Need to address issues to stem turnover of nurses
FOR THE last few decades, Caribbean nurses have been migrating to developed countries (mainly United States, Canada, and the United Kingdom) to pursue a more desirable way of life, in the hope that they will achieve better salaries, improvement in their working conditions, safety and career development, to name a few.
Currently, because of the COVID-19 pandemic, an apparent halt has been placed on migration plans for some Jamaican nurses, amid the social-distancing regulations and the closure of borders in countries worldwide. However, this challenge does not appear to be a solution to retaining nurses but appears to be just a slight variance in the trajectory of nursing turnover in Jamaica. Instead of the migration of nurses to other countries, nurses are opting to migrate to other professions, or to other areas of healthcare where bedside nursing and direct patient contact is inevitable.
HISTORY
Nursing turnover has been an ongoing and challenging situation globally for the nursing profession, especially here in Jamaica and the wider Caribbean region. This has contributed greatly to the shortage of nurses and has subsequently led to a deterioration in standards of patient care.
In Jamaica, the challenge of the nursing shortage and the decrease in the standards of nursing care have been attributed to the migration of registered nurses (RNs), especially nurses who have been trained and certified in a speciality (speciality-trained nurses).
Statistics from the Nursing Council of Jamaica have revealed that hundreds of nurses apply for verification of licensure each year, based on the premise of migration to other countries. In 2016 alone, approximately 500 RNs resigned from healthcare institutions in Jamaica; they either migrated or left the nursing to work in other professions.
PRE-COVID-19 AND NOW
Working conditions were challenging before COVID-19 with inadequate resources, overcrowding in hospitals, inadequate infrastructure, and the subsequent increase in workload due to staffing shortage has led to staff burnout. These elements have created unsatisfactory working conditions, which often result in nurses being overwhelmed, frustrated, and dissatisfied with their jobs, prompting them to leave. Furthermore, the emergence of COVID-19 has placed more strain on the availability of sufficient material resources with which to work, and has created challenges in ethical and professional areas, such as adhering to standards of nursing care, preventing cross-contamination, and providing high- quality patient care.
Nurses are concerned for their lives due to the unfamiliar and fatal nature of COVID-19; they are concerned about the inadequate amounts of personal protective equipment available for them to work safely without running the risk of contracting the disease. Nurses also do not want to endanger their families, as insufficient protective gear while at work will increase their risk of transmitting the virus to family members within their households.
Front-line workers, particularly nurses in the hospital settings, have reported the psychological consequences they face carrying out their duties in this COVID-19 crisis. They have had to endure watching patients and colleagues die all around them each day, feeling helpless, hopeless, and fearful. Some have reported that they have had to seek psychological help in order to cope. Many nurses have been diagnosed with depression, social withdrawal syndrome, suicidal tendencies, and other social disorders as a result of traumatic experiences and life-altering changes they have undergone during the pandemic
Since the onset of the COVID-19 pandemic, I have lost track of the number of nurses presently employed to hospitals, who have asked if my institution of employment is hiring. One nurse who works at one of our more prime urban Jamaican hospitals stated, “I did not sign up for this when I decided to become a nurse, I did not think the job could literally kill me.” She further went on to say that she intends to leave bedside nursing and find another job in which she will feel safer. That is just one of the many expressions made by nurses who have conveyed a deep desire to leave the profession.
Unfortunately, that thought is the perspective of numerous healthcare workers, more so nurses. The COVID-19 pandemic has left nurses feeling unsafe, unprotected, undervalued, and afraid. Nurses are turning to other job options that are perceived as less dangerous, and many of these jobs do not require for them to be in the hospitals or at the patients’ bedside.
WHAT WILL WE DO?
Healthcare pundits are already indicating that the COVID-19 crisis will contribute significantly to nursing turnover and will worsen the shortage of nurses worldwide. Hence, it is prudent to say that the quality and efficiency of patient care will also be greatly and negatively affected.
Nursing shortage due to turnover has always been a contributor to a decrease in the standard of patient care and patient outcome in Jamaica. Thus, we need to ask ourselves, if 50 per cent or more nurses (those presently working in hospitals or health centres) leave the profession for safer alternatives, leave the bedsides of our nation’s hospitals, what will society and the patients who require the expert care of these nurses do? What will our governments do? What will our nursing organisations do?
Nursing administrators, health policymakers, health organizations and associations, the Government’s health ministry, interested stakeholders, etc., need to forecast and strategically plan effective resolutions to curtail any such probability.