The backbone of the healthcare system, the 24-hour guardian of the patient, and an integral part of the clinical team—this is the true essence of the nursing profession. Although modern medicine is unimaginable without qualified nursing care, in Georgia, this field has been a prisoner of stereotypes, harsh working conditions, and systemic neglect for many years. Nursing is often perceived not as an independent and academic branch of medicine, but as “hard manual labor,” which directly impacts both the shortage of personnel and the quality of service.
“Medscriptum” spoke with Tamar Daus, a nurse and the founder of the Nursing Association “Numane,” about the challenges facing the nursing field, systemic flaws in education, and the steps needed to save the profession.
How significant is the nursing profession, how dependent is the healthcare sector on it, and what would happen to us without it?
Right now, everyone looks at nursing through stereotypical thinking, including the nurses themselves. Nurses, doctors, students, and representatives of other professions—this already shapes public opinion, and we should no longer be surprised by a similar attitude from society.
The prevailing view is that a nurse is a performer of “hard manual labor” and their responsibility is limited to that. We have now moved past the mindset that a nurse is simply someone who gives injections or follows prescriptions. I want to say that this view did not arise entirely without reason. Nurses themselves think they are just order-followers, and the idea that this profession is actually a separate branch of medicine—with its own textbooks, guidelines, evidence-based rules, and many other complex nuances—is no longer being developed.
In reality, patient assessment and management 24/7 are in their hands. This should actually be the best-educated link in the hospital. No matter how professional a surgery is performed, the patient’s rehabilitation period is entirely in the hands of the nurse. Whether the patient’s condition worsens or whether there is a positive or negative response to medication, it is noticed by the nurse.
Unfortunately, the average level of knowledge is very low because nurses themselves do not believe that this knowledge is required of them. Therefore, I would say that this harmful stereotype, which has many root causes, has also greatly affected the mindset of nurses and created a kind of vicious circle.
I think it will take a very long time for a nurse to feel like a member of the clinical team and believe that their profession is independent with its own responsibilities, as it is in many developed European countries, such as France, Germany, or Central European countries. As soon as nurses realize that constant development is necessary, they will believe in the power of their profession and actively begin to demand to be valued. I think public opinion and the difficult, complex reality in which these people have to work will change immediately then.
You mentioned the topic of education—that diagnosis and management of a disease do not depend only on the doctor. In the context of raising education, what is being done in the country regarding textbooks?
Unfortunately, until 2018, there was one quite good book published by a German organization, which only covered home care. Other textbooks were not relevant or adapted to the syllabus, so their use is definitely not recommended. In 2018, 16 textbooks were created, which fully cover the 180 mandatory credits, and absolutely all fields were covered in the Georgian language. But it is impossible to be sure of a student’s knowledge just by the existence of a textbook; it is necessary to test this knowledge. Unfortunately, this hasn’t happened until now. Although various colleges now issue diplomas based on their own exams, it is still difficult to assess the knowledge of a person already entering the field because every institution tests knowledge in its own way.
Furthermore, unfortunately, after graduation, we do not have licensing exams and opportunities for continuous professional education in nursing. It turns out that a nurse has no obligation to learn, and you cannot demand it of them; morally, this is very difficult. We all know the reality of these people. They have to work in two jobs simultaneously, as well as go on private calls for additional income, and such a person ends up with about 250 working hours per month. Often, they don’t even have time for themselves. Therefore, even if they have the desire, they physically cannot manage to develop.
Let’s touch upon another issue: what is the age situation of nurses and how does this affect the system? What causes this situation?
Another issue is the average age. A few years ago, in a personal conversation, I remember the average age of a nurse was stated to be 47 years, which means that no matter how professional a person is with great experience, age still takes its toll. I mean that 47 is a very high number for a nurse who works 48-hour shifts consecutively and has a family of their own. It is extremely exhausting; after a certain time, it reflects on their health and the work they perform. Therefore, no matter how motivated a person is to receive and learn new knowledge, such a regime forces them to refuse such education, and this is extremely disappointing.
