The gap in the Cancer Nursing Care and Education. Challenges for Latin America

CANCER ISSUES IN LATIN AMERICA AND GLOBAL IMPLICATIONS

LUZ ESPERANZA AYALA DE CALVO. Colombia

Oncology Nursing in Latin America

Current situation

• Education in oncology

• Working conditions

Challenges of the region

2

General Problems in Nursing Education

• Few formal programs (graduate)

• High cost

• No real existence of scholarships

• Financing Individual (personal)

• Minimal, if any, government support

• Absence of continuing education

• Various levels of education within a country

• Variables academic titles between the countries

• Limited possibilities of studies and further training

• Absence of recertification requirements and professional accreditation.

La Enfermería en América Latina. Situación actual, áreas críticas y lineamientos para un Plan de Desarrollo Nájera Rosa María -Castrillón A. María Consuelo 2001

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Work in Nursing

• Nursing staff consists of three or more categories of staff

• Persists in some countries empirical occupational groups.

• Leads to lack of clarity in the division of tasks

• Interferes with the cost effectiveness of nursing care

• Causes deterioration of the social positioning and image of the professional group.

La Enfermería en América Latina. Situación actual, áreas críticas y lineamientos para un Plan de Desarrollo Nájera Rosa María -Castrillón A. María Consuelo 2001

This heterogeneity

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Nursing working conditions

• NURSES ASSUME DISPERSED ACTIVITIES:

• Personnel Administration

• Management of material resources

• Record in different Information Systems

• Billing and tasks not performed by other staff.

• Work overload ( Nurses/patient ratio, paperwork, etc.)

• Social and economic value of the profession Decreased

• Anarchy in the allocation of duties by the administrative bureaucracy of the health institutions

• Commodification of health

• Low investment in human talent within health systems (Salaries, training and education)

5

La Enfermería en América Latina. Situación actual, áreas críticas y lineamientos para un Plan de Desarrollo Nájera Rosa María -Castrillón A. María Consuelo 2001

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Some ideas about our reality ......

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COUNTRY #

ARGENTINA 11

BRAZIL 5

COLOMBIA 18

COSTA RICA 1

ECUADOR 1

MEXICO 4

PANAMA 2

PERU 5

TOTAL 47

COUNTRY #

BOLIVIA 0

CUBA 0

CHILE 0

GUATEMALA 0

VENEZUELA 0

Number of completed questionnaires

Education in Oncology Nursing

Differences in access and levels 8

Oncology Nursing Education

Short courses Refresher in

oncology topics Continuing education

Diploma, certification for

oncology

Professional Education

Basics of oncology in

nursing programs

Specialization in Oncology Nursing

Postgraduate

Master of nursing, with

oncology emphasis

Doctorate in nursing,

emphasis on oncology issues

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Specific training on Oncology Nursing

Country Nursing

assistant

Technologi

st

Nurse Specializatio

n

Master's

degree

PhD

Argentina* X X X X X X

Brazil X X

Colombia X X X

Costa Rica X X

Ecuador X

Mexico X X X X X X

Panama X X

Peru X X X

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Oncology Nursing Education Access difficulties

Lack of time / Rigid work schedules

Absence / Lack of formal academic programs

High cost / Self-financing necessary

Absence of scholarships / Weak institutional support

Little or no knowledge of English language

It is not a priority in national cancer health care plans

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Oncology Nursing work conditions Induction New staff /requirement to work in oncology

COUNTRY NUMBER OF DAYS FOR INDUCTION

2-3 7-10 15 30 45 60

Argentina X X

Brazil X X

Colombia X X X X X X

Costa Rica X

Ecuador X

Mexico X X X

Panama X

Peru X

* Only some institutions require specific training or experience in oncology

Y: YES* N: NOT

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REQUIREMENT FOR

Training Practice

N N/Y

Y Y

N/Y N/Y

N N

N N

N/Y N/Y

N/Y N/Y

N/Y N/Y

Working conditions of oncology nurses

Working another

institution

Or double shift

Yes

Yes

Yes /No*

No

No

Yes*

Yes

Yes

Yes: ECONOMIC

reasons

*No: Job schedule, Institutional

policy

*Job Location below training

level

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Country Hours worked per week

21-30 31 - 40 41- 50

Argentina X X

Brazil X

Colombia X X

Costa Rica X

Ecuador X

Mexico X

Panama X

Peru X

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Average monthly salary in dollars by education level (2010)

COUNTRY ASSISTANT

NURSING NURSES SPECIALISTS

NURSES MINIMUM

WAGE $ USD

Argentina 300 - 500 501 - 800 501 – 800 200

Chile 801 - 1200 1201 – 1800 1801 - 2500 320

Colombia 300 - 500 501 - 800 1201 – 1800 250

Costa Rica 501 - 800 1801 - 2500 1801 - 2500 380

Cuba ¿? ¿20? ¿25? ¿30?

