You are invited to become part of a once-in-a-lifetime experience: a custom-designed introduction to healthcare and nursing in Poland and Hungary traveling May 2018. Enjoy the unique culture and traditions of Eastern Europe while you spend time with the locals. Discuss current nursing and healthcare challenges in each country. Healthcare professionals, as global citizens in the 21st century, need to understand universal health care issues such as poverty, hunger, malnutrition, illiteracy, and access to health care before global healthcare goals can be achieved.   Giving back and engaging with the local community is an important part of your journey: you will have an opportunity to interact with a local non-profit organization or community project. Explore iconic sites in both cities including Old Town, Castle Square & the Church of the Holy Cross where Chopin’s heart is held in Warsaw. St. Stephen’s Basilica and Matthias Church in Budapest. Join us to explore nursing and healthcare! ​A maximum of eight (8) hours of continuing nursing education contact hours will be awarded for this journey for nurse participants completing all requirements.

IncludedNot Included
Information and support  to aid in your travel preparation

Costs to obtain a passport

Exclusively developed professional program in collaboration with Journey leader

International airfare (from designated US gateway city)

Airfare for domestic flight to gateway city

All in-country transportation for the group (including airport transfers)

Accommodations in four to five star hotels

24/7 professional English speaking guide

Individual departure taxes (where applicable)

Fees for all services, most tips and taxes

Professionally led daily program – see itinerary for full details

Travel insurance

Daily breakfast and most lunches & dinner, as specified in the itinerary

10-20 Hours of professional exchanges with counterparts in host  country

Formal and informal meetings with your peers to increase your global knowledge of your profession

Unique insight and knowledge about current issues and challenges related to your profession

24-hour support from US Nanda Journeys office and in-country support

Partnerships in every country to which we travel

Note: this journal was compiled based on information provided to delegates during professional host visits, by local tour guides, and with thanks to Wikipedia and other online informational sites.  Factual validity cannot be guaranteed.

Friday, May 18, 2018

The following 9-person international healthcare delegation (7 delegates and 2 guests) began their travel to Hungary/Poland today as part of the Nanda Journeys Nursing Journey Career Enrichment travel program:

Dr. Carol Huston
Tom Huston
Carl Pittman
Pamela Pittman (guest)
Dr. Carole Ann Shea
John Oakes
Dr. John Sutton
Janis Sutton (guest)
Corinne Lanoye
Traveling independently from California, Connecticut, and France, delegates met at the JFK airport in New York in late afternoon to begin their journey to Budapest, Hungary.  The 7-hour flight left at 5:30 p.m. and with the 9-hour time change, arrived in Budapest shortly after 8 a.m. on the 19th. 

Saturday, May 19, 2018

Delegates were met at the airport by local guide Erika Mausch and transported to the Arcadia Hotel in the heart of Budapest. After a late breakfast at the hotel and a few greatly needed hours of rest, delegates met for dinner at the nearby Első Pesti Rétesház Restaurant (Strudel House). Opened in 2007, in the heart of ‘Pest’, the Strudel House is set in a lovely historical building dating back to 1812. Strudel preparation in Hungary is a tradition and art that dates to the 15th century.
Sunday May 20, 2018

After a buffet breakfast at the hotel, delegates and guests began a day of exploring Budapest and learning about Hungary. We began with Heroes Square, which was built in 1896 to mark the 1000th anniversary of Hungary. The Millennium Monument in the middle of the square was erected to commemorate the 1000-year-old history of the Magyars. Archangel Gabriel stands on top of the center pillar, holding the holy crown and the double cross of Christianity. The seven chieftains who led the Magyar tribes to Hungary can be seen on the stand below. Statues of kings and other important historical figures stand on top of the colonnades on either side of the center pillar. When the monument was originally constructed, Hungary was part of the Austrian-Hungarian Empire and thus the last five spaces for statues on the left of the colonnade were reserved for members of the ruling Hapsburg dynasty. The Hapsburg emperors were replaced with Hungarian freedom fighters when the monument was rebuilt after WWI.

A buffet lunch was provided at Trófea Grill Restaurant near the foot of Margaret Bridge in ‘Buda’.

In the afternoon, our tour included the Buda Castle Quarter which houses the 700-year-old St. Stephen’s Basilica, Matthias Church and Fisherman’s Bastion. The basilica was named after Saint Stephen who became king of Hungary in 997, and the Fisherman’s Bastion provided an incredible panoramic view of the distinctive building of the House of Parliament, with its seven towers representing the seven Magyar tribes that settled in the Carpathian Basin in 896.

