A WORLD WITHOUT NURSES

Have you ever envisioned a world without nurses and ask yourself " WHAT WILL IT MEAN?" There are more than 7 Billion people in the world today but we have only 17 million Nurses, this number is already few compared to the population they are already serving every day. So ask yourself " In a world without nurses, WHY SHOULD YOU CARE?"

FEWER NURSES MEANS

• Your life could shorter. This is already experienced in third world countries especially Kenya where the life expectancy has been reducing drastically.
• You have higher chances of getting serious infections. Serious infections that are treatable and preventable will take our loved ones away from us. 
• You may experience more complications from surgery or hospitalization. These are situation that no one ever appreciates since nurses prevent patients from these complications that would others wise do more harm or even kill the the patients.
• Less nurses could mean life and death for acute care patients. acute care patients need a nurse the most since they require round the clock care meaning that the fewer the nurses the higher the chances of death for this patients.

Nurses can help you live longer, healthier and even happier lives. What is SECRET do nurses have to ensure that  their patients live longer, healthier and happier lives?

• Nurses care for people not conditions and they evaluate the whole person. The care from nurses focus on the whole well being of their patients, they don't just focus on the disease that has brought you to the hospital. Nurses view the patient in the bigger picture 'their life in general'
• Nurses Educate people. Nurse are constantly interacting with their clients and teaching them how to live healthy and better health seeking behavior.
• Nurses make prevention their priority. In a country that doesn't appreciate the few nurses they have  means they don't appreciate that nurses prevent the expected from occurring.

While technology and research advances so does the knowledge and intelligence of nurses from tertiary study and clinical placement to Continued Professional Development (CPD). This happens because education improves quality of care that's why we have nurses with PhD, Masters, Degree and Diploma.

Nurses are also getting older more than half the nurses in the world are over 40 yrs, 20% of nurses in the world will reach the age of retirement  in the next 5 years. Many countries share the same problem, the critical shortage of nurses. The USA will need 1 million more nurses by 2020, Australian official estimate90000 will retire by 2020, in the United Kingdom around 180,000 are expected to retire within the next 10years.In Kenya we have a chronic shortage with more than half the nurses retiring soon since there has been no better solution despite the growing population. That is nearly half of the nurses.

In a world without nurses:

• who will care for your loved ones?
• who will manage people with chronic illness?
• who will look after you?

WHY SHOULD YOU CARE?   YOU SHOULD. If your country has less nurses demand for more nurses don't really need to ask this for the citizens they serve. The citizens should ask this from the leaders they elected TO INCREASE THE NUMBER OF NURSES.

DYSLEXIA

It is a chronic reading problem. People with a learning difference like dyslexia may have trouble with reading, writing, spelling, math, and sometimes, music.

Experts say dyslexia has little to do with recognizing the visual form of words rather, the brains of people with dyslexia are wired differently, making it difficult for them to break the letters of written words into the distinct sounds of their language.

It can occur at any level of intellectual ability.
These people are visual, multidimensional thinkers who are intuitive, highly creative, and excel at hands-on learning.
That is, they do well in the arts, creativity, design, computing, and lateral thinking.

Dyslexia tends to run in families, and researchers have identified the genes that may be responsible for the condition.

Symptoms

People with dyslexia may have problems reading, spelling, writing, and pronouncing words.

Here are some early signs that are characteristics of people with dyslexia:

* Underachievement. It may be early or late in crawling, walking, or talking; appears intelligent but doesn't read, write, or spell at grade level; may be seen as not trying hard enough; may not perform well on tests despite a high IQ.
* Motor skills. Will have poor handwriting or trouble writing or copying. Poor coordination; does not do well at team sports. Difficulty with motor-oriented tasks. May be ambidextrous; confuses left and right, and over and under. Learns best through hands-on experiences.
* Language and reading skills. That is, gets dizzy, headache, or stomachache when reading. Doesn't read for pleasure. Shows transpositions, additions, substitutions, or reversals in letters, numbers, and words when reading or writing. Spells phonetically and inconsistently. Difficulty putting thoughts into words. May not like maths Math/numbers.
Difficulty learning to tell time or being on time. Can do arithmetic but not word problems. Trouble grasping algebra or higher math. Poor memory for sequences. Thinks using images or intuition, not words.
* Behavior. May be disorderly or disruptive in class. Is easily frustrated about school, reading, writing, or math. May wet the bed beyond appropriate age. Shows dramatic increase in difficulties under time pressure or emotional stress.
* Vision. May complain of vision problems that don't show up on standard tests. May lack depth perception and peripheral vision.

