Montserrat’s workforce challenges were highlighted in a presentation at the UK Health Security Agency’s annual Public Health Conference in Miami earlier this week. Nurse Anaesthetist Brenda Daley and Nursing Educator Naomi Joseph-Foster made the joint presentation sharing their perspective on Montserrat’s situation.
The nurses are in Miami as part of the Montserrat delegation led by Permanent Secretary Camille Gerald. Other members of the delegation are Chief Medical Officer Dr. Sharra Greenaway-Duberry and Senior Medical Technologist, Kimona Daniel-Bourne.
Nurse Daley told the conference that since 2016, there has been increased outward migration of nurses and midwives to the UK, USA, and other Caribbean islands. Exit surveys from the nurses cited low salaries as the primary reason for leaving. She added that the continued reduction in nursing numbers has impacted the ability of staff to provide both routine and emergency care within the hospital and at the community health centres.
With the island’s demographic and epidemiological profiles showing an aging population, with a high prevalence of chronic non communicable diseases with co-morbidities, and complications, Montserrat has a need for an “adequate number of staff with requisite competencies at all times,” the presentation noted.
The presenters shared that in 2022 the Ministry of Health embarked on an extensive global recruitment drive, which was unsuccessful. This took the nursing shortage from acute to a chronic.
Daley told Discover Montserrat that other Overseas Territories said they resonated with the local situation as they are in similar positions and they will be pursuing opportunities to collaborate to strengthen the workforce for the tiny nations.
The presentation also gave a SWOT analysis of Montserrat’s situation.
A Strength, was that local nurses were well trained and highly competent at both primary and secondary levels of healthcare. Having a nursing educator trained at the Masters level provided additional support to strengthen the professional and assistant nurses within the system. Montserrat’s collaborative partnership with regional and international agencies/stakeholders to include PAHO/WHO, CARICOM, PANCAP, CARPHA & UKHSA was also noted as a Strength.
Weaknesses included the ministry’s inability to attract school leavers to the profession, an aging nursing workforce, no significant local nurse training programme. lack of opportunity for progression, promotion or maintenance/development of skills, lack of capacity to deal with complicated cases, and the costly dependence on external recruitment to fill vacancies.
Opportunities for Montserrat in the area of nursing care is that with the size of the population, even small investments in building capacity would garner significant gains, Nurse Daley told the conference. She added that nurses are enthusiastic about accessing professional development and establishing scholarships specifically for nurses in specialty areas would go a long way to boosting staff. The nurse also stated that the Nurses and Midwives Act needs to be amended to provide more guidance for nursing education and practice. Taking a proactive approach to staff development to include specialization and succession planning, offering short term exchange and recruitment programmes would improve staff morale and capacity.
The major Threat highlighted was the continuous outward migration of trained nurses and midwives. Montserrat’s small population did not provide nurses here with the opportunities to keep their skills up to date and the low pay structure and the high cost of living makes it a challenge for nurses to enjoy a good quality of life on the island.
The nurses highlighted that the March 2023 visit by teams from several UK health agencies provided an avenue for local nurses to share their current challenges and to offer suggestions on a way forward. Nurse Daley added that the nurses now feel as if they were heard as it has moved beyond a conversation to action to the benefit of nurses and the community.
She shared that within short, nurses will have access to online courses to support their work in Mental Health, Critical Care, Geriatric Nursing, Tissue Viability, and Nursing Leadership.
There will also be a Montserrat Care Certificate set up to provide entry level training for Geriatric and Community Health Aides. A Florence Nightingale scholarship for the Chief Nursing Officer and other talent management programmes for nurses and midwives are in the works.
Daley said “the future looks bright for Nursing On Montserrat.”