Things we learned from our local guide:

  • Hungarians originally emigrated from the Ural Mountains in Russia.  The population then split with many traveling north to Finland and the remainder staying in Hungary
  • Hungary was one of the most powerful and rich countries in the world in the 15th century.
  • Budapest is a city of 1.8 million people.
  • Hungary has a population of 10 million.
  • Roman Catholicism is the predominant religion.
  • The subway system in Hungary is the oldest electrified underground railway system on the European continent, and the third-oldest electrically operated underground railway in the world, having been established in 1869.
  • The minimum income allowed in Hungary is 350 Euro/month.  The maximum is 750 Euro/month.
  • An average apartment in Budapest costs 400 Euro/month so most single people have multiple roommates and multiple generations of families living together is common.
  • The Chain Bridge that separates “Buddah” from “Pesh” is flanked by stone lions at each end. The statues of the four lions that guard each end of the bridge are said to have no tongues. Wikipedia suggests that less politically correct commentators will claim that they once had tongues, but they were stolen by Gypsies. The legend has evolved, it is said that upon hearing that his lions had been sculpted with no tongues, the artist,  János Marschalkó, killed himself. The same fate was said to have befallen the bridge’s primary engineer, Péter Wellner, who – as the legend goes –  also did himself in when he discovered that he had not ordered enough material for the bridge to expand the full width of the Danube. Neither legend is true.
  • To live in the Castle district, inhabitants must inherit the property.
  • The Parliament building in Budapest is 96 meters high as is the Basilica.  No building in Budapest can stand at over 96 meters (314.9 ft) tall. This is thanks to regulations which restrict building height, and the fact that it was in 896 that Hungarian Magyars first came to the area, and the first stages of the Hungarian Kingdom were born.
  • Out of over 8 million men mobilized in Austria-Hungary in WWI, more than one million died during the course of the war. In Hungarian areas, this meant a death rate of 28 per 1000 persons - a level of loss exceeded within Austria-Hungary only by German Austrians.
  • 2/3 of the buildings in Budapest were destroyed during WWII and 5% of the total population died.
  • The Hungarian Nazi party began to deport the Jews in March 1944.  Many Jews were relocated to ghettos in 1944 and 1945. The detainment, torture, and murders of Jews was also carried out in the House of Terror, in downtown Budapest. The site is now a museum with exhibits related to the fascist and communist regimes of 20th-century Hungary and is also a memorial to the victims of these regimes.
  • There is a 27% sales tax in Hungary, an 18% hotel tax, and 14% tipping is common.  The income tax is 33%, but this covers retirement, healthcare, and education for all.
  • The currency of Hungary is the Forint. At the time of our visit, 1 Hungarian Forint equaled 0.0038 US Dollar, so approximately 265 Forints = $1.
  • There are 46 letters in the Hungarian language.

Dinner was by individual arrangement although the delegates decided to dine together at The Spoon restaurant on the Danube. This venue provided a great view and wonderful food.

Monday, May 21, 2018

Following a buffet breakfast at the hotel, delegates visited the ORFI Hospital & Institute. This hospital is the headquarters of the National Institute of Rheumatology and Physiotherapy, a specialty facility offering a variety of patient care services as well as training in the healthcare arena. They have a variety of departments including a Rheumatology Department, Central Physiotherapy Unit, Department of Clinical Immunology and Rheumatology, Intensive Therapeutic Department, Rheumatology Rehabilitation Department, a central laboratory, MRI Lab, the ORFI Osteoporosis Center, and other administrative departments. The Central Physiotherapy Department for example, provides practical training and examinations of physiotherapeutic assistants and massage therapists, in which their practitioners take an active role. Since 2007, the department has been accredited for postgraduate medical education.

There are 370 staff and 402 beds, all inpatient. The hospital was downsized from 1000 beds in the last five years.  There were no patients present in the therapy units we visited today since it was a national holiday in Hungary.  Most staff had the day off, and the patients were allowed to go home and return after the holiday. The average length of stay for patients is two weeks for the initial diagnosis and treatment, but patients may stay longer if more extensive rehabilitation is needed.

Mrs. Terbéné Szekeres Klára, Nursing Director of the hospital and Mrs. Ridegné Cseke Írén provided a presentation to delegates discussing nursing education models in Hungary.  

We learned:

  • Florence Nightingale started nursing in Hungary.
  • Kossuty Zsuzsanna (1817-1854) was a famous Hungarian nurse instrumental during the uprising in Hungary.
  • Actual training for nurses pre-1945 occurred only for midwives and health visitors.  Whatever training was available for nurses, was provided by the churches.
  • The centralized formalization of nursing education began between 1945 and 1950, with most requiring 24 months of general training. Schools of nursing were not organized, however, by the Health Care Ministry until the 1970s. At that time, most nurses entered programs to study nursing at the age of 14 and completed four years of training that also included a high school education.  Passing the high school exit exam (GCSE) was required for graduation.
  • Vocational nursing programs began in 1993.  This training was paid for by the government.
  • Hungary transitioned from a vocational training program to a bachelor’s degree as entry to practice with the country’s induction into the EU and adoption of the EU’s Bologna process in 1999. The Bologna Process was a collective effort of public authorities, universities, teachers, and students, together with stakeholder associations, employers, quality assurance agencies, international organizations, and institutions, including the European Commission to establish a three-cycle educational system (bachelor/master/doctorate), to strengthen quality assurance, and to create commonality between educational qualifications and periods of study across the EU.
  • As part of the Bologna transition, vocational nurses could enroll in “lifelong learning” programs to upgrade their education. These educational upgrades typically required an additional 1-2 years of training depending on whether the student had an earned high school degree or if the vocational training occurred as part of high school.
  • Students applying to nursing programs in Hungary must complete high school exit exams.  There are 480 points possible on the application.  In addition to the high school exam score, students can earn extra points for foreign language skills, writing awards, and the completion of prior science or nursing courses. Entrance into public universities require higher scores than private universities.
  • The typical BS program in Hungary is 7-8 semesters and requires 210-240 academic units.  A master’s degree in nursing takes three semesters to complete and requires 90-120 credits.
  • “Retraining” is required every five years.  Some of this retraining is required content and CPR. Other training involves choice of content.
  • Leadership and management are not taught at the undergraduate level.
  • Salaries are the most significant problem for nurses in Hungary with most nurses earning the equivalent of about $500/month.  Many of those nurses who complete their education in Hungary migrate to other countries to work for higher salaries, leaving Hungary with a severe nursing shortage.
  • Nursing is considered a low status occupation in Hungary.
  • 90% of the nurses in Hungary are female.
  • 40% of Hungarian nurses currently have a bachelor or master’s degree.
  • There are public and private hospitals in Hungary.  Typically, public hospitals have lower quality outcomes and long waits for treatment.

