A few days ago Governments decision not to continue to bond nurses in the various government nursing training colleges sparked a wave of panic and anger amongst most in the nursing and health care community.

This was the second and perhaps the final blow to what has supposed to be profession that so many young men and women troop to. The prospects of easily getting a job after school was for a long time of the reasons many trooped to the profession . The decision implies that from 2020/2021 the government will no longer be obliged to hire nurses after their rotation. The impact of this decision is far reaching and disastrous

First of all let's look at the history of the bonding

HISTORY

The decision to bond nurses and provide ready-made jobs for them was taking by Government several years ago primarily in an attempt to reverse the brain drain of the nurses to other developed countries. It's good to note that even with the current system of providing allowances and guaranteed jobs the brain drain still continued albeit with reduced numbers.

Aside the Bonding there were other incentives designed to increase the intake and retain our nurses after completion.

These include:

I. The allowance given to students during training

II. Availability of jobs after school

III. Relatively good salary ( single spine salary introduction)

IV. Cheaper or subsidized school fees

Brain Drain of Ghanaian Nurses

Nurses who left in 2004. 700

Nurses who left in 2013. 107

Nurses who left in 2014. 192

All these factors made the profession attractive and encouraged young men and women to pursue a career in such a field. The Government and the nation benefitted by having enough nurses to post to all parts of the country to provide urgent and essential care to the inhabitants . As of Today , all these incentives have been negated. The increase in cost of living has nullified the single spine salary and the school fees has increased over the period.. In effect all the benefits and perks of being a nursing student and nurse have all but vanished.

SALARY

With the proliferation of private nurses schools in the country , the nation is already facing an epidemic of unemployed nurses. This coupled with the inability of government to employ even those who went to public school has created an atmosphere for them to be abused by private hospitals. Most private hospitals therefore are taking advantage of this development to underpay their nurses. For instance whilst diploma nurses in public sector take home at least 1000 cedes Their counterparts in private sector take home as low as 450 a month. Whenever supply outstrips demand the value depreciates and this is exactly what is happening in the nursing sector. The medical Profession is able to control this by regulating the number of admissions into medical school.

With these new directives some nurses trained in Government sector will have to join their colleagues in private sector in search of nonexistent jobs. Those who are lucky enough to be employed will be poorly paid . The others who are not so lucky will stay at home and or change professions. Indeed we currently have nurses who have decided to pursue other careers after nursing school simply because they could not get jobs.

QUALITY OF HEALTHCARE

NOW let's get this straight .The decision not to bond nurses any longer was not borne out of over staffing of hospitals or the Government no longer needing their services. On the contrary ,the nurse to patient ratio is still high, 1:1251 and Government still need nurses to work especially in Health centers and less deprived areas of our nation. A surgeon in Korlebu says sometimes there is no theatre nurse and Doctor will have to "scrub" to assist the surgeon in theatre . A nursing officer in Navrongo mr Salisu also complains of busy work schedule and how that's affecting both his marriage and his work.

The decision was primarily borne out of an IMF directive restricting Government to expand its wage bill. What this means is that Ghana needs more nurses but cannot afford them . In other words we have an APPARENT SHORTAGE of nurses. Secondly this new directive will push more nurses into the private sector. These are nurses who could have benefitted by working under supervision in public hospitals now being sent home or to find work in private hospitals where they may have to work without supervision.

The quality of teaching and training of nurses has always been better in the public nurses' schools. Indeed most private nursing training school often search for an opportunity to do their clinical at teaching or public hospitals. The reason is simply because the public hospital have experienced matrons and senior nurses who supervise on a daily basis the work of these fresh nurses .

Governments control of these private hospitals is also limited. Government ,does have much say in the remuneration or practice of nursing in our private hospitals. These nurses are often left on their own with only the In-service training to upgrade their knowledge.

THE IMAGE OF PROFESSION

The image of the profession is already poor in the eyes of the public and I am afraid this decision will further worsen if this new directive is implemented. With the cancellation of allowances and ready-made job jobs the desire and ability to pursue the nursing career would be dealt a heavy blow. Nurses who are qualified and have passion for the job might not be employed. This will make it difficult for those in poor families to pursue the programme and rather open gate for those who are financially sound to pursue the program. Ironically these are the same people who refuse postings to deprived areas and prefer to stay in our big hospitals in the cities.

