Friday, January 15, 2010

Nurses Association-NST: 1MALAYSIA CLINICS: Lift our nurses' standards

1MALAYSIA CLINICS: Lift our nurses' standards
DATIN HATIJAH YUSOF, Honorary General Secretary, Malaysian Nurses Association 2010/01/15

I REFER to the letter "Rethink 1Malaysia clinic move" by the Malaysian Medical Association (MMA) (NST, Dec 25). The Malaysian Nurses Association (MNA) supports Prime Minister Datuk Seri Najib Razak's choice of registered nurses (RNs) and medical assistants -- now known as assistant medical officers (AMOs) -- to run 1Malaysia clinics.

These clinics are to offer treatment for common illnesses, attend to minor ailments, and do follow-up treatment for well-controlled diabetes, hypertension and asthma, which RNs and AMOs have been doing for decades in rural and urban areas.

The public should be aware that RNs and AMOs have been the main providers of primary healthcare. There are simply not enough medical officers to provide healthcare to millions of Malaysians.

The MMA has expressed concern over the quality of medical care at 1Malaysia clinics. Nurses have been providing healthcare for decades, particularly in maternal and child healthcare.

They are all well-qualified public health nurses who have undergone a year's training in midwifery and another year in public health, apart from their three-year training as nurses.

These nurses have five years of education and training and several years of experience before they take the public health course. Since 1996, nurses have not only been providing healthcare to mothers and children but also to the elderly, children with special needs, women and adolescents. We also provide mental healthcare.

As a doctorate candidate (PhD), I did field observation of RNs and AMOs in six states on their roles in early 2000.

It was obvious that RNs and AMOs were the main healthcare providers in all these clinics. While the nurses are champions in maternal and child healthcare, health education, prevention and promotion, the AMOs treat the general outpatients.

In most of the clinics, AMOs saw 90 to 100 per cent of the patients. The MMA can easily check such data at any health clinic. There are far too many patients for one or two doctors to cope without the help of these AMOs.

A morbidity survey of community health then and retrospective data of six months collected from each clinic showed that the diseases they sought treatment for were just common illnesses.

It is unbecoming of the MMA to run down nurses by saying that allowing nurses and AMOs to run
1Malaysia clinics would place "the standard of these clinics at the level of Third World countries".

The MMA is ignorant of the fact that in developed countries such as the USA, Canada, the UK and Australia, community clinics are run by nurses independently.

These nurses are known as "nurse practitioners" who are advanced-practice nurses with master's degree education or degree nurses with specialisation.

Is the MMA aware that we have several RNs who are PhD holders and that many have a master's degree? We have also quite a number with degrees and specific specialisation.

We also wish to inform that we are advocating that all RN training should now be at tertiary level. We want to be under the "professional group", not in the "supportive group".

We feel that diploma-level training is no longer suitable for RNs. Nursing colleges here should offer degree courses instead.

To give quality care, the MNA has recognised four areas of basic nursing competencies that RNs should possess.

These are problem-solving, knowledge-based practice, clinical competence, and accountability and ethical practice.

In the area of clinical practice, nurses should have clinical skills in physical assessment to detect medical abnormalities, skills in auscultation, palpation and percussion, just like the AMOs who have this special training.

Even though nurses lack clinical skills, experienced nurses would have no problem running a 1Malaysia clinic.

On the MMA's remark that we have sufficient doctors and that "2,000 to 3,000 new doctors are returning to our shores annually", I would like to ask: where are they?

The truth is, medical officers have to work very hard to meet patient care demand and are frequently on call due to a shortage of medical officers. They work straight on for 34 hours, which is inhuman.
Also, apparently MOs are not keen to work in semi-urban or rural areas.

We predict that there will never be enough MOs in the Health Ministry as it is a hard life and less lucrative than working in the private sector or setting up private practice.

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