Becoming Florence Nightingale

A new head of the Health Ministry’s Nurses Administration has taken up her post in Jerusalem.

By JUDY SIEGEL-ITZKOVICH
Dr. Shoshy Goldberg (photo credit: JUDY SIEGEL-ITZKOVICH)
Dr. Shoshy Goldberg
(photo credit: JUDY SIEGEL-ITZKOVICH)
If you’re looking for a profession that involves a wide variety of subjects to choose from, is free from the risk of unemployment, brings in a decent salary, has flexible hours, offers opportunities for higher studies and advancement and has no glass ceiling for women – there is such a thing. It is nursing.
The profession has come a long way since modern nursing was founded by English social reformer Florence Nightingale, known as the “Lady with a Lamp,” who treated wounded soldiers under fire in the Crimean War.
With the chronic shortage of physicians (due to state limits on admissions of medical students, whose learning is subsidized), the aging of the population and the growing sophistication of the work, nursing in the answer for many young people looking for a career.
Since last fall, the Health Ministry has had a new head of its Nursing Administration. Dr. Shoshana Riba retired, and Dr. Shoshana Goldberg – who insists on being called Shoshy – advanced from being head nurse of Sheba Medical Center at Tel Hashomer to replace Riba in Jerusalem.
Born in Holon to a family with three other daughters, Goldberg married a businessman and had three children, one of them a daughter who is an ophthalmologist. The Goldbergs have three grandchildren.
“I always wanted to be nurse; if I had to choose again, I would decide the same,” Goldberg told The Jerusalem Post in an interview in her office in the capital. She received a bachelor’s degree at Tel Aviv University’s Nursing School as part of the IDF’s academic program and was an officer for three years.
She also earned a master’s in business administration at TAU and a doctorate in health systems at Ben-Gurion University of the Negev. To get to ministry headquarters in the morning, she drives from her home in Rishon Lezion.
“I have worked with patients, in surgical departments and also in academia. I was head of the nursing school affiliated with the Wolfson Medical Center in Holon and spent nine years at Sheba, where there are 3,000 nurses, as head nurse. Then I came to the ministry.”
She has “a lot of love for the profession.
Nurses here and around the world are a very important force for public health,” she said. “They are in the front of the medical system, in the closest contact with patients.
They have to know all their needs and how to solve their problems. Every day there is more technology to master and knowledge to amass. Unlike the past, when many nurses were practical nurses, today, the vast majority – 87% – have bachelor’s degrees. Others have even master’s and doctoral degrees in nursing.”
There are some 70,000 nurses – 13% of them male – in Israel today, said Goldberg, who does not know exactly how many are actually employed in the field.
Nursing has a great deal of variety in jobs.
“You can develop in clinical fields based on evidence, specialize, do research or administration.
You can also teach, work in a community clinic or in a hospital, care for children, for young- or middle-aged adults or the elderly. You can deliver babies or advance even more and become a nurse practitioner.
There is so much flexibility and you can switch whenever you want,” Goldberg said.
”There are 20 different nursing specialties. You will never have trouble getting a job. And those who don’t like seeing blood or operations can manage fine as a lactation counselor, a diabetes nurse, an expert in the prevention of infections or pressure sores. By contrast, doctors work in one field in depth and go into subspecialties. They only rarely switch fields.”
As for pay, nurses’ gross salaries including benefits start at NIS 250,000 a year today. They earn among the highest nurse salaries in the OECD. A nurse who works night shifts or weekends and holidays – which no one is forced to do – can earn even more.”
Institutions increasingly compete for nurses, and a growing number of academics who have bachelor degrees in other subjects – even business or economics – can apply for retraining and become nurses after only two years of study instead of four.
“We already have 400 of these per year, some of them Israeli and some new immigrants,” Goldberg said.
The idea of retraining academics to go into nursing started some years ago, and the pace has accelerated. We hope to expand it. However, you can’t work in this profession unless you have compassion for the patient.”
Goldberg recently returned from a Nefesh Be’Nefesh conference in the US to find ways to encourage American Jewish nurses, as well as academics who want to retrain as nurses and are interested in settling in Israel.
THE NURSING Administration she heads serves as a staff unit in the ministry and is charged with formulating nursing policy and developing the profession as an integral part of the health system.
As a member of the ministry’s executive, the head of the administration serves as an adviser to the minister, the director-general and the rest of the executive in all matters relating to nurses and the fields of practice.
