Croatian consultancy practices: a nurse’s experience report Práticas de consultoria croatas: relato de experiência de uma enfermeira

| INTRODUCTION: The article analyses the professional path of a nurse consultant. Nursing consulting is an expanding and stimulating profession with advanced practice roles and responsibilities. It emphasizes the nurse consultancy practice created through persistent effort, challenges, successes, and personal growth. Engaging in partnerships with healthcare organizations to enhance patient care, optimize workflows, and address challenges within the healthcare system. OBJECTIVE: To report on a nurse’s work experience as a nursing consultancy practice in Croatia's healthcare system. METHODOLOGY: The methodology utilizes descriptive, qualitative, and narrative approaches, with a specific focus on personal experiences and reflections. This methodology aims to share the nurse's journey and the transformative impact of their work in the nursing field. The study emphasizes the significance of authenticity, tenacity, and ongoing learning in nursing management and the execution of nurse consultancy practice in Croatia. RESULTS: The author underscores the significance of embracing a fresh outlook on Croatia's nursing and healthcare systems, particularly workflow integration and a comprehensive perspective of organizational and management business concepts. It provides insights into the process of establishing new hospitals, encompassing expertise in general management as well as specialized abilities in leadership and healthcare management. It also explores the evolution of patient rights and advocates for increased empowerment of nurses in influencing healthcare policies and decision-making, utilizing business Intelligence data to guide the advancement of the field. CONCLUSION: In summary, the nurse is dedicated to transforming the nursing profession by implementing innovative ideas and procedures, focusing on changing patient care attitudes and practices. The narrative journey embarked upon in this has provided a profound understanding of the nurse's career, offering insights into their thoughts, struggles, attitudes, and triumphs, the process of growth, adaptation, and unwavering commitment to bringing about a positive impact in the field of the nursing profession.


Introduction
The role of a nursing consultant in Croatia improves the growth of patient/client care through practicebased initiatives and organizational consultation.Croatia's healthcare system is predominantly publicly funded, with the Ministry of Health overseeing the planning, coordination, and regulation of healthcare services.All citizens and legal residents have access to healthcare services through Croatia's public healthcare system.It mandates mandatory health insurance, which the Croatian Institute for Health Insurance (HZZO) monitors through payroll deductions.The system includes primary, secondary, and tertiary healthcare, bolstered by a network of healthcare facilities, including hospitals, clinics, and specialized institutions.Larger cities tend to have more advanced medical facilities, while rural areas may have more basic services.
Croatia has been working on implementing e-health initiatives to enhance healthcare services, including the use of electronic health records (EHRs) and digital technologies to improve efficiency and patient care.According to the Croatian Central Bureau of Statistics (CBS) population census, 3,871,833 people were living there overall in 2021.Years of declining birth rates, rising mortality rates, and unfavorable migration patterns have affected general population trends.The birth rate was 9.4 per 1,000 people, the mortality rate was 16.2 per 1,000 people, and the overall fertility rate was 45.6 per 1,000 people, respectively.
The natural rate of change was -6.8, indicating a decrease.Based on the statistics from the Central Bureau of Statistics, the life expectancy at birth in Croatia in 2021 was 76.8 years for both genders.Specifically, women had a life expectancy of 79.9 years, while men had a life expectancy of 73.7 years.In 2021, there were a total of 137 new-born fatalities, resulting in an infant mortality rate of 3.8 per 1,000 live births.Pathologic problems during the prenatal period and congenital deformities were the primary factors leading to baby fatalities.In 2021, Croatia documented a total of 62,712 deceased individuals.Circulatory disorders were the primary cause of mortality in 2021.Subsequently, neoplasms were observed, and fatalities were attributed to COVID-19.
These three categories of diseases were 75% of the total causes of mortality, while the remaining deaths were attributed to endocrine system disorders, accidents and poisonings, respiratory system diseases, and other less prevalent causes. 1 The healthcare workforce comprises physicians, nurses, and allied health practitioners.Pharmacies are extensively distributed, providing both prescribed and non-prescribed drugs.Like many healthcare systems, Croatia faces challenges such as demographic changes, an aging population, and the need for healthcare infrastructure development.Balancing the demand for healthcare services with the available resources is an ongoing concern.Then, the nursing consultancy offers the chance to offer assistance of quality with a focus on patient care.
The term nurse consultant gained prominence in American literature throughout the 1970s.The different nursing positions are sometimes grouped as advanced practice, with consulting recognized and endorsed within these advanced positions.Four distinct types of nurse consulting can be recognized in the literature.Second Caplan (1970) the categorizes: that client-centred consulting can be conducted while working directly with the consultee, such as the patient, client, their family, or colleagues.The remaining three forms of consulting involve responding to requests from the organization or colleagues.In all cases, the consultant must actively participate in the consulting process and utilize the required skills within their role.The choice of consultant model depends on the specific area of expertise and the desired result of the consultancy partnership. 2rse consulting is a diversified profession in which skilled, knowledgeable, and experienced nurses utilize their expertise to offer specialized guidance and assistance in different areas of healthcare, government, and private healthcare institutions.This multi-faceted position includes providing advice, ensuring quality, delivering education, and conducting training, among other duties.Nurse consultants engage in collaborative partnerships with healthcare organizations and educational institutions.
Their purpose is to provide valuable insights aimed at improving patient care, streamlining healthcare processes, and tackling the various difficulties present in the healthcare system.The process generally encompasses a thorough review of requirements, the formulation of suggestions, the execution of solutions, and continuous monitoring and assessment.Nurse consultants might originate from several fields, such as clinical nursing, education, informatics systems, and quality improvement.Their efforts are essential in enhancing healthcare standards, optimizing operating efficiency and guaranteeing adherence to rules and best practices.

