General provisions

1.1. The nurse of a general practitioner (family doctor) belongs to the category and directly reports to [name of the position of the head].

1.2. A nurse of a general practitioner (family doctor) is appointed to the position and dismissed from it by order of [position title].

1.3. A person who has a secondary professional education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "General Practice" without presenting requirements for work experience is accepted for the position of a nurse of a general practitioner (family doctor).

1.4. A general practitioner (family doctor) nurse should know:

Laws and other regulatory legal acts of the Russian Federation in the field of healthcare;

Theoretical foundations of nursing;

Fundamentals of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle, as well as family medicine;

Rules for the operation of medical instruments and equipment;

Statistical indicators characterizing the state of health of the population and the activities of medical organizations;

Rules for the collection, storage and disposal of waste from medical institutions;

Fundamentals of the functioning of budget-insurance medicine and voluntary medical insurance;

Fundamentals of clinical examination;

The social significance of diseases;

Rules for maintaining accounting and reporting documentation of a structural unit;

Main types of medical documentation;

medical ethics;

Psychology of professional communication;

Basics of labor legislation;

Internal labor regulations;

Rules of sanitary, personal hygiene;

Rules and norms of labor protection, safety and fire protection.

Job Responsibilities

The nurse of a general practitioner (family doctor) is responsible for the following:

2.1. Organization of an outpatient appointment with a general practitioner (family doctor), providing him with individual cards of outpatients, prescription forms, referrals, preparation for the operation of devices, tools.

2.2. Maintenance of personal records, information (computer) database of the health status of the population served, participation in the formation of groups of dispensary patients.

2.3. Implementation of preventive, therapeutic, diagnostic, rehabilitation measures prescribed by a general practitioner (family doctor) in a polyclinic and at home, participation in outpatient operations.

2.4. Providing a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, overalls.

2.5. Accounting for the consumption of medicines, dressings, tools, special accounting forms.

2.6. Monitoring the safety and serviceability of medical equipment and equipment, the timeliness of their repair and write-off.

2.7. Carrying out pre-medical examinations, including preventive ones, with recording the results in an individual card of an outpatient.

2.8. Identification and solution within the competence of medical, psychological problems of the patient. Providing and providing nursing services to patients with the most common diseases, including diagnostic measures and manipulations (independently and in collaboration with a doctor).

2.9. Conducting classes (according to specially developed methods or a plan drawn up and agreed with the doctor) with various groups of patients.

2.10. Reception of patients within their competence.

2.11. Carrying out preventive measures: performing preventive vaccinations for the attached population according to the vaccination calendar; planning, organization, control of preventive examinations of contingents to be examined for the purpose of early detection of tuberculosis; taking measures to prevent infectious diseases.

2.12. Organization and conduct of hygienic education and upbringing of the population.

2.13. Providing first aid in case of emergencies and accidents to the sick and injured.

2.14. Timely and high-quality maintenance of medical records.

2.15. Obtaining the information necessary for the qualitative performance of functional duties.

2.16. Managing the work of junior medical personnel, monitoring the volume and quality of their work.

2.17. Collection and disposal of medical waste.

2.18. Implementation of measures to comply with the sanitary and hygienic regime in the room, the rules of asepsis and antisepsis, the conditions for sterilizing instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.

2.19. [Other ].

Rights

The nurse of a general practitioner (family doctor) has the right to:

3.1. For all social guarantees provided for by the legislation of the Russian Federation.

3.2. For the free issue of special clothing, special footwear and other personal protective equipment.

3.3. Receive information about the activities of the organization necessary for the performance of functional duties from all departments directly or through the immediate supervisor.

3.4. Require the management of the organization to assist in the performance of their professional duties and the exercise of rights.

3.5. Get acquainted with the draft orders of the management regarding its activities.

3.6. Participate in meetings that discuss issues related to its work.

3.7. Demand the creation of conditions for the performance of professional duties, including the provision of the necessary equipment, inventory, a workplace that meets sanitary and hygienic rules and regulations, etc.

3.8. Improve your professional qualifications.

3.9. [Other rights provided for by the Labor legislation of the Russian Federation].

Responsibility

The nurse of a general practitioner (family doctor) is responsible for:

4.1. For non-fulfillment, improper fulfillment of the duties provided for by this instruction - within the limits determined by the labor legislation of the Russian Federation.

4.2. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.

4.3. For causing material damage to the employer - within the limits determined by the current labor and civil legislation of the Russian Federation.

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1. INTRODUCTION

1.1 The relevance of the problem of developing primary health care according to the principle of a general practice nurse

The socio-economic transformations of the early 1990s affected all aspects of life that determine the health of the population. Psycho-emotional tension, a decrease in the level and quality of life are accompanied by a deterioration in public health indicators, an increase in morbidity and mortality, a change in the type of pathology, and an increase in the number of social and infectious diseases.

On the other hand, the lack of funding has led to the accumulation of problems in healthcare and, first of all, in its outpatient and polyclinic link, which at present cannot fully provide the population with affordable qualified medical care.

In addition, the recent process of specialization has led to the irrational use of resources, to the weakening of the personal responsibility of doctors for the results of treating patients. Important factors that require the transformation of outpatient care are the narrowing of the scope of the district doctor, the fall of his authority, the discrepancy between many of the functions assigned to him and the legal possibilities for their implementation. The level of training of the district therapist does not allow him to treat patients with a number of common diseases, to consider the patient from the point of view of his social status, marital status, work activity and other aspects that affect health and life. These problems require the improvement of primary health care.

One of the priority areas of reform, according to many health care organizers, is family or general practice medicine, the central figure of which is a general practitioner/family doctor.

However, for the successful implementation of a system of family or general practice medicine in our country, it is necessary to solve a number of issues, among which the scientific substantiation of the activities of a general practitioner and nurse, the development of issues of its financing, logistics, organization of work, types of accounting are essential. and reporting documentation, search and creation of methodological foundations for a comprehensive medical and social study of the family, the formation of public opinion and the interest of the population in a new form of medical care.

1. Conduct a comparative analysis of the benefits of providing nursing care on the basis of a general practice nurse.

1. Study of the principles of activity of a general practice nurse in Russia and abroad.

2. Conduct a comparative analysis of the activities of a general practice nurse and a district nurse using the example of the work of the NHI of the Departmental Hospital at Taishet station of JSC Russian Railways.

1.3 Objects and methods of research

Object - the population, nursing and medical personnel of the NHI of the Departmental Hospital st. Taishet JSC Russian Railways.

Methods - sociological survey, data processing, statistical method of data processing.

2. Literature review

2.1 Nursing at the present stage

The twentieth century has ended - the century of scientific and technological progress, revolutionary changes in society and humanity as a whole. Perhaps there is no such sphere of human activity that has not been affected by these changes. This fully applies to medicine as a science and the system of medical education as the most important component of the healthcare industry.

Human health is a special enduring value bestowed on him by nature. The preservation of physical, mental, emotional health should be in the center of attention, both for an individual and for a civilized state.

The relationship between a doctor and a nurse is one of the key in medical practice. With the development of the technical equipment of the industry, the role of nursing personnel in health care is constantly being improved and increased. Today, nursing staff to work with patients must possess not only complex technical manipulations and skills, but also possess modern medical and natural science knowledge.

