Analysis of familiy practice nurse tasks and workflow management

U sustavu zdravstva Republike Hrvatske radi raznolika struktura radno aktivnih medicinskih sestara. Neujednačenost između obrazovnog procesa i zakonom određenih kompetencija i stvarne prakse dovodi medicinsku sestru u položaj koji je daleko od onoga kakav zaslužuje njezin profesionalni identitet. Ordinacija obiteljske medicine su ulazna vrata u zdravstveni sustav za svakog pripadnika neke lokalne zajednice i većina problema pokušava se riješiti na toj primarnoj razini. U ordinaciji obiteljske medicine ugovorena je jedna medicinska sestra opće zdravstvene njege, a Zakon propisuje za to radno mjesto medicinsku sestru s temeljnom naobrazbom. Zakon o sestrinstvu je najvažniji zakon u području sestrinstva kojim se određuju uvjeti i načini obavljanja djelatnosti, standard obrazovanja i kompetencije medicinskih sestara. Ne postoji potpuna podudarnost između zakona, pravilnika i stvarnih poslova koje obavlja medicinska sestra u ordinaciji obiteljske medicine. Analizom ključnih zakona i kompetencija može se zaključiti da medicinska sestra s temeljnom naobrazbom na radnom mjestu u ordinaciji obiteljske medicine radi svoj posao u skladu sa Zakonom i pravilima struke. Između Zakona i poslova/zadataka koji ona obavlja postoji nesuglasje, jer Zakon propisuje vođenje sestrinske dokumentacije što u stvarnosti nije moguće; naime, ta dokumentacija ne postoji ni u informatičkom programu u kojem radi, a ni u papirnatom obliku. S druge strane, postoje i poslovi koje medicinska sestra na svom radnom mjestu obavlja, a Zakonom propisane kompetencije ih ne uključuju. Analiza propisa o radnom mjestu pokazuje da rad medicinske sestre u ordinaciji obiteljske medicine podrazumijeva prikupljanje podataka o pacijentu, analiziranje te definiranje problema, utvrđivanje prioriteta, definiranje ciljeva i planiranje intervencija. Međutim, provedenu zdravstvenu njegu sestra ne može i evaluirati. Da bi je mogla evaluirati, morala bi raditi po procesu zdravstvene njege, što drugim riječima znači da bi trebala imati kompetenciju da procjenjuje potrebe, planira, provodi i evaluira pruženu sestrinsku skrb. Prema Zakonu o sestrinstvu sestra je dužna evidentirati svaki provedeni postupak u sestrinsku dokumentaciju. Budući da ta dokumentacija zapravo ne postoji, potrebno je sestrinsku dokumentaciju implementirati u informatički program u kojem sestra radi. Nadalje, potpuno usklađivanje zakonskih normi i Pravilnika nameće potrebu visoke kvalifikacije medicinske sestre u ordinaciji obiteljske medicine. Segment rada medicinske sestre koji se može dokumentirati, a odnosi se prvenstveno na rad ordinacije obiteljske medicine i predstavlja osnovu za financiranje dijela prihoda tima obiteljske medicine, čine provedeni DTP postupci. I tu se pokazuje manjkavost, jer većina postupaka koje sestra može bilježiti za posao koji je obavila nije opisana u DTP postupcima.The health care system of the Republic of Croatia involves a varied structure of actively employed medical nurses. There is a mismatch between the process of education, competences required by legislation and actual practice which positions medical nurse far from the one deserved by her professional identity. Family practice is the first point of entry into the health care system for each member of a local community, and most of the problems brought to the health care system are expected to be resolved at this primary level. The regulatory authority requires that the staff of each family practice office includes one secondary-level vocational nurse and the law requirement for this workplace is a medical nurse with basic education. The Nursing Act is the governing legislation in the area of nursing which defines conditions and scope of practice, standard of education and competences of medical nurses. There is no absolute consistency beween the laws, a health centre regulations and actual tasks carried out by the nurse in the family practice office. Based on the analysis of key regulations and competences it could be concluded that a nurse with secondary-level education employed in the family practice office performs her tasks in compliance with regulatory requirements and rules of the profession. One of the inconsistencies that exist between the law and nurse's actual workflow arises from the fact that the Nursing Act requires from a nurse to conduct nursing documentation which is not possible; nursing documentation does not exist neither in a computerised template formate nor in a paper form. On the other hand, there are tasks which are not included in the competences defined by regulatory requirements but are performed by nurse in her workplace. The analysis of regulations defining the nurse's workplace shows that nurse's workflow includes tasks such as collection of patient information, analyses and definition of health problems, defining priorities, defining goals and planning interventions. However, in order to be able to evaluate her performance, medical nurse should follow the assumptions for nursing care within the content of her education, in other words, the nurse should be authorised to evaluate patient's needs, to plan, conduct and evaluate performed nursing care. According to the Nursing Act, nurse's duty is to record all conducted procedures in her documentation which in reality cannot be done. To enable this, nursing documentation should be implemented in the currently used software programme. Complete compliance between regulatory norms and a health centre staffing requirements implies the need for higher level of nursing education in the family medicine nurse workplace. A segment of the nurse's actual tasks that could be documented includes conducted DTPs which indicate an office's daily activities and represent a basis for the part of its income. The role of DTPs is not fulfilled because the majority of procedures performed by the nurse are not included in the DTPs