Professional standard for junior medical personnel. Whatever you call a ship, so it will sail

"Medical statistics and organizational method work in

healthcare institutions", 2013, N 12

The organizers of the activities of junior medical staff face some typical problems. They are related to the correct naming of the positions of cleaners, nurses and nursing assistants, the definition of their duties and labor standards, as well as the organization of their training. This article is devoted to the analysis of these problems.

Job titles of junior medical personnel

Medical workers, according to Art. 350 of the Labor Code of the Russian Federation, are entitled to a reduced working week: it, taking into account the reduction by 30 minutes on a Saturday, should not exceed 38.5 hours. Does this right extend to nurses and cleaners in health care facilities?

Since this right applies to medical workers, it is necessary to find out whether nurses and cleaners are medical workers? The answer to the question should be sought in the nomenclature of positions of medical workers. So, in accordance with the nomenclature of positions of medical workers and pharmaceutical workers<*>Nursing staff include:

• nursing assistant;
• orderly;
• medical attendant;
• housewife sister.

As you can see, in the nomenclature there is a position of a nurse, i.e. she is a health worker, and there is no cleaning position, which is therefore not a health worker. The conclusion is clear: nurses have the right to a shorter work week, but cleaners do not.

The situation is less certain when it comes to a barmaid or a bath attendant, since there are no such positions in the nomenclature of medical workers. However, in the event of a conflict with the inspection bodies, one can refer to the orders on staff rationing that have not yet been canceled, where these positions are named. However, success is not guaranteed.

The question arises even more acutely when it comes to assigning preferential pensions to nurses-barmaids of infectious and anti-tuberculosis institutions. Let us give an example of such a judicial history.

Dispute over early retirement

When determining the right of an employee to early retirement, the Pension Fund of the Russian Federation refused to include in the length of service giving the right to early retirement the 10 years that she worked as a barmaid in a tuberculosis department. As a result, she did not have enough preferential service, and was denied early retirement. The woman filed a lawsuit. In substantiation of her claim, she noted that, while working as a barmaid, she cared for the patients of this department, organized the distribution of food, feeding the patients, and cleaned the dining room and pantry. The plaintiff combined her position with the work of a ward nurse at the tuberculosis department. The work was carried out in conditions of contact with patients.

The representative of the Pension Fund did not recognize the claim in court, referring to the validity of the refusal to grant a pension due to insufficient special experience. The nomenclature of positions of medical workers, as well as the list of positions of health workers who are entitled to early retirement, do not contain the position of "barmaid nurse". The employee also did not provide the Pension Fund with a job description, which would indicate her obligation to care for the sick.

The representative of the hospital where the plaintiff worked considered the stated requirements reasonable and subject to satisfaction, since her work was carried out in conditions of contact with patients.

The court took note of the Instructions of the Ministry of Health of Russia dated April 26, 1993 N 1-31-U "On the procedure for applying section XXIV of List N 2 of industries, jobs, professions, positions and indicators giving the right to preferential pension provision", which states that when resolving issues related to the appointment of preferential pensions for middle and junior medical personnel directly serving patients, according to List No. 2, section XXIV, one should be guided by the following: "Direct service for patients" is work performed in conditions of contact between a medical worker and a patient. The implementation of a number of diagnostic and therapeutic procedures, measures for the care of patients, the creation of an appropriate medical and protective regimen require direct contact between personnel and patients. "Also, these Instructions of the Ministry of Health provide approximate lists of activities of junior staff related to direct patient care, which, in particular, include washing dishes, distributing food, feeding the sick and indicative lists of positions of junior staff related to the direct service of patients.However, the position of a barmaid is not in this list.But, as stated in the Instructions, the above list is an indicative one and the final decision on determining the list of jobs and positions, the employees of which are entitled to preferential pension provision, remains with the administration, which confirms the nature of the work and brings to the attention of the employees. that she was engaged in direct work with patients. She was in direct contact with the patients, fed them, cleaned the dishes, and she also had to wash, cut, change bedding for patients in the tuberculosis department.

In view of the foregoing, the court decided that the absence of the plaintiff's job description indicating in it the direct service of patients in the tuberculosis department does not affect the factual and legal nature of her medical activities and her right to early retirement. The personal accounts submitted to the court, which indicate a 25% bonus to wages for harmfulness at the main place of work, as well as a certificate of the number of shifts and hours worked, confirm the work of the plaintiff on a full-time basis and a shift in the tuberculosis department. The court satisfied the claim and obliged the Pension Fund to include in the plaintiff's special experience the period of work as a barmaid in the tuberculosis department.

Thus, when determining the right of an employee to a preferential pension, the Pension Fund, first of all, checks whether the position occupied by the employee is in the nomenclature of positions of medical workers and in List No. 2, which lists the positions of employees eligible for benefits. The current nomenclature of positions for the position of barmaid is not provided. It is also not in List No. 2. Further, the employees of the Fund usually do not understand and refuse to receive preferential pensions on formal grounds. On this basis, the pension was also denied to the barmaid from the tuberculosis department.

Therefore, in order to ensure the right of barmaids of anti-tuberculosis and infectious diseases hospitals to early retirement, it is necessary to rename the position of a barmaid to the position of a nurse, about which the employee should be notified in writing at least 2 months in advance. Otherwise, due to the incorrect title of the position, you will have to go through the court to prove your right to be included in the length of service, which gives the right to a preferential (according to List No. 2) pension to the barmaid.