The words of A.P. Chekhov: "The profession of a doctor is a feat. It requires self-sacrifice, purity of soul and purity of thoughts. Not everyone is capable of this." Self-sacrifice and feat were not only a mandatory requirement, but were also the norm of behavior of our great compatriots. I.I. Mechnikov and D.K. Zabolotny experienced the action of cholera vibrios. S.A. Andrievsky by self-infection confirmed the zoonotic nature of anthrax.

The coming XXI century is accompanied by a further increase in the role and responsibility of the doctor in society. Due to the threat and the presence of regional armed conflicts, an increase in the number of crimes, the problem of morality and morality has become more noticeable in the activities of medical and nursing personnel. Accordingly, the role of comprehensively educated, professionally trained and morally pure people in a white coat has increased.

The problem of the relationship between a doctor and a nurse is one of the key issues in medical ethics. At the same time, the vast majority of authors consider this problem from the standpoint of paternalism - the "paternal" care of the medical class over nursing staff. Doctors of the ancient period were educated in family schools, where knowledge and skills were either inherited or communicated to trusted persons.

With the advent of the first universities in the 9th century, the training of doctors began to gradually move to a scientific track. At the same time, almost until the 18th century, only therapists belonged to doctors. Surgeons came out of the sphere of barbers and were at a lower level. As science and technology developed, the face of medicine changed. Within it, separate directions were formed with the subsequent specialization of graduates. This principle has actually been preserved to this day.

The doctor has been and remains one of the key figures in any healthcare system.

Nursing has also gone through a long and difficult path of development. For the first time in Russia, female labor for caring for the sick in hospitals was used under Peter I. The beginning of nursing in Russia is considered to be 1803, when the service of compassionate widows appeared. In 1818, an institute for compassionate widows was organized in Moscow, and special courses for nurses began to be organized at hospitals. It is during this period that special training of nursing personnel begins. The first service of nurses in Russia was organized by Christopher von Oppel, who in the preface to the nursing education manual wrote: "Without appropriate care and support for patients, even the best doctor cannot restore health and prevent death."

The wider involvement of female labor in caring for the sick in Russia was resorted to during the Crimean War in 1853-1856. It was during this period that for the first time in world history, nurses assisted the wounded on the battlefield. In 1885 N.I. Pirogov developed a collection of instructions for nurses. In the future, nursing in Russia developed under the sign of the Red Cross. Since 1926, the term "sister of mercy" has been changed to "nurse". In 1953, the medical schools were reorganized into medical schools, which train nursing personnel to this day.

Since 1991, the training of nursing staff has also begun in colleges under a 4-year program. During the same period, faculties of higher nursing education were opened in medical universities.

Nursing in Russia is part of the general medical activity. The need to single out nursing is due to a number of organizational, psychological and ethical aspects.

With the transition to the provision of primary health care on the principle of a general practitioner (family doctor), the need arose for the training of general practitioner nurses. A general practitioner should have more autonomy in her work, and not just be a doctor's assistant. The work of nursing staff can have two levels of functioning. One level is working as part of a general practice team. In this case, the nursing staff works during the reception of patients, carries out diagnostic and therapeutic procedures, and provides patronage of patients at home. The second level of nurses' work, which is just emerging in Russia, should provide for more of their independence.

One of the main areas of health care reform, carried out in order to fulfill the constitutional guarantees to the population in the field of health, is the reform of primary health care. Due to the fact that almost 80% of the population starts and completes examinations and treatment in primary health care, the efficiency and quality of the entire health care system, the preservation of the country's labor potential, as well as the solution of most medical and social problems largely depend on the state of outpatient care. problems at the family level.

A general practitioner (family doctor) and a general practitioner nurse provide comprehensive and continuous care to all patients, regardless of gender and age, taking into account their family relationships and social status. One of the main priorities of general practice is accessibility and preventive focus, which helps to prevent the development of diseases in risk groups and their complications requiring inpatient treatment. A well-trained general practitioner is able to independently provide care for 80% of patients visiting outpatient facilities, which significantly reduces the need for subspecialists at this stage of care.

One of the main problems is the lack of accurate data on the needs for nursing care, the features of its planning, the moral and legal responsibility of general practice nurses. Back in the 1960s, the WHO Expert Committee on Nursing defined it as "the practice of human relationships", believed that a nurse should be able to recognize the needs of patients, "considering patients as individual human beings." Nursing care should be aimed at the individual, at the physical, psychological and social problems that arise before this individual in connection with the disease, as well as at the family as a whole.

The nurse, together with the patient and his relatives, and not just with the doctor, outlines the activities that need to be carried out to achieve a specific goal. She must foresee the result of these activities. Since the nurse spends more time with the patient, and relatives in the conditions of the family, the success of the nurse's action will depend on the ideas of the patient and his family about health, illness and the need for success.

2.2 Order of the Ministry of the Russian Federation dated 26.08.92. No. 237 "On a phased transition to the organization of primary medical care on the principle of a general practitioner"

Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens declares the right to choose a general practitioner and nurse who will provide PHC to any of its members, regardless of age and gender.

The Ministry of Health of Russia has developed the Concept for the Development of Health Care and Medical Science in the Russian Federation (approved by Decree of the Government of the Russian Federation of 05.11.97 No. 1387), which considers the development of primary health care, including general medical (family) care, as a priority in improving the organization of medical care. ) practice.

The priority of reforming the "primary link" of health care is due to such features as:

accessibility to the public;

Profitability;

Implementation of all the main stages of medical care

population - prevention, treatment and rehabilitation;

Ensuring constant monitoring of the health of the population.

In order to accelerate reforms in healthcare and adapt the industry to the conditions of a market economy, an order of the Ministry of Russia dated 26.08.92 was created. No. 237 "On a phased transition to the organization of primary health care on the principle of a general practitioner (family doctor)", which approved the regulations on a general practitioner and a nurse, qualification characteristics and a standard curriculum for training specialists.

Appendix No. 5 to the order of the Ministry of the Russian Federation of August 26, 1992 No. 237.

Regulations on the nurse of general practice.

1. General position .

1.1 A general practitioner nurse is a specialist in nursing, works in conjunction with a general practitioner (family doctor) and provides medical care to the attached population, including preventive and rehabilitative measures.

1.2 Nurses who have been trained in the specialization program "General Practice Nurse" are appointed to the position of a general practice nurse.

1.3 A general practice nurse works under the guidance of a general practitioner or independently under the terms of an agreement (contract).

A general practice nurse is appointed and dismissed in accordance with applicable law.

2. Responsibilities of a General Nurse. The main responsibilities of a general practice nurse are:

2.1 Implementation of preventive, therapeutic, diagnostic measures prescribed by a doctor in a polyclinic and at home, participation in outpatient operations.

2.2 Providing patients and victims with first medical aid in case of injuries, poisoning, acute conditions, organizing hospitalization of patients and victims according to emergency indications.

2.3 Organization of an outpatient appointment with a general practitioner (family doctor), preparation of a workplace, instruments, tools, preparation of individual outpatient cards, prescription forms, examination of the patient, preliminary collection of anamnesis.

2.4 Compliance with the sanitary and hygienic regime in the room, aseptic and antiseptic rules, sterilization conditions for instruments and materials, measures to prevent post-injection complications, serum hepatitis, AIDS, in accordance with current instructions and orders.

2.5 Maintenance of medical records (statistical coupons, emergency notification cards, referral forms for diagnostic studies, mailing lists to VTEC, sanatorium and resort cards, dispensary observation control cards, etc.).

