The Nurses and Midwives Letter Issue 4
THE NURSE & MIDWIVES LEADERS’ THINK TANK 2020 Lead
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VOICE UP: TELL YOUR STORY! Leadership is utterly exhausting! I recently exclaimed to another colleague. We were seating across from each other, not able to hug or shake hands. A computer screen nicely separated us in what has begrudgingly become our new normal in the time of COVID-19. She looked at me for a second and pondered what I had just told her. Then, she asked—in what way? I remained silent. In what way is leadership “utterly exhausting” she asked again, as if I had not heard her the first time. I was taken back by her question. Isn’t it obvious that it is? I asked in exasperation. Perhaps. Perhaps not, she calmly replied. My friend is also my mentor, and she has a way of asking annoying questions. Questions I am forced to think about and eventually, reluctantly, answer. But her lackluster response made me think about a critical issue impacting nursing and midwifery today—we assume the world knows our story. So, we do not strive to tell it. We assume they understand our struggles. So, we make no effort to articulate the challenge. We assume they know that our work adds value. We therefore exert minimal effort to quantify it. We assume they know we are the backbone of the healthcare system! We are frankly irritated when they don’t acknowledge this obvious fact. We assume they know that the work of caring, while rewarding, is also exhausting! To borrow from my friend’s response: perhaps. Perhaps not. Clearly, not the answer we want to hear. As the COVID-19 pandemic ages, so does the mounting expectation and responsibility of every nurse and midwife of this nation to care and serve. To show up, no matter what. To shoulder the responsibility of strengthening the system. To drive better system and patient outcomes. And the list goes on. We know you are ready for the challenge. But what we are not hearing, are your stories of leadership, hope, courage, resilience, trust, and effort. And may be, the sheer exasperation at the worsening conditions of work. Or your fears for your safety and the safety of your colleagues. We should spare no effort in telling these stories. So, Voice Up! Send us your stories. This space was created just for you. Yours sincerely,
Dr. Rose Clarke Nanyonga (Ph.D.—Yale) Chief Editor Nurses and Midwives Leadership Think-Tank Newsletter uganursemidwife.leaders@gmail.com
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INTERVIEW WITH NURSE OF THE YEAR DORIS One of our editors recently had a catch-up with Miss Doris Okudinia, the Ugandan Nurse of the Year. Congratulations upon being awarded Nurse of the Year 2020. How has the award changed your life? I was recognised countrywide as a nurse and a hero. Since I was rewarded with a smartphone, I now have a chance to chat with people on social media. It also helped me remember the history of Florence Nightingale. However, on the downside, I now fear for my security. Where do you see yourself in the next two years; you received many offers to upgrade, do you know all of them and are you considering any of them? I will go for further studies in two years' time. What is your message to young nurses? My message to my colleagues and fellow nurses: Prayer - Pray for God's protection and direction in your work. Be devoted to your work - Especially commit yourself, focus your effort and give time to understand and ascertain any matters that arise. Take up duties and make sure you have them signed off from your supervisor.
“…Treat Patients equally regardless of their background, appearance, religion, culture and family background…”
Have a patient-centered mind; handle and treat patients equally regardless of their background, appearance, religion, culture and family background. Respect the patients. Be professional in your work; smart in uniform, time conscious and maintain patient confidentiality. Have a Spirit of Teamwork so that you can get along with your colleagues. As our motto says; "We love & Serve" I say this for God and my country.
