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1PRESENT SITUATION NURSING HR ALLOCATION IN MONGOLIA
NAMJILMAA.G, OYUNCHIMEG.B
PhD
Darkhan Medical School, MNUMS, Mongolia
Backround: By 2023, 14494 nurses are working in our country and 37.4 percent of them work in rural areas, and 9,875 are working directly in medical services. In rural hospitals, the workload of nurses is so high and we need to meet the work to international standards based on medical science.
The supply of nurses does not meet the required standards, especially in rural areas, nursing services cannot meet the demand of care is limited in terms of quantity and quality, and it depends on a huge amount of transition of nurses.
Purpose: The survey was conducted to analyze the current situation of allocation and migration of nursing human resources in rural areas.
Methods: Evidence-based and descriptive research models identified nursing human resources reports, data, and statistics. Policy implementation analysis is based on the Walt and Gilson (1994) model of content, context, and the role of policy makers and implementers, and qualitative research is analyzed using the Miles and Huberman (1994) and Creswell (2002) methodologies. The research is provided according to the research ethics committee by permission of the Research Ethics Committee №13-1A meeting of the Research Ethics Committee №13-03 / 1A. Research design and scope: A total of 560 nurses working in rural areas, including 10 aimags in 4 economic regions of Mongolia, were selected from two-level hospitals. In this research involved 134 nurses as representation of total nurses.
Analyses: Focus group discussions were matched with keywords. The sub-headings and guided questions are grouped by region (review of sub headings and guided questions).
Policy documents were analyzed by analyzing and summarizing the documents. In addition, capacity, structure, and management decisions in nursing human resource stratification were compared by comparing health indicators. The future direction of nursing human resources was determined by extrapolation.
Results: The analysis of the implementation of the policy paper shows that there is no causal analysis of human resource policies, strategies in the areas of health, education, labor, and social protection, which are slow to implement, whose participation is weak, and whether there is duplication of functions. This is: ."Medium-term human resource outlook for the health sector 20052015" policy was under-implemented by 2317 nurses. The government's health sector policy for 2012-2016 has not been achieved. The "State Health Policy" aims to make the ratio of doctors and nurses 1: 1.6 by 2021 and 1:2 by 2026, but the reality is 1: 1.1.
Comparing the distribution of nurses working in rural hospitals with the lower limit of the standard, the average number of nurses in the aimags is 315.3 and the number of nurses is understaffed from 1623 to 2434.5. The number of nurses will be 14494 in 2023, and a dynamic analysis of the population shows that the human resources for nursing have increased by 3.4 percent over the past year. According to our survey results, there are 14494 nurses nationwide in 2023, of which 37.4 percent work in rural areas and 63.6 percent in urban areas, increasing the migration of nurses to urban areas. Eighty-eight percent of all local nurses work in direct inpatient care.
The average age of nurses working in rural areas is 39.29 ± 9.1, which is expected to increase significantly over the next 20 years, especially in rural areas. Risk factors for nurses to relocate include poor working conditions, poor job satisfaction, and inability to provide adequate nursing care. According to our survey, 40.7 percent of nurses working in rural areas are dissatisfied. 44.0 percent said that the workload of nurses working in rural areas was very high and 39.3 percent said that they were overworked. Underemployment, overwork, and increased overtime contribute to dissatisfaction among nurses, and the survey found that most of their working hours (over 80.0 percent) were spent
on injections. In rural areas, 49 percent of nurses said that their productivity was not realistically assessed, and 83.1 percent said that it was not enough.
In rural areas, nursing is influenced by many factors. These include: Increased wages and benefits in remote rural areas, adequate human resources to reduce workload and streamline job descriptions, focus on retraining, nurse training, program optimization at the local level, professional degrees and specialization, supply of tools and equipment, Improving the legal environment. In summarizing the findings of the study, there is a similar result of study, and the most pressing issues for nurses in the regions are salaries, workload, ABT, and improving the legal environment.
Table 2. Nurses' views on ways to address the issues:
№
Scope of the problem
Challenges
Proposed action
1 Work load
2 Working conditions
3 Training
4 Human resources
5 Care
standards
Job
evaluation
The workload of nurses working in rural areas is high
The working environment and conditions of nurses working in rural areas are poor
Retraining of nurses working in rural areas is insufficient
Insufficient human resources
Balancing workload, reducing nurse workload Optimizing the nurse's work schedule Reduce workload
Improving public perceptions and attitudes about nursing
Provide supportive management, understand and support nurses at the management level Improving the supply of modern tools and equipment To ensure safe working conditions for nurses supply of disposable nursing equipment. Addressing nursing social issues.
Systematic improvement of nursing education Skills training.
Continuous development of nursing professionals To train a large number of specialized nurses, Stable operation
Define human resource policy correctly, monitor implementation_
Tthe implementation of STD standards is insufficient and the quality of STDs is poor In rural areas
The evaluation of the work of nurses working in rural areas is unrealistic
Plan, develop and sustain human resources based on STD standards.
Increase the number of nurses at the local level,
Hiring nurses and paramedics.
Optimize the nurse-patient ratio.
Distribute and place newly graduated nurses in rural
areas
The nursing care system needs to be changed to ensure equal access
Improving compliance with STD standards
Need to develop home nursing
Training in teamwork skills
Improve monitoring of nurse performance
Ensuring the quality of STD refinement and
development
Optimize job descriptions
Change the salary chain, increase salaries, pay by education gap
Providing regional allowances Provide real incentives
Improvement of job evaluation objectively optimize allocation
According to our survey, 40.7 percent of nurses working in rural areas are dissatisfied. 44.0 percent said that the workload of nurses working in rural areas was very high and 39.3 percent said that they were overworked. Underemployment, overwork, and increased overtime contribute to dissatisfaction among nurses, and the survey found that most of their working hours (over 80.0 percent) were spent on injections. In rural areas, 49 percent of nurses said that their productivity was not realistically assessed, and 83.1 percent said that it was not enough.
Conclusion: There is a need for a policy to modernize Mongolia's nursing care in rural areas, and to allocate and retain nurses. Although the legal environment is in place, implementation has been slow and needs to be further improved. Nursing human resource growth is averaging 2.01 percent per year. The number of nurses working in rural areas has decreased by 21.4 percent over the last 25 years. There is a need to reflect cross-sectoral cooperation and the roles, activities and participation of policy stakeholders in the implementation of nursing human resource policy.
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