Pearl traveled to Tanzania to study and compare leadership values in nursing
Let me begin by saying that choosing nursing as a career was the best decision I have made so far in my life. To begin to put into words the profound change it has made to who I am now is impossible. Standing on stage with HRH Princess Anne to accept my Cavell Nurses’ Trust Leadership Award was a defining moment for me. In those few moments, it captured the wins, the struggles and every possible experience I have had through my journey.
As I currently stand, I am about to embark on the next step of working as a newly qualified nurse at St Thomas’ Hospital in London. And although my mind sways between fear and excitement, I cannot help but feel I’m ready. Ready to make a difference, ready to learn, ready to overcome what may seem as insurmountable challenges. I’m as ready as I can be, not because I know all there is to be the perfect nurse, but because like many trainees all around the UK and the world, I know I’ve done all that I can to best prepare myself for life after nurse training. This has been significantly helped by the incredible opportunity to return to Tanzania to learn and experience cultural submersion amongst our nursing colleagues in East Africa.
My second experience in Arusha, Tanzania was all I expected and more. I returned to embark on a comparative field study of nursing leadership values and decided to take this all the way to the Chief Nurse of the district Sister Jane Bararukuliliza. During my first experience, I was met by extreme poverty, which was mirrored by just as much hope in a country on the cusp of political change. The healthcare system seemed to me a complex infrastructure, somewhat disjointed and driven by necessity rather than provision. The provisions we are fortunate to have in London are rare or non-existent in Arusha, where patients are fortunate to be given the very basics and from speaking to many of them, did not expect much else. I was fortunate to have been supported and guided by two esteemed local professionals, Dr Japhet Milayka (Public Health Doctor) and Sister Jane (Chief Nurse of Arusha and Vice President of the Tanzanian National Nursing Association). Both gave my perspective more depth and meaning in their knowledge of their countries healthcare system.
Sister Jane can be described as an innovator and a leader in the truest sense. Her presence alone inspired complete respect amongst her teams. I soon learned this was due to her brilliance in making progressive changes and improvements in various hospitals throughout her lengthy career. Dr Milayka is similar in that he was key in helping implement Tanzania’s first computer based patient information system. Both understood my long term vision, which was simply this: to share knowledge and reflect on our very similar values in nursing and healthcare. This was the basis for my return and helped conceive the focus group of impressive nurses from across Arusha to hold discussions about leadership and nursing values.
The Focus Group
The focus group consisted of 16 hand selected nurses from varying government hospitals across Arusha district. Amongst them included a Specialist Nurse Anaesthetist, Kore Thomas and two Head's of Nursing, Sister Redempta J. Moshy and Sister Miwaeli S. Sumari both of whom were held in high esteem amongst their colleagues and community for their services. Sister Jane and I felt it important to include these nurses amongst their juniors as they understood leadership and innovation in circumstances that could sometimes appear impossible to achieve progress.
The focus group centred on the theme of "leadership in practice" and I identified five specific points of discussion that have been common themes in UK nursing. What makes an effective leader; why is leadership in nursing important to you; should the nursing profession have autonomy; what challenges face nursing in Tanzania today and what nursing values are important to you?
The group were very engaged, interactive and passionate about their views. Despite a minor language barrier, I was unsurprised to find their contributions reflected nursing values of those shared in the UK. What they had to say once again demonstrated that above all else, nursing is a universal language in all its facets, including leadership.
What makes an effective leader?
Further to breaking down the various styles of leadership they had encountered, the group collectively decided that to them being a role model, accountability, competence, flexibility, knowledge, communication and vision were important in making an effective leader. The group explored these attributes further and identified these characteristics as important in decision making and problem solving. Lucy, a nurse/midwife, also highlighted the importance of distinguishing between a manager and a leader, power and authority.
Why is leadership important to you?
Group contributions for this theme included the need to organise and address issues specific to nursing and the need to have their own independent vision and mission for the healthcare of their country. The group also discussed the importance of inspiring each other to meet goals and to remind each other of their responsibilities to their patients. The importance of building morale to overcome challenges was also raised as they felt in Tanzania nursing was still a growing profession and required good representation to raise their concerns at the highest level of government.
Should nursing have its own leadership?
The group felt very strongly about this. There was a complete and unanimous ‘yes’ to this question, as they felt nursing was an independent profession and required autonomous leadership from medicine in particular. Sister Jane also raised the point of garnering respect and influence amongst the public through being valued by their skills and attitudes. She felt at the time, as 80% of health interventions in her region were carried out by her nurses, there was a notable gap in nurses being decision makers. She felt however, that through TANA (Tanzania's National Nursing Association) work would begin to address this.
What challenges face nursing today?
The group felt that the glaring inequality in privileges and reimbursements between nurses and doctor's created some low morale. They added that at the top of leadership and administrative levels there was no nursing representation to address their interests and concerns. Current areas of concerns were the high infection risks, limited resources, staff shortages (with ratios of up to 1:40), and unsubsidised education and skill levels not being recognised in the creation of enough specialist roles.
What nursing values are important to you?
The group contributed the following, communication, being a role model, transparency, confidence, accountability, being a patient advocate, faithfulness, partnership, respect of patient dignity, knowledge, compassion, empathy, unity and confidentiality. These were their agreed values that they felt were important to high quality nursing.
My time spent with Sister Jane in Arusha demonstrated to me that despite cultural barriers, nursing is a profession with values that transcends cultural barriers and within that there is a strong and enduring cry for continued representative leadership. Sister Jane demonstrated that innovation in nursing is key to transforming the quality of care given to patients, despite the back drop of environment or setting. Research supports the idea that strong leadership in healthcare has a correlation with good quality patient care (NHS Leadership Academy, 2015) and this can be applied across all spectrums. Jane Cumming's (Chief Nursing Officer for England) summarised this succinctly in saying that nurses today are faced with the challenge of dealing with today's pressures while still being a part of tomorrow's vision (NHS England, 2014).
I was also afforded the opportunity to support an excellent project being led by Laboratory Technician Linda Midjord, whose mission was to vaccinate HIV positive children from the local community. Linda has spent several months organising sponsors and planning the project, including sourcing vaccines from Dar Es Salam and delivered across the country to Arusha, ensuring the highly vulnerable children she had identified received the simple yet potentially life saving treatment. I observed Linda working alongside the nursing team in this collaborative effort, where they relied on her skills as much as she relied on their knowledge to achieve what had once seemed an impossible feat. Linda continues to work on her inspired project across Arusha hoping to reach more children and their families and I continue to be inspired by her projects life changing achievements.