepared to perform all the procedures prescribed by the doctor, and have precisely developed technical skills."

In the 1963 Popular Medical Encyclopedia, a nurse is described as: "A person of average medical qualification working under the direction of a physician and carrying out his prescriptions and certain procedures"; The Brief Medical Encyclopedia of 1994 defines a nurse as "a specialist with a secondary medical education working under the direction of a doctor in a health facility."

In 1993, the main principles of the philosophy of nursing in Russia were formulated for the first time, according to which a nurse is "a specialist with a professional education who shares the philosophy of nursing and has the right to nursing work. She acts both independently and in cooperation with other professional healthcare workers." First, in educational institutions, and then in treatment and prevention, the concepts of "nursing process", "nursing diagnosis", "nursing medical history", "patient's needs" began to be considered.

1 . Nursing Development Program

The state program for the development of nursing in the Russian Federation was developed in accordance with the order of the Ministry of Health of the Russian Federation of December 31, 1997 No. 390 "On measures to improve nursing in the Russian Federation."

At present, it has become obvious that a complex of unfavorable demographic, socio-economic, political and environmental factors that have emerged in recent years in the country has had an extremely negative impact on the health of the population.

The increase in demand for medical services occurs against the backdrop of an ever-increasing shortage of material and financial resources. The amount of healthcare financing from the budgets of all levels and from the funds of compulsory medical insurance cannot provide the population with free public medical care.

In the current situation, nursing personnel, who constitute the largest category of health workers, and the services they provide are seen as a valuable health resource to meet the needs of the population for accessible, affordable and cost-effective medical care.

The reform of nursing education carried out in the country under the leadership of the Ministry of Health has yielded concrete results, expressed in the creation of a multi-level system for training nursing personnel, improving the quality of vocational education, and for the first time in Russia, specialists with higher nursing education have been trained.

At the same time, the lack of a legal basis for the activities of nursing professionals, mechanisms for its regulation, means and methods of social protection and motivation of qualified personnel leave the declared, but so far unfulfilled, need for practical healthcare to use the existing nursing potential. There is a significant staffing imbalance in the industry in the ratio between doctors and nursing staff, the outflow of qualified nursing staff from public institutions health care, workloads, staff dissatisfaction and social tensions are increasing.

In this regard, there is an urgent need in the country for a well-thought-out state program for the reform and development of nursing. The program should be based on the real conditions and possibilities of state and municipal health care. The main directions, approaches and principles laid down in the Program should serve as a guideline for programmatic and other management actions at the regional and local levels.

Basic concepts used in the Program

Nursing - an integral part of the health care system, which includes activities to promote health, prevent diseases, provide psychosocial assistance and care to people with physical and (or) mental illnesses, as well as disabled people of all age groups. Nursing encompasses the physical, intellectual, and social aspects of life as they affect health, disease, disability, and death.

Such assistance should be provided by nursing staff in health care facilities and any other institutions, as well as in the home, in other words, wherever there is a need for it.

Nursing staff -- these are employees who have a medical education in the specialties of nursing, obstetrics, general medicine (qualification of a paramedic) and admitted to professional activities in the prescribed manner.

The diversity of roles nurses perform requires an understanding of the factors that affect health, the causes of disease, how it is treated and rehabilitated, and the environmental, social and political contexts in which care is provided and the health system operates.

Terms and stages of the program implementation

To ensure consistency in the implementation of the main directions of the Program, work on its implementation will be carried out in stages in 1998-2005.

The first stage -- 1998--2000 includes the preparation of priority, urgent measures (creation of regulatory, legal, material and

technical and organizational base) for the implementation of the Program.

The second stage -- 2001--2005 includes the implementation of cost-effective forms and methods of nursing services in the healthcare system of the Russian Federation.

Resource support of the program

The program is being implemented at the expense of the federal budget, funds from the budgets of the constituent entities of the Russian Federation and extra-budgetary sources attracted for its implementation, which do not contradict the existing legislation.

Financial support for resolving issues that are under the joint jurisdiction of the Russian Federation and its constituent entities is carried out mainly at the expense of the budgets of the constituent entities of the Russian Federation.

Organization of program management and control over the course of its implementation

Management and control over the implementation of the Program is carried out by the Ministry of Health of the Russian Federation. The main directions and provisions of the Program are annually refined and monitored based on the progress of its implementation and the effectiveness of the use of funds.