Thus, we have three types of nurses in the country today. Newly graduated people with college diplomas, who have received a diploma, but we don’t know if their knowledge was actually assessed with evaluation instruments. The second type is older people who may have graduated in nursing at the end of the last century, and until now, accumulating seniority and their own development depended entirely on them.
And the third type are people working in the so-called “nurse assistant” position. A position that was perceived by many representatives of the field and various institutions as a way to bypass the law. These are people who, after the ninth grade, received the third level of professional education. The document confirming the completion of the third level is a certificate and not a diploma. Accordingly, they did not have the right to work as a nurse. Unfortunately, they often had to perform the heavy duties of a nurse or even more intensive work, and often the salary was much lower than the average income of a nurse. The sad thing is that people with the title of nurse assistant face a dilemma because, realistically, they do not have the opportunity for professional development by law. The requirement of the Ministry of Education is that they finish school and then complete the 5th level vocational nursing educational program, which realistically involves enormous time and effort.
That is why, very soon after the introduction of this term, we saw thousands of young people full of health and motivation leave the healthcare sector and start working in a completely different sector, for example, in retail chains, where they were offered relatively higher pay and less stress and physical exertion. Of course, when people with years of accumulated seniority leave the sector, this weighs heavily on the healthcare field itself and becomes one of the contributing reasons for the existing shortage of nurses.
Another vice is that often, due to physically hard and fast-paced work or an acute shortage, the demand from clinics is focused directly on young people. Therefore, many first-year students are hired, who, in addition to an already very busy university schedule, have to perform heavy labor here as well. We end up with these bright and motivated kids burning out completely within three months, both morally and physically. In principle, we aren’t talking only about students here, but when a young person faces reality and realizes what they are dealing with and how much they have to learn, great conflicts arise in their mind, making this process extremely difficult. Therefore, in the end, it turns out that we have very elderly nurses on the market.
At the same time, let’s mention the profession of “midwife-nurse,” a profession that has virtually disappeared in Georgia. Since no midwife-nurse diploma has been issued in Georgia for fifteen years. One reason for this is that the midwife-nurse program was moved from vocational to a bachelor’s program, and practically no one applies for this program.
The second major problem regarding the shortage of nurses is where they go after receiving their diploma; because even the small contingent of these people mostly goes into aesthetic medicine, where there is more financial benefit. As a result, the shortage of surgical, emergency, anesthesia, and general nurses worsens.
In your opinion, what causes a young person graduating from school not to be interested directly in nursing? Is it only because it is not financially favorable, or is there another reason?
Of course, there is. Finance and a decent salary are only part of the motivation because, hypothetically, if I don’t want to work somewhere where I am treated poorly and the conditions are very bad, even if you pay me thousands of GEL, I won’t go there, or I won’t last and will leave soon. It works the same way here.
Beyond that, there is no prospect of development. You become a nurse, and that’s the end of it. No matter how talented, motivated, and educated you are, no matter what great seniority and experience you have accumulated, wherever you go—be it research, academic work, or the latest innovations—the answer is always the same: that you lack the qualification and competence, which is actually determined by an academic degree.
And when you ask: “Yes, I understand, how can I raise this qualification now to fit your standards?” they answer that you must re-enroll in a bachelor’s program, and only after that is it possible to perform work that mostly doesn’t even need the knowledge received at the university. And to the next question, why the nursing line cannot be developed and why it’s necessary to lose so many years, there is never an answer.
Yet, development through the nursing line, with continuous professional education, is possible, which many European countries have done, for example: the Czech Republic, Slovakia, Poland, Germany, France, Great Britain, and many others. Unfortunately, this does not happen in our country. Therefore, when we ask the question: “Why doesn’t a young person apply for nursing? Is it because it’s a bad profession?” No. It’s because this profession has no development.
How can you ask a young person to try their hand at this profession when we live in an era where, without even leaving home, just by creating good content on TikTok, you can become famous, have appreciation, and make money. Therefore, if there is no motivation for the personal development of the workers, it makes no sense. At the very least, we should show society examples of successful nurses—those “pearls” and individual stories that can interest a person. The more opportunities we give to those employed in this field to achieve more, the more interest there will be.
