Dr. Hanna Admi is one of two hospital-based Directors of Nursing in Israel to hold a Doctorate in Nursing.
 She earned her MSc and Phd in Nursing from the University of Pennsylvania with fellowships from the World Health Organization. In 1975, she was the recipient of the first Cheryl Spencer Memorial Scholarship, which she used to complete her BA in Nursing at Tel Aviv University.

Q Since becoming Director of Nursing at Rambam in 1997, you have spearheaded the academization of the nursing staff. What is the importance of that for patients?
A The sick person wants someone who understands the meaning of a disease and, most importantly, the link between the pathophysiology and the humanitarian, caring aspect.
The nurse works in partnership with the medical team — doctors, other nurses, social workers, the dietician, the physiotherapist — for the patient’s benefit, but often the nurse serves as the patient’s advocate and the case manager and is the first one to look at the holistic aspects of the person with the disease. Also, because nurses attend hospital patients 24/7, they play a central role in advancing the therapeutic process and encouraging patients to accept responsibility for self-care and their own health.

Q What was the profession like in Israel before academization?
A In the early days, every nursing school was adjacent to the hospitals.
The model was British – theoretical studies plus on-the-job training already in the first year.
Hospitals looked at the nurses as apprentices there to assist patients with the activities of daily living such as eating and showering. The nursing schools wanted to separate from the hospitals because of this, but the hospitals’ big fear was that they would lose working hands if the nurses learned too much and [that the nurses] would distance themselves from the patients. In the 1970s, when Israeli hospitals first started talking about academization, the Health Ministry was against it, and some doctors and nurses said, “You don’t need a BA to give a patient a bedpan.” Those who went to learn tried to hide the fact.

Q Did Israel’s first academically educated nurses in fact distance themselves from patients?
A No, what happened is that the first nurses who went and learned came from educational and
managerial positions, and afterwards they returned to their positions. Later on, bedside nurses went to learn and they returned to treat the patients. It’s very important that nurses will expand their knowledge and [also] stay by the bed of the patient.Especially today, when our patients are better educated, the nurse needs more knowledge, too. The expectations are higher. The period has finished where the doctor is a god and speaks in a language that the patient doesn’t understand; the nurse can explain something that the patient hasn’t understood, and then there is the aspect of emotional support – not just [the nurse’s] being nice, but also understanding the psychological process [of illness and healing]. It’s beyond Florence Nightingale.

Q Speaking of Florence Nightingale, why does someone choose to become a nurse? Why did you?
A Nursing is one of the most beautiful professions. It doesn’t just look at the illness, it takes a holistic view of the patient’s personality, it asks how the personality influences the patient’s talents, social skills, coping skills. Also, ours is a very diversified profession. On the one hand, a nurse can choose psychiatry, which requires communication skills, and on the other hand, the operating room, which requires mostly technical skills. Everyone finds what she likes, the babies, the elderly.

I learned at Hadassah Hospital in Jerusalem, and at that time [nursing] was [in my eyes] mystical.
I saw the nurses all in white taking care of wounded soldiers and patients in need. It was a romantic, not a rational choice.

Q How long does it take for someone to earn a BA in Nursing in Israel today, and what subjects are studied?
A The BA takes 3 years. The study program is composed of basic and life sciences — for example, anatomy, pathology, physiology, pharmacology, dietetics; psychological and social sciences ncluding communication, social work, and management skills; and of course, clinical training – edical, surgical, pediatrics, psychiatry, and so forth.

Q In addition to medical knowledge, what personal qualities does a nurse need?
A Motivation, passion, intelligence: the nurse must love to learn and develop! A nurse must also be caring, tolerant and empathic and be sufficiently mature to cope with life and death because many patients and families turn to the nurse to express their intimate concerns and problems along with their anger and frustrations. I believe a nurse also must have leadership skills, provide a personal example, and be a social activist.

Q Can empathy be developed?
A I believe that we can develop everything, leadership, empathy, everything! If we invest in caretakers, they will invest in sick persons. At Rambam, [empathy] is part of the organizational culture, it comes from the nursing and hospital management, from our respect for the patient and our belief in service. We use a questionnaire to conduct an annual statistical survey of patient satisfaction, and on the basis of the results, we continue to improve our [provision of] healthcare.

Q How does the Department of Nursing foster leadership?
A Our vision is to maintain the balance between the core values of nursing – patient-care and compassion — and the development of new roles and research that will advance the health of the
patients within the changing healthcare system. We have created tens of programs for staff development and hundreds of projects for quality improvement. For only one example, in answer to the problem of fragmentation in modern medicine that has arisen from specialized care, we have developed the role of Nurse Coordinator. We have 15 Nurse Coordinators at present, and each belongs to a sick patient 24/7, not to a department. In the case of breast cancer, for instance, the Nurse Coordinator accompanies the woman to diagnosis, to the oncologists, to the surgeon if necessary, and is available for every question or concern of the woman. One of our measures of success is the many thank you letters that we have received. For another example, in recent decades, Israel’s healthcare system decision-makers and the public at large have come to appreciate qualitative research performed on-site by hospital nurses as a resource for understanding the psychosocial experience of patients, developing innovative treatment methods, and improving administrative standards for care. Our Department actively encourages the nurses to conduct such research. In February 2008, approximately 300 RNs from Rambam and from the professional nursing community throughout Israel gathered at Rambam for Research Day, a first event of its kind.

Q What is your dream for Rambam?
A We already have a professional staff – excellent doctors, world-class nurses in terms of knowledge, expertise and a caring attitude, so we have made a huge jump.
Now the patients need better environmental conditions because in a hospital as dense as ours, the patients face loss of privacy; One patient has to vacate or vomit a few centimeters from another patient. It’s hard enough because of the illness! Someone who is sick deserves humane and respectful conditions that contribute to recovery.