2.6 Providing the office of a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, overalls. Accounting for the cost of medicines, dressings, tools, special accounting forms. Monitoring the safety and serviceability of medical equipment and equipment, their timely repair and write-off.

2.7 Carrying out personal accounting of the population served, identifying its demographic and social structure, accounting for citizens in need of home medical and social services.

2.8 Carrying out pre-medical preventive examinations of the population in the polyclinic (outpatient clinic) and at home.

2.9 Organization of registration of dispensary patients, disabled people, often and long-term sick people, etc.; control of their visits, timely invitation to the reception.

2.10 Participation in the conduct of sanitary and educational work at the site: promotion of hygiene knowledge, a healthy lifestyle, rational nutrition, hardening, physical activity, etc.

2.11 Preparation of the sanitary asset of the site, conducting classes on self-help and mutual assistance in case of injuries, poisoning, acute conditions and accidents; training of relatives of seriously ill patients in methods of care, provision of primary first aid.

2.12 Preparation of patients for laboratory and instrumental studies.

2.13 Timely maintenance of established accounting and reporting, statistical documents

2.14 Continuous improvement, improvement of one's professional level, knowledge, professional culture

2.15 Compliance with internal labor regulations, medical ethics, labor protection and safety requirements

3. Rights of a general practice nurse .

3.1 Make proposals on the organization of work, providing the necessary medical medicines, tools, dressings, as well as on improving the medical and preventive care of the population within its competence

3.2 To take part in meetings (meetings) on the issues of medical, preventive and organizational work at the attached site

3.3 Constantly improve their knowledge, at least once every 5 years on the basis of schools (departments) for advanced training of employees in secondary specialized medical and pharmaceutical education

4. Responsibility of a general practice nurse

A general practice nurse is responsible: for the ongoing professional activities, failure to provide medical care to patients in life-threatening conditions, for illegal actions or omissions that caused damage to the health or death of the patient, in the manner prescribed by law.

All this requires professional special training and retraining of nurses in general practice. The creation of new curricula should not provide for a simple "building up" of knowledge and an increase in the number of values, but for the training of specialists with "different levels of categories and functions that provide for the right to make independent decisions."

2.3 Order of the main health department of Irkutsk dated 23.10. 2003 No. 630 "On the improvement of outpatient care for the population of the Irkutsk region"

In the Irkutsk region, as well as in the Russian Federation as a whole, an analysis of the main indicators of resources in the activities of medical institutions showed that, as before, priority in the provision of medical care is given to more expensive inpatient care. At the same time, it was noted that the number of positions occupied by local general practitioners is decreasing, and the proportion of specialist doctors working in hospitals is constantly increasing.

The organization of primary medical care, focused on the district and specialized district services, does not provide the necessary efficiency. The functions of a district doctor do not allow him to provide continuous and comprehensive care to the main categories of patients, regardless of gender and age. There is no responsibility of the doctor for the health of the family as a whole and continuity in the management of patients during their transition from children's polyclinics to adult service.

The key task in solving these problems is to develop the principles of family medicine and increase the role of general medical (family) practices in primary health care. In pursuance of the orders of the Ministry of Health of Russia dated November 20, 2002 No. 350 “On the improvement of outpatient care for the population of the Russian Federation”; dated March 21, 2003, No. 112 “On the staffing standards of the Center, department of general medical (family) practice; dated August 12, 2003, No. 402 “On the approval and implementation of the primary medical documentation of a general practitioner (family doctor)” and in order to further improve and effectively organize outpatient care for the population through the phased introduction of general medical practice (family medicine)

2.4Organization of the work of a general practitioner abroad

Different countries have different practices for creating new places for general practitioners: some countries have certain legal acts regulating the creation of new places (Italy, Austria, etc.), others do not (Belgium, the Netherlands, etc.). In a number of countries, for example, Sweden, Finland, where general practitioners receive a fixed salary, new general practitioners are accepted only if there are vacancies. It should be noted that in the presence of such regulation, Italy has the highest density of general practitioners and a low workload per general practitioner, and in the absence of such regulation (the Netherlands), the lowest density of general practitioners and the largest number of patients per doctor.

The number of inhabitants per general practitioner ranges from 850 to 2430, and three groups can be distinguished:

The first - up to 1000 people (Australia, Spain and some others),

The second - from 1000 to 2000 people (Canada, France, Great Britain, USA, Germany, Japan),

The third group - more than 2000 people per general practitioner (Sweden, Holland, Singapore, Hong Kong).

The number of consultations per GP per week in most countries was in the range of 100 - 200 consultations. In the countries of Southeast Asia (Japan, Singapore, Hong Kong), as well as Germany, the number of consultations was much higher - from 220 to 375 per week.

Characteristics of primary care in different countries.

The number of hours per week spent on GP consultations in Denmark, Spain, France is from 25 to 32, while in most countries the average is about 45 hours (42-48), and in Germany and Southeast Asian countries (Japan , Singapore, Hong Kong) - this time is 50 hours or more per week.

The work of a general practitioner is a prestigious profession and this is confirmed by the fact that his average income exceeds the average income of private sector workers.

The most common among general practitioners is to organize medical care outside office hours on their own, however, in some countries, such as Italy, there are special services that provide medical care and ambulance when general practitioners are not working.

In Austria, for example, general practitioners must be available to the public from 9 a.m. to 7 p.m. on weekdays. During weekends, assistance is also provided by special services. In Italy, general practitioners are required to be available to the patient from Monday to Friday from 8 am to 8 pm with a 2-hour break, and on Saturday from 8 am to 2 pm.

The choice of a general practitioner is a serious factor in the competition between physicians. Among the reasons that play a certain role in choosing a general practitioner, according to a number of researchers, the following can be considered the most important:

The attractiveness of the doctor's work methods,

Good attitude towards children

Eligibility (former left)

He has been treated by him since childhood, is the doctor of his wife/husband;

Dissatisfaction with the previous doctor,

Impossible to find another.

A general practitioner can work alone - the so-called solitary practice, in partnership (2 general practitioners) and as part of a certain "team" - group practice. Recently, such a form of organization of general practice as health centers has become more and more widespread.

Recently, there has been a trend towards a wider distribution of group practice, as more preferable than solo or in partnership. So, according to some data in the UK in 1951, 81% of general practitioners worked alone or together, and only 6% in a general practice consisting of 4 or more people; in 1983 this ratio was already 29% and 49% respectively, at present the number of solitary practices has decreased to 10%. When working in group practice, there is less workload on duty, a greater opportunity and duration of rest (vacation), more opportunities for diagnosis, treatment (due to better equipment, the ability to purchase equipment). In addition, this expansion of opportunities for professional communication, mutual consultations, study, etc. It is advisable to consider health centers (CH) using the example of Finland. Primary care has been a priority in Finnish healthcare since 1972. Characteristically, in the early 1970s, almost 90% of all health care resources were spent on specialized hospital services, leaving only about 10% for primary care. However, the health status of the population did not improve, although health care spending grew twice as fast as the gross national income.

