Obzornik zdravstvene nege, 51(4), pp. 264–273.
https://doi.org/10.14528/snr.2017.51.4.202
Fast-paced development of society and increasing 
needs for healthcare services call for a discussion on 
knowledge in nursing which could help meet these new 
demands. This leading article further develops some 
topics previously touched on in the leading article 
Professionalism in nursing: what is its current level in 
Slovenia (Skela-Savič, 2016a), adding new evidence 
from the project Nursing as a scientific discipline in 
Slovenia (Skela-Savič, et al., 2017a).
Based on my previous research work, I would 
describe the process of nursing professionalization 
as an organized system of formal higher education 
for an occupation with a strongly defined work 
ethic, responsibilities and code of conduct where its 
practitioners are members of a professional association. 
The work in performed on the basis of clearly defined 
guidelines and standards for monitoring work quality, 
self-monitoring, and evidence-based practice. The latter 
calls for a system of scientific research which provides 
new knowledge, assesses the appropriateness of existing 
practices, successfully addresses professional issues and 
needs of the society, and poses challenges for a new 
paradigm—in our case, the paradigm of nursing as a 
socially responsible scientific discipline and profession.
Who is responsible for professionalization of nursing 
in Slovenia?
A profession develops as the end result of the process 
of professionalization which is not a one-time event, 
but rather a series of development activities dependent 
primarily on the competencies of the highest-level 
decision makers, on their ability to strategically plan 
the implementation of changes and to clearly articulate 
the need for improvements in clinical practice to 
meet the needs of the healthy and ill populations. 
So—who is responsible for that? The answer lies in 
representative studies conducted in Slovenia (Skela-
Savič, 2017; Skela-Savič, et al., 2016a, 2017a, 2017b). 
Nursing managers in healthcare institutions and long-
term care facilities, managers in higher education 
institutions offering nursing programs, and managers 
of the national nursing association are the ones who 
should assume responsibility for the development of 
nursing at present and in the future.
The conditions for making the shift from an 
occupation to a profession include formally acquired 
knowledge, competencies, abilities, and values for 
development work in nursing as these can generate 
the understanding of development competencies 
and the implementation of evidence-based practice 
(Skela-Savič, et al., 2017b). In their employees, 
nursing managers must encourage the development 
of knowledge in research and evidence-based nursing 
care (Skela-Savič, et al., 2016a). By doing so, they will 
overcome the mentality identified in qualitative group 
interviews of experts in nursing which included, for 
example, understanding research and development as 
nurses' leisure activities, low self-awareness, a lack of 
interest for obtaining knowledge needed to establish 
research and development, and a lack of respect for 
research knowledge (Skela-Savič, 2017).
Current healthcare managers (including nurse leaders) 
must have obtained postgraduate-level managing and 
leadership skills as well as knowledge and competencies 
in the following areas: communication and relationship 
building, knowledge of the healthcare environment, 
modern approaches to leadership, establishment of 
Leading article/Uvodnik
Professionalization of nursing in Slovenia: challenges and responsibilities for nurses 
with a higher education degree
Profesionalizacija zdravstvene nege v Sloveniji: izzivi in odgovornosti za visokošolsko 
izobražene medicinske sestre in zdravstvenike 
Brigita Skela-Savič
Associate Professor Brigita Skela-Savič, PhD, MSc, BSc, RN, Research Counsellor; Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 
4270 Jesenice, Slovenia
Correspondence e-mail/Kontaktni e-naslov: bskelasavic@fzab.si
The leading article is based on a submission by Brigita Skela-Savič entitled Slovenian nursing care and professionalization—challenges for 
the future, published in the journal commemorating the 90th anniversary of professional nursing association in Slovenia issued in 2017 in 
Ljubljana./Uvodnik je nastal na osnovi prispevka Brigite Skele-Savič Slovenska zdravstvena nega in profesionalizacija – izzivi za prihodnost, 
objavljenega v zborniku 90. let organiziranega delovanja v zdravstveni negi v Sloveniji, izšlega v Ljubljani leta 2017. 
Received/Prejeto: 1. 11. 2017
Accepted/Sprejeto: 6. 11. 2017
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273. 265
professionalism at all levels, efficient system management, 
development of employees' knowledge and abilities 
needed to appropriately meet the needs in their 
environment, demographic trends, public health issues, 
establishment of values that support evidence-based 
practice, responsibility, quality and safety, intersectoral 
collaboration, implementation of the policy of constant 
quality monitoring and improvement, implementation 
of quality principles, and introduction of information 
technology solutions in healthcare, also in terms 
of improving work processes and ensuring active 
involvement of service users (American College of 
Healthcare Executives, 2014; Skela-Savič, 2016b). 
According to the American College of Healthcare 
Executives (2014), a specialization in nursing 
management is required for top nursing positions, 
yet no such requirement exists in Slovenia. With this 
in mind, it is easier to understand research findings 
that reveal successful professionalization of nursing 
in Slovenia. Skela-Savič and colleagues (2016a) have 
found that managers need a clear vision of development 
in research and evidence-based practice which is an 
integral part of the hospital's operations. To achieve 
that, they must develop nurse leaders whose job is to 
foster a culture of research and evidence-based practice 
in the clinical settings.
Also, we must reconsider the currently established 
practice in Slovenia that, when nurses with a higher 
education get promoted to head nurses, they stop being 
involved in direct patient care. Does that truly benefit 
the development of the profession? A comparison 
with physicians reveals that, when they get promoted 
to directors, medical directors or heads of major 
departments, they always retain some of their work in 
the clinical setting. Therefore, they do not face difficulties 
when it comes to understanding the clinical setting, 
being a part of it and returning to the clinical setting 
after the leadership position term ends. The practice 
common among nursing managers—that after assuming 
a leadership position they cut their ties with the clinical 
setting—is actually debilitating for the profession, 
possibly deterring the formation of a competitive arena 
for leadership and development positions, discouraging 
education at the second and third cycles, and neglecting 
those with a postgraduate degree who are not given an 
opportunity to transfer their knowledge into practice. 
