The Lead Voice of Nurses – Reflections by Patrick Martin, MD – May 2017

The theme for International Nurses Day 2017 called for greater nursing activism in achieving Sustainable DevelopmentWhy should nurses in St. Kitts and Nevis care about development policy? It is a fair question given the demotivating stresses they face.

The vision of Sustainable Development is a more harmonious balance between economic growth, social justice, and environmental protection. In practice, policymakers and healthcare providers are expected to pay due attention to social determinants of health i.e. the conditions in which people are conceived, born, raised, live, work and age. These circumstances, such as barrier-free access to high quality drinking water, food, healthcare, and education, plus unpolluted air, appropriate wages and satisfactory housing, are far more important contributors to good health than high tech equipment.

Thus, health and well-being cut across the seventeen Sustainable Development Goals (SDGs) adopted in 2015 by the United Nations. While the goals are not legally binding on governments, St. Kitts and Nevis can use them as performance indicators in relation to ecosystem preservation and the safeguarding of human health and social welfare. Consequently, nurses have a profound advocacy role to play in achieving the major milestones, namely: 1 – Eradication of injustices that force people into poverty; 2 – Fair share of the benefits of economic growth; and 3 – Optimal resilience to effectively tackle climate change.      

It may be argued that the Federation’s SDG journey commenced in 1950s when the foundation of the network of community health centers was laid. Unquestionably, nurses were in the forefront of all of the health improvements achieved since then. Today, their legacy is a small island nation whose life expectancy, infant mortality, maternal mortality, and general level of health, compare favorably with the wealthiest countries in the world.

Going forward, two health and sustainability issues require the attention of nurses: 1 – The impoverishing effects of treatment for disorders such as cancer, diabetes, renal failure and violent trauma; and 2 – The threat to the quality of healthcare services posed by nurse shortages and attrition.

Paying out-of-pocket for major medical procedures and a lifetime of medication is already bankrupting individuals and families. National Health Insurance is designed to ameliorate this unfairness and nurses should lend their voice to its speedy implementation. In so doing, the point should be made that universal access to health services will be an illusion if the supply of general and specialized nurses continues to lag behind demand.

Therefore, nurses should be more vocal in their call for increased recruitment based on an agreed human resources for health strategy. At the same time, they should petition for the re-positioning of insensitive senior managers who frustrate good talent into leaving the public service. Additionally, nurses should request the immediate end to the protracted absence of a Permanent Secretary and a Principal Nursing Officer in the Ministry of Health. These statutory posts should be occupied by emotionally intelligent persons capable of addressing matters central to improving worker performance. Chief among them are relevant training, service quality, workplace safety, merit-based career advancement, and personal and professional respect.

Healthcare is too big to fail. Nurses in St. Kitts and Nevis must emerge as a lead voice for healthy public policy. Their considerable weight is needed to ensure adequate, predictable and sustainable resourcing of health promotion, prevention services, well-maintained and secure health centers, integrated delivery systems, multi-disciplinary teamwork, proactive human resource planning and effective facility management. This is not to discount the value of dialysis, chemotherapy and MRI. These services are now essential. However, no country can spend and treat its way out of chronic disease, addictions and violence.

The Federation of St. Kitts and Nevis has nurses of the highest quality – a testimony to their tenacity in the face of tirades, accusations, and discouragement. They are the cornerstone of every healthcare system. It behooves the political directorate to reset the workplace environment to enable nurses to become empowered, better organized, and a lead voice in the achievement of health and development goals.

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