Public and private hospitals – different opportunities for nurses (Bulgaria, Pleven, 2016-2018)

Abstract

Abstract Background The freedom of private initiative is one of the basic principles of Bulgarian health reform. Since 2000 to 2018 the private hospitals increased over 6 times and hospital beds - over 40 times. The total number of nurses decreased by 3%. Nurses/physicians ratio dropped to 1.03:1. Private hospitals with better facilities and higher payment attract great proportion of nursing graduates. Public hospitals cannot compete and often fall in financial crisis and lack of human resources. We aimed to analyse the opportunities, motivating and demotivating factors for nurses in public and private hospital settings for lifelong learning (LLL). Methods The study included a sample of 573 nurses (448 in public and 125 in private hospitals). By anonymous self-administered questionnaire we collected and compared information about opportunities, motivation and obstacles for LLL in different hospital settings using parametric and non-parametric tests (t-test, chi-square) and correlation coefficients (Phi, Kramer, contingency coefficient). The accepted level of statistical significance was p < 0.05. Data processing was performed by IBM SPSS v.24. Results Great discrepancy was found in age distribution: in private hospitals 52,8% were below 40 years while in public hospitals 69,2% - over 40 years (p < 0.001). Significant differences were observed in motivation for LLL: in public hospitals 46.4% ranked “better payment” compared to 36.8% in private hospitals; “career development” took 31.2% in private hospitals and 24.1% in public hospitals (p < 0.05). Financial problems were the biggest obstacle in public hospitals (49,8%) and substantially lower (33.6%) in private hospitals (p < 0.01). Prevailing form of LLL in public hospitals was on-site training. Conclusions Our results underlined the significant differences in nursing profile, opportunities and motivation for LLL in public and private hospitals. Public hospitals do not provide equal prerequisites for nurses' professional development. Key messages Lifelong learning is irreversible prerequisite for provision of high quality and safety health care. Nurses in public and private hospitals should have equal opportunities to participate in LLL. Public hospitals need substantial investments to provide better opportunities and to attract younger nursing generations able to respond to increasing requirements for high quality health care.