This policy can be destructive and is detrimental for 
nursing as a profession. Actually, nursing managers 
should stay involved in clinical work, applying the tools 
of matrix organizational structure and transformational 
leadership in nursing and increasing the competencies 
of lower-level managers.
Knowledge and competencies in nursing
Extant research (Skela-Savič, et al., 2016b; 2016c; 
2017a) clearly shows that nursing professionals in 
Slovenia have difficulties when it comes to the basic 
understanding and implementation of the first phase 
of professionalization, namely ''the formation of 
profession'', as termed by Watkins (2011), because they 
do not understand nursing competencies according 
to educational levels. Although competencies from 
secondary school nursing programs are not repeated 
in higher education nursing programs, the reality of 
clinical practice reveals a different picture. In fact, 
competencies for specialist work and for advanced 
practice in clinical settings, as outlined by the European 
Federation of Nurses Associations (EFN Workforce 
Committee, 2014), do not yet exist in Slovenia. 
Moreover, research (Skela-Savič, et al., 2016b; 2016c; 
2017a) conducted as part of a two-year project has 
indicated a host of issues, such as education-related 
differences and mistrust among secondary schools 
and higher education institutions, or the still prevalent 
belief that a secondary school degree in health care is 
required for enrollment into higher education nursing 
programs, despite the fact that a European Directive 
(Directive 2013/55/EU of the European Parliament 
and of the Council, 2013) unambiguously defines the 
requirement for enrollment as having completed 12 
years of general education. Such attitudes are hindering 
the development of university programs which earn 
graduates the professional title registered nurse (RN). 
After all, all European Union (EU) member countries 
and most former Yugoslavian countries committed 
to developing these programs. A four-year education 
at the university level would better equip graduates 
with the knowledge necessary for understanding and 
implementing nursing professionalization.
Finally, the system of continuous professional 
education—a condition for obtaining a nursing 
license—is in need of reform. It has been shown that 
Slovenian nurses holding a higher education degree 
receive very little education in applied research, 
development work and evidence-based practice 
(Skela-Savič, et al., 2016a). The obligatory programs 
for a nursing license have to be expanded to include 
the understanding of ethics not only in terms of 
responsibility towards the patients and long-term care 
residents, but also in terms of responsibility for the 
development of the profession—that is what nursing 
care should be like, but it is sadly not. Obligatory 
educational programs should also include evidence-
based practice.
Patient needs and human resource requirements 
It has to be carefully considered which knowledge 
and skills nurses need to meet current patient needs 
and how human resource requirements should be set to 
ensure enough patient time and an acceptable quality 
and safety of patient work. For the past decade, higher 
education system has produced masters in nursing, but 
advanced practice positions in healthcare institutions
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273.266
have yet to be systematized although the needs for 
these positions already exist. Good examples are family 
medicine reference clinics (FMRCs). Nurses with a 
higher education degree employed at these clinics are 
included in postgraduate education modules planned 
by family physicians. However, these modules are not 
accredited and therefore do not earn them a higher 
level of education. According to the ICN guidelines, 
nurses working in advanced practice should have a 
master's degree. When we come across the fruits of 
labor by RNs employed at FMRCs published by family 
physicians in international and Slovenian journals, 
these nurses are rarely credited as co-authors and 
their position is stated as advance nurse practitioner. 
That is the case in articles, but a master's degree is not 
a requirement for their position in practice. What is 
more, few community health centers support RNs 
working in FMRCs in their efforts to obtain a master's 
degree in nursing of health promotion. 
Evidence-based results must be presented to 
underline the need for more nursing professionals 
with a higher education degree. As part of nursing 
development nursing, nurses should go on strike as a 
unified occupational group and demand that human 
resource requirements be increased, that European 
directives be followed in practice, and that the level 
of education in nursing be raised, as these measures 
would lead to a decrease in complications which come 
with a price. There is more than enough evidence to 
support these demands. The most recent study by 
Aiken and colleagues (2017) revealed that, if a nursing 
team consists of four nurses with a higher education 
degree and two nurses with a lower education and cares 
for 25 surgical patients, substituting one nurse with a 
higher education for a nurse with a lower education 
increased the patients' odds of dying by 21 %. The 
study was conducted in Belgium, England, Spain, 
Switzerland and Finland. And how many nurses with 
a higher education degree care for 25 surgical patients 
in Slovenia? After considering this question, we can 
no longer claim that Slovenian nurses will never go 
on strike, but we should rather say that they must 
strike—by doing so, we take the right ethical stance 
for the provision of high-quality, safe nursing care. A 
strike would let patients know that they could receive 
better care if our conditions were similar to those in 
other countries and if work standards for nurses were 
comparable to those of physicians.
Slovenia is at the bottom of EU member countries 
in the percentage of nurses with a higher education 
degree (OECD, 2013). It is not enough that only a few 
members of the higher education arena are drawing 
attention to the fact that although Slovenia's educational 
system is in line with the European directive for 
regulated professions, this is not reflected in human 
resource requirements only in the field of nursing, 
unlike in medicine, dentistry, midwifery, pharmacy, 
veterinary medicine, and architecture. After 90 years 
of existence, RNs are still not the predominant nursing 
care providers in Slovenian clinical settings. Most 
nursing care is still conducted by assistant nurses who 
lack the necessary level of education and professional 
competencies for the scope and level of difficulty of 
the work they conduct. In reality, nursing managers 
drive assistant nurses into exceeding their professional 
competencies on a daily basis (Skela-Savič, et al., 2016c) 
by failing to employ enough RNs. Who is responsible 
for this situation? The answer is provided in a research 
report by Skela-Savič and colleagues (2017a)—the fact 
that assistant nurses are exceeding their competencies 
due to a lack of nurses with a higher education degree 
was created within the nursing profession itself. An 
interesting research question therefore emerges: what 
would the study by Aiken and colleagues (2017) reveal 
if it was conducted in Slovenia?
