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Ema Dornik, Institut informacijskih znanosti Maribor, Slovenija doc. Izdajo sofinancira Javna agencija za raziskovalno dejavnost Republike Slovenije. Kot predhodnica Zdravstvenega obzornika je od leta do izhajalo strokovno-informacijsko glasilo Medicinska sestra na terenu v izdaji Centralnega higienskega zavoda v Ljubljani. The articles explore the developmental paradigms of the relevant fields in accordance with their scientific, theoretical and philosophical bases, which are reflected in the experimental and non-experimental research, qualitative studies and reviews.

The articles consider nursing and other health sciences as scientific and professional disciplines and include the key dimensions of their development such as theoretical concepts, models, ethics and philosophy, clinical practice, health promotion, the development of practice and more demanding modes of health care delivery, education, management, quality and safety, health policy and others. The articles published in the Nursing Review, which are interdisciplinary oriented, ificantly contribute towards the professional development of nursing, midwifery and other health professions in Slovenia, the Balcans, and the countries of the Central and Eastern Europe which share common characteristic of nursing development of post-socialist countries.

The Nursing Review follows the international standards in the field of publishing endorsed by the international editorial board and a critical selection of reviewers. All published articles are available also in electronic form. Before publication the articles in this quarterly periodical are triple-blind peer reviewed. Some original scientific articles are published or translated in the English language. The history of the magazine clearly demonstrates its impact on the development of nursing and midwifery care in the Balcan area. In the first issue of the professional periodical of the nurses and nursing technicians Health Review Slovenian title: Zdravstveni obzornik, ISSN was published.

From it bears the title The Slovenian Nursing Review. As a precursor to Zdravstveni obzornik, professional-informational periodical entitled a Community Nurse Slovenian title: Medicinska sestra na terenu was published by the Central Institute of Hygiene in Ljubljana. Their concerns and activities are broad, including issues related to regulation, professional practice, and socio economic welfare, just to mention a few.

Their Strategic Plan has a strong focus on making sure that the nursing agenda is addressed both within the nursing community and outside of the nursing community. Her experience during her visit to Slovenia reinforced the impact nurses can have on national policy, nursing practice and the health of the people when nursing works within the nursing community and partners with government and other organisations.

In her comments, she would like to reflect on her observations in relation to three of the four themes of the ICN Strategic Plan: 1. Global Voice: the goal is ''to bring solidarity and cooperation across the profession in collaboration with other stakeholders''. Throughout her visit in Slovenia, she had the opportunity to meet with members of the NNA, members of the various nursing organisations and sectors, and Government officials. It is clear that there are open channels of communication within nursing and with other stakeholders.

Global Voice does not mean that there is always agreement on every topic but there is solidarity and respect. Efforts are made to work together on issues that matter. She was reassured to see that such a condition exists in Slovenia, which is an enabler to work together. Unfortunately, in many of the countries, nursing organisations do not necessarily understand the importance of solidarity for the overall goal to advance health and nursing.

Strategic Leadership: the goal is ''to provide strategic leadership to empower nurses and nursing organisations to advance nursing worldwide through coherent, efficient, effective and judicious advocacy by and for nurses, nursing and health''.

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While Global Voice is the foundation for working together, in order to have solidarity it is not sufficient. The Global Voice is the way to come to agreement on the issues that need to be dealt with and build a strategy to do so. In spite of this, nurses understand the importance of Strategic Leadership.

It is evident that in order to change and move the health and the nursing agenda they need to take the Global Voice and use our Strategic Leadership to move that agenda forward. In her visit to Slovenia, and later on participating in the meeting of the Region 3 NNAs in Croatia, it was clear that Strategic Leadership is being built in the region. It is not easy; all of the countries in the region have undergone enormous changes in our lifetime that requires learning about different styles of governments and learning how to have a voice and how to lead in them. Some of the countries have experienced bitter and tragic internal conflicts and some political challenges are still under way.

Despite this, there is clear evidence that strategic leadership by nurses and nurse leaders is in place. There has been ificant evolution of nursing education and there has been the establishment of nursing organisations.

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And she personally experienced the leadership of the men and women she has met. As ICN works in partnership with their members and as they focus on key areas that need change, the importance of Strategic Leadership becomes more and more important. Leadership is a science and an art that is learned. One becomes good at it by knowing the art and the science and by stepping forward and practicing the needed strategic leadership.

Any meaningful change is a journey; sometimes it is a long journey, but having a ''global voice'' and ''strategic leadership'' are two very important ingredients.

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Policy impact: the goal is ''to influence the de and implementation of policy in health and other related areas to achieve better health outcomes''. This is the ''punch line'' as they say, this is why having a global voice and strategic leadership is so important. Having a global voice and strategic leadership can lead to valuable contributions and can help in building support to issues within and outside of the nursing community, but having all that without policy impact is like having very good soccer players on the field but they never score a goal.

Having policy impact is the way by which they will change reality. What she has seen and heard in Slovenia is that the majority of the people delivering nursing care are still secondary school educated. By all standards, this is not the recommended workforce both from the quality care aspect and the individuals who give the care perspective.

