NML-ISSUE 2

Vol. 1 | Issue 2

May 12th, 2020 Call to Action

THE NURSE AND MIDWIFE LEADERS’ COVID-19 THINK TANK

2020 is the International Year of the Nurse and the Midwife…To this end, we urge governments and relevant stakeholders to: (1). Invest in the massive acceleration of nursing education. (2) Create at least 6 million new nursing jobs by 2030. (3) Strengthen nurse leadership (WHO, 2020).

The Year Of The Nurse And Midwife Congratulations to all Nurses on this International Nurses Day, 2020. The COVID-19 pandemic has redefined the Year of the Nurse and Midwife by not only showcasing the strengths of the Nursing and Midwifery profession and the central role they are playing to put a stop to the pandemic, but also the work that needs to be done to ensure no one is left behind. As we celebrate, we reflect on that strength and look to the future with hope. The State of the World Nursing (SOWN) report (2020) delivers 10 key actions reflecting the future directions for nursing workforce policy. They include: 1. Countries affected by shortages need to increase funding to educate and employ at least 5.9 million additional nurses. Additional investments in nursing education are estimated to be in the range of US$ 10 per capita in low- and middle-income countries (LMIC).

2. Countries should strengthen capacity for health workforce data collection, analysis and use.

3. Nurse mobility and migration must be effectively monitored and responsibly and ethically managed.

4. Nurse education and training programs must graduate nurses who drive progress in primary health care and universal health coverage.

5. Nursing leadership and governance is critical to nursing workforce strengthening 6. Planners and regulators should optimize the contributions of nursing practice.

7. Policymakers, employers and regulators should coordinate actions in support of decent work.

8. Countries should deliberately plan for gender-sensitive nursing workforce policies.

9. Professional nursing regulation must be modernized.

10.And, collaboration is key.

We encourage all Nurses, Midwives and leaders to take some time to read this report.

Congratulations.

2020 ICN 2020

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More than 200 nurses around the world have died in the course of the duty as a result of contracting COVID-19 (ICN, April 20th, 2020).

# PPENOW

#FRONTLINERS

Strengthening Health Systems—Protecting the Workforce

In a recent brief, the president of the International Council of Nursing (ICN) Prof Annette Kennedy reported that at least 23,000 healthcare workers (according to the World Health Organization) have been infected with COVID-19 in more than 50 countries. Among those, 220 Nurses had died in the course of their duties. COVID-19 not only endangers the lives of frontline healthcare workers, but also places additional burden on an already stretched resource envelope and infrastructure.

Previous studies and anecdotal notes highlight severe resource gaps in majority of health work environments. For this reason, the Nursing and Midwives’ Leaders Think Tank has prioritized PPEs for frontline providers and was able to raise a total of 19,700,000/= and from these items (Gloves, Surgical Masks, N95 Respirators, Aprons) were procured. The Department of Nursing at Min of Health together with NNC coordinator and Registrar were welcomed to Mulago National Referral Hospital and Entebbe Grade B Hospital to distribute these items.

We continue to lobby and advocate for more funds in order to meet this objective. The team has devised a simple and more effective means to achieve this in a measurable tool. For $18 only, a Nurse or Midwife will be able to receive a pack of PPE for her shift. This pack includes an apron (re-usable), 2 pairs of gloves, a hair net, N95 mask (with instructions on how to sterilize), and soap.

Please feel free to contact us via our email Uganurses.midwives@gmail.com on ways in which you can support this cause.

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200 YEARS OF FLORENCE NIGHTINGALE

Be a Trail Blazer—Light the Path for Others

Florence Nightingale, also known as the "Lady with the Lamp,'' OM, RRC, DStJ was an English social reformer and statistician, and the founder of modern nursing. Born on May 12, 1820, in Italy.

Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organized care for wounded soldiers.

She gave nursing a favorable reputation and became an icon of Victorian culture. The importance of her later work in professionalizing nursing roles for women. In 1860, Nightingale laid the foundation of professional nursing with the establishment of her nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world and is now part of King's College London. In recognition of her pioneering work in nursing, the Nightingale Pledge taken by new nurses, and the Florence Nightingale Medal, the highest international distinction a nurse can achieve, were named in her honor, and the annual International Nurses Day is celebrated on her birthday.

Her social reforms included improving healthcare for all sections of British society, advocating better hunger relief in India, helping to abolish prostitution laws that were harsh for women, and expanding the acceptable forms of female participation in the workforce. Nightingale was a prodigious and versatile writer.

