Key messages What is the problem?
• Ineffective management system of nursing services in health organizations of the Republic of Kazakhstan, associated with the underestimation of the role of nursing personnel in the medical and diagnostic process and the subordination of a nurse to a doctor who does not know the concept of nursing care.
• Inadequacy of the functioning of the system of nursing education, science and practice to European directives (best international practices). Lack of good nursing practice in the practical healthcare of Kazakhstan. • Imperfection of legal acts regulating the activities of nurses that do not meet the needs of modern nursing services (including the lack of national guidelines, standards for nursing services, etc.).
Option 1. Creation of effective legal regulation of the interaction of health organizations with medical education organizations based on the experience of leading world universities and colleges, by:
•The introduction of a new organizational structure of nursing services in health organizations, in which nurses and doctors work equally and independently, bearing collective responsibility for the activities of the interprofessional team, can significantly increase the effectiveness of nursing services.
• The introduction of financial mechanisms for direct payment of nursing services allows us to provide conditions for the development of nursing services of the advanced practice;
• The introduction of the position of Nursing Coordinator (Chief Nursing Officer) at the level of the Central and local health authorities allows for more effective monitoring and coordination of nursing services.
Option 2. Improving the industry-specific qualifications framework for nursing professionals in accordance with European directives by:
• Consolidation of qualification levels, labor functions, competencies, requirements for nursing specialists in the sectoral qualifications framework and professional standard;
• Harmonization of all elements of the sectoral qualifications system of nursing specialists (labor functions, training programs, assessment systems) in accordance with European directives;
• Annual grants (at the expense of the republican and local budgets) for the training of advanced nurses, including accelerated training programs (for working nurses);
• Implementation of mechanisms for compulsory working off by graduates of applied undergraduate programs in regional health organizations for distribution.
Option 3. Ensuring the development of evidence-based nursing practice with the implementation of universally recognized international standards and models, the development of national guidelines and standards for nursing services, by:
• Implementation of a universal progressive model of patronage service in primary care organizations and a new model of nursing service in health organizations (in terms of secondary health care, triages, health schools, screenings, etc.);
• Implementation of the international classification of nursing diagnoses and nursing interventions at the national level;
• Preparation of a pool of experts on the development of nursing guidelines and standards for nursing services, the implementation of evidence-based nursing practices;
• Development and adoption of evidence-based nursing guidelines and standard operating procedures for nursing procedures at the national level;
•Development of research in nursing will ensure the implementation of the best evidence-based practices of nursing in the country's health organizations;
• Providing access for medical colleges, higher medical colleges, medical universities and medical organizations to the world databases of nursing - CINAHL, NRC, etc.;
• Providing training for nursing specialists on research in nursing, evidence-based nursing practice - both within the framework of master's programs, and through advanced training of specialists from colleges and universities;
• Introduction of PhD doctoral studies in the specialty "Nursing" and ensuring the regular allocation of budget places for the preparation of doctoral students in this specialty.
Vision on the implementation of policy options
Each of these policy options can help improve the effectiveness of nursing in the health system of the Republic of Kazakhstan. However, given the differences in options in the direction of actions, resources and methods used, a more substantial achievement of the goal of improving public health by strengthening the role and status of a nurse, these
options can give when they are combined.