“Doing What Needs To Be Done”: An Ethnographic Study Of The Roles And Work Of Mongolian Medical-Surgical Ward Nurses

Purpose: The purpose of this research is to identify the roles and work activities of nurses working in Mongolian public hospitals and to compare it to what is known about nurses’ work in other countries in order to inform policy and service development within the Mongolian health system.

Design: An ethnographic methodology, viewed through the lens of critical realism, was used to develop a description of medical and surgical ward nursing in public hospitals in Mongolia.

Procedure: 208 hours of participant observation and 9 semi-structured interviews were used to generate data from one medical ward in a secondary level care hospital and a medical and a surgical ward at a tertiary level care hospital in Ulaanbaatar. Constant comparison was used to identify activities nurses do and the roles they fulfill. To facilitate comparison with findings from other countries, an integrative literature review was undertaken to identify nursing work activities from an international perspective.

Findings: A model of Acute Care Nursing Work was developed that describes the work of medical and surgical ward nurses according to three core nursing functions: patient care, ward functioning, and professionalism. While these core functions are present both internationally and in Mongolia, Mongolian nursing was assessed as having more ward functioning activities than in many other countries.

Conclusions: Medical-surgical nurses on Mongolian public hospital wards are responsible not only for patient care, but for ensuring the ward functions in a way that meets patient needs. While some of these expectations have their roots in the Soviet model of nursing on which Mongolian nursing was founded, many work activities are the pragmatic result of nurses doing what needs to be done to facilitate the carrying out of doctors’ orders. As many of nursing’s roles and work activities are shaped not only by nursing policies and practices, but by medical practices, hospital funding, staff-mix, and government leadership, proposed changes to nurses’ work should done in concert with government, education, and health sectors. The Model of Acute Care Nursing Work can help with assessment and understanding of the roles and work activities of nurses and the factors that influence it.