The most consistent thing about people with dyslexia may be their inconsistency, their skills and abilities may seem to vary from day to day.
A dyslexic child who can spell a word one day may be unable to spell it the following day.

An assessment for dyslexia includes reading or writing while the tester looks for signs of dyslexia, such as adding, dropping, or changing words; pulling words from other lines; or reversing or transposing words and letters.

While not diagnostic in itself, body language may provide a clue.
A person with dyslexia may frequently clear his or her throat, tap a pencil, or fidget during the testing out of anxiety about performing the test.

Dyslexia is a disorder present at birth and cannot be prevented or cured, but it can be managed with special instruction and support. Early intervention to address reading problems is important. Parents must understand that children with dyslexia can learn normally, but probably need to learn in a different way.

When you realise this, immediately visit the hospital with the child to help manage it.

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PAIN ASSESSMENT

This is how to best evaluate and describe your pain.
Use the acronymn, SOCRATES.

SITE:
Where is the pain? At what site is the pain at its maximum?

ONSET:
When did the pain start? Was it sudden or gradual?

CHARACTER:
How is the pain like? Is it stabbing, or like a burning sensation? Is it like someone 'standing on your chest'?

RADIATION:
Does the pain radiate (or move) from one part of the body to another?

ASSOCIATIONS:
Are there any other signs and symptoms associated (that come along) with the pain?

TIME COURSE:
Does the pain follow any time pattern? It is recurring or intermittent?

EXACERBATING FACTORS:
Does anything make the pain worse? Do you need to take any food or assume any position to lessen the pain?

SEVERITY:
How bad is the pain? On the scale of 1 - 10, can you rate the pain?

Get the best from your Nurse practitioner or MO  by giving the best pain assessment.

ENSURING THE SAFETY OF PATIENTS AND DELIVERY OF QUALITY HEALTH CARE

Quality is the optimal balance between possibilities realized and framework of norms and values. Errors pervade our lives in our homes, on the roads and in our place of work. In the hospitals setting health workers are also affected by near errors and the consequences of these adverse events. These health care errors and poor quality health care have affected all our lives directly or indirectly. Health and health care are very important and are among the basic pillars for a countries economic gains. There are also profound economic cost to a society if policy and action do not deliver optimum well being thus the government investment to health is a right they owe to the people who vote them in.

Nursing, the largest health profession is on of the main areas the government should invest in to ensure the delivery of Safe and Quality health to its people. Care provided by Nurses has the capacity to save lives, prevents complications, prevents suffering and save money and in order for the government of Kenya and her citizens to understand how nurses execute their responsibilities and roles it is important to under stand what nurses do exactly. It is so sad when I hear that an elected leader in Kenya can describe the role of a nurse in the hospitals as just giving drugs and injections and i bet he/she can't even survive through one day in a school of nursing. Let me shed some light to this political leader on the reasons why the content of his/her cranium is 99% water. Even for that simple procedure as Drug administration a lot happens, does this leader even know the 6 rights of a patient before a nurse administer that medication does this leader appreciate the knowledge content needed for the safety of the 6 rights. Away from the politician lets go back to patient safety and quality nursing care, an American journalist and nursing advocate, Suzanne Gordon, offers this summary to describe what a nurse actually does to ensure quality and safety to a patient:
"Using their considerable knowledge, [nurses] protect patients from the risks and consequences of illness, disability and infirmity, as well as from the risk  ans consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability makes it difficult, impossible or lethal for patient to perform activities of daily living - ordinary acts like breathing, turning, going to the toilet, coughing or swallowing-  Nurses (MScN, BScN, diploma and enrolled) are constantly participating in the act of diagnosis, prescription and treatment and thus make a real difference in the outcome of the patients" .