Nightingale wrote Notes on Nursing (1859). The book served as the cornerstone of the curriculum at the Nightingale School and other nursing schools, On 21 October 1854, she and the staff of 38 women volunteer nurses that she trained, including her aunt Mai Smith, and 15 Catholic nuns were sent (under the authorization of Sidney Herbert) to the Ottoman Empire which is modern-day Turkey.

They were deployed about 295 nautical miles (546 km; 339 mi) across the Black Sea from Balaklava in the Crimea, where the main British camp was based.

Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). Her team found that poor care for wounded soldiers was being delivered by overworked medical staff in the face of official indifference.

Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients. She then sent a plea to The Times for a government solution to the poor condition of the facilities, the British Government commissioned Isambard Kingdom Brunel to design a prefabricated hospital that could be built in England and shipped to the Dardanelles.

Stephen Paget in the Dictionary of National Biography asserted that Nightingale reduced the death rate from 42% to 2%. Nightingale implemented handwashing and other hygiene practices in the

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war hospital in which she worked. Nightingale also initiated the use of infographics to illustrate disease trends.

Death rates were sharply reduced, but she never claimed credit for helping to reduce the death rate.

Nightingale's signal achievement was the introduction of trained nurses into the workhouse system in Britain from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff.

Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Her ideas inspired the volunteer body of the United States Sanitary Commission.

This year 2020 we celebrate her life and mark her bicentennial. It has been marked as the year of the Nurse and Midwife by the World Health Organization WHO and International Council of Nursing (ICN).

Proud to Be Born a Nurse and I Will Die as a Nurse

AKEREUT M. MARGARET

5-MINUTES WITH THE SPNO Current Principal Nursing Officer (Ag. SPNO), Soroti Regional Referral Hospital What I love most about my work as a nurse is seeing the very sick patients recover after my care. As an administrator, working with a focused team and being able to beat deadlines brings me much joy.

My work as SPNO, has given me a platform to share ideas beyond Uganda, and it has enabled me keep abreast with new trends in Medicine and Nursing.

The major challenge I face is some Nurses and Midwives in Uganda are still not self-driven, and therefore require a lot of supervision in order to fulfill their duties. Sometimes task shifting is needed as well.

Moreover, due to the high Nurse - Patient ratio, and increase in workload, there is a growing number of sick Nurses and Midwives.

Those who are still able to work, do so with minimal required equipment and space. There is also an inconsistent supply of uniforms for professionals.

If I had all the power and means I would do the following for our profession: 1. Revise the salary of Nurses and Midwives upwards because they work long hard hours 2. Equip hospitals with high tech equipment, design and construct bigger wards through which standard patient spacing can be done to improve aeration, privacy and cater to Uganda’s growing population.

3. Additionally, I would divide the ward/units into smaller units so that one Nurse is assigned to a small manageable section.

4. Employ Health Workers on contract basis to improve performance and quality of work.

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5. I would recruit Public Health Nurses to carry out prevention activities at the community level.

6. Nurses and Midwives who fall sick in the line of duty would be eligible for early retirement with benefits so as to create vacancies for others to enter into and contribute to the Health Workforce of the country.

The Government and Ministry of Health should recruit more staff/counsellors so as to reduce staff shortages at Health Facilities. Additionally, promotions should be decentralized to facility level & awarded according to performance. This will improve both quality of care and patient recovery rates. Sponsorship for Nurses & Midwives to upgrade should be prioritized and their awarding decentralized to District Offices. Training of Nurses should be very well regulated, new schools should not take on overwhelming numbers of students, as this compromises quality. Those without proper practicum sites should not be allowed to conduct student training.

Intensive care Nurse (Kampala Hospital) and Head of Intensive care Unit at Paramount hospital Kampala.

To Love and Serve

DAN MURAMUZI

“Caring for terminally and critically ill patients is my passion” I believe that due to the many needs of patients, and the expectations from their loved ones, patient care should be holistic in order to ensure the best possible outcome. A holistic, highly trained Nurse is a treasure.

Unfortunately, many human resource manuals do not attribute fair value to highly trained Nurses, and if they do, it is not reflected in their remuneration. This has prompted highly trained Nurses & Midwives to search for better opportunities, creating a gap in quality service delivery which affects the quality of care provided. Worse still, the high Nurse-patient ratio means that a Nurse is likely to work on 8-10 patients, and by the nature of our work, this is likely to be for long hours. Most hospitals, especially in the private sector run 12hour shifts, four days a week.

Working under the old Nurses’ Act, this has affected the growth and independence of Nurses in Uganda. For Nursing to change, we need to recognize, mentor and create positions within the clinical setting for Nurses and Midwives who have undergone advanced training, especially the young Nurses & Midwives.