Evaluation of the effectiveness of medical - social and economic consequences from program implementation

The medico-social and economic efficiency of the Program will be assessed based on the indicators of the effectiveness and quality of the nursing services of the nursing staff of healthcare institutions, education and social protection of the population, as well as their structural divisions, in the course of implementing the main directions, provisions and activities of the Program.

2. Program content

Decree of the Government of the Russian Federation dated 05.11.97 No. 1387 "On measures to stabilize and develop healthcare and medical science in the Russian Federation" provides for the implementation of a reform in the industry aimed at improving the quality, accessibility and cost-effectiveness of medical care to the population in the conditions of the formation of market relations.

An important role in the healthcare reform, ensuring the availability and quality of services provided to the population, strengthening the preventive focus, and solving the problems of medical and social assistance is assigned to specialists with secondary medical and higher nursing education and constituting the largest category of healthcare workers.

For the rational and efficient use of the existing human resources nursing potential in the current situation, the formation of state policy in the field of nursing and increasing the responsibility of authorities at all levels for its implementation are becoming important.

In this regard, in the context of the Concept for the Development of Healthcare and Medical Science in the Russian Federation, the State Program for the Development of Nursing has been developed in order to specify and implement its directions and provisions related to all aspects of nursing.

Main goals programs.

Providing assistance at the federal level and in the subjects of the Federation to bodies and institutions of healthcare, education and science in creating optimal conditions for the development of nursing;

Improving the efficiency of resource use in health care;

Development of new organizational forms and technologies of nursing care;

Improving the system of training and use of nursing staff;

Improving the management system of nursing services;

Improving the legal regulation of the use of nursing staff in health care;

Raising the professional and social status of the nursing profession;

Ensuring social security of nursing staff;

Promoting the development of professional nursing, midwifery, feldsher associations and involving them in the implementation of state policy in the field of nursing development.

Program principles

Universality, social justice and accessibility of medical care to the population;

Preventive orientation, health promotion;

Efficient use of labor, material and economic resources;

Ensuring the quality of nursing care to the population;

Active participation of the population in solving health issues.

The main activities of nursing staff

In accordance with the Concept for the Development of Health Care and Medical Science in the Russian Federation (hereinafter referred to as the Concept), the main directions in improving the organization of medical care, focused on the transition to less expensive technologies, are the development of primary health care based on municipal health care and the redistribution of part of the volume of care from expensive inpatient sector to outpatient.

Primary health care is becoming the main link in the provision of medical care to the population. A special role is given to the development of the general practice of family medicine.

The reorganization of the inpatient sector, focused on reducing the duration of the hospital stage, provides for the distribution of bed capacity depending on the intensity of the diagnostic and treatment process and the level of nursing care as follows: intensive treatment - up to 20%; rehabilitation treatment - up to 45%; long-term treatment of patients with chronic diseases - up to 20%; medical and social assistance - up to 15%. Nursing activities are highly diverse, ranging from high-tech clinical interventions to a wide range of primary health care services. There are also significant fluctuations in the degree of independence of nurses in providing medical care, making decisions and choosing tactics of action.

In accordance with the priorities established by the Concept, it is necessary to ensure the development and improvement of the activities of nursing personnel in the following areas:

- primary health care with an emphasis on preventive work;

- treatment and diagnostic assistance, including the provision of intensive inpatient treatment and care;

- Rehabilitation assistance and medical and social assistance to the chronically ill, the elderly and the disabled;

- medical and social assistance to incurable patients and dying (providing palliative and hospice care).

The special role of nursing staff in primary health care and family medicine is to use modern technologies prevention, including the formation of medical activity of the population.

The role of nursing personnel in the health education of the population in such important areas as the formation of a healthy lifestyle, the prevention of diseases, poisoning and accidents, sex education, family planning and safe motherhood is increasing.

Nursing personnel are responsible for providing training to the population in emergency care and methods of caring for sick and disabled persons, which will facilitate the solution of a number of medical problems. social problems by the population and the patients themselves, as well as increase the effectiveness of the activities of special services in emergency situations and the aftermath of natural disasters.