This acknowledges the fact that Nurses have the biggest role to ensure quality of health care and safety of patients. A combined statement from WHO, ICN (International Council of Nurses) and ICM (International Confederation of midwives in March 2007 declared that increasing nursing work force capacity, improving skill mix and creating a positive workplace environments is critical in the general health of all nations. Despite this nurses in Kenya are being forced to work with insufficient staffing, overwhelming workloads and and inadequate skill mix resulting in avoidable deaths and injury thus many nurses abandon the profession creating chronic shortage of nurses thus compromising the health of the whole community. Insufficient staffing and overwhelming workload is one of the major causes of stress on the nurses leading to many error  with most ending up with the death of the patients. The only way to avoid this is by employing more workers and educating the community to practice preventive medicine. Inadequate skill mix or as i can call it career progression and addition of knowledge, this has been the worst area as the ministry hasn't been providing ways to motivate the nurses by having a clear path to career progression as many workers stagnate at the same job group thus the morale to work optimally.  On addition of knowledge, nurse have been having horizontal knowledge progression for decades with the top management being rigid to encourage  vertical knowledge progression as it is the trend in the scientific community (as you get fat get tall as well).

It is a high time the government starts to invest in nursing care since nursing does make substantial contribution to reduction in morbidity and mortality. Nursing interventions are cost effective through care and surveillance, education and interventions that prevent adverse outcomes and keep people well.  Investing in nursing care provides returns of better care outcomes and less use of expensive health care resources. These benefits extends beyond the wall of health care setting since those who recovered from or avoided illness can contribute to national productivity through participation in the community and the workforce. Despite the significance of nursing towards the health of their community they fail to acknowledge the values that nursing bring to their lives. Their is a risk to the community of loosing their loved ones if a nurse i overworked beyond limits of safety, has insufficient experience,  and less staff in the health facility. Thus the community should also be held responsible for the state of hospital near you because the community has the responsibility to ask for more workers and quality care in the health facilities that serves them. The leader especially the governor also has a responsibility to ensure that he has a healthy community with him any way he needs the numbers to be in that post so why not have accessible quality health care, why do they make health budgets that doesn't recognize the input from the nursing profession.

I have been talking about why we Kenyans need quality nursing care and the safety of the patients (our fellow community members). Now what do we require to so as to achieve all these according to the Australian Nursing Federation, 2009: 

• An adequate number of Nurses 

Nurse staffing levels of heath care setting have a significant effect on morbidity and mortality and the occurrence of adverse events, with higher staffing levels is associated with lower mortality, lower incidence of infections, decubitus ulcers, postoperative pulmonary complications, pneumonia and septicemia. 

•  An appropriate skill mix (proportion of MScN to BScN to Diploma to enrolled nurses)

An increase in registered nursing staff is associated with decrease in pneumonia,lower rates of "failure to rescue" and reduces incidence of death from shock or Cardiac arrest, GI bleeding, sepsis, deep venous thrombosis or pneumonia. Ensuring different proportion at each level of nursing is represented in the team the quality of care increases too. I congratulate KNH for realizing this.

• Nurses who are educationally and clinically prepared   

To produces nurses who are educationally an clinically prepare you need to make sure that they are always at pur with the current state health education through continuous professional development and awarding them scholarships to go out of the country and come with new better ideas towards quality care from other successful countries.

