NURSING HUMAN RESOURCE DEVELOPMENT IN MONGOLIA

There is a need for a policy to modernize Mongolia's nursing care in rural areas, and to allocate and retain nurses. Nursing human resource growth is averaging 2.01 percent per year. The number of nurses working in rural areas has decreased by 21.4 percent over the last 19 years. There is a need to reflect cross-sectoral cooperation and the roles, activities and participation of policy stakeholders in the implementation of nursing human resource policy.

to develop human resources in the health sector in 2004-2013 was implemented incompletely by 2941 nurses, "medium-term human resource outlook for the health sector 2005-2015" policy was underimplemented by 2317 nurses, the government's health sector policy for 2012-2016 has not been achieved, the "State Health Policy" aims to make the ratio of doctors and nurses 1: 1.6 by 2021 and 1:2 by 2026, but the reality is 1: 1.1, according to the standard approved in 2017, there will be 2.0-2.5 nurses per doctor and 0.5-1 assistant nurses per 4 nurses, which shows that there is a shortage of 2434.5 nurses in rural areas, out of 1623.
Comparing the distribution of nurses working in rural hospitals with the lower limit of the standard, the average number of nurses in the aimags is 315.3 and the number of nurses is understaffed from 1623 to 2434.5. The number of nurses will be 12,773 in 2019, and a dynamic analysis of the population shows that the human resources for nursing have increased by 3.4 percent over the past year.

Fig.1. Current supply and growth trends of nurses
Overall, the consolidated trend analysis shows that the number of nurses increases by an average of 2.01 percent per year, which is very low. The highest increase in the number of nurses was in 2014, when it increased by 7.8 percent, and the lowest in 1997, when it decreased by 4.7 percent. The average of the last 5 years is estimated to be 12772.9 nurses in 2019, indicating that the current (12773 nurses) can be used to extrapolate future human resource trends. In 2020, there will be 13,041.07 nurses, and in 2030, there will be 16,156.6 nurses.   Summary of group discussion. In rural areas, nursing is influenced by many factors. These include: Increased wages and benefits in remote rural areas, adequate human resources to reduce workload and streamline job descriptions, focus on retraining, nurse training, program optimization at the local level, professional degrees and specialization, supply of tools and equipment, Improving the legal environment. In summarizing the findings of the study, there is a similar result of study, and the most pressing issues for nurses in the regions are salaries, workload, ABT, and improving the legal environment.  The implementation of STD standards is insufficient and the quality of STDs is poor in rural areas − The nursing care system needs to be changed to ensure equal access − Improving compliance with STD standards − Need to develop home nursing − Training in teamwork skills − Improve monitoring of nurse performance − Ensuring the quality of STD refinement and development 6 Job evaluation The evaluation of the work of nurses working in rural areas is unrealistic − Optimize job descriptions − Change the salary chain, increase salaries, pay by education gap − Providing regional allowances − Provide real incentives − Improvement of job evaluation objectively optimize allocation According to our survey, 40.7 percent of nurses working in rural areas are dissatisfied. 44.0 percent said that the workload of nurses working in rural areas was very high and 39.3 percent said that they were overworked. Underemployment, overwork, and increased overtime contribute to dissatisfaction among nurses, and the survey found that most of their working hours (over 80.0 percent) were spent on injections. In rural areas, 49 percent of nurses said that their productivity was not realistically assessed, and 83.1 percent said that it was not enough.
Employee dissatisfaction and suicidal ideation are directly related to high turnover, and the lower the employee's level of satisfaction, the higher the risk of dismissal.

Fig.4. Types of nursing human resource placement systems
Based on the factual research, we have developed a system for allocating and allocating nursing resources, how political, socio-economic and technological factors affect it, forecasting the future of human resources, training a sufficient number of nurses, how to place and allocate them, stable employment and nursing care. A unified model has been developed to take into account the results of quality service delivery. The analysis of the implementation of the policy document shows that human resource policies and strategies are slow to be implemented, there is no analysis of the causes and effects to determine who is weak, there is no duplication of functions, and the parties do not know how to participate in cross-sectoral policy. Cooperation is weak and policies are not implemented from the top down.
Conclusions. There is a need for a policy to modernize Mongolia's nursing care in rural areas, and to allocate and retain nurses. Although the legal environment is in place, implementation has been slow and needs to be further improved. Nursing human resource growth is averaging 2.01 percent per year. The number of nurses working in rural areas has decreased by 21.4 percent over the last 19 years. There is a need to reflect cross-sectoral cooperation and the roles, activities and participation of policy stakeholders in the implementation of nursing human resource policy.