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Neglected health professions push for new standards

The problems were raised in the years many times, noted Alexander Alexandrov

Representatives of several health professions, including nurses, midwives, rehabilitators, laboratory technicians, medical assistants and assistant pharmacists, advocated clear rules and standards to work on.

These problems have been raised many times over the years. The problems have long been unresolved and now it is high time to pay attention because we are really in a difficult situation in healthcare, in crisis", said the Chairman of the Union of Medical Assistants and Paramedics in Bulgaria Alexander Alexandrov in the studio of "Bulgaria in the Morning".

The main problem is the lack of appropriate rules and standards for nurses, medical assistants and other health professionals to be recognised and regulated. These professionals play a key role in healthcare and are often at the forefront of helping patients.

Aleksandrov pointed out on the air of Bulgaria ON AIR that at the moment a large part of the medical staff does not stay in Bulgaria, and the reasons are not only financial, but also related to the working conditions and the lack of opportunities for professional development.

He stressed that legislation and regulations need to be changed, taking into account the views of these professionals already when creating new rules.

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Nurses, assistant pharmacists and medical assistants want a meeting with the President of the National Assembly, the President and the Prime Minister

The lack of constructive dialogue with the institutions and audibility for the problems of the medical professions, decision-making without hearing them, the lack of a clear formula for postgraduate studies, the destruction of the professional authority of the medical professions - these are the serious problems accumulated for years faced by several professional guilds. This is what Lilyana Petrova, Chairwoman of the Bulgarian Association of Assistant Pharmacists (BAAPF), warned at a press conference today at a joint press conference with the Bulgarian Association of Health Care Professionals (BAHCP), represented by its Chairwoman Milka Vasileva, and the Bulgarian Union of Medical Assistants and Paramedics (BSLAF), represented by the Chairwoman Alexander Alexandrov.

The press meeting was held under the motto "Together to protect our professions for the health of patients".

The three organizations have recently signed an agreement that unites to protect the professions they represent and express readiness for joint action against isolation, inequality in contacts with institutions and the long-standing lack of adequate and workable solutions in healthcare to solve the personnel crisis, it became clear at the press conference.

“In such an environment, there can be no expectation of those wishing to pursue these professions. Solutions to the alarming trend of the personnel crisis are late, there is a serious legislative vacuum related to the role of the professions in healthcare, "said Lilyana Petrova.

The Chairwoman of BAPZG Milka Vasileva reminded that when the organization was formed in 1993 there were 55 000 nurses in our country and today there are 22 820, and every third is of retirement age, the situation is similar for midwives. According to her, 89% of nurses and midwives suffer from burnout, there is practically no nurse working in only one place, and a deficit in itself is a prerequisite for a deterioration in the quality of medical care.

“In many places, the pay levels provided for in the CLA have not been reached,” Vassileva further said.

Alexander Alexandrov, President of the Bulgarian Medical Association, explained that the profession of ‘medical assistant’ is not even included in the CLA, while at the same time more than 2000 medical assistants and paramedics, as they used to be called, have been working in different units of the system. Six higher medical schools in Bulgaria have been preparing such staff for 7 years, which can be very useful for healthcare. Aleksandrov also confirmed that in most cases, normative acts directly affecting the work of the medical professions are not discussed in advance, and it becomes clear to them much later, when they are already about to be finalized.

According to Lilyana Petrova, it is important to realize that medical professionals are needed in all structures and units of health care, because it is they who provide the necessary health and pharmaceutical care for people, especially in remote regions where the staff deficit is most noticeable.

The three professional organizations have prepared an open letter to the President of the 51st National Assembly Assoc. Natalia Kiselova, President Rumen Radev and Prime Minister Dimitar Glavchev. In it, they demand a meeting to discuss the problems of the medical professions and to look for ways out of the severe personnel crisis in healthcare.

"We are convinced that the most valuable thing in healthcare is the staff and we are determined to protect our professions and, in the interests of our patients, together to seek a positive and lasting solution to the crisis," the letter states.

You can find the full text here.

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Healthcare professionals, assistant pharmacists and paramedics want rules for their professions

Representatives of several health professions, including nurses, midwives, rehabilitators, lab technicians, medical assistants and assistant pharmacists, announced on Tuesday clear rules and standards to work on. Their professional organizations say they have been neglected so far, but will now lead a "war" to regulate their professions.

Problems go back many years. For more than 15 years, we have been telling the government, the media and the public what will happen in our health system if no action is taken. We wrote a lot of protest statements, letters, contacted the institutions, which treated politely, but unfortunately to no avail. Of the 55,000 nurses in 1993, we now have 22,820 nurses. One in three nurses is of retirement age. One in four midwives is of retirement age. And in the next few years, a third of the sisters will be of retirement age. I think that there is no person who, with these numbers, cannot realize that Bulgarian healthcare is in collapse," said Milka Vasileva, chairman of the Bulgarian Association of Health Care Professionals (BAHCP), which brings together 35,000 nurses, midwives, lab technicians, rehabilitators, etc.

