COMMENTARY: Nurses-a force for change: Improving health system resilience

I wish to congratulate my professional association, the Dominica Nurses Association (DNA), and the Ministry of Health (MoH) on the observance of International Nurses Day and Nurses Week 2016.

I write primarily, however, to draw attention to the unacceptable working conditions of nurses and request that nurses demand the change and leaders begin the change . This year the International Council of Nurses (ICN) encourages nurses to be change agents who improve health systems’ resilience so that these systems can best respond, adapt, and be strengthened when exposed to shocks, such as disease outbreak, natural disaster, and/or conflict.

The ICN further states that one of the critical ways that the health organization can improve its resilience is by ensuring a positive practice environment – this means creating a safe and healthy workplace, opportunities for continuing education and development, access to necessary equipment and supplies, appropriate workloads and attractive working conditions. Positive Practice Environments also include an organizational culture that supports effective team work, open communication and transparency, as well as support, supervision and mentorship.

Against this background, I ask the question, how can nurses at the foot of the ladder, be they in the primary or secondary care settings improve health system resilience, when the very system endangers their physical, environmental, mental, economic and social health? I also ask the question, are nurses at the top of the ladder doing enough to improve health system resilience?

Permit me to refer to specific examples which violate the rules of PPE and strong health systems : – the Newtown Health Center is rodent infested, crowded, and poorly ventilated; the latter being compounded by a problem of molds. Over five months ago the building was declared a health hazard by the Environmental Health Department with the recommendation that the facility be relocated. In my capacity as PRO for the Association of Dominica Midwives Inc, I wrote via email to the Permanent Secretary of Health over a month ago and subsequently to the Minister of Health, (almost two weeks now). I have received no acknowledgement of receipt of my emails.

The Marigot Health Facility, now located downstairs the abandoned hospital, is also small, crowded and poorly ventilated and may also be considered a health hazard. The absence of a hospital in the Marigot Health District, the home of our airport, is a grave contradiction to health system resilience.

The Ans de Mai Health Center has been a chronic hazard for several years and has been in the news before. The facility is close to a large drain of stagnant water, a very suitable breeding ground for the ades agypti mosquito. It is also located in an isolated area. The current District Nurse/Midwife has for obvious health and safety reasons declined to live in the nurses quarters, located in the immediate vicinity of the facility. It is over three years since this problem is being highlighted and the authorities have failed to provide a satisfactory solution.

When the workplace is unsafe nurses need to communicate and demonstrate loudly and clearly that this makes both the nurse and the system less resilient.

This month (May) marks six years since a nurse was injured at the Dialysis Unit, upon receiving an electric shock from the faulty electrical system. A couple years ago a nurse was wrongly diagnosed and treated for breast cancer. Both nurses have become victims of the health system which to date has refused to compensate them. Within this context, a question posed by ICN is relevant, “If nurses and organizations in health care cannot care for themselves, how can they care for the populations and communities they serve?”

I pause here to commend nursing leadership on the initiative of a recent mentorship program and consistent continuing education which includes topic such as ‘customer care’ among others. I hasten to add, however, that some mentors themselves need mentoring while some supervisors need training in building supervisor-employee relationships. Their acts of victimization, intimidation, bullying, dishonesty, favoritism, injustice and lack of professionalism towards staff, including new nurses, only serve to fuel low morale, poor patient care and migration from the national scene.

The favorable recommendations of the consultants following the Job Classification Exercise which was completed in 2014 raised the economic hopes of nurses and midwives and would certainly contribute to the PPE; but alas these hopes have been dashed. Many who have pursued higher education (degrees) are struggling to pay back their loans while there are little or no signs on the horizon of when they will be compensated for their degrees. Those who continue to pursue higher education are advised before hand, that they should not expect promotion upon completion of their studies – how sad! Notwithstanding, the fact that many are granted study leave, is commendable and they remain grateful.

“Safe staffing saves Lives’ was the ICN Nurse’s Day theme a few years ago. Inadequate nurses, heavy workloads, high patient to nurse ratios, poor staff mix, all endanger the practice and health of nurses and the lives of patients. These certainly make quality care for all impossible, and obviously weaken rather than strengthen the health system. In fact according to ICN, “an adequate number of trained health workers” is a number one building block for resilient health systems.

Other aspects of a PPE such as an organizational culture that supports effective team work, supervision, open communication and transparency all impact on the resilience of the health system; the extent to which nurses use them to strengthen the health system is not determined here neither will the measure needed to improve be stated. Lack of access to necessary and often basic equipment and supplies remain a malignant problem which reduces the quality of care delivered and the confidence of the health consumer in the system. This ought not to happen, at least not as frequently as it does, if we are seriously looking to address resilience

Positive Practice Environments have the potential to attract and retain nurses. It also has the power to foster a happy and satisfied nursing service not only during nurses’ week but throughout the year. You should want it, you deserve it, it is your right to have it. In the mean time nurses at the helm are well positioned create and protect these Positive Practice Environments.

I further urge you to deliver efficient, respectful and compassionate patient care, respectful, compassionate and fair staff supervision and coaching and mentoring that empowers, all towards a stronger and more resilient health system. In so doing you will be responding to and participating in ICN’s campaign for health change, a desperately needed change to make our health system strong and sustainable.