Qualification characteristics for the positions of junior medical personnel

Having learned that the young nurse of the surgical department had a good command of the computer, the head of the department obliged her to type discharge summaries into the computer in her free time from cleaning. Is it legal?

Often there are disputes in labor collectives whether it is possible to oblige an employee to perform this or that work. To understand this, a qualification characteristic for the position of an employee can help. The labor functions performed by him must correspond to his qualifications. Consider the qualification characteristics for the positions of junior medical staff.

Qualification characteristics of positions of junior medical and pharmaceutical personnel<*>

Nursing Assistant Nurse

Job responsibilities. Assists in the care of patients under the guidance of a nurse. Carries out simple medical manipulations (setting cans, mustard plasters, compresses). Ensures cleanliness of patients and rooms. Ensures proper use and storage of patient care items. Makes a change of bed and underwear. Participates in the transportation of seriously ill patients. Monitors compliance by patients and visitors with the internal regulations of the medical organization. Collects and disposes of medical waste. Carries out activities to comply with the rules of asepsis and antisepsis, sterilization conditions for instruments and materials, prevention of post-injection complications, hepatitis, HIV infection.

Should know: methods of carrying out simple medical manipulations; rules of sanitation and hygiene, patient care; rules for the collection, storage and disposal of waste from medical institutions; internal labor regulations; rules on labor protection and fire safety.

Qualification requirements. Initial vocational education in the specialty "Nursing" without presenting requirements for work experience or secondary (complete) general education, additional training in the direction of professional activity without presenting requirements for work experience.

Mistress Sister

Job responsibilities. Supervises the work of nurses and cleaners to keep the premises of the medical organization (unit) clean and tidy, provides the serviced unit with household equipment, overalls, hygiene items, stationery, detergents, bed linen and underwear for patients. Makes a change of bathrobes, towels for employees of a medical organization. Draws up requests for the repair of premises, equipment, inventory and supervises its implementation. Provides power supply units (buffet, canteen) with equipment, utensils and monitors their correct labeling and use. Maintains accounting records.

Must know: the expiration dates of linen and equipment used in a medical organization (department); methods of sanitizing inventory; conditions of operation and storage of inventory; forms of accounting and reporting documentation and rules for filling them out; rules for compliance with the sanitary and hygienic regime in a medical organization (subdivision); internal labor regulations; rules on labor protection and fire safety.

Qualification requirements. Secondary (complete) general education and additional training in the direction of professional activity without presenting requirements for work experience.

Nurse

Job responsibilities. Cleans rooms in a medical facility. Helps the senior nurse in obtaining medicines, tools, equipment and delivering them to the department. Receives from the hostess and ensures the proper storage and use of linen, household equipment, dishes and detergents. Removes bedside tables from bedridden patients after each meal. At the direction of the ward nurse, she accompanies patients to the treatment and diagnostic rooms. Performs the functions of a courier, carries out washing of pharmacy dishes. Informs the hostess about malfunctions in the heating system, water supply, sewerage and electrical appliances. Prepares rooms and bathrooms. Systematically (after each patient) carries out sanitary and hygienic treatment of the bath and washcloths. Provides assistance to patients when taking a hygienic bath, when undressing and dressing. In the absence of a junior nurse to care for the sick, she receives underwear and bed linen from the hostess and changes them. Receives prepared food at the catering department, checks it by weight and count. Signed in the distribution sheet. Produces food heating. Distributes hot food to patients according to the menu and prescribed diet. Washes dishes, cleans the pantry and dining room, observing sanitary requirements. Systematically cleans refrigerators intended for storage of products of patients. Provides sanitary and hygienic maintenance of the pantry and dining room. Informs the management of the department in a timely manner about the need to repair equipment and pantry inventory.

Must know: rules of sanitation and occupational health; the purpose of detergents and the rules for handling them; internal labor regulations; rules on labor protection and fire safety.

Qualification requirements. Secondary (complete) general education without presenting requirements for work experience.

As you can see, in the qualification characteristics of a nurse there are no requirements to be able to work with medical records and have computer skills. This means that no one has the right to charge her with the duty to print discharge summaries.

Job Descriptions

The nurses of the reception department were obliged to perform courier functions. The nurses of the intensive care unit were involved in the transportation of corpses to the morgue. Is it legal?

The labor duties of each employee are determined by his job descriptions. It must be firmly understood that there are no uniform job descriptions for all nurses or nursing assistants in our country, and cannot be. They are compiled in each health facility and for each workplace individually. It all depends on the specific working conditions. So, in one office, the duties of a nurse may include performing courier functions, for example, to deliver samples for research in the laboratory, but not in another. The job descriptions should also indicate whose instructions the employee should follow, and who is obliged to provide him with the information necessary for work. Let's give an example of a current job description for a nursing nurse in the intensive care unit of one of the large departmental hospitals.

Nursing Nurse Job Description

1. General provisions

1.1. A person with an education of at least incomplete secondary education and who has completed courses for junior nurses in patient care is appointed to the position of a junior nurse for patient care. It is also necessary to conduct special on-the-job training after enrollment.

1.2. The junior nurse for patient care is appointed to the position and dismissed from the position on the basis of the order of the head physician on the proposal of the head of the department and the head nurse.

