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Solutions to the Problem with Nurses Exist – Copy the Teachers, but Act Quickly

This Wednesday, the issue of the shortage of nurses in Bulgaria was discussed in the Education Committee. On Thursday, the topic was also discussed in the Health Committee.

The exact reasons for the problem were partly named, but some of the proposed solutions had nothing to do with the issues.

In our country, there is already a good example to follow – that of the teaching profession.

After the large teachers’ strike in 2007, several changes were made, which took time to unfold and show results, but now we can say that the situation has significantly improved, at least concerning those working in secondary education.

Briefly:

  • A plan was made for raising salaries, which was applied by all subsequent governments; (the increase in salaries in education for the first two years of the reform is 46%); currently, teachers are among the highest-paid people in several small municipalities, and in larger ones – with an average salary level;
    • 111 small schools were closed in 2007, 340 in 2008, and 44 in 2009;
    • Almost all schools were renovated through European projects, and the material base was updated; in many municipalities, the school is the only one that has been renovated, and while the number of students decreases, the number of those in need of medical care will grow – the reason is the same – low birth rates, aging, and increasing life expectancy;
    • Local communities were more actively involved through school boards;
    • A slow conversation began about the quality of educational services and improving student outcomes;
    • Initiatives were organized to attract young people to the profession, including by creating professional communities for exchange and discussions.

    If you replace school with hospital and teacher with nurse, you will already have a plan that has been proven to work.

    And still, let us consider some peculiarities while offering solutions.

    ProblemSolutionInfluence on the problemProbability for occurrence
    Disproportionate pay compared to workloadIncrease salaries according to workload.In 2 years, there will be real results.High: This is the easiest and most understandable measure. It has significant public support – there is funding, the issue is how to direct it to the nurses. 
    Continuous training for acquiring specialization, when receiving a diploma recognized in the EUReduce training duration by at least one year – from 4 to 3 years (EU requires a minimum of 3 years of training for automatic recognition of nursing diplomas).In 2 years, there will be real results.Low: Reluctance from medical universities, lack of understanding from the Ministry of Health (EU Directive 2005/36 is cited). Emigration undermines efforts to reduce the duration of education. Demand for the nursing profession is currently relatively weak. 
    Poor working conditions, especially in municipal facilitiesClose municipal hospitals. Create medical centers offering basic services under better conditions.In 2 years, there will be real results.Low: Significant resistance at the local level, despite poor quality of health services and lack of medical specialists. 
    Nurses and midwives cannot create their own practices, whose services are paid by the NHIFLegal possibility for nurses and midwives to have independent practices, paid by the NHIF.In 1 year, there will be results.High: Indications of agreement to allow healthcare specialists to open independent practices. A working parliament is needed. 
    Mandatory requirement for a nurse in each nursery group, etc.Normative “release” of many nurses from structures where there is no comparable need as in hospital care.In 1 year, there will be results.Low: Some legal exceptions for ensuring medical specialists in nursery groups have already been introduced. 
    High dropout rate during education – realizing the profession is not for themCareer guidance for young people aged 18 to 30 who consciously choose the profession.In 3-4 years, there will be results.Medium: A new career guidance system needs to be created in secondary education, along with active efforts for people outside the education system. 
    Lack of career development horizonClear plan for training, seminars, skills enhancement, etc., leading to salary adjustments. Building a comprehensive and well-regulated system for continuous education for healthcare professionals.In 3-4 years, there will be results.Medium: Relatively easy to plan and implement. Depends on the administrative capacity of the Ministry of Health and directors of healthcare institutions. 
    Difficult/slow/impossible recognition of foreign qualificationsThe EC explicitly states that the recognition of professional qualifications should not depend on language skills, unless they relate to qualifications (e.g., speech therapists, language teachers).In 1 year, there will be results.Medium: Resistance from doctors.

    No reform is easy, especially when many stakeholders are involved – hospitals, doctors, municipalities, NHIF, while the most important one – the patient – is missing from the negotiations.

    It is unclear whether this time there will be progress, because it depends on those who have been talking about the need for reform for years without actually doing anything.


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