The study conducted by Albreht (2005) projects the need 
for more higher education nursing programs by taking 
into account only the demographic data for nurses with 
a higher education degree without considering patient 
needs. When Slovenia acceded to the EU and the Directive 
for regulated professions was implemented, nursing 
managers, higher education managers and the Nurses 
and Midwives Association of Slovenia (NMAS) failed to 
explain, based on international research evidence, that 
the number of higher education nursing programs must 
be increased and the number of secondary school nursing 
programs decreased as even then many assistant nurses 
faced unemployment. Moreover, a divergence began to be 
seen between nurses with a secondary school degree and 
a higher education degree when Slovenia entered the EU, 
and that divergence continues to be felt and is hindering 
the development of nursing as a profession. We continue 
to focus on the fifth and seventh levels according to the 
Slovenian Qualifications Framework, while patient needs 
call for specialist nurses, masters in nursing, and doctors 
of nursing practice. Today, Slovenia no longer faces a 
lack of nurses with a higher education degree; the issue 
today is that there are not enough systematized positions 
for these nurses. Systematization of four categories of 
practitioners (EFN Workforce Committee, 2014) with 
clearly defined competencies is sorely needed. 
Professional title after completed formal education 
Another issue related to professionalization of 
nursing in Slovenia concerns the professional title 
of this occupational group. The project Nursing 
as a scientific discipline (Skela-Savič, et al., 2016c) 
revealed that the term caregiver has low social status, 
being perceived as less worthy and as such being 
inappropriate for a nursing care practitioner. In 
addition, the representatives of secondary healthcare 
schools did not embrace some new areas of nursing 
work, such as long-term care. Since 2007, there has 
been an ongoing debate about the professional title for 
nurses with a higher education degree which would 
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273. 267
clearly illustrate the nature of work they conduct. In 
the last decade, the Slovenian Board for Nursing (SBN) 
has adopted a different title for this occupational group 
twice, most recently in 2014 when the adopted title was 
'health care practitioner'. This represents only a minor 
change since this title ('zdravstvenik') has been in use 
for male nurses since 2004. The Ministry of Health has 
not yet implemented this proposal by placing it on the 
list of healthcare professions. 
Discussions on the need to rename the professional 
title have sparked and continue to spark objections. 
A frequently heard reasoning is that the existing 
title, 'medical nurse' ('medicinska sestra'), is accepted 
in Slovenia and there is no need to change it. These 
arguments show a lack of understanding for the concept 
of professionalization. After all, even Angela Boškin—
the first Slovenian nurse with a higher education 
degree—had the title 'care nurse' and not 'medical nurse'. 
As the occupation of nursing undergoes the process of 
professionalization, we should think about whether the 
professional title of Slovenian nurses is appropriate for 
usage of today and tomorrow. Decades ago, medical 
schools in Slovenia were renamed into healthcare 
schools, while the professional title of female nurses still 
holds the word 'medical'. No matter how we try to find 
evidence in an effort to understand why the professional 
title cannot be changed, one conclusion can be drawn: 
caring as the essence of the nursing profession has not 
been researched enough to withstand expert judgment, 
in nursing and outside of it, that it is also science. And 
that is the key problem with nursing as a scientific 
discipline, if compared to medicine. Both nursing theory 
and practice have to be developed and compared. We 
have to stop with the division of theoretical discourse in 
schools and practical knowledge in the clinical setting.
According to Carvalho (2014), healthcare professions 
differ from each other primarily in knowledge obtained 
through research work. Some nurses perceive this 
new knowledge as a deviation from nursing care and 
rather opt to support the local context of knowledge 
in practice. Horton and colleagues (2007) claim that, 
from a historical perspective, nursing entails the basic 
tasks of caring for and helping the ill and their families. 
At the moment, the profession is caught between the 
provision of care which was historically practiced 
by less educated 'caregivers' or those who acquired 
the knowledge, and nursing as a science which 
is—or should be—practiced by nurses with a higher 
education degree. Why is the proposed professional 
title 'graduated nursing practitioner' unacceptable if 
the occupation is termed nursing care?
Challenges for the future
Several years of research work went into defining, 
at the strategic level, the national responsibility for the 
development of nursing as a scientific discipline and 
the indicators of whether national responsibility is 
being fulfilled (Skela-Savič, 2017), and the results are 
published in this issue of the Slovenian Nursing Review. 
Fulfilling the national responsibility for achieving 
progress in professionalization of nursing is of utmost 
importance and must become the priority in the 
national strategy of nursing development in Slovenia. 
The defined national responsibility can be fulfilled by 
responsible managers who possess the knowledge and 
skills needed to recognize resources and opportunities 
for meeting the indicators for fulfilling the national 
responsibility. The goal is professionalization of nursing 
for high-quality, safe and efficient health care provision. 
The tools for reaching this goal include systematic 
research, expert judgment, development of critical 
thinking, and evidence-based decision making.
The efforts to make research work in nursing 
established can only be realized through a national 
institute for research work in nursing which must be 
founded by the NMAS. It is not reasonable to wait 
that nursing receives support from other institutions 
on this issue, especially regarding the current state of 
healthcare policy in Slovenia. The institute should be 
funded from membership fees of NMAS members and 
from calls for application. Such a national research 
institute will have an 'evidence-based' influence on 
politics; once it becomes scientifically established, 
it can obtain public funding for its operations. 
The institute should follow the maxim expressed 
in the previously mentioned study: ''The center of 
development and research work must be the patient'' 
(Skela-Savič, 2017).
Our professional association is celebrating 90 years 
of its existence. The national professional association 
(NMAS) is facing a special challenge: it has to formulate 
an ambitious and modern vision of development and 
set down its goals and the strategy for achieving them. 
A clear vision of development which supports social 
responsibility and responds to the needs of society 
calls for a systematic division of funding, a reflection 
on the current structure, and allocation of funding 
for research and development. It is crucial to demand 
a transparency of operations both at the level of the 
Association and at the level of regional societies. 
Professional associations must become the engine 
of professionalization, advocating evidence-based 
practice and research work. At the level of the national 
association, a clear distinction between the profession 
and politics must exist because only nonpartisanism 
will enable it to function in an evidence-based manner 
regardless of the political party in power. This is not to 
say that political activation of nursing professionals is 
undesired—on the contrary—, but it should take the 
form of candidacy in national and regional elections.