It is necessary to increase the participation of nursing staff in new organizational forms of community care: day hospitals, outpatient surgery and medical and social care centers, consultative and diagnostic services and home care services.

Ensuring the availability of medical care rural population requires the preservation and further expansion of the network of FAPs. It is necessary to take measures to improve the material and technical support of FAPs and health centers, the development of mobile forms of medical diagnostic and advisory assistance with the broad involvement of nursing staff.

In connection with the restructuring of the hospital bed fund in terms of the intensity of the treatment and diagnostic process, the profiling of activities and the rational use of nursing staff are becoming important. There is a growing need for personnel who can work with modern medical equipment, monitor the patient's condition, master the nursing process, the basics of psychology, and provide comprehensive comprehensive care and rehabilitation of the patient.

Reducing the duration of the hospital stage provides for the intensification of the nursing process in the hospital.

The practice of maintaining nursing care plans and documenting the activities of nursing staff should be extended.

Some of the expensive inpatient beds are to be converted into nursing beds (departments and nursing homes) to provide long-term care to the chronically ill, the elderly and the disabled. These measures will reduce costs while maintaining the volume and quality of medical and social assistance provided to the population.

The patronage service, various types of home care, requires further development and improvement.

It is necessary to take effective measures to develop palliative and hospice care, which in their content is a new stage in humanistic medical and social care for incurable patients.

The decisive role in the organization of all areas of activity of nursing personnel belongs to the heads of nursing services at various levels, starting with the head nurses of the departments of medical institutions and ending with the chief specialists in nursing of the health authorities. subjects of the Russian Federation. Particular attention should be paid to the formation of the administrative and managerial direction of nursing.

The development and improvement of the main activities of nursing staff should be accompanied by scientific support. In addition, for the successful implementation of the planned directions, a system of interaction and cooperation of nursing personnel with doctors, other specialists and services should be clearly thought out and provided.

3. Improving the organization of work of nursing staff

In the conditions of decentralization of the healthcare system, the development of market relations and the transition to budgetary insurance medicine, it became obvious that the quality and safety of medical care, as well as the effectiveness of medical services provided to the population, largely depend on the organization and management system of medical care.

A serious limitation of the existing system of providing medical care to the population is the lack of general principles and approaches to organizing the work of nursing personnel. Currently, there is no unified management system for nursing services at all levels, which negatively affects the quality and efficiency of nursing staff.

It is necessary to create a multi-level system for managing nursing services with a rational distribution of tasks and powers of nurses-leaders, starting with the chief specialist in nursing of the Ministry of Health of the Russian Federation, health authorities of the constituent entities of the Russian Federation and ending with the elder sister of the department of the healthcare institution.

Improving the quality of nursing care will be facilitated by the implementation of a set of measures for standardization, licensing, accreditation and certification.

The development and implementation of standards for the professional activities of nursing personnel both in outpatient and hospital settings should ensure a clear organization of the work of nursing services.

Creation required information systems, allowing the use of comparable data on improving the quality of care to the population.

In order to rationally organize work and assess the quality of care provided by nursing personnel, it will be necessary to computerize health care institutions and create appropriate information and analytical systems.

The culture of nursing, ethical standards of conduct, respect for the rights of the patient should become the basis for the professional activities of nursing staff in all its organizational forms.

Unfortunately, in our country, nursing as an independent professional industry does not yet have a sufficient number of highly qualified specialists involved in the development of ideology, the creation of textbooks, teaching materials. All this is mainly done by doctors.

On the other hand, it is impossible not to note the conservatism of doctors (and nurses, too), which impedes changes in the field of nursing. Indeed, nursing has always been focused on meeting the needs of doctors and has not developed as a profession in itself, but simply followed the development of medicine, becoming more functional and purposeful. It is convenient for a doctor to have a nurse nearby as an assistant, and not as an equal partner.

A June 2000 survey of 31 doctors and 45 nurses in the Sergiev Posad District showed that nurses are more aware of the nursing process than doctors and are more optimistic about its future (see table).

It can be seen from the above data that they are already inclined to realize their professional status in accordance with the norms accepted in the world community.

4. Improvement of personnel policy

Personnel policy issues should be addressed taking into account the changes taking place in all areas of health care. It is necessary to improve the system of planning, forecasting and monitoring the training and employment, certification and attestation of nursing personnel.

