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No one to nurse their many grievances
COVID-19 has increased the workload of nurses and heightened their exposure. Pix by Indika Handuwala
Nurses in Government hospitals are paid low wages, work long hours and have no perks like car permits. And the nurse-to-patient ratio is so high that each deals with between 15 and 20 people at a time, health sector sources said.
Frequent strikes have caused many of these issues to be viewed through a political lens. But the problems nurses face are longstanding and dire. COVID-19 has increased their workload and heightened their exposure.
Today, even simple matters like getting home after gruelling shifts are a challenge owing to the pandemic. In addition to the stresses of work, many have children and households to upkeep. There are just 38,000 nurses in the Government sector and 10,000 in the private sector. And only around 2,000 enter the workforce each year from State nursing schools while several hundred retire or resign.
The international standard is one nurse for every 4 patients. Sri Lanka is far from this and nursing seniors believe the country needs at least 50,000 to be inducted this year alone. “Basically, the biggest issue surrounding nursing right now is recruitment and retention,” said one source who, like most others, did not wish to be quoted.
There are also yawning gaps in nursing training, said Nadeeka Jayasinghe, an educator who qualified and worked in Australia. While it has been promised to upgrade Sri Lanka’s 17 nursing schools to degree-offering universities, it has not been done. And the institutions have no resources or facilities for it.
“The standards of classrooms are not like any classrooms in Sri Lanka or around the world,” she said. “The main schools in Colombo, Ampara, etc, are good but everywhere else the facilities are very poor. They are just basic halls. We need computer labs to ensure digital literacy. We need learner management systems. And we need proper people to carry out training in such areas.”
Others pointed out that there was no evidence-based practice, no research. And nursing graduates–from the four universities of Ruhuna, Colombo, Peradeniya and Eastern–face hostility when they attempt to join Government hospitals. The preference is for diploma-holders.
Many sources lamented that Sri Lankan policymakers have “taken the professional aspect out of nursing” and that nurses are “more or less providing workforce for hospitals”. Nurse education is still under the Ministry of Health which focuses on meeting demand.
And the numbers are still insufficient. “The high nurse-to-patient ratio does have a disastrous outcome on patient wellbeing,” Ms Jayasinghe said. “One-on-one care comes from nurses. Most people don’t know that nurses are handling this many patients. This is why there are an overwhelming number of complaints. Nobody knows what’s going on behind the scenes.”
Because of low job satisfaction and less-than-optimum conditions, many nurses are now going overseas after obtaining degrees or job training. The numbers cannot all be captured through the Sri Lanka Bureau of Foreign Employment, one source said, because some also go on studies and then gain employment abroad.
“There are now more opportunities owing to the pandemic and our nurses have higher recognition,” she pointed out. “Those who have bonds with the Ministry of Health pay whatever’s left and resign. In my own experience, around 500 to 600 have left in the last six years.”
A male nurse from a leading hospital said he received a “pretty good Government training” because he studied in Colombo. In the three years since leaving nursing school, he had exposure to “thousands and thousands of patients”. Those in outstation institutes do not, however, benefit from the same quality of resources or facilities.
His father was a Postal Department worker. “After my A/Levels, I applied for a number of jobs but most of them were not permanent,” he narrated. “One day, my father brought me the Government gazette and advised me to apply for the position of male nurse because he said it would have numerous benefits.”
Today, this man (he wished to remain anonymous) is a 42-year-old father of four and a critical care nurse working in intensive care units (ICU). After completing five years of service, he got a job in West Asia in the cardio-thoracic ICU. He took no-pay leave and worked for three years in Oman.
“I gained that opportunity because of my training, the considerable exposure and position I held as a critical care nurse,” he reflected. When he returned, his service was reduced. He applied for a nursing tutor position when it was advertised but was turned down saying he had taken foreign leave.
“I marketed Sri Lankan nursing overseas,” he said. “I learned a lot during my three years abroad and felt I could teach others. But when I came back, they made issues.”
Healthcare jobs are stressful, those interviewed said. And nursing is especially stressful. The status granted to nurses is poor. They are not even categorized by specialty. There is only a single centralized profession–or, as one disappointed nurse put it, “Just nurse”.