A professional uprising

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Press reports of nurse salary disputes, shortages and strikes in the past few months have painted a picture of a profession in turmoil. But on closer inspection Jo Hartley finds a far more positive reality.

On the surface it would seem that nursing is in a state of negative upheaval, with disputes over pay and on-going shortages. But these noises of discontent, say nurse leaders, are actually the soundings of two professions finally finding their feet.

Both nurses and midwives have woken up to the fact that they are in demand, and have an integral role to play in the new climate of quality driven healthcare, being set up all over the Gulf.

"We are at the tipping point towards professionalisation," says Lauren Arnold chief nursing officer at the Mohammed Bin Rashid Al Maktoum Academic Medical Centre in Dubai Health Care City.

The centre is behind the 400-bedded University Hospital development, which will become a centre of nursing excellence when it opens in 2011.

Arnold plans for the hospital to win ‘Magnet' recognition from its very inception. If acheived it will be the first Magnet hospital in the region. Singling it out as a place where nurses deliver excellent patient outcomes, carry out nursing research and are integral in decision-making on care.

"We want the endorsement that this is a unique hospital environment [for nursing] and that it is a Magnet organisation that has passed the international test for high quality nursing care," she tells MT.

Her plans are ambitious but Arnold is not alone in her aspirations for the professional development of nursing and midwifery. A ground swell of enthusiasm and activity around reevaluating the professions' roles is taking place in many countries in the Middle East.

The movement is being triggered to a large extent by government desires to establish international standards of healthcare.

"You can not have international levels of care unless you have quality nursing," points out Judy Wollin, head of the nursing school at Fatima College of Health Sciences in Abu Dhabi.

International forces

The United Arab Emirate's [UAE] for example has a target for all hospitals to be internationally accredited by 2010. Nurses working in acute care settings who have already taken part in the Joint Commission International [JCI] accreditation process say this alone has led to increased recognition and respect for their roles.

"JCI accreditation was mainly conducted by nurses, and there is now a good atmosphere here to give the nurses more responsibility and to extend the nursing role," says Osama Diabat, one of 17 newly appointed practice development nurses working across the Department for Health and Medical Services [DoHMS] in Dubai.

The practice development role requires post holders to act as mentors, to be responsible for professional development opportunities, to improve the quality of care by introducing evidence based practice, and to conduct research.

Diabat's remit is to improve the quality of mental health nursing throughout Rashid Hospital - a long neglected area of care.

"We are involved in quality, education and research activities - I have even been asked to give lectures on communication to the doctor's interns - the future looks bright," Diabat enthuses.

The JCI process also led to the rewriting of all nursing and midwifery policies to be evidence based, the development of specialist in-house training courses, and the up-skilling of nursing assistants, according to Judith Brown, director of nursing and midwifery development at DoHMS.

"It has provided the pressure - the work had to be done - and it gave the nurses and midwives support from management, and from the hospital as whole that the standards had to be developed," she tells MT.

An all graduate affair

Abu Dhabi has also made moves to prepare the nursing profession for future demand. Health Authority Abu Dhabi [HAAD] took radical steps in September to end all nursing diploma courses in favour of degrees.

This was to ensure the capital's healthcare facilities would be staffed by internationally educated nurses, according to Wollin, who was recruited from the school of nursing at Griffith University in Australia, which is accrediting the new undergraduate dgree and bridging courses.

"The government was looking at up grading nurse education from a diploma and they wanted to move to a bachelor's education to improve the quality of registered nursing. It is part of their plan to build Abu Dhabi as an international centre for healthcare, like Thailand," she reveals.

The courses put Abu Dhabi on a par with the most advanced countries for nursing and midwifery education in the world. The move is an important step in the professionalisation process, Wollin adds, because it trains nurses to think critically and to base care on evidence, rather than on learnt tasks.

"We have got to make sure nurses are well educated so they can think as a professional, and then they have the right to talk as a professional," she reasons.

Nurse education in Oman and Qatar, which have both suffered in the past from cultural barriers to women performing personal care, are also on the way to producing degree educated nurses. The University of Calgary in Doha opened the doors to its faculty of nursing just over a year ago, offering the first and only degree courses in the country. Oman is planning to follow suit once a tie in with Cardiff University, in the UK, is finalised next year.

"They are just starting to develop programmes here [Qatar] and the degree is the standard elsewhere. It's not just about a piece of paper but about the kind of teaching that goes with being a profession," says Sheila Evans, interim dean and chief executive officer of the faculty.

The same degree based education is now being applied to midwifery, which was seen as an extension of nursing rather than a separate profession, across the region until recently. Dubai is leading the way with the establishment of the first postgraduate degree specifically for midwifery. It will be open to national and Arab nurses, and should be up and running in February.

Nurses and midwives in the region are not stopping at degrees, however, more and more are taking their academic studies further, attainting masters degrees and PhDs, with some countries, such as Oman, UAE, Saudi Arabia and Qatar, paying for their top nurses to study abroad.

"These nurses are collecting evidence to help us understand things that affect patient care," Evans says. "We believe that the nursing we do should be based on theory and evidence and not just because other people have always done it that way."

Specialists in need

However, it's not just prequalification education that is being ramped up. Opportunities for qualified staff to gain specialist training, and management and leadership skills, are also popping up across the Middle East.

Such training is essential to meet the growing complexity of patient needs, and to use the high-tech equipment that has become part of everyday nursing and midwifery practice, Arnold says.

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