Lunch was provided at a local restaurant

In the afternoon, delegates met with Mrs. Judit Hegedus, Head Nurse and Director of Nursing and Patient Care at the Tabitha Child Hospice in Torokbolint, Hungary, a suburb of Budapest. Tábitha House is a non-profit, full-service home for incurable children and their families.  It opened its doors on September 2011 when the founder donated his personal home as their headquarters and funded its operations. A palliative care license was granted in 2014.

Tabitha House is the largest pediatric hospice institute in the country (five beds), and plays an important role in the treatment of terminally ill children both due to its assignments and its location.  The long-term goal is to increase the facility to seven beds. (The other pediatric hospice is 200km from Budapest, has only two rooms, and does not have an MD on staff).

Currently the House is operated by a new owner, Baptist Aid as the Tabitha Non-Profit LLC. All their services are free of charge for the infants, children and adolescents living with life-threatening illnesses. Their goal is to surround the children with expert medical care and nurturing support. A secondary goal is to emphasize family care, not just sick child care. Services include end of life care, respite care, day care, transitional care, sibling therapy, 6-12 hours of day care and psychological support. There are 15 nurses, 1 psychologist, 1 physiotherapist, 1 specialized teacher, and 21 volunteers on staff.

Four of the five beds are typically used for respite and one is reserved for end of life. With end of life care, the family can move into a small unit in the house that has a bedroom and a kitchen.

Ms. Hegedus (Judit) began her presentation by comparing GDP and morbidity/mortality statistics between Hungary and US.  She also provided additional information about the training of nurses in Hungary.  She noted that while the first BSN in the USA was earned in 1909, that same hallmark was not achieved in Hungary until 1989.  The first prepared midwife graduated in Hungary in 2006.  Midwife and nursing education are completely separate. Judit also shared that while she sees an important role for nurse practitioners in Hungary to supplement the MD shortage, this model does not currently exist, and Judit believes that society is not yet ready to accept the nurse in this role. That said, master’s prepared nurses have been able to write prescriptions, make diagnoses, and do physical exams on patients since 2016.

Judit then shared the following information about pediatric hospice in Hungary as well as the Tabitha House:

  • The Hungarian hospice movement was founded in 1991.
  • Hospice financing was assumed by the National Health Insurance Service in 2004, but only for adults.
  • There are 90 hospice organizations for adults in Hungary, but only one for children.
  • There are 17 inpatient palliative care units with 10-15 beds each.
  • The WHO recommends 600 hospice beds for Hungary, but there are only half of that.
  • It was not until 2017 that pediatric hospice/palliative care became funded by the government.
  • The five beds in the Tabitha House must serve the 2.1 million total children aged 0-21 in Hungary. In 2017, 73 children were admitted to Tabitha House.
  • Currently, 1/3 of Tabitha House expenses are funded by the government, 1/3 is funded by Baptist Aid, and 1/3 is funded by private donations.
  • Hospice is reimbursed at a rate equivalent to $72USD per day and is limited to 150 days of coverage.
  • Respite is limited to 28 days per year.
  • Both Judit and the Medical Director (MD) are on call 24hours/day for families who are not yet ready for admission or for whom there are no beds.  No outpatient care is formally available yet.
  • More than 200 families have been served by Tabitha House to date.
  •  More than 4,000 patient care days have been provided, without family members present .
  • 30% of the patients are oncology patients; 20% have neuromuscular diseases, 20% have CNS disorders, and 30% have other diagnoses.
  • The Velux Foundation donated 731,000 Euro in 2016 for reconstruction/ enlargement of the Tabitha House to 10 beds, but by the time the gift was received, the estimated cost for the reconstruction had doubled.  Fundraising must continue.
  • The ratio of caregiver to children is 1:2 at Tabitha House as compared to 1:6-7 in acute care hospitals.
  • We saw a memory stone garden on our tour which had children’s names painted on them in their memory.  A similar memory tree with displayed in the front hall of the House, memorializing children who died at Tabitha House.
  • Tabitha House hosts several memory events each year for families who lost a child at the hospice.

