RAISING THE STANDARD OF NURSING CARE IN BENGHAZI

Nursing care at inception

Prior to the arrival of DENOS, the Ministry of Health recruited nurses from the Philippines, India, Bosnia, Serbia and Ukraine. Local Libyan nurses were also appointed in various positions. DENOS appointed a Chief Nursing Officer, Deputy Nursing Officer – Clinical and Deputy Nursing Officer – Training, and tasked them with evaluating nursing services at the BMC, and provide an action plan to improve services.

Evaluation of nursing services

Language Barrier

One of the major obstacles identified was a major deficiency in effective communication among nursing staff and between nursing staff and other health care professionals. Most Libyan nurses could only read, write and speak Arabic, and nurses from Eastern Europe had a very limited knowledge and use of English. This posed a serious threat to patient safety and treatment protocols, as hardly any notes were made in the patient’s Medical Record.

Different schools of training

The variety of countries of origin led to different applications of nursing care and treatment. No standardization existed, and in many cases, care was counter-productive. Levels of training and skills were also varied from highly skilled to very little experience and knowledge.

Teamwork

Hardly any teamwork existed. Staff formed informal groups based on language, country of origin and religion, and due to a variety of backgrounds, the divide among staff grew. The barriers for effective teamwork were numerous, and had to be addressed for effective nursing care.

Methods of evaluation

The senior nursing team used DENOS language tests to determine the level of English proficiency. Depending on the results, nurses were classified in different groups, so that targeted remedies could be applied. DENOS standardized competency tests were translated into the major foreign languages (including Arabic) and nurses were subjected to an examination. Based on previous experience and qualifications, each nurse had the opportunity to write two tests based on knowledge. Translators were available to assist during examinations, to ensure that nurses had the best possible opportunity to reflect their skills.

Findings

English language proficiency

90% of Philippine nurses were highly successful in passing the English tests. 72% of Indian nurses passed, and only 2% of the Eastern European and Libyan nurses managed to score above the pass rate. In some cases, no questions were answered. Nurses were categorised on their English proficiency, and different levels of English Foreign Language courses were suggested and implemented.

Clinical competence and skills levels

Nurses wrote tests designed for different nursing disciplines, and based on outcomes, were placed in units and sections. Nurses who failed their tests were given the opportunity to write a test in a different discipline. All candidates that failed with less than 10% below the pass rate, were allowed to do self-study and return for follow-up tests a week later. Failures with more than 10% below the pass rate, were assigned to proctors in various disciplines, and were not allowed to practice without supervision, until written and clinical (practical) competencies were passed.

Other observations

A serious lack of nurses in disciplines such as ICU, Cardiac, Paediatrics and Scrub existed, and proposals for specific training courses were tabled. The same scenario existed for supplementary services such as CSSD, wound care and chemotherapy. The serious lack in qualified, experienced registered nurses led to the decision to create a new level of care giver, so that qualified staff can concentrate on clinical duties.

Implementation of action plan

English language classes were presented to nurses, and only the use of English was permitted in written clinical documentation and for communication among professionals. This encouraged staff to learn the language, and practice the use as much as possible. Different levels of training exist, and nurses completed the courses in tandem. After the first year, a major improvement was noted, which encouraged other staff to pull through and become English proficient.

Theoretical and practical training courses were presented for ICU, Cardiac Care, CSSD and Scrub Nurses, and certificates were issued to successful candidates. The programs continue on a rotation basis, and new nurses are accepted in new cycles. The courses proved to be so successful, that negotiations started with the local nursing school to offer combined classes and practical sessions.

A caregiver course was developed. Staff members in non-clinical positions, but with prior experience in hospitals, were allowed to apply. After a series of interviews, 50 initial candidates were selected, and started the caregiver course. Within the first six months, 35 successful candidates were awarded certificates, and are now fully engaged in the provision of services to patients.