Final thoughts 
As an expert and researcher in nursing and health care, 
I wish to convey the following message: the development 
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273.268
of nursing as a profession and a scientific discipline 
is becoming increasingly dependent on how it is 
perceived within the occupational group. There are two 
distinct dimensions of perceiving nursing which have 
to coincide—the scientific dimension of nursing care 
provision and the dimension of reflection on nursing 
practice. The first provides nurses with a higher education 
degree with new knowledge to be tested in practice, while 
the second must serve as an imperative to researchers for 
scientific investigation and be categorized either in the 
field of nursing knowledge or, conversely, in the field of 
non-evidence-based practice. To achieve the latter, every 
RN must possess the necessary knowledge to understand 
the importance of research resulting in scientific findings. 
RNs should support development work in nursing and 
contribute to the exchange of evidence and findings 
from practice. That is how nursing will be able to retain 
the values which have historically shaped its relation to 
the healthy and the ill, and add the values of scientific 
knowledge on nursing care, professional development 
and evidence-based practice. Such a compromise is 
beneficial, enabling theory and practice to merge into 
one. A combination of these two dimensions will solidify 
the position of nursing as a profession and a scientific 
discipline providing care based on scientific evidence. 
If nurses with a higher education degree will fail to 
undertake this task, nursing will become a peripheral 
supporting service of the healthcare system and get lost in 
a myriad of those who, in the increasing needs for health 
and health care provision, will seize the opportunity and 
become advocates for the needs of the healthy and ill 
populations. Therefore, we cannot afford to waste time 
on unproductive squabbles and reproaches on excessive 
ambitiousness of individuals proposing changes. Instead, 
we should come together and scientifically substantiate 
our work—nursing care provision—as was done 
previously by our forerunners, Florence Nightingale and 
Angela Boškin, according to the level and understanding 
of the occupation at the time.
Slovenian translation/Prevod v slovenščino
Dinamičen družbeni razvoj in večanje zahtev po 
zdravstvenih storitvah zahtevata razpravo o znanju v 
zdravstveni negi, kakršno bi bilo tem novim zahtevam 
kos. Pričujoči uvodnik nadaljuje teme, začete že v 
uvodniku Professionalism in nursing: what is its current 
level in Slovenia (Skela-Savič, 2016a), in dodaja nova 
spoznanja iz projekta Zdravstvena nega kot znanstvena 
disciplina v Sloveniji (Skela-Savič, et al., 2017a). 
Na osnovi dosedanjega lastnega raziskovalnega 
dela bi pot profesionalizacije stroke zdravstvene nege 
opisala kot urejen sistem formalnega visokošolskega 
izobraževanja za poklic, ki ima opredeljeno poklicno 
etiko in odgovornost ter kodeks delovanja, izvajalce 
določene stroke pa povezuje profesionalno združenje. 
Podlage za poklicno delo so izdelane smernice in 
standardi za spremljanje kakovosti dela, vzpostavljen 
nadzor lastnega dela in z dokazi podprto strokovno 
delo. Delo, podprto z dokazi, zahteva tak sistem 
znanstvenega raziskovanja, ki prinaša nova znanja, 
potrjuje ustreznost ali neustreznost obstoječega 
delovanja v stroki, odgovarja na probleme v stroki 
in na družbene potrebe ter postavlja izzive za novo 
razvojno paradigmo, v našem primeru za paradigmo 
zdravstvene nege kot družbeno odgovorne znanstvene 
discipline in profesije.
Odgovorni za profesionalizacijo zdravstvene nege 
v Sloveniji
Profesija se razvije v procesu profesionalizacije, ki ni 
enkratno dejanje, temveč je niz razvojnih aktivnosti, ki 
so odvisne predvsem od usposobljenosti odgovornih 
na najvišjih pozicijah odločanja, od njihove sposobnosti 
strateškega načrtovanja sprememb in argumentiranega 
izražanja zahtev za izboljšave pri delu, s katerimi lahko 
odgovorimo na potrebe zdravih in bolnih. Kdo so torej 
odgovorni? Odgovor temelji na v Sloveniji izvedenih 
reprezentativnih raziskavah (Skela-Savič, 2017; Skela-
Savič, et al., 2016a, 2017a, 2017b). Menedžment 
zdravstvene nege zdravstvenih in socialnih zavodov, 
menedžment visokošolskih zavodov s študijskimi 
programi zdravstvene nege in menedžment 
nacionalnega združenja v zdravstveni negi so tisti, ki 
morajo prevzeti odgovornost za razvoj zdravstvene 
nege danes in v prihodnosti. 
Za premik, da se stroka razvije v profesijo, so potrebni 
formalno pridobljeno znanje, kompetence, sposobnosti 
in vrednote za razvojno delo v zdravstveni negi, ki 
lahko generirajo razumevanje razvojnih kompetenc in 
uresničevanje z dokazi podprtega dela (Skela-Savič, et 
al., 2017b). Menedžment zdravstvene nege mora pri 
zaposlenih podpreti razvoj znanj iz raziskovanja in 
znanj z dokazi podprte zdravstvene nege (Skela-Savič, 
et al., 2016a). S tem bo presežena miselnost, ki smo 
jo prepoznali v kvalitativnih skupinskih intervjujih 
strokovnjakov zdravstvene nege, npr. opredeljevanje 
raziskovanja in razvoja kot prostočasnih aktivnosti 
medicinskih sester, nizko lastno zavedanje in 
nizek interes za pridobivanje znanj za vzpostavitev 
raziskovanja in razvoja, nizko spoštovanje znanja o 
raziskovanju (Skela-Savič, 2017). 
