Overcrowding among myriad causes of high failure rate at nursing exams

The Guyana Nurses Association (GNA) on Friday lamented the high failure rate at the last State Final Examination written in October and APNU Leader David Granger is calling for a complete re-evaluation of nurse training in order to improve patient care.

Results from the October examination released during February, revealed that of the 120 students enrolled at the Georgetown School of Nursing who wrote the examination, only 19 were successful, according to APNU.

It was further stated that 255 students had entered the 3-year Professional Nursing Programme in April 2010 but only 120 of them persevered to write the final examination.

A statement from GNA said the high failure rate was discussed by its executives at a recent meeting and it was found that there were several contributing factors.

Both the GNA and APNU blamed the student/tutor ratio for ineffective learning at the three schools of Nursing in Guyana. APNU said the massive intake of students in each cohort was simply unmanageable.

The lead opposition alliance said there are insufficient full-time tutors and suggested that an increase would allow for an acceptable student/teacher ratio. Granger, speaking at APNU’s press conference on Friday, added that 10 to 12 students per class in the learning laboratory and one instructor to 8 students in the clinical courses would be ideal.

The GNA statement said that many years ago the association had spoken against the large intake of students. It noted that despite the utterances of some top officials, whose view is that the association has no control of the process used to select student nurses, one of the GNA’s objectives is to advance the status of nursing as a profession by supporting the measures which affect the administration of nursing affairs by members and the better selection of student nurses.

It was noted that in 2007, there were approximately 90 student nurses in one cohort; 144 in 2008 and 255 in 2009.

The GNA said that in 2010 a new curriculum was introduced at all three nursing schools, at the same time with 500 students and this hindered the effectiveness of the curriculum. This was done in spite of a review by a designated committee and a recommendation by a PAHO Consultant to have the curriculum implemented with a small number of students at one nursing school.

The intake of student nurses per cohort has since been reduced.

However, the GNA said it is greatly concerned and outraged that the Ministry of Health continues to enrol students without meeting the stipulated criteria for implementation of the curriculum. These include a curriculum guide, student procedure manuals and clinical instructors. It was revealed that there is a dearth of clinical instructors, but to date, three batches of students have been enrolled in each of the three schools of nursing since the implementation of the current curriculum. The nurses’ body questioned whether the ministry was interested in quality or quantity.

Additionally, the GNA statement said, there was reduced bed capacity at the Georgetown Public Hospital Corporation (GPHC), which also affected students’ performance. The hospital has been downsized to 450 beds, it said.

Meanwhile, nursing students have to compete with other health professionals also doing practical training, such as medical students, medex students, interns and others.

Both APNU and the GNA said poor infrastructure such as inadequate lighting and ventilation in classrooms and unhygienic sanitary facilities also affected learning capacity. Indisciplined students, alarmingly high absenteeism rates, poor punctuality and abusive behaviour have also led to the abysmal performance.

The GNA statement called for students need to take responsibility for their own learning and recommended an immediate cessation of intake until there is some form of stability and measures are put in place to assist unsuccessful students. It also recommended a review of the curriculum currently being used, a revisit of the procedure manuals, the recruitment and training of tutors, the training and appointing of clinical instructors among other things.

It urged that the Ministry of Health seek an agreement with GPHC for designated wards equipped with all necessary tools to be used for learning purposes.

Granger said textbooks used by student nurses should be relevant and current. He said nurses should have easy access to the internet while at class since these tools are important to learning.

Meanwhile, APNU also expressed concern over the loss of nurses citing reports from various international agencies which pointed out that the local rate of attrition was 18.5 per cent in 2007 and that this continued today. The coalition said Guyana spends approximately $600 million on nurses’ education annually.

APNU’s Dr George Norton said nurses often go to the University of Guyana to study but the benefits after studying are really small, thus leading to the attrition.


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