When forming a promising personnel policy, modern approaches should be developed to address issues of employment in health care and the distribution of resources, taking into account the needs of the population and new principles for organizing medical care.

The uneven provision of the population with nursing personnel, the existing imbalance in the ratio between doctors and nursing personnel require a significant adjustment in personnel policy at the federal, regional and local levels.

In this regard, it is necessary to reorganize the system of planning and distribution of human resources, which should change the ratio of doctor / nursing staff in the direction of increasing the latter with the transfer to nursing staff of some of the functions currently performed by doctors.

The most important areas of personnel policy should be the formation of evidence-based approaches to the calculation of needs, planning, training and use of nursing personnel, ensuring a rational balance and interaction with other health workers and providing a system of socio-economic incentives for personnel.

Particular attention should be paid to the creation of an effective system of certification and attestation, which would ensure an appropriate level of professional readiness and qualification of specialists, guaranteeing the quality of medical services provided to the population.

A bank of unified test items to improve certification and attestation in accordance with the nomenclature of specialties.

Improvement of personnel policy will also contribute to:

n increasing guarantees of social protection;

n providing prospects for professional growth, development and career;

n regulation of the remuneration system for specialists, taking into account the level of education, complexity, volume and quality of assistance provided;

n wide use of the contract system of recruitment;

n setting and indexing the wages of nursing staff in an amount not lower than the subsistence level;

n development of tariffs for nursing services;

n ensuring safe and favorable working conditions.

The system of remuneration of nursing personnel should be reformed in order to achieve the greatest possible correspondence between the amount of remuneration for the volume and quality of the work performed, the creation of economic incentives to improve labor efficiency and the rational use of resources necessary for the production of services.

In the field of ensuring labor protection of nursing personnel, it is necessary to:

Develop regulatory documents on labor safety in healthcare facilities;

Organize training on labor protection for managers and employees of healthcare institutions, students of vocational educational institutions;

To pursue a unified policy to establish compensations and benefits for the special working conditions of medical workers.

5. Improvement of professional education and development of scientific research in nursing

The formation of a qualitatively new level of nursing care for the population is based on the improvement of professional training, the development of scientific research in the field of nursing and the use of their results in practical health care.

Why is nursing research needed? The answer is simple. They let the nurses find best ways patient care. Evidence-based nursing practice is a practice based on objective data about the most effective ways of nursing interventions.

Already at the time of Florence Nightingale's observations and her statistical approach to reducing mortality from infectious diseases among soldiers in the Crimea, specialists expanded their knowledge by using scientific methods in their practice (gathering information, changing one variable while keeping other factors unchanged to identify differences in results, etc.).

Scientific research in nursing provides objective answers on how to provide patients with the best possible care. In this ever-changing landscape of increasingly complex technologies, the only effective way to reassure us of the validity of the care provided is to bring together collective knowledge and expertise through nursing research. Research is a scientific tool that allows you to objectively determine whether answers to clinical questions remain true over time and whether they remain true in more than one clinical situation.

Putting scientific research into practice not only helps patients, but also strengthens nursing as a profession. If nursing is indeed a profession and not just a job or occupation, then nurses must be able to constantly evaluate care and be held accountable for providing the best possible care.

The evaluation process is a crucial moment in the conduct of scientific research as well as in the provision of care. To determine if a study is ready for practical use, the nurse should ask herself the following key questions: how similar are the study examples to patients, do I understand the findings and conclusions of the study sufficiently, and will patient care improve as a result of the changes suggested by the study? If the nurse answers "I'm not sure" to any of these questions, then colleagues should be consulted and their opinion taken into account in the subsequent evaluation of the scientific method.

The first step in working with a patient is the ability to collect information about the state of his health, lifestyle, support systems, characteristics of the disease and adaptation, strengths, constraints and resources. This information can only be obtained in the process of communication with the patient.

However, communication with the patient is whole science and it is necessary to use it in practice gradually, as if gaining a skill "skill". A future nurse can collect information only by mastering the art and methods of communication, asking questions to the patient and his relatives.

Research in nursing provides answers to both how to provide care and what kind of care to provide.

The requirements for the qualification, attestation and certification of nursing personnel are the basis for the creation of vocational and educational programs for the training and postgraduate education of personnel in accordance with the classifier of specialties in the healthcare system.

