The killing of Nigeria’s nurses

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Kunle Emmanuel
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The killing of Nigeria’s nurses

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Nurses are a special breed of professionals and this country will toy with their welfare at its peril.
There is no level of government where any group of policy makers has sat down to determine how many nurses are needed at each level of health care in order to determine what is good enough for our country’s healthcare system.It is a sobering realisation and it is even a little frightening.

I say this because the statistics are daunting enough, and we do not even know how many people in this country.
Governments are building wonderful-looking hospitals around the country, but no thought is spared for the calibre of personnel that such facilities require.

In the end, staffing of those establishments becomes something of an after thought.
What brings us to this topic is a recent encounter I had at a public hospital.It was a weekend and I was visiting to see a friend’s wife.

It was a large, open ward with about 24 beds. Time was around 7pm and the far end of the ward was somewhat dark.
Going over to the nurse on duty to introduce myself was awkward; she was not really interested to know whether my mission was social or not; she was very busy scribbling furiously away in her report book so that she would be able to hand over to the next shift without undue delay.

The rest of the ward was poorly lit but around where the nurses’ station was located, the lighting was bright as the most seriously ill of the patients in the ward were in that bay.
I enquired with enormous sympathy whether she was alone on duty. Even though I suspected what the answer might be, I was still taken aback when she answered in the affirmative.
She had a nursing aid of course, an orderly, who had gone on an errand to obtain drugs for a patient from the pharmacy. However, it was with some concern I went to see the subject of my mission in that ward and was on my way out within some 15 minutes when something odd struck my attention; a patient had fallen off her bed and was too weak to even raise an alarm. Or so I thought.
The situation was worse than that: she was not even breathing.A closer examination revealed that she was dead. So, it was necessary to inform the single nurse on duty of my finding.
The patient in the second bay, I announced as quietly as possible, is on the floor and not breathing. She bolted out of her chair as though a fire had been placed there.
We went to the bay together to confirm my finding. Her first concern was that she would have to rewrite her report. Then she would inform the doctor on call.
But first, we needed to get the patient off the floor and unto her bed. Her two other neighbours were asleep and didn’t see a thing.
As we made our way from the bay with the nurse in front of me, it suddenly struck me that this particular nurse was unfit physically even for this kind of work. She was overweight and walked in pain because of some arthritis of the knees. Those knees were bent and her movements slow and ungainly.
Even if that patient was alive after the fall, was this nurse in any physical condition to get her off the floor? Clearly, she was not. She herself needed treatment, as well as a ‘softer’ department to do her work, such as being posted to the central sterilisation unit where she could do a considerable amount of her work while sitting down.
It is known around the world that nurses are frequent sufferers of low back pain and other pains due to improper positioning of different parts of the body as a result of the peculiar work they do.
Pushing patients in their beds or wheelchairs; pulling beds and trolleys; lifting patients; rolling them from one side to the other so as to change their beddings; bending over them to perform various vital signs observation and the dressing of their wounds.

It is a whole series of engagements that seem to be normal, but which exert enormous pressures on the back and joints of these professional workers.
Many are in almost constant pain but the sheer passion for their work, coupled with the fact that many are not good at anything else; compel them to continue in their endurance.
And as the rest of the world embraces more of powered devices in every aspect of hospital work, our system seems to go deeper into the chaos of manpower-driven applications.
The bulk of these people are unfortunately, women. Worse still is the fact that there aren’t even enough of them.
There is a strong relationship between adequate nurse to patient ratios and safe patient outcomes. In that connection, even if there is a paucity of doctors in a particular department, adequate trained nursing staff would determine the outcome in most cases.

Conversely, if a hospital was teeming with doctors of the highest calibre and there aren’t enough trained staff nurses, the effectiveness of those doctors would be grossly limited.
Nurses are the staffs who stay the most with the patients. As a result, adequate nursing staff must be seen as a responsible thing to make sure of by all organisations running hospitals.
This serves to reduce medication errors; dosage related errors; decrease in mortality; decrease in patient complications; reduced nurse burn-out; improved patient satisfaction; improved job satisfaction and reduced nurse fatigue. The kind of staffing solutions needed to achieve even some of these objectives require leadership support and recognition.
In many hospitals today, there is a generational gap such that many are top-heavy with matrons and senior sisters and not enough staff nurses to do the required work. The result is a rapidly aging nursing work force that is sure to become a major crisis in a few years down the line if something urgent is not done.

For the first time in any professional group in the health care sector, we have people aging faster than there are young, trained hands to replace them. There’s trouble on the way.
There must therefore be a way to boost their numbers. This is achievable in a variety of ways.
1) Increase the retirement age for nurses who have reached a certain rank.
2) There should be a base minimum of the number of nurses that can look after a certain number of patients.
3) Deliberate efforts must be made to encourage more people to embrace the profession.
4) There should be a reduction in the emphasis for the acquisition of university degrees in nursing as a prerequisite to certain kinds of employment. In every hospital, there should be a mix of bedside nurses and the academic types.
5) No matter how small a hospital ward is, there should be a minimum of two nurses per shift insuch a ward. To have a single nurse doing everything in any ward in any shift should not be countenanced.
6) Other nurses who have retired but still show a certain willingness to work for some more time ought to be encouraged.
7) Finally, some of the retired hands can be re-engaged to manage health centres and cottage maternities, while the younger energetic hands are deployed to run the busier hospitals.

If the nation is unable to do something quickly along the suggested lines above, many of the challenges being experienced now in many hospitals would appear by comparison like a tea party within a generation.
It is an urgent national need. Let us tackle the problem with the tact and seriousness that it deserves.

Written by Dr. Sylvester Ikhisemojie
Together We Light Up The Profession one candle at a time.
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