Paying tribute to nurses, a valued but demanding profession

There are approximately eighty thousand general nurses working in the Czech health care system in the long term, with around fifteen hundred graduates of universities and colleges entering the system each year. Slightly fewer practical nurses enter practice after graduating from secondary schools. Although the overall numbers of graduates in general nursing have been increasing slightly in recent years, and with a rate of about nine nurses per 100 000 inhabitants we are one of the countries in the world with a better nurse-patient ratio, it is also a fact that there is still a deficit of about eighteen hundred full-time general nurses in the whole department.

However, according to Professor Andrea Pokorná, Vice-Dean for Non-Medical Programmes and Information Technology at the Faculty of Medicine of Masaryk University, this is not an exceptional situation. "The shortage of general nurses is evident all over the world," she assesses, referring to hard data and some recent studies. According to them, while the profession of general nurse enjoys society-wide recognition and is positively perceived by the public, this is not always enough to balance its undeniable demands, both physical and psychological.

One notable study, for example, is that a general nurse walks more than 9,700 steps during a day shift, or about six and a half kilometres. From this alone, it is clear that "the physical activity of nurses is higher than that of the general population," summarise the authors of the two-year-old text. Add in the tasks involved in handling patients, including lifting heavy weights, and it is not so surprising that, in a survey of more than 500 respondents conducted by Professor Pokorná's team, 93% of nurses said that they experience back pain, with two-thirds of them believing that this condition is at least partly related to their profession.

A follow-up survey comparing back pain in general nurses from the Czech Republic and the United Kingdom found that Czech nurses were much more likely to report lower back pain in particular and that it was one of the reasons why they would consider leaving the profession. Physical problems can have a number of negative consequences, ranging from seeking less strenuous jobs to a decline in productivity - as Professor Pokorná notes, there are many 'heartthrobs' among nurses who often attend work despite their own health problems, thus committing 'presenteeism'.

Demands on the nursing profession are increasing

That is why, for example, the Ministry of Health of the Czech Republic, as part of its efforts to keep nurses in the system, is launching a project called Nursing Workload Measurement, the aim of which is to map the activities of nurses at individual workplaces and, based on the monitoring data, to adjust their working conditions and optimize staffing. At the Faculty of Medicine of Masaryk University, where 25-30 students have been admitted to the three-year General Nursing course each year in recent years, future nurses are consistently prepared for the demands of the profession during their studies. As required by legislation, they spend half of the 4,600 hours of teaching in clinical practice, but they are also given support to cope with the workload.

"We teach students about ergonomics and ergonomic practices in providing care, and all students are encouraged to take care of their bodies, and it doesn't have to be just mandatory PE," says Andrea Pokorná. However, according to her, the psychological demands on the nursing profession have also increased recently. This is not only due to the shift work and the difficulty of combining personal and professional life. "We are seeing an increase in patients' health literacy. Which is good, of course, but it also means that patients and their families have higher information demands on us, on nurses and other healthcare professionals. At the same time, hospital stays are getting shorter and there's not as much time per patient, so those demands on how much a caring professional should know are generally increasing." In this respect too, the medical faculty tries to counter potential future problems during their studies and is the only one in the country to provide students with psychological support in the form of a Mindfulness programme and psychosomatic exercises, with the aim of managing psychological stress and burnout.

A need for systematic solution

However, Pokorná said the faculty approach is only one part of the solution. It must first and foremost be systemic in order to break the frequent practice of "everyone doing everything". "On the one hand, this leads to exhaustion, and at the same time it is a certain defalcation of the knowledge of educated non-medical health professionals, including general nurses," notes Professor Pokorná, who believes that the decreasing resilience of the population and the shift in the worldview of the upcoming generations, who are beginning to prioritise their own needs more, should also be taken into account, which she says may be another aspect leading to earlier retirement for future nurses.

The systemic solution should be the hierarchization of nursing professions, which is already being discussed in cooperation with faculties and hospitals and at government level. And inspiration can be drawn from abroad. "While in some countries there are entire clinics run by nurses, in our country there is no such hierarchy of workplaces, with a few exceptions. This means that it is necessary to change the composition of entire nursing teams so that specific interventions and care delivery procedures are carried out by a given professional with the appropriate training. Ideally, more nursing support staff must be added so that nurses can increasingly devote themselves to professional activities. If we support and nurture nurses with specialised competence, we will also relieve the whole system. Specialist nurses are able to take over some of the competences of other members of healthcare teams, they manage the coordination of care and in many cases, in effective cooperation with doctors, they improve the quality of the patient's passage through the healthcare system and the availability of care, which must gradually be oriented towards strengthening community care," Pokorná says.

The challenges that the current healthcare system has to overcome are many, some are manageable from the position of educators, but many require the systemic changes mentioned above. Educators contribute by trying to pass on not only the available scientific knowledge, but also a positive attitude towards a profession that is one of the most challenging, but from Professor Pokorná's personal perspective, one of the most beautiful within the helping professions.

"On the occasion of Nurses' Day, one cannot but think of other non-medical health professionals (midwives, paramedics, nutritional therapists, physiotherapists and others), without whom general nurses would not be able to carry out their work. We are very grateful to all those who not only fulfil their duties in clinical practice responsibly and selflessly, but also help us to educate the next generation of health professionals. It is a great pleasure for me to see how our students work together with already 'ready professionals' and how they respect and enrich each other. I deeply believe that this trend of mutual cooperation will continue and I thank repeatedly everyone who cares for, treats and cures our patients. And last but not least, my thanks go to my colleagues from the Faculty of Medicine of Masaryk University who do not give up and try to pass on the best of their professional knowledge and skills and human qualities," says Andrea Pokorná on International Nurses' Day.

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