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“5 MINUTES WITH OUR LEADERS” NEW COMMISSIONER FOR NURSING AND MIDWIFERY One of Our most notable achievements as indicated in our objectives includes advocating for leadership in the fraternity. We caught up with our newly appointed Commissioner for Nursing and Midwifery at Ministry of Health, Comm. Beatrice Amuge for a quick interview. Comm Amuge is a former Assistant Commissioner, Mulago National Referral Hospital (MNRH). What plans do you have to reposition the Ugandan Nurse & Midwife for success? My plan is to have capacity building for nurses and midwives through training, mentorship and coaching. For the nurses and midwives to continuously strengthen their skills; specialization/specialized training is also very important if we are to take nursing to the next level and I encourage nurses to embrace this. The second item on my agenda is the Nursing Policy. To ensure that I fast track the completion of the Nursing and Midwifery policy and have it launched. This is important for us to have a policy framework within which we operate. My plan also includes ensuring that the structures for recruitment of nurses and midwives are clear and streamlined right from the ministry facility level which is a (Health Centre III). Research: We need to ensure that nurse’s research is brought to the table and that we are able to inform/provide evidence for policy. The public, leaders and policy makers need to know what nurses are doing. Strategic Plan for the department: Ensure that our department has a strategic plan to direct us on where we are, where do we want to go and how shall we reach where we want to go. Database/Data Bank, we need to have a data base of all nurses and midwives to establish which regions have more nurses and midwives, which regions have less nurses and midwives and also strengthen IT support for the department to continuously update the database for nurses and midwives. Who are some of the key partners that are vision aligned, strategic partners to work alongside MOH and to help you achieve the vision for nursing and midwifery? Since I joined Office, I have mainly interacted with: ¨ Seed Global Health, UNFPA, Aghakan University, and some Professional bodies. ¨ I Know ACHEST have previously supported the formation of the Federation of Nurses. What would you like to enhance or change in the Nursing dept. in the next 5 years? Ensure we have a strategic plan and policy Strengthen the research Agenda for nursing and midwifery. Realign the structures that are in line with the schemes of service. Work together as nurses and midwives - foster unity.
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For many years Nurses and Midwives in this country have been dissatisfied with their remuneration. What plans do you have to be able to address this need? We need to advocate and lobby for increment of salaries. In addition to this, we should also look at other occupational concerns like number of nurses, workload and the length of the shifts. For example, it is not realistic to expect nurses to work 12-hour shifts because of the nature of our work. There are studies which provide evidence on the occupational hazard’s nurses face like back problems. This is why as nurses; we need to publish our research to provide evidence for policy makers. Professional bodies, Associations and the Union play a vital role in lobbying and advocating for better pay for nurses. What challenges do you foresee in Nursing and Midwifery for Uganda and what are some solutions you would like to see implemented both in the medium to long term? The challenges revolve around poor remuneration, low numbers and long working hours, lack of policy and strategic plan for the profession. Some nurses do not support the schemes of service. Solutions to these challenges from my point of view include: 1. 2. 3. 4.
Working together as nurses and midwives, fighting for the same thing. Continue advocating and lobbying for better pay and working conditions. Provide Evidence through publishing our research. Have a strategic plan and policy for nursing and midwifery in Uganda.
You have read the State of the World Nursing Report (WHO, 2020) which calls on countries to prioritize three key areas for investment; Investing in Nursing Education, Investing in Jobs, and Investing in nursing leadership. What strategy do you have to implement this WHO agenda for Nursing and Midwifery in Uganda? ¨ Education; we need to encourage nurses to embrace education and also specialize so that we can discuss at the same wavelengths with our colleagues in the medical field. ¨ Leadership - we need to mentor and train nurses in good leadership skills and then also position nurses to take up leadership positions. ¨ Jobs- we need to push for filling of vacant positions to be done immediately and also, we should not encourage acting positions for long. Nurses also need to be willing to go and work in the upcountry/provide primary health care to rural communities. ¨ Advocate and encourage institutions to implement the “Lastly, I schemes of service.
encourage Nurses and Midwives to work together and support each other. If we are united, we shall take our profession to the next level”
Technology and the use of it, has taken center stage especially in the face of the Covid -19 pandemic. It will continue to be at the center of people, processes and practice. What ought to happen to increase the technology capability of nurses and midwives in this country? We need to train, orient and mentor nurses in use of technology. We also need to advocate for resources to access this technology especially for nurses working in the rural areas.
