On Nurse and Midwife Leadership During COVID-19
“Shortly after the first case of COVID-19 was confirmed, Uganda went into lockdown as a measure to contain the virus and limit its spread. Nurse leaders recognized a number of challenges facing the profession prior to COVID-19, which were amplified by the pandemic; among which was the challenge of leadership gaps. At that time, there had not been an appointment of the Commissioner of Nursing at the Ministry of Health to replace the individual who had passed away in December 2019. This leadership gap created a sense of a lack of direction and representation for nurses and midwives.
Another key challenge was the lack of nurse and midwife involvement in the policy and decision making at the national level for the National COVID-19 response. Nurses and midwives were facing key challenges like lack of PPE, transport challenges due to the lockdown, lack of training, and leaders felt they did not have anyone to advocate for them. These key challenges created a sense of hopelessness and demotivation amongst nurses and midwives.
Nurse leaders from across the country including representatives from the Ministry of Health, Ministry of Education, professional associations, and other leaders, convened with the National COVID-19 task force to address these challenges. A Nurses and midwives think tank was formed on April 12 2020 to advocate for nurses and midwives during COVID-19 and beyond. Through engagement, dialogue, and advocacy with the Ministry of health, the think tank has achieved key milestones within a short period of time.
Key achievements include the appointment of a Commissioner of Nursing at the Ministry of Health, leading two successful webinars on leadership and regulation, ran a successful fundraising drive to provide PPE for nurses, midwives, and other health workers at the frontline and biweekly newsletters sent to nurses across the country. For the first time in a long while, nurses have felt connected with their leaders and feel that there is a team of dedicated leaders who are advocating for their needs.
Through the creation of the nurses and midwives think tank, leaders have demonstrated that This guiding principle has become the guiding force leading us within the think tank.”
“A clear example of the flexibility and skill of Malawian midwives emerged when one non-governmental organization (NGO) led a “train-the-trainers” workshop this past March in Blantyre. The trainers from that NGO were suddenly evacuated due to COVID-19 and Malawian midwives were left to continue the training without the trainers!
Local midwives used innovative techniques to complete several simulation exercises on post-partum hemorrhage and fetal distress in labor. One of my colleagues from Kamuzu College of Nursing took a leadership role, making the shift from trainee to the trainer. Her talents and warmth were on display that day, and everyone appreciated her energy and willingness to go above and beyond what was expected of her. I believe that her leadership helped everyone at the workshop feel more empowered in their own professional settings to teach their colleagues throughout Malawi.”
What actions can be taken to ensure nurses and midwives are given the recognition and support that they deserve?
I recently heard this apropos saying: “Take a place at the table, or you will be on the menu.” Midwives cannot have a voice and a presence unless we are part of the conversation. We need to be at the table whenever the role of nurses and midwives is being discussed. We need a voice in politics, and we need a voice in each of our institutions. If we do not speak up for what is needed for our communities, then we suffer reduced and insufficient work conditions and our patients will suffer less than ideal care.
“Nurses and midwives should be represented in health services and health program leadership roles to ensure the voice of the largest health workforce is represented. Involvement should not only occur at the implementation phase but at the onset when decisions are being made. Through this shift, policies and guidelines will be adhered to and have a longer-lasting impact. Additionally, we must ensure nurses are well paid, as they are responsible for 80% of health outcomes in Uganda. Nurse pay should be commiserate with this, which will help build a well-motivated nurse and midwifery sector. Finally, we must discuss education and professional development. To truly recognize nurses and midwives, we must ensure they are able to access advanced level education, as evidence shows that having highly educated nurses and midwives improves health outcomes.”
Is there a story or call to action that you’d like to share?
“The World Health Organization State of the World’s Nursing Report calls for governments and all stakeholders to invest in nursing education, jobs, and leadership. Nurses are central to achieving Universal Health Coverage, strong health systems, stronger economies, improved health outcomes, and gender equity. Through investment in nurses and midwives, they will be able to achieve their fullest potential at the benefit of all people around the world.”
“In many places, the role of midwives has been pushed aside with the increased medicalization of maternity care. In low resource areas, where care has often been “too little, too late,” we now see the modeling of “too much, too soon.”
The art of midwifery has been diminished, if not lost. Midwives used to be caregivers for most women around the world. A midwifery-led model ward is one way to address this problem, and we hope it will soon become a reality in Malawi. In collaboration with our medical colleagues, we are striving for a care model of “right amount, right time.” The time has come for all of us to work together to improve the lives of women.”
Irene Atuhairwe is the Technical Advisor, Nursing and Midwifery for Seed Global Health, Uganda.