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Nursing development programme: Latvia. October 2002
U P D A T E
Nursing development programme: Latvia. q October 2002 Jenny Booth and Deborah Wheeler BACKGROUND In May 1990 a nurse development programme was commenced with the aim of offering a short period of orthopaedic clinical nursing experience and observation to nurses from the states of the Baltic Republic – Latvia, Lithuania and Estonia. The programme was a joint venture between the Keggi Orthopaedic Foundation in USA and the Nuffield Orthopaedic Centre, Oxford, with finance, in the form of a scholarship, from the Smith and Nephew Foundation in the UK. The overall aim of the visits was to offer an insight into nursing in the UK, to enable the visiting nurses to return with ideas in the hope that they could introduce changes within their workplaces. Part of the scholarship grant was to be used for textbooks.
REASONS FOR THIS VISIT We had concerns about the value of the programme in its present form. We were not sure that the individual nurses, some of whom were in fairly junior positions and from a variety of institutions, would be able to make changes in their hospitals on their return. Deborah had never visited Latvia, so had no idea of the working environment and practices. As my last visit to the republics had been 7 years ago and nursing was likely to be developing very fast in Latvia, I could not be sure that my advice to her on suitable programme content remained valid. In addition, the RCN Society of Orthopaedic and Trauma Nursing already has overseas
q In October last year Deborah Wheeler, Chair of SOTN and myself, Jenny Booth, Vice Chair, travelled to Latvia to review a nurse education programme, which started in 1990.
Journal of Orthopaedic Nursing (2003) 7, 161–163 doi:10.1016/S1361-3111(03)00064-5
C
2003 Published by Elsevier Science Ltd.
links with the USA and Canada and as Chair and Vice Chair of SOTN we wanted to see if it would be possible to include this programme in the International nursing links initiative.
NURSING IN LATVIA AT THE START OF THE PROGRAMME IN 1990 The republics had just gained their independence from the Soviet Union when the programme commenced; in fact the first nurses from Latvia were in Oxford when independence was declared. The programme has therefore taken place throughout a period of incredible change in all three countries. At the start of the programme, there was no national training programme for nursing. There was no system of national registration for nurses or continuing education programmes. Shortages of everything were the norm. There were very few dressings – nurses cut and folded swabs, drugs were in short supply, equipment in some hospitals was old and in short supply. There was no nursing documentation; all nursing care was prescribed by doctors, and drugs and treatments were listed by patient name on one document. Medical records were completed by the doctors and kept in their office. Nursing was very task orientated, with one nurse responsible for all the dressings, another for giving all the drugs. Nurses were working shifts of up to 24–48 h in some hospitals, and staffing levels were very low; 2–3 nurses caring for 30–40 patients. Medical students would often work on wards at the weekends in place of or alongside nurses. The status of nurses was low, as was their salary. Nurse education was medically focused, with most lectures given by doctors. Despite the difficulties they were facing, there was a genuine openness and willingness to learn
162
Journal of Orthopaedic Nursing
and take on new ways of working and new ideas. Many of the nurses paid for the extra English lessons they needed, and somehow found the time to improve their English enough to be able to take part in the programme.
WHAT WE SAW ON OUR VISIT TO RIGA, LATVIA IN OCTOBER We visited the Ministry of Welfare and met with the head of the Strategic Planning Department, a nurse who had been to the UK on the development programme. Here we were given an excellent overview of health care in Latvia, including a great deal of background information on health policy. Our next visit was to Riga City Hospital Number 1, a 675 bed general hospital in the centre of Riga, where we were greeted by the Chief Nurse who, along with one of her nurses had been to the USA for clinical experience. In this big general hospital there are 675 beds, 419 trained nurses, 56 nursing assistants and 223 sanitary nurses (staff on the wards who serve meals, clean, etc). There are 288 doctors. Nurses work either 12 or 24 h shifts in a 38–40 h working week. Nursing salary a month is 84–119 Lats, after 7 years training. (1 Lat is approx £0.90). There is a nursing assistant training programme running in the hospital, which is now in its third year, with 20 students completing a 9month course. The patients were in 2–5 bed rooms, some with their own toilets but none with curtains between the beds. There was some individual patient nursing documentation, which was kept at the nursing station separate from the medical notes. A dependency scale with three levels of care was in use, but assessment seemed to be on clinical judgement rather than against objective criteria. The Head nurse wanted to introduce standards of care and nursing documentation throughout the hospital, and was hoping to set up a working party to begin the process. The following day, we went to the Riga Nursing School Number 5 and met with the Director and three of her education team. It was here that some of the most dramatic changes that had taken place over the last 5 years since my last visit were. There is now a state-wide nurse education programme, with a State Board Exam at the end of 3 years on a Baccalaureate Diploma programme and 4 years for a Degree programme. These were based on programmes in Finland and Denmark, from where they have received developmental support. Students enter a vocational training program at 16 years and Nurse education at 19. There are also Masters and Doctoral programs, as well as a training program for Nursing Assistants.
