Winchester Hospital Trains Armenian Nurses as Part of Healthcare Reform

At first, Keaney said they tried to send the students off-site two by two, because they weren’t sure how comfortable they would be alone, but as time went on, some went off alone too. Keaney said that they found out about the specialties of the students from their instructors ahead of time so tried to both make sure they learned about that in the US, as well as get exposed to things they didn’t know about.

Barsamian arranged a visit to the Hebrew Rehabilitation Center in Roslindale to see what she called the gold standard in geriatric care and also because there were Russian-speaking nurses and patients there who could easily communicate with the visiting Armenians.

They also went to Boston Medical Center, the main teaching affiliate of the Boston University Chobanian and Avedisian School of Medicine, where Barsamian said nurse practitioner and research coordinator Arlene Dermovsesian gave them a tour of the Alan D. Solomont and Susan Lewis Solomont Clinical Simulation and Nursing Education Center. This is where the nurses and doctors train at that hospital.

Keaney declared at the end of the practicum, “I think what was eye-opening for them was the degree to which we empower nurses here. Nurses have a voice and we listen to them, especially the nurses at the bedside – what’s going well, what’s not going well, what do we need to improve on. I think that is not their norm in their country. That’s what they tell me. I hope that they are inspired by that and I hope they are able to go back to their country and make some changes in the future because our model really supports the best patient care possible.”

Nurses Give Their Impressions

In a round-table discussion with the Mirror-Spectator on their last day at Winchester Hospital, the nurses confirmed Keaney’s words, and all only had positive things to say about their experiences during their practicum. They pointed to the advanced equipment which made work much easier, whereas there is a lack of sufficient equipment in Armenia. Blood samples, for example, could be quickly analyzed unlike in Armenia.

Compared to Armenia, there are a large number of workers. In Armenia, a nurse has to do all kinds of tasks, many of which are unconnected to nursing, such as compounding medicines, and has insufficient time to do patient assessments. The division of the emergency room into children’s and adult’s sections in Winchester made care easier, said a nurse from the Muratsan Emergency Clinic. Drug boxes were opened here with id cards, and specified for each patient, which leaves less opportunities for nurses to make mistakes. Patients had identification bands, unlike in Armenia, and an electronic health record system was used which, among other things, prevents errors due to handwriting.

The teamwork and cooperation between doctors and nurses were specifically noted by many of the nurses as particularly praiseworthy, as was the close communication with patients. Ani, from the Intensive Care Unit (ICU) of St. Gregory the Illuminator Hospital in Yerevan, said that hierarchy was not very emphasized in Boston, so that you would not necessarily see who is the doctor and who is the nurse at first glance, and people were very friendly with each other.

Simple things taken for granted in the US, like hand hygiene for nurses which is important in order not to transmit infections to others, were appreciated.

Natalie, from the ICU of the Nork-Marash Medical Center in Yerevan, observed that unlike in Armenia, nurses in the US have a lot of authority to work on their own, which makes patients look at nurses with more trust. In addition, physicians understand that giving authority to nurses makes their work easier so it will improve patient outcomes. When she returns to Armenia, she hopes this approach can be implemented there.

Lilit from the Yeolyan Hematology and Oncology Center in Yerevan said that only doctors in Armenia, not nurses, are allowed to do patient assessments, unlike in the US. She hoped that in the future it would be possible for nurses to do it in Armenia too. She also noticed that QR codes are used to provide information to nurses about each patient.

Liana, an ICU nurse from St. Gregory the Illuminator Hospital in Yerevan, said she liked the positive atmosphere and smiles on the nurses’ faces. She said, “It works and I will also change myself. I smile but not that much. I will smile more.” The leadership style at Winchester led her to think of how she could be a leader in the future in Armenia, she said.

One of the visitors said that in Armenia nurses would have to do sometimes two or three 24-hour shifts within a week, which takes a punishing toll on the body. In the US, the maximum a shift can last is 12 or sometimes 16 hours. Therefore, she said that their group will try to work to lower the shifts in Armenia.

Datev, from the Pediatric Department at Wigmore Women’s and Children’s Hospital in Yerevan, said that though they had studied how things work in the US and Europe, to come here and see for oneself is different. She said that though unfortunately many things don’t exist in Armenia she was sure that everyone will go back to Armenia full of new knowledge and experience that they will use. She said, “I am very thankful and grateful to have this chance to come to Winchester Hospital and see and meet such welcoming people.”

Possible Changes in Armenia

AUA instructor Vicky Hergelian, who accompanied the nurses’ group to the US, said that not only did everyone welcome the group in a nice way, as well as treat one other positively, but the Armenian visitors got to see how the role of nurses is recognized in the US. This was all previously only theoretical for the students. She thought that since the Ministry of Health of the Republic of Armenia has accepted the granting of BSN degrees for the first time, it will also help somehow to bring about changes in the Armenian healthcare system.

Nurses there are neither well paid nor respected, therefore by giving them more education and showing they can be leaders who can make decisions themselves, the field will be seen as a more attractive profession, she said.

Barsamian said that changes are happening in Armenia, and the government is supportive of upgrading the education and role of nurses there. According to a recent study, she said there is almost a 47-percent decline in the number of nurses getting educated. Universal health care is coming to Armenia in 2027 according to the Ministry of Health, so it will be even more critical that the hospitals will have a high quality of care. People will then be able to choose where they get their health care, she said.

The level of care will improve, Barsamian said, when nurses do more work involving higher-level, critical thinking, patient-centered actions, becoming professionals with developed skill sets and improved communication and empathy skills. Nurses might still be doing “lower-level” basic tasks, she said, but the development of a position like a certified medical assistant or nursing assistant in Armenia could relieve them to do more. As the latter position does not exist right now, the person cleaning a hospital room also changes bedpans and other things that nurse aides do, but without the training of the nursing assistant.

Fortunately, Barsamian said, the AUA program is expanding. There are 10 more in the junior class and 20 more in the sophomore class coming up and there are others just studying English at the moment to prepare for entering the program. She also said she had heard that another hospital in Armenia is considering starting a college of nursing to provide baccalaureate degrees too after seeing what is possible at the AUA program.

Barsamian was excited about the women who had come to Winchester: “These nurses are up against all odds. The pay is not great, the work is really difficult, but each of these nurses are these unique and really compassionate women who know that what they are doing is making a difference. They are really and truly pioneers and leaders in this field. I don’t think that they themselves even realized how important it was until they came here, and saw the impact and the professionalism — where nurses can be, how well respected they can be, what a difference they can make.”

Keaney said, “What we didn’t expect was what a great experience it has been for all of us. It has been wonderful…I would say the best part of this program — there are so many great parts to it — is that they’re lovely. You never know what you are going to get with a group of students. You never know if you are going to get people who just want to check the boxes and say they have completed their course requirements. This was a group very interested in everything – learning, the clinical piece, the administrative piece, the social dynamic.”

She said, “They are good people. I told them that they make me proud of my heritage.”

Keaney said that they knew right out of the gate that one of the things most of them are looking for is mentorship, and now, she said, “We are all willing to keep in touch with them. We encouraged our team to keep in touch. Mentorship can be in any form.”

When asked whether Winchester Hospital might host another such group from Armenia, Keaney did not hesitate to state: “If there was a need we would be willing to support that need. It’s been that great of an experience for all of us.”