NML-ISSUE 7 VOL 2 DEC 2024

NMLTT NEWSLETTER Issue 7 | Volume 2 | December, 2024

Always on Call for the Nation Celebrating Nurses and Midwives

NM AT WORK

0 CONTENT: NURSES AND MIDWIVES LEADERS THINK TANK NEWSLETTER ● PAGE 01: EDITORIAL NOTE: IT’S A WRAP: By Rose Clarke Nanyonga ● PAGE 03: LEADERSHIP AND QUALITY FOR EDUCATION AND TRAINING FOR HEALTH By Dr. Safinah Kisu Museene ● PAGE 06: TRANSFORMING NURSING AND MIDWIFERY REGULATION THROUGH DIGITAL INNOVATION AND CONTINUOUS LEARNING By Registrar Christine Nimwesiga ● PAGE 09: THE NEXT GEN NURSING by Elizabeth Pearson ● PAGE 12: CELEBRATING THE HIHA WINNERS ● PAGE 17: THE ONGOING INTERNSHIP PLACEMENT CRISIS By Irene Atuhairwe ● PAGE 19: STRESS-FREE HOLIDAY SEASON FOR NURSES AND MIDWIVES: TIPS AND STRATEGIES. By Judith Hope Kiconco ● PAGE 22: FROM VILLAGE ROOTS TO A GLOBAL NURSE ICON: By Lilian Nuwabaine ● PAGE 27: THE VALUE OF INTERNSHIP FOR NURSES AND MIDWIVES IN UGANDA by Susan Asiimwe

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1 EDITORIAL: IT’S A WRAP. HAPPY NEW YEAR EVERYONE

Dear readers, the end of the year often feels rushed and overwhelming. For many of us, it’s a time of reflection—looking back on both significant and smaller events that shaped our work and lives. Yet, I often find myself frustrated by how little I remember of the key moments that defined the year. Time seems to slip by, and with it, the details of these experiences. It’s a reminder of the importance of intentionally cataloging moments to preserve their significance. As we bid 2024 farewell, we’d like to take a moment to highlight a few key events that shaped nursing and midwifery this year.

First, the issue of internships took center stage earlier Dr. Rose Clarke Nanyonga is the Vice Chancellor at in the year, leading to major government decisions Clarke International University and the Chief Editor of directly impacting the internship program. Two of our the NMLTT Newsletter feature authors reflect on this ongoing issue in this edition—see pages 17-18, article by Irene Atuhairwe, Seed Global Health, and 27-29, article by Susan Asiimwe, Lecturer Kabaale University.

Additionally, the internship debate sparked broader conversations around the quality of education and training for health professionals. In this issue, Dr. Museene, Chair of the NMLTT, reflects on the Leadership and Observation of Quality for Education and Training of Students in Health Training Institutions/Medical Schools and highlights where we collectively need to focus our efforts moving forward.

Technology increasingly shapes both our work and personal lives. It is, therefore, fitting to conclude the year with key insights from the Registrar of the Uganda Nurses and Midwives Council, Ms. Christine Nimwesiga. In her report, she highlights how digital innovation and continuous learning are revolutionizing nursing and midwifery regulation. Find her insights on pages 6-8.

2 We also celebrate this year’s winners of the HIHA awards, as highlighted on pages 12-16.

Whether you are active on social media or not, we hope you didn’t miss the Aster Guardians Global Nursing Awards, where our very own Lillian Nuwabaine was named among the top 10 finalists. Her inspiring story is featured on pages 17 to 21.

In other news, our editor and Director of the National Healthcare Conferences Uganda, Ms. Pearson, has been busy leading a rebranding effort, transforming NHCC into the Diaspora Uganda Nurses and Midwives Society (DUNMS). Read the special announcement on page 29.

On a personal note, I am delighted to share that this year I was appointed as a member of the Executive Board of the Inter-University Council of East Africa, representing private universities.

Additionally, I was inducted into the Uganda National Academy of Sciences, joining the esteemed company of Dr. Rose Chalo as one of the few nurses in this prestigious institution.

Lastly, I want to extend heartfelt thanks to the incredible NMLTT Newsletter editorial team, who continue to volunteer their time for this worthy endeavor. There is much to celebrate and even more to be grateful for. As we move into the new year, let us remember to express appreciation to those in our work community. A simple “thank you” can go a long way—no awards required.

Wishing you all a happy and prosperous New Year!

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LEADERSHIP AND QUALITY FOR EDUCATION AND TRAINING OF HEALTH REFLECTIONS BY DR. SAFINAH K. MUSEENE

Leadership focuses on the capacity to guide, inspire, and influence individuals or groups to achieve a common goal. For health, education, and training, the common goal is the production of adequate and quality (skillful) health professionals (Leithwood, 2005). For this goal to be achieved the leadership at Health Training Institutions/Medical schools, at the Ministry of Education and Sports, and in the clinical training facilities is critical and paramount.

Dr. Museene is the Commissioner Health Education and Training MoES and the Chair of the Nurses and Midwives Leaders Think Tank

Over 70,000 (seventy thousand) students undergo education and training on an annual basis at various levels of specialization to become health professionals. Making these students competent and skillful requires deliberate efforts in preparation for teaching and clinical rotation, the use of appropriate methodologies, the use of effective mentorship/preceptorship for students on clinical rotation, and effective assessment methods.

Klingborg, Moore & Varea-Hammond (2006) defines Leadership as a process-oriented, nonspecific practice of challenging the process and inspiring a shared vision to enable others to act, through modeling the way and encouraging the hearts of others to perform towards the set goal.

The leadership at the Ministry of Education and Sports is headed by the First Lady and Minister of Education and Sports Hon Janet K Museveni. The Minister is very passionate about quality delivery, and, in my opinion, I call her the Champion for health professional education and training. This is because a lot has been achieved during her tenure of service.

