Department Head of Public Health Nursing of the Mongolian National University of Medical Sciences (MNUMS), Associate Professor Ya.Enkhjargal delved into ways to solve the shortage of nurses in our country and international experience in this field in the following interview. She has been teaching for more than 10 years while doing academic research in the field of nursing.
What do you think is the reason for the shortage of nurses in Mongolia? We have been talking about this for many years, but we have not reached a significant solution.
As the society and economy change rapidly and the concentration of the population increases, the need for health care and services grows. Therefore, there is a shortage of nurses not only in our country but also in the world. Nurses make up about 60 percent of the health sector in any country. There are 28 million health workers in the world, 19 million of whom are nurses. So nursing is a very big field. The World Health Organization estimates that the global shortage of nurses will reach 12.9 million by 2035. Therefore, it was recommended that each country make policies and plans to prevent this. It also warned that the lack of nurses will harm the health of citizens if proper policies and plans are not made and implemented.
In Mongolia, 56,500 people work in the health sector, of which 13,473 are nurses and 90 percent of them are women. Currently, the number of nurses working in hospitals does not reach the approved number of the workforce. Therefore, considering the current needs of health care and services, more nurses are needed. It means that the nurses who are working now are carrying a lot of burden. They don’t have the time to learn and develop themselves. Perhaps the shortage of nurses affects the quality of care and services and patient satisfaction to some extent. For instance, a nurse has a sincere desire to provide care and services to a patient for 20 minutes. However, because there are 20 more patients waiting behind one patient, the nurse only spends a few minutes on each patient. There are supposed to be 13 nurses in one ward, but there are cases where only two are working the night shift. They are individuals who have families and need to take care of their own health. However, they serve 70 to 80 people for eight, 16, or even 24 hours straight, and their physical and psychological health is affected.
Nurses themselves explain that there is a shortage of nurses due to their low wage and appreciation. Can it be understood that the lack of human resources will disappear if the salary is increased?
A wage raise is only one part of the necessary measures. The biggest concern for all nurses and hospital staff right now is salary, but there are many other issues. Of course, raising wages will not solve all problems. In other words, it is believed that there will be no long-term results. Addressing the nursing shortage requires a comprehensive policy response. In particular, we need cooperation from all sides, including the government, universities and public and private health institutions. The most important measure is to increase the number of jobs for nurses. This will eliminate the shortage of nurses, increase their leadership, improve their knowledge and education, and provide opportunities for learning. Along with it, their salary will increase. For example, the Philippines trains English-speaking nurses. I read that nurses trained in the country work abroad, including in the UK, the USA and Germany, and send 1 billion USD a year to their home country or to their families. We can also develop our nursing sector, solve our domestic problems and further train English-speaking nurses.
How do you think jobs need to be increased? How does this relate to increasing the value of labor?
It is right to increase the number of types of nursing licenses and allow them to work in many fields. In specific, there are nurses who work in the field of occupational health. They are responsible for assessing whether the natural or artificial lighting, desks and computers in the patient’s sitting environment are harmful to health, and advise how to adjust them. In other words, they assess the health risks of patients and also calculate the productivity of health organizations. But we don’t have such jobs.
Most countries have school health nursing. Nurses teach children how to practice good hygiene. They are required to deal with psychological problems faced by teenagers such as bullying. However, we have almost no such experience. But only Hobby School has a nurse. A student of mine who graduated from our school works there. Because it is a school operating according to American standards, nurses are employed there. School nurses advise and teach students how to brush their teeth, what foods to eat and how to support and protect their health. It also plays a role in creating a healthy school environment. Many business sectors also need nurses. Therefore, if all of this is taken into consideration and the legal framework is formed, the number of students enrolled in nursing schools will increase and the value of the profession will also grow accordingly. People’s quality of life will also improve.
Has the number of students at your school decreased in recent years?
MNUMS prepares nurses at the bachelor’s and diploma levels. Through post-graduate training, we also let nurses specialize in 22 fields, including surgery, diabetes and public health. Moreover, the university runs master’s and doctoral training programs. Recently, the undergraduate admissions quota has decreased a bit. Diploma-educated nurses spend one year studying to earn a bachelor’s degree. The demand for it is increasing. For instance, nurses, midwives and other professionals with diplomas often attend this one-year course.
In order to address the shortage in the workplace, the government decided to provide a tuition fee discount for those studying nursing at public schools. Does it help increase the number of students?
