Nursing Fees Lack Transparency / No Tools to Counter 'Pseudo-Nurses'

The head of the Nursing Organization pointed to two challenges, low and non-transparent nursing fees, and the lack of tools to confront 'pseudo-nurses.' He said the organization has requested that this authority be transferred to it, and that it is ready to help the government oversee private-sector nursing services and home care.

According to Ambassador Arjan's report, Dr. Ahmad Najadian said at the Nurse's Day press conference held today (October 21) that the country's conditions are special from a social, political, and economic point of view. Accordingly, we are prepared for any eventuality. It can be said that the economic war that the country is facing is also considered very important. Iran's enemies and ill-wishers have put us in a very difficult situation.

Stating that the country's inflationary conditions are very difficult, he clarified: almost all salary-earning sections of the society, including the health workers, are under severe economic pressure. Health workers are one of the capitals of the country, but they are among the groups whose income is not proportional to their livelihood and life.

Nejatian said: War, with all the ugliness and damage it inflicts on the country, people and the psyche of the society, reveals some components. National solidarity is one of these components. We witnessed the solidarity of the Iranian people, especially when they threatened the infrastructure.

The head of the nursing system organization stated that wars and crises expose some groups and groups to attention more than in the past and said: In such a situation, people realize that the country and society need the presence of which groups. It is possible that the importance of some groups is not understood under normal conditions, and for example, we can mention the media and nurses.

He said about the role of nurses in war conditions: Nurses were present at work in war conditions; The issue that we felt more during the 12-day war; Because we were somewhat used to the conditions during the Ramadan war. Even some bakeries, whose services people need, were closed, but hospitals were never closed. The society has come to this conclusion to what extent the health system can be helpful and promising in situations like this.

Stating that the health system performed brilliantly in the last two wars, Nejatian clarified: the health system got a good score and health services were never stopped in the country.

Stating that nurses are one of the leading forces and the front line of the health system, he said: Nurses have been on the front line during past wars; In a way, we witnessed the direct presence of nurses in war conditions. 500 martyred nurses during the holy defense era, about 20 to 30 thousand fighters of the holy defense and the martyrdom of 24 nurses in the last two wars are a confirmation of the presence of nurses in the front line.

He added about the testimony of the children of some health workers in Minab School: Several health workers have lost their children in Minab School. One of these people is a member of the nursing community.

Nejatian stated that the new narratives heard about the war, said: We have identified a nurse in the Persian Gulf islands who served in those islands and was caught in a situation where she was not able to move much for three days.

Stating that we must prepare for all scenarios, he said: The country is in a state of war and we must be prepared for all possible scenarios. The enemy has shown that he has no boundaries; From targeting schools and gymnasiums to residential areas and using all kinds of weapons. Therefore, today we must prepare ourselves; Of course, this does not mean to scare people. We must be prepared for any scenario such as chemical attacks and the possibility of radioactive attacks.

The head of the nursing system organization stated about the readiness of the health system to provide neighborhood-oriented services in mosques: a news was published about this issue; This issue shows that the health system prepares itself for every possible scenario in order to be able to provide services in all localities. Therefore, we are not in the normal conditions of the country and this situation requires taking serious measures. It has been announced that a council called War Economic Council is being established. The health system must also be prepared for war conditions and any other situation.

He stated that the health system has several duties and said: The health system is responsible for improving people's health and protecting them financially. Providing financial resources to maintain the resilience of the health system is considered one of the most important issues. These resources can include financial resources, storage of medicine and equipment, and maintaining resources necessary to provide services. Human resources is also important and I believe that it is a more important component. We may not have medicine in some situations, but it is very difficult and unfortunate to imagine not having a service provider.

Referring to the economic conditions of the country and its effect on the health system, the head of the nursing system organization said: The reality is that we are in a difficult economic situation. The economic blockade and damage to transportation have affected the provision of health services. Although it is announced that the health field is not sanctioned and activities in it are free, but the limitation of financial resources and transportation restrictions actually means sanctioning the health system and restricting people's right to fair access to health services.

