Barbados Community College

Division of Health Sciences

Department of Nursing

Basic 1: Group 3

GEED 102-Introduction to Sociology

How is the economic downturn affecting nurses in

Barbados?

By

Elliott Rock

Delana Modeste

Joy Richards

Lana N. Lynch

Tutor: Ms. C. Brathwaite

November 18, 2009

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Table of Contents

Chapter Title Page

Table of Contents 1

Abstract 2

1 Introduction 3

2 Staffing 7

3 Training & Recruitment 10

4 Facilities 12

5 Patient Care 16

6 Conclusion 19

References 20
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ABSTRACT

Purpose of the Research

The global economic crisis has affected the stability of countries world-wide. Jobs

have been made redundant, many persons have lost their homes, and on a personal level, the

pressures originating from the recession have been so great on some individuals that they

have taken their lives. This study sought to determine whether the global economic crisis has

had an impact on Barbadian nurses. More specifically, it sought to establish whether the

nurses at the Queen Elizabeth Hospital (Q.E.H) were affected.

Design and Method

Using qualitative research, a total of eight (8) nurses were interviewed using semi-

structured interviews. The nurses were asked questions about their experience as

professionals, prior to and after the recession. Next, two patients were interviewed and asked

about their subjective views on the quality of care received before and after the recession to

see if the recession had an impact on care received.

Results

It was found that the recession has not had any impact on the nurses at the

Q.E.H. As such, there has been no change in the quality of care administered to the patients.
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Chapter 1: Introduction

According to the Taylor, Lillis, LeMone & Lynn (2008) the American Nursing

Association defines nursing as “The protection, promotion, and optimization of health and

abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and

treatment of human response, and advocacy in the care of individuals, families, communities,

and populations.” Most nurses definitively opine that nursing is a very dynamic and

rewarding profession financially and spiritually as worldwide there is a great demand for

quality nurses and the care they provide which makes nursing a very viable profession is

partially immune to the effects of our global economic decline or recession.

Purpose of the Research Paper

The aim of this study was to examine, through qualitative research, the effects of the

economic downturn on the nurses in Barbados. A background to the global economic crisis

will be given followed by an analysis of the effects of this crisis on nurses in terms of:

1. Staffing;

2. Training and recruitment of nurses;

3. Facilities available to nurses; and

4. Patient care.
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Methodology and Limitations

The research approach used to collect data influences the questions asked, the results

obtained any inferences made and overall, the core objective of the research. Therefore, it is

crucial to select the appropriate approach (Barriball & While 1994).

The aim of this study was to examine, through qualitative research, the effects of the

economic downturn on the nurses in Barbados. However, because of time constraints, a

representative stratified sample of the population of nurses in Barbados could not be used.

Thus, the researcher focused on one public institution, namely the Queen Elizabeth Hospital

(Q.E.H).

It was thought that a qualitative approach using semi-structured interviews would be

best given that the researcher was interested in the experiences of the nurses and in finding

out the exact impact the recession had on their professional lives. Although a qualitative

approach is very time-consuming and limits the number of participants that can be involved

in a study, it allows the researcher to obtain a deeper understanding of people’s lived

experiences, perspectives, motivations and actions. Semi-structured interviews allow for

greater interaction, probing and flexibility; and “it provides the opportunity to evaluate the

validity of the respondent's answers by observing non-verbal indicators, which is particularly

useful when discussing sensitive issues” (Gordan 1975 cited in Barriball & While 1994 p.

329) - thus the reason for choosing the qualitative, semi-structured approach.
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Some other limitations which hampered the study are:

1) First, because of the time constraint, only a small sample size was deemed

appropriate for this study. However, research would have benefited more from a larger

sample in order to uncover a greater wealth of information and a vast variety of perceptions.

2) At first participants were a bit sceptical about contributing to the study; however, after they

were ensured that they would not be identified, the majority opened up freely. However,

there were still a few nurses who did not want to participate.

Background on the Global Economic Crisis

Between June 2005 and July 2007 the world’s economies were thriving. This was

evident by the drastic increase in the total value of output and production of all the

resources within the borders of a country or gross domestic product (GDP) of many

developed countries such as the United States of America which grew by an average of 8.4%

yearly (Bureau of Economic Analysis U.S. Department of Commerce, 2009) and China

which grew by grew by 8.4% (National Bureau of Statistics, China, 2009).