The vocational education system should provide differentiated training of nursing personnel depending on the needs of the population and the service market and guarantee appropriate qualifications and competence in solving professional problems.

Creation and development state system multi-level training of nursing personnel is an important step in improving professional education and a necessary condition for ensuring the quality of nursing care to the population. The system includes 4 professional educational levels, each of which corresponds to a mandatory minimum content and duration of training in the specialty (State Educational Standard):

Basic (basic) level in colleges and schools;

Advanced (advanced) level in colleges;

Higher nursing education in universities;

Postgraduate education (internship, residency and postgraduate studies).

It is necessary to ensure continuity and integration between all levels of training.

The enhanced level of education should provide qualified nursing professionals who have advanced clinical training and are ready to provide a wide range of services in primary health care settings.

Particular attention should be paid to the development of higher nursing education, which forms the potential for scientific research in the field of nursing and provides highly qualified managerial and pedagogical personnel, designed to largely determine the level and quality of nursing care in our country in the future.

It is also necessary to develop and improve the forms of postgraduate education in internship, residency and postgraduate studies with a mandatory focus on clinical practice.

Improving vocational education provides for the development pedagogical technologies and educational and methodological support for specialists at all levels and forms of education.

Naturally, by loading students with a large amount of material, teachers cannot devote the necessary time to teaching patient care itself as a basis. nursing practice.

BUT the main objective is to educate a highly qualified nursing specialist, a personal nurse who shares the philosophy of nursing, is able to creatively carry out the nursing process, aimed at meeting the needs of both a sick and a healthy person.

The Fundamentals of Nursing curriculum includes manipulation techniques, nursing in therapy, nursing in surgery, and nursing in pediatrics. Students who have not mastered the basics of nursing well enough will find it difficult to teach integrated care for various patients in the future in the scope of the new curriculum, which assumes a phased education and its continuity from course to course.

Great importance in the work on this method is given to the use of algorithms. The creation of manipulation algorithms is a creative process and therefore quite complicated.

The use of algorithms makes it possible to unify education, streamline the teacher's requirements for students, avoid misunderstandings when assessing the correctness of students performing practical manipulations in tests and exams. In addition, learning with the use of algorithms disciplines both the student and the teacher at the same time, and allows the student to create a stable stereotype of future professional activity.

So, active training using algorithms makes it possible to prepare a nurse who is fluent in professional equipment. However, using only this technique, it is impossible to achieve from the future nurse the ability to clearly navigate in difficult situations, provide emergency first aid or provide comprehensive care. To do this, it is necessary to solve situational problems and play role-playing situations. The very name "situational task" suggests that a certain

the situation from which the nurse finds the best way out. When compiling situational tasks, it is necessary to avoid verbosity, excessive workload, the possibility of a dual interpretation of the facts presented.

It is necessary to provide conditions for advanced training and obtaining a higher level of education for specialists on the job.

To solve the problems of nursing education, a multi-level system for training nursing professionals is being formed. The network of secondary educational institutions was reorganized, faculties of higher nursing education were opened in 20 medical universities. New software and methodological complexes for specialties and disciplines have been prepared. A new generation of modular curricula and programs in nursing disciplines has been put into practice, and a state educational standard has been created for the specialty "Nursing".

Unfortunately, in the domestic practice of secondary medical education, there was no special training for teachers for medical schools. It was assumed that any doctor could competently train a nurse, paramedic or midwife, and for this he did not have to be a nursing specialist, know the basics of pedagogy and master the methods of teaching these disciplines. This simplistic approach to teacher training has led to nurses now being taught by medical graduates with medical qualifications but who are not nursing professionals.

Maintaining a high professional level, acquiring new knowledge and skills, taking into account the achievements of medical science and practice, requires that the advanced training of nurses be a flexible system of continuous learning in form and constantly updated in content.

The main objectives of the program, which ensures the professional pedagogical orientation of future specialists, are to provide a holistic, systematic, conceptual study of material on the problems of general pedagogy, patterns and principles of the learning process, the essence and content of the educational process, the use of modern education technologies to select the optimal strategy for teaching special nursing disciplines in depending on the level of training of students and learning objectives, the formation of skills for designing, developing and conducting standard activities related to teaching (lessons, lectures, seminars and practical classes), familiarity with methods for studying problems related to teaching, their resolution, analysis of private and general problems of teaching, management of the learning process.