In her term, we have witnessed curricula being revised, resources being provided for; capitation, instruction materials, infrastructure improvement, wage, and capacity improvement of tutors and preceptors to mention but a few.

This is because, for her, quality is quality and nothing else but quality.

But what does quality mean in relation to the education and training of students in health educational institutions? Akareem & Hossan (2016). Described the meaning of the concept of “quality” as ‘fitness for purpose or the degree of excellence and superiority of something often

4 measured against established standards, requirements or expectations. In the education and training of students within health training institutions, specific standards are established concerning;

Curriculum and Content. The relevancy and regular update of the curriculum and its alignment with health sector industry standards and best practices is critical. Emphasis on comprehensive coverage of theoretical and practical aspects of healthcare is important. The inclusion of soft skills, communication, and interpersonal skills, and integration of technology, research, and evidence-based practices should not be omitted.

Teaching and Learning Methods. The standard here requires the use of experienced and qualified faculty with expertise in the field of health and education. Methodologies that support Student-centered learning approaches (e.g., problem-based learning and case studies) should be utilised (Mitchell, et al, 2024).

Additionally, simulation-based training and hands-on practice are essential, providing students with the opportunity to practice on dummies before working with real patients. The use of online and blended learning opportunities along with regular assessment and feedback has also now become a standard practice.

Clinical Experience and Practice. With this, students have to access well-equipped clinical facilities and resources under the supervision of willing and competent preceptors. And where supervised clinical rotations and mentorship programs are in place. Opportunities for interdisciplinary collaboration are encouraged and supported. Students are exposed to diverse

patient populations and cases. This supports their learning processes.

Assessment and Evaluation where the use of valid and reliable assessment tools, and regular evaluation of student learning outcomes is observed. Programmatic accreditation and certification and conduct of continuous quality improvement (CQI) processes are established.

This standard allows for the provision of feedback and room for improvement.

Infrastructure and Resources, this is about having modern and relevant lecture rooms, laboratories, and simulation centers; where access to current technology, equipment, and software is assured; with adequate library and information resources and support services (e.g., counselling, career guidance). Appropriate infrastructure as earlier stated, supports quality training and should never be compromised.

Another standard is student support systems.

This standard focuses on academic advice, mentorship, career counselling and placement services, mental health, and wellness support services, and financial aid and scholarship opportunities. Saha, & Saha, (2024) state that when student support systems are in place, they aid students in voicing out their concerns and appropriate help can be provided. Health Training Institutions should never omit this standard if the quality of training and education is to be achieved.

Previously, each specialization in health was independently prepared.

However, Interprofessional Education has now become the standard in medical and health training institutions. This approach fosters collaboration

5 among various healthcare disciplines, promotes team-based learning experiences, and enhances communication and teamwork skills.

Management should ensure Faculty Development, ongoing faculty training, and professional development, support for research and scholarly activities, and recognition and rewards for teaching excellence are other standards that support quality training and development. Ensuring that opportunities for lifelong learning and continuing education are availed and encouraged is critical.

Partnerships with healthcare organizations and communities are important, especially as a tool to facilitate changes and ownership of the institution by the community. Service-learning and community-based projects should be done and collaboration with healthcare stakeholders should be encouraged and supported.

Diversity, Equity, and Inclusion should also be supported. A diverse student body and faculty, inclusive learning environment, cultural competence training, and addressing health disparities and social determinants should be in place and emphasised.

As we end the year 2024 and enter into the year 2025, let us reflect, let us evaluate ourselves to determine whether whatever we do, lets us support quality education and training for health.

I request you to support the development and utilisation of an adequate and relevant curriculum. I encourage you to regularly update yourself on the appropriate methodologies that support the acquisition of hands-on skills. And to ensure that our students are attached and supported during clinical rotation. We should also monitor learning and evaluate the academic and professional progress of our students. We should be advocates for the use of competent teaching and non-teaching staff who regularly update their skills, appropriate and adequate infrastructure availability, student support systems availability, and all the quality assurance measures mentioned above.

By doing the above, we shall be able to achieve our goal of producing adequate and quality (skillful) health professionals. Congratulations on going through 2024 and I wish you a happy, prosperous, joyful, and productive 2025.

REFERENCES 1. Klingborg, D. J., Moore, D. A., & Varea-Hammond, S. (2006). What is leadership? Journal of Veterinary Medical Education, 33(2), 280-283.

2. Leithwood, K. (2005). Educational Leadership. A Review of the Research. Laboratory for Student Success (LSS), The Mid-Atlantic Regional Educational Laboratory 3. Akareem,H.S., &Hossan,S.S. (2016). Determinants of Education quality: what makes students' perception diferrent?

Open review of educational Research, 3(1), 52-67. https://doi.org/10.1080/23265507.2016.1155167 4. Mitchell, S., Sehlbach, C., Franssen, G. H., Janczukowicz, J., & Guttormsen, S. (2024). Taxonomy of teaching methods and their use in health professions education: a scoping review protocol. BMJ open, 14(1) 5. Saha, B., & Saha, U. (2024,). Enhancing International Graduate Student Experience through AI-Driven

Support Systems: A LLM and RAG-Based Approach. In 2024 International Conference on Data Science and Its Applications (ICoDSA) (pp. 300-304). IEEE.

6 TRANSFORMING NURSING AND MIDWIFERY REGULATION THROUGH DIGITAL INNOVATION AND CONTINUOUS LEARNING Dear Colleagues, As we close another impactful year, I am filled with pride and gratitude for the strides we have made together as the Uganda Nurses and Midwives Council (UNMC). Our collective efforts to elevate the nursing and midwifery professions continue to bear fruit, creating a brighter future for healthcare in Uganda.

The Uganda Nurses and Midwives Council was established by the Uganda Nurses and Midwives Act, 1996, as the regulatory body mandated to oversee the training, registration, and practice of nurses and midwives in Uganda.

