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Part II – Challenges in the Real-Life Clinical Setting

In our last post, we shared the story and dilemma of one of our graduates, who was recently promoted to a higher office position of Nursing Superintendent.  The wards at her hospital faced many issues, such as coworker discord, lack of patient confidentiality and an absence of aseptic procedures, amongst others.  There were many areas requirimg her focus, and we are glad to report that progress has been made in the workplace since she was promoted. 

She writes: “We had a difficult task at hand, but we believed in ourselves and we worked even harder to improve matters.  After six months of careful observation and assessment by our Nursing Office administrators, it was evident that things needed to change. We proposed many changes to the hospital authorities; some were accepted and some were postponed for the future.  One of the accepted changes was ongoing training for the nurses.  We have recently finished skills and knowledge development sessions.  All of the nurses (including the General wards and the Critical Care wards) were involved in the 3-month long program, however, the content differed slightly for the general ward nurses and the Critical Care nurses.

We were able to involve the doctors for teaching nurses and as we thought, the doctors started to see situations from the nurses’ perspective, which helped build teamwork and camraderie.  So far, it’s hard to gauge exactly how successful the training session has been, but I can see many changes in the wards.  I can see the nurses being interested in knowing the rationale behind procedures.  We also plan to take a small written exam as a part of the evaluation process.  Furthermore, we have also recently introduced the handover format to our nurses.  In it, I referenced the care plan from our classes at IUBAT and modified it for our hospital.  It was challenging for those nurses not comfortable with English, so there was an extra class for those needing more help with the material.  As a team, we go on rounds and note any issues with maintaining the handover sheet.  We hold weekly meetings for each ward to address their problems with workable solutions, and I am overjoyed to say that it is working!

I also noticed that the nurses were demotivated in their roles, so we set out to find out why.  We completed a survey on 100 general and Critical Care nurses, and although there seemed to be a variety of reasons behind this dissatisfaction, the main 3 issues that were raised were the low pay, the low overtime pay, and the attitudes and behaviours of fellow colleagues.  To address this, our Nursing office sought a higher salary and overtime pay rate from the hospital authorities.  After a very long discussion, the request for higher wages was approved, along with the overtime requests, after the hospital authorities realized that they needed to change their part of the problem as well.  Since this wage increase, I have seen a higher amount of respect from the nurses for the Nursing office.  They trust us as a representative for their collective voices and this unity has already been shown to have positive effects in the wards.

I must give credit where credit is due.  The hospital Chairperson, Vice-Chairperson and Director were all very cooperative with me, and consistently supported my work.   Furthermore, I had the chance to work with the hospital Chairperson of International Affairs.  As a part of this close collaboration, we are getting closer to an international joint venture with a hospital in Bangkok wherein annually, five of our nurses will travel to their site in order to learn, experience the nursing standards and apply their knowledge in practice at home.

Our Nursing office had to fight a lot with the hospital authorities for many things, but we never lost hope even if the result wasn’t what we were looking for.  I must say we are progressing and it takes much effort and work to achieve the goals.  I am happy with all we have accomplished so far, but there are still challenges left to solve.  For example, there is still conflict between the nurses.

In one unit, the nurses do not even want to talk to the other unit nurses; they do not have any collaboration and respect for each other.  This is creating a huge problem for the hospital and is even affecting the patients.  It makes me recall the conflict management workshop in the final year of the program at IUBAT.  I never realized that I would encounter such scenarios in my actual life when I was a part of that workshop.  Now, I am experiencing it and everyday I realize that IUBAT has prepared us in every possible way. Frankly speaking, it has been really tough for me to address this issue, but I know it takes time to bring about change in any attitude and behaviour.  I am optimistic that my training from IUBAT will continue to help me in this post and with improving this hospital for years to come.” 

We appreciate this graduate sharing this anecdote with our readers, and explaining how her education at IUBAT set a standard of care that she implemented in her workplace.  It was also revelatory to see how her training helped with the resolution of some of the problems that she encountered in the hospital, both technical and interpersonal.  These experiences that this graduate has shared are not specific to Bangladesh; rather, they appear globally, across a number of different industries, in one form or another.  Interestingly, these conflicts between nurses is not uncommon in Canada either (  It is prudent to note that expectations should be set about civil behaviours amongst colleagues; those who work together do not need to like one another, but they must act professionally in the best interest of patients, their families and the hospital.

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