She pointed out that working in 2-3 or even 4 places, nurses, midwives and rehabilitators "save the system".

Vassileva announced that already 3 years ago BAPZG offered standards of health care with options for determining the number of nurses, midwives and other health care professionals according to the specifics of the work and the condition of the patients.

"We are fully aware that if these standards are respected, at least half of the hospitals should be gone," Vassileva said. But he added that at the same time, these standards are clearly justified: how the required number of staff has been calculated and this is in line with the international standards of health care and the Bulgarian traditions.

We also offer opportunities to appoint caregivers and health assistants in medical institutions to be trained according to the relevant rules and to assist nurses and work under their supervision. Thus, performing basic patient care, nurses will be relieved of these duties and will work on direct medical activity: performance of medical appointments, monitoring the condition of the patient, "Vassileva said.

This, in her words, will ease the work of the sisters and increase their motivation to stay in Bulgaria. Vassileva pointed out that now 65% of the graduating nurses do not remain in the healthcare system – some go abroad to work and others do not practice the profession after graduating.

Currently, the nurses' overwork is extremely severe, burnout syndrome has covered over 89% by workers and this leads to poor quality health care," Vassileva said. Therefore, the professional organization insists on standards that guarantee quality.

At the moment, many medical institutions still have not reached the minimum basic salary of BGN 1500 for a nurse, enshrined in the last collective agreement. Low pay also pushes young people away from the profession.

The three professional organisations – health care professionals, assistant pharmacists and medical assistants – complained about the lack of constructive dialogue with the institutions and the audibility of their problems, the decision-making about their work without them, the destruction of the professional authority of their professions.

In five years, 221 assistant pharmacists have left the sector. They leave the country and with a diploma in hand go to work in other countries, because they are valued there and from every point of view they see more sense to develop there. This is the real protest against the system, not those of the yellow pavers, which are also important," said Lilyana Petrova, the Bulgarian Association of Assistant Pharmacists (BAPF).

Assistant pharmacists and medical assistants (former paramedics) share the common feeling that society is deliberately setting itself up against their professions, denouncing them as dangerous and unnecessary.

Alexander Alexandrov from the Bulgarian Union of Medical Assistants and Paramedics (BSLAF) pointed out that in their person the state has hidden potential, which, if properly implemented, the future of our health system will be better. Currently, there are about 2,000 medical assistants and paramedics in the country.

However, they work in the absence of clear standards for the profession and rules of good medical practice. "Where standards exist, the functions and activities to be performed shall be clearly identified. When there are no such standards and our professions are neglected by the government, then we give the employer the opportunity to interpret. And now it happens that a doctor's assistant works as a nurse, which is illegal. This is not right, but it is allowed," Alexandrov said.

The three organizations issued an open letter with their requests, which was sent to the National Assembly, the President and the caretaker prime minister, expressing readiness to present them to a new cabinet, if any.

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Regulate the professions of health care professionals. This was demanded at a press conference by the professional organizations.

We will fight a war for rules for our professions, announced Milka Vasileva, Chairman of the Bulgarian Association of Health Care Professionals (BAHCP). "By protecting ourselves, we are protecting patients first and foremost," she said. The insistence is that health care professionals as a regulated profession should be able to develop and qualify.

The Chairman of the Bulgarian Union of Medical Assistants and Paramedics (UBLAF) Alexander Alexandrov reported that the medical assistants are well represented and well received. In time, we suffered all sorts of shocks, they tried to close us down, he pointed out. We were hidden from the public, Alexandrov explained. We will defend the idea of the existence of our profession, he threatened. The state has hidden potential in the face of paramedics and medical assistants. Lilyana Petrova, President of the Bulgarian Association of Assistant Pharmacists (BAPF), wants support from the National Assembly (NA) to protect their professional problems. There is no constructive dialogue with the institutions and no audibility of our problems, she stressed. There is no understanding of the postgraduate training of health care professionals, according to her. The staffing problem is at a critical level, in her opinion. Urgent solutions are needed, according to the professional organisations. Decisions are critically delayed, Petrova said. The legislative vacuum in the area is deepening, she added. Many protest letters were written, many declarations were sent, but to no avail.