We are dedicated to promoting the highest standards of professionalism and ethical conduct to safeguard public health and elevate the professions of nursing and midwifery.

Ms. Christine Nimwesiga is the Registrar, Uganda Nurses and Midwives Council

Our core responsibilities include: • Registration and Licensure: Certifying qualified professionals to practice nursing and midwifery.

• Regulation of Training together with MOES departments: Ensuring training institutions meet set standards for producing competent practitioners.

• Promotion of Ethical Practice: Enforcing the professional code of conduct to uphold the dignity and integrity of the professions.

• Advocacy and Research: Partnering with stakeholders to inform policy and promote evidencebased practice.

Online Registration and Licensure One of our most significant achievements this year has been the successful implementation and adoption of the Online Registration and Licensure System (ORLS). This transformative platform has redefined service delivery at the Council by making registration and licensure more accessible, efficient, and transparent.

Key highlights include:

7 • • •

Improved Access: More than 70% of nurses and midwives are now registered or licensed through the ORLS, eliminating geographical barriers.

Enhanced Data Integrity: Accurate and up-to-date information now supports workforce planning and strategic decision-making.

Empowered Practitioners: Real-time updates and notifications on the platform promote transparency and accountability.

These achievements align with our commitment to strengthening nursing and midwifery regulation to meet national health goals and Sustainable Development Goals (SDGs).

Focus for the Next Financial Year: Research and Continuous Professional Development (CPD)

As we look ahead, the Council is committed to advancing the professions through Research and Continuous Professional Development (CPD).

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• • • 2.

• • • • •

Promoting Evidence-Based Practice Through Research: Research Agenda: Establishing a national research agenda for nursing and midwifery to address critical healthcare challenges.

Collaboration: Partnering with academic institutions, health facilities, and international organizations to foster research and innovation.

Capacity Building: Providing training on research methodologies and creating opportunities for nurses and midwives to publish in peer-reviewed journals.

Enhancing Competencies Through CPD: Digital CPD Integration: Developing an integrated CPD tracking system within the ORLS, allowing practitioners to document learning milestones.

Innovative Learning Models: Launching blended learning programs that combine online modules with hands-on training.

Specialized CPD Areas: Introducing courses in leadership, technology in healthcare, and specialized care to meet emerging health needs.

Regional Outreach: Expanding access to CPD opportunities at the district level, ensuring inclusivity for all practitioners.

Recognition of Excellence: Establishing an award system to honor outstanding CPD achievements and inspire lifelong learning.

8 Our Vision for 2025 and Beyond By prioritizing research and CPD, we aim to build a resilient, empowered nursing and midwifery workforce capable of delivering high-quality care. These initiatives will support Universal Health Coverage (UHC) and ensure that Uganda remains at the forefront of healthcare innovation.

I call upon all nurses and midwives to actively engage in these programs, share their experiences, and contribute to shaping the future of our professions. Together, let us continue to build a legacy of excellence and impact for generations to come.

Warm regards, Nimwesiga Christine Registrar, Uganda Nurses and Midwives Council

9 THE NEXT GEN NURSING

Ms Elizabeth Pearson is a Nurse Lecturer and Director DUNMS.

With the ongoing discussions and uncertainty about internships, and in preparation for next year’s announcements, the Diaspora Uganda Nurses Midwives Society (DUNMS)*; whose ultimate goal is to support the nursing work environment and improve care by equipping nurses and midwives with skills, competencies, and tools to become competent, confident professional champions, has introduced an exciting innovation that is focused to encourage our future generation of Nurses and boost morale for the next generation of Nurses. The End-of-year Student Nurse 2024 competition has a special reward attendance at the 30th ICN Congress in Finland next year. A landmark event occurred from June 9-13,

2025, in Helsinki, Finland.

The ICN Congress theme 2025 “Nursing power to change the world”, will illuminate the extraordinary influence wielded by nurses, pivotal in shaping the ever-evolving landscape of healthcare delivery. Emphasizing nurses’ profound capacity to impact lives across a spectrum of healthcare settings positively, our Congress underscores nurses’ invaluable role in enhancing equity and accessibility to healthcare services and shaping health policies at every level of governance. At the heart of this discourse lies our collective commitment to achieving Universal Health Coverage and driving the global health policy agenda forward. See ICN CONGRESS 2025 Ahead of making this new reward, the team at DUNMS is looking for some feedback to ensure that it all makes sense. The competition seeks to identify an outstanding student nurse who is inspiring colleagues and patients and is passionate about the profession.

Student Nurse of the Year aims to recognise an outstanding second or final-year student on a nursing degree course. Our inaugural winner will join a select group of standout individuals who have shown passion for the profession. See page 30 for current finalists.

Nursing degrees enable people to train to become graduate registered nurses. This award aims to celebrate them into registered nursing and the breadth of learning needed to join the profession – from clinical skills to academic achievement, which underpin the treatment of all patients.

10 In essence, entrants must combine the knowledge, skills, and qualities required to excel. As a student on a degree course, the winner will have a broad understanding of a range of conditions and treatments and demonstrate an in-depth understanding of the nursing profession and its responsibilities. Please note: You must hold a valid passport. Check out the poster for details and who is eligible to participate.

What the judges are looking for: An exceptional final-year pre-registration nurse who can demonstrate excellence in the following: ● Knowledge of and competence in clinical skills ● Understanding of the rationale behind evidence-based practice, treatment choices, and care pathways ● Interpersonal and communication skills and the ability to use them with patients, families, and carers ● An ability to act with compassion and empathy ● Active listening, responding, and personalising care to meet patients’ needs ● Innovation example to improve care ● Academic achievement ● Acting as a role model for student nursing - passionate about the role ● Team playing, appreciation of the role of nursing within the wider multidisciplinary team ● Use of reflection and the confidence to question practice even if they may challenge others

The reward - motivation to attend the congress I. II. III. IV. V. VI.

