A Case for Clinical Nurse Specialists in Kenya?
Whilst the long awaited rainy season is upon us in Kenya, it also heralds the season of joint aches and pains for my dad, especially his knees. A trip to the doctors saw him sorted out with some pain killers, with a recommendation to come back and see a specialist should he not see any improvement in his symptoms. The said specialist could only be seen on a Wednesday, as that was the only time he held a clinic.
A couple of weeks later, with no significant improvement in his symptoms, he decided to go see the specialist. He called me once he was there and quickly handed over the phone to the doctor, who introduced himself and then to my surprise revealed that he was an orthopaedic surgeon. You see, i was at a loss as to why my Dad was seeing an orthopaedic surgeon and not a Rheumatologist? I was also questioning as to if seeing folks with joint pains was actually the best use of the surgeons time and what, if any was the waiting list like to see him? Anyway, he managed to convince my Dad that it was indeed time to start using a walking stick to help take the pressure off his knees abit.
All this got me thinking about the state of specialist care in Kenya and the under utilisation of nurses and their skills within this sector. Why are there no Clinical Nurse Specialists in Kenya? And is it time ( long overdue) to introduce this branch of Nursing?
Healthcare worker with a patient.
Nurse training in Kenya, be it via government training institutions like the Kenya Medical Training Colleges ( KMTC) or via private colleges and universities, in my opinion, is one of the most rigorous and thorough all round training programme and produces very knowledgable, highly skilled and competent Nurses, who can work in various sectors and departments. These Nurses qualify with a wide range of skills from history taking, clerking, pharmacology, management just to name a few, making them well equipped to work as part of a team within a hospital setting to autonomously within a rural health centre setting.
So it makes no sense as to why Nurses are not being used to their full potential. Why patients have to wait to see a specialist. Why there is no proper follow-up or aftercare of specialist patients who are on long-term care, because there is a shortage of specialists.
Why are Clinical Nurse Specialists Important?
The concept of a Clinical Nurse Specialist is not something that is new within the Kenyan healthcare system. We do have Nurses who are specialists in areas like Immunisations and Family Planning, Infectious Diseases just to name a few areas. The problem is that, it has not extended to other speciality areas like Rheumatology, Diabetes, Cancer, just to name a few, where long-term care and close follow-up is needed to optimise treatment and improve patients quality of life. This would also create a new career path for Nurses, which would in turn help solve the employment crisis that is plaguing the Nursing sector and seems to mainly affect degree holder Nurses but also improve continuity and consistency in patient care.
So who is a Clinical Nurse Specialist and why are they important?
“Clinical Specialist Nurses/ Clinical Nurse Specialists ( CNS) work in a variety of acute and community settings, specialising in particular areas of practice, as part of a multidisciplinary team to provide high quality, patient-centred, timely and cost-effective care. They provide tailored care depending on the patient’s level of need. They also provide education and support for patients to manage their symptoms, particularly patients with long term conditions and multiple morbidities”- Royal College of Nursing(RCN).
Like every other country in the world, Kenya has a shortage of healthcare workers, and that includes Specialist consultant Doctors. This shortage means that there is a high demand often with long waiting times for one to be seen and diagnosed, as they divide their time between their hospital(s) and private practice, and often incurs a hefty price in terms of consultation and various fees. Access to specialist care also involves travelling to the big city hospitals or Doctor’s plaza, where they have their private practices. All these are barriers towards patient care and safety, as more often than not, continuity of care is lost, with the patient sometimes ending up being worse off, as their condition deteriorates, where follow-up care involves them going through the whole process above. Having a Clinical Nurse Specialist can help bridge or even close those gaps.
A Clinical Nurse Specialist can take over the supervision and follow-up care of already diagnosed patients, freeing up the Consultant Specialist to diagnose new patients and more complex patients who require a their input. This then ensures that the patients are followed-up and continuity of care is maintained which in turn helps to keep the patients out of hospital admission. From a revenue point of view, patients save money on consultation fees, transport and hospital admission costs and the specialists increase their revenue by being able to see more new patients.
On the whole, Clinical Nurse Specialists help improve patient outcomes, decrease specialist consultants workload and deliver high quality care. So isn’t it high time the Kenyan healthcare system utilised the valuable resource that is the Clinical Nurse Specialist?
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How do we build wealth and financial security as Black Female Nurses?
Tweet by David Ring RN
I have stopped reading any reports that come out about racism at work and society because as a Black Woman, I live it everyday and no report or survey is going to tell me what i and other Black people do not already know. Reports and surveys without actual change and actions do nothing but perpetuate the racial trauma we already experience. So when i saw the above tweet highlighting an NMC report about Black African Nurses, i was not surprised, because again, it is something i have talked about and written about. I chucked it up to another casualty of racism and how it frames our careers and lives as Black Nurses.
As days went by, this tweet stuck with me and i reflected on the ways racism and the status quo goes on to affect every aspect of our lives as Black Nurses. Nursing is a predominantly female profession and so it stands to reason that those most affected by the statistics reported by the NMC report would be Black female nurses. Nursing is a career and a career implies progression, climbing the ladder or whatever it is you want to call it! But is it just a job and not a career when your gender and race are barriers to your progression?
Countless studies and reports have shown that women earn far much less than their male counterparts in all parts of society( google can be your friend if you want to read all about it), not to mention the time off and part time working that women have to take on, if they want to start and raise a family. This gap in payment also translates to pensions thus affecting women’s retirement. As Black female nurses we get to fight on two fronts, the gender pay gap and the ethnicity pay gap, add the lack of career progression into the mix then you start to get the stark and bleak picture that this all paints for our futures!
