Prof. N. Fatkulina. Photo: VU MF
“During the Soviet period, it was common for nurses to simply carry out the instructions of the doctors. Even when a patient asked the nurse what injections they were getting, the nurse would usually direct them to ask the doctor. In other words, even if the nurse knew the answer, they did not have the right to provide an answer to the patient. Although it is globally recognised that communication is the basis of good nursing, in the Soviet Union, nurses simply did not communicate with patients,” said Prof. Natalja Fatkulina, Director of the Institute of Health Sciences of the Faculty of Medicine at Vilnius University.
Today, however, the stereotype of treating a nurse as a less capable professional, no longer exists. “Everyone understands that the healthcare system is unimaginable without nursing care. Nursing professionals are the main and largest workforce in healthcare,” the professor added.
Modern nurse: knowledge, skills and values
According to the professor, knowledge, skills acquired through practice, and strong values, characterise the present day nursing professional. A person who wishes to become a nurse must first and foremost love people, and be focused on the spiritual, psychological, physical and emotional well-being of their patients. “Sometimes we forget that the healthcare system is designed for the patient, who, unfortunately, can be treated by some, as someone who interferes with the work of the staff,” observed Fatkulina. The professor remembered how 18 years ago she had been expecting her second daughter and happened to experience just such a situation at one of the hospitals. “I was sitting in a crowded corridor waiting for the doctor’s consultation. Two nurses – standing at either end of the corridor – shouted to each other complaining that the patients were constantly pacing up and down and wondered ‘what are they doing here?’ So it felt like patients interfered with the nurses’ work. There is no place for such nurses. And, if it seems that a patient is interfering with a nurse’s work, if that is a problem for them, it would be better to leave the nursing profession,” the professor added.
According to Fatkulina, communication – both with patients and colleagues – is one of the most important nursing competencies: “Around the world, nursing professionals are the main connection a patient has to the wider healthcare system”. For example, a doctor’s time with a patient can be quite restricted and a nurse is able to follow-up and answer any outstanding questions a patient might have. A doctor is a specialist whose main goal is to make a timely and accurate diagnosis, and prescribe the most effective, individualised treatment. The ongoing recovery and monitoring process, meanwhile, is reliant on the quality of the nursing. It’s always teamwork.”
Prof. N. Fatkulina. Photo: VU MF
More practice in college and more theory at university?
It is generally assumed that students in colleges acquire more practical skills and those in universities acquire a more solid theoretical foundation. When asked if the professor agreed with this statement, she replied that this was a legend created by colleges many years ago: “In Soviet times, doctors had higher education, while nurses were less qualified (middle level personnel). Once Lithuania regained its independence, a higher education in nursing became available in Kaunas (Lithuanian University of Health Sciences) and later in Vilnius at the university and in Klaipėda (Klaipėda University). Colleges felt under pressure, and as a result, the myth that they provided more practical skills and universities provided theory was born.”
Professor Fatkulina also remembered that students faced stereotypical attitudes from the management and staff of the hospitals where they carried out their work experience. It was believed that university graduates were better prepared for managerial positions. Meanwhile, college graduates were usually seen as suited to standard nursing jobs. “Today, when there is a shortage of specialists, this myth is no longer discussed per se, but stereotypical thinking can be retained. It is easy to bust the myth, because both colleges and universities work under the same directive, which states that half of the study time must be dedicated to developing practical clinical skills. Considering that the duration of studies in colleges is three and a half years, and at university, it is four years, we can say that the university graduates are both better practitioners and better researchers,” Fatkulina said.
However, it is important to note that the competences of graduates from the bachelor’s degree programmes in nursing, differ from those at colleges. The descriptions of the study programmes approved in 2015 and 2021 define university studies as higher level studies. This is reflected not only in the content of these studies, but also in further prospects after the successful completion of these studies. For example, a person who holds a bachelor’s degree in nursing from a college can only continue their studies at a master’s degree level after completing additional compensatory studies. Meanwhile, those who hold a bachelor’s degree in nursing from a university, can enrol in the master’s degree programme without any additional study.
Prof. N. Fatkulina. Photo: VU MF
Higher education for nurses is essential
“The most effective healthcare systems are those that employ nurses with higher education. This is evident from the practice of such countries as the United Kingdom, the United States, Australia or New Zealand. Numerous studies have shown that only a nursing professional with higher education can be an equal member of a team. Conversely, the field of responsibility of a traditional nursing specialist is more restricted. This means that the recovery process of a patient directly deteriorates, the burden on doctors increases, and the lack of specialists may create excessive workloads, etc., weakening the healthcare system overall,” Fatkulina noted.
According to the professor, countries such as Ukraine, Belarus, Russia or Moldova have poorer healthcare systems for precisely this reason – nurses in these countries are classified as middle level personnel. Kazakhstan, meanwhile, has made extremely good progress by reforming the healthcare system under the EU Directive. “You can say that nursing has gone through three main phases. At the beginning of the 20th century, nurses received education on the basis of clinical training in hospitals. Later there was a transitional period when nursing studies were divided between higher and non-higher education. Finally, nursing was fully integrated into higher education, so that, after obtaining a bachelor’s degree in nursing, students can continue their studies at the master’s and doctoral levels,” explained Fatkulina.
At the end of the interview, Professor Fatkulina said that no-one works in the field of healthcare accidentally: “If they are initially here by accident, they don’t tend to continue – it is simply impossible to be a nurse without a calling. I am always pleased that our students choose a nursing profession purposefully.”
The professor reminded us that the pioneer of modern nursing was the elite lady, Florence Nightingale, whose birthday is celebrated as part of the International Nurses Day. She was a nurse by calling. “I wish to always remember that nursing is the work of talented, intelligent and caring people. Let nurses be happy! If a patient is cared for by a happy person, then they become happier. A happy nurse equals a happy patient!” concluded the professor.