Though GHDonline just concluded a thought-provoking panel discussion on the topic of nurse leadership in the field of global health, and I had intended to blog about that, I’ve since been in Chiapas and Guatemala, facing a face-full of new circumstances. And I can’t get my present out of my head.
Partners In Health (PIH) is beginning to recognize the importance of focusing resources toward nursing. I recently accompanied a young U.S. nurse during her first of twelve weeks in Chiapas, Mexico. Her work plan includes collaborating with and providing special training to eight nurses in six rural communities, as well as trying to establish formal connections with the local Ministries of Health. This is a large load to carry over twelve weeks, and for a volunteer at that. But I am grateful for her enthusiasm and time, as I am for PIH staff support.
PIH is relatively new to nursing, though nurses aren’t new to PIH. The Chiapanecan nurses with whom we collaborate confront many of the same challenges we all do: family demands, personal financial strain, community/neighborhood politics, lack of adequate training for the roles we end up performing, too much paperwork, force of habit and age-old burnout. But of course, there are also challenges unique to their situation. The majority of nurses with whom we work here have the equivalence of a high-school diploma in nursing; there is next to no professional development; there are public health sector strikes and medication stock outs; the most basic supplies and accurate information are often hard to come by; the nearest hospital where surgery could reliably be performed is 5 hours away; nurses are involuntarily assigned (many would say relegated) to remote under-resourced clinics; there are sometimes no doctors in clinic; the under-regulated private health sector buys low and sells high. And, yes, wonderful care does sometimes take place here, and marvelously so. But I must say, the frustrations of the situation as a whole are difficult to overcome. This is not a system that grows thriving nurses. This is a system entrenched in politics and politics, in turn, is entrenched in money, favors and power. While we can try to effect change amongst handfuls of nurses, it is the system that obstructs good patient care.
Nine hours away by ground transport, across the border in Guatemala, not much is different. It’s enough to make me think I really should’ve gone into politics, or policy, or economics – none of which I enjoy, but all of which could actually change systems. But maybe mine is the usual destiny of most nurses, to begin with careful and hopeful patient-by-patient care, only to inevitably come up against my system-foes around every corner. But in reflecting back on the recent panel discussion on GHDonline, this is the very reason why nurses need to be in leadership positions, to change systems. Or at least improve them a little. And, as Gini Williams posted in our recent discussion, this does not necessarily earn one the popularity vote. And not that I care so much about being popular, but I should perhaps care less about being branded a trouble-maker, for surely if one goes into the business of changing systems, there is some trouble to be made.
I know no other way to begin to change a system other than by being present and speaking up, both of which challenge the status quo. I imagine policy makers, politicians and economists to be more sophisticated in their methods of effecting change. Their small decisions can create wide ripples in a system. But a loud nurse going against the grain is more likely to get noticed. Though as Gini mentioned, she has too many of other nurses’ voices in her head to keep quiet. In our recent panel, many ideas for how nurses can lead change in the field of global health were highlighted: being a mentor and role model to other nurses, join committees, serve on boards, write and initiate collaboration, to name only a few. And just as some of us are quiet leaders and others are loud leaders of change, I did come to realize through the course of this panel, that there exists a multitude of expressions of leadership, and thereby many opportunities for changing the status quo.
Maggie Sullivan RN, MS, FNP-BC
GNC Board Member