•  A manageable workload for nurses

Each additional patient allocated to nursing workload increases the likelihood of patient death; Increased over time is associated with urinary tract infection, decubitus ulcers, and increased workload with patients falls, respiratory infection and patients complaints. Nurses working shifts of 12.5 hr or more are three times more likely to make an error and working 40 hours a week increases the risk of error. Reducing nurses workload  by one patient per nurse (from 15 - 50 patients per nurse) is associated with several life saved per admission. There are also evidence that implementing nurse patient ratio to a good ratio of 1:4 is cost effective and requires a willing leader to ensure its implemented

• Provision of sufficient resources to enable nurses to deliver the best possible care

Each additional patient allocated to nursing workload is associated with a 23% increase in nurse burn out and a 15% increase in nurse burnout and a 15% increase in nurses job dissatisfaction. Insufficient resources, inadequate support and inadequate equipment are all associated with an increase in injuries to nurses, higher nurse turnover and an increase in errors .

In order for us Kenyans to achieve the dream of better quality health care we are all responsible, the community, the health care workers and the leaders. If health care isn't safe and of quality patients die and this affect even the government itself as productivity reduces. I urge everybody to take the responsibility with the current health workers strike.

As I wind up, to help enlighten the community members, health is your right and you can also go to the streets or go to court and demand why you are not receiving the essential service. as a citizen you can push for the employment more nurses to ease the workload and enable delivery on quality care and safety of their family. When a patient dies due to health workers error we are hurt but your families suffer the biggest, you deserve better ask for it. The next time you go to a hospital and find a very long line, tell your leader to do something about it. The nest time your family member dies in a line  since other dying patients were being attended to look for your leader, that's how much  your vote costs. Push for establishments of modern facilities, equipments and resources. Services such as ambulance services no health will ask that for your its in your docket to ask your leaders for emergency services in your community, ask your leaders for radiology machines.


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WHAT IS NURSING? WHAT DOES A NURSE DO?

I remember very well the time i decided to join nursing school, the number of people who asked, "why don't you go to medical school?" dismayed me. It was very clear many people are unaware of exactly what  nurses do. I think that it's important that a Registered Nurse is identifiable and for Nurses to lift their heads up and even put RN before their names. I believe that when the public can identify nurses, they will be one step closer to understanding that nursing is a unique profession with its own responsibilities that needs exceptional skills.

WHAT IS NURSING
Nursing in our beautiful country, Kenya, has several challenges one of them though minor is that many people don't know who is a nurse? and what exactly do nurses do? and i strongly believe that the way we present before our patients carry big points towards them respecting us and understanding what our roles. I will start by describing what nursing is, who is a nurse and what do nurses do?


Nursing includes a range of specialties and definition that vary in different countries. in general  a nurse is someone who has formally been educated and highly trained to  care for the sick or disabled. nursing includes several fields of medicine, including the prevention of disease, caring for and monitoring as well as advising pregnant mothers e.t.c.

according to the International Council of Nurses (ICN);

• Nursing encompasses autonomous and collaborative care of clients of all ages, families, groups and communities, sick or well and in all wetting.
• Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying clients
• Nursing involves advocacy of client's rights, promotion of a safe environment, doing research, participating in shaping health policy, in-patient and health systems management and education i.e. always progress your knowledge and skills and to educate their clients. This are some of the key roles of a nurse.

other organization describe nursing or highlights the duty of a nurse  as to assist individual in doing activities that contribute to health, recovery, or peaceful or respected death. this activities are those that the patient would perform if they had the strength, will, or knowledge needed.
Nurses strive to achieve the best possible quality of life for their patients regardless of disease or disability by utilizing clinical judgement to protect, promote and optimize health, prevent illness and injury, alleviate suffering and advocating good health  care for individuals, families, communities and populations.

WHAT DOES A NURSE DO?
These are some of the issues many people are faced with since most if not all don't understand what a nurse does. A nurse is a health care profession who is focused on caring for individuals, families and communities ensuring that they attain, maintain and/or recover to optimal health and functioning. In the past nurses were known as the "handmaiden" for doctors. However , much has changed since the mid 1800 and since  the  mid 1950s. Nurses are skilled profession with separate distinct professional function from physicians.

