It is with great disappointment that we observe the long-term pressure to reduce the requirements for the education of nurses with the alleged aim of quickly getting enough nursing workers into the system, or to replace nurses with a less educated workforce, as a supposedly effective measure to supplement the catastrophic nursing shortage. This pressure is exerted not only by employers in the health sector, but also by politicians, who go along with the populist, unprofessional and unfounded claims of some representatives of secondary medical schools. For decades, no one noticed this problem, despite the fact that SKSaPA has for a long time warned and continues to warn about the fact that more nurses are leaving our system than entering it. Today we are looking for simple, but dangerous solutions, which are dangerous not only for the system, but also for the patient. Faced with these steps, with a negative impact on the stabilization of nurses and the entire health care system, SKSaPA objected for years and pointed out the effects, which are today, unfortunately, a reality for which patients pay.
The reason for the lack of nurses in the system is not their education, but long-term ignoring of their problems, poor working conditions and low pay. SKSaPA has several surveys where we find out in the results what are the motivating and demotivating factors for work in our health sector.
Some experts, as well as politicians, seem to have forgotten that we live in the 21st century, where world trends point to the important role of educated nurses in caring for the health of the population. Today, nurses take on important tasks across the entire healthcare system, they have different education, different competences, they can make decisions independently in many areas and they are taking on more and more responsibility. Modern nursing is a separate scientific field. Nursing is an applied science, it has its experts, and they should first of all decide on the direction of the field. Unfortunately, we are met with ignorance and ridicule rather than respect, especially from doctors and politicians.
Proof of this is Mr. Pellegrini's appearance in the Na telo TV Markíza show, where he said that the nurses should be given "a blue skirt and a cap with a pin and sent to the hospital." This is also one of the reasons why graduates do not want to stay in Slovakia, where no one values their work, on the contrary, leading political representatives disparage it with their sexist statements. The exodus from the profession has been going on for almost 20 years, and even the previous governments did nothing, and that was not the pandemic, the war and the energy crisis.
Infamous milestones in the destabilization of nurses in Slovakia were actions initiated mainly by medical societies – SLK, SLS, ANS and others, supported by political decisions. Such steps included an increase in the number of patients that a nurse should care for in the service, the repeal of Act No. 62 in 2013, which was supposed to stabilize nurses by determining their salaries by filing a SLK with the Constitutional Court of the Slovak Republic with the support of the then members of the National People's Congress of the Slovak Republic, dividing the duties of nurses in private health facilities into the activities of nurses and the activities of administrative workers, reducing the working hours of nurses from 1.0 to 0.9-0.5, or renaming the medical assistant to a practical nurse, efforts to replace nurses by paramedics in emergency departments, reassignment of nurses in social service facilities to nannies. These actions caused an even greater decrease in nurses, an even greater destabilization of nursing and the health care system.
It is sad that some of our fellow doctors, despite being proud of having completed specialized management studies, do not even know and use the correct terms. Today, we do not have "intermediate medical personnel" or "non-medical professions" in the system. These terms were used in the last century, when, according to the opinion of many, only doctors existed in the system, and then the so-called the average medical staff (with completed high school education) who serviced them, were subordinate to them, did only what the doctors ordered them to do and they egoistically and with a proper degree of superiority ruled the whole system. Today, it appears that many still cannot absorb this experience from the past and that teamwork and collegiality with other health professionals do not suit them very well, because they have no way to feed their superiority. Fellow doctors who were on internships abroad in the 1990s and are trying to compare our current education system with that of the 1990s should better study in more detail the laws and decrees from the reform measures from the beginning of the 21st century, which clearly define the professions of nurses and midwives, as well as other health workers and their competencies. And they should also notice how the doctors there treat other health workers. With respect and honor.
Fortunately, development cannot be stopped, and despite these attacks, nursing is also progressing in Slovakia. The quality of nursing education is improving, despite many obstacles, we are trying to bring our foreign colleagues closer to our competences, we are carrying out nursing research, we are educating new colleagues, we are applying evidence of good practice into practice, we are independent and autonomous providers of nursing care, which is also one of the motivating factors.
"Collegeization" of nursing education?
SZŠ were among the prestigious secondary vocational schools, there was an above-average interest in studying at them, but today, after the change in the education of nurses and other health professions, such as paramedics, physiotherapists, dental hygienists, midwives, laboratory assistants and others, the demands and the system of perception of these professions have completely changed, and their practice and education have moved to a higher education environment, which offers a much higher quality, scope and content of education, incomparable to education at secondary schools schools. Many statements by certain "experts" regarding the education of nurses in Slovakia are untrue, testifying to ignorance of the issue, while they have no problem interpreting them incorrectly. Among these is the claim that nurses must have a university education, because there was a bad translation of the conditions for the education of nurses during the accession negotiations of the Slovak Republic's entry into the EU. It's not true. Nurses, like other professions, can also study at a secondary health school, but the study must include 4,600 hours of professional training, of which at least half is practical teaching based on the EU Directives issued for the profession of nurses, as a regulated profession. Anyone who has even a little understanding of this issue can easily figure out that this condition cannot be met in high school in four years of study, as high school students must also complete general subjects for matriculation education. At some secondary medical schools, they also have activated a three-year full-time extension study, where nurses can study in diploma nurse study programs according to the EU directives, which are already applied in the same way in all member states. However, future nurses show little interest in this study, as they realize that studying at the faculties of health/nursing at the bachelor's level offers them a quality where they have more options for further study, e.g. in the master's degree, which is also for many the fulfillment of their ambitions and career growth. The EU states in which nurses were not educated according to the guidelines have also changed their study programs today, so the claim that nurses do not have universities in the West is biased and false, because according to the guidelines they are changing the system of training for the profession of nurses in all EU countries.
Fortunately, not all doctors and politicians are backward and narrow-minded. There are more and more people in the system who understand the importance and contribution of educated and competent nurses who are ready for new advanced roles. Nurses work for licenses, are owners of home care agencies, provide long-term care services. Today, nurses can issue prescriptions, prescribe medical devices, and make independent decisions. Nurses work using the nursing process method, assess patients' condition, use scales, care maps, standard procedures, keep records of their activities in nursing documentation, evaluate outputs. Many activities performed by a Slovak doctor have been performed by educated nurses abroad for decades, which also brings an economic effect. The practice of nurses has changed significantly and is still changing in terms of scientific progress. The nurse spends the most time with the patient, and therefore the treatment and recovery, as well as the patient's condition, largely depend on her knowledge and experience.
Every sensible society invests in the education of its citizens, especially those who care about people's health and lives. Scientific studies prove that the more educated nurses working in healthcare facilities, the better chance patients have for survival and recovery.
Source: Slovak Chamber of Nurses and Midwives www.ksapa.sk
Slovak Chamber of Nurses and Midwives (SK SaPA) is a self-governing state organization with pan-Slovak scope, headquartered in Bratislava, bringing together 40,000 nurses and midwives. The main task of SK SaPA is to defend the professional, economic and social interests of the members of the chamber in medical, social, school and other facilities.