Prof. Inga Millere has started over many times and doesn't fear challenges

On 18 November 2019, Inga Millere, the Dean of the Faculty of Public Health and Social Welfare at Rīga Stradiņš University (RSU) and a Professor of the Department of Nursing and Midwifery, was awarded the Cross of Recognition for her outstanding and significant contribution to the development of nursing education and research.

Prof. Inga Millere has worked at RSU for 19 years. From 2012 to 2014 she was the Dean of the Faculty of Nursing, and since 2014 she is the Dean of the Faculty of Public Health and Social Welfare. The faculty trains prospective nurses and midwives as well as specialists in nutrition, sports, health psychology, supervision, public health and social work.

On 11 and 12 November 2019, a delegation from Turkmenistan visited the RSU Faculty of Public Health and Social Welfare in order to attend a two-day seminar organised by the faculty – Understanding the Development and Applications of Registration Systems Within the Latvian Health System.

Upon receiving the award the professor thanked her parents who are both recipients of the Order of the Three Stars. ‘They drove and developed new initiatives and ideas throughout their lives, and were both doctors and innovators in their respective fields. From them I learned to follow my ideas and convictions despite the time and effort that it takes.’

Inga Millere’s mother, Rita Kukaine (1922-2011), was an academician of the Latvian Academy of Sciences (LAS) and for many years headed the LAS Augusts Kirhensteins Institute of Microbiology and Virology (currently the RSU Institute of Microbiology and Virology). She promoted the development of the field of virology in Latvia and developed many new scientific directions in microbiology and virology. Inga Millere’s father, Viktors Kalnbērzs, is an academic and an orthopaedic traumatologist who has developed the fields of surgery, traumatology and orthopaedics in Latvia and for many years headed the Research Institute of Traumatology and Orthopaedics and the Department of Traumatology, Orthopaedics and Military Surgery of Rīga Medical Institute (now RSU). 

Why did you decide to work in administration at the university rather than becoming a doctor?

My path has indeed taken many twists and turns, but I am basically a doctor and that is the professional identity through which I approach various issues.

There have been different stages in my career. The first one was right after graduating from the Rīga Medical Institute, when I was enrolled in a postgraduate programme and was working on my dissertation, which is similar to modern doctoral studies. I worked in the Augusts Kirhensteins Institute of Microbiology and Virology laboratory doing research in oncovirology. I was a junior research associate and successfully developed a doctoral thesis there. One of my supervisors was Modra Murovska, the current director and leading researcher of the institute.

1983. ‘This is me during my placement in Saldus after the 5th year of medical studies. We spent several weeks living in hospital facilities and working in wards. During this placement we were sent to a motorcycle race as a first-aid team. I remember that all four of us students were scared because we did not have an experienced doctor with us,’ remembers Prof. Inga Millere. Photo from the RSU Museum archives.

The next stage was after Latvia restored its independence. It was a time when everything was changing and falling apart, but also being built up. I changed my professional direction radically and started in a psychotherapy residency programme. The programme was new at the time and headed by Prof. Gunta Ancāne. After the residency, I worked as a psychotherapist for more than ten years.

Then I landed in the RSU Faculty of Nursing. I was invited by Professor Jānis Vētra to join the faculty. I joined with great enthusiasm at a time when the field of nursing was evolving at the university. As RSU was beginning to engage in many European projects that opened up new directions in developing care and nursing education, I quickly realised that I would not be able to combine everything and gradually moved away from practicing medicine and psychotherapy and became increasingly interested in education management and organisation.

I am still in this third stage. The Faculty of Nursing has evolved into the current Faculty of Public Health and Social Welfare and is now the second largest faculty at RSU. It is only slightly behind the Faculty of Medicine in terms of the number of students.

What do nursing studies entail?

The term “māszinības” [nursing studies in English – Ed.] emerged at the time that Latvia regained its independence as this field began to be developed at the university. Not everyone initially accepted the term, but it is now in common usage.

As the field was developing into something you could study at the university and be awarded a degree in, it became necessary to upgrade and improve the terminology associated with it, and one of these new terms was "nursing studies". The nursing profession is ancient and has had different names over time: the Grey Nuns, deaconess sisters, the Sisters of Mercy, sisters or medical nurses.

Currently, the profession is called nurse, but unfortunately the Soviet term "medicīnas māsa" [roughly translated as “medical sister” in English – Ed.] is still being used. 