Menedžerji v zdravstvu (mednje sodijo tudi 
vodilni v zdravstveni negi) morajo dandanes imeti na 
podiplomskih izobraževanjih pridobljene sposobnosti 
za upravljanje in vodenje ter znanja in kompetence 
za naslednja področja: komunikacija in gradnja 
odnosov, znanje o zdravstvu in okolju, sodobni 
pristopi v vodenju, izgradnja profesionalizma na vseh 
ravneh, učinkovito upravljanje sistema, razvoj znanj 
in sposobnosti pri zaposlenih za ustrezen odziv na 
potrebe okolja, demografski trendi, javnozdravstveni 
problemi, izgradnja vrednot, ki podpirajo z dokazi 
podprto delo, odgovornost, kakovost in varnost, 
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273. 269
medsektorsko povezovanje, udejanjanje politike 
nenehnega spremljanja in izboljševanja kakovosti ter 
udejanjanje načel kakovosti, uvajanje informacijske 
tehnologije v zdravstvu tudi z vidika izboljševanja 
procesov dela in aktivne vključenosti uporabnikov 
storitev (American College of Healthcare Executives, 
2014; Skela-Savič, 2016b). Ameriško združenje 
izvršnih direktorjev v zdravstveni negi (American 
College of Healthcare Executives, 2014) pravi, da 
mora biti specializacija iz menedžmenta zdravstvene 
nege obvezna za prevzem vodilnih delovnih nalog, 
vendar v Sloveniji teh pogojev nimamo. Zato je lažje 
razumeti tudi nekatera spoznanja raziskav, ki kažejo 
na uspešnost profesionalizacije zdravstvene nege v 
Sloveniji. Skela-Savič in sodelavci (2016a) ugotavljajo, 
da mora menedžment prispevati jasno razvojno vizijo 
raziskovanja in z dokazi podprto delo v zdravstveni 
negi, ki je umeščena v delovanje celotne bolnišnice. V 
ta namen morajo razvijati vodilne medicinske sestre/
zdravstvenike, katerih naloga je oblikovanje kulture 
raziskovanja in z dokazi podprtega dela v kliničnih 
okoljih.
Zamisliti se je treba tudi nad uveljavljeno prakso v 
Sloveniji, da ko visokošolsko izobražena medicinska 
sestra/zdravstvenik postane glavna medicinska sestra/
zdravstvenik, izgubi stik z neposrednim delom pri 
pacientu. Ali je to v korist razvoja profesije? Naj to 
primerjamo z zdravniki, le-ti, ko postanejo generalni 
ali strokovni direktorji ali predstojniki večjih klinik, 
vedno ohranijo del svojega strokovnega dela v 
kliničnem okolju. Zato nikoli nimajo problemov, 
da kliničnega okolja ne bi razumeli, da ne bi bili del 
njega in da se po končanem mandatu ne bi vrnili 
v klinično okolje, iz katerega so prišli na vodilno 
delovno mesto. Praksa menedžmenta zdravstvene 
nege, da po prevzemu vodilne funkcije posameznik ne 
deluje več v kliničnem okolju, slabi profesionalizacijo, 
saj lahko pride do zavor pri ustvarjanju konkurenčne 
arene za vodilna in razvojna delovna mesta, zaviranja 
izobraževanj na drugi in tretji bolonjski stopnji in 
spregleda tistih, ki končajo študij na drugi ali tretji 
bolonjski stopnji in ne dobijo priložnosti za prenos 
znanj v prakso. Taka politika je lahko destruktivna 
in zdravstveni negi škodi. Menedžment zdravstvene 
nege naj ostane vključen v strokovno delo, pri tem naj 
uporabi orodja matrične organizacijske strukture in 
transformacijskega vodenja zdravstvene nege, poveča 
naj pooblaščanje vodilnih na nižjih nivojih vodenja. 
Znanje in kompetence v zdravstveni negi
Raziskave (Skela-Savič, et al., 2016b, 2016c, 2017a) 
zelo jasno pokažejo, da imamo v slovenski zdravstveni 
negi probleme v temeljih razumevanja in uresničevanja 
prve faze profesionalizacije, torej pri »oblikovanju 
profesije«, kot je fazo poimenovala Watkins (2011), 
saj imamo težave pri razumevanju kompetenc v 
zdravstveni negi glede na ravni izobraževanja za 
poklic. Res je, da se kompetence srednješolske 
ravni izobraževanja ne podvajajo na visokošolskem 
izobraževanju iz zdravstvene nege, realnost v praksi pa 
je popolnoma drugačna. Kompetenc za specialistično 
delo in za napredne oblike dela v kliničnih okoljih po 
zgledu evropskega združenja v zdravstveni negi (EFN 
Workforce Committee, 2014) v Sloveniji namreč še ni. 
Tudi raziskave (Skela-Savič, et al., 2016b, 2016c, 
2017a) v okviru dvoletnega projekta opozarjajo na 
številne probleme, od tega, da med srednjimi šolami 
in visokošolskimi zavodi prihaja do razhajanj in 
nezaupanja glede izobraževanja, do tega, da je še 
vedno prisotna miselnost, da je za vstop v visokošolsko 
izobraževanje potrebna srednješolska izobrazba 
zdravstvene smeri, kljub temu da evropska direktiva 
(Directive 2013/55/EU of the European Parliament 
and of the Council, 2013) jasno opisuje pogoje za 
vstop v izobraževanje, to je zaključeno dvanajstletno 
splošno izobraževanje. Takšna stališča onemogočajo 
razvoj univerzitetnih (UN) študijskih programov 
za pridobitev strokovnega naslova diplomirana 
medicinska sestra/zdravstvenik (UN), h katerim so 
pristopile vse evropske države in tudi večina držav 
bivše Jugoslavije. Univerzitetno izobraževanje, ki bi 
trajalo štiri leta, bi diplomante bolje opremilo z znanji 
za razumevanje in uresničevanje profesionalizacije 
zdravstvene nege.
Potrebna je tudi prenova kontinuiranega profesionalnega 
izobraževanja, ki je pogoj za pridobitev licence. Vemo, 
da se visokošolsko izobražene medicinske sestre/
zdravstveniki zelo malo izobražujejo iz aplikativnega 
raziskovanja, razvojnega dela in z dokazi podprtega 
dela (Skela-Savič, et al., 2016a). V obveznem 
izobraževanju za licence je potrebna nadgradnja 
vsebin, kot je razumevanje etike ne samo v dimenziji 
odgovornosti do pacienta in varovanca, temveč tudi 
v dimenziji odgovornosti za razvoj stroke – takšna bi 
zdravstvena nega namreč morala biti, pa žal ni. Del 
vsebin obveznega izobraževanja mora postati tudi z 
dokazi podprta zdravstvena nega. 