A dinner cruise on the Danube was provided this evening. There was a wonderful buffet of foods, live music, and incredible views of the city at night, but the highlight was likely Erika demonstrating her expert folk dancing skills… with a little help from Carl.

Tuesday, May 22, 2018

We headed to the airport early this morning, leaving Erika behind, to begin our travel to Poland. Our Polish Lot flight took just over an hour, landing in Warsaw at 11:15 a.m. Our local guide, Mr. Andres Andrzej, was at the airport to greet us. Our first stop was a gingerbread shop, where we hand-decorated gingerbread ornaments and drank coffee from gingerbread cups. Some delegates purchased ornamental gingerbread wall hangings and ornaments to take home.  This was a fun way to start our time in Poland.

Delegates were then treated to a late lunch at a restaurant where a plethora of Polish foods were served. The group was then escorted to our hotel, the Golden Tulip, which was is in the business district of Warsaw, near the Millennium Plaza, Warsaw Spire, Warsaw Trade Tower, and Euro Centre.

On the bus ride, we learned that:

  • The number of Jews in Poland on September 1, 1939 was about 3,474,000 people.
  • One-fifth of the Polish population perished during World War II, half of them were the 3,000,000 Polish Jews killed in The Holocaust. Many Roman Catholics were also killed.
  • Of the 1.3 million population in Warsaw during WWII, 800 thousand people died.
  • 85% of Warsaw was destroyed in WWII
  • Poland has only been a free/independent country for 29 years (since 1989)
  • For centuries, Poland was home to the largest and most significant Jewish community in the world. Poland was the center of Jewish culture, thanks to a long period of statutory religious tolerance and social autonomy. This ended with the Partitions of Poland which began in 1772, in particular, with the discrimination and persecution of Jews in the Russian Empire
  • There was a nearly complete genocidal destruction of the Polish Jewish community by Nazi Germany and its collaborators during the 1939–1945 German occupation of Poland in WWII and the ensuing Holocaust.
  •  Since the fall of communism in Poland, there has been a Jewish revival, characterized by the annual Jewish Culture Festival, new study programs at Polish high schools and universities, the work of synagogues such as the Nożyk and the Museum of the History of Polish Jews. Some discrimination, however, continues to exist.
  • The Polish Zloty is the currency of Poland. During our trip, $1 US =3.57 Zloty.

The remainder of the evening was free.

Wednesday, May 23, 2018

Delegates met this morning with Bozena Czarkowskar Paczek, MD, PhD, the Dean of Nursing at the Medical University of Warsaw. This modern academic center with 8,500 students, has 25 research and didactic units and offers a broad range of degrees including nursing specialties. It is one of 11 medical universities in Poland. The nursing division had a department of basic nursing, clinical nursing social nursing, nephrology nursing and surgical and transplantation nursing.

The Dean shared that:

