The shortage of qualified nurses working in Lebanon could become even more acute if working conditions are not improved, nurses and public health experts warned on the eve of World Nurses Day.
A new study released by the American University of Beirut in collaboration with the Rafik Hariri School of Nursing found high levels of job dissatisfaction among nurses, who cited low salaries, inconvenient hours, a lack of autonomy, and an absence of career advancement opportunities as the major reasons behind the low retention rates in the profession.
According to the study, two in three nurses in Lebanon want to leave their jobs, and one in three wants to leave the profession altogether. One in five Lebanese nurses who receives a bachelor’s degree intends to emigrate within two years of graduation, with many finding better paid, more rewarding work abroad, particularly in the Gulf.
Fadi El-Jardali, associate professor of health management and policy and one of study’s primary authors, described the study’s findings as “very alarming” because nurses, as primary care givers, are the backbone of any health care system.
“If we don’t invest [in the nursing profession], the health care system will break down even further and the outcome of care will be impacted,” he said, pointing out that shortages lead to more errors, which could have grave implications for patient safety.
Jardali emphasized the importance of creating nonfinancial incentives if hospital administrators and employers expect to retain good nurses. In other countries, he said, nurses are often promoted to senior management, or go on to become policymakers or professors, but in Lebanon nursing is considered more or less a dead-end job.
“We cannot solve everything with money,” said Jardali. “There are other things nurses are asking for. It’s about creating better working conditions.”
Unfortunately, he added, the problem is also partly political. A draft law that would regulate nursing education and raise standards for nursing staff has been stuck in Parliament for 12 years, he said, because some of the lawmakers on Parliament’s Health Committee are also stakeholders in hospitals or clinics, which have a vested interested in keeping salaries low.
Jardali’s concerns were echoed by Helen Samaha Nuwayhed, the president of the Lebanese Order of Nurses, which represents a little over 10,000 registered nurses, only a portion of whom are active health care providers.
In addition to the reasons outlined by Jardali, Nuwayhed said high rates of violence in the workplace were another factor behind the shortage of nurses. She cited a study that found a majority of nurses had been subjected to verbal abuse, roughly one-third had been exposed to violence and about 10 percent had suffered bodily harm.
“We need to shed light on the work conditions and how these affect nurses and patient care,” she said, adding that the order would make violence both against nurses and in the workplace a primary issue at Wednesday’s celebration to mark International Nurses Day, traditionally held May 12.
“I met a lot of nurses who have moved to the Gulf who say they would like to come back but they want better salaries, to have a say in what they do, in decision-making; they want institutional support for higher education and reduced exposure to violence,” she said. “The solutions are simple. They are very well known. It’s not rocket science.”
Ending violence in the workplace starts with awareness and advocacy, she went on to say. Nurses should be encouraged to come forward and report their abusers, be they doctors, hospital administrators, patients or patients’ families, without fear of repercussions.
But while the Order can offer legal and moral support, Nuwayhed added that educating the broader community was equally important to ensuring nurses receive the respect they deserve.
“People should know that when they abuse a nurse [it means] when they come back to this hospital many of the good nurses may not be there because [their rights] have been violated, and people have not valued their input,” she concluded. “Nurses do add quality to their lives; we help save lives.”