The health center has been adopted as the main health facility in the community primary care system. The health center does not mean just a building or a complex of buildings, but represents an integral system of organizing primary care. The minimum number of people served is about 10,000 people. There are more than 200 HCs in Finland and most of them have at least 4 GPs to ensure duty. Support staff on average 11 people. Some HCs have their own specialist consultants, but in any case, consultations may also be provided by external consultants. The HC has a laboratory, X-ray and local hospitals (beds) for acute and chronic patients. Services are provided in various branches scattered throughout the territory. Some of them are open both day and night, some are available 2 times a week. 75% of doctor-patient contacts are carried out at the level of the central health center, the rest through insurance funds and private doctors. Among the services provided by the CH, it should be noted: the protection of motherhood and childhood. A woman visits the HC about 16 times during pregnancy and after childbirth. 95% come for examination up to 4 months, and more than 99% of women give birth in the hospital. Emphasis is placed on the health of the elderly, family planning, health education. Physiotherapy, observation of the mentally ill and many other groups are carried out.

It is characteristic that, in general, home visits are performed by nurses from health centers, and general practitioners make home visits only to elderly or chronic patients for whom a hospital is organized at home.

Health centers do not have a personal, patient registration system, as all physicians are collectively responsible within the service area of ​​the health center. This does not allow continuity of care, which is why more and more people are now seeking more personalized care from the doctor of their choice. These trends are taken into account by health care organizers and in the future it is planned to replace collective responsibility with individual responsibility for patients registered with a given doctor.

95% of all health center GPs work 37-hour weeks and are paid. Additional payment exists for night and telephone duty. In their free time, doctors are allowed to earn extra money in private practice, which is paid on a “pay-for-service” basis. Only 5% work as private practitioners. Patients can use the private sector as needed, while being partially reimbursed for the cost of treatment from public insurance funds earmarked for the private sector.

According to the definition of the American Academy of Family Physicians, PHC is a type of first contact medical care and involves responsibility to the patient for maintaining his health and treating the disease. It includes a unique interaction and connection between the patient and the doctor. This type of care, comprehensive in nature, includes the management of the patient's problems: biological, behavioral and social. The use of consultants and community resources is an important part of effective primary health care.

The provision of PHC in economically developed countries is carried out by GPs or FDs. There are an average of 2,000 people per doctor, and he solves up to 80% of all medical problems of patients, freeing them from unnecessary visits to specialists.

The appeal of WHO in the 1970s to the problems of PHC marked an extremely important change in the strategy of organizing the most massive medical care. Implemented on the basis of the new concept of transformation in PHC led to serious positive shifts in the health status of the population in both developing and developed countries. It is paradoxical that in the USSR, which organized the first WHO conference on primary health care, authoritarian power structures ignored the problem of a radical transformation of mass medical care, which, combined with the crisis, caused a significant deterioration in public health indicators in the 80-90s.

The English scientist W. Stephan, who in 1982 summarized the experience of organizing PHC in 22 countries, formulated the basics of its concept and brought together the opinions of specialists in general and family medical practice. He stressed that the problem of care at primary levels is the problem of satisfaction of the population with the entire system of medical care. Physicians have always faced a dilemma between providing the best medical care and its financial acceptability, which is resolved by finding the right balance of the content and volume of medical care provided at primary (PHC), secondary (specialized) and subsequent levels (highly specialized and unique). However, the essence of the problem is not in financial limits, but in avoiding mistakes in medical practice at the primary level.

The GP, like no one else, knows the needs of patients, evaluates the advantages and disadvantages of diagnostic and treatment methods. Therefore, the GP should not be subject to any financial and bureaucratic constraints, he acts as an intermediary between the patient and the healthcare system. W. Stefan argues that no health system can effectively function and meet the needs of people if it does not provide well-organized primary health care. Denmark, Finland, New Zealand and the UK have a well-developed system of primary health care for GPs. The preparation of GPs is well carried out in all Scandinavian countries, France, Germany, the USA and especially in Canada, where family medicine is traditional and the world's only magazine "Family Doctor" is published.

The World Health Forum (1982) emphasized that a typical mistake in the organization of health care is to reduce the share of expenditures at primary levels of care, which are actually used by 80-90% of patients. Noting the apparent success of the PHC experience, the forum believes that there is no ideal model due to geographical and ethnographic differences.

The only general criterion for accessibility is a competent doctor or other medical professional who helps the patient assess the situation and make the right decision - how to be treated and where to go if necessary. The ability to provide the benefits of the healthcare system to the people is, first of all, the achievement of a sustainable understanding between GPs, their assistants and regular clients. Providing the necessary amount of responsibility to support staff is an essential feature of the proper functioning of the primary level. The position of physicians, who insist that only a doctor can examine and treat the patient, has had a paralyzing effect on the development of the structure and function of health services.

Personal contact is one of the best aspects of being a general practitioner. The initiative of contact between the doctor and the patient can equally belong to both parties, the forms of contact should not be limited (at home, invitations to appointments, telephone consultations, visits at inpatient treatment, training in self-treatment and self-control schemes). The main issue is giving the family the opportunity to seek help from one person, most often a FD. He should be able to diagnose and treat most diseases, be able to carry out simple preventive measures and engage in health education. This requires sufficient training and the ability to rely on a well-functioning system of secondary (specialized) care.

GPs are hired, as a rule, by local authorities with funds from national and territorial taxation funds allocated for healthcare. In addition to the salary, he is provided with a trust account in the bank for the maintenance of support staff, rent of premises, purchase of equipment and medicines. By invoicing the services provided to patients, he thus spends the loan issued to him in order to fully repay it at the end of the year. Although primary care is free in most European countries, the funds allocated for this are constantly in circulation, which is the only correct way to evaluate the effectiveness of their spending. Only the system that is able to use the entire volume of available and, first of all, massive, relatively cheap resources can properly direct the funds entrusted to it to the contingents of patients who need a special approach. Funds are used especially rationally where there is a local initiative, traditions of informal assistance, without any bureaucratic restrictions.

2.5Training and retraining of general practice nurses

According to the literature data, the obvious advantages of the system of general medical practice include a decrease in morbidity and an improvement in the quality of life, leading to a promising reduction in the cost of medical care, which is associated with a predictable decrease in the need for expensive inpatient and specialized treatment due to systematic preventive work and constant observation by teams of general medical practice over the level and state of health of the attached contingent.

In support of the development of primary health care based on general practice, the Ministry of Health approved in 1999 the branch program "General (family) practice". It defines the requirements for training, the rights and obligations of general practitioners, specifies the legal, organizational and financial basis for the existence of a general practice.

Family medicine involves the work of a team of doctors with the family as a whole and with each of its members for a long time. In the system of general medical practice, the functions of a doctor and a nurse are much wider than those of district therapists and pediatricians and nurses working with them, a more diverse range of medical services is provided here, many of which are traditionally provided by specialist doctors, so patients do not need to use with their help, for example, to determine visual acuity or to change the postoperative bandage. In more complex cases requiring specialist intervention, the general practitioner who determines the need for a consultation may refer the patient to him, but the same specialist should have more time to work with those who need his help, and this time will appear if part its functions will be taken over by a general practitioner.

A significant role in the work of general medical practices is given to nursing staff. Knowing the social status of the family, the level of health of each of its members, the characteristics of the development and course of diseases, enjoying the trust and authority of their patients, the family nurse can more effectively engage not only in coordinating activities, but also in the development and implementation of specific preventive measures necessary for each family , in accordance with the living conditions of this family, as well as the development and implementation of plans for nursing care for patients.

For successful work, a general practice nurse needs extensive knowledge and skills that exceed those acquired at the basic level of education, since the functions of a family nurse are much more diverse than those of nurses in hospitals and nurses working in therapeutic and pediatric areas of outpatient clinics .