1.3. The junior nurse for patient care in her work is subordinate to the senior nurse of the department, the ward nurse.

1.4. In her work, the junior nurse for patient care is guided by the regulations on the department of anesthesiology-resuscitation and the department of resuscitation and intensive care, the internal labor regulations of the department, this job description.

1. The Nurse Nurse is responsible for:

2.1. Help the ward nurse of the department in caring for the sick (feeding, washing and washing away the patients);

2.2. To ensure the maintenance of cleanliness and neatness of patients, for which it is necessary to make timely re-laying of the beds of patients, to carry out sanitary and hygienic measures for the care of the sick (removal of the vessel, trays, followed by their treatment with disinfectants);

2.3. Systematically carry out wet cleaning, airing, chambers. To clean the wards must have the necessary equipment and devices;

2.4. Monitor compliance with the sanitary and epidemiological regime and safety measures;

2.5. Participate in shifting and transporting patients;

2.6. Participate in the transfer of corpses for delivery to the morgue;

2.7. Assist in the delivery of linen, equipment and other property, deliver food and feed the sick;

2.8. Comply with fire safety regulations. In the event of a fire in the department, take part in the evacuation of patients, property and equipment.

1. The nursing assistant has the right to:

3.1. Demand from the administration of the department in the required quantity good-quality equipment for cleaning the wards, caring for the sick, and small-scale mechanization;

3.2. Make proposals to the administration of the department to improve the organization of working conditions;

3.3. Participate in minimum sanitation classes for junior staff;

3.4. Inform the sister-hostess of the department about all malfunctions of the heating, lighting and other systems.

1. The nursing assistant is responsible for:

4.1. Clear and timely fulfillment of the duties stipulated by this job description, the internal labor regulations of the department.

Let's pay attention to point 2.6. on the transportation of corpses - its inclusion in the job description is explained by the peculiarities of the work of the intensive care unit. Let us also pay attention to the obligatory participation of a nurse in training within the framework of the sanitary minimum for junior medical staff. There are no instructions in the instructions for performing courier duties. This is neither good nor bad - it simply reflects the situation in the particular department for which this instruction is drawn up. At the same time, I would like to draw attention to one drawback of the above instructions: it does not define the duty of the nursing nurse to inform the ward nurse or doctor about the changes she has noticed in the patient's condition, for example, about the appearance of an inadequate response to her appeal.

Professional standards for the positions of junior medical personnel

Drawing up job descriptions for various groups of personnel is often difficult. Therefore, many managers prefer to use a variety of collections of ready-made instructions, despite the fact that they do not always correspond to the established practice of working in their healthcare facilities. Where to look for help?

We invite the reader to seek help from the draft professional standards for the positions of middle and junior medical staff. At present, the country is carrying out large-scale work to draw up professional standards for all sectors of the national economy, including healthcare workers. In particular, draft professional standards for the positions of junior and secondary medical staff have been developed by the Russian Association of Nurses. By now, the period of their discussion by the nursing community has ended. Their approval is awaited.

Professional standards will contain requirements for the content and working conditions, qualifications and competencies of medical personnel. They will list the main labor functions for each position, labor actions for each function and a list of knowledge, skills and abilities necessary to perform these actions.

Let us give an example of how the project formulates the main labor functions of a nurse and other workers from among the junior medical staff. It is these lists of labor functions, first of all, that can come to the rescue when it is not possible to find a suitable wording when developing job descriptions.

Labor functions of a nurse

• carrying out hygiene procedures for patients;
• cleaning rooms;
• sanitary maintenance of the chambers;
• cleaning of offices, surgical departments;
• performance of auxiliary sanitary works in offices, departments of a surgical profile;
• disposal of medical waste.

Unlike a nurse, the draft standard for a cleaner includes only:

• cleaning of common areas in healthcare facilities;
• cleaning of sanitary facilities and toilet rooms in medical facilities;
• implementation of collection, temporary storage and transportation of waste to health facilities.

A nursing nurse has a wider range of work functions compared to a nurse:

• general medical care for patients with insufficient self-care;
• maintenance of the medical and protective regime in health care facilities;
• maintaining the infectious safety of the hospital environment;
• determination of insufficiency (deficiency) of self-care in patients;
• transportation, escort and relocation of patients;
• general hygienic care for patients with insufficient self-care;
• feeding patients with limited self-care capabilities;
• performing the simplest medical manipulations of nursing care;
• provision of benefits and care during physiological functions;
• provision of first aid;
• general medical care for the dying;
• health education and patient/family education in general care.

Thus, the professional standard first defines labor functions by position. Further, for each labor function, a detailed breakdown of the labor actions that must be performed for its implementation is given. For example, when carrying out hygiene procedures for patients, the nurse, according to the draft standard, must perform the following actions:

• obtaining medical information on the volume of sanitization of the patient;
• coordination of the scope and type of work with the nurse;
• receiving linen, detergents and cleaning products, household equipment from the hostess sister;
• preparation of the bathroom for hygiene procedures;
• giving the patient soap, towels, a set of clean underwear, pajamas, slippers;
• carrying out special sanitary treatment of the patient in the emergency department in accordance with the doctor's prescription;
• accompaniment (transportation) of the patient to the ward after a hygienic bath (shower);
• informing the patient about the possibility of being in hospitals in home clothes, using personal hygiene items;
• sending the patient's personal clothes and shoes for storage or transferring them to their relatives (acquaintances) for storage;
• dispatch of personal clothing of patients with infectious diseases for chamber disinfection in the prescribed manner;
• carrying out planned hygienic treatment of patients;
• providing benefits for physiological administration to patients with insufficient self-care;
• cleaning, maintaining a sanitary condition and order in the bathroom;
• collection of dirty hospital linen;
• transfer of dirty linen to the central linen room;
• compliance with labor protection and fire safety;
• first aid in emergency situations, injuries, accidental poisoning, accidents.