These paradoxical figures are not consistent with any global normative recommendations. There are many studies like the RN4Cast European Commission,studies by Aiken and colleagues ; that recognise conclusively the need to have well prepared nurses in order to give the best care and increase the chances for patients to stay alive and recover quickly. The author is sure that the high school educated workforce are very nice group of boys and girls, but they are boys and girls far too young to be exposed to complex work and far too young to understand the physiological and psychosocial aspect of care that is required.

Furthermore, year olds need the opportunity to shape and learn their own personality and identity; to expose them and expect them to try to learn to become a healthcare professional is not conducive for their development. So the question and the challenge is how to have a policy impact and change the current Slovenian reality using human resources as one example.

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On the occasion of the Regional Summit held in Opatia, Croatia the representatives of the National Nurses Associations of Croatia, Macedonia, Montenegro, Serbia and Slovenia have accepted this declaration: "We, the nurses and midwives from the above countries in ICN's Region 3, have encountered many similarities regarding education, competencies, employment and working conditions in which we practice nursing.

Our patients have equal human rights, one of which is the right to accessible, safe healthcare services in accordance to their needs. Evidence in Europe and many other regions demonstrates that, in order to serve our citizens at their time of need, we must have nurses with university level education who provide professional, quality and effective care in the best interest of patients.

We recommend to our governments to take all the necessary actions to transform the education system in order to educate nurses and midwives responsible for delivering nursing care at university programmes which are harmonized with EU Directives and demonstrated by research as being the proper level of preparation for quality patient care. For the nurses and midwives who were educated at the level of secondary vocational schools, we wish to provide the opportunity to obtain additional knowledge, in order that they can achieve university level education, which could be achieved through implementation of the 'bridging programmes' within the framework of academic public institutions.

Furthermore, for the public interest, we call upon state officials to put stronger efforts into the process of legislation and put forward the Nursing Act and Midwifery Act in order to regulate the nursing and midwifery professions" International Council of Nurses, In conclusion, she thanked for the privilege to have the opportunity to visit Slovenia and see first-hand how well the Slovenians live the ICN's Strategic Plan of She also extended her congratulations for the great progress and accomplishments achieved.

She expressed every good wish that the contribution of nurses to the health of the Slovenian population and to nursing be continued.

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Obisk dr. Med obiskom v Sloveniji se je dr. V Sloveniji obstajajo vsi pogoji za tako sodelovanje. Vodenje je znanost in umetnost, ki ju je potrebno usvojiti. Po mnenju dr. Available at: [ ]. October Obzornik zdravstvene nege, 49 4pp. The aim of the RN4CAST-study was to study how features of work environments and qualifications of the nurse workforce impact nurse retention, burnout among nurses and patient outcomes.

Methods: The study was conducted in twelve European countries and was conducting a cross-sectional survey in hospitals in which more than 33, nurses and more than 11, patients were involved. These data were linked to patient outcome data from administrative databases. : The study showed that patient outcomes such as patient mortality and patient satisfaction is highly related to nurse staffing characteristics such as patient-to-nurse ratios, nurse qualification and nursing work environment.

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Also nurse outcomes such as burnout, intention-to-leave, job satisfaction are related to staffing adequacy and nursing work environment. Discussion and conclusion: The RN4CAST study generated a large evidence base of nurse workforce issues across European health systems which is quite unique in terms of the and qualification of nursing staff, the quality of working environments, burnout rates, job satisfaction rates, intention-to-leave rates that can be used for policy making.

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Dobljene podatke smo povezali s podatki o izidih zdravljenja, ki smo jih pridobili iz podatkovnih administrativnih baz. At that time they found little evidence that the quality of care is affected by the staffing patterns of nursing personnel.

It launched the research agenda to fill the gaps in the understanding of the changing hospital environment and the impact of staffing on patient outcomes. In the years following the report, several landmark studies were published in leading medical and nursing research journals such as the New England Journal of Medicine Needleman, et al.

A systematic review and meta analysis of the association of nurse staffing levels and patient outcomes identified 96 studies with sufficient rigor to be included in the analysis Kane, et al.

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That review concluded that there were statistically ificant associations of nurses per patient day and a wide range of outcomes including mortality, failure-torescue, length-of-stay and various other complication rates. Despite growing evidence in the United States of America USAlittle evidence has been available to evaluate them internationally.

It is one of the largest studies on nurses ever conducted. The study is well reported in the scientific literature generating until now more than 50 scientific publications.

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We will focus on the sample, instruments and measures, translation and ethical approval. Setting and sample The study was conducted in twelve European countries Belgium, England, Finland, Germany, Greece, Ireland, Norway, Poland, Spain, Sweden, Switzerland, and The Netherlands that were selected on the basis of research expertise, availability of patient discharge data from hospitals, geographic distribution, and duration of membership in the European Union. Two of the three countries performed the study as well what provided a very broad international perspective on the study.

In each of the 12 countries 30 hospitals were selected randomly. Within each hospital a minimum of 2 nursing units 1 general surgical and 1 general medical nursing unit were randomly selected from a master list of nursing units. The study sample included only adult medical surgical care nursing units since the science of linking different elements of nursing practice environment including nurse staffing to patient safety and clinical outcomes is best documented within this area. Specialized nursing units e. In each country all staff nurses providing direct care to patients on the selected nursing units were included in the nurse survey.

A one-day census approach was used to select patients of the selected nursing units. All eligible patients i.

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