Physicians still write orders but nurses are expected to know when an order, a medication, a dosage e.t.c. is wrong and to be able to effectively communicate to a physician the reasons the nurse cannot follow the order as given. For example, there are big differences in the amount of medication given by mouth, versus by injection, versus by intravenous. A nurse has the legal responsibility to know it's wrong of a doctor mistakenly orders a dose higher than medically  advisable to give


Physicians still write orders. But, nurses are expected to know when an order, a medication, a dosage, etc., is wrong and to be able to effectively communicate to a physician the reasons the nurse cannot follow the order as given. For example, there are big differences in the amount of medication given by mouth, versus by injection, versus by intravenous. A nurse has the legal responsibility to know it's wrong if a doctor mistakenly orders a dose higher than medically advisable to give by a particular route of administration.


Nurses are capable of assessing, planning, implementing, and evaluating care independently of physicians, and they provide support from basic triage to emergency surgery.

Nurses may practice:

• clinics
• cruise ships
• hospice facilities
• hospitals
• industry (occupational health settings)
• long-term care facilities
• military facilities
• pharmaceutical companies (for example, as researchers)
• physician offices
• private homes
• retirement homes
• schools
• schools
• camps

Some nurses may also advise and work as consultants in the the healthcare,legal or insurance sectors. Nurses can work full- or part-time, and many work on a per Diem basis or as traveling nurses or as we call it locum.
Back to what Nurses actually do. Basically a nurse is supposed to see the restoration of normal physiology in the clients they are taking care of, how you ask- human normal physiology comprises of ;

1. Respiration - Involves ensuring that your client is perfusing to the recommended reference values. is the breathing normal or abnormal.The dangers of hyperventilating and hypo ventilation. Circulation is an important component of perfusion and it should be normal, if not a nurse must work toward returning all these irregularities back to normal using the several skills acquired during their training. a nurse should be able to note any changes concerning respiration and circulation and articulating its occurrence with other systems in the body.
2. Nutrition - this is a very important component that many patient don't put into consideration. The body immunity depends on good nutrition thus ensuring your client is well fed speeds up recovery. using scientifically proven ways or as i like calling it evidence based practice certain feeds are recommended for client in certain conditions. Nutrition also provide the patient with the energy to do other important physiological functions such as respiration. Ensuring you client is well fed is one of the keys to quick recovery. Nutrition also involves the digestive system i.e. is the system able to digest the given food to components needed by the body and this involves also the liver since sometime as nurse we opt not to use the normal alimentary canal to deliver our feeds due some scientifically proven reasons.
3. Excretion - This one is a must know for all nurses and it includes defecation, micturation, sweating in others words all the processes that lead to excretion of  unwanted substance from the body. The most vital here is micturation as it assess the the renal function. Your client must remove urine 1-2 L per day. When your patient is on oral feeds ensure that they are defacating . Other organs like the lungs also help to remove these harmful waste like carbon dioxide from the body. most organ involved in excretion help to maintain a balance in the body, this process is called homeostasis.
4. Movement - this involves the muscle especially in long stay clients since  a nurse should help them return to their activity of daily living thus their muscle movement must always be checked. Involving a physiotherapist and an occupational therapist to assist in these long stay clients is helpful.
5. Reproductive - the reproductive functions and area your clients must be respected and injuries to this area may lead to very serious psychological problems.
6. Sensitivity - this now speaks of the nervous system
7. Growth - applies mostly to children where growth is very important and should be monitored 

There are many other factors a nurse must put in to consideration such the environment according to nightingale should be clean with fresh air, no noises, and proper lighting and the patient must be taken care of in all aspects i.e psychological care, spiritual care, biophysiological care e.t.c. Nurse do a lot more, they make the medicine the doctor has prescribed to work best for the client, they prevent the doctor from overdosing or underdosing their clients Nurses are advocates of the patients rights to proper health. They are the reason you are admitted to the hospital so that they can ensure your full recovery.These is just to mention but a few, there are many other things nurse do that if I am to put in to writing will take me pages and pages.




