Appreciating the nurses is not enough; The health system needs practical reforms

While nurses shoulder the main burden of caring for patients on normal days, holidays, and even during wartime, the lack of manpower, seven-month tariff arrears, livelihood pressures, and housing problems continue; The challenges that show that appreciation of this group without providing stable resources and full implementation of the approvals will not lead to real improvement of their working conditions.

According to Ambassador Arjan, quoted by Khane Mellat, on the eve of Nurse's Day, in addition to celebrating the round-the-clock services of this group in the health system, their long-standing demands regarding the lack of manpower, payments and living conditions have been taken into consideration once again. Demands that are partially answered in the reform of the laws and the organization of the nursing profession, and now the two plans "Comprehensive Nursing Care" and "Nursing System Organization Law Amendment" are on the verge of being announced in the parliament.

Nurse's Day is an opportunity to appreciate the round-the-clock efforts of nurses who bear the main burden of caring for patients at all hours of the day, on holidays, and even in crisis and war situations; The responsibility and sacrifice that during the 12-day and 40-day wars, with the martyrdom of 16 nurses, showed other dimensions of the difficulty and danger of this profession.

However, in addition to honoring the memory of martyred nurses and appreciating the round-the-clock efforts of this group, the structural challenges of the nursing field still remain, and despite measures such as increasing the tariff for nursing services, reforming the payment of overtime and hiring staff, the structural and livelihood problems of this group continue.

Behind the occassional honoring of nurses, there is a set of accumulated demands from lack of manpower and delayed payments to livelihood concerns and obstacles to staying in the profession; Demands that, despite some support measures, still constitute an important part of the challenges of the nursing system.

The persistence of deficiencies and the gap between the approvals and the implementation of commitments show that the appreciation of this group cannot be realized only by honoring and promising, and it requires effective decisions, providing sustainable resources, and amending laws and support mechanisms; A necessity that coincides with Nurse's Day, once again brings the demands of this group and the responsibility of the health system towards them back to the center of attention.

In the meantime, two plans "Comprehensive nursing care" and "Nursing system organization law amendment" are on the verge of being announced in the parliament; Plans that are supposed to cover part of the legal gaps in organizing nursing services, determining professional qualifications and monitoring the provision of care services.

Lack of nurses, work pressure, delay in payment of claims, insufficient support against inflation, difficulty in providing housing and legal loopholes in monitoring nursing services are among the issues that Seyed Mohammad Jamalian, head of the Nursing Committee of the Parliament's Health Commission, Alia Zamani Kiasri, a member of this committee, and Ahmad Najadian, head of the Nursing System Organization, emphasized the need to address in a conversation with Khane Mellat.

lack of power; A problem beyond annual recruitments

Seyyed Mohammad Jamalian, head of the Nursing Committee of the Parliament's Health Commission, in an interview with Khane Mellat reporter, referring to the measures taken to improve the condition of nurses, recruiting human resources, reforming overtime and increasing the tariffs for nursing services are among the measures that have been followed in recent years to respond to the demands of this group.

However, according to him, the recruitment rate alone does not meet the needs of the health system, and the annual withdrawal of nurses from the service cycle and their retirement should also be included in the calculations.

According to Jamalian's explanations, nearly 13 thousand nurses were recruited last year, and about 12 thousand are expected to be recruited this year. Meanwhile, about 2,500 nurses leave their profession every year, and including retirements, the health system needs to recruit about 10,000 people a year.

Ahmad Najadian, the head of the nursing system organization, in an interview with Khane Mellat reporter, considers the lack of nursing staff to be a structural problem that cannot be attributed to just the last one or two years.

From his point of view, this shortage is not only limited to increasing the workload of nurses, but also affects the capacity to provide hospital services and in some centers, it makes it difficult to set up or fully operate departments.

According to Nejatian, in some medical centers, departments cannot be opened due to the lack of nursing staff, and this situation, along with multiple shifts and difficult work, leads to the departure of nurses from hospitals and a decrease in the quality of medical services. An issue that ultimately affects people's ability to receive the services they need.

In the same context, Alia Zamani Kiasri, a member of the Parliament's Health Commission, also emphasized the need to pay attention to the different nature of nursing work in an interview with Khane Mellat reporter.

According to him, unlike many administrative jobs, nursing services are not limited to specific working hours and patient care continues around the clock; Therefore, support policies should be designed and implemented according to the actual conditions of clinical forces.