Stating that we are also facing an increase in the costs paid by people in the field of health, he said: Although we do not have official statistics and reference on this issue, daily observations show that people are exposed to back-breaking health costs. These days, if a person in a normal family gets a severe and unfortunate disease such as various types of cancers, his family will definitely go below the poverty line with the current expenses. This is a warning and a worrying sign. I hope that the national health accounts will be updated so that the policy makers know what is happening in the country.

Nejatian said about the importance of how to make decisions in critical situations: The important thing in critical situations is how we should behave. Research has shown that in critical situations, transparency and accountability can be an important way to solve problems and accompany people.

The head of the nursing system organization said about the importance of transparency in the allocation of health system resources: there are headlines that people are not aware of. Social audit is a very important issue; A concept that says that the common people of the society should also be familiar with the distribution of health system resources. I believe that the importance of this issue increases in war conditions; Because people should know how much resources are in the health system, who are the providers of these resources and where these resources are spent.

He continued: It should be clear what percentage of the health system's expenses are in the field of medicine and how much is spent in the field of medical equipment, tariffs and inpatient services. We hope that these reports will be published as soon as possible and that the regulatory bodies will also enter into this matter.

The head of the nursing system organization stated that there were criticisms of the nursing tariffs this year and said: One of the criticisms is how the revenues are distributed in the form of medical and nursing tariffs. The organization of the nursing system strongly believes that the tariffs distributed under the title of nursing are very small compared to the performance and efforts of nurses.

Nejatian continued: Last year, it was agreed that the tariff would be increased by 100% in two years in two stages in order to compensate the nurses' livelihood to some extent. The amount related to nurses increased by about 60%; While other groups that did not have much problem before, experienced increases of 100 and in some cases 120 percent.

He continued: We have followed up this issue seriously and we protest against this issue. We wrote letters to various institutions and officials and raised our complaint. The demand of the nursing system is that there should be transparency in the distribution of health system resources and a reasonable ratio of health system costs should be allocated to different departments. We hope that justice will be achieved in the distribution of resources.

The head of the nursing system organization stated that this issue is also discussed in the nursing community and said: If you go to hospitals today and talk to different people, you will see that the same issues are raised. Some people bring up issues and say that someone has studied for 13 years and another for 12 years, while nurses have studied for four years. Yes, this is a fact, but the world has formulated it. The difference in the income of different groups must have a basis.

Stating that we are still facing the issue of arrears in the field of nursing, he said: Nurses will receive the tariff of March of last year at the end of October. However, these conditions are better in some universities. In inflationary conditions, receiving the right that belongs to the previous year, with the same resources, is considered a form of oppression. In inflationary conditions, the value of that amount decreases drastically and is practically invisible. Maybe if we paid the tariff for March of last year at the same time, with amounts of eight, seven or six million tomans, it would be more reasonable than if we want to pay the same amount in October and November of this year.

The head of the nursing system organization said about the increase in nursing tariffs this year: We had about a 67% increase in the tariff amount, but the final amount is not very significant. When the amount of six or seven million tomans becomes 10 million tomans, its increase is not significant. In terms of percentage, we may say that we have increased by 67%, but when the basic amount is low, this increase does not show itself much.

Nejatian continued: Currently, the most important problems of nurses in the field of nursing tariffs are the low amount and the lack of transparency in distribution. Despite the great efforts of our colleagues, this formula is still not fully transparent.

In another part of his speech, he stated that the supervision of nursing services in the private sector and at the community level is still facing serious problems, and said: Today, the phenomenon we refer to as "nursing" shows itself strongly. Various institutions have asked us to intervene in this field, but we do not have the necessary legal tools at our disposal. Although the law has assigned this task to the organization, we do not have the proper tools for monitoring. The supervision of this area is the responsibility of the Ministry of Health and this ministry is responsible for it, but the nursing system organization has requested that if this authority is given to the nursing system organization, we are ready to help the government in supervising nursing services in the private sector and home care.

He stated: We have made it possible to inquire about the nurse on the organization's website. If a person goes to a hospital or a home and says that he is a nurse, his status can be easily searched and checked through the organization's website. Home care centers have also been announced.

Nejatian said about the importance of home care services: Home care is an issue that is rarely addressed. In the future, this field can help the health system to provide services to the elderly and people with incurable and long-term diseases. Despite the importance of this issue, it seems that the health system still does not understand its importance properly and does not pay enough attention to it.