The title of medical sister was closely related to how health care was structured during the Soviet era: either a three-tier structure where nurses were like service staff, or a two-tier structure where nurses, or so-called middle-tier medical staff, merely executed doctors’ orders. Nowadays the profession has taken on a completely different role in the healthcare system. Nurses’ knowledge and competence allows them to stand beside doctors as colleagues, not just as staff executing orders, or managing the care process. In order to reach modern professional standards, the profession had to change a lot. I am, however, hesitant whether as time goes by and technologies progress, we aren’t losing some of our compassion.

What are some current topics in nursing education? 

The nursing profession is constantly evolving and new changes await as the occupational standards are about to be updated.

In line with the new occupational standards, a work group from the Ministry of Health is proposing new general care nurse standards that clearly define the new competencies and comply with European directives. This means that as of 2022 the nursing profession will only be available as a professional bachelor's programme. The report “Par māsas profesijas turpmāko attīstību” (On the Future Development of the Nursing Profession) was approved by the Latvian Cabinet of Ministers in October 2019. In my opinion, the different levels of education and competencies that you currently find within a single profession – vocational secondary education from the Soviet era, first-level professional higher education, second-level professional higher education, master’s and doctoral education – confuse a lot of people and make organising healthcare work difficult.

The same applies to nursing specialisations – each speciality has so far had a relatively narrow focus: paediatric nurse, ambulatory care nurse, surgical nurse, operating room nurse, mental health nurse, nurse anaesthetist, intensive and emergency care nurse, internal medicine nurse. If an operating room nurse wanted to change their job and work in surgery or outpatient care, they would have to study at the university again. The new model offers one educational process and greater labour market mobility.

In the future, nurses will have broader knowledge and competencies, which is now essential to our healthcare system. These new competencies will require a nurse be able to make independent decisions about patient care.

Expanded competencies will allow nurses to be more mobile and accessible in the labour market and to become more involved in patient care thus relieving doctors’ work and achieve better patient care outcomes by providing care that is more accessible and of better quality.

In many developed countries nurses have been given the right to prescribe medication, but this has not yet been sufficiently utilised here in Latvia.

Of course, there is a great deal of work ahead of us concerning societal stigmas where nurses are seen as helpers or subordinate professionals and not as professionals who make decisions. And this is where RSU can help, by providing nurses with the opportunity to develop their competencies so that they are able to make such decisions about patient health and care responsibly. In order for this new bachelor's degree program in Nursing to get its qualification we will establish a study process at RSU in close collaboration with professionals from the RSU Red Cross Medical College.

I would like to emphasise that nurses are and will be in high demand on the labour market. There haven’t been enough nurses in Latvia for a long time, but in the last 10 years numbers have been critically low, in my opinion. The number of nurses in Latvia per 100,000 people is by 42% lower than the EU average, and about 40% of working nurses are of pre-retirement or retirement age. Additionally only half of Latvian nurses work in their profession. I believe that if salaries were sorted out nurses would be more motivated to work in their profession.

From the left: President of Latvia Egils Levits and Prof. Inga Millere, Officer of the Cross of Recognition, Dean of the RSU Faculty of Public Health and Social Welfare. Photo: Ilmārs Znotiņš, Chancery of the President of Latvia.

What should be improved in nursing education at RSU for the planned changes to be implemented?

We have been moving our Nursing bachelor’s study programme in this direction so the programme meets the new requirements with only a few minor improvements left to be made. All we have to do now is dot the i’s and cross the t’s before making appropriate changes to the programme license and accreditation.

Is there research in nursing? Why is it important to conduct research in this field?

In Latvia, research within care and nursing is rather underdeveloped, which is related to how the field has developed. Healthcare science has only been a branch or sub-branch of science in Latvia for about eight years. Nurses have the opportunity to pursue doctoral studies and receive a doctoral degree. Currently, there are about twelve nurses with doctoral degrees in Latvia.

It is impossible for the profession and evidence-based care and practice to develop without research.

In my opinion, research is currently developing quite poorly and chaotically. There is a plan to establish a Research Development Coordination Board within the Latvian Association Of Nurses that would summarise and direct the development of the research necessary for the profession. So far, we have studied the quality of nurses’ working life, psycho-social risk factors in the work environment, various aspects of patient care, such as pain care etc. in greater detail. It is important to mention the extremely extensive doctoral thesis on the development of the nursing profession in Latvia, because without the knowledge and understanding of the past it is difficult to plan for the future.

One of the research projects we have been involved in since 2016 is about insufficient care –  “Nepilnīgi veikta aprūpe: starptautiska un daudzdimensiju problēma” (Insufficient Care: an International and Multidimensional Issue).

