Impacts of skilled Nursing workforce to patient safety and quality of healthcare delivery

Skilled Nursing workforce and Patient safety

A skilled nursing workforce has a significant impact on patient safety and the quality of healthcare delivery. Studies have shown that higher nurse staffing levels are associated with lower rates of patient mortality, morbidity, and complications. For example, a study by the Agency for Healthcare Research and Quality (AHRQ) found that a 10% increase in the number of registered nurses (RNs) per patient was associated with a 5% decrease in the risk of patient death.

Skilled nurses play a critical role in ensuring patient safety by:

• Providing high-quality care: Nurses are responsible for administering medications, monitoring patients' vital signs, and providing wound care. They are also responsible for educating patients about their condition and how to manage their care.

• Identifying and responding to changes in patients' condition: Nurses are the eyes and ears of the healthcare team. They are responsible for monitoring patients' condition and reporting any changes to the physician. This is especially important for patients who are at high risk for complications.

• Preventing errors: Nurses are responsible for following safe medication administration practices and other protocols to prevent errors. They are also responsible for reporting any errors that do occur so that they can be investigated and prevented from happening again.

• Advocating for patients: Nurses are patients' advocates. They are responsible for ensuring that patients receive the care they need and that their rights are respected.

In addition to their direct impact on patient safety, skilled nurses also contribute to the quality of healthcare delivery by:

• Providing continuity of care: Nurses often work with patients over extended periods of time. This allows them to build relationships with patients and their families and to gain a deep understanding of their needs.

• Coordinating care: Nurses play a key role in coordinating care among different members of the healthcare team. This helps to ensure that patients receive seamless care and that their needs are met in a timely manner.

• Providing education and support: Nurses are responsible for educating patients about their condition and how to manage their care. They also provide support to patients and their families during difficult times.

In conclusion, a skilled nursing workforce is essential for ensuring patient safety and the quality of healthcare delivery. By investing in nursing education and training, healthcare organizations can help to improve patient outcomes and reduce the risk of adverse events.

International Patient Safety Goals (IPSGs) utilization for maternal and childcare improvement

International Patient Safety Goals (IPSGs) utilization for maternal and childcare improvement

The International Patient Safety Goals (IPSGs) are a set of evidence-based standards developed by the Joint Commission International (JCI) to help healthcare organizations improve patient safety. The IPSGs are widely recognized as a global benchmark for patient safety and are used by accredited organizations in over 100 countries.

The IPSGs can be used to improve maternal and childcare safety in a number of ways. For example:

• Improve the accuracy and completeness of patient identification. This can help to prevent misidentification of mothers and babies, which can lead to medication errors and other problems.

• Improve the effectiveness of communication among caregivers. This can help to ensure that all members of the care team are aware of the mother's and baby's condition and are working together to provide safe care.

• Improve the safety of high-alert medications. This can help to prevent medication errors, which are a leading cause of harm in healthcare.

• Reduce the risk of healthcare-associated infections (HAIs). HAIs are a major cause of morbidity and mortality in mothers and babies. By implementing IPSGs related to hand hygiene, environmental cleaning, and safe injection practices, healthcare organizations can reduce the risk of HAIs.

• Reduce the risk of patient falls. Falls are a leading cause of injury in mothers and babies. By implementing IPSGs related to fall prevention, healthcare organizations can help to keep mothers and babies safe.

In addition to these specific IPSGs, all of the IPSGs can contribute to improved maternal and childcare safety by promoting a culture of safety within healthcare organizations. By focusing on patient safety, healthcare organizations can create a safer environment for mothers, babies, and all patients.

Here are some specific examples of how IPSGs have been used to improve maternal and childcare safety:

• In one study, the implementation of an IPSG on patient identification was associated with a significant reduction in the rate of medication errors in newborns.

• In another study, the implementation of an IPSG on communication among caregivers was associated with a reduction in the rate of adverse events in the neonatal intensive care unit (NICU).

• In a third study, the implementation of an IPSG on the safety of high-alert medications was associated with a reduction in the rate of medication errors in the maternity ward.

These studies provide evidence that the IPSGs can be effective in improving maternal and childcare safety. During my clinical practice in a busy obstetrics and newborn unit, I have seen tremendous reduction of incidences and quality improvement after adoption and utilization of IPSGs. I will affirm that, by implementing the IPSGs, healthcare organizations can make a significant contribution to improving the safety of mothers and babies in Kenya and around the world.

How the agony of underrated BScNs in Kenya equates to the 30-50% churning rate

What is BScN cadre of Nursing?

BScN nurses are highly skilled and knowledgeable professionals who play a vital role in the healthcare system. The extensive 5 year degree training gives them a broad understanding of nursing science, as well as the clinical skills necessary to provide care to patients of all ages. BScN nurses are also able to think critically and solve problems effectively.

Cadre differentiation

For objectivity in this discussion, I will state a clear difference between BScN and KRN/KRM/KRCHN.

According to the regulating body of Kenyan Nurses-NCK, BScN is a 5-year undergraduate degree program that provides students with a broad education in nursing science. BScN graduates are qualified to work in a variety of healthcare settings, including specialized hospital units, clinics, nursing homes, research centers and even training institutions..