Potrebe pacientov in kadrovski normativi 
Razmisliti je treba, kakšno bi moralo biti naše znanje 
glede na potrebe, ki jih imajo pacienti danes, in kakšni 
bi morali biti kadrovski normativi, da bi bilo delo s 
pacientom humano in na sprejemljivi ravni kakovosti 
in varnosti. Visokošolski sistem že 10 let izobražuje 
magistrice in magistre zdravstvene nege, pa delovna 
mesta za napredne oblike dela v zdravstvenih zavodih 
še danes niso sistematizirana, potrebe po njih pa so. Lep 
primer so referenčne ambulante družinske medicine 
(RADM). Visokošolsko izobražene medicinske sestre/
zdravstveniki, ki delajo v RADM, imajo podiplomsko 
izobraževanje, ki so ga pripravili zdravniki družinske 
medicine. Toda to podiplomsko izobraževanje ni 
akreditirano in jim ne prinese dviga stopnje izobrazbe. 
Usmeritev Mednarodnega sveta medicinskih sester 
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273.270
(International Council of Nurses – ICN) pa je, da je 
za napredne oblike dela potreben strokovni magisterij. 
Ko danes prebiramo rezultate dela diplomiranih 
medicinskih sester/zdravstvenikov v RADM, ki jih v 
člankih objavljajo specialisti družinske medicine, in 
to v mednarodnih in domačih revijah, je soavtorstvo 
diplomiranih medicinskih sester/zdravstvenikov 
prisotno le izjemoma, njihovo delo pa je opisano kot 
advance nurse practitioner. Tako v člankih, realno 
pa za zasedbo delovnega mesta strokovni magisterij 
ni pogoj. Še več, redki so zdravstveni domovi, ki 
diplomirane medicinske sestre/zdravstvenike v RADM 
podprejo pri magistrskem študiju zdravstvene nege ali 
promocije zdravja.
Z dokazi podprto je treba povedati, da potrebujemo 
več visokošolsko izobraženega kadra. V okviru 
procesa razvoja profesije bi danes medicinske sestre/
zdravstveniki morali stavkati kot enovito poklicno telo 
in to za dvig kadrovskih normativov, za upoštevanje 
evropskih direktiv v praksi in dvig stopnje izobrazbe v 
zdravstveni negi, saj navedeno pomeni manj zapletov 
v zdravstveni obravnavi, vsak zaplet pa ima svojo 
ceno. Za takšno držo imamo dovolj dokazov. Zadnja 
raziskava Aiken in sodelavcev (2017) kaže, da če v timu 
zdravstvene nege, ki skrbi za 25 kirurških pacientov in 
ga sestavljajo štiri visokošolsko izobražene medicinske 
sestre/zdravstveniki in dva manj izobražena izvajalca 
zdravstvene nege, nadomestimo eno visokošolsko 
medicinsko sestro/zdravstvenika z manj izobraženim 
izvajalcem zdravstvene nege, verjetnost za smrtnost 
pacientov povečamo kar za 21 %. Raziskava je 
potekala v Belgiji, Angliji, Španiji, Švici in na Finskem. 
Koliko visokošolsko izobraženih medicinskih sester/
zdravstvenikov na 25 kirurških pacientov pa imamo 
mi? Po takšnem premisleku ne bomo več izjavljali, 
da medicinske sestre/zdravstveniki ne bodo nikoli 
stavkali, ampak bomo rekli, da medicinske sestre/
zdravstveniki morajo stavkati, ker s tem zavzamemo 
pravilno etično držo za izvajanje kakovostne in varne 
zdravstvene nege. Stavka bi paciente opozorila, da 
bi zanje lahko bolje skrbeli, če bi imeli vzpostavljene 
mednarodno primerljive pogoje in take standarde 
dela, kot jih zahtevajo tudi zdravniki. 
Slovenija je na repu držav Evropske unije (EU) po 
deležu visokošolsko izobraženih medicinskih sester/
zdravstvenikov (OECD, 2013). Zato ni dovolj, da le 
redki predstavniki visokošolskega prostora opozarjajo 
na dejstvo, da država Slovenija sicer izobražuje 
po evropski direktivi za regulirane poklice, da pa 
izključno za področje zdravstvene nege zapisanega 
ne prevede v kadrovske normative, medtem ko to 
upošteva pri zdravnikih, zobozdravnikih, babicah, 
farmacevtih, veterinarjih in arhitektih. Dejstvo po 90 
letih delovanja je, da diplomirane medicinske sestre/
zdravstveniki niso večinski izvajalci zdravstvene 
nege v kliničnih okoljih. Največji del zdravstvene 
nege izvajajo srednješolsko izobraženi tehniki/-ice 
zdravstvene nege, ki pa za izveden obseg in zahtevnost 
dela nimajo ustrezne stopnje izobrazbe in poklicnih 
kompetenc. Situacija je namreč taka, da menedžment 
zdravstvene nege tehnike/-ice zdravstvene nege sili 
v dnevno preseganje poklicnih kompetenc (Skela-
Savič, et al., 2016c), saj ne zaposli dovolj diplomiranih 
medicinskih sester/zdravstvenikov. Odgovornost za 
takšno situacijo lahko razberemo iz raziskovalnega 
poročila Skele-Savič in sodelavcev (2017a), saj smo si 
stanje preseganja kompetenc tehnikov/-ic zdravstvene 
nege zaradi pomanjkanja visokošolsko izobraženih 
medicinskih sester/zdravstvenikov, ustvarili znotraj 
stroke sami. Postavi se raziskovalno vprašanje, kaj bi 
pokazala raziskava Aiken in sodelavcev (2017), če bi 
jo izvedli v Sloveniji? 