I have not worked in the care home sector, so really can not speak to work and career progressions within that sector but i’m sure it holds the same prospects for Black Nurses as in any other sector: cheap labour and barriers to progression. As for the agency sector, it holds no progression whatsoever but provides that work flexibility that doesn’t exist with a substantive post, without the job security( but then again is job security a luxury afforded to us Black Nurses?)! More often than not, we sacrifice our dreams and hopes for that fulfilling career as a nurse( and i’m not talking about job satisfactionhere), and buckle down and work the hand that we have been dealt, as we have our immediate and extended families depending on us both here and abroad( back home), as well as the ever present bills and everyday living costs.
How do we ensure that we secure ourselves financially in the present and for the future? That we have something to show for all our hard work and that we can retire and live comfortably with our health both physical and mental, intact? That we can build or start to build that generational wealth? That we can leave our children better off? While the nursing path career now has more choices than just bedside nursing, we as Black Nurses, especially female nurses, have to find a way to diversify like some of our white colleagues who have taken to providing beauty treatments like botox or like Doctors and other Allied health professionals who can open a private practice We can not just rely on that one income stream from working for a care home or agency. How do we make our nursing NMC PIN work for us?
I can not pretend to have the answers as to how we can secure ourselves financially, i will leave that to the experts, but i hope this post starts a conversation, starts something, a spark, a desire to learn about wealth management, to have wealth, blessed wealth, to live comfortably , to not shy away from the notion that we are worthy, worthy to live a comfortable and financially secure life.
If you are looking for some direction or inspiration, then i would recommend reading ‘The Professional Troublemaker: The fear fighters manual’ https://amzn.to/3uHMLbYby Luvvie Ajayi Jones and also listening to the podcast as well. Another great book to read would be ‘The Power of Expertise’ https://amzn.to/3HJaQXVby Elle Pierson RN and ‘We should all be Millionaires’ https://amzn.to/3BqbFAWby Rachel Rodgers another one would be ‘Get Good with Money’ https://amzn.to/3W5XSHtby Tiffany Aliche. You can also follow their accounts on social media for hints and tips if reading is not your thing( you can get them in audio format as well!).
Here is to taking charge of our financial security and to a better future as Black (African) Nurses!
Clinical Judgement & National Early Warning Score(NEWS2).
The National Early Warning Score(NEWS2) has been mandated by NHS England and NHS Improvement for use for adult in acute and ambulance trusts. It should not be used in children under 16 or pregnant women.
It's used to identify acutely ill patients, including those with Sepsis by using a scoring system that measures 6 physiological parameters: Oxygen saturation, Respiration rate, Pulse rate, Level of consciousness or new onset confusion, Temperature and Systolic blood pressure.
Some handy safety tips are included below ⬇️
Learn more about NEW2 on the Royal College of Physician's website ⬇️⬇️ https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
Racism, Nursing and the NHS
Racism,Nursing and the NHS
The Extreme Sport of Nursing While Black: The Unofficial Survival Guide, started off as me passing on the do’s and dont’s to my daughter who was thinking of working for the NHS and like every other thing her race came into play. She is in the band of what i call the ‘triple threat’ i.e Woman, Black and Muslim. Unfortunately she, like many of us before her would have to do thrice the work, constantly prove herself in all that she does. I was determined to at least equip her with the weapons she would need as yes it is a war out there. At the same time there was also a lot of issues around racism and nursing on social media and this is how the book or booklet idea was born of using my experiences working as a nurse as examples of the things that are likely to trip you up as a black nurse on the NHS and how to avoid them, hence making work a tad more bearable while the NHS and other health organisations catch up to racism within themselves and work towards finding lasting solutions to eradicating it within and without themselves. For far too long, the onus of fixing the racism problems that plague the world had been left at our doors, we, the very victims. it was time the script was flipped.
It is crazy that Black people are still making firsts in 2021 worldwide and in the NHS. You would be forgiven for thinking that Black people only recently arrived in the U.K as opposed to having been part of the NHS since it's inception! How is it that out of the 223 NHS trusts only two have chief excutives from BME background , one being black? According to NHS providers.org: https://nhsproviders.org/inclusive-leadership this under representation of BME’s is repeated across NHS boards country wide, and even though they note that the number of senior BME’s is increasing, i wonder how many of them are Black? The NMC does not escape this affliction, looking at their 16 senior representatives.
How is it that those who are at the snowy white peaks of power within the NHS did not notice or question why the peak was so white? It all well and good that they are questioning this now but how is it that they did not notice this anomaly while rising up? How did they not question why their black colleagues were hardly getting out of the band 5 starting block, while they were sprinting towards positions of power? How did they not notice the email exchanges alerting them to new career progression options or the fact that some had job vacancy adverts tailored to their specific needs, just short of actually naming them? How did it escape them that they were disproportionately referring BME staff to their regulators for fitness to practice? Did they not notice or did they not want to notice?
How are we as BME healthcare staff and more importantly as Black healthcare staff now trust that these same people who most likely scaled to the snowy peaks of power on the back of our blood, sweat and tears all over sudden have been on their road to Damascus and have now realised that we as Black healthcare workers are equally as qualified if not over qualified and are quite capable to sit at and take command of the table? The proof will be in the pudding or so the saying goes because we Black people are not going anywhere! So while you all are busy trying to find ways to ‘invite’ us to the table, a table which we really don't need an invite to as we are not guests and have never been,you will come to realise, hopefully when it is not too late that We own the table!