The dismal performance of nursing students at their final examination is a result of the large numbers being taken into the programme, stretching the small teaching staff and creating a situation where trainee nurses are not adequately supervised on the wards.
This is the position of the Guyana Nurses Association (GNA) and according to its Chief Executive Officer Grace Bond this issue has been raised since 2004 but the powers that be “do not listen.”
In a wide-ranging interview with the Sunday Stabroek, during which she addressed the issue of the unprofessional conduct of nurses, Bond dismissed the suggestion that the poor performance of students was a consequence of the alleged low requirements for entry into the schools.
“As a matter of fact the requirement has been upped so it is not lowered; I read it in the newspaper and I don’t know where they got that from,” Bond said.
However, the retired nurse, who has worked in the profession for 40 years, said that while the curriculum is covered the students are not exposed to the right number of tutorials to assist them.
She also clarified that none of the nurses has failed outright, as they all passed one or two of the three areas of study, but their performances could have been better, because there are quite a lot students who are not eligible to become nurses this year and would have to re-write some of the examinations.
This year at the Georgetown Nursing School some 146 students wrote the examination while just 32 are eligible to graduate. To emphasise the difficulty in relation to the student to tutor ratio, Bond revealed that presently Georgetown has 540 students and only eight tutors, although some of the students take evening classes and are lectured to by part-time tutors.
However, Bond said she would not recommend evening classes, one of the reasons being that it is better to be in the wards during the day as at night patients are sleeping.
She pointed out that in years gone by persons were accepted into the nursing schools for training twice a year and in “manageable numbers,” with batches not exceeding 40; however, over time only one batch a year was trained. At present over a hundred nurses are being trained at one time and while the programme has changed, Bond said that is not the issue but rather “the amount being trained is too much for the staff.”
“Putting curriculum aside there are just too many student nurses being taken into the School of Nursing and you do not have the amount of tutors,” Bond said.
According to the retired nurse while there are about 40 part-time tutors who work in the evening there is still a shortage for the day-time sessions, and this is what is causing the failing marks. The shortage of tutors exists in all of the regions.
She explained that the trend started in 2004 and soon after she was appointed the acting Chief Nursing Officer. Then Minister of Health Dr Leslie Ramsammy had expressed concern about the number of students failing the nursing examinations, and she had recommended to the minister that batches be taken in twice a year as was done in the past to keep the numbers manageable. Teachers, she said, started leaving in the ’80s and the school has not recovered since.
She pointed out that it is not only the theory that the students have to benefit from but also the practicals in the wards, and many times there are not enough trained nurses to supervise them. This has seen the students “coming whenever and leaving whenever.”
“But nobody ever listens; that year 2004 there was no intake and from the next year 2005 the intake started to mount…it just kept rising,” she noted.
Bond recalled that when Hydar Ally was appointed Permanent Secretary at the ministry he was excited at the prospect of training large numbers of nurses, and even though she had cautioned him that training nurses was different from teaching they went ahead with increased intakes.
“So the thing about the politicians [is] the policy-makers are not listening. I don’t know if they think the nurses don’t know what they are talking about,” Bond said, adding that after she had given her opinion she no longer addressed the issue and she eventually retired in 2008.
“You know when they seem bent on doing something they do it…and I had already spoken…and I didn’t say it upon my own… I had dialogue with the principal tutor, also with director of nursing at the Georgetown Public Hospital Corporation and that is what we came up with.”
Meanwhile, when asked about complaints made against nurses Bond frankly said “…some of the complaints are justified indeed,” while pointing out that she has to be honest as her answer is based on reports from nurses.
She explained that there are many nurses who would visit their loved ones in hospital without making it known they are members of the profession, and they would complain bitterly about the manner in which they are being treated by the nurses.
But she indicated that the indiscipline of nurses is a “complicated issue” as most of the complaints come from the Georgetown Public Hospital (GPH) and many of the ward managers lament that they are unable to deal with errant nurses because they have direct access to a senior official at the institution.
“There is a lot of feedback that the [senior official] is causing nurses not to follow instructions of the nurses in charge…” Bond said, and she listed the issue of mode of dress which she said is not at times adhered to.
This issue had been one of contention for quite some time and Bond said the association discussed it early this year. One of the recommendations they made was that all matters pertaining to nursing must be managed by the competent nursing administrators in the various institutions. She recalled when she was a student it was unheard of for a senior official at any hospital to have anything to do with nursing; it was the staff nurse, ward sister, departmental sisters and then the matron.
“That was the line of authority, so it was a nurse disciplining a nurse. There was no [senior official] for a nurse to run to with grievances,” she said.
She called for the senior nurses to be allowed to professionally carry out their responsibilities by the authorities who should not allow “eyepass” to be taken by the juniors.
“That has happened and that is happening and so the supervisors feel well, what is the use; it is demoralizing, even in the classroom there is some of that,” Bond said, adding that students are sometimes given the telephone numbers of senior officials and told to call when there is problem,” she said.
This situation, Bond said, causes disrespect and that there are some nurses who do not treat patients professionally and they need to be cautioned and sanctioned.
The Guyana Nurses Council is responsible for disciplining nurses and can go as far as revoking their licence but she said it is not something that is common as nurses are seldom recommended to the council. She is not sure why this is but noted that it may be because we are a society that believes in giving chances. But she also pointed out that Guyanese do not like to put their complaints in writing and this needs to be done before the council can launch an investigation. She said any member can make a complaint to the council which is located at Lot 10 Fourth Street, Kingstown in a building known as the Georgetown School of Nursing Annex.
Where the issue of salaries is concerned, Bond said she is not of the opinion that the unprofessional behaviour should be excused because of the low remuneration. While salary is important, she went on, and many persons leave owing to this, those who are forced to remain cannot use the issue to not be the best they can at their job.
“A lot of nurses would tell you they love the profession; yes, they would love to have higher wages but they love the profession and they do their best,” Bond said. However, she also feels that a better working environment and nurses being equipped with the required materials to effectively do their work could go a far way to addressing some of the issues.
She said salary is often mentioned because it compounds numerous other problems. She said the nurses should also be made to feel wanted and needed and should be rewarded when they do well.
Speaking about the GNA, Bond said the association, located at the corner of Alexander and Charlotte Streets, is responsible for registered nurses, midwives, nursing assistants and patient care assistants, and its membership stands at 600. The numbers have been growing since 2010 when the association was one of the three associations which was approached by the Ministry of Housing & Water in relation to a housing drive, and they were asked to compile a list of interested persons together with the required particulars. Since then several nurses have been granted house lots based on the determination of the housing ministry.
Bond said she is happy that nurses are more motivated to join the association following the housing drive, but there are other areas in which the association assists it members, such as free continued education. In addition, recently they restarted offering bursary awards to children of nurses who wrote the Grade Six Assessment. Persons who suffer loss by fire or flood are also given some assistance, and nurses across who have performed exceptionally well are awarded at an annual ceremony.
She said also if a nurse finds him/herself in a situation where they feel they need representation they could approach the association which would pen a letter to the relevant authority.
“Any nurse can approach the association about any matter of concern and we would discuss it and see what can be done,” Bond said, when asked if a nurse has to be a member of the association to seek help.
She lamented the fact that “nurses complain a lot” but seldom make formal complaints to the association.