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?
Useful Links:
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
