Nurses are an integral part of healthcare services the world over as they provide basic, yet important, healthcare to patients in both private and public health institutions. As nursing expert Donna Wilk Cardillo has previously said, “Nurses are the heart of healthcare”; a reminder to us that it is important for health-governing bodies to ensure that nurses are given the most suitable working conditions.
To emphasise the importance of nurses , the world commemorates International Nurses Day (IND) every 12th of May. The date marks the anniversary of the birth of Florence Nightingale, who is known the founder of modern nursing. The day has been celebrated since 1965 and this year is the 191st anniversary of her birth.
Nightingale is known for her leading role in the first recorded nurses’ strike in history when she refused to let her charges disembark their boat until hospital working conditions were cleaned to her satisfaction. Today, I am certain she would be right at home in leading advocacy for better remuneration and working conditions alongside Zimbabwean nurses.
Nurses: A force for change
This year’s theme for IND was “Nurses: A force for change: Care Effective, Cost Effective”, bringing attention to the fact that nurses are an indispensable part of ensuring proper healthcare at lower costs. In a toolkit provided by the International Council for Nurses (ICN) for 2015, emphasis is placed on the fact that nurses are part of the solution to achieve better health for all in a cost-effective and care-effective way. This means that it is important that nurses are equipped with information that allows them to contribute to national budgetary allocations for the health ministry so that they actively participate in the formation and implementation of health policies.
This year, IND comes at a time when health services around the world are faced with an all-time high shortage of human resources in the health sector, a result of cutbacks by governments on recruitment. Likewise, the Zimbabwean government has been battling with the challenge to adequately finance the country’s health system. In January this year, the Minister of Health and Child Welfare Dr David Parirenyatwa announced that government had reduced nurse recruitment as a result of the freezing of posts effected five years ago. At that time, the total number of unemployed nurses was over 2 800 countrywide.
But government health woes don’t end there.
Just two weeks ago, nurses were on strike for the second time this year, demanding an increase in their overtime payments which had been at a meagre US$3 per month. Nurses also demanded an introduction of a risk allowance. The Zimbabwe Nurses Association argued that nurses were only getting $44 each from the funds released for health workers’ allowances by government whilst other health professionals were getting more per person. In as much as the issue of government finances is affecting everyone, it is the nurses who are at the lower end of the health professionals’ chain that are always the first to feel the pinch yet they are the core of basic health care.
To reduce the continuous alienation of nurses in the health professionals’ chain, the ICN suggests different ways that nurses can be incorporated into decision-making processes that will allow the provision of health care at the convenience of health professionals as well as patients.
The diaspora and the mass exodus
The direct impact of cutting down on recruitment is the exodus of health professionals to the diaspora – especially nurses- in search of greener pastures. The shortage of nurses is a global phenomenon and the great numbers of nurses who have fled Zimbabwe have found employment in the UK, South Africa, Australia and Ireland for example. There is an increased shortage of nurses because most of them are dissatisfied with wages and a lack of educational and employment advancement opportunities.
This also explains why most nurses who have left Southern Africa, particularly Zimbabwe, have settled in Europe. The paradox that our own nurses are more than willing to grab the opportunities being shunned by European nurses is an indication that the working conditions in this corner of the world are actually worse for nurses than elsewhere.
This is further depicted through country examples where four Southern African countries namely, Malawi, Lesotho, South Africa and Malawi are presented as the hardest hit countries by a shortage of nurses. Instead of the 50:10 000 nurses to patients ratio recommended by the World Health Organisation (WHO) Malawi only had 25% of the required numbers in 2010 and the number has only risen from 1.7 nurses to 3.4 nurses per every 10 000 people since then. The situation is even worse in Mozambique where there are 2 nurses per 10,000 people, and as a result, in one district many patients died during a two-month wait to start anti-retroviral treatment.
Lack of adequate funding for the health system results in poor remuneration for health professionals; which results in worker exodus, which in turn leads to shortage of skilled human resources. This has a negative impact on the patient who will be deprived of proper health care or may not access the service at all. Caribbean and American countries are also affected, although to a lesser extent.
The quality of health care depends on the working conditions of the nurses. The most problematic of these are work load and remuneration. Increased workload results in fatigue and job dissatisfaction. In such cases an increase in wages becomes necessary but not at the expense of the patient. An increase in dissatisfaction leads to nurses seeking better opportunities in foreign lands or the private sector which results in a shortage of health staff. To reduce the negative effects of this cycle, ICN suggests that nurses should be part of policy making in health systems.
Because nurses have direct and primary contact with patients, they are well versed with the primary needs of patients thus governments incorporate them in the health policy formulation processes. Nurses work with patients in different settings such that they are better positioned to provide solutions on how to best deal with emergency situations. Likewise, they know how the different primary needs of patients and how lack of them may affect their families or friends.
Nurses provide an important – an often undervalued – service to Zimbabwe’s social services sector. They are long overdue our appreciation and investment in respecting and upholding their rights.