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“FEATURE ARTICLE - NURSING LEADERSHIP” LEADING FROM WHERE YOU STAND By Christine Nimwesiga, Nurse-midwife, Asst. District Health Office -Ibanda district I guess the majority if not all of us agree that leadership is a very strong pillar in achieving the health care needs of our country. The stewardship of the health care leaders greatly influences the planning, decision making, resource allocation, prioritization, coordination of various stakeholders and health care service delivery. It is therefore of great interest everyone is involved in the health care leadership at the various levels of action in the health care system. At the central level of the system, leadership usually rests within political leaders, such as ministry of health, ministries of other related sectors, directors of nongovernmental organizations and professional associations at the national level. The key responsibility here is directing and guiding policies, evaluating, influencing other top-level leaders, resolving central policy issues, mobilizing and directing resources in support of the system. At the intermediate level of leadership, there usually lies the bureaucrats and technocrats, senior officials of nongovernmental organizations, political and other elected or appointed leaders at district levels. Their leadership responsibilities include providing managerial direction for the implementation of the policies, health care strategies, monitoring and evaluating, resolving implementation issues and participating in policy making including allocation of resources. At this level, leadership functions become an integral part of managerial functions and effective managers are therefore characterized by their leadership qualities. At the community level, leadership devolves on a wide range of people including health workers, locally elected community leaders, religious leaders, representatives of voluntary agencies or nongovernmental organizations, representatives of other sectors, the private sector and village volunteers, etc. Their leadership responsibilities embrace mobilizing and coordinating community action for health, including resources, setting community level targets and monitoring them, and influencing those at higher levels for support towards community health programmes. The challenge amidst us today is a thinking that leadership is for those who hold the various positions in the system. This thinking has not, cannot and will not work, it’s not taking us anywhere!!! At such a time when our
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focus is on achieving universal health coverage, health for all, it is so evident that strengthening our health care system calls for everyone’s involvement at all levels of the system to act to the fullest in their capacity. “Leading from where you stand” demands for everyone’s involvement and interest in achieving the health care needs of our country with or without a leadership position. On many occasions, we lament on how much leaders have failed us, forgetting that we probably also didn’t play our part. Good performance in our hospitals is a collective responsibility of every service provider in the hospital including the cleaners and security. For example, if all my fellow colleagues, the nurses, who actually make up more than 60% of the entire health workforce played the roles and responsibilities to the fullest, the performance of our healthcare system would be so tremendous. The attitude exhibited in the way one executes their duties deeply reveals the nature of a leader in an individual with or without a leadership position. We ought not to wait for leadership
“The attitude exhibited in the way one executes their duties deeply reveals the nature a leader…”
positions like ward in charges, area managers, principal nursing officer and the sort to do the right thing. Nothing stops any nurse or midwife from mobilizing team mates to ensure that the protocols of nursing care, proper documentation, infection prevention and control are adhered to in the day to day ward activities. One certainly needs no leadership position to ensure every patient is treated with respect and dignity. We have all been trained on what to do but our attitude in many cases puts us down. Leading is all about influencing others for a particular cause
and direction that is aimed at causing change. You can make a difference by just the way you execute your duties. By just doing your job right and excellently, many patients and colleagues will love the way you do it, get inspired, copy what you do, learn from you and your promotion is often unstoppable. Where everyone is accountable, everyone wins. Get changed, lead from where you stand, be the change you want to see. You can read this article on the Nurses and Midwives blog site: https://nhccuganda.com/home/f/leading-from-where-you-stand The Think Tank Newsletter accepts articles on a rolling basis under the sub themes below; ● ● ● ● ●
Research and Innovation in Practice Continuing Professional development (CPD) Policy, Leadership/Governance Clinical Practice Covid-19 Response.