He stated about the need to revise the regulation of home care centers: the current regulation is about 10 years old and needs to be revised. Necessary experts have been conducted in this field and the nursing system organization has also been consulted, but still no new regulation that can solve the current problems has been announced.

The head of the nursing system organization said: one of the important issues in the health field is the insurance coverage of home care services. One of the topics that should be considered in the new regulation is the insurance coverage of home care services. Today, wealthy people in the society use these services, while people with lower incomes should benefit more from these cares. Insurance coverage can enable these groups to use more home care services.

Referring to some obstacles to the development of home care centers, he stated: There are other issues that may not seem very important at first glance, but they have influenced the development of these centers. Issues such as obtaining fire department approval are one of these. After the clinic fire in Tajrish, a directive was issued according to which all institutions must receive fire certification.

Nejatian continued: Home care centers do not provide any services in their office; These offices are only a place to sign contracts with people and maintain some equipment. However, for these centers, it is also required to get fire approval, which is a very difficult task, and even issues such as elevator standards are raised.

He continued: In the same building where the institute's office is located, there may be an office where 100 patients visit daily, but none of these standards are requested from that office. This is very strange; An institution that has only administrative activities and a technical officer is stationed there to answer calls or set up contracts should have fire fighting facilities, but a center that sees dozens or hundreds of patients daily, including patients who travel with crutches or wheelchairs, does not have such an issue.

The head of the Nursing System Organization said: We have approved 38 nursing services in cooperation with the National Standards Organization, and these services have been registered on the website of the Standards Organization as standard nursing services. We try to register other nursing services according to the format of the standard organization. The nursing system organization and the nursing assistant of the Ministry of Health follow the standardization of services due to their commitment to maintaining the quality of services. We hope that the standard book will be published and the registration of services in this field will continue.

Nejatian also said about the approval of the nurses' rights charter in the Supreme Council of the Nursing System: Another issue that was approved in the Supreme Council was the nurses' rights charter, which perhaps we could not address sufficiently. This document was neglected in the past. Previously, we had the charter of patients' rights, which specified how the nurse should treat the patient and what the patient's rights are. We also had the nursing code of ethics, which explained the rights of the patient and the duties of the nurse and other service providers towards him and how to treat the patient ethically.

He added: In the meantime, there was an empty place for a document that specifies the rights of the service provider. Just as people as recipients of services have a right to be treated well, service providers also have rights that must be considered.

Referring to the drafting of the nurses' bill of rights for the first time in Iran, the head of the nursing system organization said: In the Supreme Council of the Nursing System, based on a research model that was conducted in the form of a doctoral thesis in one of the universities, we compiled the nurses' bill of rights and published it for the first time in Iran in the past few months. This charter includes 17 basic rights of nurses and specifies what rights nurses have in their work environment.

Nejatian said about providing psychological counseling services to nurses in cooperation with the Psychological System Organization: We have started providing psychological counseling services in cooperation with the Psychological System Organization; Because we felt that the amount of mental crises and mental disorders in the society in general is increasing. Nurses who have faced crises are also vulnerable.

The head of the nursing system organization said about the follow-ups for two measures: one of these measures is the amendment of the law of the nursing system organization. About 25 years have passed since the approval of this law, and during this time, the conditions of the country and the nursing profession have changed a lot; Therefore, it was necessary to amend the organization law. This issue was raised in the Supreme Council and now it has been registered as a plan in the parliament. We hope that the announcement will be received as soon as possible and that we will be able to amend the law in this parliamentary term.

He said about the necessity of developing a comprehensive law on nursing health care: another law that is perhaps less noticed, but very important, is the comprehensive law on nursing health care. In a situation where nurses are facing financial and livelihood problems, this issue has not been taken into consideration as it should be. Currently, we do not have a law in the country that defines a nurse. A series of problems have been raised in the form of the comprehensive nursing health care law.

In the second part of this press conference, in response to a question about the measures taken to improve the living conditions of nurses, the head of the nursing system organization stated: the authorities should announce the good news; We are waiting for the extremely special issue of nurses and health system employees to be assigned in the second half of the year.