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Charles W. Hostler Student Center Welcomes Students, Staff and Alumni
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Redefining Nursing in Lebanon
Collecting Lebanon's Past
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Summer 2008 Vol. VI, No. 4

Redefining Nursing in Lebanon

At AUBMC, Nursing Services is undergoing the Herculean process of becoming a "Magnet-Designated Facility," a process that demands significant changes in the way that nurses operate - and has resulted in a new level of appreciation for the nursing profession in Lebanon.

The American Nurses' Credentialing Center (ANCC), which is affiliated with the American Nurses Association, established the Magnet Recognition Program in 1994 to recognize and encourage best practices in nursing services. Supporters of the program point out that to earn "Magnet" status a hospital must be able to demonstrate that its nurses deliver excellent patient outcomes and enjoy a high level of job satisfaction. Assistant Hospital Director for Nursing Services Gladys Mouro says that the environment and the culture of AUBMC have changed as a result of the Magnet process.

Although she acknowledges that there are criticisms of the Magnet process and even admits that she once shared some of them, "the more I learned about Magnet, the more I became convinced that it really would make a difference in patient care," Mouro says. "I sense the difference among the nurses. Staff are happier, patients are more satisfied, and our outcomes have improved in patient care. Physicians respect and rely on nurses more than they did and the image of nursing at AUBMC and in the community is so positive."

Anthony Shamoun, who is currently an advanced practice nurse at AUBMC, left Lebanon in 2005 to study for a master's degree at the University of Pennsylvania. When he returned to AUBMC, he couldn't believe the changes that had taken place during his absence. "I was shocked because of the huge leap we had taken in such a short period of time," he says. "When I was in the US I had the opportunity to discuss the changes that had taken place in nursing in recent years with some of my fellow students. Almost everyone agreed that the process of changing had been hard, long, and tedious. My experience at AUBMC has been just the opposite."

Although a number of nurses will agree that there have been changes, some of them will tell you that the biggest changes are in how others perceive them as nurses. Nada Shehab, who is now assistant nursing director for education, remembers her father's disappointment when she announced that she wanted to be a nurse - and not a doctor. "Nurses were really considered servants at that point in time," she says. Although she welcomes some of the changes, she has some regrets too. "More people enter nursing now because they know they will be able to find a job when they graduate. Many of us who chose to be nurses back then did so because we wanted a career that allowed us to help patients and their families."

Hanadi Massalkhi is another nurse who had to convince her family that she wanted to be a nurse and not a doctor. Looking back, she says that "from the first day I joined AUBMC in 1990, I sensed that nurses were the core element at the hospital." She remembers feeling "empowered" even then but says, "empowerment and autonomy were not words that we used in those days."


Although nurses have always played important roles in hospitals, there have been some significant changes in the way in which they work. Iman Al Kouatly explains that nurses are more knowledgeable now and are treated more like "partners in care" rather than "followers" as they were in the past. "Their opinion in patient care is well respected by other health care professionals and they contribute more to the decision making process than they used to," she says.

Ghada Hamdar, who has been working at AUBMC for 20 years, sums it up nicely. "We believe that it takes an integrated effort to provide quality care to our patients… Nurses are the people who are with the patients 24 hours a day, 7 days a week." It makes sense therefore that any process that gives nurses a louder voice and that encourages them to take more initiative would benefit everyone - the patients most of all. Mazen El Ghaziri, the Magnet project manager, says that nurses are responding to this encouragement. "Nurses are much more proactive now especially as it relates to practice and patient care," he says.

Randa Shahine, for example, describes how she and some of her colleagues at the Children's Cancer Center of Lebanon (CCCL) have implemented an educational program to inform cancer patients and their families about a number of cancer-related issues. When the center started treating patients with sickle cell disease, the program was expanded to include this topic too. According to Shahine, this project has benefited nurses who have learned more about these important issues and "most importantly has increased patient satisfaction."

Rima Saad, who also works at the CCCL and is currently enrolled in the MSN program at AUB, says that she was encouraged by Magnet to propose initiatives such as the research study that she is currently conducting on the evaluation of the quality of palliative care at CCCL and to get involved in outreach activities to promote the image of nursing in the community. She stresses that under the leadership of Gladys Mouro, Magnet is a very hands-on process - something that "we not only practice, but that we actually live."

Although they have already been at it for more than five years now - since May 2003 - they still have a long road ahead of them. Mazen El Ghaziri, the Magnet project manager, explains that in addition to the monumental written application they are in the process of writing, they are also preparing for a visit from a team of Magnet appraisers who will travel to Beirut to verify the information in the written application and evaluate the organizational setting in which nursing is taking place at AUB. "We have embarked on a journey that will impact patients, nurses, and health care at AUBMC, Lebanon, and the region," Ghaziri says. Mouro agrees. "We are making history in the Middle East in the area of health care that will have an impact on future generations. It may not be obvious today, but in a few years as more and more hospitals follow this path, we will see a significant difference in the quality of patient care throughout the region. This will be our legacy."