The writer
The nursing shortage is not simply a customer service or comfort issue for patients; it can mean the difference between life and death. In a study of over 6 million discharge records, researchers found that patients in hospitals with lower nurse to patient ratios were more likely to suffer cardiac arrest, shock, urinary tract infections, hospital acquired pneumonia, and stomach and intestinal bleeding. Patients in highly staffed hospitals had shorter average stays. Surgical patients in the highest staffed hospitals were less likely to die from surgical complications.
Hospital patients can also hire private nurses to attend to their personal needs whiles on admission to improve their clinical outcomes. Nurse staffing level standards or requirements for hospitals have not been met. The number of beds managed per nurse must be looked at to help improve medical outcomes and quality of care. We have a few polices and laws to improve conditions of service for nurses, physicians and health personnel which have not be properly funded.
We must work to reduce death at hospitals due to lack of bed spaces or needed medical attention. Some of these deaths maybe more than death from road traffic accident, breast cancer or even AIDS. About one in 100 lives maybe dying due to medical errors, or lack of adequate nursing care. Medical errors include improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries, falls, burns, pressure ulcers, mistaken patient identities and medication errors, such as a patient receiving the wrong drug or an overdose of the correct drug.
Medication errors caused preventable injuries to hospital patients at a rate of about 10 per week at each of two large teaching hospitals; one in five were life threatening. The causes of medical errors are varied including language barriers system fragmentation and complexity, and staff shortages. Of even greater concern is a study showing that while hospitals are doing a better job of reporting medication errors, they continue to make the same mistakes repeatedly.
We should focus on programs and where appropriate develop legislation to address: (a) labour shortages issues (b) increasing pharmacy cost (c) cost and availability of malpractice and other insurances (d) study the sources of capital funding and the effect of rating on hospitals and their cost implications. The shortfall in NHIS Levy and what is released or Ministry of Health funding must be carefully addressed at cabinet. We must coordinate better the wide array of services and reduce fragmentation and duplication within Ghana Health Services. Develop future utilization projections for NHIS services based on an actuarial analysis of the eligible population in Ghana.
Our health industry should be supported to do more preventative care than treatment of emergencies. Explore development of nonhospital alternative systems for people to access appropriate care in community settings. Explore development of nonhospital alternatives for people experiencing mental health crises to access service. Provide more community-based services, particularly mobile emergency crisis services, for people experiencing chronic health crises, like diabetes mellitus, hypertension, and kidney failure.
We must pay the true cost of health services to providers and explore ways to improve the amount of revenue generated by NHIS and more important how much is released to NHIS from the consolidated fund. In all of this the conditions of service for health work force must be carefully looked at and improved.
Seek out and take full advantage of all existing sources of educational assistance for students in nursing and allied health programs in Ghana, and where none exists, secure additional resources to make education more accessible and manageable. It is essential that today’s students, particularly non-traditional students, have adequate support services in place to enable them to complete their healthcare education program. We must expand eligibility criteria for existing healthcare workers who wish to further their education whiles on the job.
Collaborate with public and private sectors to develop new/creative solutions to meet defined financial needs: – Identify and take advantage of all financial resources available (grants, scholarships, loan forgiveness) for non-traditional students pursuing nursing or allied health education who have minimal financial resources for education. Expand eligibility criteria for existing state assistance to such students where possible. Ascertain availability of access to childcare and transportation for health workforce.
Provide additional resources for hospitals to ensure they are able to attract and retain qualified healthcare workers by providing competitive salaries, adequate staffing levels, and thorough training and orientation programs. Training and orientation programs must be expanded to ensure a successful transition from education to practice (hospitals must have resources to maintain trainees in such orientation or “residency” programs rather than incorporating them into the regular staffing schedule).
Address the lack of diversity in healthcare professions by actively recruiting and providing development and outreach programs to target populations, particularly to those for whom a healthcare career would be perceived as well paid and upwardly mobile. Remove remaining barriers to effective, comprehensive, articulated healthcare education.
The healthcare industry, both labor and management, should work together to continue researching and analysing current staffing practices and identify functions performed by licensed staff that do not require the level or ability of a licensed practitioner (e.g., preparing and maintaining staffing schedules, filing documents, arranging for ancillary services such as blood work and radiology, passing fluids, transporting patients and other similar tasks), and continue exploring alternative staffing models and models of care that take appropriate advantage of skill mix.
When we deploy the needed mix, we can free up bed space at our emergencies or wards and then be able to admit more to our emergencies. When patients have been discharged to a ward from emergency room, what measures have been put in place to ensure efficient transition from emergency to the ward at any department.
I agree that quality improvement is an ongoing process and therefore should be addressed on an ongoing basis. Our goals must be to establish an ongoing healthcare quality improvement program for Ghana and to develop systems that will provide public accountability.
We should not take health promotion and preventative work for granted so that we as a country can reduce the emergency room visitations. This write up is just an introduction to what must be seriously considered as we work on improving healthcare delivery and saving lives.
By Dr. Adomako Kissi