The global platform provides an opportunity for networking with global nursing leaders; To demonstrate how you meet continuing professional development requirements; To learn about the latest research and/or innovations in nursing; For career development opportunities; To gain insights into global health policies; And to engage in discussions on nursing education and practice.

11 Please attach any relevant supporting evidence to your submission via https://forms.gle/4GorJ4nQNPPJwfVX7 This includes testimonials from registered nurses, mentors, and from your university/training institute letter. Submissions opened 5 November 2024 and ended on 5 December 2024. Successful candidates will be invited to make a presentation via Zoom on 24th January 2025.

For our friends, well-wishers, and stakeholders who can partner with us and support us deliver this special reward package to a lucky student nurse which includes :- Early bird student registration fee (for low to middle-income country) - One adult economy return flight - 5 nights of student accommodation.

- Travel insurance.

Contact us at nhccuganda@gmail.com, info@nhccuganda.com or check the website www.nhccuganda.com. #ToLoveAndServe #NextUgGenNurses #DUNMS #Diaspora Contributions Diaspora Uganda Nurses Midwives Society (DUNMS)* see page 30.

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CELEBRATING THE HEROES IN HEALTH AWARDS (HIHA) WINNERS

Atako Harriet: Midwife of the Year, 2024

Harriet Atako is a passionate midwife at Dei Health Centre II in Pakwach district, serving a remote population of 16,000 on the Uganda DRC border. Since joining Dei HC II in 2015, Harriet has transformed maternal and neonatal care in her community, pioneering services in the centre’s modest setup with unmatched dedication. Atako’s exceptional skills, resilience, and commitment have earned her community admiration and professional recognition, including the title of Safe Motherhood Champion by West Nile Local Maternity and Neonatal System (LMNS). Her steadfast devotion has led to an astounding 764 successful deliveries in the past year alone, making her a lifeline for hundreds of mothers in this underserved area.

Despite operating as the lone midwife, Atako provides comprehensive maternal and child health (MCH) services, including antenatal and postnatal care, family planning, immunisations, malaria prophylaxis, and critical HIV prevention measures. Her tireless efforts to support families have seen the facility’s delivery rates increase from an initial 15 per month to 65, underscoring the impact of her compassionate and client-centered approach. Atako’s close engagement with Village Health Teams, expert mothers, and local leaders has fostered trust, enhancing the quality of healthcare while addressing community-specific needs. Her seamless coordination with other health teams to ensure timely referrals, pre-referral treatment, and post-care follow-up, greatly improving maternal health outcomes.

13 Atako’s devotion to healthcare extends beyond the health facility. In a region where many mothers might otherwise forego essential care, she bridges gaps by building relationships, promoting health education, and mentoring young healthcare professionals. Atako’s work exemplifies resilience, empathy, and community partnership, driving impactful change and setting a standard in compassionate healthcare. As we honour Atako with the Heroes in Health Midwife of the Year Award, we celebrate her expertise and profound dedication to the well-being of every mother and child she serves. (Source: Awardees for 2024 - HIHA)

Jedah Twebaze: Nurse of the Year, 2024.

Twebaze Jedah, the Assistant Nursing Officer and mentor at Kyaka II Refugee Settlement exemplifies the true spirit of humanitarian healthcare in his dedicated work combating HIV and TB within refugee communities. For over nine years, Twebaze has committed himself to improving healthcare outcomes and fostering resilience among some of Uganda’s most vulnerable populations. Through rigorous screening programmes and innovative care approaches, he has played an instrumental role in identifying and managing critical cases in challenging resource-limited settings, significantly improving the health and quality of life of countless refugees. His compassionate service has touched many lives, offering healing and hope to those who often feel overlooked.

Twebaze’s influence extends beyond patient care. As a mentor and advocate, he trains and empowers healthcare workers, strengthening the community’s capacity to combat HIV and TB effectively. His organisation, Queen Elizabeth Medical Foundation Uganda, which he founded in 2018, further reflects his dedication to holistic health and social care.

14 This foundation serves children and adolescents affected by HIV and TB, providing healthcare, education, and livelihood support, especially to those living in and around Queen Elizabeth National Park. Through this initiative, Twebaze has led health programmes for over 1,500 adolescents, distributed hundreds of maternal kits, and conducted family planning outreach, thereby promoting safer and healthier futures for these communities. Twebze’s work in advocacy has also been transformative. He collaborates with local and international partners to secure resources essential for the continuation and expansion of HIV and TB services. His persistence in engaging with policymakers and stakeholders has brought much-needed attention and support to healthcare needs in refugee settlements. Twebaze’s efforts bridge the gap between communities and healthcare providers, ensuring that everyone, regardless of their circumstances, receives the care and support they deserve. For his tireless dedication, expertise, and compassionate leadership, Twebaze is an inspiring nominee for the 2024 HIHA Nurse of the Year Award. (Source: Awardees for 2024 - HIHA)

Dr. Elizabeth Ayebare: Maternal and Child Health Award, 2024.

Dr. Ayebare is a midwife and Lecturer at the Department of Nursing, Makerere University, Uganda. She holds a Bachelor of Nursing and a Master of Nursing (Midwifery and Women’s Health) degree from Makerere University. She received a PostGraduate Diploma in Child Nursing from the University of Cape Town, South Africa. She has special interests in maternal and child health, particularly intrapartum and newborn care. Her doctoral work focused on birth asphyxia in Uganda: associated factors, intrapartum care practices, and the predictive value of umbilical artery lactate.