  • There are 420 publicly funded nursing programs in Poland and 100 private.  The university education is free.
  • To enter nursing, applicants must pass the high school exam.  This is the only required criteria and scores typically determine ranking for admission.
  • Both bachelor and master’s degrees in nursing are offered at the Medical University.
  • The bachelor’s degree is 180 units with 4600 hours of clinical and theory (a total of 4720 hours).
  • 1/3 of the units are theory and 2/3 are clinical.
  • 120 hours of English language coursework is required.
  • A Bachelor’s degree has been the accepted entry level into nursing since Poland entered the EU in January 2004 and adopted the Bologna agreement.
  • Nursing students have MDs, nurses, and psychologists as their faculty.
  • Students often spend 12 hours a day in the classroom and clinical setting (0800-2000) to earn the bachelor’s degree.
  • The bachelor’s curriculum is organized around KSBs (knowledge, skills, and behavior). There are 168 knowledge objectives, 151 skills objectives, and 10 behavioral objectives.
  • The bachelor’s curriculum encompasses 16 credits of basic science, 16 credits of social science/English, 24 credits of basic nursing, 34 credits of specialty nursing, 55 clinical credits, 30 professional practice credits, and 5 credits for the final exam.  This totals 180 credits.
  • Only 250 of the typical 500 applicants to the bachelor’s program are accepted. Of the 235 students who actually start the program, only 185 usually graduate.
  • 160 hours of simulation center practice is provided for bachelor’s students before they enter the hospital.
  • Although there are only three palliative care centers in all of Poland, students in the bachelor’s program have one required credit in this specialty area… so clinical placements in palliative care can be challenging. So too can placements for acute care pediatrics.
  • A maximum of 35% of the bachelor’s curriculum can be taught by self-study (not in the classroom or clinical setting).
  • There is no culminating NCLEX exam for the bachelor’s degree. Passing school exams qualifies the graduate to work as a nurse.
  • 5% of the nurses in Poland are male.
  • The Master’s program lasts at least 4 semesters, has 120 credits, and 1300 hours total.  No self-study is allowed.
  • The 63 credits in the master’s curriculum consist of 17 credits of social sciences, 18 credits of specialty nursing, 8 credits of professional practice, and 20 credits of final exam/thesis defense.
  • The 625 hours of master’s clinical content includes teaching skills, pharmacology, geriatrics (long term care and rehabilitation), and epidemiology.
  • A bridge study program was created for vocational nurses to earn bachelor’s degrees in 2006 to comply with Bologna standards.  This program was stopped in 2016 in public universities as the government felt 10 years was long enough to subsidize the educational upgrades.  Bridge studies are still offered at private schools.
  • Poland has a complex and sophisticated accreditation system in higher education.  Both internal quality assurance (overseen by the rector) and external accreditation (by the Polish accreditation committee and the state accreditation committee) are required. National accreditation lasts a maximum of five years.  Accreditation criteria include concept of the field of study, the study program itself, internal quality assurance methods, in country cooperation, internationalization, teaching infrastructure, student support, and learning outcomes.
  • Nursing is the only major required to have two accreditations.
  • The nursing shortage in Poland is the worst in the EU. This is primarily due to salaries.  Polish nurses earn approximately $10,000 US equivalent per year although the cost of living in Poland is comparable with the US. With Polish nurses earning only 20-30% of their counterparts in other EU countries, migration out of Poland is rampant. Destination countries are frequently Germany and England. Some graduates simply never work in nursing as they cannot support themselves or a family on that salary. There is no salary differential for having a bachelor’s degree over a vocational degree.
  • The average age of practicing nurses in Poland is 50-55 years so a tremendous shortage exists, that will get even worse shortly.  Currently, 60,000 more nurses are needed.
  • There are approximately 25-30 PhD educated nurses in Poland.
  • Leadership/management is taught at the master’s level only.
  • The nurse midwife program is totally separate from the bachelor’s program.  Students do not intermix.
  • There are no nurse practitioners in Poland, but master’s educated nurses can prescribe independently per formulary or refill prescriptions.
  • MD training takes six years, 5500 hours of training, and requires 200 hours of English language training.  There is a one-year internship.  Because of a recent labor strike by young doctors several years ago, they are now earning more than many specialists.

Lunch was at a local restaurant in Warsaw’s Old Town. 

After lunch, delegates met with the officers of the Main Chamber of Poland, which would be equivalent to the US American Nurses Association, although it is not a trade union. 

We learned:

  • The goal of the Chamber, established in 1991, is to promote high standards in nursing.
  • There are 222,000 working nurses in Poland and 27,000 midwives.
  • With a population of 38 million in Poland, there are 5.2 nurses per 1000 people as compared to 9.4 per 1000 in the rest of the EU.
  • The average age of Polish nurses is 51 years old.
  • No auxiliary or support workers are used in Poland, only nurses and doctors.
  • Low salaries for nurses is the biggest healthcare problem.  Nurses have protested, wearing black clothes, to bring attention to the problem.  With a salary of equivalent $1100 per month and 40% deduction for taxes, the take home salary for nurses is among the lowest in Poland.  There is little pay difference between public and private hospitals although salaries are a bit higher in the cities than in rural communities.
  • Low salaries lead to migration---- 20,000 nurses migrated out of Poland after induction into the EU. Few migrate into Poland because of the low salaries and because of regulations that migrants must speak Polish and meet the legal right to work standards.
  • The RN to patient ratio in hospitals may be 1:20-30. 1:20 is most common.
  • Although nursing was identified by the Polish populace as the 3rd most esteemed position (doctors ranked #7), most parents would “feel sad if their daughter chose to become a nurse, because she would be doomed to a life of poverty.”
  • All nurses must join the union by law. Union dues are 1% of the salary (equivalent to $5-$6 per month).
  • The Bologna agreement and complex accreditation requirements assure high standards in nursing education.  It is likely the greatest strength of Polish nursing education.
  • Poland graduates 5,000 new nurses each year, but this is only half of what is needed.
  • There are seven approved specialties for master’s educated nurses.
  • Polish healthcare issues/concerns include care for the aged, a declining birth rate, and an aging society.
  • The Chamber has authored a Code of Professional Ethics of Nurses and Midwives in the Republic of Poland in English.  A copy was provided to the delegates. A card of Patient Rights also exists.
  • For nurses with chemical addictions, temporary suspension from work and rehabilitation are available.

Thursday, May 24, 2018

After a wonderful buffet breakfast at the hotel, delegates met with staff from the Department of Nurses and Midwives of the Ministry of Health (MOH) as well as District nurse leaders in epidemiology. The Ministry regulates national healthcare policy and oversee the state-financed system including the National Health Fund.  It is also responsible for overseeing the labeling and safety of medical goods and services.
The Department of Nurses and Midwives of the MOH collects and analyzes data on nurse and midwifery professions; conducts and supervises matters related to post-graduates and  the post-graduate education of nurses and midwives; cooperates with external entities in these professions; cooperates with the Polish Accreditation Commission and the National Accreditation Board of Nurses and Midwives in accrediting nursing and midwifery programs;  and performs tasks related to the activities of national consultants in the field of nursing and midwifery. They also oversee matters regarding the determination of the procedure for the treatment of the right to practice the profession of nursing and midwifery for the country.

