By Ekemini Simon
“The COVID-19 Pandemic reminds us of the vital role of nurses and midwives play. Every day, nurses put themselves at risk to alleviate the suffering of COVID-19 patients… While contending to provide care for other patients “. – Dr Tedros Adhanom Ghebreyesus, WHO Director-General. As the world battles with COVID-19 pandemic, the above statement by the Director-General of World Health Organization on Tuesday, April 7, 2020 during the occasion of the World Health Day reminds us that in deed nurses are the backbone of every health system. As at April 15, 2020, the world over, there were 2, 083, 048 cases of Coronavirus with 134, 603 deaths while 501, 187 have recovered. In Nigeria, there were 407 confirmed cases. 12 deaths while 128 recovered. Interestingly, before and during this period of COVID-19 pandemic, nurses are known to work hard in ensuring their patients recover from any ailment affecting them.
Even though many factors vis-à-vis health professionals may play an essential role in the recovery of patients in case of any ailment, the nurse often plays an underrated yet integral role in the patient’s recovery. Of course, much is involved in that process. It is more than just the performance of routine tests, such as checking the pulse and blood pressure. What really is involved you may wonder. According to The American Medical Association Encyclopedia of Medicine, “the nurse is more concerned with the patient’s overall reaction to the disorder than with the disorder itself, and is devoted to the control of physical pain, the relief of mental suffering, and, when possible, the avoidance of complications.” In addition, the nurse offers “understanding care, which involves listening with patience to anxieties and fears, and providing emotional support and comfort.” Many patients who recover from disturbing ailments have attested to the care from nurses as playing a significant role for their determination to survive. No doubt anyone who has spent time as a patient in a hospital can recall a sympathetic nurse who displayed the spirit of self-sacrifice.
And when a patient is dying, the source quoted above notes, the nurse’s role is “to help the patient meet death with as little distress and as much dignity as possible.” Further, the WHO Director-General notes that for critical COVID-19 patients who are isolated, the last human touch they may feel is that of a nurse’s hand. He adds ” The kindness of caring for strangers has never been more important to them”. What is more, Ghebreyesus mentions that in this period of the pandemic, nurses have added responsibility to include that of reorganizing wards to open more beds for COVID-19 patients, taking stock of new equipment and lending it out across units, while contending to provide care for other patients health needs including women in labour and relating information that change daily or hourly.
The WHO Director-General points out that in the face of the COVID-19 pandemic because health workers are on the front line of the fight, nurses are the most at risk. He reports that more than 3000 health workers with nurses toping the list around the world have been infected by the virus and many have paid the ultimate price through death. Such a responsibility is no tea cup party. Little wonder the World’s first professor of nursing, Mary Adelaide Nutting, noted “Nursing is one of the most difficult of arts. Compassion may provide the motive, but knowledge is our only working power.”
Today, nurses make up what is considered to be the largest professional group in our health-care system. According to the 2017 World Health Organization Global Health Observatory, Nurses and midwives account for nearly 50 per cent of the health workforce. Of the 43.5 million health workers in the world, it is estimated that 20.7 million are nurses and midwives, yet 50 per cent of WHO Member States which Nigeria is included a report to have less than 3 nursing and midwifery personnel per 1000 population (about 25% report to have less than 1 per 1000). In Nigeria, the Nursing and Midwifery Council of Nigeria indicates that there were around 240,000 qualified nurses and midwives within Nigeria. The report by the Federal Ministry of Health notes that by 2030 the country will be needing 471,353 nurses and midwives.
Nigeria is ranked 7th among 57 countries classified as facing a critical shortage of health workers. The Country is ranked second in Africa behind Ethiopia with 152,000 nurses and Midwives. Clearly, being a nurse requires great self-sacrifice. Let us take a closer look at both the challenges and the rewards of this noble profession.
The Joy of Being a Nurse
What are the prizes of nursing? The answer to that question will depend on a person’s field of nursing activity. Midwives, for example, feel rewarded with every successful birth. “As a practising nurse/ midwife, my motivation is seeing mothers walk out of the delivery suite with a smile,” says Ani-Ekah Etuk who has been in practice for over 10 years in Akwa Ibom State. She adds ” The joy that a new person is brought into the earth through my observation, monitoring and assistance keeps me on in practice.”
Yet, appreciation from patients and relative is another reason for joy on the part of nurses/ midwives. Ekah notes that there is a sense of fulfilment that gush out from her heart when the mother and father of the new born infant or patient pour out his or her heart to bless her after a hectic work. Iniobong Attah also collaborates the feelings of Etuk. She says: “I am usually touched by the expressions of thanks I receive from patients and their families, especially in emergency situations when we manage to recover a patient for whom we thought there was no hope.”
Facing the Challenges
But along with the joys of nursing come many challenges. There is no room for mistakes! Whether giving medication or drawing blood or inserting an intravenous device or even simply moving a patient, a nurse must be extremely careful. He or she cannot afford to slip up. Yet, sometimes the nurse is placed in a difficult situation. For example, suppose the nurse feels that a doctor has prescribed the wrong medication for a patient or has given orders that are not in the patient’s best interests. What can the nurse do? Challenge the doctor? That requires courage, tact, and diplomacy—and it carries an element of risk. Sadly, some doctors do not take kindly to suggestions from those they view as subordinates.
However, Etuk quoted earlier advises that Health care service is team work hence if a doctor makes a mistake in his prescription, it is the duty of a nurse to draw the doctor’s attention diplomatically to that mistake and it will be corrected. She notes “That’s the essence of studying pharmacology in nursing. Nurses and doctors should work in harmony and not as an antagonist, for they have a specific goal to attain”.