The work has led to intrapartum interventions to prevent and manage birth asphyxia in Northern Uganda. She is a member of the Association of Graduate Nurses and Midwives of Uganda, Sigma Theta Tau International Nurses Honor Society, and the Deputy Country Lead for Lugina Africa Midwives Research Network. Ms. Ayebare has worked with nurses and midwives in

15 Uganda to improve care for patients through clinical audits, skills training, and mentorship. The NMLTT featured her PhD journey last year in NML Issue 2 Vol 2 (MY PHD JOURNEY: DR ELIZABETH AYEBARE (PhD HEALTH SCIENCE) - Issuu)

Primrose Magala, Diaspora Merit Award, 2024.

Primrose Magala, a British Ugandan senior ophthalmic nurse practitioner based at Moorfields Eye Hospital in London, has made remarkable strides in transforming eye healthcare in Uganda and beyond. As the founder of Eye Health Africa (EHA), she has facilitated the donation of both decommissioned and new equipment to multiple hospitals across Uganda, including Rubaga, Nsambya, and Hoima Regional Referral Hospitals. These contributions have significantly improved service delivery and brought life-changing eye care services to communities that would otherwise lack access. Her leadership extends beyond equipment provision; she has spearheaded knowledge exchange by encouraging specialists like Prof. Lyndon da Cruz and Dr Kaveh to provide care and build capacity in Uganda.

Magala’s vision for healthcare is anchored in collaboration and sustainability. Through Eye Health Africa, Magala has organised numerous free eye medical outreaches in Uganda, offering essential services and leveraging international expertise. EHA also works closely with organisations like the Uganda Nurses and Midwife Association UK (UNMA-UK) to conduct capacity-building sessions for local healthcare providers. Magala is committed to addressing the critical shortage of ophthalmic care in Sub-Saharan Africa and has dedicated her efforts to establishing sustainable institutions that can offer world-class eye care services on the continent. She aims to ensure that no African citizen needs to leave their country to access specialised eye care. driven by a passion for serving Africa’s marginalised and vulnerable communities, Magala’s work exemplifies the powerful impact of the African Diaspora in shaping their home countries.

She is actively working towards establishing an Africa-wide Eye Health Consortium, with a focus on building centres of excellence and eye health institutes across the region. By aligning

16 her work with global Sustainable Development Goals, she is making lasting contributions to healthcare systems in Uganda and creating a legacy of healthier eyes and lives across the continent. (Source: Awardees for 2024 - HIHA) PHOTO OF THE YEAR This year, our photo pick of year goes to this nurse in Kumi. In November 2024, a colleague posted

these two images of a nurse in one of the health facilities in Kumi -Uganda, going out with her team for Mass polio immunization. Image Courtesy of @MinofHealthUG

17 THE ONGOING INTERNSHIP PLACEMENT CRISIS BY IRENE ATUHAIRWE Since the liberalization of medical training, the number of graduates from health training institutions has been steadily increasing each year. Looking back almost a decade, around 964 health professionals were eligible for internship placements, whereas in 2024, the number has risen to approximately 2,644. This sharp increase has led some to believe there is an overproduction of health professionals. In fact, some have even proposed regulating the number of trainees from health institutions to deal with the ever-increasing number of eligible interns. However, according to the recently released Health Labor Market Analysis (HLMA) by the Ministry of Health of Uganda and the World Health Organization, Uganda faces a 42% shortage in meeting the recommended number of health workers per 10,000 population as outlined in the Sustainable Development Goals. To address this gap, Uganda must prioritize investment in the entire ecosystem that produces health workers, from quality training and internship placements to recruitment and retention of qualified professionals.

Medical interns are crucial frontline workers in our health facilities, providing the majority of care to patients in tertiary health facilities. When patients arrive at a facility, it is often the intern who provides the essential care before the patient is seen by a specialist or senior health worker. This enables the limited number of specialists

Irene Atuhairwe is the Country Director, of Seed Global Health and is a PhD Candidate.

and senior health workers to focus on higher-level care. Without this key workforce, the existing health workers become overwhelmed by the volume and complexity of care, which hampers the quality of service. The absence of interns also exacerbates absenteeism, a common issue in public facilities, likely due to the heavy workload.

Medical internships are critical for newly qualified health professionals to gain and refine their clinical skills before they are allowed to practice independently worldwide. During this internship period,

18 these professionals also serve the community. Moreover, the internship is a mandatory requirement for registration with the Uganda Medical and Dental Practitioners Council, Uganda Nurses and Midwives Council, and the Uganda Pharmaceutical Society. The Uganda Nurses and Midwives Council further mandates that professionals must have at least five years of practice in a reputable health facility before they can practice independently. As such, internships ensure that health workers receive sufficient clinical experience beyond their formal education, providing a crucial quality assurance mechanism.

begin with anticipating the number of interns required each year and allocating the necessary resources to ensure the deployment of all eligible interns for that year.

According to the Uganda Human Resources for Health Strategic Plan (2020-2030), Uganda needs 41,923 health workers to meet staffing norms in both the public and private health sectors by 2025. However, since the plan’s inception, medical interns have contributed less than 15% of this requirement. This emphasizes that the idea of overproduction of health workers is an illusion, as the gap in staffing remains significant, and all evidence and policies highlight the need for more health professionals.

It is not too late for Uganda to change its course and address the challenges of an under-resourced health workforce.

Recognizing the high return on investment from deploying medical interns, along with the significant benefits to patients, health workers, and the broader health system, is an important first step. This process should

There is a pressing need to strengthen the quality of health workers produced by regulating training institutions to ensure that they only train numbers in line with available resources, including teaching staff, clinical experiences, and supervision.

Regulators must hold institutions accountable for their enrollment and training practices. Additionally, enhancing the capacity of Regional Referral Hospitals and other health facilities to provide quality care and adequate supervision of interns through the presence of specialists will improve the training process.

Lastly, there must be a commitment to implementing long-term plans and policies, such as the Human Resource for Health Strategic Plan 2020-2030, which provide critical direction regarding the number of health workers, specialties, and cadres required to meet the nation’s needs.