Crude oil is the driving force behind the world’s economies as it is needed to

produce goods and services which are sold for money and valuable foreign exchange on the

regional and international market in an effort to maintain and develop the economy. It was

during the period of January 2005 and June 2007 that members the Organisation of the

Petroleum Exporting Countries (OPEC) recognised that the demands for oil far exceeded

the supply. In an effort to curb this demand, using the law of demand which states that the

as the price of a commodity rises the demand decreases, the price of oil was increased. The

price of oil almost doubled from June 2007 when the cost of a barrel of oil was an average
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of $64.10 (U.S. dollars) to an average of $127.19 (U.S. dollars) (Energy Information

Administration, 2009). There were unintended consequences of this increase.

The unintended consequences of this increase originated in the United States of

America the world’s largest consumer of oil and then rapidly expanded world wide. As the

price of oil rose so did the price of goods and services such as food in the supermarket,

electricity, doctor visits and medication. This meant that the purchasing power of

households decreased significantly as there was no increases in income to compensate for

the rising cost of living. World economies were now said to be inflated. Inflation occurs

when prices are constantly rising and the real value of money or its purchasing power is

falling (Frank & Bernanke, 2006).

As time continued and inflation progressed there was a significant drop in the levels

of consumption of goods and services. As a result there was seen worldwide a decrease in

countries’ gross domestic product. These decreases in the world gross domestic product

were carefully monitored and the beginning of 2008 ushered in a global recession, a period

of general economic decline; typically defined as a decline in the gross domestic product

(GDP) for two or more consecutive quarters (Frank & Bernanke, 2006). This recession was

characterised by an increase in unemployment , by a drop in the stock market, an increase in

unemployment, and a decline in the housing market and other sectors contributing to the

gross domestic product.

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Chapter 2: Staffing

Under the rules of the World Health Organization (WHO) nursing is seen as a

service, which now allows for free movement of nurses to ply their services globally. This

has impacted on the number of nurses in the profession as some migrate regionally and

internationally to seek greener pastures in terms or working conditions and remuneration.

Specifically, at the Queen Elizabeth Hospital staffing has been presenting a headache for

management even though there has been an influx of nurses from Queen Elizabeth Hospital

from neighbouring St. Vincent. With allocations for eight hundred and thirty eight posts in

the nursing department only six hundred and ninety four have been filled, this impacts on

efficient and effective nurse- service delivery to the patient, possibly compromising patient

care.

Shortages

Shortages of nurses have been a crisis in Barbados for any years which seemly to

date cannot be solved. Mechelle Marshall, registered nurse and former Vice President of the

Barbados Nursing Association, is quoted as saying that “Sometimes we operate on a ratio of

one registered nurse on night duty with one nursing assistant to 24 patients, all requiring

nursing care.” (Barbados Advocate Newspaper, 2005). However, when comparing these

same conditions in Barbados and Europe, and Australia and North America, she said that

“the ratio of nurse to patient is 1:6.” Her sentiments were reiterated by Ms. Jacqueline

Brown who held the opinion that there has been no improvement with regard to the nursing

shortage.
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Work load

A typical nurses’ work day should be eight hours; however, with the current shortage

of nurses, some nurses out of a sense of duty end up working as much as fourteen hours a

day especially those with specialized training. This makes the work load heavier and more

burdensome and has the potential to impact negatively on the quality of patient care. In an

interview with Ms. Bynoe, registered nurse of the Queen Elizabeth Hospital, she recalled

instances where she herself became negligent in giving patients their medications. This was

not due to the fact that she was incompetent or complacent, but simply because she was

physically and mentally fatigued. Also she recalls many instances where her tolerance levels

had significantly declined and her mannerisms were sharper than usual.

