RSU is a respected institution in Latvia, has a partnership with many reputable medical institutions in the country, harnessing their expertise to educate students. These medical establishment and staff are quite motivated and does a good job in doing what they are consulted to do. The nursing curriculum also is quite like the JAMK curriculum except for minor variation in the delivery system. The nursing curriculum has a period of school lectures and practical classes in specialized facilities and sometimes in partner hospitals, mostly in the first and second year. The practical training takes place second and mainly the third year, arranged according to specific sets of nursing skills. The students attend this training in a specified health care facility for a stated duration. Each training session is accompanied with theoretical assignments, mostly in the form of care evaluation or outright care plan for own patient. Some practical training session could be as short as 5-7days while some could last 2-3weeks. For instance, infectious disease control practical training in the assigned hospital lasted 5days, while the ambulatory care and social rehabilitation lasted 2weeks each. However, two semesters are dedicated to practical training targeting various nursing skills and students do these practices in the designated hospital according to the planned time frame.
RSU has international students mostly in medicine. The nursing program is predominantly in Latvian language. During my PT program I was assigned a student tutor, and mentor (a member of the teaching staff). The content of my PT program was to follow the practical training plan designed for the local students. I worked constantly with my Latvian student tutor, who also has similar learning plan like mine. Therefore, she was responsible for the interpretation and explanation of everything going to me in English. We are mostly peered together at the hospitals during nursing or clinical procedures, though on a few occasions I worked with other students who can manage in English. The PT mentoring approach is different from JAMK system in principle but similar in some ways in practice. There is a formal understanding between the hospital (staff) and JAMK in some cases to train (teach) international students with low Finnish language proficiency in English, but in my case, at RSU PT program there was no such agreement to the best of my knowledge. The language barrier was to be managed by the RSU via student mentorship. This approach proved helpful and supportive to my learning, in my opinion. Some staff, nurses and doctors on occasion also explain in English if they feel comfortable with English language use and the other students do not object to it as well. Honestly, just like my experience in one of my practices in Finnish hospital, where I had the opportunity to work with a Finnish student that was willing to assist with my learning when she realized my struggle with hospital experience due to the language difficulty. It was better and easier, when mentored by fellow student, if the nurses are there to guide both students simultaneously. The student mentor just supporting in instances where verbal explanation are really necessary and the nurse mentor taking care of the practical aspects.
Most hospital systems in Latvia differ from the Finland system in a number of ways. Generally, the composition and the role of medical and health personnel, work ethic and social-cultural influence on hospital environment. I think the work environment is a lot more relaxed and supportive. Doctor-nurses interaction reflects the classic but subtle hierarchical system in hospital setting. I think subordination does not only exist between the doctor and nurses alone but maybe more pronounced among the nurses and their nursing assistants or careers. The hospitals are well equipped, orderly and the aseptic culture is good. In most hospital you would find the following professional more or less; doctors, nurses, physiotherapist, social rehabilitator, assistant nurses, carer and other staff such as cleaners, janitors etc. The nursing roles, therefore, differs significantly from the Finnish system. Take for instance in a surgical ward. A doctor works with an operation/surgical nurse, who performs functions like a scrub nurse. He or she prepares the sterile field, assist the doctors with the surgical instrument and prepares the patient for the surgery. I think doctors take care of the cleaning and disinfection of the body part to be operated and does the draping. The surgical nurse is assisted by an assistant nurse. The assistant nurse I understand is not a trained nurse but an auxiliary staff whose duty comprise in part the function of a circulating nurse. He or she gets the materials needed during the operation for the surgical nurse. In addition, he or she does the cleaning of the operating theatre after the completion of surgical procedure. Such function is designated to other personnel in the Finnish hospital (The circulating nurse and the cleaning staff).
The anaesthesia nurse performs a similar function as in a Finnish hospital, except that most part of patient monitoring is done by the anaesthesia doctor who is always present in the operating room throughout the surgical procedure. Anaesthesia nurses prepare the patients, does the preparation of drugs, material for injections, induction, intubation, extubating. He or she also administers the drug or other nursing intervention when required during the operation. He or she also assists the patient alongside the anesthesiologist to the recovery room. In a classic ambulatory health care system, the setting I observed also differ in some ways from the Finnish system. Nurses are concerned mainly with drug administration and health report. Patient hygiene, nutrition and rehabilitation are designated to other personnel. The carer or nurse assistant takes care of patient’s hygiene and the Physio and social rehabilitator are concerned mainly with physical rehabilitation, outdoor and social activities. The much-coveted ‘bed wash’ synonymous with Finnish hospitals and nursing curriculum is not widely a nursing role Latvian hospital. The career and nurse assistant adopt different washing style. The location and equipment depend on the level of independence of the patients. While some require little supports some may be transported to the bathroom completely aided with bath lifts and patient lifts slings. One equipment that seems unique or unfamiliar to me is the bathtub used to bath immobile patients. They are transferred to the ‘bathing bed’ and given regular wash with water and soap.
