COMMENTARY: Nurses’ Plight: Flight or Fight

For the past years, Dominica has been producing some of the most well-trained nurses in the Caribbean. However, the consistent increase in Nurse migration commands a critical review of human resource management skills, need for policy review and a strategy for making nurse retention seamless.

Aggressive Human Resource Management Skills is crucial in preventing our nurses’ flight. There have been a lot of effort into recruiting nurses over the past years. This is evident in the number of nurses who graduate from the Department of Health Sciences at the Dominica State College and enter the nursing workforce. There is much deficiency though, in the other functions of human resource management which includes, employee maintenance and employee development.

In a study done by Jones and Wright (1992) they highlighted that the provision of compensation incentives and employee involvement and training can help in enhancing staff retention.

Another study accentuated that employee turnover has an important influence on organizational productivity (Tibilisi, 2015).

These studies tell us that it is not only good that the government provide the nurses with an education and a job but must also put effort into ensuring that the human resource department plays their part as it relates to job satisfaction as a modus operandi to retain nurses and sustain productivity.

Recently, the news highlighted the nursing shortage that has escalated after the Hurricane Maria, when 28 nurses left our island, (Minister of Health, 2018) leaving behind heavy workload for those who remained. This has caused further deterioration of our health care system, but also an opportunity to address the growing ulcer that has been unattended for a long time.

As I reflect on my experience as a nurse over the past 10 years, I must confess that staff shortage was always an issue. I am sure my nursing colleagues will all agree with me. My most recent four years were spent on the male medical ward and it has always been overcrowded with limited staff to accommodate the patient needs. Despite the fervent efforts of our departmental supervisor to get nurses to work overtime on days off, her attempts were sometimes futile and the workload remained overwhelmingly high.

It was so much an issue that last year January 2017, in my capacity as acting supervisor, I thoroughly reviewed data of sick calls that came from nurses on a few wards at the Princess Margaret Hospital for over a five (5) year period. The wards were Glover, Imray and Dawbiney. It was my desire to get a clear picture of the severity of the problem.

At first, I really thought that Imray Ward, being the one with the heaviest workload at Princess Margaret, would be the one with staff who called in sick most. But I found out that the other wards, with less workload, had very little difference in terms of sick call-ins per month.

The data I collected revealed that on an average of 30 days, there were at least 11 sick call-ins per month on every ward and a total average of 112 per year. Although further research is needed to finish the study but the results from this small sample already speak volumes. A lot of deductions can be made but foremost is the shining proof that staff shortage has been around for a while now.

With only 13 nurses assigned to my ward and maximum three nurses on duty per shift, on a full ward, that leaves two nurses to function when one of the three call in sick. Until a substitute can be found by the efforts of the supervisor, the nurses are left to function with much frustration, considerable risk for burnout and the stress that comes with working on skeletal staffing. I can only imagine the struggle as it has escalated now.

In 2009 there was one nurse to 239 persons(Commonwealth Health Online, 2009). What is the ratio of nurses to persons in Dominica at present?

Nurses have been speaking, both silently and vocally. We have done so in articles, via media, and through research conducted by the nursing school. Unfortunately, we have not been heard. Now the Dominican population is paying the price for nurse’s flight tickets, paid for by our leaders’ indifference to our cries. A listening ear would have sufficed.

Many boasts about the soon coming state of the art health facility. And of course, this will give the community of Goodwill a facelift. But having the state of the art surgical equipment’s with no surgeon is just as bad as having a surgeon with no surgical equipment. Now imagine a state of the art hospital with limited human resource qualified to carry out the necessary functions….do you get my point?

In my journeys around the Caribbean and internationally, I have had the opportunity to converse with nursing colleagues who took flight to Tortola, St. Martin, St. Thomas, Anguilla, St. Lucia, U.S, Canada and their theme for migration comes under one bracket: better work packages and more money.

Dr. Darroux said in an article I read on DNO recently, that salary is not the only issue. I do agree that it is not the only issue, some other issues include “professional development, improved working conditions, higher standards of living.” (Journal of Nursing scholarship, 2003) however, I believe it is one of the MAIN issue at present in Dominica.

A nurse who gets paid well can save enough to care for her children, send herself to school without depending on a government scholarship, and have enough to live happily after paying her basic bills. Any Nurse who can do these, will not be motivated to leave for another country to have a new beginning from scratch. The nursing standard reiterated that “Distorted pay scales may mean loss of staff motivation and the reward that comes from promotion and training.” (Nursing Standard, London, 2013)

Whilst it is true that nurses have a right to migrate, it is very important that the necessary bodies take heed to the factors that send our nurses to flight.

The Minister of Health stated in one of his speeches that an increase in salary at present is not possible as it is not the right time. Fifteen (15) years ago it wasn’t the right time, 10 years ago it wasn’t the right time, today nurses are still whispering to themselves that things will get better one day. If there are nurses who have been whispering to themselves for the past 15 years that things will get better, I’m here to rudely awaken you and tell you that our leaders have failed us.

Our Minister of Health has failed us and our minister of finance has failed us. Why is it so easy to spend millions on a bridge, but so difficult to increase the salary of the people who care for the citizens of this country? Why is it so easy to spend thousands on recruiting political leaders in a matter of weeks, but spend over 20 years debating salary increase for nurses? Nurses, it is time to stop the whispering and start the shouting. Shout from your bedrooms and on the streets. Shout in the buses and at your workplaces, so that our voices can be heard. Many of us want a revolution and change, but if we don’t stand and fight, if we don’t raise our voices, there can be no revolution.

I am no politician, and I have no intention of studying politics. I am just a nurse victim standing up for what I rightfully deserve. I choose to stay and work in my country, not because I have no choice, but because I believe that I should have the opportunity to work and be happy in my own home, just as any other minister of government do and I will continue to shout until my voice and the voices of the many other nurse victims are heard.

Some of the recommendations made in the previous research papers conducted by the nursing school include and still stands: modification of nursing salaries to compliment the inflated cost of living in our country, provision of scholarships to nurses to pursue necessary specialties, formation of a research base to gather data and make evidence-based decisions.

I will add: working closely with the faculty of health sciences to keep track of nursing research conducted on behalf of the nurses, as a step to develop policies and to evaluate existing ones, the need to train nurse managers to provide better mentoring and leadership to their staff, and to conduct yearly employee satisfaction surveys. These are just a few.

Dr. Darroux’s efforts to import the Cuban nurses is well-intentioned (Dominica News Online, 2018). Its rational on the surface is convincing to the average citizens of Dominica. However, as Nurses working with the health care system, we see things differently. This Cuban nurse importation strategy is nothing but a temporary band aid to a growing sore.

My experience in the nursing profession obliges me to put forward these recommendations, which in my view will augment nurse retention, develop a positive and productive nursing workforce and bring much satisfaction to the recipients of health care in Dominica. In the spirit of progressive health care advancement, as key stakeholders, we are confident that the powers that be, will embrace the input in making nurse retention seamless in Dominica and halt the flight of another nurse who is forced to leave our beautiful country today in search of some better work and financial packages elsewhere.