Editorial | New approaches to market for nurses

Hopefully, Jamaica’s nurses are back to good health after a substantial portion of them fell ill this week. It kept them away from work. If they are better, our wish is that they remain so. For, in this COVID-19 crisis, their service is vital.

The situation requires sensitive handling by the Government. This is not the time for acrimony and one-upmanship, with unproductive questions about the conduct or professionalism of those who stayed away from their jobs. The circumstance insists upon a frank discussion about how Jamaica compensates its healthcare professionals, the status of the public-sector reform project – including what workers can reasonably expect out of it, and, honestly, when. At the same time, in its current wage talks with the public-sector workers, among whom are nurses, the administration should be open about what it can reasonably afford to pay, rather than employing its usual incrementalist approach to the negotiations and the settlement.

Indeed, we, like most people, assume that Finance Minister Nigel Clarke’s two per cent wage offer is an opening gambit. The point, though, is that after nearly two years of COVID-19 people are too stressed, with little appetite for the usual strategic posturings. They want, quickly, to reach the bottom line.

Beyond addressing the immediate concerns, there are other, larger strategic considerations, including labour market management and training issues with respect to nurses that the Government and its healthcare industry partners should place on their agenda.

Even if by some stretch, Prime Minister Andrew Holness’ recent remarks about what might be afforded to ill healthcare professionals at hospitals could be conflated with denying them preference, that was not the cause for the nurses’ indisposition. In any event, Mr Holness made no such statement. Responding to a hypothetical question, he outlined what even beginner nurses know to be the appropriate procedure in an emergency of multiple patients needing attention. They are triaged to determine who gets priority.

REAL ISSUES

The real issues, therefore, over which nurses are legitimately concerned, is how much they are paid; how hard they have to work; the even more stressful environment in which they now have to work; and what the Government intends to do about these matters. That conversation is urgent. But it requires context.

Around 4,500 nurses work in Jamaica’s public health system. A handful more are in the private sector. Jamaica’s ratio is a little over 16 nurses for every 10,000 people or, put more starkly, less than one per 1,000. Less than a year ago, the Government employed over 400 more nurses – an additional eight per cent. But they have left. Most have emigrated, having been recruited to work mostly in the United States, Britain, Canada and other developed countries, where their skills are in high demand and the pay, by Jamaican standards, is good.

In Britain, where there are approximately eight nurses per 1,000 population and the National Health Service is continually recruiting to close a shortfall, an entry-level registered nurse (RN) can earn nearly £32,000 a year, depending on where on the scale they start. At the very senior level, the pay can be nearly £100,000 and above.

In the United States, the median salary for an RN is in the mid-US$30,000 range, but can go as high as US$70,000. And demand could also be a push factor, driving salaries even higher. Indeed, industry analysts estimate that demand for nurses could continue to grow at over seven per cent a year, for the next five years or more. And demand, some feel, could even accelerate, given the pressure on the country’s healthcare system caused by COVID-19.

OFFER INCENTIVES

Yet, like Britain, Canada and some other wealthy countries, the United States is not training enough nurses. Developed countries, as they have long done, recruit from abroad. In some cases, they offer incentives, including waiving exam requirements for experienced nurses, as part of the recruitment drive.

It is understandable that a Jamaican RN or midwife, whose base salary is around J$1 million a year, would be enticed by foreign recruiters. And in a liberal democracy, nurses, like other professionals, cannot be chained to the country. Adjusting salaries upwards is only a partial answer, but Jamaican salaries, neither in the near nor minimum terms, would not be competitive with those in the United States and Britain.

So Jamaica, even as it tries to retain its skilled professionals, including nurses, has to be realistic that some will emigrate and plan for that. It has to train more to ensure that domestic requirements are filled, and to close gaps when people leave.

This kind approach should include present and future value analyses of the cost of training professionals and any economic contribution they may make to the country from abroad. Additionally, there should be serious discussion with friendly recruiting countries on the short-term cost to the Jamaican economy, and society, from their recruiting and how they might help to mitigate its effects. They might, for example, provide technology that lessens the stresses on Jamaican institutions when healthcare professionals leave, or enhance Jamaica’s ability to train more people faster. Further, in the case of Jamaica, the ability to provide clinical rotation is a bottleneck to training more specialist nurses. Developed countries might help in this arena, even in circumstances where it is not an immediate benefit to their recruiting.