We followed this by visiting the Continuing Education Centre in Riga, where we were met by the Director. There are two main departments here – the Continuing Education Department, responsible for developing teaching material for nursing schools, planning, running and accrediting courses for continuing education throughout Latvia, setting and marking State Board exams and a department responsible for the State Registration process for all nurses in Latvia. The register was established in 1995, and there are now 16,500 registered practitioners in Latvia, 12,957 of who are in practice. They now have a 5 yearly re-registration process. All nurses have to collect continuing education points to enable their re-registration. Our next visit was to The State Hospital of Traumatology and Orthopaedics in Riga, this was the first hospital I visited in Latvia in 1992. Again I saw major developments. We spent time in the newly furbished and very well equipped operating room and sterilisation unit. Instruments are autoclaved and packed in trays, with single packed instruments available. On my first visit, instruments were steam sterilised and laid onto trolleys as needed from the sterilisers. The 40 bed ward was bright, clean and well equipped. Again, patients were in 2–5 bed areas, with the doors shut. Nurses were allowed to administer some drugs without a doctor’s prescription. Epidural anaesthetics are used and kept in place postoperatively, with nursing staff topping them up for up to 3 days. There were nursing care algorithms and individual nursing records for patients, all kept on the nursing station. A clinical teacher was available on the ward, and there were individual profiles/records kept for all nursing staff. Our final visit was to Valmiera Regional Hospital, a 2 h drive from Riga. This was a more modern hospital, built around 20 years ago. We visited A&E, the in-house blood transfusion service, ITU, paediatric ward and an orthopaedic ward, as well as the operating rooms.
PLANS FOR THE FUTURE
• Draw up a 5-year development plan for the scheme.
• Widen the entry criteria to nurses from specialities other than orthopaedics.
• Development of a core programme for visits. • Involve Middlesex University (education •
provider for the Whittington Hospital) to gain their support and guidance. Try to arrange a bi-annual nursing conference in Latvia. All nurses who have visited UK should be expected to present their
Nursing development programme: Latvia. October 2002
•
developments. Event to be attended by someone from UK. Gain accreditation for the programme from the Continuing Education Centre, so that it carries credits towards re-registration.
163
• Target some of the more senior Head nurses/ Chief nurses of hospitals and bring them to the UK on the programme for 2 weeks. Jenny Booth, Deborah Wheeler
Nursing development programme: Latvia. q October 2002 Jenny Booth and Deborah Wheeler BACKGROUND In May 1990 a nurse development programme was commenced with the aim of offering a short period of orthopaedic clinical nursing experience and observation to nurses from the states of the Baltic Republic – Latvia, Lithuania and Estonia. The programme was a joint venture between the Keggi Orthopaedic Foundation in USA and the Nuffield Orthopaedic Centre, Oxford, with finance, in the form of a scholarship, from the Smith and Nephew Foundation in the UK. The overall aim of the visits was to offer an insight into nursing in the UK, to enable the visiting nurses to return with ideas in the hope that they could introduce changes within their workplaces. Part of the scholarship grant was to be used for textbooks.
REASONS FOR THIS VISIT We had concerns about the value of the programme in its present form. We were not sure that the individual nurses, some of whom were in fairly junior positions and from a variety of institutions, would be able to make changes in their hospitals on their return. Deborah had never visited Latvia, so had no idea of the working environment and practices. As my last visit to the republics had been 7 years ago and nursing was likely to be developing very fast in Latvia, I could not be sure that my advice to her on suitable programme content remained valid. In addition, the RCN Society of Orthopaedic and Trauma Nursing already has overseas
q In October last year Deborah Wheeler, Chair of SOTN and myself, Jenny Booth, Vice Chair, travelled to Latvia to review a nurse education programme, which started in 1990.
Journal of Orthopaedic Nursing (2003) 7, 161–163 doi:10.1016/S1361-3111(03)00064-5
C
2003 Published by Elsevier Science Ltd.
links with the USA and Canada and as Chair and Vice Chair of SOTN we wanted to see if it would be possible to include this programme in the International nursing links initiative.
NURSING IN LATVIA AT THE START OF THE PROGRAMME IN 1990 The republics had just gained their independence from the Soviet Union when the programme commenced; in fact the first nurses from Latvia were in Oxford when independence was declared. The programme has therefore taken place throughout a period of incredible change in all three countries. At the start of the programme, there was no national training programme for nursing. There was no system of national registration for nurses or continuing education programmes. Shortages of everything were the norm. There were very few dressings – nurses cut and folded swabs, drugs were in short supply, equipment in some hospitals was old and in short supply. There was no nursing documentation; all nursing care was prescribed by doctors, and drugs and treatments were listed by patient name on one document. Medical records were completed by the doctors and kept in their office. Nursing was very task orientated, with one nurse responsible for all the dressings, another for giving all the drugs. Nurses were working shifts of up to 24–48 h in some hospitals, and staffing levels were very low; 2–3 nurses caring for 30–40 patients. Medical students would often work on wards at the weekends in place of or alongside nurses. The status of nurses was low, as was their salary. Nurse education was medically focused, with most lectures given by doctors. Despite the difficulties they were facing, there was a genuine openness and willingness to learn
162
Journal of Orthopaedic Nursing
and take on new ways of working and new ideas. Many of the nurses paid for the extra English lessons they needed, and somehow found the time to improve their English enough to be able to take part in the programme.