The functions of a general practice nurse include, among others:

Carrying out personal records, collecting demographic and medical and social information about the assigned population;

Identification of risk factors, carrying out activities aimed at reducing their impact on the health of the population;

Carrying out measures for hygienic education and education of the population: teaching nursing, teaching pregnant women and their families, teaching the population a healthy lifestyle, knowledge and skills related to specific diseases, caring for children and the disabled;

Teaching the population to provide self-help and mutual assistance in case of injuries, poisoning, emergency conditions;

Consulting on medical and social aspects of the family, family planning;

Organization of medical and psychological support for family members, taking into account the state of health and age characteristics;

Implementation of preventive, therapeutic, diagnostic and rehabilitation measures prescribed by a doctor in a clinic and at home.

Currently, the training of sisters is focused mainly on working with people who are already ill; predominantly trained personnel for hospitals, which does not allow paying sufficient attention to the preventive activities of nurses, although at all levels of training of nursing personnel, great importance should be given to maintaining the health of healthy people, as well as preventing the further development of existing diseases. However, such an orientation in the training of general practice nurses is unacceptable: along with knowledge of the peculiarities of nursing for various diseases, they need extensive knowledge in the field of family relations, and in the field of psychology, and in the field of preventive medicine. She should know the peculiarities of nursing in the primary health care system, be able to provide palliative care, assistance to families with disabilities and much, much more. Therefore, the main task in the preparation of general practice nurses is to create conditions that ensure maximum approximation to the realities of modern society, the modern family with their medical and social problems, ensuring a holistic approach to the activities of a nurse when working with a family.

It is this approach to training - the breadth of skills, knowledge and views necessary for a nurse in general practice - that the State Educational Standard provides, in accordance with which family nurses are trained. Currently, the State Educational Standard, adopted in 2004, is in force. This is a second generation standard (the first educational standard was valid from 1997 to 2003), it takes into account the changes that have taken place in recent years in society and healthcare.

The training of nurses of general medical practice has been carried out since 1992, when the Order of the Ministries No. 237 “On a phased transition to the organization of primary medical care on the principle of a general practitioner (family doctor)” was issued. During this time, significant experience has been accumulated in training general nurses in the direction of in-depth training "Family Medicine".

In accordance with the State Educational Standard, nurses with experience and those who have just completed training at the basic level study at an advanced level of education.

Nursing professionals in family medicine structures include:

General practice nurse (secondary education plus three years of college, 1st level) works with the general practitioner;

Paramedic (secondary education plus four years of college, 2nd level) works as a general practitioner assistant in rural medical structures and in separate offices - independently;

An academic nurse (higher education, 3rd level) works as a manager of the department of general practitioners, head or head nurse.

Family medicine, an integral part of nursing, focuses on the individual, family, society as a whole, is based on the concept of public health in a given country and the most important social and hygienic problems. Training and retraining of a general practice nurse should include in-depth knowledge of nursing subjects horizontally (therapy, surgery, obstetrics and gynecology, etc.) and interdisciplinary cooperation vertically (pedagogy, psychology, etc.). The cornerstone of many disciplines should be the nursing process as a scientifically based method for the nurse to solve patient problems.

With the transition to the organization of primary health care for the population (PMSPN) on a family basis, the role and workload of a general practice nurse increases sharply, her responsibility towards the patient increases, and at the same time the patient's responsibility for their health increases.

The process of transition to family medicine requires a revision of the principles of medical education and approaches to it. In contrast to the current system of training medical personnel with a priority on the study of clinical disciplines. Medical education at the present stage must necessarily include not only individual medical, but also medical and social prevention, the study of family problems.

The formation of the institute of general practitioners (family doctors) involves the expansion of the functions of nursing staff, the training of nurses and managers of general medical practices.

The nurse manager with a nursing degree serves as a connecting bridge between physicians and mid-level healthcare professionals. Knowledge of the basics of practical psychology, marketing, law and economics significantly increases the value of this specialist for the functioning of general medical practice.

Future organizers of various departments of health care facilities (deputy chief physician for nursing, head and elder sister of the hospital, manager of the department of general practitioners) undergo in-depth training in all sections of the activities of the team of general practitioners, taking into account the peculiarities of their work in departments, offices and outpatient clinics.

The program "Nursing in Family Medicine" for the Faculty of Higher Nursing Education was compiled taking into account the qualified characteristics of these specialists. The main task of training nurses with higher education in the organization of nursing in family medicine is teaching the technologies for organizing primary health care to the population in general medical practices.

In this regard, the head nurse should clearly understand the features of the work of all departments of general medical practice, current trends in the development of nursing and family medicine in Russia and abroad, the direction of development of insurance medicine, the role and tasks of the general practice nurse in the system of family health and society, the main social and psychological problems of the family.

A family sister is an equal participant in all types of medical and preventive work on the site, along with a family doctor.

Nurses with higher education should know:

Fundamentals of healthcare legislation;

Decrees of the Government of the Russian Federation;

Orders of the Ministry of Russia;

Orders of the Main Department of Health under the regional administration;

Other documents regulating the work of general medical practices.

Also be able to:

Use them when working as managers of general medical practices;

Ensure the smooth and uninterrupted work of the team of general practitioners;

To draw up programs for the medical, psychological, social and professional rehabilitation of patients in general medical practices.

2.5 Qualification requirements for the work of a general practice nurse. Skills and abilities

In accordance with the Order of the Ministry of Russia dated August 26, 1992 No. 237 “On a phased transition to the organization of primary medical care on the principle of a general practitioner (family doctor)”, the reorganization involves changing the structure and essence of the work of polyclinics, transforming their outpatient clinics, offices and departments of general practitioners practices (family doctors).

The range of problems that a general practice nurse must solve is much wider than that of a district nurse. (Basic requirements for the work of a general practice nurse // journal "Russian Family Doctor" No. 2 - St. Petersburg, 2000)

The tasks of a general practice nurse include:

Carrying out sanitary and anti-epidemic work;

Carrying out immunoprophylaxis;

Education of the population in the simplest methods of self-help and mutual assistance; organization of care for children and the sick;

Carrying out diagnostic and rehabilitation measures as prescribed by a doctor within their competence;

Providing first aid for acute diseases, injuries, poisoning, accidents, including in children;

Organizing and supervising the work of junior staff;

All this requires special professional training, which was taken into account when creating new curricula that provide for a difficult "build-up" of knowledge and an increase in the number of disciplines, and the training of specialists with different levels of function categories that provide for the right to make an independent decision.

Short list skills and abilities of a general practice nurse, qualitatively distinguishing her from the usual "desk" nurse, can be represented in the following form:

Recording of electrocardiogram, respiratory functions on a portable device;

Determination of visual acuity and hearing;

Eye tonometry;

Express analysis of blood, urine, determination of bilirubin, bile pigments;

Performing physiotherapy procedures;

Knowledge of the basics of therapeutic massage;

Cardiopulmonary resuscitation, electrical defibrillation for vital indications;

Basic knowledge of medical statistics;

Work on a personal computer in the scope of the user.

A general practice nurse performing a program to protect and promote family health should know and be able to evaluate the family as a system, its cultural and ethnic characteristics, the relationships of its members, the nature of food in the family, bad habits and risk factors, determine the impact of changes in family composition on health. If there are believers in the family, the nurse should find an approach to them in order to positively influence the health of members of this family. The general practice nurse gives a detailed assessment of the health status of the family and recommendations for correcting the identified violations, together with the family evaluates the results of preventive measures carried out by her, the general practitioner and the family. That is, the general practice nurse conducts primary screening of various aspects of family health.