One in three nurses is of retirement age, one in four midwives is of retirement age. Healthcare is collapsing, Milka Vasileva said. The fact that nurses and rehabilitators work in 2 and 3 places saves the health system. Health care professionals are adamant that health care reform is needed. No health minister has ever dealt with one before. Young people have no motivation to study in our profession, Vassileva said. The starting salary of BGN 1500 has not been reached, as it should be under a collective agreement. About 65% Graduates do not enter the health care system. At the same time, there is a huge gap between young and old cadres, as young people are trained in new models and technologies. The problem is that every hospital has its own rules. Therefore, health care professionals want unified rules of work. The government should finally realize the problems of the sector, according to Milka Vassileva. We want a constructive dialogue, she stressed. They want health care standards.

Recently, health organizations signed an agreement uniting to protect the professions they represent and express readiness for joint action against isolation, inequities in contacts with institutions and the long-standing lack of adequate and workable solutions in healthcare to solve the personnel crisis. They ask why the opinion of the professions is not sought before making management decisions, as well as why medics from the represented professions continue to leave. Conscious organizations are alarmed by the personnel crisis, which is already spreading to large cities, health imbalances are becoming more apparent, but this does not cause an adequate response and measures to be taken to contain them.

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65% from graduating nurses do not flow into the Bulgarian healthcare

Professional organizations of health care professionals insist on a decent remuneration

Three organizations of health care professionals signed an Agreement on common actions to protect their professional interests.

An open letter with their requests will be sent today to the President of the National Assembly, the Prime Minister from the caretaker cabinet and the President.

In it, they insist on working solutions to a deepening personnel crisis in healthcare.

The main problems, according to Milka Vassileva, President of BAPZG, Lilyana Petrova, President of BAPF and Alexander Alexandrov, President of BASAF, are the lack of dialogue with the institutions and the audibility of their problems, decision-making for the "development" of their professions without hearing representatives of our professions, the lack of a clear and working formula for understanding postgraduate education, the lack of a comprehensive approach to solving the personnel crisis, including decent pay and preserving our professional authority, the worrying trend of lack of health and pharmaceutical care in the problem regions.

35,000 are the health care professionals in Bulgaria - among them nurses, medical assistants, paramedics.

Of the 55,000 nurses in 1992, there are now 22,820, with one in three nurses of retirement age. Each of them works in 2-3 jobs, if necessary, we will fight a war for our regulated professions, Milka Vasileva said during the discussion on "Protection of professions and patient health".

At the meeting, they insisted on a unified standard of how many health care professionals should work in a Clinic or Department.

65% of the graduating nurses do not merge into the Bulgarian healthcare - one part go to work abroad, another part work not in the specialty, but only a small part work on it, it became clear at the discussion.

A huge problem is the impossibility of postgraduate training of these staff, which is why there is no interest from young people to train in these professions, explained Alexander Alexandrov, Chairman of the Bulgarian Union of Medical Assistants and Paramedics. Only BGN 1500 is the salary of a doctor's assistant in the Pediatric Department in a large hospital, Aleksandrov gave as an example.

According to him, for 7 years in our country 6 universities train medical assistants, and from there they graduate 20 people a year, who are actually the young people in this profession. These are the former paramedics in our country, which, however, has been closed before and there is a gap of 15 years in which such cadres have not been trained.

Currently, we have a total of 2,000 medical assistants in the country, said Alexander Alexandrov.

Aleksandrov also pointed out that, together with the other two professional organizations, they will defend the rights of medical assistants and paramedics. In the face of medical assistants, the state has hidden potential for a better future of the health system, and medical assistants would have a serious place in schools.

4000 are assistant pharmacists in our country, but for our problems there is also a lack of constructive dialogue with the institutions, pointed out Lilyana Petrova, President of the Bulgarian Association of Assistant Pharmacists. They insist on the possibility of consulting patients in the pharmacy when buying over-the-counter medications.

Professional organizations of health care professionals insist on a decent remuneration based on mandatory Rules for the work of health care professionals, compliance with the National Code of Ethics and Rules of Good Medical Practice.

For the time being, the Collective Agreement for 2025 in the healthcare sector has not been signed, and these specialists are missing at all in this CLA, it became clear at the discussion.

Dissatisfaction with the situation is felt in our guilds, which leads not only to the departure of experienced and long-term staff, but also to a permanent reduction in the number of people willing to train and work in our professions. The legislative vacuum related to the role of our professions in the healthcare sector causes harm for which we from the Bulgarian Association of Health Care Professionals, the Bulgarian Association of Assistant Pharmacists and the Bulgarian Union of Medical Assistants and Paramedics cannot remain indifferent.

We are convinced that the most valuable thing in healthcare is the staff and we are determined to protect our professions, as well as in the interest of our patients, together to seek a path to a positive and lasting solution to the crisis. We are asking you to hold a joint meeting with you to present the specific problems of our professions, possible solutions and proposals for legislative changes, taking into account our professional experience and good European practices for the adequate integration of our professions in healthcare, write to the authorities of the three organizations.

