When the backbone of healthcare is disrupted

The January football transfer window period is here and the English and Spanish football fans across the world are watching their teams to see who leaves and who comes in. Meanwhile, closer home, it is also the domestic transfer window for nannies and home managers as the year begins. 

Many households are holding their breathe wondering if their long-serving care providers will come back from the Christmas break. Some have found greener pastures, others have opted out of employment to pursue other interests while others just need a break from it all. 

In healthcare, the transfer window also exists and can grossly impact care. In 2021, our transfer window was occasioned by the establishment of new medical facilities by the Nairobi Metropolitan Services (NMS). When the NMS advertised for healthcare workers to fill up 1,500 posts, there was pandemonium in the city. The middle level private and especially faith-based healthcare facilities took a major hit as their staff joined the exodus! The most affected profession was nursing. 

Linah* was ready to pack her baby and go home 48 hours after her caesarian section. She could not believe just how unsatisfactory her birth experience had been. When she delivered her first baby in this same hospital just three years back, she had an amazing experience and was full of praise. She referred her friends to the same facility because she loved the nursing care. 

Fast forward to 2021 and she was a disappointed mother. She felt there were too many gaps in the care. She kept calling for her pain medication, she had to remind the nurse about the baby’s umbilical cord care, she struggled with breastfeeding without assistance from a lactation specialist and overall, she felt that she was largely ignored because she was not a first time mother. 

When I came to review her, she asked to be discharged early as she felt she would get better care at home. She took to social media to express her dissatisfaction and her comments drew mixed reactions.

I completely understood where Linah was coming from. I also understood that this was not a permanent situation and that it would get better, but by then, Linah would be long gone and her experience permanently affected. 

In any institution, the nursing profession is the actual backbone of care. Nurses are the care providers who cover the hospital 24 hours a day, working in teams like a well-oiled machine. They must build cohesion and fit into the hospital’s work culture.

They heavily determine the patient’s experience, which is a reflection of the hospital’s culture. It is therefore quite an upheaval when a large part of a team exits suddenly, leaving a gap that must be filled by completely new people, without a transition period! 

However good an individual nurse may be, they are forced to fit into a completely new working environment, with a different organisational culture and routine. They will need to learn how their new work environment puts their skills to use, how the chain of command works, what values the new institution holds dear and what support systems exist to enable them to deliver. 

Susan* thought that moving from a faith-based institution to a large private hospital was going to be easy. She was posted to the maternity unit where she expected to fit right in. She was quite surprised by the differences. She had to quickly adjust to a fully automated, paperless health records system. The sheer volume of records that she had to fill in at every patient interaction left her worn out. She felt that she spent more time in front of the computer than with the patients! 

It took her several weeks to find her footing. She learnt how to navigate the system faster, to type faster hence spend less time on the screen. This allowed her to spend more time with her patients, finally feeling more like a nurse and less like a clerical officer. She finally feels like she has fit into the unit. 

Susan is lucky she was the only new person in the unit when she joined. The experience was tougher for Marianna*. She had been looking for a job in Nairobi for two years. She wanted to relocate to the city to be closer to her ailing mum so she could take better care of her.  She was finally called for a job interview at a middle level hospital after it lost many of its staff to NMS. The day she reported to work, they were nine new nurses posted to the maternity unit. They formed more than one third of the unit nurses. It was utter chaos for weeks on end as they strived to settle in. No amount of orientation could prepare them for this. Patients complained but the unit head did not take it personally. She would field the complaints all day and at the end of the shift, she would send her staff home with a word of encouragement. 

The tumultuous period has since settled down. The upheaval greatly compromises quality of care even if temporarily. Institutions must also strive to retain their nurses at all times, with fair remuneration and acceptable working conditions so as to be able to whether such transfer windows with minimum disruptions!

Dr Bosire is an obstetrician/gynaecologist