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The inability of students to pass the local nursing exams is a major cause of low completion rates and has resulted in a “sub-optimal quality of training,” a recent World Bank study on nursing shortage in the English-speaking Caribbean has found.
“While we recognised that there were multiple reasons for low completion rates (e.g. drop out due to family situations, financial constraints, or loss of interest), interviews conducted in Guyana pointed to the inability of students to pass exams as a major cause of low completion rates and, as a cause of the inability to pass exams, to a sub-optimal quality of training,” the report, released yesterday, said. As a result, it raised the question as to whether students who were required to invest financially in their education were less likely to drop out. Almost all of the nursing programmes in Guyana are free and nurses are actually paid a stipend during their attendance.
The report, titled ‘The Nurse Labor and Education Markets in the English-Speaking CARICOM: Issues and Options for Reform,’ said that students in Guyana are allowed to write their final exams three times.
Touching on the migration of nurses from Guyana-an issue it said affected all countries-the report said that in 2007 there were some 470 vacancies in the sector which represented a 54% vacancy in the nurse labour market. Supervision, administration and management positions accounted for 90% of the vacancy, the report said.
Further, the report said that the local rate of attrition from the nurse labour market was 18.5% in 2007 and according to the data provided 75 nurses were reported to have left the nurse labour market for various reasons, seven retired, and one died, 55 migrated and the remaining 12 did not specify reason for leaving. “It must be noted that this data may be an underestimation of the actual attrition rate given that all hospitals could not provide data on annual attrition and formal exit interviews were not conducted with all nurses,” the report said. Additionally, it noted that the nurse registry in Guyana does not have up to date information on nurse attrition. It said that outmigration was the main source of nurse workforce attrition.
Recently, Health Minister Dr Leslie Ramsammy said that about $600M is spent on nurses’ education annually and about half of that is lost in migration for the same period.
Meanwhile, according to the report the salary of many cadres, including, staff nurse, midwife, ward sister, department sister, health visitor and tutor, ranges between $US200 to $US500 per month with the difference between the minimum and maximum salary being less than US$100 per month for all cadres.
The report said that the country’s approach in attempting to managing the human resources of health workers mainly focuses on increasing the intake of nursing students; providing financial incentives; improving the quality of staff; and improving the physical and technical infrastructure of hospitals.
It said that since 2005, the target number for recruiting nursing students has been 250, which is three times larger than for the previous years. “Although it is aimed at providing a sufficient number of nurses for both local employment and possible migration, it has not been implemented due to the fact that there were not enough students who meet the minimum requirements for entry in to the schools,” the report said.
Significantly the report added that the loss of teachers through migration has also limited the ability of schools to increase intake of nursing students. Increases in monthly allowances were introduced to help cushion the effects of the high cost of living and provide a more realistic living wage.
According to the report there is a planned introduction of performance management where training opportunities and promotions will be linked to performance which can provide professional development for all staff.
Meanwhile, giving an overall view of the situation in the entire English speaking Caribbean, the report said that nursing shortages across the countries limit access and quality of health services and affect the region’s competiveness.
It said that the region is facing a rapidly growing shortage of nurses as demand for quality health care increases due to an aging population, and high numbers of nurses emigrate, drawn by higher paying jobs in Canada, UK and the US. “These shortages have tangible impacts that may compromise the ability of English-speaking CARICOM countries to meet their key health care service needs, especially in the areas of disease prevent and care,” a release on the findings of the report said.
In addition, it said the shortage highly trained nurses reduces the capacity of countries to offer quality health care at a time when Caribbean countries aim to attract business and retirees as an important pillar of growth.
The World Bank estimates that there are 7,800 nurses working in the region or rather 1.25 nurses per 1,000 people, roughly one-tenth the concentration in some other countries. In addition, demand for nurses exceeds their supply throughout the region, 3,300 or 30% of all positions in the sector were vacant at the time of the study.
In order to meet the demand for nurses in the region the report recommended that focus be placed on increase training capacity, managing migration and in this regard in addition to creating barriers to migration and recruiting abroad countries also need to “carefully consider policy options that range from leveraging the expatriate community, mentoring, staff exchange, and codes of practice for international recruitment.”
There is also need for the strengthening of data quality and availability and adopt a regional approach, the report recommended.