Objective
To report a nurse's work experience as a nursing consultancy practice in Croatia's healthcare system.

Methodology
The methodology used in this study is descriptive, qualitative, and narrative, focusing on personal experiences and reflections to explore the nurse's journey and the impact of their work in transforming the nursing field.The study also highlights the importance of authenticity, perseverance, and continuous learning in nursing management and nurse consultancy practice in Croatia.
Considering my professional path, and my wishes, a natural and logical choice was to be a nursing consultant.This report must compose an essay that highlights the most noteworthy breakthroughs, challenges, and achievements in the domain of nursing leadership and nurse consultancy in Croatia.
Almost forty years ago, I began one nursing professional path, which has been full of transitions, lessons, situations, new experiences, dynamics, years, and hard work aimed at advancement.It's important to stress that the foundation is the result of a great deal of effort, many challenges, some victories, and some low points.Perhaps it's inappropriate to discuss failures, but I always picked up, grew in confidence, and pushed myself to new heights.The answer to the question of what is causing all these shifts and where to find an endlessly mobile power source could be found in genetics or own lifestyle.Being authentic and going your own way when searching for ikigai is the key to success. 3Additionally, the main principle is never to give up. 4Chances don't just happen; circumstances create them.Then, what can be the professional wishes of one nurse?... Maybe the wish is not realistic; maybe the wish is just a thought.Maybe it's seeking Nemo. 5ree things I want to do are try something new, learn something new, and make improvements.Par example, Simba offers a possible acceptable answer in the Lion King movie.There are lots of things in life that we just don't get.The one certainty in life is that nothing goes according to plan. 6

