Recognizing Caribbean Nurses in the COVID -19 era: Highlighting a Community for All

The blog this week is based on a report  by  Ms. Peggy DaSilva, Chair of the Caribbean Regional Nursing Body (RNB).  It is a follow up in reference to her comment  made in the April 9 Blog,  Celebrating 2020 World Health Day - Supporting Nurses and Midwives - in a time of Crisis. In a  report covering a range of issues, Ms. DaSilva has sourced data and responses from nursing bodies in the 15 CARICOM Member States and 5 Associate Members.  It is evident that the RNB is a vibrant regional enterprise that represents a critical force on the frontline of the fight against COVID 19.  GOFAD joins in the well-deserved commendations for the dedicated efforts of our nurses. The CARICOM COVID-19 Dashboard tracker, places in context the spread of novel coronavirus throughout the region.   The tracker on April 30 shows that there are 1177 confirmed cases, 62 deaths and 337 recoveries.  Jamaica has the highest rates including 396 confirmed cases, 8 deaths and 29 recoveries. 
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The CARICOM region has been plagued by a number of challenges that have serious negative effects on the functioning and sustainability of health systems in general, nursing, in particular. These are not limited to migration trends that have shown a significant brain drain related to the experienced and qualified nurses.  They also have implications for the quality of leadership among the nursing profession in the region.  The  World Health Organization (WHO) State of the World’s Nursing 2020 Report has underscored the  critical  role of nurses  towards the achievement  of universal health coverage.  Nurses have always been and will continue to be central to the health systems in spite of new and emerging technologies and other modalities in the management of client systems.  The  growth of new and emerging infections, exacerbated by the Chronic Non-Communicable Diseases (NCDs) as we have seen in the case of COVID 19,  has intensified the prevention, care and essential services demanded of nurses.
 
WHO declared 2020 as the International Year of the Nurse and Midwife with a call for governments to invest more in Nursing.  The advent of the COVID-19 pandemic has brought to the fore the critical importance of the need for such investment.  The global economic challenges affecting countries, especially small and middle to low income ones like ours in the Caribbean, are projected by the CDB and IMF, as well as our local experts to have a serious and debilitating impact on the economy and workforce.  The epidemiological data and trend analysis associated with the current pandemic predict a potential second and third wave. In these circumstances, the economic and human resource impact will be especially challenging for CARICOM member states, especially if the need for additional resources required for effective management of those who are critically ill becomes more pronounced.
 
The immediate challenges faced by the nursing profession in the Caribbean have persisted over a long period of time.  COVID 19 has however brought them into sharp focus.  Based on a sample of responses from a cross section of CARICOM States the following have emerged:
 

• As women continue to give birth during this period of crisis,  the dearth of midwives is evident. This is so especially at the secondary care level. It  is a result  of  a pull for midwives between hospital and community services, with midwives mostly opting for the socially easier option of primary health care, where the grade is higher, and the possibility of working nights and unsociable hours is less.
• In some countries,  the absence  of stipulated procedures for the registration of foreign nursing is  a major setback in the event  of emergencies and/or natural or manmade disasters.
• Absence or limited capacity of nursing schools to provide online theory and practical teaching/learning will have to be seriously addressed.
• Unavailability of qualified and competent staff as well as resources to facilitate online assessments.
•  Insufficient scholarship opportunities for advanced nursing education, training  and  job security.  
• Fear expressed and demonstrated by some health care workers including nurses of overexposure to COVID-19.
• Inadequate  remuneration packages including  variation in salaries between the public and private sectors.
• In the current period, many  countries have reported:

 

• high levels of absenteeism amongst nursing personnel.      
• fear of nurses in contracting and bringing home the disease to relatives.  
• requests by nurses for special accommodation  instead of going home to their
• families.
• inability  of nurses to make use of allotted shopping days due to work schedules and long lines of people waiting to access supermarkets.
•  Inadequate Personal protective equipment (PPE) and  supplies.

 
There are other dislocations confronting nurses that need to be urgently addressed. These include:
 

•  Lock down of the country and mandatory curfews instituted by the Governments that are contributing to the need for  some nurses having to make additional child care arrangements.
• Limited or absence of psychosocial support for nursing personnel to address multiple issues including personal and professional issues associated with functioning effectively under the intensity of  the stressful environment.
• Stigma and discrimination against nursing personnel caring for patients with COVID 19.
• Inflexible regulations requiring that replacing and expanding  of the  nursing pool can only be made where there are vacancies.
• Inadequate training programs  to expedite increasing the nursing pool to respond to health emergencies.
• Insufficient  testing kits.

 
The Regional Nursing Body has developed a Strategic Plan for Nursing and Midwifery (2020-2024).  It was finalized and presented to the Council of Human and Social Development (COHSOD) in September 2019.  Many issues contained in that plan require urgent implementation.  Among them is the need to increase the number of nursing graduates, ensuring that they find jobs, are adequately remunerated and retained in the health system.  Specifically mentioned in the Plan are the needs for:

• Evaluating and revamping the  Regional Examination for Nurse Registration (RENR)  managed by the Caribbean Examination Council (CXC).
•  Standardizing the  Clinical Assessment Tool for final year nursing students  based on recommendations made by RNB.
• Regulating and standardizing  the employment  and deployment of Assistive Nursing Personnel (ANP).
•  Addressing the perennial problem of migration of trained nurses from the Caribbean.

 
Conclusion
 
While COVID-19 has placed a strain on the healthcare system as more resources are funneled toward caring for coronavirus patients, nurses and other health professionals still need to pay attention to the essential services.  Maybe, the Caribbean might wish to consider paying  homage to our nurses and others on the frontline by dedicating a time and day when the entire region would collectively  pause, toot their horns, wave , applaud, and symbolize in whatever way,  the importance we ascribe to  these valiant soldiers  on the battle field to save lives and livelihoods of us all.  This gesture would at least bring the countries on the  Region -- physical distancing together --   in line with engendering a spirit of "CARICOM as a Community for All".  
 
 
Eddie Greene and Peggy DaSilva