Something that many people forget even the clients and the relatives is that Nurse are not angels, they are humans full of emotions just like any other human being and these emotions can burst anytime, yes it is not appropriate if it bursts when at work but most of us Nurses really try to avoid  these. People forget that Nurses have families that are looking up to them for support but they have sacrificed their time to fully care for the clients. Nursing is a very high stress job and one can easily breakdown. I usually say that here in Kenya the level of nursing is as high as any other place in the world, but the environment and nature of the job makes us easy predators to stress breakdown and negative emotions not forgetting Nurses are not paid well enough to forget the problem they have at home or rather to separate the problem they have at home from job. when they are at work and the are thinking on where next they will get the cash to solve this problem and that problem at home completely distracts their attention at the work place, one just want to finish what they are doing quickly and go somewhere else to look for money.



The media also should be able to bring out what exactly is on the ground for the people to see, before they take medical malpractice as an agenda to fight on each day. In our hospitals there few if no supplies, e.g a scenario where you are supposed to be dressing a wound  aseptically but even the bd pack itself doesn't all the things it need so you will have to use  your head and use what you have and still maintain aseptic status and if the field is compromised you have to continue using the bd packs as they ain't enough or you may be using the only and the last one available. Am not against telling kenyans the truth about some negligence in our hospitals but first exhaust all your possibilities before publishing a story. get the story from both parties. I CONDEMN ACTS OF MEDICAL NEGLIGENCE BY HEALTH CARE WORKERS AND I DO NOT IN WHATSOEVER WAY SUPPORT IT. If some one is professionally incompetent they should be uprooted from the system.

PARTICIPATING IN SCIENTIFIC CONFERENCE

International conference should be instructive and lots of fun but it can also be alarming and lonely. For nursing career development it now almost essential that you participate in scientific conferences. Most school of Nursing don't emphasize on how to make the most of the opportunity as part of its curriculum. Today we gonna talk about how you can organize yourself and make the experience scientifically productive and enjoyable. In essence you should travel, see places, meet new people, make friends and identify one or two ideas that you can apply in your work or research.

There are many reasons why you must participate in international conferences most of which are very obvious, such as, eduction. as Nurses we must be in constant pursuit for knowledge. various issues change with time (medical-legal issues, ethics issues, new technology, better ways of approach to care e.t.c.).

Here are some of the major reasons why you should participate:

1. Education - update your knowledge. we learn from other, we learn from our mistake, we learn from other peoples mistakes. listening to other peoples work and listening to their brilliant ideas and sharing what you have to offer is one of the ways you can update your knowledge fast. Scientific materials presented at the conference may be a couple of years ahead of the journals and  five years ahead of text books.
2. Inspiration - Hear new ideas and meet professional leaders. Networking especially on intellectual basis can make your career move to the next level.
3. Evaluation - scientific conference can help you review your own work and plan for the future
4. Presentation -  after conducting a research results must be analyzed and presented somewhere. you can use the journal but a scientific conference is the most effective way of making a great impact since big name and world leaders in medical science attend these conferences, those are the people you need to hear what you have and if they are interested in your work, your career grows.
5. Recreation -  don't forget you supposed to have fun while you are there, relax and enjoy the company and culture around the meeting.

There are many other objectives but the five are the major ones. Participation in a conference need thorough preparation because you don't want to be disappointed with yourself. You must know the focus of the meeting, always double check and see if your work  is in line with the focus of the conference. 

One last thing, a conference should be a healthy mixture of the social and the scientific, and should provide stimulation and renewal, but if you have the choice of a large international conferences and a small on focused on your area of interest, always go for the small one. also you must know that international conference can be addictive.

THE ROLE OF NURSES IN HEALTH CARE REFORMS

Healthcare reforms gives nurses a new opportunity to deliver care and play an integral role in leading change. Understanding these opportunities is just the first step, we need to know how we can be part of the solution to achieve better patients outcomes at a more reasonable cost. We need to do more to prevent disease; provide chronic care management to an aging, sicker and more diverse population; and offer end of life care that emphasize comfort and compassion across all settings- especially geriatrics- we must do more to prepare ourselves for the future. I will outline nine challenges that individual nurses and our profession MUST address if we are to help lead our country to a healthcare system that is more equitable and provides a higher quality of care.