Of note, starting in January 2016 nurses were given the authority to write prescriptions in Poland. Such competence came to place due to an amendment to the Act on Professions of Nurse and Midwife, which passed in July 2014. The change qualified nurses and midwives who hold a master’s degree to write prescriptions autonomously while providing care to their patients. Nurses and midwives with a bachelor’s degree are now able to write refill prescriptions, as a continuation of treatment already ordered by a physician.
Ministry staff shared:

  • The Ministry created a document in March 2017 that identified seven priorities for action for Polish nursing.  These funded priorities included: undergraduate nurse training; role/competence for nurses; employment norms; qualifications of nurses; working conditions and remuneration for nurses; the establishment of a new caretaker/nurse’s aide system, and nurse migration.
  • There were 7,679 student nurses in Poland in 2012/2013 but less than half finished (N=3,199). Retention is a real concern.
  • The average age of the working nurse in Poland is 50-55 years, so far more are expected to retire than graduate in the next few years.
  • There are 5.4 nurses per 1000 people in Poland, as compared to 9 per 1000 in the EU overall.
  • The educational standards in Poland are the greatest strength in nursing.
  • There is no government regulation of staffing standards.
  • All medical records in Poland are electronic.

The group then began a cultural tour of Poland. We delved into WWII history learning about Polish nurse, humanitarian, and social worker, Irena Sendler, who served in the Polish Underground during World War II in German-occupied Warsaw. Irena’s efforts to rescue Jewish children during WWII were only discovered in the past decade, but a street has been dedicated in her name and she is now recognized as a hero in the war. 

Delegates also viewed the “Warsaw Will Remain” film at the Warsaw History Museum. The museum is housed in 11 tenements, which show the history of the city since its founding to modern times. The short movie provided a glimpse into Warsaw during the war and the struggles they had to rebuild after the incredible devastation the war had on not only on its infrastructure, but to the people as well.
We also visited Old Town and Castle Square, home of the Royal Castle, where in 1791 the first European constitution was signed. We also saw St. John Cathedral, the Ghetto Memorial, the monument of the Warsaw uprising, the Tomb of the Unknown Soldier; and walked through Royal Lazienki Park. We enjoyed the lunch break at the Kwiaty Polskie Restaurant in Old Town. 

Delegates were then treated to a surprise visit to the newly built (three years old) Children’s Memorial Hospital in Warsaw.  This public facility, which was built by the Warsaw Medical University, has 1,600 employees, and 330 inpatient beds. There is an average length of stay of seven days.  Approximately 180 patients visit the ED every day, of which 60 are admitted.  This mission of the hospital is to “never say no to a patient or family member.”

The hospital is unique in that it is affiliated with the Ronald McDonald House.  Thus, there are 500+ beds for family members, as well as dedicated kitchen units. This hospital is the first in Poland where no parent is forced to sleep on the floor. There is also a heliport on the 7th floor, and 10 operating rooms. 

The hospital provides both acute care for sick children and obstetric services (pre-term and normal labor and delivery). All mothers are encouraged to breastfeed.

The nurse to patient staffing ratio is 1:6 but can be high as 2:1 for critically ill children.  Staffing is determined by the use of acuity scoring from 1-4. Nurses work 12-24 hour shifts and typically work one-day shift and one-night shift before having two days off.

The hospital housed two law offices.  Patient complaints are reviewed by a commission established for that purpose.  If malpractice is found, patients are offered a minimum compensation of 30,000 zloty, paid directly by the hospital. If patients refuse that amount, they can go to court, but the court does strongly consider the opinion of the commission.

Dinner was provided at the Grand Kredens Restaurant near the hotel. 

Friday, May 25, 2018

After breakfast, delegates had the opportunity to stop at a small, but locally well-known donut shop for the world-famous Polish donuts.  These donuts had a fruit filling and were wonderful.

Delegates then began their 75-minute bus trip to enjoy the Masovian countryside and explore the small villages of Brochów and Żelazowa Wola. Brochów lies near Zelazowa Wola in an area with an idyllic country atmosphere and numerous winding streams surrounded by willows and hillocks. The Brochów village’s most prized monument is the St. Roch and John the Baptist Parish Church - a unique gothic- renaissance style structure that connects sacral and defensive functions. It is here that Frederic (Fryderyk) Chopin's parents were joined in marriage and the composer himself baptized. The town has a population of approximately 400 and is also known for being the site of the successful 1939 cavalry charge against German infantry by the 17th Wielkopolska Uhlan Regiment during WWII.

 Żelazowa Wola is just 29 miles west of Warsaw and the birthplace of Fryderyk Chopin.

Chopin’s childhood home included a small annexed museum devoted to his life and was surrounded by a park with a statue created by Polish sculptor Józef Gosławski. Some delegates were thrilled when local squirrels and birds literally ate out of their hands.  In addition, peacocks strolled across the property.  What a lush and beautiful setting.

