two female nurses talking to each other in an ICU
Nurse educator Lauria Cadet (right) talks with nurse Hugenita Leopold in the neonatal intensive care unit at University Hospital in Mirebalais, Haiti.
Photo by Cecille Joan Avila / PIH

Nursing

Nursing

For a mother laboring in the mountains of Lesotho or a child suffering from cholera in Haiti, access to qualified nurses and midwives often means the difference between life and death.   

At PIH, nurses and midwives comprise 50 percent of our clinical workforce and are integral to delivering comprehensive, patient-centered care.  

Globally, nurses play an essential role in delivering health care and strengthening health systems. 

At nearly 28 million strong, according to the World Health Organization, nurses and midwives make up the vast majority of the global health workforce and deliver the bulk of health care services.  

But the global distribution of nurses is far from equitable. Five times more nurses work in high-income countries than in low-income ones, the WHO states, despite the higher burden of disease in poor countries. Consequently, clinics and hospitals in low-resource settings are overwhelmed by patients and grossly understaffed. Nurses often shoulder this burden with low pay, few educational opportunities for advancement, and inadequate resources to care for their patients. 

PIH’s emphasis on support aims to change that. We invest in nurses and midwives and call on our partners in ministries of health to do the same. Across all of our PIH-supported health facilities around the world, we collaborate with our colleagues to develop best practices for global patient care in resource-limited settings, tailored to country-specific contexts; strengthen nursing education; develop pathways for career advancement, and cultivate the nurse leaders of tomorrow. 

Nurses as Educators & Clinical Experts   

Educating the next generation of nurses is critical to delivering high-quality health care. Our nurse educators and mentors provide teaching and hands-on instruction, encouraging capacity-building and knowledge transfer by creating a support system for fellow nurses as they expand their skills and knowledge, establishing systems that ultimately improve patient care.   

In Haiti, where PIH is known as Zanmi Lasante, much of that training takes place at University Hospital in Mirebalais, internationally accredited for its medical education. Through the Nursing Center of Excellence, we support nurses throughout the Haitian health system, aiming to formalize nursing practices, build the capacity of the health care workforce, and meet the region’s urgent needs for specialized care.    

Some of our nurse educators in Haiti focus on key specialties—such as maternal health, pediatrics, critical care, mental health, and surgery—enabling us to expand the expertise of our workforce and respond to more of our patients’ needs.  

Our nurse education program in Rwanda, where PIH is known as Inshuti Mu Buzima, takes a similar approach. Since 2010, the Mentoring and Enhanced Supervision at Health Centers (MESH) program, launched in collaboration with Rwanda’s Ministry of Health, has connected nurses with experienced mentors in rural health centers, for mentoring and support to advance their skills.   

Additionally, PIH’s oncology program in Rwanda is deeply committed to nurse education. The oncology program at PIH-supported Butaro District Hospital, and its Cancer Center of Excellence, partners with the Dana-Farber Cancer Institute to support the development of Rwandan oncology nurses and continue to improve the quality of care and life for the most vulnerable and complex patients.  

In Liberia, nurses from J.J. Dossen Hospital have partnered with the local Tubman University to mentor and teach nursing students, improving basic emergency and neonatal care and modeling respectful, compassionate maternity care on the wards.  

Improving Patient-Centered Care  

As we train and support nurses in resource-limited communities worldwide, we develop best practices for global nursing care and work to improve patient outcomes, especially in maternal and child health.   

In Lesotho, nurses at PIH-supported clinics have driven the integration of maternal and child health services, leading to the creation of the Maternal Mortality Reduction Program (MMRP) in 2009.  

The program, piloted at PIH-supported Bobete Health Center, has vastly improved the lives of mothers and children in a country with one of the highest maternal mortality ratios in the world. In the year before the MMRP launched, only 46 women delivered at the Bobete facility, rather than at home. In the program’s second year, 216 women safely delivered their babies there. Since then, we have further strengthened our efforts in Bobete and expanded to seven additional facilities around the country.  

PIH Liberia also has prioritized reducing maternal and neonatal mortality. In Liberia, most maternal deaths correlate with pregnant mothers being unable to access health care because of long commute times and poor road conditions. In response, PIH-supported facilities at the community level train and empower local nurses to identify, triage, and promptly refer expectant mothers to higher levels of care when needed.   

Kangaroo Mother Care is another intervention for women and newborns. In response to the country’s high rates of preterm birth and neonatal mortality, PIH Liberia—in collaboration with the Ministry of Health and staff at J.J. Dossen Hospital— developed the innovative program known as KMC.  

Since 2017, the community-based program has facilitated safe early discharges and accompanying follow-up for vulnerable preterm infants. The KMC program emphasizes frequent skin-to-skin contact between mother and newborn; support for breastfeeding or other methods, such as syringes, for infants too weak to breastfeed; and weekly home visits after discharge to monitor infants’ weight, health, and signs of infection. Normally done in hospital settings, PIH and its nursing program have adapted KMC to reach patients at their homes and communities.  

Supporting Nurse Leaders  

Through fellowships and professional development opportunities, we accompany nurses through their careers and cultivate the nurse leaders of tomorrow.   

Our yearlong fellowship program—the Global Nurse Executive Fellowship—has supported emerging nurse leaders since 2017. The fellowship seeks to fill a void of support for nurses in senior or executive leadership roles, who often are placed in their positions without being given the necessary tools, skills, platform or support needed to be successful. 

The program provides online instruction and webinars, monthly conference calls, and mentorship from veteran nursing leaders, while also requiring each fellow to complete an individual capstone project in the country where they work.    

And at the University of Global Health Equity, a PIH initiative in northern Rwanda, work is underway to build a cutting-edge nursing and midwifery center that will transform the nursing and midwifery profession in Africa, through offering world-class global health education and training for nurses and midwives, who will in turn advocate for, care, lead, and teach the poorest and most vulnerable. 

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