Uganda has also established itself as a leader in health professional training within the region, thanks to the number of health professional training institutions compared to its neighbors. We can leverage this position to create a model for the production, recruitment, and retention of high-quality health workers, which could be shared with other countries in the region and globally.

19 Strengthening inter-ministerial collaboration between the Ministry of Education and Sports, the Ministry of Health, and the Ministry of Finance will help predict and plan for the deployment of

medical interns and other health workers in training, ensuring that there are no surprises in the numbers and that the responsible parties are prepared to recruit these professionals.

STRESS-FREE HOLIDAY SEASON FOR NURSES AND MIDWIVES:

The holiday season is here again. It’s a time of joy, celebration, and togetherness. It's a time to reconnect with loved ones, reflect on the past year, and look forward to the new one. The atmosphere is filled with festive music, twinkling lights, and the sweet scent of traditional holiday treats. Many people also look forward to upcountry travels, shopping, end-of-year parties, and exchanging gifts with loved ones and colleagues at this time of the year.

While you may be swept up in the season's excitement, attending holiday gatherings, exchanging gifts, and celebrating with loved ones, your commitment to caring for others remains unwavering as a nurse/midwife. You’re the unsung heroes of the holiday season, working tirelessly behind the scenes to bring joy, comfort, and healing to those in need. Your dedication, compassion, and expertise make a significant difference in the lives of those you serve, and your efforts are truly appreciated.

Amidst the festivities and celebrations, nurses/midwives must also navigate the added

Ms Judith Hope Kiconco is a Member of the Steering Committee and an Editor at the NMLTT Newsletter

pressures and demands of the holiday season.

Long hours, increased workload, and high

20 breaks to maintain productivity and reduce burnout.

Setting Boundaries: One of the most important things you can do to manage holiday stress is to set clear boundaries. This might mean saying 'No' to overwhelming or unsustainable commitments such as taking extra shifts during the holiday season or setting limits on your workload or responsibilities.

patient acuity can take a toll on your physical and mental health, making it a stressful and overwhelming time. Between working long hours, managing a heavy workload, and meeting the expectations of family and friends, it's easy to feel burnt out. It's essential to prioritize your well-being during this time.

Managing Family Expectations: Family expectations can be a significant source of stress during the holiday season. Whether it's the expectation of gifts, travel, or hosting duties, it's easy to feel overwhelmed. One way to manage family expectations is to communicate clearly and honestly. Let your loved ones know what you can and cannot do and be clear about your priorities and limitations. For example, you can set a budget for gifts or suggest a potluck-style meal to share the hosting responsibilities.

Here are some valuable insights and strategies to support your self-care and resilience during the holiday season and managing holiday stress as a Nurse/Midwife: -.

Navigate Increased Workload: To effectively manage the increased workload that often comes with the holiday season, necessitating nurses/midwives to cover additional shifts or take on extra responsibilities, consider prioritizing tasks based on urgency and importance, delegating tasks to colleagues when possible, focusing on efficient time management and minimizing distractions, communicating proactively with your team and supervisor to ensure a smooth workflow, and taking regular

Balance Festive Flavors with Healthy Choices: During the holiday season, getting carried away with festive treats and drinks is easy. However, it's essential to remember that moderation is key. Limit your intake of high-calorie foods like decadent cakes and pastries. Opt for smaller portions or choose lighter alternatives like

21 fruitcake or gingerbread. Regarding meats, focus on learner options like roasted or grilled chicken, and limit your intake of processed meats like sausages and bacon. Additionally, be mindful of your alcohol consumption, opting for moderation and choosing lower-calorie options.

Love Yourself More: Your well-being is paramount, especially during the holiday season. Prioritizing self-care and focusing on your physical and emotional health is crucial.

Make time for activities that nourish your mind, body, and spirit, such as exercise, meditation, and spending time in nature. Aim to rest for 7-8 hours each night to help your body and mind recharge. Engage in hobbies or creative pursuits that bring you joy, and schedule downtime into your calendar to relax and unwind. By prioritizing self-care, you can maintain

resilience, reduce stress, and truly enjoy the holiday season.

The holiday season can be challenging for nurses/midwives, but with the right strategies and mindset, you can manage stress, stay healthy, and maintain a positive work-life balance. Remember to communicate clearly with your loved ones and consider participating in local church Christmas celebrations to foster a sense of community and connections. Finally, show appreciation for those who have supported you throughout the year by gifting one or two extraordinary individuals.

With these tools, you can confidently navigate the holiday season and continue to provide excellent care.

Happy Holidays!

22 FROM VILLAGE ROOTS TO A GLOBAL NURSE ICON: LILIAN NUWABAINE

“The only person you should try to be better than is the person you were yesterday”. The cyclical patterns of this maze of life presented me with astounding opportunities as one of the top ten finalists for the Aster Guardians Global Nursing Award 2024 (out of 78,000+ applications and registrations from 203+ countries).

Ladies and gentlemen, my name is LILIAN NUWABAINE, a very zealous, energetic, innovative, and notably an ebullient Nurse-Midwife leader. I am a trainer, mentor, researcher, innovator, and entrepreneur sending you all greetings from the pearl of Africa, Uganda.

23 From the southwestern part of Uganda, is Buhweju district where I had my humble beginning. In a remote village surrounded by poverty, illiteracy, unsafe water, teenage pregnancies, and rocky feeder roads with enormous potholes that could inhabit a crocodile on a rainy day. My careworn childhood wasn’t a real dream to many. Had it not been the strong will of my parents to educate a girl child, I wouldn’t have become an extraordinary maker of positive change in health care in Uganda today. This is the desire I have strongly nurtured that made me the first graduate Nurse in the entire district.