Salaries
Although nurses are an integral part of the health team they are not highly regarded

in society as other health workers such as doctors and medical laboratory technologists. To

make matters worse, to some persons (even some patients) they are seen as maids. Based on

level of training that is required, high technical knowledge, proficiency and efficiency needed

in the execution of the job as well as the details of the job nurses are not very well paid in

the public sector. This is usually a bone of contention of nurses at union meetings and at the

Barbados Nursing Association meetings. In speaking to Ms. Jordan, registered nurse in the

Accident and Emergency Department of the Queen Elizabeth hospital, (who was on her

tenth work hour as her relief nurse was unable to come to work) she stated that “The pay is

not commensurate with the duties you have to do and the extra mile that you are forced to

go based on the code of ethics you swore.” She further lamented that “The money is in the

private sector in Barbados such as Sandy Crest, FMH and private established Doctors’
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offices, or the other option is migration to the United States, England, the Bahamas,

Bermuda where you are very well rewarded financially.” In an interview with R. Bignall

R.N., she lamented that “Salaries are woefully pitiful and are not proportionate to the

workload and the disparity with other professionals is so great, that the best nursing brains

are opting to pursue more lucrative professions or to migrate. Furthermore, can you imagine

that we do all the work, we are friends, maids, sisters, priest, you name it, we is it for the

patient.” She however said after a moment of reflection that is the spiritual rewards and not

the money that keeps you going.

Cutbacks

As a result of the recession we are experiencing and the high levels of

unemployment, the nursing profession is now starting to thrive as it is seen as resistant to

the recession. There has been a significant increase in the number of students applying to the

Barbados Community College to pursue nursing and in response noting scarcity of nurses

the Barbadian Government has made a commitment to the nursing profession to advance

and enhance it any way that it can. Mr. Donville Inniss said in the October 18, 2009 edition

of the Sunday Sun that that “It is government’s intention that Barbados, within the next two

years ,will be self sufficient in nursing where the demand will be satisfied and put this

country in a position to export nurses with that expertise to first world countries.” This is a

very positive indicator that there will not be any cut backs in this profession as there is a dire

need for it to advance.

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Chapter 3: Training & Recruitment

In the previous chapter the financial issues and the changes in shifts of the nurses were

explored. In this chapter; however, the emphasis will be placed on the training and

recruitment of the nurses. Two nurses were interviewed and the following areas were

discussed:

1) The release and recruitment of staff

2) Training

3) Any changes in policy

4) Changes in leave

Training

“The training of nurses in Barbados has never been problem.” These words came

from Ms. Bynoe, a registered nurse of 15 years. She further stated “When you start the job it

is hands on training and you learn every thing that you need to know and you learn even

what they had not taught you at the Barbados Community College.”

Ongoing training is a necessity in the medical field and as a nurse at the Queen

Elizabeth hospital you are rotated to various departments to make sure that you are well

rounded. Sometimes; however, this is not enough. Previously, through the Ministry of

Health, nurses were sent overseas to train in specialty areas such as oncology, post-operative

care and diabetes. As many as 12 nurses received this training abroad and when they
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returned it was their duty to impart some of this training on other staff members in this

department.

However, that was years ago. Today, fewer and fewer nurses are being sent for

training. This is as a result of the existing staff shortage that the Queen Elizabeth Hospital is

now facing. It must be stated nevertheless, that those nurses who are sent by the

government to pursue academic training, do so through the sponsorship of the government.

This has always been the case and has not stopped as a result of the recession.

The Release and Recruitment of Staff

Around the world thousands of jobs have been made redundant as a consequence of the

global economic downturn. This; however, has not been the case with the nursing

profession. In fact, quite the opposite has happened. More nurses are being sought to fill the

many nursing vacancies at the Q.E.H.

Changes in Leave and Policy

To date there has been no changes in the amount of leave being granted or in the policy that

governs leave.
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Chapter 4: Facilities

The aim of this chapter is to explain how the facilities at the Queen Elizabeth

Hospital affect the nurses in Barbados. The areas which will be focused on are as follows:

1) Access to equipment

2) Availability of beds

3) Availability of medication

4) Uniforms

5) Any cut backs resulting from a lack of funding

Two nurses who work at the Queen Elizabeth Hospital were interviewed in regard to

the above-mentioned areas.

Equipment

Like any other facility, the Queen Elizabeth Hospital has its share of problems. The

nurses stated that the equipment at the Queen Elizabeth Hospital is in poor working

condition which in turn makes them unavailable for use (personal communication,

November 6, 2009). Although there’s access to the equipment by staff at the hospital, it

would appear that there is a lack of proper training in the use of the state of the art

equipment which leads to malfunctioning and subsequent destruction. This is mainly due to

the fact that the persons who are trained are not always available when needed, especially at

nights. When the finances are available to purchase new equipment, it takes a considerable

period of time to reach the facility. This in turn has a negative feedback on the nurses due to

the fact that they cannot get their work done as quickly and efficiently as need be or desired.
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However these problems do not seem to be attributable to the economic downturn as

there’s consistency in malfunctioning equipment.