Albreht (2005) jasno napoveduje potrebo po 
povečanju izobraževanja na visokošolski ravni, 
kjer upošteva le demografske podatke o populaciji 
visokošolsko izobraženih medicinskih sester in ne 
potreb pacientov. Menedžment zdravstvene nege 
in visokošolski menedžment ter Zbornica – Zveza v 
trenutkih vstopa v EU in pri implementaciji evropske 
direktive za regulirane poklice niso bili dovolj uspešni, 
da bi na osnovi spoznanj tujih raziskav pojasnili, da 
je ob vstopu v EU treba povečati obseg izobraževanja 
na visokošolski ravni in zmanjšati obseg izobraževanja 
na srednješolski ravni, saj je že takrat bila očitna 
brezposelnost tehnikov/-ic zdravstvene nege. Še več, 
po vstopu v EU je prišlo do razhajanj med skupinama 
srednješolsko in visokošolsko izobraženih medicinskih 
sester/zdravstvenikov, ki jih čutimo še danes. Le-ta 
ovirajo razvoj zdravstvene nege kot profesije in še 
danes se ukvarjamo izključno s peto in sedmo ravnjo 
izobraževanja glede na slovensko ogrodje kvalifikacij, 
potrebe pacientov pa so takšne, da v kliničnem 
delu potrebujemo specialiste/-ke, magistre/-ice in 
doktorje/-ice zdravstvene nege. Danes v Sloveniji 
ni problem pomanjkanja visokošolsko izobraženih 
medicinskih sester/zdravstvenikov, temveč premajhno 
število sistematiziranih delovnih mest za visokošolsko 
izobražene medicinske sestre/zdravstvenike. Potrebna 
je sistematizacija štirih kategorij izvajalcev (EFN 
Workforce Committee, 2014), ki imajo jasno 
opredeljene kompetence. 
Strokovni naslov po zaključenem formalnem 
izobraževanju
Težave pri profesionalizaciji zdravstvene nege v 
Sloveniji se kažejo tudi v strokovnem naslovu za poklic. 
Projekt Zdravstvena nega kot znanstvena disciplina 
(Skela-Savič, et al., 2016c) pokaže, da izobrazbeni 
naslov negovalec/negovalka nima statusa in se ga 
šteje kot manj vredno in neprimerno poimenovanje 
za izvajalce zdravstvene nege. Tudi prepoznavanje 
novih področij delovanja, kot je dolgotrajna oskrba, ni 
sprejeto s strani predstavnikov srednješolskega sektorja. 
O visokošolskem strokovnem naslovu, ki bi jasno 
poimenoval vsebino dela pri opravljanju tega poklica, 
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273. 271
razprave potekajo že od leta 2007. V zadnjih desetih 
letih je Razširjeni strokovni kolegij za zdravstveno nego 
(RSKZN) že dvakrat potrdil spremembo strokovnega 
naslova, nazadnje leta 2014, ko je bil sprejet strokovni 
naslov diplomirana zdravstvenica/zdravstvenik, ki je 
blaga oblika preimenovanja, saj je le-ta za moški spol v 
uporabi že od leta 2004 naprej. Do realizacije predloga 
na strani Ministrstva za zdravje, ki mora predlog 
RSKZN umestiti v seznam poklicev v zdravstvu, še ni 
prišlo. 
Ob razpravah o spremembi strokovnega naslova je 
bilo in je še veliko nasprotovanj, tudi z utemeljevanjem, 
da je naslov medicinska sestra v Sloveniji sprejet in da 
ga ni treba spreminjati. To kaže na nerazumevanje 
profesionalizacije. Nenazadnje si je že Angela Boškin 
pridobila strokovni naslov skrbstvena sestra in ne 
medicinska sestra. V fazi profesionalizacije mora stroka 
premišljevati tudi o tem, ali je strokovni naslov poklica 
ustrezen za rabo danes in v prihodnosti. Že desetletja 
nazaj so se medicinske šole preimenovale v zdravstvene 
šole, naslov poklica pa za žensko poimenovanje še 
vedno v sebi nosi »medicino«. Kakorkoli iščemo 
dokaze za razumevanje, zakaj spremembe strokovnega 
naslova ni mogoče izvesti, lahko zaključimo, da 
negovanje kot osrednja esenca profesije še ni raziskano 
dovolj, da bi prestalo profesionalno presojo znotraj 
in izven zdravstvene nege, da gre tudi pri negovanju 
za znanost. To je ključni problem zdravstvene nege 
kot znanstvene discipline, če le-to primerjamo z 
medicino. Potrebni sta izoblikovanje in primerjava 
teorije in prakse zdravstvene nege. Treba je prenehati 
z diskurzom teoretičnega znanja v šoli in praktičnega 
znanja v kliničnem okolju. 
Carvalho (2014) ugotavlja, da profesije v zdravstvu 
med seboj najbolj loči znanje, pridobljeno z 
raziskovalnim delom. Nekatere medicinske sestre/
zdravstveniki to novo znanje zaznavajo kot odmik od 
negovanja in podpirajo lokalni kontekst znanja v praksi. 
Horton in sodelavci (2007) pravijo, da zdravstvena 
nega zgodovinsko gledano vključuje temeljne naloge 
negovanja in pomoči bolnim in svojcem. Profesija 
se tako nahaja med izvajanjem nege in skrbi, ki so 
jo zgodovinsko izvajale manj izobražene ali priučene 
»sestre«, in negovanjem kot znanostjo, ki jo izvajajo 
oz. bi jo morale izvajati visokošolsko in akademsko 
izobražene medicinske sestre/zdravstveniki. Zakaj se 
ne strinjamo s predlogom diplomirana zdravstvena 
negovalka/negovalec, če se stroka imenuje zdravstvena 
nega?
