Nursing shortages and quality care concerns at JDWNRH

The quality of patient care in hospitals can be compromised if the shortages of healthcare professionals, like nurses, are not addressed. Insights from key healthcare figures, including Deputy Nursing Superintendent Tshering Dema and Nurses, offer a comprehensive view of the situation, as well as potential solutions.

Tshering Dema emphasizes that while new nurses are being recruited, the lack of experience and skills can potentially compromise patient care and safety. With practical experience being substantially different from academic knowledge, efforts are being made to provide nursing education and guidance to new recruits. Furthermore, the shortage of experienced and specialized nurses poses a significant challenge in providing high-quality patient care.

She also highlights the attrition of senior nurses, particularly in critical areas, such as the ICU and Dialysis. A shortage of senior nurses in specialized fields poses a significant challenge in maintaining the quality of patient care.

To address the workforce shortage, a transfer exercise was initiated, with 25 nurses from other districts being requested to join JDWNRH. “Five nurses from other districts have been transferred to JDWNRH and we are still waiting for the rest twenty to apply.”

Meanwhile, the vacancy of 40 contract nurses was announced, and 39 contract nurses are being recruited in September with 1 slot being vacant.

However, challenges remain in retaining experienced nurses. Many leave for better financial opportunities abroad, and also due to a lack of career progression in Bhutan. Tshering Dema emphasized that maintaining the quality of patient care is vital, and recruitment efforts should consider qualifications and experience over numbers, however, she also acknowledged the importance of a number of nurses to meet the nurse-to-patient ratio.

The nurse-to-patient ratio as of September in surgical ward is 1:11 while the ideal ratio is 1:5, 1:11 in the medical ward while the ideal ratio is 1:6, 1:13 in pediatric ward while ideal ratio is 1: 5, 1:3 in emergency while ideal ratio is 1:2 and 1:7 in dialysis while ideal ratio is 1:2. As of September, with the standard requirement of 502 nurses, the working nurses are 350.

However, the data is before the recruitment of contract nurses and those who are being transferred.

Additionally, the National Medical Service in consultation with RCSC is planning to recruit ward assistants to help lessen the paperwork burden on nursing staff, allowing them to focus more on patient care. These measures aim to address the shortage of experienced nurses and enhance the quality of patient care.

The statement from the NS gives a view of an improved nurse-to-patient ratio and less attrition than before, however, the question arises regarding the quality of patient care and the ability to handle any emergencies.

Head Nurse, Kinga Om, from the Birthing Unit highlights the impact of losing experienced nurses and the challenges of replacing them with newly recruited nurses. She said, “The time required for new nurses to reach the level of experienced nurses can lead to increased workloads for existing nursing staff.” The quality of patient care may be compromised as new nurses face difficulties handling emergencies independently.

Kinga Om also notes the importance of retaining experienced nurses in the country, especially since they have invested significant time and effort into their careers. She emphasizes that the recent pay hike has been a motivating factor for nurses to stay in Bhutan.

She suggests providing incentives for those working in specialized fields and opportunities for professional development, particularly for diploma-holding nurses who currently must self-fund further education could probably motivate the existing nurses.

“It is better to work here, as we are working in our field of expertise, while we go abroad, we must work with what is being appointed, which is quite discouraging,” said Kinga Om.

A nurse from the pediatric ward raises concern about the increased workload and its impact on work-life balance. Longer working hours due to a shortage of staff have resulted in compromised family time, especially for those with families and children. She said, “It is challenging during the evening duty as it gets over by 08:00 PM and it becomes 09:30 and 10:00 PM while reaching home most often with complete exhaustion.” This, in turn, affects the quality of patient care, as nurses may not meet the expectations of patients and their attendants.

The nurse mentions the challenges of managing patient expectations and prioritizing care when the number of patients far exceeds the nursing staff’s capacity. The nurse said, “Some of the parent attendants get angry because they feel we are not giving enough attention to their children. We have to prioritize our care when there are more than 30 patients, and it’s a challenge for two nurses to provide full attention to all of them. We do our best, but some attendants make us feel like we are not fulfilling our responsibilities, which can be disheartening, especially given the heavy workload.”

The recent introduction of a six-month notice period before resignation has reduced attrition, but concerns remain about a potential mass exodus of nurses in the coming year.

The nurse also expressed her reservations about the government’s plan to hire foreign workers. Instead, the nurse suggests that increasing the pay for existing nurses would be a more effective strategy.  She said, “The language and cultural barriers from foreign countries could result in communication gaps, potentially affecting patient care.”

Meanwhile, a breastfeeding mother and nurse raises the issue of a lack of childcare facilities at the national hospital, emphasizing the need for an ECCD center. This facility would significantly ease the daily commute for staff, especially during peak traffic hours, and allow them to focus on their work without worrying about family and child care.

She said, “The need for an ECCD at JDWNRH is becoming a crucial need for the hundreds of staff serving in the hospital.”

On the other side, one parent in the pediatric ward expresses gratitude for the free medical service and the dedication of nurses, who work tirelessly even during late hours. He said, “They actively monitor every patient, even during the late-night hours.”

However, another attendant from the medical ward shares concerns about the quality of care provided by the limited number of nurses. He said, “Handling more than 30 patients at once presents a significant challenge, and this is seen as a hardship to the nurses, whereby the quality of patient care might be sacrificed.”

The health sector is facing significant challenges, including shortages of experienced nurses, increased workloads, and concerns about patient care quality. While recruitment and transfer exercises are underway to address staffing issues, retaining experienced nurses and ensuring their well-being remains a priority.

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