The Heart of the Healthcare System Is Faltering

In an open letter to Masoud Pezeshkian, President and heart surgeon, a nurse criticized the severe shortage of nursing staff, inequality in pay, emigration and career abandonment among nurses, and burnout caused by long shifts. The nurse called for reform of the payment structure, financial transparency, and improved working conditions for medical staff.

A nurse in an open letter to the president of the hospital and heart surgeon, Masoud Medzikian, criticized the shortage of nursing staff, inequality in payments, immigration and leaving the job of nurses, and burnout caused by long shifts, and called for the reform of the payment structure, financial transparency, and improvement of the working conditions of the medical staff.

According to Ambassador Arjan, "For a few minutes it was me and that silent heart; I imitated the pulsation with my hands." Mohsen Bahrami, a senior nursing expert, has started his open letter to Masoud Bizikian by narrating the moments of reviving the heart of an 18-year-old young man in the operating room; A narrative that starts from a vital experience in saving a patient's life and ends up criticizing the livelihood situation, discrimination in payments and exhaustion of the nursing force in Iran's health system. Comparing nurses to the heart of the health system, he asked the president to take measures to improve the nursing situation before the human resource crisis reaches an irreparable stage.

Dear Mr. Dr. Masoud Bizikian, greetings and courtesy

On the eve of Nurse's Day, I am writing this open letter not from the position of individual complaint, but from the position of a bitter and erosive truth; A truth that is repeated every day in operating rooms, emergency departments, ICUs and all treatment points in this country, but few people hear its true voice. I don't know where to start, maybe from the night when my hands were in the chest of an eighteen-year-old boy and I was directly massaging his heart.

When the resuscitation code was dialed, I rushed to the operating room. An 18-year-old boy suffered severe cardiac tamponade due to a motorcycle accident. At the moment when his life was hanging between life and death, the surgeon opened the chest and I put my hand inside his chest and performed direct heart massage. It was a strange feeling that few people experience. The heart of an 18-year-old young man was in my hands; A young heart that could no longer beat. It was me and that silent heart for minutes. I imitated the heartbeat with my hands, I understood more than ever that the nurse is not just an executive force; The nurse is the beating heart of the health system. That night I put my hand into the chest of an eighteen-year-old boy and beat with all my heart instead of his heart, hoping that maybe the young man's heart would return. You, whose hands have touched the heart many times, put your hand on the heart of the hospital and on our heart. before the threshold of irreversible asystole in Iranian nursing is reached. As a heart surgeon yourself, you know better than anyone that in a hospital, a doctor can be likened to the brain and a nurse to the heart. A body without a brain may still manage a living being, but without a heart, life cannot continue, and today it must be said loudly: the heart of Iran's health system is in "crisis". The nursing crisis in Iran is not just a shortage of staff; The management crisis is injustice, burnout, lack of motivation, resignation, immigration and structural neglect.

Perhaps the statistics are a better indicator of the crisis in Iran's nursing field, let me make a simple but telling comparison:

America, with a population of about 340 million, has nearly 4 million nurses; It means something like 1.2 percent of the population. If we consider the same ratio for Iran with 90 million people, Iran should have about one million nurses. But the fact is that the number of our nurses, in the best estimates, is around 200,000 to 300,000 people. This means that we are facing a shortage of 700,000 to 800,000 people, and who will fill this shortage with their lives, exhaustion, forced overtime, and continuous mental pressure? The nurses of this country and here is the more bitter point: we are exporting nurses to developed countries and the United States at the same time. That is, the force that should be the main pillar of care in its own country, chooses the path of migration due to pressure, inequality and lack of future. This is not just a simple migration; It is estimated that between 62,000 and 67,000 dollars should be spent to train a nursing expert, and the exit of each nurse from the system will be a big blow not only to the treatment system but also to the country's economy. This year, one of my colleagues resigned in protest against the injustices in payment and excessive work pressure, and this became an excuse to write this open letter to you; Why should a nurse who studied for 16 years for free and has 16 years of experience working in this system consider leaving the health system as a better choice?! It is vital that the reason for giving up 32 years of efforts of a young person should be investigated and it should not be a small matter for the government because nursing is a profession and not a job and requires academic education and replacing a nurse with such qualifications and clinical skills will be really difficult, time-consuming and expensive and should not be ignored easily.

You know better than anyone that justice in health is not only about beds, medicine and buildings; justice means fair distribution of human power, dignity, job security and income. Today, the income gap between doctors and nurses in Iran sometimes reaches 100 times; This is an issue that you yourself acknowledged when you were a member of the parliament, and due to the lack of transparency of the income distribution system in the Ministry of Health, we are not able to prove this claim, and we are only quoting to raise this issue, but regardless of whether it is true or false, this news has had and continues to have a strong impact on the working spirit of the nursing and paramedical groups. A gap that is neither justifiable nor defensible.

While in many advanced countries, the income difference between different medical and nursing specialties is much less and more transparent, in Iran this difference has gone out of the way of justice in a strange and erosive way. For example, in the United States, the highest-paid medical specialties such as cardiac surgery and radiology have an annual income of about $950,000, and the highest-paid nursing branches, such as nurse anesthetists, which are part of nurse practitioners, have an income of about $235,000; That means a difference of about four times and ten times for the nursing expert. But in Iran, in some cases, this distance reaches such a point that the nurse is practically on the sidelines. In my opinion, the source of this extreme difference in receipts is the lack of work of the nursing assistant in determining the unrealistic, inappropriate and humiliating rate and pricing of nursing service tariffs. For example, the official tariff for dressing a grade 3 bed wound at home is valued at less than 150,000 tomans, which means that this money will not be used as a nurse!

And the most important thing is the issue of transparency, and the simple but important question is this: Why should I see the income of a doctor who lives in America easily and transparently, but remain in the dark about the doctor who works in the same hospital next to me? This ambiguity is not just an information issue, this ambiguity itself is a symptom of a more bitter reality: when the distribution of resources is not fair, they are forced to keep it private, and this is where trust breaks down.

Mr. President, you are a surgeon and not just a politician; Today, the heart of Iran's health system needs your direct massage, it needs the hands of a surgeon to break the chest wall of this system, directly touch the heart and re-pump it. If the health system is to stand in this country, its heart must be saved, and saving the heart requires a shock, in this case it is not a biphasic shock, but a multiphasic one, a shock that can return this defunct and fibrillated heart to its normal sinus rhythm, that is, with:

Real and up-to-date valuation of nursing service tariff and overtime rate, transparency of resource distribution in the Ministry of Health, serious review of payment justice, elimination of discrimination in the use of hospital amenities, payment of loans and bank and welfare facilities with low interest and long installments, free supplementary insurance with wide coverage and free diagnostic and treatment services for the health staff like other related government bodies, improving the ratio of nurses to patients, stopping the attrition of manpower with shifts and Inhumane and forced overtime work (up to 500 hours of shift per month, personal experience) Modernization of record writing and removal of paper files and electronicization of drug requests, paraclinical services, laboratory and consultations, transparency of the description of the duties of treatment groups and allocation of tariffs to the one who does the work! Finally, create a real motivation to stay, not just "tolerate"

The nurses of this country have been bearing the burden of a structural deficiency for years; But no body can forever fill the void of a vital organ with pressure and patience. If these crises are not answered today, tomorrow we will face hospitals that may have walls, but no pulse. I am writing this letter hoping for your attention; You who took the helm of the 14th government cabinet with the slogan of justice and expert work, and I hope you will come out successful and proud in facing the challenges.

Yours faithfully, Iranian nurse Mohsen Bahrami, senior nursing expert

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