The government covers 70 to 100 percent of tuition fees for nursing students, depending on the GPA. The higher the GPA is, the lower the student’s tuition fees. For a developing country with poor financial capabilities, it is good that such attention is paid to the training of nurses. But this measure alone is ineffective. In other words, solving a single problem is not very effective. As mentioned earlier, comprehensive measures are needed.
How are other countries dealing with the shortage of nurses and what measures are they taking?
Countries such as the USA, Japan and South Korea are defining and implementing goals in accordance with the policies of the World Health Organization and the International Council of Nurses. I recently read six strategies of the American Nurses Association. According to this, it is necessary to promote the nursing profession to secondary school students and increase the number of recruits at the policy level. Secondly, it is stated that investments should be made to reduce the shortage of nurses and the internal and external environment of organizations where they work should be improved. Particularly, the Mongolia-Japan Teaching Hospital of MNUMS has kindergartens for employees. In this way, the work of creating an environment to support doctors, nurses and other workers is starting in our country. The American strategy also mentions the need to employ nurses in many fields and create jobs. It also says that policy should support the reduction of migration. In addition, in order to provide good education, it is recommended to invest in increasing the capacity of schools and teachers that train nurses and midwives.
You mentioned earlier that the lack of human resources could have a negative impact on the health of citizens in the future. What adverse effects are likely to occur?
According to international researchers, migration is one of the main reasons for the shortage of nurses. Specifically, nurses from poor and middle-income countries are increasingly going to work in developed countries. For example, our nurses are going to Japan and Germany. An Inner Mongolian doctor is studying in our master’s course. When I asked her why she was studying for a master’s degree in nursing after becoming a doctor, she replied, “I want to work in nursing in Germany.” There are many people who want to learn a foreign language well, quit their job and go abroad. It’s a personal choice, so we shouldn’t blame them. But countries that are losing nurses in this way are facing major health problems. In our country, there are many chronic diseases in adults and children. I personally see it as a lack of nurses.
Is there a way to solve the shortage of nurses based on the characteristics of Mongolia?
The government should develop 10 to 20-year strategies, long-term and medium-term measures and implement a comprehensive policy. The Ministry of Health needs to increase the number of jobs and types of nursing licenses. Also, admission quotas for nursing schools can be added based on the orders of public and private organizations and enterprises and the types of professions needed. There is also a need to support nursing education through paid research projects. Nursing education includes research and analysis, graduate, pregraduate and post-graduate courses, books and textbooks, human resources and training of teaching staff. For example, we need a public health nurse license type.
We also need to investigate how many nurses are likely to leave their jobs and what risks the country may face as a result. Of course, the government alone cannot bear such a heavy burden. Therefore, non-governmental organizations and associations can be made more active and supported by policies. Organizations should support the health of nurses, create favorable working conditions, raise wages, provide them with mortgage loans and establish kindergartens and day-care centers. Hospitals that created such an environment can be supported by the government, such as tax breaks. By implementing these, nurses will be recognized in society and the number of students choosing this profession will increase. It means that nurses themselves will participate and lead in the comprehensive measures to solve the shortage.
Another reason for the shortage of nurses is that people do not understand the profession well. They see nurses as a doctor’s assistant and do not value their work at all. How can we change this public perception and attitude?
Mongolian nurses are currently working only in hospitals. Therefore, changes should be made at the policy level and, as mentioned earlier, they should be employed in many sectors. This will probably change the public perception, social awareness and attitude in the next 10 years. In general, wherever a person is, whether healthy or sick, there is a need for nurses and nursing care. To some extent, people have recognized that nursing is an important profession amid the COVID-19 pandemic. Citizens need to understand better. There are several specialties of nursing. One of them is ethics. For example, there is narrative ethics. A few years ago, when I was working at the First State Central Hospital, an English nurse came. She talked a lot with patients and said that she had already provided them with nursing care. At that time, we didn’t understand it well and thought, “She didn’t do anything.” Because we think of medical care and skills as manual actions such as injecting, catheterizing, administering medication or monitoring. But that nurse was working according to the narrative ethics. They sit next to patients, hold their hands, talk very intimately and make them cry and laugh. This makes patients happy and uplifted. Psychologically, nurses help patients become happy. Therefore, nursing care should not be understood only as manual work. Of course, medical care and services are provided in cooperation with doctors and other professionals. The public needs to understand that it is such a humane, beautiful and sensitive profession. In order to master the nursing profession, they have to study humans from many aspects. It is also a very detailed profession that studies many sciences.