And, finally, the draft standard reveals what knowledge, skills and abilities employees must have in order to perform the necessary labor actions. So, in order to carry out the listed actions to perform hygiene procedures, the nurse must be able to:

• ensure communication based on respect for others;
• observe the rules of internal regulations, medical and protective regime of health facilities;
• prepare and provide storage of a hospital set of clean underwear, pajamas, slippers for patients;
• use overalls and personal protective equipment;
• perform hand disinfection according to the instructions/algorithm;
• carry out sanitary treatment of the patient as prescribed by the doctor in accordance with technology standards;
• provide assistance in showering, bathing or wet wiping, cutting nails and other hygiene procedures for patients with insufficient self-care;
• use a special wheelchair for hygienic procedures for the patient;
• carry out all types of bathroom cleaning in accordance with regulatory documents;
• accompany the patient from the bathroom to the ward;
• collect, sort and take out dirty linen in the prescribed manner;
• provide first aid for injuries, poisoning, accidents;
• observe labor protection and fire safety measures, use fire extinguishing means;
• adjust their own activities based on the decisions of the manager and the work team.

In addition, in order to perform the necessary professional actions for the hygiene of patients, according to the draft standard, the nurse must know:

• professional standard requirements and job responsibilities;
• rules of conflict-free behavior when communicating with patients and employees, the environment
• fundamentals of legislation on the protection of the health of citizens;
• legal support for the activities of junior medical staff of health facilities;
• medical-protective mode of health care facilities;
• requirements for the rules of personal hygiene of patients and medical staff of a medical institution in accordance with regulatory documents;
• the procedure for storing the patient's personal clothing and shoes in health facilities;
• the procedure for sending personal clothing of patients with infectious diseases for chamber disinfection;
• sanitary rules and norms for the maintenance of premises, equipment, inventory in health facilities;
• standard measures to ensure the infectious safety of the patient and staff;
• methods, techniques and means of ergonomic movement of patients, weights;
• the physiological needs of the patient and their violations, the degree of insufficiency of self-care;
• technology standards (algorithms) for patient sanitization and hygienic care;
• technology standards (algorithms) for the provision of benefits for physiological administration to patients with insufficient self-care;
• rules and regulations of labor protection, fire safety, equipment operation;
• first aid algorithms for emergencies, injuries, accidental poisoning, accidents.

According to a similar plan, the draft standard describes the rest of the labor functions of a nurse and other medical workers from among the junior and middle staff.

It is obvious that professional standards, once adopted, will help to more accurately define the professional duties of employees, as well as conduct their professional training and assess professional qualifications. In the meantime, draft standards can only be used as methodological materials.

Requirements for the professional training of junior medical personnel

What professional training should a nursing assistant have?

The level of professional training of employees is determined by their qualification characteristics. So, according to the qualification characteristics, a nurse should not have special professional training at all - only a general secondary education. The host sister must have additional professional training, but details are not specified. Nursing assistants are said to have a primary education in "Nursing" or further vocational training in addition to their general secondary education. Requirements for such training have not yet been established.

Thus, while the Ministry of Health has not established additional requirements for the training of junior medical staff in order to meet the qualifications, housewives and nursing assistants must, at a minimum, undergo this training on the basis of the health facility where they work. In turn, health facilities should provide them with such training. It can be carried out at the workplace and by the forces of your staff - an epidemiologist, an occupational safety engineer, nurses and doctors. The training program can be drawn up on the basis of qualification characteristics, draft professional standards, which were mentioned above, as well as taking into account the characteristics of a particular health facility and specific jobs.

Deputy chief physician for work

with secondary and junior medical

personnel of the medical unit of JSC "Kromburg"

Nursing staff

persons who have received special education and relevant qualifications in secondary medical schools and are admitted in the prescribed manner to medical activities. In accordance with the level and profile of education, the medical center provides pre-hospital medical care, provides for the sick, performs preventive, diagnostic, medical and rehabilitation, sanitary and anti-epidemic and organizational work under the guidance of a doctor.

Medical assistants, midwives, nurses, sanitary assistants, laboratory assistants, X-ray laboratory assistants, dentists, dental technicians, etc. are part of the S. m. determined by qualification characteristics: the official rights and duties of the S. m. p. are regulated by the relevant provisions and instructions. The list of positions of the S. m. item contains approximately 120 items.

The FAP paramedic provides the population with pre-hospital medical care, receives and visits patients at home; if necessary, directs patients for a consultation with a doctor or hospitalizes the sick and injured in the local hospital; at the direction of the doctor, conducts certain types of therapeutic measures (injections, physiotherapy, etc.), as well as anti-relapse of persons under dispensary supervision; keeps records of morbidity and ensures medical examinations of the population (see Medical examination), under the guidance of a doctor, carries out a set of sanitary and recreational measures aimed at reducing morbidity, increasing the hygienic culture of the population and landscaping.

The paramedic of the mobile ambulance and emergency team provides emergency medical care to the population in case of life-threatening conditions, accidents, acute severe illnesses and exacerbations of chronic diseases at the scene and during the transportation of sick and injured people. Works under the direct supervision of the team doctor.