She (or he) must be a registered nurse with broad professional experience, high academic training and management and leadership skills. Her responsibilities pertain to all aspects of nursing, including training, licensing, determining professional guidelines and professional development. The head nurse must also upgrade the profession through basic and advanced professional training; raise the threshold of operational standards through professional guidelines; adapt nurses’ roles according to the system’s; and determine a safe threshold level of knowledge and practice through licensing examinations. All professionals in the field must register in the nurses registry following successful passage of the government licensing nursing examinations.
DESPITE all the benefits of nursing, there are several shortcomings. The ratio of nurses to physicians is 1.36, compared to an OECD average of 2.79 nurses per doctor. According to a report published last year in the Israel Journal of Health Policy Research, “Israeli nurses suffer from poor work conditions and practice environments, particularly due to bureaucratic processes for creating needed nursing positions in hospitals. Moreover Israel has the most overcrowded hospital system in the developed world, with an average of 98% occupancy rates in hospitals, compared to a 78% OECD average. Overcrowding in hospitals has been associated with higher rates of adverse events, mortality, hospital- acquired infections and staff illness rates.| In addition, the ongoing threat of violence by patients or family members continues.
Coming about two weeks after the horrifying murder of Holon nurse Tova Karero, burnt to death when a patient set her afire, the interview inevitably touched on the topic of threats to nurses.
In the last three years, according to the ministry, there were 3,000 incidents of violence in the health system, a quarter of them involving actual physical violence. According to a poll of health system staffers, 36% have experienced physical violence, 75% have experienced verbal violence – yet only 11% decided to complain to the police.
As so many acts of violence are not reported to the police, the subject is too often swept under the carpet, and too little is done by the ministry and other authorities to counteract violence after headlines disappear from the media.
A national strike was held soon after the Karero murder and the Holocaust-survivor patient attacker – who received a vaccination at Karero’s clinic and wanted to take vengeance for “making him feel unwell” – was arrested. The Knesset Labor, Social Services and Health Committee rushed to set a session to discuss the horrific act of violence.
“We must educate the public to behave differently,” said committee chairman MK Eli Alalouf. Alalouf said that violence exists in all corners of the society, and the medical sector especially suffers from violence against medical teams. We will not accept this.”
Ilana Cohen, head of the Israel Nurses’ Union, told the committee that it had complained to the authorities for years about violence in clinics and hospitals, “but nothing has been done” to reduce it.
Clalit Health Services director-general Eli Depes, at whose clinic the Karero was murdered, said that every guard in the health fund is trained by the police, but the more extreme the event, the more difficult it is to prepare for it. We deal mostly with prevention, and to prevent the next incident, we must deal with pressure and burnout.
The health system must receive much more serious help than what has been done in recent years. The society is shocked today and forgets tomorrow. I hope we will not pass over this murder without dealing with the problem seriously,” he added.
The health system is full of stress that gets worse as the queue gets longer, said Dr. Leonid Eidelman, head of the Israel Medical Association.
“There is no justification for violence, but we must deal systematically with all the problems. We asked for and received uniformed policemen in hospitals for a pilot that was successful, and now we want to expand it. A policeman in uniform gives the team a feeling of security. Frightened staff members do not function well, thus violence causes harm to all patients,” Eidelman said.
Goldberg commented that she had not known the murdered nurse personally, but she deeply mourned her.
“I visited the clinic where it happened once, and I will visit again. Tova symbolizes the heart of the profession. She worked with dedication for 30 years in the clinic, and everybody loved her. She knew everyone in the neighborhood. I went to visit the family to express condolences. The husband, the daughters – they were all incredible. Clalit Health Services is considering the possibility of naming the Holon clinic in her memory.”
Goldberg noted that clinics and hospitals have the option of refusing to give future treatment to violent patients. Two weeks after the Karero murder, family members of a very sick, elderly woman went wild in the internal medicine department at Tel Aviv Sourasky Medical Center and threatened to murder a physician. By order of director-general Prof. Ronni Gamzu, the police were called and those involved were arrested. A few minutes later, a dissatisfied patient threw a computer at a nurse at Assaf Harofe Medical Center in Tzrifin.
“We must have zero tolerance for violence. There are workshops to teach medical staffers how to defuse violence, but such a thing wouldn’t have been effective in Tova Karero’s case. We definitely need more security. Even having emergency call buttons attached to other rooms would be a great help. If Tova had such a button, maybe she could have called colleagues for help in time,” the chief nurse said.
The ministry executive decided the morning after the murder to set up a team headed by the director-general on improving the response to violence.
“There should be monthly reports to the public on violence in the medical system, just like there are regular reports on how many people are killed and injured in road accidents,” said Goldberg.
Florence Nightingale would probably have been shocked and amazed to learn that nurses are sometimes under fire.