Are We “Poaching” Jamaican Nurses?

Are We “Poaching” Jamaican Nurses?

The government of Jamaica has asked the United States health sector to cease the poaching of its nurses. “Jamaica Says to Stop Poaching Our Nurses” was a report on National Public Radio earlier this year based on an interview with Mr. James Moss-Solomon, the chairman of the University Hospital of the West Indies in Kingston. He likened the situation to a crisis.

The exodus has forced Jamaican hospitals to reschedule some complex surgeries because of a lack of nursing staff on their floors, according to the report. Moss-Solomon says the United States, Canada, and the United Kingdom are, in his words, “poaching” Jamaica’s most critical nurses. “Specialist nurses is the problem. We have tons of regular nurses,” he told NPR. He was talking about nurses trained to work in such settings as intensive care units, oncology, infectious disease, operating rooms, and emergency rooms. They are the ones being lured away and their English language skills heighten their appeal. “We do very well training our specialist nurses here at a fraction of the cost of what it costs you in the United States or Canada or the UK; so, the issue is an economic one for us,” he explains.

In February, as part of the Jamaica Medical Mission, I discussed this issue with Althea Davis, RN, MHA, as I sat with her in a church hall in the city of Port Maria. For 27 years the mission has served the people of Jamaica under the auspices of the St. James Episcopal Church of Leesburg, Florida. The 55 members of the team represented physicians, dentists, hygienists, optometrists, pharmacists, nurses, physician assistants, and support staff. They came from Los Angeles, Ottawa, New York, San Francisco, Maryland, and Florida.

The team brought state-of-the-art health care to the people of that region for eight days and with tremendous energy and dedication delivered competent care to over 1,700 patients, who for the last 5 years have had their medical records computerized and accessible when the team visits.

Davis, a supervisory public health nurse, serves four health districts. “The nurses are expected to provide service in every aspect of care and are held to a very high standard. In the case of the public health nurse, the Jamaican nurses rank among the best worldwide,” she says.

According to Davis, the training model that Jamaica has followed came out of work done back in the 1970’s and is continuously updated. Over time, specialists have been added in areas such as nutrition, health promotion, information technology, and electronic records management, which is intended to provide a more robust care delivery system and improve patient satisfaction. “Because of training provided, we were well prepared to deal with the Ebola outbreak, and the highly contagious Chikungunya virus,” says Davis.

However, Davis quickly hastened to add that the problem facing the nursing sector is that the profession is “under resourced.”

Davis’ conclusion is an echo of Moss-Solomon’s. The skilled staff are stretched. The referral process for advanced treatment that cannot be handled at the nurses’ level is inadequate at best and unavailable at worst. “It is not just the compensation that influences nurses to leave the island,” Davis says. “It’s also the sense that nurses are not accorded the appreciation for what they do even by health care agencies.”

According to the World Bank, “these shortages have tangible impacts that may compromise the ability of English-speaking [Caribbean] countries to meet their key health care service needs, especially in the areas of disease prevention and care. In addition, the shortage of highly trained nurses reduces the capacity of countries to offer quality health care at a time when Caribbean countries aim to attract businesses, visitors and retirees as an important pillar of growth,” the report states.

In Jamaica, about three out of every four nurses trained have migrated to developed countries. But the Jamaican experience is not unique. In the case of the UK, a recent report by the Royal College of Nursing stated that the nursing workforce has moved from a situation of “net inflow of nurses to a position of net outflow in recent years.” This means that more nurses are moving abroad than are coming to the UK to practice. The main destinations are Australia, Canada, New Zealand, and the United States.

The NPR program stated that Jamaica has been offering free training for nurses to get advanced degrees. The nurses agree to work for three or four years in Jamaica in exchange for the heavily-subsidized education. “But U.S. recruiters,” says Moss-Solomon, “simply pay the fine for contract violation and the nurses fly off to lucrative jobs in the U.S.”

Jamaica’s response to these losses? They are bringing 25 nurses from Cuba to help staff some floors and have plans to recruit nurses from India and the Philippines and have recruited nurses from as far away as Burma/Myanmar.

Increased international recruitment of nurses requires that several policy issues be explicitly addressed. The international debate over the responsibilities of recruiting nations toward countries whose nurses are being recruited, many of which are developing countries, necessitates provision of ethical recruitment guidelines and codes of practice inclusive of possible financial compensation for sending countries in the face of a global nurse shortage.

Study Reports Diabetes Is Top Concern for Latinos

Study Reports Diabetes Is Top Concern for Latinos

Latinos Lives and Health, a poll released last month by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, found diabetes is the top health concern of Latinos.

With 19 percent of Latinos reporting diabetes as the foremost health concern facing their families, it far outranks the next most reported health issue, cancer, which ranked number one by 5 percent of Latinos. The results of the survey show the significant differences among diverse populations in this country and can help nurses address the specific needs and concerns of their Latino and Hispanic patients.

As is always the case, healthcare tensions involve much more than just physical ailments. The poll also reported significant amounts of stress around healthcare costs and employment issues. More than one in two Latinos are concerned that if a major illness struck, they wouldn’t have the funds or health insurance to cover the resulting bills. And in many Latino and Hispanic cultures, family comes first which can have significant impact on treatment adherence. There could be a very real reluctance among patients to take money from the family funds to pay for their own healthcare or to set aside time to care for themselves, even if it can improve their health.

According to the Office of Minority Health, rates of diabetes in Hispanic and Latino populations are high, so families have a right to be concerned. Hispanics and Latinos over the age of 18 are diagnosed at a rate of 13.2 percent compared to 7.6 percent of non-Hispanic whites. They also die of diabetes complications at a higher rate than non-Hispanic whites, so clear health information about diabetes management is essential.

As a nurse, one of the most important things is to make patients aware of diabetes as a serious disease with potentially life-threatening, and certainly life-altering, complications. Follow through on medications and lifestyle changes are essential, but when you are talking about changes and treatment, you must take cultural expectations into account, too. Various traditions around family dynamics, food, and celebrations can wreak havoc on trying to control diabetes, so making yourself familiar with some patient expectations can lead to positive treatment and care outcomes.

The Agency for Healthcare Research and Quality listed a few suggestions in their Diabetes Disparities Among Racial and Ethnic Minorities report. Involving the family in new approaches to diabetes management with medication, eating, and exercising helps. Show patients how to read labels and what to watch for. Exercise can be a family walk after dinner.

Above all else, listen to the patient and the family to see what approaches they might have and then try to work within that framework.