Midwife provides pre-medical preventive and therapeutic obstetric and gynecological care to women in outpatient and inpatient medical institutions, as well as at home. In the maternity hospital (Maternity Hospital) (departments), women's consultation (Women's consultation) and gynecological departments of hospitals, he works under the guidance of a doctor, in examination rooms, at FAP - independently within his competence. In urgent cases, the midwife provides first aid.

The midwife of the examination room performs a preventive examination of women for the purpose of early detection of gynecological diseases and malignant neoplasms, sends women with identified pathology or suspected to the doctor to the doctor.

The midwife of the maternity hospital (department) provides care and supervision for pregnant women, women in childbirth and puerperas, assists in childbirth, performs primary treatment of newborns, assists the doctor during medical manipulations and surgical interventions, and fulfills the doctor's prescription.

The midwife of the antenatal clinic, under the guidance of a doctor, keeps records and monitors pregnant women, conducts physioprophylactic preparation for childbirth, performs medical and diagnostic appointments of a doctor for pregnant and gynecological patients in a consultation and at home. It also promotes a healthy lifestyle aimed at protecting motherhood and childhood, incl. for the prevention of unplanned pregnancy.

At the feldsher-obstetric station, the midwife conducts outpatient appointments, identifies pregnant women and gynecological patients and provides them with medical and preventive care, if necessary, refers them to an obstetrician-gynecologist for a consultation, provides pregnant women and sick people at home, makes appointments and conducts preventive work on family planning .

Laboratory assistant works in the laboratory of medical and preventive, sanitary and research medical institutions, conducts clinical, biochemical, bacteriological, histological, hygienic and other studies in accordance with the profile of the laboratory. Provides first aid in emergency cases.

Dentist. In our country, the title "tooth" is assigned to persons who have graduated from medical school or the dental department of medical schools. Dentists conduct independent appointments in outpatient dental and prosthetic institutions, have the right to carry out therapeutic and surgical treatment of teeth, jaws, tongue, gums and oral mucosa; jaws with fractures; in accordance with the rules, issue certificates of incapacity for work, write out.

Dental Technician works in the prosthetic laboratory of a dental institution (department) and independently performs technical work on prosthetics, incl. production of artificial crowns, simple designs of pin teeth, various designs of bridges, removable plate and clasp prostheses, orthodontic and maxillofacial structures.

X-ray technologist works in the X-ray room (department) under the guidance of a radiologist and the head of the x-ray room (department). His responsibilities include the operation of X-ray diagnostic and fluorographic devices, participation in the conduct of X-ray examinations, the preparation of radiopaque substances, solutions of photochemical materials for the processing of X-ray film. If necessary, the radiologist provides emergency medical care.

military paramedic- an official of the middle medical staff, who is in active military service in military units, medical units and institutions of the Armed Forces. He is called up for military service from among those who have graduated from civilian secondary medical schools. The military ranks of "ensign" and "senior warrant officer" are assigned to military paramedics in the ground forces.

In the medical center of the regiment (Medical point of the regiment), a separate medical battalion (Separate medical battalion), a military hospital (Military Hospital), he is a direct assistant to a military doctor when carrying out a set of measures to preserve and improve the health of military personnel. In military units (on ships) in which full-time positions of a doctor are not provided, the paramedic carries out

In health care, the main role is given, of course, to doctors. Without their skillful qualification work, many patients would remain sick, and someone would even say goodbye to life altogether. But no less than doctors, those employees who are commonly called paramedical personnel are also important. Who are they and what is their role in saving lives and helping people?

What does average staff mean?

Nursing personnel are doctors who have received education not in higher educational institutions, but in secondary ones. They, as a rule, perform pre-medical care for patients, and also, under the direct supervision of their doctor, carry out various types of activities related to patients: sanitary, medical, rehabilitation, and so on. Nursing staff is called average because its work directly depends on the orders of the doctor who stands above him and is his direct and immediate supervisor.

Who belongs to the nursing staff

Below we list all the specialties that are commonly called nurses, but we will clarify right away: this is only in Russia. In other states, this category includes some other professions.

So, in our country, middle-level healthcare personnel are considered to be: a paramedic and job types, a medical instructor, a nurse or a nurse, an obstetrician, a dentist and / or a dental technician, instructors: a disinfector, in physiotherapy exercises, a pharmacist, an X-ray laboratory assistant and an optometrist. We will talk about each of these professions in a little more detail below, but first about which educational institutions train such specialists.

I'll go to the nurses, let them teach me!

Or in nurses, or in pharmacists - it does not matter. Another thing is important - where to go, to be taught, to get the desired specialty?

As we mentioned above, such specialties are not taught in higher educational institutions. You need to go to a specialized secondary, that is, to a medical school. It is there that all the above specialists are trained. An important point: in some cities there are separate schools for pharmacists, most often they are called pharmaceutical colleges. And in some, on the contrary, in ordinary medical schools they offer training in this specialty as well.

As a rule, most schools (including medical schools) have a similar practice: a person who graduated from such an educational institution and wants to continue his studies at the highest level is taken to the institute immediately for the third or at least for the second year. It all depends on the specific program of a particular institution.