It's good to note that the reason why most nurses are seen as rude or unempathic in the eyes of the public is because some do not have the passion for the career chosen. This directive will increase the numbers of these nurses in the system.

Secondly a lot of nurses being pushed into the private sector where the monitoring is poor means that over time the general quality of nurses in our hospitals will reduced. There a lot of nurses in our private hospitals who are working without accreditation ( PIN). Unlike the government hospitals where junior nurses are supervised daily by more experienced nurses, the private healthcare facilities do not have such luxury and sometimes a newly graduated diploma nurse is made to head the entire nursing unit of the hospital/ clinic.

Over time due to poor surveillance and large number of nurses churned out yearly into the private sector, the quality of nursing will be affected. The results will be poor health care delivery to patients.

CONCLUSION AND PROPOSED SOLUTION AND RECOMMENDATION

The only entity that will benefit from this directive will be the private healthcare facilities .The nurses, the profession, and the nation will suffer as a result of this new directive. In order to still live up to the IMF expectations the following should be considered.

CONTROL THE ADMISSION

The Government through the NMC should rather control the number of students admitted into the various training colleges. The Government through the MOH should be able to predict and project the number of nurses that will be needed by the country in subsequent years and tailor the admissions into these school accordingly. Large number of nursing staff staying at home is a threat to the nation. Training the number that you can afford to employ is better than training large numbers and hoping that someone will employ the excess.

INCREASE SURVEILLANCE

The NMC in collaboration will HRA (Health Regulatory Agency ) should increase their surveillance of private hospitals and nurses. There is a lot of Private hospital especially outside capital being stuffed with unqualified and underpaid nurses. The impact of this on healthcare delivery is obvious. The NMC also need to as a matter of urgency regulate the activities of these private nursing schools. A lot of them do not have accreditation from the council and still continue to admit unsuspecting students .These students complete school and are not able to get license to practice as nurses simply because schools are not accredited. Secondly the council should restrict the number of private nursing schools to the barest minimum. Those without licence should be close as a matter of urgency.

INCREASE THE NUMBER OF PRIVATE HOSPITALS

The Government should make it easier for serious entrepreneurs who want to set up their own private hospitals. This is the only way that the job market for our nurses can be improved. Over the past few years the process of setting up and operating a health care facility has been made very difficult and frustrating. Some entrepreneurs therefore fear the prospects of setting up their own faculty. Government can offer incentives and Tax breaks for companies and individuals who wish to set up their own healthcare facility. Import duties on healthcare equipments should also be highly subsidized. This will encourage healthcare entrepreneurs to set up more healthcare facilities to employ some of these nurses . Again NHIS payments to these private hospitals should be paid early in order to improve their finances and ability to pay their nursing staff competitive salaries comparable with their colleagues in public sector.

INCREASE THE CAPACITY OF GOVERNMENT HOSPITALS TO EMPLOY

This proposal has been on the table for several years but is yet to see the light of day. This can and should be done in stages so that it does not put undue burden on the Government facility. The MOH can issue is a directive for each Government hospital to employ and pay at least 3 Nurses from their own IGF. Hospitals such as KBTH, 37 and Ridge can be enforced to employ even more. This will ensure that thousands of nurses are employed outside of the ministry's wage bill. The ministry will still bond these nurses but these nurses can be posted directly to these hospitals without having to wait for clearance from MOF .The hospitals will have to show proof of having employed these nurses before they qualify to receive equipments and other assistance from Government. These hospital can employ a large number of these nurses into the public hospitals.

For the Good of the profession , the Nurses and the nation I pray that Government will reconsider this decision and rather make use of some of the alternatives outlined above. If Government cannot reduce unemployment it should NOT increase it. The Nursing and Midwifery council and the Ghana Nurses and Midwifery Association should work in the supreme interest of their members and do all that they can for the Good of the profession and the ordinary Ghanaian.