The Wrong System Breeds the Wrong Product we should not be supprised with the results

The Wrong System Breeds the Wrong Product

I have written several critical comments about the quality of nursing in the country. It is essential to have a look and try to analyse the causes for the ‘poor’ products. To do so we have to look at the way our nursing system is being managed.

From my observation promotions are not based on quality, qualification and competency but rather merely on the automatic promotion based on years in service in the system.
This means that as times goes by even mediocre staff will get promoted to supervisory levels. In that a mediocre supervisor cannot deliver superior service is the logical conclusion. Not only are the staff working under such supervisors being poorly supervised and quided, even the patients have to be subjected to the same system. Little can be done by the more efficient and skillfull subordinates as the system will act as a blockade against the ‘smart ones’. These more efficient nurses would be marked as ‘acting smart‘ and most likely isolated and regarded as ‘revolts‘ by their superiors.

The real ‘good nurses’ will obviously and with merit be chosen for further education and subsequently promoted to higher levels of mainly administrative functions. This in return deprives the clinical sector of excelling skillful superiors. In other words, the skillful and competent nurses will not stay too long in the clinical ward service but will go up to the administrative sector, into works that at time could be done more effectively and efficiently by trained secretaries, instead of a promoted nurse. Here such a nurse will be wasting her nursing knowledge and skills, and struggle with administrative assignments just because the system is such.

Why can‘t the system be redesigned to provide ample promotional opportunities within the clinical nursing section? Why does a horde of highly qualified nurses have to man the nursing board, where most of the work is administrative? Does it need a nurse to prepare for the issuing of adninistrative work such as registration of nurses with the board?

Why not design a system where all nurses have to undergo continues learning particular in the field of patient management. This would prevent the practices of bygone times e.g. use of zinc oxide cream for bedsore etc. Why are the specially trained nurses not assigned to pass on the skills to the clinical staff in their practice of nursing. With the passing of nursing examination a nurse has indeed just begun to learn and develope her skills.

May I suggest that prior to the annual renewal of their licence nurses have to show proof of having attained the required number of hours in attending lectures and/or seminars to update and upgrade themselves. This is a way to ensure competence in nurses and upgrade the quality of nursing for the bebefits of patients.

On the other hand, each nurse must be sufficiently motivated to acquire additional skills and knowledge in the nursing field. Personal/job satisfaction in nursing depends, to a great degree, on the competence one has and can apply. The patient-care and communication can be so rewarding they act as a motivation to continuosly improve one‘s skills and competence.
We are faced with a peculiar situation in nursing that to my observation the nurses see themselve as assistants to the doctors whose directives are to be executed and instructions to be followed. Many a time I got the response: ‘the doctor did not give instruction’. But the issues of oral care, fungus prevention on the private parts of patients, decubitus prevention and dehydration are primarily the duties of nurses and only secondary to the doctors.
It is not supprising therefore that the nurses suffer from an inferiority complex due to lack of self confidence and competence. Nurses do not see themself as professionals working side by side with the other medical professionals but subservient to them. This obviously has to do with the lack of knowledge and skills the nurse is able to display. I have never felt that way but see the management of a patient as the combined role of a doctor and a nurse. No one is superior or inferior to the other, but each has the specific duties for which they are trained and skilled.
Perhaps it is time for the respective authorities to address this phenomena and act quickly on the shortcomings as abserved before the nursing profession takes a plunge into dangerous and criminally neglegent state.

I know of many concerned nurses in the country who are vocal and energetic in search for an answer to the problem. But do they get the necessary support, or are they running against a wall?

Let all concerned nurses in the country get together and have a "no barrier", frank and honest analysis with the authorities. Hopefully the authorities will implement the necessary changes without any delay or before it is too late.

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