It is necessary to abandon obsolete stamps and pedagogical techniques, long time used in the training of nurses. One of these clichés, which has brought a lot of harm, is the training of nurses on the principle of training a doctor, when diseases with their etiology, pathogenesis, clinical options, possible complications, emergency situations, and treatment are carefully studied.

It is necessary to spread the practice of formation by health authorities of target orders for the training of specialists with the conclusion of relevant contracts with educational institutions and applicants.

Ensuring the quality of training specialists to a large extent consists in solving the problems of logistical and educational and methodological support, staffing educational institutions with qualified teaching staff and creating modern training bases for practice that correspond to the main directions of development of outpatient and inpatient care.

In this regard, it is necessary to take effective measures to support the state system of professional nursing education, to train and improve the skills of pedagogical and administrative personnel, to create and disseminate educational literature, development of information systems and providing access to databases, as well as increasing the responsibility of basic health care institutions for the practical training of nursing personnel.

It is necessary to improve the system of final state attestation graduates of medical educational institutions in accordance with the requirements of the State Educational Standard.

In international relations in the field of nursing training, one should:

Restore professional ties with the CIS member states;

To develop work on the conclusion of international agreements of the Russian Federation on the mutual recognition of diplomas and other documents on professional training, as well as on cooperation between educational institutions, internships and training of specialists abroad on the principle of exchange;

Actively participate in international projects and programs of WHO.

The Ministry of Health of the Russian Federation considers the development of scientific research in the field of nursing and applied disciplines as priority areas for the development of medical science.

The main objectives of scientific research in nursing are:

Development of scientific approaches to the development and improvement of nursing;

Development of reasonable norms, criteria and standards of nursing practice;

Development of new forms of organization and methods of work of nursing staff;

Approbation of the effectiveness of experimental models of nursing practice.

The development of scientific research in the field of nursing will be carried out on the basis of the following principles:

Integration with research in other areas of medical science;

Formation of strong links between science, practice and education;

Promoting the development of the independence of nursing practice;

State support for research teams that make a great contribution to the development of nursing, the use of extrabudgetary sources of funding, including international projects, funds, etc.;

Legislative consolidation of legal mechanisms for the development of nursing;

Creation of a permanent monitoring of scientific research, conducting an examination of scientific programs and ensuring ethical control over research.

The functions of determining and coordinating the most important directions for the development of scientific research in the field of nursing will be carried out by the scientific council, which is part of the Problem Commission on Nursing of the Ministry of Health of the Russian Federation.

6. Development of professional associations, associations and unions

An important role in the development of nursing is assigned to professional nursing associations, associations and unions. It is necessary to provide effective support to professional organizations at the initial stage of their formation at the local, regional and state levels and the lack of necessary domestic experience in this regard.

In order to promote the development of professional organizations and associations, it is necessary to promote the experience of existing associations with the attraction of funds mass media, professional newspapers and magazines.

Representatives of professional associations should be more actively involved in the discussion of topical problems of healthcare and nursing, the development of regulatory and administrative documentation regulating the activities of nursing personnel, the work of licensing, certification and attestation commissions.

Of great importance for the development of professional organizations is cooperation with national and international nursing organizations, with professional medical organizations, as well as with public non-professional organizations that advocate for ensuring public health, protecting the professional rights and interests of health workers.

The priority task of the National Association of Nurses in Russia is to join the International Council of Nurses (ICM) and participate fully in its work. ”

The Association of Nurses of Russia actively advocates the development of nursing. Thus, having discussed the problems of the development of nursing in the Russian Federation, the nurses of the conference came to the conclusion that nursing reforms, as well as healthcare reforms in general, in our country will take place in conditions of limited (deficit) economic and human resources and that in the coming years a significant influx of the number of nursing cadres in health care should not be expected.

They believe that the preservation of nursing personnel, maintaining the level of their professionalism is one of the main urgent tasks of the nursing development program in our country. They believe that the principles of primary health care should be at the heart of the strategy for the development of nursing in Russia. The nursing development strategy should solve the following tasks:

Respond to changing healthcare needs;

Have a scientific justification;

To be socially acceptable, that is, to ensure the general availability of medical care, to take into account the interests of socially unprotected groups of the population;

Provide assistance at home, at the family level, in medical institutions;

Guarantee the high quality and safety of medical care;

Be focused not on the disease, but on active prevention based on a healthy lifestyle.