On the other hand, KRCHN is a 3 year-diploma program that focuses on community health nursing majorly focused on general nursing, midwifery or psychiatry. KRCHN graduates are qualified to work in a variety of community-based settings, such as health centers, schools, and community development organizations. Based on the KRCHN curriculum, there is always a need for education advancement through Higher National Diploma(HND) for a period not less than one year so as to practice in specialized care units. 

Overall, BScN is a more comprehensive and rigorous program than KRCHN. BScN graduates have a broader range of skills and knowledge, and they are qualified to work in a wider variety of healthcare settings. KRCHN graduates are more specialized in community health nursing, and they are typically focused on direct patient care.

In addition to their clinical skills, BScN nurses are also skilled in communication, collaboration, negotiation, health entrepreneurship and leadership. They are able to work effectively with other members of the healthcare team, as well as with patients and their families. Like other cadres of nurses, BScN nurses are also advocates for their patients and work to ensure that they receive the best possible care. These attributes make them efficient to work in a variety of settings.

The Agony

For ages graduate nurses in Kenya are often underrated and undervalued. This is despite the fact that they play a vital role in the country's healthcare system.  Below are the most obvious struggles of this cadre; 

Lack of recognition

Despite their important role, BScNs in Kenya often face a number of challenges. One of the biggest challenges is the lack of recognition for their skills and expertise. It beats logic how many employers still view BScNs as being less qualified than their lesser trained counterparts, even though they have undergone rigorous training, and education. This lack of recognition can lead to BScNs being underpaid and undervalued.

Career stagnation

Another challenge that BScNs face is the lack of opportunities for advancement. Many BScNs are stuck in dead-end jobs with little hope of moving up the career ladder. This is because there are limited opportunities for BScNs to take on management or supervisory roles despite their qualification.

Poor working conditions

This is a general problem cutting across all cardres of Nurses in Kenya. They often have to work in hospitals and clinics that are understaffed and lack basic resources. This makes it difficult to provide quality care to patients and eventually leads to dissatisfaction among nurses.

Low salaries

BScN nurses just like other nursing cadres in Kenya are among the lowest paid in the world. A study by the Kenya National Bureau of Statistics found that the median monthly salary for a nurse in Kenya is Ksh 35,000 (approximately $230). This is significantly lower than the salaries of nurses in other countries, such as the United Kingdom (where the median salary for a nurse is £35,000) and the United States (where the median salary for a nurse is $75,000).

Discrimination

Younger BScN nurses also face discrimination and stereotyping in the workplace on the basis of their age and gender. This stereotyping flows all the way from human resource policy makers to peer levels. This creates a hostile work environment and makes it difficult to succeed.

Agonizing impact: High churning rates for BScNs

The low status of BScNs in Kenya has a number of negative consequences. First, it discourages young people from pursuing a career in nursing. Second, it makes it difficult to attract and retain qualified nurses. Third, it leads to a shortage of nurses in the country, which can have a negative impact on patient care. 

Increasing emigration

There is no definitive data on the churning rates for BScN nurses in Kenya, but from the Kenya Health Workforce(KHWF) report of 2017, it was estimated to be around 20-30% per year. This was significantly higher than the global average of 10-15%. It is believed that with current(2023) high cost of living and demotivating factors the rate may be above 30% and maybe above 50% by 2030.

Brain drain from emigration of locally produced workforce has left a huge gap of human resource to practice on the swelling sick population. This has impacted to challenges in patient safety, value and quality of healthcare delivery.

Emigration points

Local studies show that BScNs not only emigrate to UK(33%) and USA(49%) but also other well paying countries. This is clear picture of brain-drain

What should be done?

There are a number of things that can be done to improve the status of BScNs in Kenya. One is to increase awareness of the important role that BScNs play in the healthcare system. Another is to provide BScNs with more opportunities for advancement. Finally, it is important to ensure that BScNs are paid fairly for their skills and expertise.

Here are some specific steps that can be taken to improve the status of BScNs in Kenya:

• Increase awareness of the importance of BScNs. The government, NCK, Nursing associations(NNAK) and unions(KNUN), media, and other stakeholders like universities, MoH, need to do more to raise awareness of the important role that BScNs play in the healthcare system. This can be done through public education campaigns, symposiums, Nursing chapter conferences, media coverage, and other initiatives

• Invest in training and development programs: The healthcare industry should invest in training and development programs for nurses. The programs will lead to upgrading of the majority of the workforce and thus setting standards. This will help to improve the quality of care that nurses can provide to patients and will make them more marketable to potential employers.

• Provide BScNs with more opportunities for advancement. Both public and private hospitals and other healthcare facilities need to create more opportunities for BScNs to take clinical, management and supervisory roles. This can be done by developing career ladders for BScNs and providing them with opportunities for training and development. Without this they will be rendered redundant and make them stagnant

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• Ensure that BScNs are paid fairly for their skills and expertise. The government needs to set fair wages for BScNs and ensure that they are paid in line with their skills and experience. This can be done by conducting regular wage surveys and adjusting wages accordingly. Salary and scale standardization will be key in view of decentralization of health function and private sector.

• Policy making on scopes of practice, remunerations and professional standardization from relevant stakeholders.

By taking these steps, we can improve the status of BScNs and the overall Nursing profession thus creating a more attractive and rewarding career path for nurses. Its without doubt that this will ultimately reduce the churning rates and increase confidence in patient safety and quality of healthcare delivery.

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