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IN OTHER NEWS Appreciation and Recognition from public Public appreciation is as important as public criticism. Whereas the latter is aimed at improving the quality of work or care provided, the former motivates and gives Health Workers zeal to wake up every morning and do their best every day! Joseph Nsimbe is one of the very few people who remembered to appreciate a Health Worker that had gone above and beyond, delivering high quality care with empathy and professionalism. How did he do it you ask? He wrote a status update on WhatsApp: Although he referred to her as a Doctor (yet she is a Nurse), he did go ahead to correctly translate Musawo (a collective Luganda word for all health workers) to Nurse when we spoke to him early this month (July 2020). You posted an appreciation note about a Nurse called Martha, and our Team spotted it, could you please tell us more about Nurse Martha and the care she accorded to you and your patient? I will start from the beginning; My father has been unwell, with complications and pain in the abdomen. So, we took him to Hope Clinic for examination. They found that he had advanced Ulcers that were also causing gas retention in the abdomen, causing it to appear extended. He was also not feeding well. The kind doctors at Hope Clinic referred us to the nearest bigger Hospital in Gabba, Weinz Hospital for a scan and further management of this complex case. This was on 11th June 2020. My brother and Mom helped us transfer Dad to Weinz Hospital at around Midday, where we were warmly received by the Reception Nurse; Dezzy Nabuuma who provided emergency care for us; we immediately did blood tests and an abdominal scan. The scan results showed that he had intestinal complications that urgently needed to be corrected by way of emergency surgery. We were told that due to his age (51yrs) and his low immunity due to prior poor nutrition (which was also a side effect of his condition) Weinz was unable to perform the surgery but instead referred us to Mulago Hospital. Before we were sent off to Mulago, they performed a procedure that helped reduce the gas in the abdomen -this was also first aid, I later learnt. We were so grateful for the
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quick attention and care offered by the Weinz Dr. Barungi Charles. Weinz hospital admin then offered an ambulance for us to transport our patient as we could not transport him in a private car due to the curfew restrictions, and yet he needed surgery that very night. When did you meet Nurse Martha? It was in the ambulance that we met Nurse Martha, who was to take care of Dad on our way to Mulago. There came a nice, kind, professional, brilliant , hardworking nurse by names of Musawo/Nurse Martha who cared for dad while in an ambulance and also helped us secure a place in Mulago, find a Doctor to continue care provision for our Dad despite the fact that we had arrived in Mulago at night. How did Nurse Martha stand out? While at Mulago Hospital, we received VIP reception & treatment because every thirty minutes there was a Health Worker to check on Dad throughout the night. They took off samples for further examination and did yet another scan in preparation for surgery first thing the next morning. However, some test results would arrive much later than the slated time for the surgery, yet it was an emergency. So, the Doctors at Mulago asked for the most recent RFTs (Renal Function Tests) which we had previously done in Weinz Hospital but since we had been in a rush, we had left the results behind. We did not know what to look for, so we called Nurse Martha to help us find the results. Martha had been on night shift but in the early morning, she helped us find the results in the system. Which she kindly referred for review by the Health Workers at Mulago Hospital. The operation on the morning of 12th/06/2020 was successful. We are to go for a review in Mulago again soon. Since the operation was done, Nurse Martha has been calling to check on us, guide us, advise us on how to care for Dad and help him stabilise faster. What made you decide to write a public appreciation post about the Nurse who had cared for your Dad? Two days back, even Dad got the strength to ask me about Nurse Martha, I told him she was still checking on us to make sure we were recovering. Dad smiled and told me to thank her so much. That is why I looked for a bigger platform to thank her and show my appreciation for Nurse Martha, for the good work she has done for us, I also wanted to show many of my friends and family who view my profile - status that some Nurses and Doctors still stand out, still do a good job and just a few words of appreciation could be good for them. I am glad that she got that message and that people like you (Think Tank, plus other Nurses and Midwives in the country, also got the message). Many people will read this letter, what do you want them to know? Mulago may not be perfect, but it still does have the best treatment, reception and care. Everything was done on time, the environment was good, the Doctors and Nurses cared. Mulago is also worth some appreciation and of course, so is the Ministry of Health and the government at large for treating Ugandans.
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UPDATES PPE This month, we re-launched the PPE drive in anticipation of more of our colleagues on the frontline being affected. We want to continue to lobby and advocate for more funds in order to meet this objective. For $19.50 (UGX 70,000) only, you can sponsor a nurse/midwife to receive a pack of PPE for his/her shift. This pack includes an apron (re-usable), two pairs of gloves, a hair net, N95 mask (with instructions on how to sterilize), and soap. Please feel free to contact us at Uganursemidwife.leaders@gmail.com for further inquiries and more information on how you can donate.