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Half of the hospitals in the country should be closed if health care standards related to the necessary personnel are met.

Because of this problem, three of the professional organizations issued an open letter to the executive branch.

It calls for urgent measures to solve the personnel crisis, and in addition to nurses, there is a shortage of medical assistants. Currently, there are more than 2,000 people across the country, and only 150 graduates per year.

Ivan Georgiev is one of the few remaining paramedics in the country. He works in the Emergency Service in Ruse, where the shortage of staff is increasing.

"We are not enough numbers, it is necessary to take emergency duty to cover the teams," said Ivan Georgiev, a medical paramedic in Emergency Services - Ruse.

There is also a lack of staff in hospitals. And the use of medical assistants has proven ineffective.

"If you are given a case, you may come across a situation where one nurse is alone on duty and one doctor of both wards, as well as one nurse of two wards, which is absurd," said Tatyana Atanasova, a nurse.

"A doctor anesthesiologist can serve five, six, ten rooms in which surgery is performed, with each patient being cared for by a doctor's assistant. That is, in this way they can be integrated into the Bulgarian healthcare system and not only that. They can also be integrated into the emergency departments of the hospital itself," added Alexander Alexandrov, Chairman of the Bulgarian Medical Association (BSLAF).

They can also be used more rationally in schools where medical staff are lacking. For four years now, Desislava has been confronted with the ordinance, which limits her skills as a medical assistant.

"A child with an allergy, with an acute allergic reaction, starting with urticaria, can literally lead to an emergency in five minutes, which ends fatally. I, sitting with the ampoule in my pocket, do not have the right to perform manipulation in my office, as I have been appointed as a medical specialist," said Desislava Tsenova, a doctor's assistant.

Including as a principal, I've also experienced a death at school, so they happen. There are emergency situations. There needs to be adequate medical care, not just health care as it is now," said Danko Kalapish, director of the 107th Khan Krum Primary School.

As the medical crisis deepens, one in three nurses is of retirement age and works in several places.

"At the moment one doctor responds zero whole and ninety-five nurses. If this does not change, in the next three to five years about 10,000 nurses will drop out of the system, which means that there is no one to care for the patients," said Milka Vasileva, chairman of BAPZG.

According to alarming statistics, there are now nearly 22,000 nurses in Bulgaria compared to over 55,000 30 years ago.

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BNT

The managements of the Bulgarian Association of Health Care Professionals (BAPHG), the Bulgarian Association of Assistant Pharmacists (BAPF) and the Bulgarian Union of Medical Assistants and Paramedics (BULAF) insisted at the National Press Club of BTA on the regulation of their professions, as well as on urgent measures to solve the problems with the personnel crisis. With these unifying ideas, the three organizations signed an agreement uniting in defense of the professions they represent and express readiness for joint action against isolation, inequality in contacts with institutions and against the long-standing lack of adequate and workable solutions in healthcare to solve the personnel crisis, said Lilyana Petrova, Chairman of BAPF.

The number of health care professionals is 35 thousand, said Milka Vasileva, Chairman of the BAPZGB. According to her, 22,820 of them are nurses and in the next few years a third of the current workers will be of retirement age. Bulgarian healthcare is collapsing, and nurses, midwives and rehabilitators are rescuing the system by working in several places, she added. The professional organization has prepared the normative documents related to the regulation of the profession of health care professionals. At the moment, the rules, in her words, are not clear, and therefore with the two organizations we will fight not a fight, but a war for the regulation of our professions, for their protection, for clear rules, for the opportunity to work in the best possible way, Vassileva added. Young people are not motivated to train as nurses, as in many medical institutions the starting salary indicated in the Collective Agreement has not been reached. According to her, about 65% of graduate nurses do not remain in the healthcare system.

Our main problems are related to the lack of constructive dialogue with the institutions and audibility for our problems, making decisions for us without our hearing, lack of a clear formula for postgraduate training, the destruction of the professional authority of our profession, said Petrova. In such an environment, there can be no expectation that there will be people willing to practice these professions. In the words and solutions to the alarming trend of the personnel crisis are late. There is a legislative vacuum related to the role of professions in healthcare, Petrova said.

The medical assistants are the heirs of the paramedics, recalled Alexander Alexandrov - Chairman of the Bulgarian Medical Association, pointed out that together with the other two professional organizations they will defend the rights of the medical assistants and the paramedics. In the face of medical assistants, the state has hidden potential for a better future of the health system, he said, pointing out that medical assistants would have a serious place in schools.

The organizations will send an open letter today to the President, the Prime Minister and the Speaker of the National Assembly, in which they demand a meeting with them.

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BTA