من یک پرستارم؛ قانون را اجرا کنید
نمی خواهند که آنها را شمع دلسوز، فرشته رحمت و اسوه صبر بخوانیم، در شرایط سخت معیشتی و دشواریهای کار، مرهمی برای دلهای شان میخواهند.
یک بار دیگر روز پرستار رسیده و آنها مثل همه سالهای قبل و حتی سخت تر از آن مجبورند هر شیفت کاری را با اضطراب و استرس پشت سر بگذارند، از یک مرکز درمانی به یک مرکز دیگر راهی میشوند تا بتوانند در دل این سختیها مخارج خانواده را تامین کنند. شرح وظایف آنها با کارهایی که مجبور به رتق و فتق شان هستند تفاوتی دوچندان دارد.
یک وزیر دیگر هم آمد و رفت و طرح «تعرفه گذاری خدمات پرستاری» روی کاغذ باقی ماند. شرایط مالی و روحی و روانی ناشی از عدم اجرای این طرح میشود کوهی از درد که باید ظاهری مهربان و بی غم را به بیماران و همراهان بیمار نشان دهد و زیر این فشار خیلیها طاقت نمیآورند و هر از گاهی خبر مصیبت بار درگذشت یک پرستار در حین شیفت کاریاش به گوش میرسد.
هر چند که با همه این سختیها این روزها با افتخار و سربلند میگویند که «من یک پرستار هستم.»
به مناسبت فرارسیدن روز پرستار به سراغ سید جواد توکلی روابط عمومی نظام پرستاری مشهد رفتیم همان کسی که در تمام سال پیگیری دغدغههای پرستاران و پاسخگو به پرسشهای اصحاب رسانه است.
وی با گلایه از عملکرد و نحوه نگاه مسئولین به جایگاه پرستاری میگوید:
در طول درمان باید تمامی کادر درمان و غیرپزشکان دیده شوند که یکی از مصادیق این دیده شدنها، اجرای قانون تعرفه گذاری پرستاری بود. قانونی که دوازده سال پیش تصویب شده ولی هنوز روی کاغذ مانده است. اگر این قانون اجرا میشد علاوه بر این که به رشد جایگاه پرستاران و ایجاد انگیزه در آنها کمک میکرد بلکه بسیاری از هزینههای درمانی را هم کاهش میداد.
توکلی معتقد است: با توجه به اینکه پرستاران قشری نجیب و پرتلاش هستند و با تمام ناملایمات و کمبودها در انجام وظایفشان کوتاهی نکردند باید به اعتراضات آنان توجه کرد.
وی تصریح کرد: پرستارها درباره عدم افزایش درآمدشان در مقایسه با سایر کشورها، از ابتدا به عنوان منتقدین طرح تحول سلامت بودند چرا که در طول طرح تحول سلامت تنها درآمد پزشکان بطور قابل ملاحظهای افزایش یافت.مایه تاسف است که در کتابچهای که به عنوان طرح تحول سلامت نوشته شده حتی یک کلمه از «پرستار» نیامده بود.
توکلی زاده با اشاره به اینکه پرستاران حقوق ثابت و کارانه ثابت دارد گفت: تعداد بیمار، به نفع پزشکان است چراکه پرستاران با رسیدگی به بیمار بیشتر نه تنها درآمد بیشتری ندارند بلکه تنها وظیفه آنان سنگینتر میشود. از این رو پرستاران دید دوگانهای به این طرح پیدا کردند چراکه طرح نمیتواند منجر به برقراری عدالت شود.
بازرس خانه پرستار ضمن تاکید بر ضرورت برانگیختن انگیزه در پرستارها برای ادامه فعالیت گفت: در حال حاضر کارانه حقوق پزشکان بین 4 تا 5 میلیون تومان ثابت است. هرچقدر هم کار بیشتری انجام شود، درآمد به طور مشخص افزایش مییابد. در طرح تحول سلامت به حجم کار پرستاران اضافه شد و تعداد بیماران رشد قابل توجهی داشت اما کارانه پرستاران متناسب با این حجم کار افزایش پیدا نکرد. بر اساس بهره وری کراانه باید بر اساس عملکرد و تعرفههای پرستاری پرداخت شود، نکتهای که در برنامه ششم توسعه نیز تاکید شده است اما قانون تعرفه گذاری اجرا نشد که کارانه پرستاری افزایش چشمگیری داشته باشد.
وی با اشاره به اجرایی شدن طرح «قاصدک» گفت: کاترانه این طرح مورد نقد است و پرستاران از ابتدای اجرای این طرح مخالفت خود را با آن مطرح کردند. حاصل قادک این بود که پرداختی مسئولین پرستاری افزایش یابد ولی در بدنه جامعه پرستاری اتفاقی نیفتاد. در مواردی با اجراشدن این طرح ما شاهد کارانه منفی بودیم چرا که برخی پرستاران به دلیل استفاده از مرخصی و یا این که بخش مورد نظر آنها اتاق عمل جراحی نداشت، پرداختی شان کاهش یافت.
پرستاران طرح «قاصدک» را قبول ندارند و خواهان اجرایی شدن قانون تعرفه گذاری هستند.
در طرح قانون تعرفه گذاری هم موارد مربوط به کم کاری پرستار دیده شده است که اگر پرستاری کمتر کار کند حقوق و کارانه کمتری دارد، ما با این قضیه مشکلی نداریم.