This is what I would change about Nursing & Midwifery if I had all the power and means: 1. Implement the schemes of service without any delay or fail. Thus, allowing utilization of highly trained Nurses such as masters trained Nurses.

2. Develop and implement a National Nursing Policy & Revise the Nurses and Midwives Act 3. Empower professional Nursing associations with necessary resources to meet their objectives 4. I would encourage and support vertical growth.

Where do you see Nursing and Midwifery in the next 5 years?

Once there is good leadership from the top management (Ministry of Health-Department of Nursing) then it’s expected that the profession will have advanced further as compared to today. However, there are still struggles in nursing leadership and this ultimately affects the development of the

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profession. Also, we can’t keep working without a national direction and policy statement for Nursing and midwives in Uganda.

Love Your Profession and Adhere to the Nursing Ethics…

MBABAZI KYALITUHA WINIFRED

Advice to young Nurses: Young Nurses should learn how to advocate for their fellow Nurses, collaborate with professional associations at both national & international levels. They should seek professional advancement through research & innovations.

Newly appointed Assistant Commissioner Nursing & Senior Principal Nursing Officer, Hoima regional Referral Hospital “What I love most about being a Nurse is seeing a patient who had no hope of recovery going back home, alive. I advise all nurses and midwives to love their profession and adhere to the nursing ethics putting in mind the meaning of the nurses’ anthem.”

Where I see Nursing in five years: ● Nursing will have a directorate at the ministry of health headquarters if the top management lobbies for it. ● Probably Bachelor Nurses will be considered as the new scheme of service is implemented ● Nurses & Midwives will be better paid There are still many challenges in Nursing & Midwifery Nurses carry the majority of the work burden in a clinical setting, but are the least paid, and are undermined by other health workers. The lack of medical equipment such as thermometers, blood pressure machines and others which are necessary for adequate/standard nursing care makes work even harder for Nurses and Midwives in the Health Facilities. Worse still, a shortage of drugs and sundries frustrates both the patient, who can’t receive care and the Nurse who cannot do her job. A low number of Nurses and Midwives in the hospital increases the workload and lowers the quality of nursing care as the Nurse struggles to divide her time amongst many patients. In some cases, Nurses are forced to request caretakers for assistance in some tasks.

But even after all that, many go through their careers with delayed promotion or none at all, this demoralizes many. Furthermore, the low pay does not facilitate acquisition of proper accommodation or transportation to the Health Facilities where they work. Even for Nurses and Midwives that have advanced education, such as the bachelor’s degree Nurses, the pay is still low as they are still being employed as Enrolled Nurses, so their remuneration is not commensurate with their training. What is disheartening for many Nurses and Midwives is the fact that the Ministry of Health seems to value Doctors more than Nurses. Doctors’ demands are attended to with a matter of urgency.

If I had all the power and means I would change a lot in our profession!

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1. Increase salaries to the same level of doctors as long as the qualifications are the same, mindful of the fact that nurses do even more work and stay for long hours with the patients.

2. Make sure that Nurses and Midwives are equipped with the right tools to do their job & and are doing it well 3. Provide accommodation for all nurses and midwives 4. Advocate for internal interviews to enable promotion for those who qualify in the same institutions.

Senior Principal Nursing Officer, Mbarara Regional Referral Hospital

We must recognize that the time to act is now…!

KATUSIIME VANICE PETWA

“We must recognize that the time to act is now, to redeem our profession, if nothing is done, it will go to the dogs - there’s an ethical decay.”

“I love changing lives, seeing a new mother walking home with a live baby and in good condition brings me much joy.

As a manager I love seeing dedicated Nurses and Midwives, it is my goal to guide junior Nurses & Midwives and give them due recognition.”

Many Nurses and Midwives have done great things but without a name tag or title, documentation, or designated uniform. The credit goes to others. I am highly passionate about advocacy for Nurses’ rights and recognizing their contribution towards the Health Sector. It is a hard task because, sometimes, the people one fights for, do not appreciate the struggle. There is still a tendency for Nurses and Midwives to be timid when it comes to advocacy, plus a lack of charisma. Some Nurses and Midwives have teamed up to fight against a person who is on their side, many times.

This needs to change.