Thus, a general practice nurse is an equal participant, along with a general practitioner, in all types of medical and preventive work at the site. In accordance with world standards, a general practice nurse should treat patients as unique individuals; be able to identify their problems, including those within the family, to coordinate medical care throughout the life of patients. Good, friendly work of the tandem: a doctor and a general practice nurse is the key to reducing morbidity and improving family health.

2.6 Regulation of the work of a general practice nurse

The regulation of the work of a general practice nurse is detailed by Order No. 237 of the Ministry of Health of the Russian Federation. A general practice nurse can carry out her activities both in state medical institutions and in non-state ones in private practice. A general practice nurse works under a contract (agreement). At the same time, the serviced contingent is formed taking into account the right of free choice of a doctor and a general practice nurse.

The volume of work of a general practice nurse is determined by the license: these are outpatient appointments, home visits, emergency care, the implementation of preventive, therapeutic and diagnostic measures, and assistance in solving medical and social problems of the family.

Most successfully in the departments of general medical practice (GP) nurses solve the issues of fulfilling medical prescriptions. The qualifications of nurses and the equipment of the offices make it possible to carry out a doctor's appointment in a timely and appropriate manner: collecting and performing tests, conducting diagnostic measures (ECG recording, measuring blood pressure and intraocular pressure, determining visual acuity, respiratory function, etc.), and as well as medical treatment.

The work of family nurses at home provides for one of the main goals - the implementation of the conditions for the longest and most successful stay of a disabled person or a pensioner at home with the help of a variety of care products and technical devices.

This can be achieved by solving the following tasks :

1. Ensuring patient safety:

· Fire safety;

electrical safety;

Removal of obstacles to the care of movement;

· installation of railings, handles, reinforcement of mats, etc.;

· safe storage of cleaners, bleaches, dyes, etc.;

Reliability of shutters on windows and doors;

Safe storage of medicines, control over the contents of first-aid kits, storage of medicines;

matching the height of chairs, beds, etc. according to the patient's height.

2. Respect for human dignity, observance of human rights.

3. Respect for confidentiality (secrets of personal affairs, diagnosis, content of negotiations, etc.).

4. Ensuring the quality of communication with the patient (availability for conversation, emotional support).

5. Expanding the patient's circle of communication, creating an environment for this (accessibility of the telephone, availability of addresses, stationery, encouragement to expand communication).

6. Encouraging the independence and autonomy of the patient, allowing him to do as much as he can.

7. The use of funds to expand self-service and greater independence (equipment of premises, the use of devices: support sticks, crutches, wheelchairs, etc.).

8. Approval of the patient's actions.

9. Prevention and diagnosis of any population (mental, sexual, financial, physical).

10. Assistance in eating, moving, caring for nails and hair, washing, dressing, delivering and preparing food, performing hygiene procedures, cleaning rooms, etc. depending on the needs of the patient.

11. Ensuring the infectious safety of the patient.

12. Organization of repair of household appliances.

Let's not forget that in addition to the tasks of home care listed above, the family nurse should not only teach the patient the rules and methods to increase the level of self-care, but also his immediate environment in caring for this family member. Often this work is psychologically most difficult with old people, whose number is steadily increasing in our country.

Modern society needs professional medical and social adaptation of older people, to identify and eliminate factors that reduce their ability to self-service. Without solving these problems, it is hardly possible to consider the activities of family nurses successful. Its main object should be the elderly, the disabled, and children. These tasks can only be completed if: conditions :

1. solution of tasks set by the whole team: doctor - nurse - social worker;

2. creation of a database not only about patients, but also about families served by the department of general medical practice;

3. a sufficient number of trained professionals capable of providing all kinds of assistance to all those who need it.

3. Own data

In order to organize the issue of primary health care on the principle of a general practice nurse using the example of the NHI Departmental Hospital at Taishet station and attitudes towards medical personnel reforms, 20 doctors and 28 nurses, as well as 64 patients served by the NHI Departmental Hospital at Taishet station of JSC Russian Railways were interviewed .

3.1 Organizational structure of the NHI of the Departmental Hospital at st. Taishet Russian Railways

In order to organize the issue of primary health care on the principle of a general practice nurse, the structure and staffing of the NHI of the Departmental Hospital at st. Taishet.

Table No. 2. The structure of medical personnel.

Table No. 1. Organizational structure of the management staff of the medical activities of the NHI Departmental Hospital at Taishet station.

An analysis of the organizational structure and personnel composition allows us to draw the following conclusions. There are 64 nurses for 55 doctors, which corresponds to 1: 1.2 and does not meet world standards (1: 4). The duties and activities of the nursing staff of the NHI of the departmental hospital at st. Taishet JSC Russian Railways.

Table No. 3. Comparative analysis of job responsibilities and activities of nursing staff

Thus, a comparative analysis of the duties and activities of a family and district nurse shows a significant superiority in the volume of activities of a general practice nurse.

3.3 Results of a survey of medical workers of the NHI of the Departmental Hospital at the Taishet station of JSC Russian Railways

Table No. 4. Personnel composition of the surveyed medical

Thus, the analysis of the structure of the staff showed that for 20 doctors the number of nurses with higher education is 10%, with a secondary special education - 90%.

An analysis of the attitude of medical personnel to the reforms of Russian healthcare in the direction of general practice is presented in table No. 5.

Table No. 5. Attitudes towards reforms in Russian health care in the direction of general practice.

Thus, out of 20 doctors and 28 nurses surveyed, only 50% of doctors and 57% of nurses are positive about the reforms. 40% of doctors and 25% of nurses gave a negative answer.

Analysis of the activities of nursing staff according to the survey of medical personnel showed the following results.

Table No. 6. Analysis of the activities of nursing staff according to the survey of medical personnel.

Thus, according to the survey of physicians of MHI GP No. 1, the majority (80%) are satisfied with the work of their nurse and only 20% of physicians are not satisfied.

An analysis of a survey of medical personnel showed that the majority (90%) are familiar with higher nursing education firsthand, but only 60% of doctors consider it necessary to improve the educational level of nurses.

Thus, 60% of doctors consider it necessary to improve the level of education of a modern nurse, which will improve the quality of medical care.

3.4 Results of a survey of the population served by the NHI Departmental Hospital at st. Taishet Russian Railways

Table No. 7. Structure of the surveyed population served.

Thus, out of 64 interviewed patients, 34% are men and 66% are women. With higher education - 45%, with secondary - special - 37% and 18% have secondary education.

Table No. 8. Results of a survey of patients.

Thus, among the surveyed population, the main part (45%) regularly uses the help of specialists. The average age of patients is 62.4 years.

The most frequently visited therapists - 33%, surgeons - 22%, rheumatologist - 16%.

Table No. 9. Analysis of satisfaction with the quality of medical care for the population served.

Thus, out of 64 patients surveyed, only 50% of the surveyed patients were satisfied with the quality of medical care, 40% spoke negatively about the quality of care. The reasons for dissatisfaction were the following: a long waiting time for an appointment, an inferior examination and a short time allotted for an examination.

Table No. 10. Analysis of satisfaction with the quality of nursing care of the population served

An analysis of the activities of nursing staff showed a high percentage of satisfaction (70%) with the quality of nursing care, but 20% were not satisfied. The reason was explained by the impossibility of obtaining nursing at home and the short time of communication.