ما وقتی میبینیم که با وجود افزایش کار پرستاران که باعث شده تعداد بخیه زدنها، گذاشتن سوند کلیه، پانسمان و غیره افزایش پیدا کند، اما دریافتی پرستار تغییر نکند، قطعا نقدهای به سیستم وجود دارد.
توکلی درباره کارنامه قاضی زادههاشمی در دوران وزارتش گفت: با توجه به اینکه طرح تحول سلامت در دوره وزارت ایشان صورت گرفت، از طریق مجلس و سازمان برنامه و بودجه، بودجههای هنگفتی برای پوشش این طرح اختصاص یافت. بودجههایی نیز به تیم پزشکان متخصص و مستقر در مراکز درمانی و خصوصا در شهرستانهای دورافتاده و مناطق مرزی تعلق گرفت. در این طرح هدف کاهش پرداخت از سوی مردم بود اما در واقع هزینهها از منابع مختلفی نظیر یارانهها و بودجه عمومی تامین شد.
وی افزود: در سالهای اول و دوم با افزایش هزینهها، درآمد پزشکان اضافه شد و تعرفههای پزشکی یک شبه 2/5 تا و 2/7 برابر شد .
وی توضیح داد: متاسفانه بخاطر درآمدزایی بیشتر پزشکان، هر مریضی که به بیمارستان مراجعه میکرد با اینکه به خیلی از عملها نیاز نبود، اما انجام میشد. هزینههایی مثل انجام انواع آنژیوگرافی و سی تی اسکن و … دوباره به مردم تحمیل میشد و پول اختصاص داده به این سمت کشانده میشد.
وی خاطرنشان کرد: در چندسال اخیر با توجه به هزینههای گزاف قادر به ادامه طرح تحول سلامت نبودند. بسیاری از روشها نظیر آنژیو گرافی و یا اقدامات تشخیصی مثل انواع آزمایشها و حتی داروهایی که در این سالها تجویز شده است، با نگاه درآمدزایی از بیماران بوده است.
توکلی تصریح کرد: مساله حائز اهمیت برای پرستاران این است که تمامی گروه درمان غیر از پزشکان، شامل پیراپزشکان، پزشکان عمومی، پرستاران زحمات بسیاری برای سلامت بیمار میکشند ، اما زحمتهای شان دیده نمی شود.
وی اضافه کرد: برای عمل جراحی، بیمار باید از طریق پذیرش بستری شود و در بخش کارهایی مثل آزمایش، تصاویر، مشاورههای لازم و نوار قلب انجام شود. بیشتر این کارها توسط پرستارها انجام میشود، در اتاق عمل، پرستارها، کمک کردهها هستند، عمل توسط پزشکها و کمک کردهها انجام میشود، سپس بیمار ریکاوری میشود که باز هم این اقدام توسط پرستاران انجام میشود، زمانی که بیمار به داخل بخش برمی گردد، مراقبت میشود، پانسمان و دارو دارد، باز پرستارها هستند و پزشک به تنهایی نمی تواند کل مراحل درمان را بر عهده داشته باشد.
روابط عمومی نظام پرستاری مشهد اضافه کرد: پزشک بعد از عمل در طول روز، تنها دقایقی را صرف ویزیت مریض میکند اما پرستاران به صورت ۲۴ ساعته حضور دارند و پاسخگوی نیازهای درمانی، روحی و عاطفی بیماران هستند.
وی افزود: به همین دلی است که ما میگوییم در طول درمان باید تمامی کادر درمان و غیرپزشکان دیده شوند که یکی از مصادیق این دیده شدنها، اجرای قانون تعرفه گذاری پرستاری بود. همینطور که تمام اقدامات پزشکی دارای کد ارزشگذاری هستند، قانونی که دوازده سال پیش برای تعرفه گذاری خدمات پرستاری تصویب شد ولی هیچگاه اجرا نشد میتوانستیم با اجرای آن شاهد کاهش هزینههای درمان باشیم. با بررسی بودجههایی که در سالهای اخیر به وزارت بهداشت اختصاص داده شده است، متوجه کم لطفی در حق پرستاران میشویم.
وی در پاسخ به اینکه وزیر جدید چه اقدامی در جهت بهبود وضعیت پرستاران میتواند انجام دهد چیست گفت: پیشنهاداتی در جهت کنترل و کاهش هزینههای بخش درمان وجود دارد و اگر قانون تعرفههای پرستاری را اجرا کنند؛ باعث میشود هزینههای بیمهها و بیماران تا حدود یک سوم کاهش پیدا کند و این به نفع بیماران و باعث رضایتمندی بیشتر پرستاران خواهد بود.
وی در نهایت گفت: بایستی نگاه خود برتر بینی در بعضی از پزشکان که به علت پرداختهای بالا به وجود آمده است، حذف شود. در کشورهای مختلف این دیدگاه مطرود است و باید همه خود را کارمند سیستم بدانند و از احترام خاصی برخوردارند. احترام و دید مثبت به قشر پرستار مهم است و دوستان پزشک دید خود را اصلاح کنند. پرستاران و پزشکان اعضای یک تیم هستند و بدون وجود آنها کار پیش نخواهد رفت و هرکس در حد خودش باید انجام وظیفه کند
نوشین تمیمی
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