Lunch was provided at Przepis Na Kompot Restaurant in Żelazowa Wola. They are known for their use of farm fresh produce, especially fruits from nearby orchards.

The group then returned to Warsaw for a Chopin piano concert at the historical building of the Royal Lazienki Park along the Royal Route.  Some brief shopping in Old Town followed.  

 After a brief rest at the hotel, the group traveled to Andres’s home for dinner with his family. A feast of Polish foods was offered as well as a warm welcome. We so appreciated the hospitality of Andre and his family for our farewell dinner.

Saturday, May 26, 2018
The delegation was up early to leave for the airport. We left Warsaw at 12:25 p.m. and after an uneventful 8 ½ hour flight, landed in JFK at 3:40 p.m.  Some delegates were able to drive home from there, but some had an additional six hours of flying to the west coast to get home.

This trip was an amazing and wonderfully exhausting adventure.  We learned a great deal about both Hungary and Poland; their people, their healthcare system, and their history. New friendships were formed, and old friendships were renewed.  New collaborations were achieved and both personal and professional goals were achieved.  Thank you to Nanda Journeys, for giving us the opportunity to travel to both countries and meet the lovely people there.  Thank-you too, to the delegates who participated in this adventure.

What's Included

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Nursing Journey to Poland and Hungary, led by Dr. Carol Huston

Detailed Itinerary

Rooming Options

Warsaw Poland & Budapest Hungary| 9 days | May 18-26, 2018 | $4,999

CNE Credits

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8.0 Continuing Nursing Education Contact Hours 

** Nanda Journeys and the University of Pittsburgh School of Nursing are collaborating to develop this educational activity.  A maximum of eight (8) hours of continuing nursing education contact hours will be awarded for this journey for nurse participants completing all requirements. The University of Pittsburgh School of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC) (PO229). **

Day 01: Depart for Hungary
Depart from New York today and fly to Budapest, Hungary. ​

Day 02: Budapest, Hungary
Upon arrival this morning at the Budapest Ferenc Liszt International Airport, you will be met and greeted by a local representative and transferred to your local hotel for lunch by individual arrangement. Please note: early check-in has been confirmed for your comfort and convenience.

Enjoy some free time with lunch on your own today. All travelers will gather late this afternoon with your national guide for an early afternoon orientation and welcome. 

Your hotel Carat Boutique Hotel is located in the very center of Budapest (VI. District) and a short walk to the Deák Ferenc Square, Budapest’s most important transportation hub. The hotel offers unique services and amenities such as free high speed WiFi internet access, soundproof windows, minibar, in-room safe (for laptops), individually adjustable air-conditioning, bathroom amenities and a hair dryer.

Overnight:  Carat Boutique Hotel​ (or similar)
Meals: Dinner

Day 03: Budapest - Cultural Exploration

This morning the group will explore St. Stephen’s Basilica, Matthias Church and Fisherman’s Bastion. The Banks of the Danube, together with the Buda Castle Quarter and Andrássy Avenue, have been listed on the UNESCO World Heritage Site and are your first stop today. The Buda Castle Quarter includes the 700-year-old Matthias Church with its graceful architecture and delicate turrets. the Holy Trinity Square and the domed Buda Palace that looms over the city atop Castle Hill as well as the Fisherman’s Bastion – one of the top Budapest attractions with the best panoramic views of the distinctive building of the House of Parliament. Its seven towers represent the seven Magyar tribes that settled in the Carpathian Basin in 896. ​

Explore the largest church in Budapest, St. Stephen’s Basilica that reflects both a neo-classical and neo-renaissance style of architecture. The basilica is named after Saint Stephen who became king of Hungary in 997.

Lunch will be provided at a restaurant near Central Market Hall. You will have some time afterward to explore the market. Built at the end of the 19th century, it is the largest indoor market in Budapest and has a wonderful food market that is a must-see, even if you don’t buy anything.

Enjoy some free time and dinner on your own this evening.

Overnight:  Carat Boutique Hotel​ (or similar)
Meals: Breakfast, Lunch

Day 04: Budpaest - Professional Program
Professional members of the program will interact with nursing counterparts this morning and afternoon for substantive meetings at a local hospital, clinic or university like Semmelweis University’s Nursing Department. Founded in 1769, the Faculty of Medicine is Semmelweis University's oldest and largest faculty. 

Lunch will be provided today.

Guest program
After breakfast, accompanying guests will explore the Great Synagogue including the Emanuel Trees. The Synagogue is the largest in Europe and the second largest in the world. It was built in Moorish Revival or Neo-Moorish style, in the wake of Romanticism. Visit the Hungarian National Museum with your local guide. Founded 200 years ago, the museum is dedicated to the history of Hungary and has permanent exhibition includes furniture, textiles, weapons, metalwork and ceramics.

Enjoy a dinner cruise sailing along the Danube River to take in the gorgeous scenery. 
Overnight: Carat Boutique Hotel (or similar)
Meals: Breakfast, Lunch, Dinner

Day 05: Travel to Poland
This morning the group will make your way back to the airport for your short flight to Warsaw, Poland. Say goodbye to your local guide as you will be met upon arrival by your guide in Poland.