Regarding this topic, most people still consider the financial factor to be the main problem. Since everyone is well aware that nurses often have very low salaries, which do not even come close to the remuneration they actually deserve. This, in itself, reduces motivation. Do you see any steps, perhaps from the state or clinics, through which this problem can be solved so that nurses receive their due decent compensation and no longer have to work in two or three jobs and endure that inhumane toil?
Yes, when talking about this problem, we must primarily remember that no matter how much we look, neither in the Ministry of Health nor in private hospitals (which have their own internal standards), in their pricing where nursing service is considered—if we break down the patient’s treatment costs—indirect costs include the price of a stapler, electricity, water, floor cleaning products, and even printer paper, but the nurse is not included.
3.5–4 GEL per hour is a mockery, which was written into the law. Yes, it was a step forward and made people happy who were previously paid, say, 1.5 GEL—and we had such nurses in the country—but even this is very little. Therefore, it is necessary that the nurse be mentioned in the pricing of treatment costs. If we consider the colossal costs of treatment, I don’t think that including the nurse would cause any catastrophic damage to the clinic, because as a percentage, it is not a large number. In this regard, the surgical nurse is in a relatively better position because difficult surgeries cannot be performed without them, and surgeons have to compromise with them.
The second issue is the qualification system, which works very well in developed countries. It is not right that a nurse who has worked for 20 years and “feels every nuance with their body” and a novice nurse have the same salary. First, the quality of their service is completely different, and second, it creates a sense of injustice. Therefore, it is necessary that over time, the salary should increase according to seniority. This significantly increases motivation and the chance that people will stay in this field. I think as soon as these two issues are regulated, which can be done quite painlessly, the financial situation will also improve relatively.
If we look, for example, at statistics from the USA or European countries, there are about ten nurses per doctor, and on average two patients per nurse. In the reality of Georgia, according to various data, there are 7–10 patients per nurse, and one nurse per doctor. Do you have information about the actual situation in this regard?
Actually, I believe that we are dealing with a much smaller proportion. Unfortunately, there are no official statistics. One number that has been repeated over the years is 13,000, although I have no information on what this data is based on.
A few years ago, according to a study conducted with the help of USAID, the number of nurses increased from 13,000 to 25,000 from 2013 until the period of the study, which is practically impossible because the existing colleges in Georgia issue a total of about 200 diplomas annually. In reality, this number increased because often one nurse works in three different clinics or is registered in the labor force at at least three places.
That is why the accreditation process of hospitals, on which the Ministry pinned great hopes, could not show the real number of nurses. The exact number, in theory, will be known in June 2027, when the mandatory registration process for nurses is completed and we will also know their average age.
Where are we going and what future awaits us? How do you see the prospects? Is there any future vision that will be able to improve the current situation and return a prestigious and dignified status to this profession?
We must start working with an idea. People sacrifice themselves and die for an idea. If we formulate this idea for people and explain to them that their responsibility toward society is determined by their knowledge and that human lives depend on it—something will definitely change.
When we say that the nursing profession is in a difficult state, that even talking about prestige is redundant, and that these people often have to work in inhumane conditions and become victims of various types of violence, nurses themselves protest this, even though it’s the truth. You know, if a person understands the importance of their work and their own value as a professional, they will definitely demand better conditions and fight for it.
That’s why I say an idea is necessary—an idea that should be taught to students as early as in college. This way we will know what we are asking of nurses, and what we offer them in return will no longer be disproportionate. As soon as nurses see this and, in parallel, we demand the right obligations—be it competence or deeper academic knowledge—the demand for professional appreciation and better conditions will immediately arise in them. These two factors will greatly help the process.
Otherwise, we are heading and will definitely reach a state where, if we don’t offer nurses social benefits and housing after a certain number of years, like we do for the military, no one will go into this field anymore. Until we present nursing as a path of upward mobility and offer a decent salary to those employed in this field, we will remain in this situation and nothing will change.