• USE NURSE-LED INNOVATIONS 

 I believe that we Nurses know how to expand access to care and improve quality at lower cost. There are many innovative care models developed by nurses worldwide to prove it, including nurse-managed health clinics and home visit programs for low income mothers. by emphasizing the use of master's-prepared nurse to oversee care from the hospitals to within the homes, this model has been effective in many countries and has reduced re-hospitalization of elderly patients with multiple chronic conditions. We need more nurses to develop innovations that will help lead our country to a healthcare system that is more equitable and provides a higher quality of care.

• GENERATE EVIDENCE AND ENGAGE IN RESEARCH

 Nurse play an important role as innovators who help shape quality and safety. successful models aren't born, implemented, or sustained without solid effectiveness data. Its up to all Nurses to collect and track data to improve their own practice as part of broader efforts to improve care. Nursing research helps build the scientific foundation for clinical practice, prevention and improved patient outcomes. We must support nurse researchers through adequate funding. There are a few organizations here in Kenya and worldwide that  will help fund a nursing quality research especially research that links evidenced-based nursing care to improved patients outcomes

• REDESIGN NURSING EDUCATION

ALL NURSES need to possess basic competence to meet the demands of an aging and diverse society, with an emphasis on clinical training in multiple setting across the lifespan. The emphasis should be on quality and safety, evidenced-based practice, research, and leadership. All this concepts should be incorporated in to nursing education including quality and safety in Nursing Education. A standardized program that will incorporate all level of nursing to be able to juggle between practice and school achieved by establishing e-learning modules and also shorter period for diploma holders to upgrade to degree e.g 2.5 yrs.

A standardized program would give nurses on-the-job learning and would better prepare them for clinical practice. Certification and continuous learning opportunities are essential to a profession that's responsible for others' lives.

• EXPAND SCOPE OF PRACTICE

Degree nurses in Kenya must be allowed to practice to full extent of their education and licensure. working with doctors, they can provide cost-effective care and help address the primary care shortage. However, statutory and regulatory barriers prevent them from practicing to the full extent of their licensure. there are many who can't take insurance due to the high healthcare cost. Nurses should be allowed to provide primary care they are trained to give.

• DIVERSIFY OUR WORKFORCE

 To reduce health disparities, greater efforts must be made to ensure that the nursing workforce reflects the patients' diverse background and cultural values. Furthermore, all nurses should be educated to provide culturally competent care. Finally we need to have more men into the profession, provide scholarships to students from diverse background to attain a baccalaureate and masters degrees.

• EMBRACE TECHNOLOGY

We must learn to use the newest medical technology and electronic documentation system to improve quality. Nursing schools should use simulation labs and take advantage of online classes to educate more students. Nurses worldwide are frequent technology users and so should we. more of us need to be at the table to help make decisions about designing and purchasing the technologies that help patients the most. There should be programs that provides a process that enables nurses to identify and apply technology solution to improve patient care.

• FOSTER INTER-PROFESSIONAL RELATIONSHIPS AND COLLABORATIONS

Teamwork and collaboration are CRITICAL to seamless high quality care. The process begins with understanding the roles and responsibility of each healthcare discipline. Understanding- and the trust it fosters- must start in joint nursing and medical school training programs and continue as a cultural norm in practice settings. NOTE: for quality health care the unity between doctors must exist. and if we are not doing our part of the reforms don't expect a doctor to do it for you. "mkono mtupu haulambwi" if you don't bring anything tangible to the table no one will praise you and if you don't participate in reforms doctors won't make them for you and that's how the musymi report was drafted.

• DEVELOP LEADERSHIP AT EVERY LEVEL

 Nurses should have the opportunity to take on leadership activities whether they practice at the bedside or sit in the boardroom. They must believe they are capable and fully empowered to provide excellent care and make the changes necessary to improve ineffectual systems. I believe that doctors and administrators must support nurses in their effort. Most of all, nurses need to help each other through mentoring, educational and skills development opportunities and support networks, here is where we fail instead of supporting each other we fight whenever one of us want to compete for a leadership position with the doctors, we see our colleagues as competitors and that's we will remain stagnated and move in circle until we create order out of the chaos.