Growing up, I witnessed my young brother suffer from a mysterious disease that almost cost his life, which was much later identified as cerebral malaria. Just like any other typical African community, they strongly attributed it to witchcraft. One can only imagine how challenging it was to seek medical care as the nearest hospital was >20 kilometers away. My mother hopelessly carried her convulsing son on the back and hit the road at dawn despite the terror of the dark with not much help. Until today, I still vividly remember how loudly my mother sobbed for help to save her beloved son. I was extremely mortified by this and gathered my little strength to help. After hours of struggle, we reached the district hospital only hoping for a single miracle.

24 The warmth, care and hope we received from the attending team of nurses dressed in white uniforms was unforgettable. “What a beautiful inspiration” I mumbled in stealth. It was this moment that streamed my passion for nursing and advocacy for vulnerable groups including mothers, newborns, children and adolescents.

It is therefore with great pleasure that I represented strong women and the nursing fraternity on the international platform for Aster Guardians that offered genuine opportunity for professional growth.

This indeed was a dream come true! I am extremely humbled to have represented my country Uganda, and also as the only female who represented Africa to the globe for the highly prestigious Aster Guardians Global Nursing Award 2024.

This recognition was not only a testimony of my personal commitment and dedication to nursing but also a reflection of the unwavering support and dedication of my teams, mentors plus each and every one out there that supports and believes in Lilian.

The opportunity further inspired me to continue striving for excellence and to foster an environment of collaboration and innovation to continue advocating for excellence in nursing and midwifery in Uganda and the world at large.

For God and my country Uganda Thank you

Lilian Nuwabaine (Worlds’ Best Nurse Finalist 2024; Award Winning Researcher 2023; Heroes in Health Award Winning Midwife 2021 & Outstanding Woman of 2021)

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Lilian Nuwabaine, representing Uganda and only female representing Africa in India for Aster Guardians Global Nursing Award 2024

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Lilian Nuwabaine, from Uganda, receiving an accolade from the Minister of Health, Karnataka, India; 28th Nov 2024

Lilian Nuwabaine receiving a certificate of recognition as one of the top 10 finalists for the Aster Guardians Global Nursing Award 2024 from the Founder Chair and Managing Director Aster DM Healthcare – Dr Azad Moopen

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THE VALUE OF INTERNSHIP FOR NURSES AND MIDWIVES IN UGANDA

BY SUSAN ASIIMWE

Debates have emerged about whether internships for upgrading nurses and midwives in Uganda should be discontinued.

However, it's important to understand that nursing internships are not unique to Uganda; they are a global practice essential for developing competent healthcare professionals.

Susan Asiimwe is a Lecturer of Midwifery Kabaale University School of Medicine PhD Researcher KU Leuven-Belgium

In Uganda, an internship for nurses and midwives is a mandatory supervised training period that lasts one year. During this time, recent graduates work under the guidance of experienced healthcare providers to bridge the gap between academic learning and practical application, allowing interns to develop essential clinical skills, gain handson experience, and build confidence in their professional roles [1]. Internships play an important role in the professional development of nurses and midwives globally [2]. For upgrading nurses and direct entrants, internships offer numerous benefits that enhance their competence, confidence,[3] and overall quality of care they provide [4].

Across the globe, internships are a standard practice in nursing education, offering critical clinical exposure and opportunities for professional growth, moreover according to the World Health Organization (WHO), the global nursing workforce is approximately 27.9 million, with 19.3 million being professional nurses [5], underscoring the importance of well-structured internships in preparing this workforce to meet global healthcare demands.

Nursing internships are integral to the healthcare education system in countries like the United States, Sweden, India, Kenya, and South Africa. The internship provides diverse experiences, from advanced healthcare environments to resource-limited settings.

For instance, in the United States, nursing internships are often embedded within academic curriculums, exposing students to various specialists and clinical settings.

Similarly, Ugandan nursing and midwifery internships offer a range of experiences that prepare healthcare professionals to excel in diverse and challenging environments [1].

28 Internships are vital for transitioning nursing and midwifery students from academic learning to real-world clinical practice [6].

During internships, students apply theoretical knowledge in practical settings, enhancing their clinical competence under the supervision of experienced healthcare professionals [7]. This hands-on experience is vital for developing the necessary skills to provide high-quality patient care and build confidence in their roles [1].

Additionally, internships offer exposure to various clinical environments, broadening interns' understanding of different patient populations [1]. They also provide valuable opportunities for mentorship and professional development, helping interns develop critical thinking, problem-solving, and leadership skills [8]. Ultimately, internships aim to improve the quality of patient care and address workforce shortages by retaining nurses and midwives in the profession.

Despite the benefits of internship, nursing and midwifery interns in Uganda face numerous challenges that hinder their ideal learning, key issues include insufficient resources in healthcare facilities, such as limited medical supplies, outdated equipment, inadequate infrastructure, and lack of accommodation. Poor working conditions, characterized by low remuneration, and high patient-to-nurse ratios contribute to burnout and job dissatisfaction.

Additionally, delays in securing internship placements disrupt the completion of training in the anticipated time and delay licensure. The lack of mentorship and adequate supervision also deprives interns of the essential guidance needed to refine their skills and grow professionally.

To address current challenges, the Ministry of Health should consider several measures like; increasing healthcare funding to essentially provide necessary resources, better working conditions, and enhancing mentorship programs by pairing interns with experienced professionals will offer valuable guidance.

Prioritizing timely intern placements will ensure timely completion and licensure, raising allowances and improving salaries can alleviate financial stress and boost job satisfaction and this will lead to retention of nurses in the profession.

In conclusion, Internships are invaluable for the professional development of nurses and midwives in Uganda. They provide essential hands-on experience, enhance clinical competence, build confidence, and improve the overall quality of patient care. For both upgrading nurses and direct entrants, internships offer numerous benefits that prepare them for successful careers in healthcare. However, interns face significant challenges such as inadequate resources, poor working conditions, delays in placements, and lack of mentorship.

Addressing these issues is crucial for maximizing the benefits of internships. By investing in robust internship programs and

29 tackling these challenges, Uganda can ensure a well-trained and competent nursing and midwifery workforce capable of meeting the country's healthcare needs.