WHO Chief Nursing Officer, Elizabeth Iro mentions another challenge nurses face especially during this period of Covid-19 pandemic. She mentions that when it comes to Personal Protective Equipments, (PPE) they are often the last to receive. How then do nurses cope in Akwa Ibom State? The State Chairman of NANNM, Comrade Patrick Odu admits that nurses are on the front line of risk since the PPE is in short supply for health professionals. He advises nurses to make do with face masks and gloves with the hope that government among corporate organizations will provide for it.
Besides these, nurses also have to contend with burnout caused by stress. Staff shortages are one factor. When a conscientious nurse cannot give adequate care to a patient because of work overload, stress soon builds up. Trying to fix the situation by skipping breaks and doing overtime seems only to lead to more frustration. A nurse who practice in Akwa Ibom State noted ” – When burn out syndrome sets in, a nurse that cannot control or manage her stress may transfer the aggression on the patient.
Many hospitals are understaffed. “ Although the number of nurses had increased by 4.7 million between 2017 and 2018, the world is facing a global shortage of 5.9 million nurses especially in Africa, South Asia, Eastern Mediterranean and some parts of Latin America “, says the Director-General Of WHO. For instance, a nurse who works in a General hospital in Akwa Ibom State reveals that although WHO recommends a nurse to four patients, what is obtainable in the General hospitals in the State is that one nurse takes care of over 20 patients in a shift.
The Chairman of National Association of Nigerian Nurses and Midwives in Akwa Ibom State, Comrade Patrick Odu admits the challenge as common in government hospitals in the State. He further points out that this unbalance ratio has rather led to the death of many nurses in the State. Odu notes ” The unprecedented shortage of Nurses in Akwa Ibom State is the greatest challenge we have. Nurses are dying at a younger age because of work overload. ” Because of passion for humanity, a nurse cannot leave critical situations and go home despite the fact that there are no adequate nurses in the Hospital. “
Yet, this challenge is not experienced only in Akwa Akwa Ibom State. The Chairman of the National Association of Nigerian Nurses and Midwives, NANNM, Osibegme Augustine describes it as a common phenomenon in Nigerian hospitals. He says In Nigeria, there are about 1.5 nurses to a thousand patients. The NANNM Chairman explains in other words that Nigeria has less than 2 nurses to per 1000 patients despite the WHO recommendation of a nurse to four patients.
Nevertheless, there are a number of other factors that contribute to the stress of nurses. According to some nurses, the death of patients can have a depressing effect. One nurse noted: “Watching how terminal patients whom I had cared for closely die drains me a lot.” Yet, another nurse who works with one of the State-owned hospitals in Akwa Ibom State reveals that over the years, working as a nurse has been very challenging owing to lack of basic supplies in the Hospital. The source mentioned some of the challenges to include: lack of running water, lack of electricity supply, exposure to dangerous reptiles during night duty, insufficient medical equipment and absence of personal protective equipment. Some of these concerns were also brought to the fore recently by the Conglomeration of Healthcare Professionals in their call to the State government for preparedness against COVID-19 outbreak.
The Future for Nurses
According to report released on April 7, 2020 by World Health Organization in partnership with Nursing Now and the International Council of Nurses on the State of the World Nursing, the world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2032. The Director-General of WHO explains that the target is that the World Health Assembly has the designated year 2020 as the International year of the Nurse and Midwife in order to kick-start a push towards the goal.
Offering insight into how the world can meet the 9 million target, Ghebreyesus recommends ” We call on countries with a shortage of nurses to increase their number of nurses through the nurses they graduate by an average of eight per cent each year and also implement measures by employment and retention of nurses in the health system”.
The Chairman of NANNM in Akwa Ibom State, however, predicts doom for the health sector if more nurses are not provided for. He states ” I can tell you with certainty that in the near future if more nurses are not employed, our health system will be in shambles. This is because nurses are in the forefront and without them, nothing can be done”. While attributing the shortage of nurses to brain drain, the Chairman of NANNM in Nigeria, Osibegme Augustine recommends that the problem should be tackled from the root. He posits ” Nigeria has nurses but they keep leaving this country. In all hospitals in Nigeria, we keep losing nurses because they travel abroad in search for greener pasture. So the government need to stop the brain drain by providing a good reward system.”
The WHO Director-General assures that WHO is committed to working with countries to ensure all nurses and midwives receive the training they need, the recognition they deserve, decent conditions and salaries for their work. He adds ” Achieving health for all will depend on there being sufficient numbers of well-trained and educated, regulated and well-supported nurses and midwives, who receive pay and recognition commensurate with the services and quality of care that they provide.” Yet, will authorities take this task seriously? Ghebreyesus insists that the COVID-19 pandemic should awaken any right-thinking government to invest in nurses and also make provision for more nurses for the population since nurses who overwork themselves or are not given Personal Protective Equipments are prone to sickness leaving hospitals to scramble for more nurses.
What is more, health professionals offer insight to the fact that the growth and influence of technology increase the pressures in the field of nursing. The challenge is to reconcile technology with humanity, the humane way of dealing with patients. No machine can ever replace a nurse’s touch and compassion. One journal states: “Nursing is an everlasting profession. . . . So long as humanity exists, there will always be a need for caring, compassion, and understanding.” As nurses continue to care for patients even in the dreaded period as this coupled with a challenging environment, we should be grateful for all the attention given and sacrifices made by them, without whom hospital stays would certainly be less pleasant if not impossible! Indeed, many would share in the appreciation expressed by the Director-General of WHO to nurses ” To every Nurse and Midwife, we say thank you, thank you from the bottom of our hearts. You have our deep admiration and respect. We are grateful for all your hard work”.