• BE AT THE TABLE

As the health care professionals most actively engaged in direct patient care, nurses are positioned to provide leadership in a;; healthcare areas, including developing systems to reduce medical errors, improving quality, providing better care, coordinating, increasing access to care and averting. We have left the doctors to do this for us and its quite a shame. Doctors are the ones drafting proposals to increase access to care, coordinating what is to be done in most hospitals and also proposal for providing cheap accessible and quality healthcare. Let us also draft our proposals and develop our own policies. I am a believer of good work never goes unrewarded thus if your proposal is the best no one will shoot it down without it fighting for itself.

TEAMWORK AND COLLABORATIONS ARE CRITICAL TO SEAMLESS HIGH QUALITY CARE
 In the health sector in Kenya their is an enormous shortage of health care workers yet clinical experience isn't  enough, some of us must serve as board members and chair committees. To be a successful and knowledgeable board or committee members, nurses must be familiar with GOVERNANCE, STRATEGY, FUNDRAISING, FINANCIAL SYSTEMS, HEALTH LAW AND POLICY.  Always say "YES" when asked to be at the table. If you believe you are ready but haven't been asked, then ask to be involved in a board or committee of interest. There should be programs that should be working to bring more nurses into leadership position at the local, county and national levels. At the end of her life, Florence Nightingale said " May we hope that when we are all dead and gone, leaders will rise who have been personally experienced in the hard, practical work, the difficulties and the joys of organizing nursing reforms, and who will lead far beyond anything we have done."  Take her words to heart and prepare your self to contribute to the reforms that will take place in our lifetime. WE HAVE MUCH TO CONTRIBUTE

The author of this document is a finalist Nursing student of the University of Nairobi.

INTRODUCTION

Many of you may be wondering what this blog is all about. I will start with introduction am a finalist nursing student at the university. Many say NURSING is a CALLING(same as a leader), i cannot agree less, for one to be a nurse one has to be dedicated to give care through empathy and perfom what the client would have perfomed if they were alright. another thing that should go into our minds is that NURSING is also a PROFESSION where there is specialised, intense training and practice, also NURSING is a SCIENCE meaning that the procedures the nurses do are scientifically done. NURSING is also an ART whereby the procedures are done in a certain creative way.Nursing in general has made me appreciate several things in life to mention but a few in my clinical rotations I've been faced with various situation or witnessed different scenarios that makes me ask myself who is a Kenyan nurse, what exactly is expected of a Kenyan nurse, what are our responsibilities as nurses. I have been to various health institutions and witnessed the change in roles i.e. what responsibilities belong to the nurse. I would love to enable our clients understand our limits and for them to understand who exactly is a nurse, compare what the law requires of a nurse with what the law requires of a nurse in other countries. Another thing that has been puzzling me is the different approaches many nurses have to use to manage their clients in relation to ethics i.e with respect to teleologic and deantologic considerations. This will incorporate several nursing ways of management of various medical conditions especially the ones most common in our setting and also the bizarre conditions that are more fatal when they occur. I will also include the other fields in the health institution especially where multidisciplinary approach to care is mandatory. The blog will also have tales from the nurses outside the hospitals, the stressors, basically what a normal Kenyan nurse goes through because what many people fail to undersatand is that a nurse is a human being, a parent, a breadwinner and your care giver and will be the one who ensures your rights in the hospitals are not violated

In this blog their will be stories e-mailed to me via kenya.nurse.blog@gmail.com, which I will carefully select the ones of relevance to my objectives of starting this blog. personally i expect the blog to grow faster especially after am done with college and getting the hands on experience since views will change as i encounter many if not all of the conditions. Basically or in summary i want us to know who is a nurse, challenges they face, what they do and what they don't do and many more like what nursing care is all about. feel free to to e-mail me any query via kenya.nurse.blog@gmail.com.