References 1.

2.

3.

4.

5.

6.

7.

8.

ACHEST, Handbook for Health Professions Interns Launched. The African Centre for Global Health and Social Transformation. , 2022.

Olive, P., et al., Clinical academic research internships: What works for nurses and the wider nursing, midwifery and allied health professional workforce. Journal of Clinical Nursing, 2022. 31(3-4): p. 318-328.

Aljohni, K.A., et al., Nurse interns' experiences with the clinical learning environment and supervision. Teaching and Learning in Nursing, 2023. 18(4): p. e123-e128.

Majka, M., The Importance of Internships. 2024.

WHO, Strengthening the collection, analysis and use of health workforce data and information: a handbook. 2023: World Health Organization.

Shahzeydi, A., et al., Exploring nursing faculty, managers, newly graduated nurses, and students’ experiences of nursing internship program implementation in Iran: a descriptive qualitative study. BMC nursing, 2022. 21(1): p. 371.

Bradshaw, C., S.M. Tighe, and O. Doody, Midwifery students' experiences of their clinical internship: A qualitative descriptive study. Nurse Education Today, 2018. 68: p. 213-217.

Gemmellaro, G., et al., Evaluation of midwifery students’ satisfaction with regards to clinical internship. Acta Bio Medica: Atenei Parmensis, 2020. 91(Suppl 6): p. 118.

Susan Asiimwe Lecturer Midwifery Kabale University School of Medicine PhD Researcher KU Leuven-Belgium

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ANNOUNCEMENTS

The National HealthCare Conference (NHCC) Uganda CIC hereby informs the stakeholders and colleagues of the New trademarked name for the Next chapter - Diaspora Uganda Nurses and Midwives Society (DUNMS). Same Vision, Same Objectives.

Contact the team via nhccuganda@gmail.com, info@nhccuganda.com, or visit the website www.nhccuganda.com and the social media platforms for more information and stay updated with future events.

DUNMS 2024 END OF YEAR STUDENT COMPETITION WITH SPECIAL REWARDS The DUNMS is pleased to announce the 2024 End of Year Special Rewards for Student Nurses.

Finalists’ live presentations on Friday, Jan 24, 2025 - 12:30 to 2.00 PM Advance registration via:- the QR code on the poster (Below) After registering, you will receive a confirmation email containing information about joining.

Pointers for finalists:-

-

Individual fifteen-minute PowerPoint presentation. The presentation should be made by ONLY the student whose name is stated in the submission entry. You cannot include other colleagues or friends in your presentation. Please use English.

Presentation Topic: - Upholding the Nursing professional standards.

Question: - As a student nurse, how do you uphold the nursing professional standards?

The judges will be focusing on the following areas:1.

2.

3.

4.

Communication skills, Presentation style, Time management, and Content (knowledge of the topic and application).

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32 USEFUL CONTACTS

Please find below a list of useful contacts to forward your concerns appropriately.

UNMC queries:- info@unmc.ug UNMU:- info@unmu.ug CPD APP concerns: martin@unmc.ug National Organisations Education and Training Standards: - Department of Nursing at Ministry of Health HET (Min of Education and Sports) QUESTIONS? CALL: 0417 893600 (PRO) Mobile 0777108170 Some of the associations AGNMU: graduates@agnmu.org Critical Care Association:president@ccnau.org Midwifery Association: nationalmidwivesassociationug@gmail.com Nursing and Midwives Society: info@nursesandmidwivessociety.org Emergency Care Society of Uganda:- admin@ecsuganda.org Palliative Care Association of Uganda:- pxau.admin@pcau.org.ug Others NMLTT (Think-Tank Leaders):- uganursemidwife.leaders@gmail.com Writing articles for publication on the NHCC Uganda website:editors.nhccuganda@gmail.com Global networking Nursing Now Campaign Uganda:- nursingnowuganda@gmail.com

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PROFESSIONAL RESOURCES

The Think Tank Newsletter editing team accepts articles on a rolling basis under the sub-themes below. ● ● ● ● ●

Research and Innovation Continuing Professional Development (CPD) Policy Leadership/Governance Clinical Practice Covid Response.

Think Tank is committed to supporting nurses and midwives through strategic advocacy. Advocate for Nurses and Midwives. Please send us your current email address to be included on our mailing list.

Our faith in you is steadfast. May you continue to rise to the challenge in this international year of the Health and Care Workers by WHO - 2021. More than ever, this nation needs you. We thank you, and May God bless you.

Copy to:

The Hon Minister for Health The Permanent Secretary, Ministry of Health The Permanent Secretary, Ministry of Education and Sports Commissioner Nursing Services, Ministry of Health Commissioner Health Education & Training, Ministry of Education and Sports The President of the Uganda Medical Association All Nurses and Midwives

NMLTT NEWSLETTER EDITORIAL TEAM

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D r. S a f i n a h K i s u M u s e e n e C h a i r p e r s o n N M LT T

A s s o c P r o f. R o s e C l a r ke Nanyonga.

Executive Member; Chief

M s I r e n e At u h a i r w e D u h a g a Executi ve Member ; Editor

Editor

Ms Elizabeth Pearson N M LT T S t e e r i n g C o m m i t t e e ; Editor

Ms. Judith Kiconco N M LT T S t e e r i n g C o m m i t t e e ; Editor

M s Tr a c y K o b u k i n d o K a m a u N M LT T S t e e r i n g C o m m i t t e e ; Editor

Informed disclaimer: - All editing team members are Nurses/Midwives, and they are all volunteering their time and expertise. However, the views expressed in the articles are of the authors or writers solely. Although the editing team does its very best and is responsible for vetting the information, the authors’ opinions remain. it is, therefore, upon the authors to make sure that what they submit is referenced appropriately and accurately.