Nurse training has become sclerotic; without a cure, patient care will suffer

Mar 09, 2014 APNU Column, Features / Columnists

Public concerns over recent and repeated reports of mis-treatment of patients, mistakes leading to maternal deaths and mismanagement in hospital wards are not misplaced. It is well known that the problems facing the primary health care system are chronic, the most serious being the conditions and quality of nurse training.
The Guyana Nurses’ Association – GNA – several months ago called for “a temporary halt” to the nurse training programme until its problems could be solved. The Ministry of Health manages three nursing schools – the Georgetown School of Nursing, the New Amsterdam School of Nursing and the Charles Roza Nursing School – all of which have experienced serious problems. The most recent Professional Nursing Examination provided abundant evidence of deep-rooted difficulties and deficiencies in nurse training.
Senior Georgetown Public Hospital Corporation (GPHC) officials and GNA executives expressed alarm at the high failure rate of the last cohort of student nurses from Georgetown, Linden and New Amsterdam.
Results of nursing students who participated in final examinations in October 2013 were released last month – February 2014. Reports indicated that, of 120 student nurses from the Georgetown School of Nursing, only 19 were successful. All New Amsterdam student nurses failed. A total of 255 student nurses entered the three-year Professional Nursing Programme in April 2010, but just over 120 persevered to write the final examinations.
The main problem has been the unmanageably large number of student nurses recruited into each cohort. It is reported that there were about 90 student nurses in a single cohort in 2007; the number rose to 144 in 2008 and soared to 255 in 2009. The intakes have since been reduced. Such large student populations affected the length of time students experience practical studies, for example, at the Intensive Care Unit, Accident and Emergency Unit and Operating Theatre.
Large batches take longer, reduce the time available for each component and deprive students of precious experience. There are insufficient full-time nursing tutors for the super classes of students. Many more full-time tutors are needed to maintain an acceptable student-tutor ratio. One instructor is needed for about 10 to 12 student nurses in the learning laboratory and one instructor to eight student nurses in the clinical courses. It is impossible to achieve this ratio at present.
Big classes also require more audio-visual aids and relevant and current text books to enhance students’ learning in the classroom. Big classes require public address systems for tutors to be heard and screens for images to be seen properly. Present-day student nurses need much greater access to the internet and personal computers to enable their research.
Big classes put pressure on the limited sanitary facilities available to male and female student nurses who could spend up to eight hours daily attending classes. On one occasion, classes had to be discontinued because of non-functioning toilets. Efforts have since been made to build ‘annexes’ but, as long as large classes persist, congestion will adversely affect students’ comfort and threaten their performance.

The drive for big classes has, apparently, loosened the strict selection criteria. Some student nurses, evidently, have displayed abusive behaviour, absenteeism, unpunctuality, apathy and negative attitudes towards their studies. Misbehaviour and immaturity have been compounded by the large student population and political interference, making it difficult for professional tutors to effectively manage the students and discipline delinquents.
These problems are not new; they are well known to the People’s Progressive Party Civic administration. The lowering of training standards has contributed to increasing the pressure on better-trained nurses who, as a result, are now migrating in increasing numbers. The Ministry of Health, at least for the past five years, received several insightful reports which all called attention to issues associated with nurse training and migration problems during this time. Among them are:
–   World Bank, The Nurse Labor and Education Markets in the English-Speaking CARICOM: Issues and Options for Reform (2009).
–   USAID, Guyana Health System Assessment (2010).
–   PAHO-WHO, Nurse Migration in Guyana (2011).
These reports all pointed out that the local rate of attrition from the nurse labour market was 18.5 per cent in 2007. The attrition continues up to the present.
The Director of Maternal and Child Health last May made reference to the fact that Guyana’s efforts to achieve the Millennium Development Goals (MDGs) Four and Five which concern the reduction of both maternal and infant mortality rates could fail. Guyana’s objective to achieve the United Nations-recommended maternal mortality ratio of 80 per 100,000 by 2015, therefore, will require serious solutions to counter the plethora problems in the health sector.
There must be an immediate and intense investigation into nurse training if the haemorrhaging is to be stanched and if the problems in the health care system are to be corrected.