Beds

Although the hospital has the capacity to carry 600 beds, the availability of beds is

another factor that is a cause of concern for nurses on a daily basis. According to the nurses,

family members do not collect relatives after they have been discharged from the hospital.

Thus, these persons have to remain in the hospital and extra care has to be provided for

them until an alternative place can be found or until one family member can be contacted.

This places extra pressure on nurses, who then have to find satisfactory accommodation for

those newly admitted patients.

Medication

Health care is free for the average Barbadian and so with this comes free medication.

Sometimes; however, there is a shortage of medication. This is usually no fault of the

hospital but rather the Barbados Drug service. However, there is never a major shortage of

medication at the hospital dispensary and even then it’s only for a couple of days as there’s

also alternative medication.

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Uniforms

Another area of concern for nurses is uniforms. Uniforms are to be changed every year,

however, in reality, this does not occur. Sometimes it takes more than a year before a nurse

could get a new set of uniforms. Recently, the uniforms have been changed and those

persons with sensitive skin and allergic reactions were taken into consideration. These

persons were given scrubs.

Cutbacks

Where cutbacks are concerned some nurses seem to think that despite the many set

backs, the hospital officials seem to be doing a good job in the area of compensation. For

example, where expensive drugs cannot be readily sourced or financed, high-quality, cheaper

alternatives are found. It has also been viewed that the new government is channeling some

funds towards health care.

Since the beginning of the global economic crisis, there have been no major setbacks

or any cutbacks worth mentioning. Furthermore, there have been quite a few upgrades and

quite a lot of money spent on the upkeep and upgrade of the hospital. In addition the

compliment of staff at the hospital has also increased. The difficulties currently faced by

nurses are not as a result of the recession; but rather ongoing intricacies that have been

plaguing nurses for years. The following table, Table 4.1, is just a small select example of the

number of uniforms which have to be purchased for nurses at the Queen Elizabeth Hospital

and an indication of the money being spent to improve the health care system as a whole

and also to improve the conditions for nurses.

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Table 4.1: The Number of Uniforms tendered by the Queen Elizabeth Hospital for the
2010 financial year

List Description Quantity

#

1 White Poly linen skirt suits featuring a white bib with Royal Blue strips 196
2 White Poly linen pants suits featuring a white bib with royal blue strips 227
3 White Poly linen skirt suits featuring a white bib with green strips 839
4 White Poly linen pants suits featuring a white bib with green strips 1382
5 White Poly linen skirt suits featuring a white bib with lilac strips 580
6 White Poly linen pants suits featuring a white bib with lilac strips 440
7 White poly linen uniform dresses 105
8 White tunics with epaulettes 120
9 Black gabardine pants 90
10 Blue overalls 12
11 Health aides-scrub suits 294
12 Assistant Matrons and Senior Sisters skirt suits 20
13 Assistant Matrons and Senior Sisters pants suits 22
14 Blue poly cotton shirts with flap pockets 32
15 Blue poly linen skirt suits 92
16 Green pin feather scrub dresses 60
17 Black gabardine pants 36
18 Blue polycotton shirt with epaulettes & flap pockets 44
19 Black gabardine pants 33
20 Black gabardine pants 4
21 Green scrub pants suits 28
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Chapter 5: Patient Care

This chapter aims to explore and compare the quality of care given to patients of the

Queen Elizabeth Hospital (QEH) before and after the recession. Consequently, the

subjective experiences of these patients will be examined. In addition, the researcher also

thought that it would be interesting to also acquire the subjective view of a representative of

the nursing staff in order for comparison to ensue.

Nurses have four fundamental responsibilities:

1) to restore health;

2) to alleviate suffering

3) to prevent illness; and

4) to promote health.

However, it is no secret that the resources required to do this have never come cheaply.

