As plans to develop the ward bonus and a training programme move forward, I am becoming increasingly fascinated by this aspect of my work.
Published research seems to suggest that financial incentives are not enough to motivate health workers: good management, supervision and training is also seen as important. We are trying to use this evidence and link the ward bonus with training so that they are complementary and supportive of appraisal and appropriate training, rather than simply about rewarding performance. Of course we hope this will improve the standard of nursing care, but ideally it might also improve motivation.
It all seems possible, neat and tidy. A good idea.
Until you meet the devil who is sitting there, happily ensconced in the details. Then you realise that your good idea is not, in fact, a solution.
Here is an example.
In the hospital where I work, there are some fundamental difficulties that make nursing - difficult at the best of times - even more challenging. An obvious factor is that nurses of all cadres, and senior nurses in particular, are short on the ground. The few nurses in management positions simply do not have the time to provide full supervision to frontline staff, and this can affect patients.
Every week there is a staff nurses’ meeting in the matron’s office attended by the 8-10 staff nurses or ‘in-charges’. I went to the office last week to find the deputy matron sitting behind her desk alone.
“No meeting today”, she said. “There aren’t enough staff nurses to meet”.
Staff nurses who were in post last week can no longer be found in the hospital and their wards are now left without replacements.
Another challenge is a lack of clarity around roles. The health service here has adapted to enormous changes during years of civil war and also to the multiple and diverse initiatives and influences that exist in post-crisis development. The nurses have also adapted, and been subject to those influences, meaning there is a huge mix of skills and experience. Many work outside of their traditional job description, often through necessity, and often without the support thorough training or ongoing supervision provides. Nursing aides, for example, often work in a role similar to a UK staff nurse, while newly qualified staff nurses act in a capacity that we would recognise as ward sister. So the question is, do you accept that the work of many nurses over-extends their training and try to give them the skills to work safely, or do you try to limit their role?
Pragmatism, I believe, suggests that with human resources already stretched - my hospital is actually relatively well resourced compared with other health facilities -reducing the role of whole cadres of nurses could prove disastrous. So, increased access to training to make sure nurses can safely undertake their work would appear to be a good way to improve patient care.
But this leads me back to the case of the disappearing staff nurses. Where have they gone?
They have left their posts to undertake further training.
You can’t deny that it’s a good idea.
Becky Cridford is one of the eight 2010 Vodafone Foundation World of Difference International winners. To find out more about this opportunity visit the World of Difference website.