My family and I live in Chernivtsi. So far, this city is rather safe so we have not gone abroad. I have decided for myself that if I see that the situation is changing and there is a death threat we will have to leave. I love my native land, so I have never thought about leaving Ukraine. Since the first day of the invasion, our relatives from Kyiv and Kharkiv have been coming to stay with us, together with their relatives, friends, and colleagues. During the first two weeks of the war, we focused on where to accommodate all these people. A part of them stayed at our home, I lacked pillows and blankets for all of them. Then we found accommodation in our relatives, wherever we could. That is, Kyiv, Kharkiv and other regions came to us, and our local people started leaving in masse. I felt uncertainty. A lot of our patients have left, so now we are providing services either to those who stayed or moved here temporarily. Starting from 24 February we have worked as usual, just extended our working hours to 19:00-20:00 to make our services available to as many people as possible. We kept on working, taking turns, doing our job, and accepting patient.

Twice a month we gather food, money, sometimes medicines, and other essentials for the Armed Forces of Ukraine. We even gathered Easter baskets and children’s drawings, my colleagues wove camouflage nets, packed up first aid kits, cooked varenyky. It appeared that such small things give a lot of support to our defenders. Our health care facility has a separate manager who deals with this, organizes rallies, involves everyone. All together we are now trying to bring our victory closer, and we, at our health care facility, are making this contribution to our common cause. For the civil population there are a lot of humanitarian aid stations where the locals are helping. People have been bringing what they have at home – clothes, footwear, diapers. Our homes are open for displaced persons, the food is arranged. The local kindergartens have accommodated the displaced persons, they are bringing food, cooking, providing all the essentials on request. Children do not go to the kindergartens so far.

Right now, when we are in the third month of war, one is starting to find the balance. During the first days it was impossible to maintain any balance. We would go to work, have a lot of things to do at home, have constant movement. During the first two weeks there were people at my home, who just stayed for the night or rested from the journey. I went to work in the morning and had one people at home, when I returned – there were others. We couldn’t even think about the balance, not to mention any comfort zone. Communication with the family during the war has changed, we have been all focusing on different things: how to cook as much food as possible, where to find pots to feed everyone. Our regular Saturday movies or something else were out of question. I felt uncertainty, fear, and responsibility for my child’s life. My 8-year-old daughter Nadiika needs my attention now as much as before the war. You have to look after your child, devote time to her. Now I am beginning to understand that life goes on. We are alive and we have to learn just to embrace what we have, that the sun is shining and there is no air raid alert. The values have changed radically. It appears that we used to live very well before the war (smiling – ed.). We used to live a wonderful life, we just did not know it. We lacked time or money all the time, and now we have almost everything but peace.

Everything started with applying for participation in the course for peer group facilitation from the Ukrainian-Swiss Project “Medical Education Development”. I was hooked by the fact that not only doctors but also nurses could participate in the competition. Personally for me, it was a certain equality, for example, in education, and a chance to apply new experience. I really wanted to try myself as a leader and master new competences. Everyone from our facility applied, and I did not count on winning, I did not know what a facilitator was, or what I had to do, but I really wanted to try. That is why I was very glad to learn that I had been selected. By the way, I am one of the first facilitators to have graduated the course.

No, nobody ever knew about existence of peer groups. After the training, I began to popularize this format in our facility. It was a little difficult to launch a peer group with nurses, because our situation with CPD scores is different from that of doctors. We have to put a lot of efforts, motivate to come to the meetings, study, self-develop. But I was persistent and confident – I held the introductory training as a facilitator and speaker, tried to communicate as much information as possible about this format. I showed with my own example that the role of a speaker and preparation of the presentation are not a big deal. I invited everyone personally. So my colleagues willingly joined. I felt their support. A coffee break became a nice discovery. There had never been a peer group meeting with a cup of coffee, I saw how surprised they were. And at the next meeting it was a surprise again, because my colleagues thought that a coffee break was just for the presentation of the first meeting (laughing — ed.). I assured them that the training would always be in this format. A relaxed atmosphere, opportunity to be heard, to become independent became a strong argument and step toward new meetings.