For Nurses and Midwives that can speak up and are proactive, they are discriminated against in the workplace and most Doctors/Consultants prefer not to work with them. This discrimination also affects the various cadres of Nursing and Midwifery as Senior Consultants prefer to work alongside certificate Nurses and Midwives as opposed to bachelor’ degree Nurses. This habit has puffed up low cadre Nurses and is often a hindrance to them pursuing further studies, after all they are the favorite. There is a tendency to resist change and even work against leadership, yet we should be working together because we share the same vision - A healthy population.

If I had the power over our own directorate, I would make Nurses 1st Deputies to Hospital Directors, who at the moment must be Medical Doctors. I would abolish all Hospital Administrators and open up those positions for Nurses qualified to run those offices, procurement inclusive. I would also institute mandatory transfers for staff after every five years, this would facilitate growth at both career and personal level.

We must recognize that the time to act is now, to redeem our profession, if nothing is done, it will go to the dogs - there’s an ethical decay. At the point of entry, there should be a selection criterion to gauge interest and passion for the profession. Nursing is golden, but some Nurses would rather associate with other professions. I would liken this to a sheep suckling a goat in presence of its mother - it is painful for the mother to watch.

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Setting the Tone—The Story is Ours to Tell

My advice to the young Nurses is to always observe the chain of command as you execute your tasks, respect the Nurses and Midwives who were before you and are your leaders now, because Leadership will also come to you one day. Aim to advance your career systematically and avoid shortcuts. Find the area of your passion and pursue them. A great Nurse manager is one that has grown through the ranks & knows the challenges at each level.

CALL TO WRITING FOR ALL - RAISE THE PROFILE OF THE PROFESSION A couple of Nurses and Midwives have been writing articles which have been published in the local newspapers. It is very impressive. Because, writing in Nursing is very important for sharing knowledge and ideas. A professional Nurse should know how to express thoughts about his or her observations through professional writing.

Writing for publication is essential for the dissemination of knowledge and practice, but many health practitioners are prevented from writing by a lack of confidence or knowledge of what the process involves, and insufficient time and space in which to write. This opportunity is here to support nurses and midwives to write for publication.

As discussed by Williams B (2015). Writing for publication can, therefore, allow Nurses and Midwives to share their excellent practice and ideas with others, to benefit those who use our services.

UPDATES NURSE DORIS The Think tank was pleased to see the recognition and support from Min of Health Dr. Jane Ruth Acheng and the general public for the support Nurse Doris has received for her compassionate care given. We are also pleased to learn that she will be able to take up her offer for the scholarship offered to her.

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The Midwife and the Nation—Bringing Life Safely Into the World

INTERNATIONAL DAY OF THE MIDWIFE CELEBRATION Uganda joined the rest of the world to commemorate the International Day of the Midwife (IDM). Here, the Hon. Minister of State for PHC, the Representative UNFPA and His Excellency the Ambassador of Sweden met with the Midwifery leaders before proceeding to the Mulago Women's Specialized and Neonatal hospital where the celebrations are officially opened. Pictorial: Midwives at Mbarara, Kabale and Jinja RRHs during their celebrations.

APPLIED RESEARCH According to the UNMC database, there are about 71,000 Nurses and Midwives registered in Uganda but only about 48,000 are in employment. The short national survey currently rolled out might not be able to cater for those who are not employed, have challenges to access the internet due to various factors but we would encourage all who have not yet participated in this short survey to please do so here

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Nurses: A Voice to Lead—Nursing the World to Health

ONGOING The Think tank continues to meet once a week to check on progress and formulate strategies to support and advocate for Nurses and Midwives. We would like to thank Seed Global Health for the continued support for hosting the zoom meetings, Irene Atuhairwe and team. Webinars will be organized, and the first session will be on Effective Leadership and Advocacy for Nurses and Midwives.

Our faith in you is steadfast. May you continue to rise up to the challenge in this International year of the Nurse and Midwife - 2020. More than ever, this nation needs you. We thank you and May God bless you.

Please feel free to contact us with your concerns.

If you find this Nurse & Midwife Letter useful, we would really like to hear from you. We continually evaluate and assess the progress of our communication channels with you. Please email us at Uganursemidwife.leaders@gmail.com For God and My Country.

Yours sincerely,

Dr. Hajat Safinah K Museene Chairperson Nurses and Midwives Leaders Think Tank Commissioner BTVET, MoES Tel: +256 774 46 3085, Email: safinahm2002@hotmail.com Copy to:

The Hon Minister for Health The Permanent Secretary- Ministry of Health The Registrar, Uganda Nurses and Midwives Council The Chairperson- NATIONAL TASK FORCE COVID 19 The President of Uganda Medical Association The Ag. Commissioner- Nursing Services Ministry of Health All Nurses and Midwives in Uganda