Education at the medical school can be roughly divided into four stages. This is, firstly, a theoretical course, where the basics of science are put into the heads of future specialists; educational practice aimed at developing the acquired skills and usually taking place on mannequins within the walls of the native school; production and technological practice is already outside its walls, according to its profile; and finally, an internship, which is also a pre-diploma practice, during which a graduate can immediately be taken to a vacant position in a hospital or healthcare institution where he is an intern.

What does it take to get into medical school? Regardless of the chosen profile (by the way, nursing and midwifery are recognized as the most popular areas), you need documents on graduation - you must have a USE certificate, a document confirming your identity and citizenship, a certificate of passing a medical examination and six photographs three by four in size. In some schools, they accept only according to the results of the Unified State Examination, in some there are their own entrance tests. This issue needs to be clarified locally.

Paramedic

Let's start talking about specialties related to paramedical personnel with paramedics, and the first on their list is sanitary. He is also sometimes called an assistant sanitary doctor. Who is this, what is the specificity of his work? We will say further, but first we will briefly explain who, in principle, is called a paramedic. This is a doctor with a secondary education, who has the right to diagnose a particular disease, independently carry out the necessary treatment and send the patient to the required specialist. The assistance provided by the paramedic is called pre-medical, and the specifics of his work are essentially no different from the activities of a therapist or an emergency doctor.

So, paramedic. The paramedic of this variety performs preventive work related to the prevention of the occurrence of possible diseases in the population of any age. Its tasks include ensuring that enterprises and various institutions have such working conditions under which people will face minimal exposure to negative factors that could affect their health. So, for example, it is such a paramedic who is responsible for monitoring sanitary and hygienic conditions, for ensuring that water bodies are not contaminated, for preventing infections, and so on. The activities of the nursing staff of this plan are not only practical, but also partly research-based: for example, these specialists study the impact of various factors on human health and well-being, conduct various hygienic studies, and the like. As a rule, medical assistants are really assistants to sanitary doctors, but they can work not only with them: they also work as assistants to epidemiologists, for example, at city epidemiological stations. The salary of such a specialist in each city is different, but the average for the country is about twenty to twenty-five thousand rubles.

Who else belongs to the middle medical staff is a military paramedic. There are no tricks here: this is an ordinary paramedic, who at the same time is in military service and has a military rank. They are attached to all military units and are also available in every military medical institution.

It is interesting that for the first time paramedics began to be trained just under the armed forces. And even more interesting is the fact that barbers were originally taught these tricks - the most, of course, trained. Mass training of military paramedics took place during the Great Patriotic War, when their task was to provide assistance on the battlefield. Now military paramedics are trained in specialized military medical institutions.

laboratory assistant

This is the third type of paramedic, also related to nursing staff. To obtain such a specialty, it is necessary to enter the medical diagnostic business or laboratory diagnostics. Accordingly, as you might guess from the name of the profile, diagnostic activity is also included in the list of functions and responsibilities of a laboratory assistant. He works in a laboratory - in a research institute, a hospital, a polyclinic - and is engaged in all kinds of research there: biological material of blood, stomach, cerebrospinal fluid, and the like, in other words, he conducts tests. He does not work alone - under the direct supervision of higher-ranking doctors, and provided that he has enough experience, he may well be considered a "generalist" specialist. How well the quality and competent work of the paramedic-laboratory assistant largely depends on how correctly the doctor will diagnose the patient and prescribe treatment.

medical instructor

The next one who belongs to the middle medical staff is a sanitary instructor.

Like a military paramedic, this is a specialization of a military medical nature, but, so to speak, a lower rank. They also study in special institutions, are also members of military units, and also undergo certain military training. The task of medical instructors is to provide medical support to their unit, including personal hygiene products, as well as to provide assistance to sick military personnel and monitor compliance with hygiene standards and requirements. The medical instructor, in addition, instructs, as follows from the very title of the position, military personnel about the methods of providing medical care to themselves and to other people. The sanitary instructor in the medical part is subordinate to the paramedic, and in the military - to the head of the unit to which he is attached.

nurse (nurse)

One of the most popular and demanded specialties. And, of course, there are many more nurses than nurses, but recently they often appear. There are special nursing courses that are also gaining popularity. As a result of passing these courses, you can get a lot of specializations - from junior medical staff to care for the sick to a masseur or cosmetologist. It all depends specifically on the courses themselves and, of course, on different regions and cities. But in general, nursing (or nursing) courses are a good example of getting additional specialization, and therefore additional income.

But back to the nurse and her functions. Of course, they vary slightly depending on which institution and in which office (there is a difference - a physio or surgery room) the specialist works, but they generally coincide, and you can get a general idea.

To get the specialty of a nurse / nurse, you must first learn in the direction of "Nursing". Obtaining such an education will enable the physician to carry out primary care for patients, including assessing their condition; carry out the appointments and orders of doctors, their immediate supervisors; perform the necessary procedures, and also assist in operations; provide emergency first aid and send to a specialist and much more. Nurses and nurses work in different profiles - everyone needs them: a pediatrician, an oculist, and a cardiologist ... The average salary of nurses in this field in the country is about thirty thousand rubles.

Obstetrician

This specialty should not be confused with an obstetrician-gynecologist, which refers to senior medical personnel. An obstetrician, or in other words, an obstetrician, is a mid-level specialist who provides the necessary assistance during childbirth to women in labor, as well as pregnant women. Obstetricians are trained in the direction of "Medical and Obstetrical Affairs", and after receiving the appropriate education, they can perform the following functions: attending childbirth, assisting in gynecological operations, providing first aid in a gynecological profile, taking smears for analysis, patronage of women in labor and newborns, and the like.