Results and discussion
Croatia's healthcare system needs assistance and a fresh approach.The implementation of business procedures to characterize resources is one example.But, in healthcare, what exactly are resources?People, equipment, interior space, time, and documents are all examples of resources.Planning workplace processes is the first step towards improving productivity and effectiveness.In short, it is crucial to always know who is responsible, where that information can be verified, what room the process will take place in, which safe and correct medical devices will be used, and how many times they are needed for each procedure.
The building of day hospitals in Croatia is speeding up in each city.The principle of daily hospital short stays involves providing medical care and treatment to patients in a hospital setting for a limited duration, typically less than 6 hours.This approach aims to minimize hospitalization time, reduce healthcare costs, and enhance the overall patient experience by offering efficient and effective care.It is often used for procedures and treatments that do not require extended inpatient stays.
The worst thing that could be done would be to put in place a system of operation that hasn't been updated through analysis and improvement.So, in this way, effective nursing requires a comprehensive understanding and mastery of organizational and managerial principles, as well as specific knowledge and abilities.And to have been an integral part of healthcare transformations is a source of immense pride and fulfillment for me.
In 1995, the American International Health Alliance (AIHA) established a collaboration between Dartmouth Hitchcock Medical Centre (DHMC) in New Hampshire, USA, and three different hospitals in Zagreb, Croatia. 7 was also a part of that nursing study visit to the United States as a member of the hospital team.The aim was to study nursing management, asthma, and tuberculosis management.There, we, especially myself, had an enlightening experience.This was the beginning of my nurse management professional path.
Changes then occurred in Croatian hospitals.The Children's Hospital for Respiratory Disease, Srebrnjak, established the concept of a "child-friendly" hospital by allowing parents to stay with their children for long periods, painting the walls, and giving the hospital a more homely feel.This represented a shift to a new principle of care in which the patient's right was given top priority.Changing the long-held assumptions through which nurses and doctors operated was a must.And neither is it easy nor simple.Even if many things were rather different not too long ago, today such a premise feels normal as if it had never been different.Today, a child in the hospital never got decubitus because his or her family wasn't there.It can observe improvements in Croatia's healthcare systems because of cooperation, diligence, and progress.Patients have more rights and options; nursing education development to a high degree; and the evolution of nursing as a profession.A person's upbringing, culture, experiences, and personality all influence their values.What are Croatian nurses' human values? 8The results of the study allow us to draw the following conclusions: the values of benevolence, universalism, and safety are the most widely held among nurses.Since this study was done during the peak of the worst Corona epidemic, worry for one's own and others' safety is understandable.In light of the study's findings, it is reasonable to conclude that for the Self-Transcendent, Universalism, and Benevolence nurses in Croatia, it is feasible to recognize the predominant values following the Schwartz Theory of Human Values. 9e values held by male and female nurses, as well as younger and more experienced nurses, differ significantly.Security, which is a part of tradition, is likely to be linked to the outbreak of the Corona epidemic and a strong earthquake in Croatia.Selfengagement, Power, and Achievement have lower scores.That may be why there are a lot of physicians in government or politics, yet we nurses continue to make no progress. 8e study underscores the need for greater influence for nurses in shaping healthcare policies and decision-making.Nurses should be respected as vital partners in all aspects of society, including politics, to effect positive change.Initiatives such as ethics education, empowerment, and mutual support can enable nurses to make a meaningful impact.Younger nurses' values offer a promising direction for necessary changes in the profession, emphasizing adaptability and innovation.This brings us back to the original question: as an autonomous profession, we need to have a firm grasp on our long-term goals.We are not the doctor's right hand; we are an integral element of the team.To provide the greatest care for patients, it is essential to identify the problems that exist in modern nursing and communicate to them effectively.
There is never a lack of difficulties in the nursing field.If we want to alter our social standing, I believe it is vital to alter the human nurses' value system.We number in the tens of thousands (approximately 40,000 nurses in Croatia), yet we are underrepresented in politics, we should change the nurse image in public, education and we aren't consulted on matters of vital importance to the public's health. 1 When I first met a nurse with a doctorate, it was in 1996 at the University of Tyler in Texas.This is the first time I've ever seen the clinical skills cabinet with full equipment for practicing nursing skills.I wrote at this time, "I hope that one day we in Croatia will have highly educated nurses, Doctors of Science," for the Croatian nursing publication Sestrinski glasnik. 7t was exciting, but it also felt like looking into an unknown future that I could not yet comprehend.Twenty-five years on, nursing cabinets stocked with mannequins for clinical skills in nursing are a regular sight.Additionally, we already have a sizeable number of Ph.D. holders in nursing, so I was joining the ranks of my fellow colleagues who hold that level of education.Last example, though I have plenty to choose from.In 1996, I visited the United States and noticed that everyone there used a computer.It's my final minute; I have to start learning computer science, as I told my husband when I got home.I feel obligated to explain that many years before that, my husband had insisted that I begin learning computer science or risk becoming technologically illiterate.I'm getting close to retirement age, but because of all my years of experience with computers, I now have the expertise to claim that I use informatics possibilities in advanced areas.
Fortunately, the new vocational education reform recognizes the relevance of informal education as well, which includes specialized skills and information not gained in traditional classroom settings.It's always interesting to hear from young nurses how senior colleagues say they don't want to learn computer science because they know enough at the basic level.And that's always been a pinprick of irritation and provoke for me.However, life is not black or white; exceptions make the rules.It is possible to meet oldschool nurses with advanced levels of informatics knowledge.I'm getting close to retirement age, but because of all my years of experience with computers, I now have the expertise to claim that I use informatics possibilities in advanced areas, and the widespread implementation of healthcare informatics are all examples of how the healthcare system has evolved throughout the years and last few decades.
My biggest pet peeve is playing the "we work so hard; we give a lot of love and warmth to our patients" card when nurses communicate with the press or politics.This is not the proper course of action, in my view.I'll explain my viewpoint now.Florence Nightingale, the "founding mother of modern nursing," used business intelligence ideas 150 years before anybody else by presenting data on the positive effects of providing treatment to patients.That's the best option available. 10Where are we now, how far have we progressed, and where did we begin?Too little, in my opinion.Instead, we often use emotion as I previously explained.However, it is necessary to say clearly and loudly and emphasize the following: we are professionals who, for success and quality of work, need to have emotional intelligence, which includes compassion and empathy for everyone we work with and collaborate with, but most of all for the patients we care for.On the other hand, love belongs in a different category; it has no business being discussed in the workplace.I think it's important to argue your case or request, and that means doing things like conducting studies and analyses that will tell you things like: how many of us are needed in the system by category of specialist and professional vertically educated workers; how much our work is worth; what percentage of the state's gross income comes from our labor; and how to put a money amount on the value of your work.
When we know the answers to these and other questions, we can negotiate as equals, earn our place as experts in the field, and guide patients in making life-changing decisions.
Always, we should underline and never forget that the mission of each nurse is to be a rights advocate for each patient.Finding solutions to these problems and leveraging business intelligence data equips us to steer the evolution of our field.In this second half of the article, I return to the idea of human values from the first, stressing their importance in securing one's financial future.Discourse and instruction can strengthen those moral principles.Nurses in positions of management should be entrusted with financial autonomy and decision-making authority as part of efforts to improve patient care, but it's crucial to remember that this comes with a great deal of responsibility.
A true profession is one in which all decisions are made autonomously, and one has the duty and competence to deal with them based on the necessary information and skills acquired during one's working life through formal and informal education.However, I began my journey to become the sole proprietor of the first Croatian consulting firm dedicated to improving the quality and efficiency of the country's healthcare system.Meeting and speaking with other consultants from all around the world was a huge affirmation for me.A US-based colleague of mine who served as a nursing consultant for 35 years just retired.But I was overjoyed because, as she described her job duties, I realized that I had already figured out what I wanted to do and was headed in the right direction.In Baku, Azerbaijan, I worked as a consultant for a brand-new hospital, where I gained invaluable expertise in business process planning, introducing an information technology (IT) system in nursing, organizing nursing services, and much more.I have written a book detailing my personal experiences and observations of the city of Baku. 11e purpose of being a nursing consultant in Croatia is to provide specialized expertise and guidance in healthcare settings, contributing to the improvement of patient care, quality assurance, operational efficiency, and overall healthcare standards within the country.But today isn't going exactly as I had hoped.I have already referred to the Lion King's Simba. 6In my opinion, consulting in the nursing industry will become the standard in the next two decades.It's far too soon to begin now.When I made the decision, I was certain that Croatia required it (a belief I reinforce daily).Someone had to get the ball rolling, and I figured that person might as well be me.
The University Hospital Sestre Milosrdnice in Zagreb, where I worked as a consultant, is a large, well-established institution.Things are evolving gradually, and these alterations are consistent with contemporary notions of nursing practice.The entire KBCSM administration, under the direction of the director and assistant director, is deserving of praise for their willingness to consider suggestions, openness to feedback, and laser-like focus on implementing the novel in a way that will achieve the organization's stated goals.The ability to innovate and incorporate my own expertise into my work has provided me with immeasurable satisfaction.
In the nursing profession, I had the privilege of being the head of numerous organizations and nursing associations related to pulmonology, diabetes, and nursing management in Croatia and the EU.I fearlessly and unwaveringly embraced every new opportunity that presented itself to me.And more than enough to last a lifetime, retirement is on the horizon, but now is not the time to retire; I can still, I know, and I want to alter the future.My story has further probed the nurse's commitment to continuous learning and their readiness to embrace challenges, aligning with the theme of adaptation in the face of life's unpredictability.Lastly, the central theme of this report on the nursing profession was to share the innovative ideas and practices that have been brought during my nursing journey career.