Thank You
TRAINING CPD TRAINING FROM UNMC If you have not yet registered with WCEA, please use this link:- http://wcea.education/new-councils-onlineplatform/ to register. The CPD credits will automatically be captured by UNMC. Any queries or problems, please see email below. The Think-Tank encourages all Colleagues to download and equip themselves during this period. CPD for leaders is also available.
WEBINARS: The next webinar will be a follow up discussion with the Ministry of Health; we shall get a chance to hear from the Commissioner of Human Resources and Commissioner for Pharmacy. Date and time will be communicated. Our Webinars will be held on a monthly basis, in the third week of the month.
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SAVE THE DATE! THE NATIONAL HEALTH CARE CONFERENCE IS BACK
The 2nd National Health Care Conference NHCC Uganda - the knowledge sharing platform for Nurses and Midwives on 21st - 22nd August with speakers including Dr Rose Clarke Nanyonga, Prof Omaswa, Mrs Catherine Odeke, Commissioner Nursing and Midwifery Beatrice Amuge, and Commissioner BTVET Dr. Safina K. Museene among our local leaders and experts in different fields. A call for abstracts is still open for topics covering Infection Prevention and control, Management of Infectious diseases and Nursing Leadership. Register for the FREE Conference at: https://bit.ly/32MwFkM Once registration is complete, you will receive information on how to join this two-day conference for Nurses and Midwives.
APPLIED RESEARCH The rapid national Nursing and Midwifery survey to assess the impact of covid-19 on the workforce concluded on 30th May 2020 at midnight. A report will be made available as soon as possible. Although the survey did not cater for those who are not employed, have challenges accessing the internet due to various factors, we thank all those who participated.
LIST OF USEFUL CONTACTS Please find below a list of useful contacts to forward your concerns appropriately. UNMC queries: info@unmc.ug UNMU: info@unmu.ug CPD APP concerns: martin@unmc.ug National Organisations Education and training Standards: Department of Nursing at Ministry of Health BTVET (Min of Education and sports) QUESTIONS? CALL: 0417 893600 (PRO) Mobile 0777108170 Benevolent fund: Department of Nursing at Ministry of Health, Uganda Some of the Nursing and Midwifery associations. (Find out more information about their membership and activities)
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AGNMU: graduates@agnmu.org Critical Care Association: president@ccnau.org Midwifery Association: nationalmidwivesassociationug@gmail.com Nursing and Midwives Society: info@nursesandmidwivessociety.org Emergency Care society of Uganda: admin@ecsuganda.org Palliative care Association of Uganda: pxau.admin@pcau.org.ug Others NMLTT (Think - Tank Leaders):- uganursemidwife.leaders@gmail.com Writing articles for publication on NHCC Uganda website:- editors.nhccuganda@gmail.com Global networking Nursing Now Campaign Uganda: nursingnowuganda@gmail.com
ON GOING NMLTT continues to work in collaboration with the National task force in the Management of Covid-19. The Think Tank continues to meet every two weeks to check on progress and formulate strategies to support and advocate for Nurses and Midwives. We would like to thank Seed Global Health for the continued support for hosting our zoom meetings and webinars. Our faith in you is steadfast. May you continue to rise up to the challenge in this International year of the Nurse and Midwife - 2020. More than ever, this nation needs you. We thank you and May God bless you. Please feel free to contact us with your concerns. If you find this Nurse & Midwife Letter useful, we would really like to hear from you. We continually evaluate and assess the progress of our communication channels with you. Please email us at the address above. Copy to: The Hon Minister for Health The Permanent Secretary, Ministry of Health The Chairperson, NATIONAL TASK FORCE COVID 19 The President of Uganda Medical Association Commissioner Nursing Services, Ministry of Health All Nurses and Midwives in Uganda Compiled and Edited by Think Tank Debrief team on behalf of NMLTT: Dr Rose Clarke Nanyonga, Elizabeth Pearson, Irene Atuhairwe, Tracy kobukindo, Judith Hope Kiconco