The Ways of Development of Nursing as a Separate Health Profession: a Comparative Analysis of Legislative in the Nursing Profession in Bosnia and Herzegovina and Countries in the Region

Introduction. The rising need for quality health care, increased workload, accountability and healthcare reforms, are factors that resulted in growing requirements for recognition of the nursing profession, which are clearly defined in the Munich Declaration (2000). Unfortunately, in the current health care system in most of the transition countries of the Region of the South East Europe, nursing is still not adequately validated as a special profession. Aim. Presentation of legal solutions related to nursing profession in Bosnia and Herzegovina (B&H) from the aspect of definition of nursing activities, education standards, licensing and labor mobility. Methods. Desktop analysis as a method of quality research of legislative and strategic documents related to nursing in B&H. Analysis of the directive and legislation in the countries of the region and the EU. Comparison with the legislation of B&H. According to the constitutional solutions, within the competence of the Entities (Republic of Srpska), the area of health care in B&H is divided by the competencies of the entities and cantons (the Federation of B&H), that is, within the competence of the Brčko District of B&H, therefore, there is also a separate entity legislation. In 2013, the Government of the Federation of B&H adopted the Law on Nursing and Midwifery and secretly defined the nursing domains in accordance with the EU directives. In the Republic of Srpska and the Brčko District, this is partly defined in the systemic health care laws (amended in 2015). Conclusions. In all the legal acts reviewed, there are still shortcomings in the defined domains for the nursing profession. By addressing these issues, the progress of nursing development would speed up, strengthen and modernize the health system, which would undoubtedly increase the quality of health care to a higher level. The Ways of Development of Nursing as a Separate Health Profession: a Comparative Analysis of Legislative in the Nursing Profession in Bosnia and Herzegovina and Countries in the Region Croat Nurs J. 2018; 2(2): 141-148 142 Zelić S. et al. The Ways of Development of Nursing as a Separate Health Profession... Croat Nurs J. 2018; 2(2): 141-148 profession, increasing the mobility of nursing workforce, and improving the health care system in which nurses are an essential part, both as participants and as policymakers. The health of the population is undergoing significant changes in the current conditions of altered socio-environmental factors, the increasing challenges and risk factors in the environment, the new pathology, the need to strengthen health promotion and disease prevention, and bring new therapeutic approaches (4). Continuous monitoring and strengthening of health care is necessary. Consequently, the role of a nurse as a health care manager, from the planning, organization, management and control process is immeasurable in the health system of each country. There is not a single healthcare profession that treats individuals of all ages, families, groups and communities in a more comprehensive way, sick or healthy in all environments, such as nursing. Nursing involves health promotion, disease prevention, and care for sick, disabled and dying people. In addition, the key roles of nursing are the promotion of a healthy environment, research, participation in shaping health policy and managing hospital and health systems as well as education. Therefore, strengthening the profession of nursing is also a necessity and a need for the improvement of health systems in all countries of the world. Starting from the premise that health systems in countries all around the world are part of a global international health system, the EU, as an intergovernmental and transnational community of European states, emerged through the process of cooperation and integration, continuously implements the process of adapting health systems of all EU member states to the global health system and strives to achieve a recognizable quality of health education. Introduction The rising need for quality health care, increased workload and accountability, are factors that resulted in growing requirements for recognition of nursing and consequent health care reform. Relating to medicine as a science and profession, nursing must be defined as a specific branch of medical science, which has its own and completed framework of knowledge, methods, procedures and skills, as a part of the entire medical science. As a logical sequence of these demands, the Vienna Nursing Conference, 1988 and the Munich Conference, which further strengthened the status of nursing profession, were held. At the Munich Conference, the Munich Declaration 2000 was also adopted (1). Conclusions from these conferences became a guide to the legislative authorities of transition countries, such as the Southeastern European countries, which, through strong socio-economic reform processes, have begun to work on the development and advancement of nursing legislation and the advancement of nurses’ position in Europe, as independent and interdependent professionals. Furthermore, the European Union (EU) has defined the processes and norms of nursing education. The health systems of all EU Member States should be adapted to the global health system of the EU and achieve the prescribed and recognizable quality of health education. Implementation of those reforms requires the fulfilment of the Guidelines of the World Health Organization Regional Office for Europe, European Union Directives (2005/36/EC and 2013/55/ EC), and the Guidelines on the recognition of professional qualifications (2, 3). Unfortunately, in the current health care system in most of the transition countries of Southeastern Europe and the Western Balkans countries, nursing is still not adequately validated as a special profession. The aim of the paper is to analyze the legal and strategic solutions related to nursing and offered through legislation in Bosnia and Herzegovina (B&H) from the aspect of definition of nursing activities, education standards, licensing and labor mobility. By harmonizing these domains with EU standards, it can contribute to further strengthening the nursing Zelić S. et al. The Ways of Development of Nursing as a Separate Health Profession... Croat Nurs J. 2018; 2(2): 141-148 143 According to the constitutional solutions, within the competence of the Entities (Republic of Srpska), the area of health care in B&H is divided by the competence of the entities and cantons (the Federation of B&H), that is, within the competence of the Brčko District of B&H, and therefore there is a special entity legislation (6,7,8) complicated state system, poor coordination of competent sectors and many other problems, the process of harmonization of health laws will have to take place in those phases. The best example of this phase approach to solving the harmonization problem is the adoption of the special Law on Nursing and Midwifery of the Federation of B&H (Official Journal of the FB&H 43/13) (9). The basic goal of this law is to regulate the profession, i.e. define the activities, competencies, standards of education, licenses and other domains in order to place this profession in B&H at the same level with other regulated professions in health care. This would make nurses equal in rights and obligations with their counterparts in the EU, which would also enable the mobility of the personnel and the basis of this profession, the satisfaction of the end user or the patient. The law is mutually beneficial, both for nursing and for patients, and this is reflected in the following: • providing professional, efficient and effective nursing services for patients, • informing the patient about the possibilities of choosing services, • guarantee of quality of services, • encouraging the development of the profession, • recognition of the expertise, identity and social position of nurses. Through the Law, the nursing domains are clearly defined in accordance with EU Directives. Although not fully harmonized with European legislation, the part that could be harmonized is harmonized, and the part that is not harmonized due to existing obstacles will wait for the solution of these problems. In the Republic of Srpska and the Brčko District, this is partly defined in the systemic health protection laws (7, 8). Also, Directives 2005/36/EC and 2013/55/EC (2,3) provide the basis for mobility in the European labor market for sectoral professions, including nurses. Labor market mobility requires university education of Methods • Desktop analysis* as a method of quality research of legislative and strategic documents related to nursing profession in B&H • Analysis of directives and legislation in the countries in the region and the EU • Comparison with B&H legislation Directive 2005/36/EC of the European Parliament and of the Council on the Recognition of Professional Qualifications (2), (Directive 2005/36/EC) and its upgrading the Directive, Directive 2013/55/EC are two key EU Directives on Independent Professionals Of the European Parliament and of the Council on the Recognition of Professional Qualifications amending Directive 2005/36/EC on the recognition of professional qualifications and Decision (EU) no. 1024/2012 on administrative cooperation through the Internal Market Information System (3) (Directive 2013/55/ EC). These Directives contain standards that are the basis for the adoption of various legal acts in the field of nursing. In addition, the Bologna Declaration of June 1999 launched a series of reforms needed to make higher education in Europe more compatible and more comparable, more competitive and more attractive to its citizens and to citizens and scientists from other continents. Among the main objectives are the development of a progressive convergence of the overall framework of educational titles and cycles in the open European Higher Education Area, as a develo