I made a rough plan — to convince the administration of the health care facility I work at to create a peer group there. I did not want our meetings to be prescriptive in a form of a 5-minute meeting. For me it was important for the nurses to understand that we would study and exchange experience, first of all. I tried to establish communication with my colleagues, explained them the advantages of these meetings. Of course, it required time and effort. Our entire administration, heads of departments, the chief nurse came to our first meetings, they wondered what we discussed. So, in the beginning, the group did not really consist of peers (smiling — ed.). Let’s say, the atmosphere was not really the one I wanted. And now, a year later, we are absolutely independent. At one of the trainings I took the initiative to ask the nurses whether they were ready to work independently without a doctor. Only one nurse out of 10 was ready for such a step. I think it is fear, and to overcome it one needs time and quality training, the desire to change the obsolete stereotype that ‘a nurse is a doctor’s handy tool’. It is not so easy to develop self-confidence. I hope for the changes in the approaches to nursing education, because the problem comes from there.

We meet once or twice a month. For example, this week (7-11 February 2022 — ed.) it’s the first time we have organized meetings twice a week, because it became necessary to address a clinical case — to enter the data on vaccination against polio. I saw the nurses did not know how to do it, so we had to meet as soon as possible and learn. As a rule, we meet offline, but last week (beginning of February) I organized an online meeting for the first time, the colleagues from my dispensary participated offline, and those from the other dispensary joined online. The mixed format allows involving more colleagues, although it is difficult to facilitate it. So, it is more appropriate to focus on one format.

I took over organization of these meetings. We usually meet for 1-1.5 hour. I inform the management about these meetings in advance, and only after I get their approval, I organize the meetings, agree with the doctors to let the nurses go, approach everyone personally. Doctors sometimes do not allow nurses to go due to certain reasons; in this case I turn to the head of department and ask her to help.

It is easy to choose the topic – we take the one which helps to respond to the urgent issue. One of the nurses prepares the material for the selected topic and we dig deep into it. The most interesting topics are related to vaccination. With vaccination of little children there is always a chance of a non-standard situation, the colleagues can see something new for themselves in practice or a child’s mother will ask an unusual question. By the way, before the meeting every participant has 5 minutes to share their emotions for the week. Some may have difficulties at work, some want just to talk out, this helps to maintain the atmosphere of trust a lot. My personal positive case is when my colleagues, who were reluctant to come for discussion, hear the feedback or stories of our colleagues, understand how cool it is to be with us, and join. And when someone from other facilities wants to join, they are always welcome! I announce the meetings wherever possible. Once we even sent out the questionnaires around the city, selected the participants who registered and held two meetings with them.

There is one facilitator doctor at our facility, she gathers a peer group for doctors. Once we made a joint format for doctors and nurses to discuss vaccination. We sometimes invite local doctors as speakers. We once had a doctor from Lviv as a guest. We have not invited international colleagues though. It would be great if support of peer groups within the facility was defined on the legislative level, so that the administration had the budget to invest in the education of its employees, hold trainings. Then the employees would be more motivated to learn.

Professional and personal development, new acquaintances are the most valuable. We did not have such a quality interaction with everyone before. I have been working as a nurse for 12 years and it’s the first year the changes have been implemented. At the beginning of February I was proposed to gather the nurses of primary and secondary health care of the city in two weeks, and I am now working on this, thinking which topics to choose. I have never done anything of the kind, so I wonder if I manage. If there are such proposals, it means we are doing something in the right way.

I have never seen myself as a trainer. This proposal was both surprising and shocking for me (laughing — ed.). I even do not know whether I will cope. The only thing I can do is to share experience. The more time passes, the more new things I learn. A facilitator is definitely a team leader, a person with professional competences, he/she should lead the colleagues by example, inspire, have a kind and open heart. I am not a chief nurse in our department, but I see that I have a certain authority, a lot of nurses come to me for advice. As a facilitator, I would like to convey resilience to my trainees, not to give up at the beginning of the path. There can be disappointment, sometimes you want to give up, but do not stop, you have to move on. It’s good that I did not stop. There are a lot of difficult moments, but I always remember Renato’s words: “It won’t be easy”. I like to bring everything to conclusion, not just study and say that nobody needs that in the end, or hold one meeting and think that this format is not interesting for people. If you start something, you have to go to the end with dignity.

