1. European Festival of Psychiatric Nursing, Malta 07.11.200 8 Mgr. TOMAS PETR BLANKA NOVOTNÁ Psychiatric Nursing in Czech Republic

2. Who are we? Tomas Petr (MSc, BSc, RN) - BSc General Nursing - MSc Management in Health Care - Currently Manager of Psychiatric Intensive Care Unit, Central Military Hospital, Prague Blanka Novotná (RMN)MN) - Registered mental health nurse - Currently manager of nursing care, Psychiatric Hospital Prague

3. Overview Introduction Health care system in Czech Republic General information about mental health Structure and organisation of services Nurses training, registration, professional bodies Specific issues, challenges

4. Czech Republic Population: approx. 10 mil. Nationality: 95% Czech 5% Slovak, Polish, German, Vietnamese, Ukrainian Official language: Czech Capital: Prague

5. Prague

6. Health care system in The Czech Republic - main features - Social health insurance system - Compulsory contribution – 13,5 % from salary (4,5% employee, 9% employer) - State – contribution for unemploeyd people, children, retired people, women on maternity leave - 9 insurance companies - Since 1.1.2008 – regulatory fees (a doctor´s appointment – 30 CZK, 1 day at hospital – 60 CZK, prescribtion of drugs – 30 CZK = 1,2 EU etc.) - Expenditure on health services – 7,3 % of GDP

7. Percent of GDP spent on health care (OECD, 2004) UK7,7 France9,7 Germany10,9 Sweden9,2 Czech Republic7,3 Spain7,6

8. Lack of nurses (deficit of 1000 nurses in the system) Re-defining competences of nurses (higher education, but the same competences) Low salaries Changes in education - 3 900 nurses completed study - 200 started working in hospitals - 1 180 carried on with study on higher level - rest of them dissapeared Main challenges in nursing in Czech Republic

9. Mental health care Cinderella between medical disciplines Lack of interest from politicians and public Retaining stigma of psychiatry (media, movies etc.) Insufficient funding (mental health – only 3,5 % from health care budget)

10. % of health care budget Zdroj: MHEEN, 2004 Expenditure on mental health care 3.5% from health care budget

11. STIGMA OF PSYCHIATRY representative sample of 1248 respondents, 1999 1 – the best, 5 – the worst SOCIAL PRESTIGE

12. Choosing a job ??? Nurse? Teacher? IT?

13. Jobs with the highest prestige Jobs with the lowest prestige Physicians – 88 Scientists – 82 University teachers – 77 Nurses – 72 Secretary - 41 Member of Parliament - 34 Priest - 40 Cleaner - 30 CVVM 9/2008 Prestige of nursing job 99 – the highest prestige, 0 – the lowest prestige

14. On the way to becoming a psychiatric nurse step 1 age of 18 finished secondary education A.3 years study on nursing school  general nurse B. 3 years on university (bachelor degree)  general nurse

15. step 2 On the way to becoming a psychiatric nurse step 2 general nurse diploma general nurse diploma 12 months of field experience 12 months of field experience 3 years postgradual study 3 years postgradual study 640 hours - 50% theory, 50% practice  psychiatric nurse Less then 30% of nurses working at psychiatric hospitals have got specialization at psychiatric nursing.

16. Where to work, if you are psychiatric nurse? Asylum-like hospitals (20, 9 858 beds) Psychiatric wards (32, 1 439 beds) Ambulatory care providers (1 295 providers) Community care

17. Asylum-like hospitals 20 68,8% of hospitalisations happens within asylums average length of hospital stay – 79,4 days 2,5% of clients longer then 1 year number of nurses - 2 899

18. Psychiatric wards 32 average length of hospital stay – 20,9 days number of nurses - 700

19. Ambulatory care providers number of them is growing up (in 2005 – 24,4% more then in 2000) private, paid by insurance companies number of nurses – not known

20. Community care poor network mainly concentrated in big cities problems with funding number of nurses - 6

21. Structure of services - main issues - Most of the care happens within hospitals Lack of community services Long hospitalization Frequent rehospitalization High cost of care/low effectiveness Poor conditions within inpatients settings

22. Psychiatric nurse What your job will be like? - 12 hours shifts - 1 nurse – group of 20 clients - Increase of paperwork - A lot of stress - Average salary – 1000 EU/month

23. Compulsory since 2004 Registration term lasts 6 years Condition for renewing: - 40 credits - clinical practise - CRB - good state of health Registration of nurses

24. Professional bodies CNNA – Czech National Nurses Association - Member of ICN, PCN, WENR - Divided into 69 sections - 21 000 members - Membership is voluntary

25. CNNA Psychiatric section 700 members full member of Horatio Main activity: Organizing conferences, congresses, workshops Working on clinical guidelines Participating in clinical research Publishing study materials Horatio congress in Prague - 2010

26. Conditions within psychiatric hospitals - contrasts -

32. TOMAS_PETR@HOTMAIL.COMBLANKA.NOVOTNA@PLBOHNICE.CZ Contacts:

33. QUESTIONS