Table 11. Analysis of satisfaction with the activities of the district nurse.

Thus, only 50% of the surveyed patients (20 people) are satisfied with the work of the district nurse.

Table 11. Analysis of satisfaction with the activities of the family nurse.

Thus, a larger percentage of the interviewed patients (20 patients) are satisfied with the work of the family nurse, especially the versatility of her activities.

Conclusion

1. A comparative analysis of the activities of a general practice nurse in Russia and abroad showed that family practice has a strong position abroad, and in Russia, according to literary sources, it is only beginning to be widely used in practice.

2. After conducting a comparative analysis of the activities of a general practice nurse and a district nurse, it was revealed that the duties of a family nurse are characterized by greater versatility and depth of activity.

Analysis of the activities and quality of nursing care on the example of the Departmental Hospital at the Taishet station of JSC Russian Railways.

3. showed that a larger percentage of the interviewed patients (80%) gave positive answers regarding the activities of a general practice nurse.

Conclusions:

Based on the results obtained, the following conclusions can be drawn:

1. The activity of a general practice nurse is characterized by a high level of professionalism, high efficiency, versatility and complexity of manipulation activities.

2. The medical staff of our hospital has a positive attitude towards the reforms of Russian health care, however, a low level of awareness is stated.

3. The staff of nurses is characterized by a low educational level, only 2 nurses have higher education.

4. The main percentage of medical personnel consider it necessary to improve the level of education of a modern nurse, which will improve the quality of medical care provided.

1. In order to improve the education of nursing staff, permanent seminars for nurses should be organized.

2. Managers of the middle medical level need to improve their educational level by studying at the Faculty of Higher Nursing Education in the direction of advanced level and higher education.

3. Introduce the “School of Health” into educational programs with the population and apply the professional skills of specialists with higher nursing education.

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Application No. 1

Statistical map for studying the patient's opinion

Dear patient(s),

We ask you to answer the proposed questions that will help to study the professional activities of medical workers: nurses, and improve care for patients with your disease. Anonymity of responses is guaranteed.

1. Year of birth __________________________________

3. Education:

Medium - special,

Average.

4. How often do you visit the clinic?

Annually,

I find it difficult to answer.

5. Which specialists do you contact most often?

Therapist,

- ______________

6. How often do you call a doctor at home?

Regularly (once every six months),

Annually,

I find it difficult to answer.

7. How often do you use the help of a district nurse?

Regularly (once every six months),

Annually,

I find it difficult to answer.

8. How do you feel about the activities of a general practitioner?

Positively,

Negative.

I find it difficult to answer.

9. How do you feel about the activities of a general practice nurse?

Positively,

Negative.

I find it difficult to answer.

10. Are you satisfied with the help of your local doctor and nurse?

I find it difficult to answer.

11. Do you prefer the work of a family or district nurse?

I find it difficult to answer.

12. Do you also think that the family nurse is more qualified?

I find it difficult to answer.

13. Do you know about higher nursing education?

I find it difficult to answer.

14. Does a nurse need to have a higher medical education?

I find it difficult to answer.

Application No. 2

1. Position held:

Nurse.

2. Education:

Medium special.

3. How do you feel about the activities of a general practitioner?

Positively,

Negative.

I find it difficult to answer.

4. How do you feel about the activities of a general practice nurse?

Positively,

Negative.

I find it difficult to answer.

5. Do you also think that the family nurse is more qualified?

I find it difficult to answer.

6. Do you think it would be expedient to switch to family medicine as part of the reform of Russian health care?

I find it difficult to answer.

7. Do you know about higher nursing education?

I find it difficult to answer.

8. Does a nurse need to have a higher medical education?

I find it difficult to answer.

9. Are you satisfied with your nurse's work?

I find it difficult to answer.

1. General Provisions

1. This job description defines the duties, rights and responsibilities of a general practice nurse.
2. A person who has a secondary medical education and appropriate training in the specialty "General Practice" is appointed to the position of a general practice nurse.
3. A general practice nurse should know the basics of the Russian Federation legislation on health care; legal documents regulating the activities of healthcare institutions; the structure and main activities of medical and preventive and sanitary and epidemiological institutions; the health status of the population served; fundamentals of labor legislation; internal labor regulations; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.
4. A general practice nurse is appointed and dismissed by order of the head of the institution in accordance with the current legislation of the Russian Federation.
5. The general practice nurse reports directly to the general practitioner.

2. Job responsibilities

Carries out therapeutic, preventive and diagnostic measures prescribed by a doctor in a clinic and at home, participates in outpatient operations. Provides sick and injured first aid in case of injuries, poisoning, acute conditions. Organizes hospitalization of patients and victims according to emergency indications. Organizes an outpatient appointment with a general practitioner (family doctor), prepares a workplace, instruments, tools, outpatient cards of patients, prescription forms. Conducts a preliminary examination of the patient and the collection of anamnesis. Observes the sanitary and hygienic regime in the premises of the medical facility, the rules of asepsis and antisepsis, the conditions for sterilizing instruments and materials, measures to prevent post-injection complications, serum hepatitis and AIDS in accordance with the current regulatory documents. Fills out medical records (statistical coupons, emergency notification cards, referral forms for diagnostic tests, mailing lists to the medical and social expert commission, sanatorium and resort cards, dispensary observation control cards, etc.). Provides the office of a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, overalls. Keeps records of the costs of medicines, dressings, tools, special accounting forms. Monitors the safety and serviceability of medical equipment and equipment, their timely repair and write-off. Conducts personal accounting of the population served, identification of its demographic and social structure, registration of citizens in need of home medical and social services. Conducts pre-medical preventive examinations of the population in the clinic (outpatient clinic) and at home. Organizes registration of dispensary patients, disabled people, those who are often and long-term ill, etc., promptly invites them to an outpatient appointment, monitors their visits to health facilities. Carries out sanitary and educational work at the site (dissemination of hygiene knowledge, promotion of a healthy lifestyle, rational nutrition, hardening, physical activity, etc.). Prepares the sanitary asset of the site, conducts classes on self-help and mutual assistance in case of injuries, poisoning, acute conditions and accidents. Trains relatives of seriously ill patients in methods of care, provision of primary first aid. Prepares patients for laboratory and instrumental studies. Timely completion of the accounting and reporting documentation established by the current regulatory legal acts. Qualified and timely executes orders, orders and instructions of the management of the institution, as well as legal acts on his professional activities. Complies with the rules of internal regulations, fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors. Systematically improves his skills.

The general practice nurse has the right to:
1. make proposals to the management of the institution to improve the diagnostic and treatment process, incl. on the organization and conditions of their labor activity;
2. control the work of junior medical personnel (if any), give them orders within the framework of their official duties and demand their precise execution, make proposals to the management of the institution for their encouragement or imposition of penalties;
3. request, receive and use information materials and legal documents necessary for the performance of their duties;
4. to take part in scientific and practical conferences and meetings, which discuss issues related to his work;
5. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
6. to improve their qualifications at refresher courses at least once every 5 years.
A general practice nurse enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The general practice nurse is responsible for:
1. implementation of the official duties assigned to it;
2. failure to provide medical care to patients in life-threatening conditions, for illegal actions or inaction that resulted in damage to the health or death of the patient;
3. organization of their work, timely and qualified execution of orders, instructions and instructions of the management, regulatory legal acts on their activities;
4. compliance with internal regulations, fire safety and safety;
5. timely and high-quality execution of medical and other service documentation provided for by the current legal documents;
6. providing, in accordance with the established procedure, statistical and other information on their activities;
7. prompt action, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors.
For violation of labor discipline, legislative and regulatory acts, a general practice nurse can be brought in accordance with applicable law, depending on the severity of the misconduct, to disciplinary, financial, administrative and criminal liability.

