2021 - MOTION 1 -
Empowering the nursing voice
MOTION
We ask the OCB Board to ensure that the nursing voice be present in guiding strategy and policy development at the highest decision-making levels in OCB.
This is needed to ensure improvement in quality of care and provision of person-centred care per ambitions of the 2020-2023 strategic orientations.
Background and explanation to the motion
FEEDBACK
During the year, OCB-board members have initiated several meetings with some of the motion writers as well as with the medical and the operational directors. The meetings have focused on the meaning of “the nursing voice”. How OCB can ensure that the nursing voice is present at the highest decision-making level. At MSF’s international level, a similar motion was approved at the International General Assembly (IGA) in 2021. The OCB board has followed up on the international discussion in the IB and in the medical standing committee.
Below the executive response to the motion is presented by the medical director and the operational directors. A part of it refers to processes that were underway before the gathering 2021. Other parts respond directly to the motion.
While important steps have been taken (see executive response provided by Catherine Van Overloop, medical director OCB, and Ahmed Abd-Elrahman and Marc Biot, operational directors OCB, here below) the OCB-board considers this to be a motion that needs to be followed up during the coming years, for instance through discussions on the piloted strategies.
Executive response to the nursing motion 2021
Response to this motion is/will be implemented on 2 levels: field and HQ.
- Field
- Training
Investment in training for nurses has been massively scaled up the last years with the MSF Academy initiative focusing on nurses’ competences, both with the development of competency-based curricula, and with the roll-out of these continuous professional development programmes in hospitals in Sierra Leone, CAR and South Sudan (and Mali with another OC for the moment). Starting end 2022, hospital nursing staff in Yemen will benefit as well. A second MSF Academy project sent several qualified nurses from CAR and Sierra Leone to specialize in anesthesia and obtain diploma- or bachelor level for some-in Ivory Coast and Ghana; All 35 graduated and were inducted into their new function in the course of 2021. As regards the quality of consultations in outpatient care, the Academy has been piloting a course to increase competencies in diagnostic, clinical decision-making and patient management, and the learners of this programme are for the vast majority of nursing training; this has already taken place in Sierra Leone, Guinea and South Sudan.
Besides the Academy, there are other trainings developed and implemented as the BASIC, where nurses are trained in emergency and critical care
- Medical coordinators
In the medco-pool analysis for March 2022, nurses represent 25% of the medical coordinators.
65% Of the medical coordinators are doctors, and the remaining 10% are other paramedical, midwifes, or medical specialists as surgeon or anesthetists.
As a medical coordinator, one has the most strategic role in that mission. However, we admit that it is not in that role that one can prioritize the provision of “nursing leadership”.
- Nursing coordinator pilot
To foster the role of “nursing leadership” in a mission, we want to pilot in 2 missions a position of “nursing coordinator” under the medical coordinator. Missions to be eligible for the pilot will be missions with a large nursing workforce and with hospitals in the portfolio (options can be South Sudan, DRC, CAR, Afghanistan, …). The role of these nursing coordinators will be:
- To ensure oversight of the quality/safety of nursing care provided by MSF in the mission and work closely with the medical coordinator to improve the quality of care in our projects
- To work specifically on patient centeredness and patient caring activities allowing resource and time more dedicated to these activities
- To ensure the nursing standards of care in the projects and be the bridge between development of standards, protocols and SOP’s by nursing referents in HQ and the actual implementation by nurses in the field
- To give coordination and structure to the nursing workforce to make our service safer and of better quality
- To represent a nursing leadership in that mission for our largest workforce
- To contribute to development of new strategies and project activities on a mission level
- To ensure external representation and connect to the nursing council bodies in that country, ensuring there is understanding of the local scope and frame in which nurses work.
Taking into account the responsibilities towards the nursing workforce and the external representation role, we would like to nationalize these positions from the start.
This position will be part of our larger intentions to develop “Clinical leadership” in the field: as much on nursing as on medical topics and disciplines. At the same time, it will enable nurses also to have a clinical career pathway within nursing (different to a career in humanitarian public health and humanitarian operations).
- Nursing directorates
Today, in most of our hospitals we have a Head Nurse, Nursing Activity Manager or nursing director, in the management organigram. The NAM/ ND is the overall supervisor of the nursing workforce in the hospital and the responsible for the nursing standards and quality of care. However, there is room for improvement to include the ND as an equal voice in the directorate to re-boost the caring approach to our patients and be more involved in decision taking on strategies and resources of that hospital. With the hospital management support unit and the operational managers, we will stress and reinforce this space for NAM/ND’s in our hospitals.
- HQ level
- Medical directors
In October 2021, the nursing motions and proposed nursing vision paper were discussed in the dirmed platform with the leader of the Nursing Care Working Group. The conclusions of that discussion are listed below:
- We really support the intention of the vision and are supporting the objective of giving more value to the nursing profession and workforce in MSF
- We do see the problems the WG stated in the vision but there might be other solutions to certain problems (not only talking about the nursing director)
- We will ask the working group to break down the problems stated in different chapters and work on options of solutions for these and then to have more regular discussions on the individual chapters in the dirmed platform.
- Policies and protocols
With the dirmeds we will ensure that the working groups developing or updating protocols and policies that include nursing components of care, will consult the NCWG for consultation or input.
The same will be guaranteed for protocols and guidance papers developed on the level of the medical department of OCB. We ‘ll make sure that the nursing voice will be part of the circles where the role of nursing should be present to ensure multidisciplinary collaboration.
- Strategic input
The nursing referents are responsible for the strategic development of nursing care to facilitate quality improvement and patient centered care in our projects.
We‘ll ensure that the nursing voice is included in all strategic proposals to ensure that the caring of our patient is at the core of any re-orientation of OCB strategies.
One practical example is to include a nursing representative in relevant projects (hospital projects) as part of the working group that will develop the project document and logframe after the “project intention proposal” has been approved.