Nurse, Mary

About

Mary has formal clinical training but a limited ability to conduct complex surgical procedures. She sees +/- 50 patients a day, sometimes in their homes. She is literate in English and understands local dialects. She is sometimes stationed far from her rural town/family in spurts and makes regular trips to districts to hand-deliver reports.

Mary lives on $5/day and depends mostly on solar power at the clinic as she may not have electricity at home. She is enthusiastic about technology but has had little exposure. She has an email address that she does not check regularly and has a basic understanding of Windows OS. She uses Facebook and M-PESA on a low-end phone.

Values

• Good health. Anyone is only able to work and therefore take care of ones and other people’s needs if and when in really good health
• Family is the essence of one’s existence and that each child is entitled to love that can be best provided and experienced in the family setting
• Education is the ticket for better, healthier and happier life for everyone

Responsibilities

• Assessing patients and providing primary care
• Reporting service delivery statistics to health system officials
• Coordinating care for high-priority patients through CHWs and supervisors
• Initiating events to promote healthy practices in the community

Needs

• Nurse Mary wants nil (zero) maternal and child mortalities in the community served by the health facility
• Nurse Mary needs all the community to be aware of the health care services that they can access at the health facility
• Nurse Mary needs everyone in the community to have access and adhere to continuous quality care provided at the health facility
• Nurse Mary needs all defaulters to health care available at the health facility that are in the community to be traced and re-introduced to care
• Nurse Mary needs to keep and get accurate data of the target population that she provides health care for
• Nurse Mary needs to keep abreast with new editions of nursing procedures through regular trainings/seminars

Motivations

• Community enjoying services of skilled health professionals for deliveries which translates to no or very few maternal and child mortalities. More money for her to run the facility as finances for performance is a policy that is in use now in Kenya.
• Healthier children, with fewer neonatal, infant or child mortalities, and 100% full immunization of all under-fives.
• Progress within the nursing profession with continues and recognized certifications.
• Model health facility where other health facilities are encouraged to emulate and adopt those standards.
• Prompt report submissions to supervisors and the recognition by the supervisors for that.

Strengths and Assets

• Literate
• Strong clinical knowledge
• Organizational skills
• Constant source of income-employment by the government
• Mobile phones: smart phones, facebook, Whatsapp and access to email
• Computer literacy: access email, basic understanding of the windows OS
• Access to either solar or electricity power at the health center

A Day in the Life

Her day at work starts early as she must be on duty at 7 am, to relieve the nurse who has been on cover of the health facility at night if she is in a health facility that as at least 2 of them. In the health facility, where she is the only nurse she comes to pick up from where she left last evening, if she was “lucky” not to be woken up to attend to a patient at night.

She gets a report from the “night nurse” of all the in-patients-mainly women in labor, newborns born at night, children less than 5 years brought in at night for care and injuries resulting from accidents.

8am going to 9am, the outpatient is swollen with patients: mothers with under five children bringing them to the child welfare clinic, pregnant women some with under five children coming also for antenatal care, and elderly women and men, all weak, sick looking and would pass for nutritional support-if only there were supplements for the elderly. The ones in store are for the under 5 malnourished and pregnant women.

Anyway, she notes the need to do a health education session on how to eat a well-nourished meal using the locally available food stuffs, but now, she must do one on how to prevent contracting cholera as cholera as for the last 2 months being reported in many parts of the country. It is a regular practice to carry out health education sessions to the out patients. She will also talk to the CHEW today for a health education session with the CHWs during their monthly meeting on cholera prevention that the CHWs must disseminate to the community. She and the field CHEW must liaise consistently as they work together with the CHWs to promote the health of the community. Her role is to oversee the field CHEW and to help her meet the knowledge gap of the CHWs by consistently teaching CHWs on common local diseases and how to prevent them, identifying them, giving first aid and referring patients for specialized health care.

The CHWs are critical to her as they are the link between the community and the health facility that is very important. The CHWs help her trace the children under five lost to follow up, malnourished children in the community who need follow up, chronically ill patients in the community that need home based care and refer and support orphans and vulnerable children in the community. The field CHEW co-ordinates this activity, after giving her the list of the patients to be followed.

Her next in line activity is to see the ANC mothers, she co-ordinates their care, sends them for laboratory work, prescribe treatments and supplements based to the general health assessments of the woman and the lab results. She records care given in the maternal child booklet, and advises her on when to come for her next follow up. She briefly counsels on how to take care of herself during pregnancy, feed well and the exercises to take, maintain good hygiene and to plan to deliver her baby in the health facility: the individual birth plan, must be reinforced by the CHWs who can afford some more time for a one to one talk with the woman. She keeps a record of all the pregnant women she sees, both the new and those that come for subsequent visit. She will write a report based on this at the end of the month showing the new pregnancies, those that have it 4+ANC visits, new PMTC cases among other details.

She will also attend to the under-fives, both those that have come for the routine immunization and growth monitoring and the sick ones who were brought for treatment. She will record all the care given in the mother child booklet and give brief advice on nutrition of the child while charting the weight on the growth monitoring chart. She will attend to the other sickly patients as well, give family planning counseling and services, and monitor the mothers in labor in the ward. Among other duties that she must attend to are emergency cases referred from the community, accompanying complicated cases to the higher level hospital for more specialized care, and assisting the doctors and clinicians in handling special cases when in facility like a hospital where these services are offered.

The day has not started or ended if she has not read the temperature of the thermometers of the vaccine boxes to ensure that it is in the required temperature ranges and therefore the boxes are in good order.

Her monthly reports range from daily vaccine monitoring chart, to the ANC, immunization related records to the vaccine usage rates for the month. She places monthly based order for vaccine supplies based on the month’s usage, and must collect the vaccines from the sub-county headquarters before the end of the first week of the month. She attends a monthly visit organized by her supervisors at the sub-county district, at least monthly and frequently meets her colleagues during the irregular continuous education seminars organized by their supervisors.

Nurse Mary faces a lot of challenges, but the most pressing is the workload coupled with the intensity of the nature of the work that she faces day in, day out. She is entitled to work a maximum of 45 hours a week, but is that really what happens?