One nurse describes her experience in Trinidad and Tobago - 'We're overworked, underpaid, and undervalued'

“Overworked, underpaid, and undervalued.”

This is how one registered nurse (RN), who preferred to remain anonymous, has described her experience. She is still waiting to hear from one of the regional health authorities for employment.

But with her patience wearing thin, she has decided to apply for positions in both Canada and the UK.

She said, “A lot of nurses question why they even got into nursing in the first place. The burnout is real.”

“The hours you are on shift – some eight, some twelve, depending on where you work – are long and tedious with hardly any breaks. In the morning, especially on a heavy ward with very dependent patients, sometimes you will be lucky if you get a water break and to use the bathroom.

"For lunch, it’s just a quick bite to eat and back out on the ward. Sometimes you forget to eat because you are so caught up with work.”

In a candid interview, the nurse said on a regular day, when the day shift takes over, they must be briefed on the status of the patients from the night-shift nurses.

“This can take a while depending on the workload of the night staff.

"After this, the morning shift checks on patients, makes notes and deals with patients’ needs in order of priority. The area is tidied, bed baths are done if they weren’t and linens are changed."

Then they have to administer medication before breakfast is served. Those who need help get it from nursing assistants or students. They also try to change any dressings the patient needs before visiting hours.

"You may get a break if you aren’t caught up with other tasks depending on the patient’s category and the workload of the ward as some wards are busier than others.

"We also try to tend to whatever needs or requests the patients may have during this time. Around midday, we start to prepare for afternoon medication administration and to serve lunch.

"Varying hygiene needs are also met around this time and feeding whoever has to be fed. This must be finished before 1 pm, when the evening staff comes in for their shift.”

And, this is only part of a nurse's duties. They must also carry patients for procedures or tests, bring them back safely, constantly update the patient's notes, do multiple diaper changes, catheter emptying, among others, depending on the needs of the patient on the ward.

Nurses' needs not met

She also said management also treated staff without consideration. She said often times they are told nothing can be done so the RN on the ward just has to "figure it out" when there is one of them to a ward.

"That can be a risk for patient safety," she said, while admitting that there was a nursing shortage around the world.

But, she added, "TT has numerous nurses sitting at home awaiting employment only to be told they will be called. Meanwhile, the wards are short-staffed.”

She added said the lack of resources needed for patient care can also leave nurses feeling disillusioned.

When asked why she was opting to take her chances abroad, she admitted it was to develop her career while also being able to provide a better quality of life for her children.

“Special-needs kids seem to be thrown at the wayside in TT and the resources are few and far and it’s mostly available only if you have the financial resources because the grant from the government doesn’t even begin to cover it.”

As for her career, she said, “TT lacks opportunities to specialise in different fields in nursing and some are non-existent. If you do decide to stay, you have to work your three years as an RN, then apply for one of the programmes to specialise and wait to get in.

"There are many more opportunities to advance your skills and knowledge abroad.”

President of the Registered Nurses Association Idi Stuart agreed. In a phone interview with Newsday on March 16, he said if nurses in TT wanted to specialise, there are very few positions and they only get an additional $420 in their salaries.

This, he said, was in comparison to junior doctors who receive a starting salary of $20,000 which increases when they move up in rank.

And while salaries were better abroad, depending on the country and its taxes, Stuart said in TT nurses were working for a 2013 salary of approximately $8,000 when in the US, nurses can earn up to US$5,000 or over TT$30,000.

'Take the risk'

The nurse who spoke with Newsday encouraged her counterparts to pursue their careers abroad if the benefits outweigh the risks.

“Starting a new life in a new country is hard and a lot of hard work is involved. However, if they are serious about being more than a bedside nurse, wanting to expand their knowledge and skill level, gaining a better quality of life and a greater access to resources, then they should because TT is lacking in these departments.”

However, she hopes TT will begin to appreciate nurses and put measures in place to prevent burnout while also allowing them to advance their knowledge and skill set by creating new opportunities.

“This will in turn increase the quality of care given and the overall satisfaction of both clients and nurses alike.”

To support these claims, the TTRNA used their social media platforms to provide a breakdown on of the nursing staff at the various RHAs in a ten-part series last month.

The South West Regional Health Authority (SWRHA) had the highest number of vacancies being 1,329 with the North West Regional Health Authority (NWRHA) being second with 1,239 vacancies.

The information includes statistics between 2017 and 2022, except 2018, and it showed the number of staff established, employed, vacancies and the dates the information was acquired.

Both RHAs were contacted for comment by e-mail on March 16, but neither has responded to date. Phone calls and WhatsApp messages to communications personnel also went unanswered.

At the Tobago RHA, the TTRNA said there were 574 people employed; 354 of whom are temporary and out of the total employed staff, 61.5 per cent were nurses.

The North Central RHA has 1,223 employees with 615 temporarily employed. Of that figure, 50.3 per cent are nurses. The Eastern RHA has 794 employees, 291 being temporary and 36.6 per cent are nurses. Out of 1,668 employees at the NWRHA, 313 are temporary and 18.5 per cent are nurses.

These figures exclude senior nurse managers, nurse instructors/educators/counsellors, dental nurses, and other categories that are not found across all RHAs.

The TTRNA posed a question to the Prime Minister in one of its Facebook posts.

“After reviewing this information and cross referencing with the respective RHAs, will the Prime Minister finally act to implement the WHO (World Health Organisation) and ICN (International Council of Nurses) retention methods to keep our nurses home, prevent a collapse of the health system and save the lives of our citizens?”

The retention methods mentioned are listed in a 2022 policy brief by the WHO: Nurse workforce sustainability in small countries: monitoring mobility, managing retention.

Those methods include: supportive and safe workplaces contribute to retention of nurses; flexible working hours, where nurses have some choice over working hours and shift patterns; professional autonomy, where the governance and management structures encourage and facilitate nurses to be autonomous in practice; professional development and career progression; opportunities for professional development through in-service training and continuous professional development; expansion of roles; if nurses have facilitated and structured opportunities to move into advance practice roles; remuneration; fair levels of pay can support retention – pay and conditions of employment must reflect the contribution nurses make, their skills, qualifications and experience, and there should be no gender-based discrimination in determining pay levels; return to practice; offers of refresher training may enable some to return to practice and retraining/additional training of staff.