EKSD 2018. Edition dated April 9, 2018
To search for approved professional standards of the Ministry of Labor of the Russian Federation, use reference book of professional standards

General practitioner nurse (family doctor)

Job responsibilities. Organizes an outpatient appointment with a general practitioner (family doctor), provides him with individual cards of outpatients, prescription forms, referrals, prepares devices and tools for work. Maintains personal records, information (computer) database of the health status of the population served, participates in the formation of groups of dispensary patients. Performs preventive, therapeutic, diagnostic, rehabilitation measures prescribed by a general practitioner (family doctor) in a polyclinic and at home, participates in outpatient operations. Provides a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, overalls. Takes into account the consumption of medicines, dressings, tools, special accounting forms. Monitors the safety and serviceability of medical equipment and equipment, the timeliness of their repair and write-off. Conducts pre-medical examinations, including preventive ones, with a record of the results in an individual card of an outpatient. Identifies and solves medical, psychological problems of the patient within the framework of competence. Provides and provides nursing services to patients with the most common diseases, including diagnostic measures and manipulations (independently and in collaboration with a physician). Conducts classes (according to specially developed methods or a plan drawn up and agreed with the doctor) with various groups of patients. He accepts patients within his competence. Carries out preventive measures: performs preventive vaccinations for the attached population according to the vaccination calendar, plans, organizes, controls preventive examinations of contingents subject to examination for the purpose of early detection of tuberculosis, takes measures to prevent infectious diseases. Organizes and conducts hygienic education and education of the population. Provides first aid in case of emergencies and accidents to the sick and injured. Maintains medical records in a timely and accurate manner. Receives the information necessary for the qualitative performance of functional duties. Supervises the work of junior medical staff, controls the volume and quality of their work. Collects and disposes of medical waste. Carries out measures to comply with the sanitary and hygienic regime in the room, the rules of asepsis and antisepsis, the conditions for sterilizing instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.

Must know: laws and other regulatory legal acts of the Russian Federation in the field of healthcare, the theoretical foundations of nursing, the basics of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle, as well as family medicine, rules for the operation of medical instruments and equipment, rules for the collection, storage and disposal of waste medical institutions, statistical indicators characterizing the state of health of the population and the activities of medical organizations, the basics of the functioning of budgetary insurance medicine and voluntary medical insurance, the basics of clinical examination, the social significance of diseases, the rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation, medical ethics, psychology of professional communication, basics of labor legislation, internal labor regulations, labor protection and fire safety rules.

Qualification requirements. Secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "General Practice" without presenting requirements for work experience.

Jobs for the post of Nurse of a general practitioner (family doctor) according to the all-Russian database of vacancies

You can download the job description of a general practice nurse for free.
Responsibilities of a General Nurse.

I approve

________________________________ (Surname, initials)

(name of the institution, its ________________________

organizational and legal form) (director; other person

authorized to approve

job description)

JOB DESCRIPTION

GENERAL PRACTICE NURSE

______________________________________________

(name of institution)

00.00.201_ #00

I. General provisions

1.1. This job description defines the job duties, rights and responsibilities of a general practice nurse _____________________ (hereinafter referred to as the "enterprise").

1.2. A person who has a secondary medical education and training in the specialty "General Practice" is appointed to the position of a general practice nurse.

1.3. Appointment to the position of a general practice nurse and dismissal from it is carried out in accordance with the procedure established by the current labor legislation by order of the head of the healthcare institution.

1.4. The general practice nurse reports directly to _____________________

(Head of Department, Deputy Chief Physician)

1.5. The general practice nurse should know:

Laws of the Russian Federation and other regulatory legal acts regulating the activities of healthcare institutions;

Current regulatory and methodological documents regulating the activities of medical institutions;

Methods and rules for the provision of medicinal and emergency medical care;

The structure and main activities of sanitary-epidemiological and treatment-and-prophylactic institutions;

The health status of the population served;

Rules and norms of labor protection, industrial sanitation, safety and fire protection;

Basics of the labor legislation of the Russian Federation

Internal labor regulations.

1.6. During the absence of a general practice nurse (business trip, vacation, illness, etc.), his duties are performed in the prescribed manner by an appointed person who is fully responsible for their proper performance.

II. Job Responsibilities

General practice nurse:

2.1. Carries out diagnostic measures and therapeutic and preventive measures, which are prescribed by the doctor in the clinic and at home.

2.2. Participates in outpatient operations.

2.3. Provides first aid to the sick and injured.

2.4. Organizes the hospitalization of sick and injured patients according to emergency indications.

2.5. He prepares the workplace, forms of prescriptions for instruments, devices, outpatient cards of patients, and also organizes an outpatient appointment with a general practitioner.

2.6. According to the current legal documents, it observes the sanitary and hygienic regime in the premises of the medical facility, the conditions for sterilizing materials and instruments, the rules of asepsis and antisepsis, measures to prevent post-injection complications, AIDS and serum hepatitis.

2.7. Conducts a preliminary examination of the patient and the collection of anamnesis.

2.8. Fills out medical records.

2.9. Keeps records of expenses of medicines, special accounting forms, dressings, tools.

2.10. Provides the office of a general practitioner with medicines, overalls, dressings, sterile instruments.

2.11. Monitors the safety and serviceability of medical equipment and equipment, their timely repair and write-off.

2.12. Conducts personal accounting of the population served and pre-medical preventive examinations of the population.

2.13. Organizes registration of dispensary patients, disabled people, those who are often and long-term sick, etc. and invites them to an outpatient appointment.

2.14. Carries out sanitary-educational work on the site.

2.15. Trains relatives of seriously ill patients in methods of care, provision of primary first aid.

2.16. Carries out the preparation of the sanitary asset of the site and the preparation of patients for laboratory and instrumental studies.

2.17. Timely and competently executes orders, instructions and instructions of the management of the institution

2.18. Complies with internal regulations.

2.19. Complies with the requirements of labor protection, industrial sanitation and safety

III. Rights

The general practice nurse has the right to:

3.1. Make proposals to the management of the enterprise on the optimization and improvement of medical and social assistance, including on issues of their work activities.

3.2. Require the management of the institution to assist in the performance of their duties and rights.

3.3. Receive information from the company's specialists necessary for the effective performance of their duties.

3.4. Pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category.

3.5. To take part in the work of meetings, scientific and practical conferences and sections on issues related to their professional activities.

3.6. Enjoy labor rights in accordance with the Labor Code of the Russian Federation

I V . Responsibility

The general practice nurse is responsible for:

4.1. For the proper and timely performance of the duties assigned to him, provided for in this job description

4.2. For the organization of their work and the qualified execution of orders, orders and instructions from the management of the enterprise.

4.3. To ensure that subordinate employees comply with their duties.

4.4. For non-compliance with internal regulations and safety regulations.

For offenses or omissions committed in the course of therapeutic measures; for errors in the process of carrying out their activities, which entailed serious consequences for the health and life of the patient; as well as for violation of labor discipline, legislative and regulatory acts, a general practice nurse can be brought in accordance with applicable law, depending on the severity of the misconduct, to disciplinary, material, administrative and criminal liability.