Nursing: A Leadership Role in Quality Improvement

"As nurse managers, we are like orchestra conductors," said Doris Quinn, RN, MSN, director of process improvement at Vanderbilt University in Nashville, TN and moderator of the AIHA nursing workshop. "Like conductors, we must direct the flow of arrows that move a patient horizontally through the hospital path of recovery."

Nurse leaders from every NIS partnership sounded a common theme—the need to enhance the role and status of nurses as a necessary, cost-effective method for improving the management and clinical infrastructure of the health sector in the NIS. At the workshop, nurse leaders agreed to establish an NIS-wide nursing association to unify every partnership nursing initiative. Tatyana Mikheeva, RN, deputy director of the St. Petersburg Postgraduate Nursing School, and Jane Younger, RN, chair of the AIHA NIS Nursing Task Force, will serve as co-chairs of the association. "This is an exciting time for nurses throughout the NIS to work together to support the expanding role of today's nursing leaders," said Mikheeva.

Workshop participants noted common problems in each sphere of the health care delivery system that can re-route a patient's path of recovery, including sudden change in the patient's condition, insufficient medication, inaccurate lab results and lack of equipment. Flow charts allow nurses to understand their patients' needs and identify potential problems along the path of recovery.

Because of cost-cutting measures, the ratio of patients to nurses continues to grow, despite recent efforts to reduce the patient load. In the city of Bishkek, Kyrgyzstan, the average of eight patients per nurse in 1993 rose to 12 in 1995. Continued economic constraints have forced some hospitals to eliminate sanitary help, increasing nurses' workload.

At the same time, advances have been made in nursing. Galina Perfiljeva, MD, dean of the School of Nursing at the I.M. Sechenov Moscow Medical Academy, noted nurses' low professional status and educational preparation as problems that limit quality improvement in NIS hospitals. Perfiljeva's Postgraduate Nursing School at the academy has responded by introducing Russia's first master's degree nursing program.

Kalkaman Ayapov, MD, president of Almaty Medical College School of Nursing in Kazakhstan, explained his college's adoption of a new four-year nursing curriculum leading to a bachelor's degree in nursing administration. The curriculum, which includes night school, is supported by the Kazakh Ministries of Health and Education and has been adopted by nine other medical colleges in Kazakhstan.

Still, Ayapov noted these reforms would be futile without commensurate salary increases. "Without such incentives, we would lose many skilled nurses," said Ayapov. "We were fortunate that the Ministry of Labor not only approved an increase in salaries, but also the creation of four new categories of nursing positions for [our] graduates."

Irina Bakhtina, MD, dean of the School of Nursing at the St. Petersburg Medical Center in the Name of Sokolov, described how her hospital created a microhospital--a new unit in which nurses are the primary care givers. She noted a striking improvement in patient services that resulted from an increased level of nursing care. "We are discovering that our patients who pay for their services are beginning to count their money—and they are beginning to demand quality care."

Bakhtina explained how nurses at the microhospital provide cost-effective, quality care to the patient as evidence for continued support of improved nursing education and expanded job descriptions. Bakhtina's nursing school has been a leader in nursing reforms, introducing mandatory 36-hour, continued education courses for all nurses at Hospital 122; creating 20 faculty nurse positions at the school; and increasing nurses' salaries commensurate with their position and level of education.

Jane Salvage, RN, regional advisor, Nursing and Midwifery, WHO/Europe, applauded the partnerships for their advances in nursing reform, and presented WHO's Russian-language NIS report, "Nursing in Action," due to be released in the NIS in early 1996.