At first, back in ancient times, women who were engaged in such work were called in Russia midwives, midwives. Later, the word "obstetrician" came from the French language, and the profession itself, previously quite rare, became more in demand and came to the fore.

Dentist (dental technician)

Surprisingly, but who else belongs to the nursing staff is a dentist. It would seem that he is like a doctor! Why, then, is he classified as a middle-level specialist?

In Russia, dentists have been known since the time of Peter the Great, it was he who brought instruments for dental treatment to our country. Then dentists were called dentists (this word was again borrowed from French), but later the word “dentist” came to replace the name and practically replaced the first one from common use. Meanwhile, there is a fundamental difference between these terms and, consequently, between the professions themselves. A dentist is a specialist who has received a higher education. A dentist, on the other hand, is someone who has a specialized secondary education, he is engaged in prosthetics of teeth and provides practical assistance in their treatment. He is able to cure simple cases with unstarted caries, more and more difficult - already to the dentist. Dentists are specialists such as a dental technician and a dental assistant.

Instructor-disinfector

This specialist carries out all kinds of disinfection measures, while he also decides with what help, in what way and to what extent these measures will be carried out. It is his responsibility to control the preparation and use of solutions for disinfection, keeping the necessary equipment clean and in order. The same specialist regulates the observance by disinfectors (they are subordinate to him) of labor protection rules and safety rules. In addition, the job description of a medical disinfector stipulates the need to complete all relevant documents. The average salary of a disinfector varies between twenty and thirty thousand rubles.

Exercise therapy instructor

Exercise therapy is an abbreviated name for physiotherapy exercises. What it is, no need to explain. But the duties of the nursing staff of this profile are the following things: conducting individual and group classes in exercise therapy and preparing for them; recommendations to patients on the necessary physical exercises and self-study; control over the state of all kinds of simulators, swimming pools and other equipment and facilities necessary for exercise therapy. This physician must have knowledge of the physiological (including pathological) characteristics of the human body, methods of physiotherapy exercises, the specifics of therapeutic massage, and also understand the indications and contraindications for physiotherapy exercises. A person who has received a secondary medical and / or physical education can become an exercise therapy instructor.

Pharmacist

A pharmacist, in other words, a pharmacist, is the same person who stands behind the counter in a pharmacy and not only dispenses the necessary medicines, but can also give recommendations if necessary. Pharmacists are trained, as mentioned above, depending on the region, both in ordinary medical schools and in specialized pharmaceutical colleges.

Despite the apparent simplicity, this is a very difficult job: how much you need to know the drugs, keep all kinds of analogues in your head, remember what this remedy is for, and what it is for another ... The pharmacist must know, in addition to what contraindications the drug has, what else can be advised applied patient. This is really serious and responsible work.

X-ray laboratory assistant

A person applying for this position can complete a course in any direction - "Obstetrics", "General Medicine", "Nursing", but a certificate of an X-ray laboratory assistant in radiology must be a plus.

This specialist conducts x-ray studies, maintains the necessary devices and the x-ray room itself, monitors the patient's condition during the procedure and, if necessary, provides first aid. Those wishing to work in this area should know a lot of important information, including the rules of work in the departments of radiology.

optometrist

This specialist has common roots with an ophthalmologist, he is also in the part of the eyes, but in a slightly different area. The name "optometrist" is related to the word "optics". This person is a vision correction professional. In many countries, an optometrist is only a separate profession, but in our country you can meet an ordinary oculist working in a clinic who prescribes glasses himself, that is, he is also an optometrist. Nevertheless, individual specialists in this field, of course, also exist. They work in optics salons, for example.

An optometrist can not only prescribe glasses and give advice, but he also measures intraocular pressure, checks the condition of the cornea or lens, and also diagnoses the quality of vision using a computer. It is the optometrist who can see the alarming symptoms of the disease and advise you to contact an ophthalmologist who is already directly involved in treatment - this is the essential difference between these two close, but different professions. The average salary of an optometrist fluctuates around 45 thousand rubles.

Training

Advanced training of nursing staff is possible in a fairly large number of different areas. This is nursing, and obstetrics with gynecology, and operating business, and so on. You can get an increase in special centers for advanced training or on the basis of medical technical schools and institutes.

From all of the above, it can be seen with the naked eye how important and responsible the role of nursing staff is in preserving the health and life of the population. Involuntarily, the memory of the so-called little man comes to mind. Nursing staff is also a "little man", but without him there would be no "big" people!

Catering and feeding of patients

In the organization of nutrition of patients in the hospital, both medical workers and catering workers take part. The doctor conducting the examination and treatment of the patient prescribes a certain diet for him, making an appropriate note in the medical history. The general daily management of the nutrition of patients is carried out by a dietitian who is responsible for the correct preparation and application of therapeutic diets, in addition, provides advice to the doctors of the departments in choosing a dietary table for patients. The direct management of the work of the catering unit (control over the quality of products, their laying, cooking, delivery to departments) is assigned to the dietitian. Distribution of ready-made food is carried out only after sampling by the doctor on duty of the hospital. The food at the catering unit is prepared according to the ration, which is daily compiled by the head sister of the hospital. When compiling, his main sister summarizes the portions coming from the departments and from the emergency room for patients who arrived at night.