Anything that a patient needs in their care that is not performed or is performed incompletely is considered insufficient care. There can be many different reasons for care providers to give insufficient care, but it must be understood that patients suffer as a result. One of the factors affecting and jeopardising care is, for example, increased workload due to reduced staff in the unit. There are hospital wards in Latvia with one nurse is assigned to care for 40–60 patients – the European average is one nurse to 4-8 patients. Nurses are unable to manage everything, because they simply don’t have the time. Medication is, for example, sometimes administered later than prescribed by a doctor, patients might not be turned over often enough to prevent bedsores, or receive sufficient education or instructions. Insufficient care is a problem in many countries. In many ways this is due to a lack of human resources, issues with the management process, work organisation, or a lack of professional knowledge or attitudes. We all know that many Latvian healthcare workers are burned out. Many countries are currently thinking about how to change and improve the care situation.

As part of the project on insufficient care we are organising and participating in seminars and educational activities, developing various international guidelines and gathering international experience with other European countries. We have translated and adapted research tools to evaluate how care is provided in Latvia. We conducted this study at several hospitals and the data is not very heartening. Together with other European countries we are now developing international recommendations that will be targeted at head nurses, as the provision of quality care is in many ways linked to work organisation.

Faculty of Public Health and Social Welfare graduation ceremony on 27 June 2019 in the RSU Great Hall.

You have been working at RSU since 2001. What is the accomplishment that you feel most satisfied with?

There are several things! Looking at our graduates at each graduation I am delighted with the work we have done to create and provide opportunities for professional and personal growth, for example. RSU is shaping the future of our health care by educating young professionals in various fields.

I was very pleased that the Ministry of Health’s report “On the Future Development of the Nursing Profession” was approved as the faculty had invested a great deal of work and energy in it over many years. Of course I also have to mention that last year was very significant for RSU and the Faculty of Public Health and Social Welfare, when we became a partner of the World Health Organization (WHO). We are now a WHO Collaborating Centre for Health Professional Education. This means that the global organisation has acknowledged the high quality of work and capacity of our faculty. I am very pleased about that!

What are the most important jobs to be done now that you are the Dean of the Faculty of Public Health and Social Welfare?

We are constantly developing. As I said before, nursing education programmes need to be developed further, as 2022 is not far away.

We plan to develop new directions in the Health Management Master’s study programme offering the opportunity to acquire new specialisations. Issues of digital health are becoming more and more urgent, for example, because much can happen through technology, just as much cannot happen without technology. 

International projects provide us with a lot of opportunities and allow us to develop RSU study programmes in an international direction. The European Universities Initiative involves the creation of alliances between universities that will allow for experience exchange with Finland, Sweden, Lithuania and France and the development of new international programmes.

RSU’s new brand slogan “Open to the World!” that was announced at the end of last year accurately characterises this. Students will be able to acquire part of their study programme in Latvia and part in Sweden, Finland or another country. This is a new direction in Europe and we are currently writing an application for the European Universities Initiative.

What is the hardest part of your job?

Anything can be done, you just have to start doing it! One of the processes I would call maybe not the most difficult, but perhaps the most complex, is change management. I mean this in the broadest sense – in relation to study programmes, teamwork, etc. My motto is: “Do not be afraid of change, but see it as a challenge and guide the change!”

What do you think a student should learn in university in order to become a leader in the field of public health and social welfare after graduation?

The student must become a competent specialist and critical thinker, be able to evaluate a vast amount of information, work with research data, and find the latest trends to put into practice and provide evidence-based care at any level. The student must have leadership skills and be willing to cooperate to manage processes and teams and develop the profession of their choice.

The students who are able to make independent decisions and are ready for continuous development will become leaders.

Next year marks the 70th anniversary of RSU. What would you wish your university?

I would like to see the university in constant development. Let’s be open to the world!

Facts about Inga Millere

• 2012 – 2014, Dean of the Faculty of Nursing
• 2014 – present, Dean of the Faculty of Public Health and Social Welfare
• Professor at the Department of Nursing and Midwifery
• 1984, doctoral diploma from the Rīga Medical Institute (now - RSU)
• 1989, PhD in Medicine
• 1997, psychotherapist qualification through a residency at the Latvian Academy of Medicine (now - RSU)
• 2001 – present, working at RSU
• Study courses taught at RSU: Research Methods in Nursing, Management and Organisational Psychology, Educational Psychology and Methods, Psychosomatic Medicine, Management and Organisational Psychology, Health Concept and Conception, etc.
• Co-author of the book Priestera Vincenta de Paula žēlsirdīgo māsu apvienības darbība Latgalē (1789-1864) (Activities of the Association of Merciful Nurses of the Priest Vincent de Paul in Latgale (1789-1864))
• 38 local and international articles published
• 63 conference and congress theses written
• 2011 – present, health care expert, Latvian Council of Science
• 2019, received the Cross of Recognition