Analysis of nurses ' activities in providing outpatient drug treatment

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Today, we have the task of improving primary health care (PHC) in the national health system in the foreground [2]. At this stage, the nurse plays a key role. It consists not only in providing medical care, but also in developing modern methods of preventive work, including the formation of sanitary (medical) literacy and individual health of the population. [4]. It is worth noting that a large number of regulatory documents regulating the priority of preventive measures in the health care system are currently of particular importance [5]. As a result of optimizing the functional responsibilities of a nurse in providing primary health care and developing preventive work with the population, we will improve the quality of medical services, resulting in increased patient satisfaction [6]. in many European countries, the role of nurses is very significant and prestigious. As one of the examples, the author cites Shvedova N. A. about the professional activity of a nurse in the United States, who is considered as a full-fledged nursing specialist, who has all the authority to detect symptoms and offer the doctor a method of treatment [7]. In the process of reforming nursing, it is advisable to increase the role of secondary medical personnel to the level of European countries [3]. As we have already said, the activity of a nurse is key in the provision of primary health CARE. it is at this stage that the nurse witnesses the patient's first contact with the health care system. However, the conditions for the provision of primary health care in different regions and even in one area can have differences. This may be due to the degree of centralization, the level of equipment of the material and technical base, the availability of personnel, and many other factors. In this regard, it is obvious that there is a need to conduct local timekeeping of nurses ' working hours to study the main time losses. In her works, I. V. Bublikova writes that there are basic standards of time for performing medical manipulations, which sometimes do not correspond to real needs and do not contribute to improving the quality of medical care [1]. As a result of the above, it is necessary to time the labor process of outpatient nurses. The purpose of this study is to optimize the work of secondary medical personnel. The analytical base of observation is the state medical INSTITUTION "Regional narcological dispensary".6 nurses with work experience of 5 years or more participated in the timekeeping. All participants in the study have certificates in nursing in narcology. The timing was carried out during the working shift of an outpatient nurse, the shift has a duration of 7 hours and 12 minutes - from 8.00 am to 15 hours. One of the objectives of the study was to identify the main activities of a nurse. The study allowed us to get an actual picture of the distribution of working hours of the staff of this clinic. All activities were divided into six groups: 1. Main activity; 2. Auxiliary activity; 3. work with documentation; 4. Office conversations; 5. Personal activity. 6. Home patronage. From the analysis of the comparative table, it follows that: 21.6% of the time is spent on the main activity, and 16% of the working time is spent on the auxiliary activity of a nurse. The main working time of a nurse is working with documents-35%. 6.7% of the working time is spent on official conversations. Personal activity costs-3 %.A nurse spends 17.7% of her working time on home care. Based on the analysis of the timing of the main types of work of nurses in the outpatient Department, we see that the main loss of working time is due to excessive workload of paperwork-this is 35 %. This analysis confirms the fact that the dispensary Department does not develop and implement more advanced forms of documentation for optimizing the work of the nursing process. It is established that there is no information in regulatory documents about the standard distribution of working time required for a nurse to perform a particular type of activity. All these factors prevent mid-level medical workers from fully performing their direct duties, which are designated as "main activity"in the classifier. During the analysis, it was found that within the functional responsibilities of medical nurses in the dispensary Department, they devote enough time to issues of the sanitary and epidemiological regime. When starting to work, we are guided by the labor legislation, which in turn regulates the activities of employees as official duties. To increase labor productivity in a medical institution at all workplaces, it is necessary to identify and eliminate factors that lead to unproductive time losses, and to look for reasons for non-fulfillment of functional duties. Further, to identify problems that hinder the provision of quality medical care, we conducted a survey among all nurses. The survey was conducted on the basis of a drug treatment dispensary 66 nurses out of 76 participated in the survey, which was 87% of respondents.One of the main issues is the satisfaction with the workplace of nurses. As the survey shows, the main reason for dissatisfaction is poor computer equipment. The problem of equipping a nurse's workplace is urgent. As shown in figure 2, job satisfaction is 26%, and job dissatisfaction is 74%. To the question: "do your functional responsibilities Coincide with the employment contract signed by you?»31 nurses responded"Fully", which was 47%, and "Partially" - 35 nurses, which was 53 %. As we can see in figure 3, less than 50% of all respondents have the same functional responsibilities as the contract. As a result of the analysis, we see in figure 4 that nurses perform work that does not meet their qualifications - this is 62%. What section of work do You spend more time on? 38 nurses, which is 57.5%, spend on "Registration of medical documentation", figure 5. The results obtained in the course of the study helped to determine the main values and key tasks that these participants face in the process of providing medical care in modern conditions. To develop practical recommendations, the following problems were identified: 1.The increase in load due to the increase in paperwork.2. Non-computerized workplaces.3. Low coverage of patients by a nurse at the site due to the workload of paperwork.4. Lack of clear functional responsibilities.5. Dissatisfaction with the workplace of nurses. There are theoretical and practical prerequisites for reviewing nursing functions: 1. Improvement of the material and technical base in the medical organization. 2. Optimization of the nurse's workplace.3. Reallocation of authority from nursing staff to other staff. Factors for expanding the role of nursing staff providing specialized medical care: 1. Increasing the life expectancy of the population.2. Increasing number of patients with chronic non-communicable diseases.3. the Emergence and spread of new psychoactive substances. 4. Increasing the level of requirements for medical care.5. Changing ethical standards in the healthcare system. 6. Changing values in the healthcare system. Main conclusions and recommendations: 1. Develop and implement better forms of documentation management to optimize the work of the nursing process2.Modernize all the functional responsibilities of nurses, put great emphasis on the performance of functions related to compliance with the sanitary and epidemiological regime.3. Optimize the workplaces of nurses to perform functional duties in accordance with the contract. 4. Provide primary care staff with the opportunity to fully realize their professional potential in the prevention and treatment of infectious and non-communicable diseases.5. Transfer of authority from the nurse (filling out non-medical documentation, consulting patients, routing, issuing supplies and keeping records of supplies (storekeeper's functionality), preparing the doctor's office for admission, cleaning) to other staff. 6. Review of the regulatory framework, including the legal definition of the limits of responsibility of specialists of secondary medical personnel. Advantages of expanding the role of nursing staff: patient satisfaction with medical care, patient health indicators, continuity of patient treatment, motivation of specialists to improve their professional knowledge and skills, professional development and satisfaction of specialists,optimization of the cost structure for healthcare.

About the authors

Alena Yachsenko

Author for correspondence.
Email: Alena3123@yandex.ru
ORCID iD: 0000-0002-1596-991X
SPIN-code: 5910-5097
Russian Federation, 625037,РОССИЯ,Тюменская обл,,Тюмень г,,Бакинских комиссаров ул,1,114

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