Nurses are the backbone of Jamaica’s health system and some have earned the reputation of being among the best in the world, so it’s no wonder they are increasingly sought after internationally. As expected, the poaching of nurses from the public health care system is again on the national agenda. Indeed, given the ease of this nurse brain drain, one is left to ponder whether Jamaica, by itself, has the ability to retain its nurses, particularly specialist nurses, in this competitive environment.

Between 2015 and 2016, the Jamaica health system lost over 200 nurses — a group including more than 170 specialists. Undoubtedly, poaching will continue because the World Health Organization’s (WHO) non-binding memorandum of understanding does not effectively prevent countries from recruiting health care workers from member states.

While the perennial problem of other countries recruiting Jamaican nurses can be mutually beneficial to the source and destination, this compromises an already fragile Jamaican public health system, with several wards and specialist units — such as intensive care units and operating theatres — having to scale down operations or close their doors.

IS IT ALL ABOUT MONEY?

In researching the impact of no user fees on the work of professional nurses, the 2006-2009 data revealed that, despite an increased workload and delivering care under poor working conditions, nurses opted to remain in Jamaica and extended themselves to ensure that users accessed health care. Dominant opinions, however, were that nurses were disenchanted with lack of recognition for their worth and work, as well as a remuneration package not always comparable to others in the Caribbean region.

These were, however, not identified as key determinants for nurses to migrate or resign from a public health facility. Nurses were more concerned about the lack of supplies and the impact on their ability to perform, as well as how it influenced the users’ perception of them. Additionally, they raised concerns about the lack of administrative support, inadequate counselling services for nurses, or even a crèche for those with young children.

THE DOOR SWINGS IN

Successive governments have attempted to plug the gap in the system by engaging other countries, such as the United Kingdom, Cuba, India, Nigeria, and the Philippines, to either assist with training additional specialist nurses or recruiting extra nurses to satisfy the local demand.

However, Jamaica’s attempts to recruit health practitioners, particularly specialist nurses, from other countries have certain inherent problems. Dominant opinions among local nurses are that the language barrier between natives and overseas nurses can create problems for users of the public health system.

For example, one nurse recounted: “We are Jamaicans and we use certain terms…A patient came to the Outpatient [Department] at one time and told the doctor that he had ‘operation’…[The] doctor did not understand [it to mean] diarrhoea…so you have to be careful.”

Another issue with overseas nurses was that the local nurses were unhappy that overseas nurses received better remuneration packages. This could be remedied with standardisation.

Further, local nurses also raised concerns about the close supervision that is required for overseas-recruited nurses. The nurses felt they needed to take extra responsibility for the overseas nurses. Registered nurses recounted the challenges they experienced while working with some overseas nurses, some describing the experience as stressful.

Said one nurse: “I’ve worked with a few of them and it just puts more stress on me because you have to be watching. Even if you assign [them] to, say, do this, as soon as you turn…they are going to do something else. They don’t know about a sterile dressing…they don’t know about passing a female U Cath [urinary catheter]…they don’t understand…they just take up gloves, put [them] on and are ready to go. There was a situation where one just came, took a nurse’s notes from the day before and just copied everything.”

This further raised concerns regarding the level of training overseas nurses received and whether the curriculum is consistent with that utilised to train local nurses. One registered nurse recounted: “When you use certain terms to them they don’t understand…nursing terms; you are a nurse, you are supposed to be familiar [with these terminologies].”

Without doubt it is necessary to undertake an examination of the efficiency of immigrant nurses. Recruitment of overseas nurses in an attempt to complement staff has given rise to certain issues, among which are the quality of training and attained competence.

SYSTEMIC BLOCKS

Despite increased recruitment and training, the research showed that this did not sufficiently relieve the shortage. Furthermore, nurses were concerned about the archaic cadres (established number of trained professionals in the public health system) resulting in fewer posts for appointment of new staff. This phenomenon further compounds the shortage of staff in health facilities generally. Consequently, nurses are often redeployed to other facilities to ensure minimal coverage, especially in primary health care facilities. For this reason, continuity and accepted standards of care by nurses cannot be guaranteed.

NO PLUG FOR THE DRAIN, BUT…

Migration of nurses to the private sector and overseas will be with us for some time, so it is time for policymakers to be creative and engage recruiters of Jamaican nurses in a more strategic and sound manner. Recruiters should be made to contribute to the training of Jamaican nurses by providing both financial support to training institutions and practice settings, while boosting a resource-constrained public health system which continues to produce world-class nurses.

Above all, clearly defined strategies to train and retain Jamaican nurses in order to effectively manage the needs of the industry must be established.

Adella Campbell, PhD, is a graduate of Victoria University of Wellington, New Zealand, and is head of the Caribbean School of Nursing, University of Technology, Jamaica.