Honestly, since russia invaded Ukraine, we haven’t held peer group meetings. There was such a chaos, that we were not able to put ourselves together. On a positive side, our director invited a psychologist to our facility, who held two trainings about professional and emotional burnout. They were very helpful, distracted us from what was happening around. It is very difficult without psychological support now. Such trainings with a psychologist will probably be continued.

Last summer I took part in the Azov School of Family Medicine. I remember the training in emergency care held by Dmytro Samofalov. He placed emphasis on forming the team working with emergency states and having an algorithm: “You have to go out into the corridor, say three magic words, and things move on”. In particular, all the involved employees must have a strategy, understand and remember who is responsible for what. For example, one person measures the blood pressure, another is calling an ambulance — distribution of such roles is very important. And clinical skills must be practiced regularly. We also had an interesting training in otoscopy. I learnt to carry out this kind of diagnostics myself. I also liked the tasks in vaccination from Olena Kondratenko. I never would have guessed that vaccination can be such a complicated process: when you have a task and you have to decide in which case which vaccine to use, how many vaccines you can use at a time. Thus, when I returned to my facility, I had a lot of knowledge and skills which I wanted to teach my colleagues. I borrowed otoscopes from family doctors and told to my nurses: “Let’s figure out and try, we are not worse!”. So we had a training in otoscopy for nurses. I printed out all the tasks in vaccination and organized a relevant training. The nurses solved these tasks anew, discussed”.

Development, independence, professionalism.

You give nurses the opportunity to develop and learn. I have always said that there is finally the Project which has paid attention to us. Doctors have always been the priority, there has never been anyone to pay attention to nurses and say that we are needed. The Ukrainian-Swiss Project “Medical Education Development” impressed me with this. The Azov School of Family Medicine, Forum of Nurses which was held in Kyiv for the first time – no one has ever held such important events for nurses. It is very inspiring when you come and really see the nursing community. That is what I am grateful to the Project for, for this idea. I also feel solidarity and commitment to communication in the Project community. Here I feel equal among health care managers and doctors. I can always turn to you for help, idea, recommendation, and feedback. Everyone at the Project is open to everything. I am thinking about what will happen when the project is over...

After I had joined your community, it inspired me even more. I decided to learn further. I prepared to the independent external testing in biology and Ukrainian by myself and entered the bachelor’s course in nursing. It’s all thanks to your Project, because no one has ever inspired me the way you do. I wanted to move ahead, learn further; I understood the nursing position is not the end yet. I made a lot of effort to work and prepare for the external testing individually. I was extremely happy when I got my scores and learnt that I was enrolled as a full-time student to Chernivtsi Medical Professional College. I couldn’t believe that I would be studying for a Bachelor’s degree in nursing! People ask me why I need all this, and I say that I just wanted it. It is difficult to combine work and study, but I was ready to it psychologically and did not worry that it was going to be difficult for me. It was the point of growth – whether I could or could not. Now the one-year bachelor’s course brings me satisfaction from studying and allows developing professionally. Let’s look, for example, at independent vaccination by nurses. This procedure can be performed only by a nurse with a bachelor’s degree. Therefore, specialists with higher education definitely have advantages.

It was my first time in MOH, we discussed human resources and the programs we use, issues related to awarding qualification categories to nurses, how to hire a nurse, what happens after a dismissal. During the next meeting we have to discuss the right of the nurses to vaccinate independently, without a family doctor’s participation. As I have already mentioned, a nurse must have a bachelor’s degree and own electronic key for this. Independent vaccination is a controversial issue, both doctors and nurses react to it differently. I consider the practice of independent vaccination by nurses to be great. We have always vaccinated anyway, there is nothing special about it.