WHAT WE SAW ON OUR VISIT TO RIGA, LATVIA IN OCTOBER We visited the Ministry of Welfare and met with the head of the Strategic Planning Department, a nurse who had been to the UK on the development programme. Here we were given an excellent overview of health care in Latvia, including a great deal of background information on health policy. Our next visit was to Riga City Hospital Number 1, a 675 bed general hospital in the centre of Riga, where we were greeted by the Chief Nurse who, along with one of her nurses had been to the USA for clinical experience. In this big general hospital there are 675 beds, 419 trained nurses, 56 nursing assistants and 223 sanitary nurses (staff on the wards who serve meals, clean, etc). There are 288 doctors. Nurses work either 12 or 24 h shifts in a 38–40 h working week. Nursing salary a month is 84–119 Lats, after 7 years training. (1 Lat is approx £0.90). There is a nursing assistant training programme running in the hospital, which is now in its third year, with 20 students completing a 9month course. The patients were in 2–5 bed rooms, some with their own toilets but none with curtains between the beds. There was some individual patient nursing documentation, which was kept at the nursing station separate from the medical notes. A dependency scale with three levels of care was in use, but assessment seemed to be on clinical judgement rather than against objective criteria. The Head nurse wanted to introduce standards of care and nursing documentation throughout the hospital, and was hoping to set up a working party to begin the process. The following day, we went to the Riga Nursing School Number 5 and met with the Director and three of her education team. It was here that some of the most dramatic changes that had taken place over the last 5 years since my last visit were. There is now a state-wide nurse education programme, with a State Board Exam at the end of 3 years on a Baccalaureate Diploma programme and 4 years for a Degree programme. These were based on programmes in Finland and Denmark, from where they have received developmental support. Students enter a vocational training program at 16 years and Nurse education at 19. There are also Masters and Doctoral programs, as well as a training program for Nursing Assistants.
We followed this by visiting the Continuing Education Centre in Riga, where we were met by the Director. There are two main departments here – the Continuing Education Department, responsible for developing teaching material for nursing schools, planning, running and accrediting courses for continuing education throughout Latvia, setting and marking State Board exams and a department responsible for the State Registration process for all nurses in Latvia. The register was established in 1995, and there are now 16,500 registered practitioners in Latvia, 12,957 of who are in practice. They now have a 5 yearly re-registration process. All nurses have to collect continuing education points to enable their re-registration. Our next visit was to The State Hospital of Traumatology and Orthopaedics in Riga, this was the first hospital I visited in Latvia in 1992. Again I saw major developments. We spent time in the newly furbished and very well equipped operating room and sterilisation unit. Instruments are autoclaved and packed in trays, with single packed instruments available. On my first visit, instruments were steam sterilised and laid onto trolleys as needed from the sterilisers. The 40 bed ward was bright, clean and well equipped. Again, patients were in 2–5 bed areas, with the doors shut. Nurses were allowed to administer some drugs without a doctor’s prescription. Epidural anaesthetics are used and kept in place postoperatively, with nursing staff topping them up for up to 3 days. There were nursing care algorithms and individual nursing records for patients, all kept on the nursing station. A clinical teacher was available on the ward, and there were individual profiles/records kept for all nursing staff. Our final visit was to Valmiera Regional Hospital, a 2 h drive from Riga. This was a more modern hospital, built around 20 years ago. We visited A&E, the in-house blood transfusion service, ITU, paediatric ward and an orthopaedic ward, as well as the operating rooms.
PLANS FOR THE FUTURE
• Draw up a 5-year development plan for the scheme.
• Widen the entry criteria to nurses from specialities other than orthopaedics.
• Development of a core programme for visits. • Involve Middlesex University (education •
provider for the Whittington Hospital) to gain their support and guidance. Try to arrange a bi-annual nursing conference in Latvia. All nurses who have visited UK should be expected to present their
Nursing development programme: Latvia. October 2002
•
developments. Event to be attended by someone from UK. Gain accreditation for the programme from the Continuing Education Centre, so that it carries credits towards re-registration.
163
• Target some of the more senior Head nurses/ Chief nurses of hospitals and bring them to the UK on the programme for 2 weeks. Jenny Booth, Deborah Wheeler