Nursing in Armenia Today and Tomorrow

Nancy A. Barsamian, DNP, MPH, RN

As an experienced Armenian American nurse, assistant professor, and a recent graduate of the Tan Chingfen Graduate School of Nursing at UMass Chan Medical School, I have had the opportunity to teach nursing students in the U.S. and in Armenia. Over the last three decades, I observed firsthand how the healthcare system in Armenia has attempted to evolve from its foundations of the Soviet Union healthcare system. The current healthcare system in Armenia is still developing. They do not have universal healthcare, and many non-governmental organizations have stepped in to support the healthcare system, leaving a healthcare patchwork. The main access points to healthcare for the average citizen in Armenia are outpatient polyclinics, much like the Community Health Center models in the U.S. In addition, there are several large specialty hospitals in the capital city of Yerevan. The average person pays for their healthcare out of pocket and usually seeks care only when it is an emergency or significantly impacts activities of daily living. In addition, fifty percent of the population lives in rural areas with no access to acute care hospitals. Patients in these areas need to travel for hours to access care.

In many ways, the family structure serves as the safety net for healthcare support. The prominent feature of a traditional Armenian household is the extended family, several generations under one household. Many of the day-to-day health issues are managed with homeopathic remedies, passed down by generations, such as using different types of teas for digestive issues. Nurses realize the importance of patient education in primary prevention and chronic disease management and work to infuse needed health education into Armenian families.

As in most parts of the world, nurses are the largest part of the healthcare workforce in Armenia where there are 16,700 practicing nurses (56.5/10,000 population) [1]. The hospital nurses in Armenia function much like licensed practical nurses in the U.S. They receive a certificate or a diploma, not a college degree, after completing their nursing education. They work as healthcare generalists, inserting intravenous catheters, giving injections, and administering medications. The average caseload of patients on a medical-surgical unit is 6-10 patients. In rural Armenia, there is a shortage of medical doctors, and nurses function independently providing primary medical care, often treating patients in their homes under the ongoing shortage of medicines and supplies.

Country-wide, nursing salaries are very low with a slight variation if the medical facility has private or public ownership and if financial support to the institution is supplemented by the diaspora. The salaries of intensive care unit nurses are among the highest nursing salaries. Most nurses work 24-hour shifts and earn 25,000 drams equivalent to 65 U.S. dollars per 24 hours. Nursing position descriptions are written in very general terms such that nurses often perform tasks typically done by different disciplines in addition to their work, especially if the requests come from their supervisor or the medical director of the hospital.

A 2020 qualitative study of nursing in Armenia revealed nurses believe that the general public does not respect nurses and that nurses' roles are much more restricted than they are in the U.S. [2]. Participants noted that nursing roles focus on providing support to physicians and administration, there is no platform for advancement or professional development, and nursing is not considered an autonomous healthcare profession [2]. Armenia faces a nursing shortage with high turnover, especially among new graduate nurses. Once new nurses realize how difficult the work is and how low the salaries are, they quickly make a career change.

There is hope that the nursing profession will advance its efforts to meet the needs of Armenians. In the Fall of 2022, the American University of Armenia began the first Bachelor of Science in Nursing program in the country. The program is designed for nurses with proficiency in the English language, who have a diploma in nursing or midwifery and want to advance their education. The program is based upon the American Association of College of Nursing standards. The American University of Armenia nursing faculty are introducing nursing students to advanced assessment skills, critical thinking, evidencebased practices, the use of informatics, quality improvement, and ethics. These nurses have taken the initiative to advance their knowledge and recognize the importance of becoming competent professionals who work as part of the healthcare team. Graduates from the BSN program will be future leaders of the nursing profession in Armenia. They strive to move the nursing profession forward and at the same time improve the quality and access to health care in Armenia.

Nancy A. Barsamian, DNP, MPH, RN, serves as Assistant Professor at the UMass Chan Medical School, Tan Chingfen Graduate School of Nursing. She also holds an Adjunct Professorship at the American University of Armenia's Turpanjian College of Health Sciences. For inquiries, reach out to nancy.barsamian@umassmed.edu