A group of nurses and hospital administrators from Tbilisi, the capital of the former Soviet state of Georgia, recently visited the Georgia State University and Emory University nursing schools as part of continuing education program and partnership begun nearly a decade ago.

Called Partners for International Development and headed by Dr. Kenneth Walker of Emory University School of Medicine, the U.S. group is working in conjunction with Tbilisi's new Gudashuri Medical Center and the Iashvili Children's Hospital to increase the skills of the nurses responsible for patient care and nursing administration in these facilities. It is funded through a $1 million, five-year grant from USAID.

While in Atlanta, the group observed clinicals and tried their hand putting IVs in the nursing schools' simulated patient models, and watched and took notes on how nurses at Emory, Crawford Long and Grady hospitals organize their daily work flow.

"[In Tbilisi,] nurses - and the science of nursing - has chiefly been that of handmaidens to doctors," said Judith Wold, Ph.D., RN, who has helped administer and facilitate the program at both Emory and Georgia State.

In 1997, Wold was one of 20 American educators invited to Uzbekizistan to address the health care work force issues affecting the then newly independent states of the former Soviet Union. An original member of the nursing education team for Partners, she has maintained that contact over the years. Without an organizational structure and with limited education for their nursing graduates, nurses enter the health system from ninth grade.

Members of the group said they did not have a nursing shortage in Tbilisi - but what they did have was a lack of professional development and organizational structure. The visits by nurses and administrators are a hope to stimulate change in the country's nursing education structure, as well as create a workflow organizational structure in their respective facilities.

"Nurses don't have specialization or job descriptions," said Lida Kalmakhelidze, clinical nurse manager for emergency services at Gudashauri NMC. "They often don't know who's responsible for what."

While the ER in her hospital deals with many of the same types of problems that U.S. hospitals do, she noted that the ER staffs she observed in metro Atlanta were "more flexibile and had a better organizational structure."

The next step, said the nurses, is to bring back these organizational ideas to their hospital's CEO, and "try and convince him that each piece of the structure is important to the proper management of a hospital."

Wold said the program is looking for nurse educators in the United States and possibly a retired nurse who is a former nurse administrator to go to Tbilisi for a few weeks.

"We are always looking for people who know how to teach. Another contingent is going [to Tbilisi] this January," she said.

For information, contact Wold at jwold@emory.edu.