The medicine store in most hospital is managed by the head nurses. He or she is responsible for ordering and ensuring that medications needed by the patients are available to the nurses in charge of patient’s medications for prompt dissemination. The nurses are supplied daily packet of needed drugs based on patient medical history, nursing reports and doctor’s fresh prescription. The list is submitted to the head nurse who would sort the drug front the drug store. The documentation is a combination of paper and computer medium. The anesthesiologist at the Stradin hospital uses the paper format for patient monitoring and reports. While in ambulatory care, patient reports were done on the computer. The drug arrangement in the drug store, on like in most Finnish hospital was not arranged in alphabetical order rather based on the active substances and the drugs therapeutic functions. I had a hard time sorting for drugs the first time I was assigned to such duties. It requires a good knowledge of pharmacology. More than your pharmacology course grade though, I think it depends more on experience which can only come with hands-on practice.
A nurse in the hospital oversaw 106 patient’s medication per shift. It is a lot of patients to take care of in 24hours, but the nurses have mastered their trade, they manage to do their work in good time and even have spare time for coffee and occasional breaks. There is no national law or regulation concerning the autonomy or restriction regarding the level of care that could be overseen by a student nurse. Some students practice in hospitals or care homes where they are given some level of responsibilities and care functions while in other places most of the times student only observed during the procedures and help with getting needed material. The level of involvement of student in the nursing care in most place of practice is highly dependent on the hospital policy, even more so the mentor nurse a students is working with. But in surgical ward, students mostly assist with basic stuff and take on the role of observing in most of the procedure. It is worth to mention that the system encourages a lot of verbal discussion on related subjects, concerns or observations made by the student on a daily basis. The patients are easy to manage and are open or sometimes excited to work with a student nurse. They are very friendly and thankful to students and nurses for their service most times. In my opinion, due to the tight work schedule, I think Latvian nurses spend less time with the patients, and this could contribute to the value attached to their presence by the patients.
There is a shortage of nurses in the Latvia system, however, the younger population are not highly interested in the profession. Just as in many western systems, the poor wage, rigorous work schedule and under-appreciation for nursing professional came up in my chat with my friends. A nurse is called ‘Māsa’ – meaning ‘Sister’ or the other form Māsina – trying to make it sound a bit better or nicer. Such title many nurses opined has a despiteful connotation. The work schedule is lengthy, mostly 24hours per shift, 3.5euros per hour would be a good enough bargain. An average of 850e per month is a regular wage of a nurse and a little lesser for a nursing assistant, social rehabilitator or carers. Nurses and other health personnel such as nurse assistant and carers do an average of 7 shift per month in any one establishment. It is not uncommon to have two or three jobs to ensure moderate financial autonomy. Private hospitals pay more and there is less work, but offers are scarce or competitive or depending on whom you know. Some if not most nursing students combine study with work as well. It is a good avenue to get on-the-job experience and simultaneously make some ends meet. Students from there second year can get nursing or nurse assistant job from both the government hospital and the private clinics. These also make Latvian nursing students really independent during their practical training. It was intimidating practicing along side most of them who have been working in the hospital system already for quite some time. But they try to rather assist and support you in your learning and not let you feel awkward. It was interesting to share their views on Latvians outlook on the nursing profession, the challenges and their own personal motivation and goals as a nurse. If nothing at all, these set of young Latvians nurses are courageous and resilient people. They make light of the situation and state loudly with positive mindset how they have learned to cope with the situation. They are determined to stay here because the system needs them and because this is their county and they have no plan to look for greener pasture anywhere.
Regardless of the popular notion of Latvia economic challenge, the Latvian health system is up and running. Except you are really interested in the details the system seems fine. Most private and government hospitals are well equipped. The common problem of long queues in public hospital makes the private hospital the preferred for those who want urgent treatment and have the economic power to pay for their services. There is a couple of old government hospital without the newest equipment but so also are many new and modern facilities and another medical infrastructural project underway. The professional ethics and hygiene in most hospitals are good. The hospital environments are relaxing and welcoming. I witnessed a cultural practice at the hospital which involved given a residence doctor a water bath just after completing her first successful operation independently. The nurses often have a bucket of water ready for such operation. The resident also is partly expectant. This practice is common when residents’ doctors are growing in proficiency and able to perform certain otherwise difficult procedures successfully and independently. I guess it was a mixed reaction for the lady doctor I saw experienced the ritual, a mix of pride and embarrassment. But in a supportive and sociable working environment like the Latvian system, such an act would remain for a long time to come, and many future doctors would still get drenched by their nurses.