The recession, a phenomenon initially seen in developed countries, and which began to take

root in developing countries, is now a world-wide phenomenon. Not surprisingly, the tiny

Caribbean island of Barbados proved to be no exception. However, while many persons

believed that the recession would have not only a huge impact on the nurses’ ability to carry

out their functions as professionals, but also on the public health-care system as a whole, as

seen from the empirical evidence in the previous chapters, this is not the case.

Since the public health-care sector has not been exposed to the brunt of the recession, one

would naturally infer that the quality of care patients receive should remain consistent. But is

this the case? Are they indeed affected? We will look at this next. Two patients who have
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been for a long time receiving treatment at the Queen Elizabeth Hospital several times a

week because of debilitating diseases and one staff nurse were interviewed. A few selections

of verbatim quotes will be used to demonstrate grounding in the data (Denzin & Lincoln

1998).

When the patients were asked to compare the quality of care they receive now to

before the recession started, Annie say the following:

“Man I was going to de hospital for years now, and to me the care I does get hey

today is de same as when I first start out. At first when de recession really hit Barbados I was

frightened, cause I was wondering how things would be up dey (Q.E.H), but it is de same.

De nurses looking afta me good. You know yuh would got some nice ones and then some

not-so-nice ones. But to be honest, things ain’t change one bit”.

Linda echoes this same sentiment:

“In my opinion, my care hasn’t changed. The same number of nurses is still here,

even more now to tell you the truth. It seems as if I see a new face every day. If things were

so bad financially, this would not be the case. I do hear them complaining sometimes about

work conditions like the extra work they have to do when nurses don’t turn up for work,

and uniforms, but that has been going on for years, not only now. When it comes down to

care, it has not changed.”

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The Sister interviewed stated the following:

“There has been no change in care at the QEH as a result of the recession. It is

business as usual. I admit the working conditions for the nurses have not been ideal, but

modifications will soon be made. We are doing the best we can with what we have. The

nurses have been maintaining the same quality of care that they have been in past times. Yes,

you do have some nurses that I really wonder what made them do nursing in the first place

you know? But the good ones outweigh the bad. We aren’t anymore short of staff now than

in times gone by, medication is still being distributed, yes sometimes we are short, but this

has nothing to do with the recession.”

As seen above, it is evident that while working conditions are not idyllic at the Queen

Elizabeth Hospital., both nurses and patients share a common view – that the quality-of-care

given by the medical staff has not been affected by the recession.
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Chapter 6: Conclusion

In analysing the global economic crisis and its effects on the economy and specific

aspects of the nursing profession it can seen that the recession has had no significant impact

on the profession. What has persisted before the recession, for example a nursing shortage

and long hours still continues to occur today, and is no worse. It can also be seen that the

recession has had a positive effect in that more is being actively done by the government to

assist the profession since it recognises the value of the profession.

In conclusion, the balance scale tends to tip in favour of positive and forward

movement of the nursing profession in spite of the recession.

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References

1. Barriball, KL & While, A 1994, ‘Collecting Data Using a Semi-Structured Interview: A

Discussion Paper’, Journal of Advanced Nursing, vol.19, 2, pp. 328-335.

2. Bureau of Economic Analysis U.S. Department of Commerce (2009). Gross Domestic

Product. Retrieved from http://www.bea.gov/briefrm/gdp.htm

3. Denzin, NK, Lincoln, YS 1998, Collecting and Interpreting Qualitative Materials, Sage

Publications, Thousand Oaks, CA.

4. Energy Information Administration (2009). World Crude Prices 1978- 2009.Retrieved

from http://tonto.eia.doe.gov/dnav/pet/pet_pri_wco_k_w.htm

5. Frank, R.H., Bernanke B.S. (2006).Principles of Macroeconomics. (3rd Ed.). Inflation.

Wilward, Ohio, McGraw Hill.

6. National Bureau of Statistics, China (2009). GDP Growth in China 1952-2009 Retrieved

from http://www.chinability.com/GDP.

7. Taylor, C., Lillis, C., LeMone, P., Lynn, P. (2008). Fundamentals of Nursing: The Art

and Science of Nursing Care. (6th Ed.). Definition of Nursing. 530 Walnut Street,

Philadelphia PA, Lippincott, Williams & Wilkins.

8. Marshall, M. (July 11, 2005). Nurse Migration Affecting Health Sector. Barbados Advocate,

pp.3