This is part of the series: Unique characteristics of Kenya’s health care settings,We have already looked at part 1 of turbulence.
Even the best of effort is only a singular contribution to the journey for the greater good that we refer to as quality health care. For example, if six patients in a 42-bed Nyayo ward were to press their bell(s)-(where there are some) at the same time and there was only one nurse on duty (as is sometimes the case), five may not be answered. What if one of them had fallen off the shared bed?
In some developed countries, if a patient were to fall, the nurse could be found negligent for failing to stay within an arm’s length of the patient. Should the discharge-in patients get such an opportunity to sneak out when the nurse was busy who should pay for his bill?
The same staff nurses who were striving to meet complex patient needs being expected to act as procurement staff and pay the patient’s bills was asking too much from them. These tended to add to the challenge of providing quality care and keeping patients safe. With very bad ratios of the nurse to patient, there was a lot of uncertainty.
Turbulence contributed to heavy workloads and interruptions. Hospital administrators must create and maintain clinical environments that supports nursing practice; they need to monitor effects of the dramatic changes in the healthcare environment on nurse performance. Nurses on their part should speak up! Why was it difficult for nurses to mind their own business? Even as the nurses’ strikes in Kenya become an on and off ‘short fuse’ phenomena nowa days. They are reactions to pent up frustrations much of which can be attributed to turbulence in nursing. These were issues for weighing and considerations.
A lot was due to the good naturedness of nurses. Altruism somehow means minding others interests and quite often it means sacrificing your own interests for the sake of others. We can do this for patients but should we do so for everybody? This was exploited.
Tasks shifting is real in many parts of Africa. But any additional training (including EmOC must EXPLICITLY certify that nurse so and so who has undergone this training can now be allowed to do ABC. Training alone does not imply licensing even when it outlines what the course covered. In any controversy the license prevails.
In a lifesaving situation we need to understand how much indemnity liability allows you as an individual to stretch … that much. In resource constrained environment, a lot will depend on good will, but I say leadership. In a place where the team spirit got some perceived ‘frienemies’ (the type of colleagues/cadres hakuwachi na pia hakungojei) then you are better off sticking to your line of duty.
Such clauses need to be in the Nurses act as amendments as well as scope of practice from time to time. A progressive profession recognizes and engages its paralegal arm on an on-going basis, never on adhoc like we do here in Kenya. By the way – do we even have paralegal nurses in Kenya? Unions alone will not do, much so when they are ridden with vested interests.
Picture An overwhelmed health care provider is often in a dilemma amid competing nonclinical tasks
(Picture courtesy of Caroline Ryan)
Meeting the expectations of all those seeking health care services in many public health facilities can a big challenge to an overwhelmed health care provider. Many times their time has been taken up by non-core work that someone else should be helping them do. Other aspects considered as turbulence includes holidaying while we wait and number of beds and cots and lay caretakers.
Do you see turbulence as a problem? We are asking for your help in the way forward and spreading the word.