Yes, these are mainly patients who are hesitant. I did not even expect that there can be so much negativity from patients. Here one should work with all the target groups of society. A nursing trade has to be popularized among public, we should speak that this work is important, that a nurse can take decisions independently if he or she has a relevant level of education, because for a patient a nurse with or without higher education makes no difference. This is a matter of recognizing a nurse as a qualified specialist by the society. Perhaps there will be trust then.

No, we have not reached this practice yet. The decision that allows nurses to vaccinate patients without doctor’s participation has just been made at the legislative level, but practically it requires time. However, taking into account the fact that we do not have so many nurses with higher education, this may become a motivation to study more and change something.

A nurse should develop professionally, this is important both for her/him and patients. This professional should be tactful in communication, neat, open. A patient should not be afraid to ask something, he/she should feel comfortable. This is a matter of trust. At one of the peer group meetings we told that before every procedure we should inform a patient what exactly we will be doing. I often see the tendency that a nurse just opens a syringe and gives a shot silently. It is probably also a problem of education, that’s the way we were taught. But the patient has scary thoughts at the same time, because he/she does not know what is happening. The patient may be familiar with the procedure, and may not be. Every action has to be discussed and the patient will understand what is going on sooner.

In general, communication with patients depends on a human factor. I sometimes see nurses with decade-long experience who are just not ready to change. And there are those who will always smile and tell you something.

I think that thanks to communication it is much easier to understand what is happening to all of us. There is support, you see who to look up to and understand which environment you are in. Sometimes you read the nurses’ comments and think: “This is something incredibly cool, very interesting”. Of course, there can be some negativity. So community is a certain guidance. There is a community called “The Best Nurses” in our health care facility; I also know about Bukovinian Nursing Community on Facebook and Viber. Our administrator and other participants regularly post useful news dedicated to medicine, links to webinars or new protocols or orders, write about achievements. The community consists of people from different departments. Before that, we did not know what happened in other facilities, departments. Today communication is much more accessible.

Perhaps, after Zelenskyy (President of Ukraine — ed.) promised a salary of UAH 13,500, it will become attractive (laughing — ed.). You see, I do not really believe the nurses who say that they have dreamt about this profession since childhood. Even if you dreamt about it, when you come to a neglected department with gravely ill people and have a salary of UAH 3,000, your dreams immediately turn into something else. I deliberately chose the nursing profession, just because I didn’t see myself in any other. At the same time, I cannot say that nursing was my dream. I dreamt about a bicycle in my childhood (laughing — ed.).

I dream about completing my education and nurses to be perceived as independent professionals. I dream about a separate office for nurses and our facility supporting peer groups financially. I also think that traveling is always cool. And finding time for your family is something you always strive for. I am trying to implement these things somehow. I want my folks to stay healthy. It’s supportive when you know that your folks are fine and you have someone to talk to about even little achievements. Every day my mom asks me what’s new at my work, how the Project is going, who I communicated with there, what I was proposed. In general, when you have strong support and positive atmosphere in your family, you can move ahead professionally.

The last book I read is A Non-Scary Book by Anastasiya Leukhina. It did not come easily, I never thought that I would need to get ready to open a book and read further. Especially, the last section about children – I couldn’t finish reading it, honestly, it was very difficult. This book is a fantastic human resource. I recommend it to everyone who has a terminal illness or whose relatives receive palliative care. You can find the words of support for yourself and your closest ones. I recommend it to health care workers. When I organized a peer group meeting, I brought this book, told about Anastasiya Leukhina, gave it to read to everyone who wanted.

As for the film, my family has a tradition of Saturday movies. I do not always remember the names, because my husband takes care of it. I ask him what we will watch, and he says that it will be interesting. When the film ends, I ask the name, and he responds that I will not remember it anyway (laughing — ed.). But I can recommend 1+1. It impressed me with the idea that a person has to love his/her job and then he/she will always do it well. Even if it’s palliative care and the person is gravely ill, there should always be someone to support; this connection is very important. The most important thing in everything is love. If you do everything with an open heart, everything works out.