Referring to the state of the nursing force in the country, Jamalian states that the ratio of nurses to hospital beds is about 1.1 to 1.2 at the national level and says that this ratio reaches less than one in some cities and provinces, while the standard he refers to is 1.7 nurses for each hospital bed, and this gap highlights the necessity of planning for the provision of human resources and its proportional distribution in different regions.

Jamalian emphasizes that the lack of human resources cannot be managed for a long time by simply increasing the work pressure and efforts of nurses, and the supply of sufficient personnel should be continuously pursued according to the needs of medical centers and increasing the capacity of hospital beds.

increase in tariffs and overtime; not enough

In addition to the lack of manpower, the status of payments and the proportionality of nurses' receipts with the amount of their responsibilities are other common axes of the statements of two members of the health commission and the head of the nursing system organization.

Jamalian considers the reform of overtime and the increase of nursing tariffs among the measures taken, but Nejatian emphasizes that the increase of tariffs alone has not been able to compensate the economic pressures on nurses.

Referring to the 67% increase in nursing tariffs this year, the head of the nursing system believes that the growth of living costs and inflation has reduced the effect of this increase.

Stating that inflation has been around 100% or even more during this period, Nejatian does not consider the increase in tariffs to be proportional to the growth of living costs and believes that plans should be made to increase tariffs next year, at least proportional to the inflation rate.

Nejatian also informs about almost up-to-date payment of nurses' overtime, but says that their tariff demands were about 7 months late at the time of this interview.

According to him, the problems related to overtime payment have been solved to a large extent with the support of the Ministry of Health and the decisions made in the Supreme Council, but the amount of labor is still low and its arrears reach about 7 months.

Zamani Kiasri also points to the increase in tariffs and the value of overtime, and emphasizes that the nominal increase in payments can lead to the improvement of the living conditions of nurses when it is appropriate to the economic conditions and living costs.

Referring to the measures taken in the 12th Parliament and the Nursing Committee of the Health Commission, this member of the Health Commission says that the Riyal value of overtime hours has also increased by two and a half to three times, but the growth of inflation in the last one and a half years has caused these increases to not fully show the expected protective effect.

From the point of view of the representative of the people of Sari and Miandorud in the parliament, the issue is not only the approval of credit or setting the tariff, but the way of allocating resources and how to implement decisions are also important.

This member of the health commission also criticizes the difference in how clinical forces and administrative department employees benefit from some payments and support and believes that the special conditions of nurses' activity should be recognized in payment policies.

According to Zamani Kiasri, it is not possible to evaluate the employees who take care of patients directly and around the clock, regardless of the difference in responsibilities and working conditions, with other departments.

resource limitations; A loop between approval and implementation

Another part of the nursing community's problems is related to financial resources and how to implement the approvals; An issue that Kiasri once considered as one of the factors of the gap between policy making and practical results.

Referring to the resources foreseen for the health field in the 1404 budget, he explains that more than 80 hemats from the sale of government shares were intended for this area, but according to him, about 20 hemats of these resources were provided in the form of bonds and the resources were not provided to the Ministry of Health as expected.

Zamani Kiasri believes that the limitation in the realization of resources will face medical sciences universities with financial problems and finally, it will affect the possibility of timely payment of the demands of health workers.

This member of parliament also emphasizes the necessity of increasing the share of health from the public budget and believes that the share of health from the country's resources should return to the range of 6-7% in order to provide the possibility of meeting the needs of this area.

From the point of view of this member of the health commission, sometimes decisions are approved at the policy level, but in the implementation phase, due to the lack of credit or the way it is allocated, they do not have the expected effect.

Criticizing the non-fulfillment of the financial obligations of the government and the program and budget organization towards the Ministry of Health, he emphasizes that the realization of the resources foreseen in the budget is necessary to fulfill the obligations of the universities of medical sciences and pay the demands of the employees.

Once, Kiasri reminds that universities of medical sciences face more difficulty in paying the demands of their employees, especially the nursing staff, when they are faced with accumulated debts and have difficulty in providing equipment and paying their expenses.

Nejatian's statements about the backlog of tariff demands also show a part of the same problem, in the sense that even if the tariffs are increased, until the necessary resources are provided and paid on time, the approved changes will not necessarily lead to a tangible improvement in the working and living conditions of nurses.

Referring to the follow-ups carried out with the Ministry of Health over the past 2 years, Nejatian announces the formulation of 7 proposals to solve some of the problems of nurses, which include issues such as the retirement of nurses and the establishment of an investment and welfare fund for nurses.