Food delivery is carried out centrally in certain dishes on special vehicles, which are not used anywhere else. Tanks and pots for food should always be clean and have lids. In the departments, food is delivered to the distribution room, where there are heating devices: electric or gas stoves, hot water, sinks.

Barmaids distribute food to the sick. The dishes are washed in special sinks with mustard, after which they are rinsed under running hot water and placed in special drying cabinets or on nets. Forks and spoons dry. This is how they wash dishes in somatic departments (therapy, surgery, etc.). Patients eat in the dining room with good natural light.

Chairs should not be upholstered so that they are easy to clean. After each meal, the dining tables are cleaned, and at the end of the day, the tables are washed with hot water. Food waste is collected in closed containers and taken out in a timely manner. The dining room, distribution should be kept clean, this is monitored by barmaids, but controlled by their older sister and ward nurses.

When feeding patients, all external conditions associated with eating are taken into account: table setting, appearance of dishes, their smell, taste, neat appearance of the barmaid.

The atmosphere in the dining room should be calm. The nurse must be convinced of the importance of nutrition in restoring health.

Feeding the seriously ill

Seriously ill food is brought to the ward in a warm form on special heated tables. Before eating, all medical procedures should be completed. Some patients only need to be helped to sit down, cover their chest with an oilcloth or apron, others - move the bedside table and give it a semi-sitting position, raising the headrest, others need to be fed. When feeding a seriously ill patient, the nurse slightly raises the patient's head with her left hand, and with her right hand brings him a spoon or a special drinker with food to his mouth. In the case when the patient cannot raise his head so that he does not choke, you can use the following method of feeding. A transparent tube (8–10 mm in diameter and 25 cm long) is put on the nose of the drinker, which is inserted into the mouth. After inserting the tube into the mouth, it is removed with fingers, then slightly raised and tilted, while simultaneously unclenching the fingers for a few seconds, so that food enters the patient's mouth in the volume of one sip (the transparency of the tube allows you to control the amount of missed food).

artificial nutrition

In a number of diseases, when it is impossible to feed the patient through the mouth, artificial nutrition is prescribed. Artificial nutrition is the introduction of nutrients into the body using a gastric tube, enema or parenterally (subcutaneously, intravenously). In all these cases, normal nutrition is either impossible or undesirable, since it can lead to infection of wounds or ingestion of food into the respiratory tract, followed by inflammation or suppuration in the lungs.

There are two main areas of care for the sick - general care and special care.

General care - the implementation of general care measures, regardless of the nature of the disease (general examination, body temperature measurement, change of linen, etc.).

Special care - the implementation of specific care measures depending on the diagnosis of the disease (for example, preparing the patient for cholecystography, catheterization of the bladder).

Responsibilities of nurses and nurses

Patients are cared for by middle and junior medical personnel.

Nursing staff

A nurse is a specialist with a secondary medical education (graduates from a medical college). A nurse is classified as a nurse, she acts as a doctor's assistant in medical institutions, performs medical appointments and carries out the nursing process. According to the WHO definition, the essence of the nursing process lies precisely in the provision of patient care.

The duties of a nurse depend on the type and profile of the medical institution where she works, her position and the nature of the work performed. There are following positions of nurses.

Chief Nurse. Currently, this is a specialist with a higher medical education, graduating from the faculty of higher nursing education at a medical university. She deals with the issues of rational organization of work, advanced training of the middle and junior medical staff of the hospital and monitors their work.

Senior nurse assists the head of the department of the hospital (polyclinic) in administrative and economic matters, organizes and supervises the work of ward nurses and junior medical personnel.

Ward Nurse carries out medical appointments for patients in the wards assigned to it, monitors the condition of patients, takes care of them and organizes their meals.

procedural nurse performs medical appointments (intravenous injections and infusions), helps with manipulations that only a doctor has the right to perform, takes blood from a vein for biochemical studies.

Operating room nurse helps the surgeon during surgical interventions, prepares surgical instruments, suture and dressing material, linen for the operation.

District nurse helps the local doctor at the reception of patients living in the area assigned to him,

performs medical procedures at home as prescribed by a doctor and participates in preventive measures.

Nurses working at the reception of patients with doctors of narrow specialties(oculist, otorhinolaryngologist, neuropathologist, etc.).

Dietary Nurse (Nutritionist) Under the guidance of a dietitian, he is responsible for the organization and quality of medical nutrition, draws up a menu, controls the cooking and distribution of food, as well as the sanitary condition of the kitchen and dining room for patients.

Despite a certain division of the functions of nurses, there is a range of responsibilities adopted for the middle medical level as a whole.

1. Fulfillment of medical appointments: injections, distribution of medicines, setting mustard plasters, enemas, etc.

2. Implementation of the nursing process, including:

Nursing examination - primary examination of the patient, measurement of body temperature, calculation of the frequency of respiratory movements (RR) and pulse, measurement of blood pressure, control of daily diuresis, etc.;

Proper collection of material for analysis (blood, sputum, urine, feces);

Providing care for the sick - care for the skin, eyes, ears, oral cavity; control over the change of bed and underwear; organization of proper and timely nutrition of patients.

3. Providing first aid.

4. Ensuring the transportation of patients.

5. Reception of admitted patients and organization of discharge of patients.

6. Implementation of control over the sanitary condition of the departments.

7. Monitoring compliance by patients with the internal regulations of medical institutions and their compliance with the rules of personal hygiene.

8. Maintaining medical records.

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