Nurses believe that the ultimate goals of the draft "National Plan for the Development of Nursing in the Russian Federation" should be:

maintaining the health of all citizens of the country;

• equality, accessibility of medical care for the entire population with its high efficiency and safety;

Improving the social and legal status of a nurse, midwife, paramedic.

Today, despite the existing problems, both social and economic nature , the main cadres of nurses have preserved the traditions of Russian mercy, professionalism, and enthusiasm. There has been a revitalization of their activities, the creation of nurses' associations, their commitment to change in nursing and support for change. This is an important factor. contributing to the development of nursing reforms.

7. Program implementation mechanism

For the implementation of the Program, specific measures are determined for each section, indicating the deadlines for their implementation, responsible executors, and the amount of funds necessary to carry out the activities.

The implementation of program activities is managed by an interdepartmental working group created by the Ministry of Health of Russia in agreement with the interested ministries and departments, the Association of Nurses of Russia.

Conclusion

The observed stratification of society, the increase in the number of socially unprotected groups of the population negatively affects the availability of medical care.

In the context of a shortage of economic funds and human resources, it is difficult to provide the population with generally accessible, safe and high-quality medical care. The decentralization of health care and the education system in our country has certain negative consequences. In particular, this led to a violation of the coordination of actions, a decrease in control over the quality of medical services, a drop in the level of education and, most importantly, to the loss of information about the problems and human resources of healthcare, and hence to a decrease in the reliability of the data obtained.

The health of the population of our country, the level of education are the main indicators that ensure the security of the state. We urge the government state organizations to maintaining financial security in the Russian budget of expenditure items for health care and medical education.

For the preservation and strengthening of nursing care, the development of nursing in the Russian Federation, we consider the following activities as priority:

Development national program healthcare (health protection);

Development (within the framework of the national health program) of a program for the development of nursing in the country;

Determining the limits of the competence of a nurse, depending on the level of education and qualifications,

Revision of workload norms and work standards for nurses of various specialties, the nomenclature of positions and consolidation and X legislative legal documents;

Revision of the level of remuneration of nurses, midwives, paramedics, improvement of social conditions:

Strict regulation and control of labor safety at the workplace of physicians:

Development of professional associations in the regions and approval of the status of associations in the legislative order.

nursing medicine social economic

Bibliography

1. Agafonova B.V. Material for staff rationing of doctors and honey. sisters, M., 1990

2. Andreeva O.V. Application of some active methods in nursing, Journal “Med. help” No. 7, 1996

3. Barkman E.M. Hospital management, M., 1972

4. Druzhinina A. About nursing, Journal "Nursing" No. 3, 1997

5. Zhenner S. Why do we need research in nursing?, Med. help” No. 1, 1997.

6. Zadvornaya O.L. Continuous postgraduate education med. sisters. M., 1995

7. Kovalenko T.V. College of Medicine in the system of continuing nursing education, Journal "Medical Sister" No. 3, 1999

8. Markova A.K. Psychology of professionalism, M. “Knowledge”, 1996

9. Mukhina S.A. Theoretical foundations of nursing, M., 1996

10. Naumov L.B. business games in medicine, M., 1986

11. Ostrovskaya I.V. Nursing: Status Evolution, Med. sister” No. 4, 2000

12. Pavlechenko T.N. On the problem of training teachers of nursing, Journal “Med. help” No. 5, 1998

13. Perfil'eva G.M. Reforms of secondary medical education in Russia, Journal of Medical Assistance, No. 8, 1996

14. Perfil'eva G.M. Nursing process, Journal “Med. sister” №3 1999

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16. Romanyuk V.P. History of nursing in Russia, St. Petersburg, 1998

17. Rudneva T.I. Fundamentals of pedagogical professionalism, Samara, 1996

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The main objectives of the modernization of Russian healthcare and the activities of any medical organization. Improving the quality and accessibility of medical care. Medical and nursing as independent professions. Functions and goals of nursing.

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 of 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 the 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 ratio of a doctor to the average medical staff 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.

Healthcare as an industry in recent years has 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.