Community nurses in Armenia: Task shifting for a new cadre of nurses

Background: Since the Soviet Union's fall, Armenia's health systems have deteriorated. Suffering the most are the rural communities, where nurses provide the only medical services at health posts, Feldsher Acousher Posts (FAPs). Because FAP nurses serve a critical primary care function, the Ministry of Health (MOH) decided to develop them into a new cadre of providers as part of its adoption of a national rural health plan to reform outdated health systems. The MOH identified the skill set a FAP nurse needed—a set broader than family nurses who do not work as independently but instead work alongside doctors. The government sought to retrain existing FAP nurses, but the only qualified training institutes were in Yerevan, and FAP nurses could not afford to be away from their job/family for six months. The USAID-funded Primary Health Care Reform (PHCR) project created a training package to be delivered on-site.

Method: The PHCR training focuses on clinical skill-building and includes: diagnosing cardiovascular, neurological, endocrine and infectious diseases; allergies; tuberculosis; emergency care; palliative and end-of-life care. Also, nurses learn to pro-actively address health problems.

The half-year training—delivered by master trainers and clinical preceptors—utilizes in-service, peer and distance learning formats so that nurses stay in their communities. Classroom trainings are held one week a month in regional nursing colleges. Clinical skills training is provided at nearby clinics or health centers.

Results: The nurses took a baseline knowledge test of 100 questions and scored an average of 31%. Their final assessments averaged 87%; 85% showed excellent results during the oral examination (on ten-point-scale).Upon successful completion of the training, the nurses received nationally recognized certification.

By providing more care independently, FAP nurses have gained confidence, saved time and money and can treat patients for more illnesses and emergencies instead of having to refer patients to hospitals. Trainings have resulted in new communication and support systems between nurses and trainers, doctors, and preceptors to solve medical problems.

Conclusions: Through PHCR, FAP nurses are self-standing specialists and significantly expand their scope of practice, improve performance, and demonstrate their functional and financial value to primary health care.