Enjoy an afternoon foodie tour including lunch. Learn about the local cuisine as well as discover history of the dishes and cultural influences.

The centrally located Polonia Palace Hotel also offers free high speed WiFi internet access, complimentary water in the room, bathroom amenities, hairdryers, an in-room safe as well as onsite business center, restaurant and bar.

Dinner is by individual arrangement (own expense).
Overnight: Polonia Palace Hotel (or similar)
Meals: Breakfast, Lunch

​​Day 06: Professional Program - Warsaw
Professional members of the program will interact with nursing and allied medical counterparts this morning and afternoon for substantive meetings at a local hospital, clinic or university.

Meetings will be requested with facilities such as the Medical University of Warsaw and the Department of Nurses and Midwives of the Ministry of Health (or similar).

Lunch will be provided today.

Guest program
After breakfast, accompanying guests will depart for a guided orientation of Warsaw’s local flea markets to get a sense of everyday life in Poland. Spend time this afternoon in the Wilanów Palace, which serves as a branch of the National Museum. Wilanów Palace, a splendid example of Baroque architecture, was built in the 17th century as a summer residence for King Jan III Sobieski, prominent Polish sovereign and victor over the Turks in the Relief of Vienna in 1683. Take a day trip to the palace, which serves as a branch of the National Museum. Żelazowa Wola, the 1810 birthplace of Polish composer and virtuoso, Frederic Chopin, is a charming village on the River Utrata, bordering the Kampinos National Park.

Enjoy dinner in the home of a local Polish family including a chance to share in the cooking duties.

Overnight: Polonia Palace Hotel (or similar)
Meals: Breakfast, Lunch, Dinner

Day 07: Cultural Exploration
The group will discover the beauty of Warsaw during visits to Old Town and Castle Square, the house of Madame Curie, St. John Cathedral and Market Square.

Enjoy a nice lunch break at a local restaurant this afternoon.

See the Royal Castle, where in 1791 the first European constitution was signed; visit the Ghetto Memorial, the monument of the Warsaw uprising and the Tomb of the Unknown Soldier; and walk through Royal Lazienki Park, Chopin's monument and Belvedere Palace.

Dinner will be provided this evening. Immediately following, the group will enjoy the private Chopin piano concert, a highlight of your stay in Warsaw, at the historical building of the Royal Lazienki Park.
Overnight:  Polonia Palace (or similar)
Meals: Breakfast, Lunch, Dinner

Day 08: Warsaw, Cultural Exploration
This morning visit Brochow and other local villages bordering the Kampinos National Park to enjoy the scenery of the Masovian countryside. Brochow lies near Zelazowa Wola in an area with the idyllic country atmosphere and numerous winding streams surrounded by willows and hillocks. The Brochow commune's most prized monument is the St. Roch and John the Baptist Parish Church - a unique gothic- renaissance style structure that connects sacral and defensive functions. It is here that Frederic Chopin's parents were joined in marriage and the composer himself baptized.

After lunch, the group will delve into WWII history as you learn about Irena Sendler and her incredible story. Polish nurse, humanitarian, and social worker, Irena served in the Polish Underground during World War II in German-occupied Warsaw. Learn about her important role during visits to the Warsaw Ghetto and a walking tour of Old Town.

Share your memories and experiences with other delegates during your last dinner in Poland.
Overnight:  Polonia Hotel (or similar)
Meals: Breakfast, Lunch, Dinner

Day 09: Depart for the USA or continue on to the optional extension
​Today say goodbye to Poland, departing for the airport early this afternoon for your flight back to New York.

Note: For those travelers who are participating in the extension, they will have some free time to explore independently with lunch on your own arrangements. Your guide can assist with baggage storage.
Meals: Breakfast

Professional Participants - As this Nanda Journey is focused primarily on professional development, costs associated with your participation on the program may be tax deductible as an ordinary and necessary business expense. Consult with a tax professional to determine eligibility.

Please note: All itineraries are subject to change based on availability of hotels, flights and hosting organizations at the time of finalization of booking. Comparable meetings and activities will be arranged should an itinerary change be necessary. 30 days before departure, a finalized itinerary will be available and reflect final details.

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Travel Journal |Warsaw Poland & Budapest Hungary | May 18-26, 2018 | Dr. Carol Huston

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Dr. Carol Huston

Dr. Carol Huston is a past president of Sigma Theta Tau, the International Honor Society of Nursing. She recently retired as director of the school of nursing at California State University-Chico (CSUC).

  • Author/co-author, Leadership Roles and Management Functions in Nursing, Professional Issues in Nursing, and Leadership and Management Tools for the New Nurse
  • Co-developer, Marquis-Huston Model for Teaching Critical Thinking, which has been recognized internationally by nurse scholars
  • Co-chairperson, 2010 International Year of the Nurse (IYNurse) Initiative—a global                           partnership effort between                                         Sigma Theta Tau                                                 International Honor                                                   Society of Nursing, the                                                 Nightingale Initiative for                                             Global Health, and the                                         Nightingale Museum of London
  • Inducted as a Fellow of the American Academy of Nursing