Conclusion
In conclusion, this article highlights the significant contributions and experiences of a nurse consultant in Croatia.The nurse's commitment to transforming the nursing field through innovative ideas and methods, particularly in changing attitudes and approaches towards patient care, is a prominent theme.
The article emphasizes the importance of resilience, adaptation, and continuous learning in a nurse's professional journey.It also discusses the implementation of business processes in healthcare settings and the importance of effective nursing management.Overall, the nurse's dedication to making a positive impact in the healthcare field is evident throughout the article.
Throughout this exploration, a strong emphasis has been placed on the foundational aspects of resilience and personal growth.The paper has acknowledged the presence of failures in the nurse's journey, highlighting their transformative role in propelling the nurse to new heights.Failures, in this context, are seen not as stumbling blocks but as stepping stones.
In sum, this report has provided a holistic and inspiring portrayal of a nurse's professional journey, emphasizing the enduring themes of resilience, adaptation, and unwavering commitment to making a transformative impact in the healthcare field.Through personal narratives and reflective storytelling, it has celebrated the complexities and triumphs of a career that spans nearly four decades, offering valuable insights for both healthcare professionals and those seeking inspiration in their own journeys.

Conflicts of interest
No financial, legal, or political conflicts involving third parties (government, private companies and foundations, etc.) have been declared for any aspect of the submitted work (including but not limited to grants and funding, advisory board membership, study design, manuscript preparation, statistical analysis, etc.).