Izzivi za prihodnost
Z večletnim raziskovalnim delom smo na strateški 
ravni opredelili nacionalno odgovornost za razvoj 
zdravstvene nege kot znanstvene discipline in 
kazalnike uresničevanja nacionalne odgovornosti 
(Skela-Savič, 2017), kar je objavljeno v tej številki 
Obzornika zdravstvene nege. Uresničevanje nacionalne 
odgovornosti za doseganje napredka v profesionalizaciji 
zdravstvene nege je ključnega pomena in mora postati 
prioriteta v nacionalni strategiji razvoja zdravstvene 
nege v Sloveniji. Opredeljeno nacionalno odgovornost 
lahko uresniči odgovoren menedžment, ki ima znanja 
in sposobnosti za prepoznavanje resursov in priložnosti 
za doseganje kazalnikov uresničevanja nacionalne 
odgovornosti. Cilj je profesionalizacija zdravstvene 
nege za kakovostno, varno in učinkovito zdravstveno 
obravnavo. Orodja za doseganje cilja so sistematično 
raziskovanje, strokovna presoja, razvoj kritičnega 
razmišljanja in odločanje na osnovi dokazov. 
Prizadevanja in uveljavljanje raziskovalnega dela v 
zdravstveni negi se lahko uresničijo le skozi nacionalni 
inštitut za raziskave v zdravstveni negi, katerega 
ustanoviteljica naj bo Zbornica – Zveza. Čakanje, da 
bi zdravstveno nego pri tem podprle druge institucije, 
glede na stanje zdravstvene politike v Sloveniji namreč 
ni smiselno. Inštitut naj se financira iz članarin članov 
Zbornice – Zveze in iz prijav na razpise. Skozi tak 
nacionalni raziskovalni inštitut bo dosežen »z dokazi 
podprt« vpliv na politiko, čemur v prihodnosti, ko 
bo inštitut znanstveno uveljavljen, lahko sledi tudi 
pridobitev javnih sredstev za delovanje inštituta. 
Inštitut naj sledi povedanemu v omenjeni raziskavi: 
»Središče razvojno-raziskovalnega dela naj bo pacient« 
(Skela-Savič, 2017). 
Stanovska organizacija praznuje 90 let. Nacionalno 
strokovno združenje Zbornica – Zveza ima pred 
seboj poseben izziv. Oblikovati mora ambiciozno in 
sodobno vizijo razvoja, zapisati cilje in strategijo za 
doseganje le-teh. Jasna vizija razvoja, ki je družbeno 
odgovorna in je odziv na potrebe družbe, zahteva 
načrtno razdeljevanje sredstev, premislek o obstoječi 
organiziranosti in usmeritvi sredstev v raziskovanje in 
razvoj. Nujne so zahteve po transparentnem delovanju 
na ravni organizacije in regijskih društev. Strokovne 
sekcije morajo postati motor profesionalizacije, 
spodbujati z dokazi podprto stroko in raziskovalno 
delo. Na ravni nacionalne organizacije mora biti stroka 
ločena od politike, ker ji le nestrankarsko delovanje 
omogoča z dokazi podprto delovanje ne glede na 
politično opcijo, ki vodi državo. Na drugi strani pa 
je politična aktivacija zaposlenih v zdravstveni negi 
zaželena, vendar naj se le-ta izkazuje preko kandidatur 
za državne in lokalne volitve. 
Zaključna misel
Na ravni strokovnjakinje in raziskovalke v 
zdravstveni negi in zdravstvu želim sporočiti sledeče: 
za razvoj zdravstvene nege kot profesije in znanosti 
postaja pomembno dojemanje zdravstvene nege 
znotraj poklicne skupine. Obstajata dve dimenziji 
pogleda nanjo, ki se morata »ujeti«. S tem mislim 
na znanstveno dimenzijo negovanja in dimenzijo 
refleksivne prakse nege in skrbi. Znanstvena dimenzija 
daje visokošolsko izobraženim medicinskim sestram/
Skela-Savič, B., 2017. / Obzornik zdravstvene nege, 51(4), pp. 264–273.272
zdravstvenikom nova znanja, ki naj jih preizkusijo v 
praksi. Refleksija na delo v zdravstveni negi pa naj bo 
raziskovalcem imperativ, da ga znanstveno preverijo 
in tako uvrstijo ali na področje znanja o negovanju 
ali nasprotno v polje z dokazi nepodprtega delovanja. 
Pri tem mora vsaka diplomirana medicinska sestra/
zdravstvenik imeti znanja, da lahko razvije sposobnost 
razumevanja pomena raziskav, rezultat katerih so 
znanstvena spoznanja, zato naj podpira razvojno 
delo v zdravstveni negi in naj prispeva pri soočenju 
dokazov in spoznanj iz prakse. Tako bo zdravstvena 
nega ohranila vrednote, ki so jo skozi zgodovino 
oblikovale v odnosu do zdravega in bolnega človeka, in 
dodala vrednote znanstvenega spoznanja o negovanju, 
strokovnega razvoja in z dokazi podprtega dela. Le-
to je dober kompromis, da se teorija in praksa zlijeta 
v eno. Preplet teh dveh dimenzij bo zdravstveno 
nego potrdil kot profesijo in znanstveno disciplino, 
ki »neguje« na osnovi znanstvenih spoznanj. Če tega 
koraka v profesionalizaciji visokošolsko izobražene 
medicinske sestre/zdravstveniki ne bodo naredili, bo 
zdravstvena nega postala obrobna podporna služba 
zdravstvenega sistema, ki se bo izgubila v množici 
tistih, ki bodo v vse bolj naraščajočih potrebah po 
zdravju in obravnavi bolezni, izrabili priložnost postati 
zagovorniki potreb sodobnega zdravega in bolnega 
človeka. Zato nimamo časa za neplodne prepire 
in očitke o pretirani ambicioznosti posameznikov, 
ki predlagajo spremembe, temveč je treba stopiti 
skupaj in na znanstveni ravni utemeljiti naše delo, 
tj. negovanje, kot sta na takratni ravni zahtevnosti 
in razumevanja stroke to znali že naši predhodnici 
Florence Nightingale in Angela Boškin. 
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Cite as/Citirajte kot: 
Skela-Savič, B., 2017. Professionalization of nursing in Slovenia: challenges and responsibilities for nurses with a higher education 
degree. Obzornik zdravstvene nege, 51(4), pp. 264–273. https://doi.org/10.14528/snr.2017.51.4.202