Ecuador 300 - 500 501 - 800 1201 – 1800 240

Panama 300 - 500 501 - 800 1201 – 1800 350

Uruguay 300 - 500 501 - 800 501 – 800 200

Venezuela 300 - 500 501 - 800 801 -1200 NR

LATIN AMERICA 800 1500 (Physician)

United States* 4220 7060*

Survey Working and educational conditions of oncology nursing in Latin America Ayala de Calvo, Luz Esperanza. 2010

*Advanced Registered Nurse Practitioner (ARNP) $84,730/ year, Registered Nurse (RN) $26.39 per hour. 2014 numbers.

Prioritized location of oncology nursing trained staff Country Chemotherapy BMT Mix Radiotherapy Surgery ICU ER Nursing

clinics

Other

clinics

*Patients O I I --- O I O I I O O O

Argentina 1 4 2 3 5

Brazil 1 3 5 2 4

Colombia 1 2 4 3 5

Costa Rica 1 4 2 3 5

Ecuador 1 3 2 5 4

Mexico 1 3 2 4 5

Panama 1 4 3 2 5

Peru 1 2 4 5 3

*O = outpatients I = inpatients

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PRIORITY NURSING ACTIVITIES / RESPONSIBILITIES NURSES ASSISTANTS

Education to patients before starting chemotherapy 1

Control of fluids administered and eliminated 1

Physical assessment of patients before receiving chemotherapy 2

IV fluid administration 2

Administering IV chemotherapy* 3 +

IV equipment installation, Central Catheters 4 6

Direct care to surgical inpatients 4

Education to patients undergoing chemotherapy 5

Administration of premedication* 6 3

Review of clinical tests before and during treatment 7

Comfort measures or assistance in the management of side effects 5

Preparation (mixing) for IV chemotherapy 8 7

Education families about patient care* 8 16

Oncology Nursing activities performed less

*Professional responsibilities

*NURSES ACTIVITIES: MINIMAL OR NOT MADE

1. Physical assessment of patients before receiving radiotherapy

2. Monitoring and control of outpatient treatments

3. Identification and management of treatments side effects

4. Direct care to surgical inpatients

5. Education to families about patient care

6. Patient education before starting radiotherapy

7. IV fluid administration

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Perception of oncology nursing care SURVIVED PARTIES

No opinion

Bad Not good/

not bad

Good Excellent

Patients receiving care 6 53 41

Other nurses 6 11 60 23

Other oncology professionals 8 6 6 61 19

Institutional managers 11 6 19 45 19

Professionals from other institutions

14 16 39 31

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Laura A. Levit, Patricia A. Ganz Delivering High-Quality Cancer Care. Charting a New Course for a System in Crisis. Institute of Medicine of the National Academies. 09-2013. www.iom.edu/qualitycancercare

A High-Quality Cancer Care Delivery System

Challenges for Oncology Nursing in Latin America.

The needed changes.

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Conditions that favor Migration Nursing

• Unsatisfactory conditions of employment and work

• Unsatisfactory social conditions and life

• Limitations on career advancement Local conditions

• Better working conditions, especially wages

• Better social and living conditions for themselves and family

• Access to training, education and professional development

• Aggressive recruitment campaigns (developed countries)

External conditions

• Aspirations and goals (dreams)

• Enthusiasm for high quality practice

• Spirit of Adventure

• Wish to know the world

Personal conditions

MIGRACIÓN DE ENFERMERAS EN AMERICA LATINA. Malvárez, Silvina Asesora OPS. Noviembre de 2006

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Challenges for the immediate future. Institutional level

Implementation of standards of care (Nurses/patient ratio)

Recognition of specialized professionals (better wages)

Better working conditions (resources and fewer hours per week)

Education opportunities in service (Continuing education, graduate education)

Improve occupational protection (access and using specific elements)

2

3

4

5

6

1

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Challenges National level: Leader oncology nurses propose Health Policies

Increase research and evidence-based practice

Application of scientific evidence in daily practice

Various education strategies in oncology nursing

Implementation of standards of care, specific protocol

Recognition of specialized professionals (better wages)

Better working conditions (specifically settings location)

Specific training of pharmacists to mix chemotherapy.

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Challenges for the immediate future. Latin American level

1

Countries share networks on

specific issues of practice nursing

Encourage internships and

training in specialized units

and cancer centers

Working in partnership with

developed oncology nursing

societies

Periodic scientific meetings on

clinical and labor issues

Improve English language training 24

Challenge Education for the immediate future. Latin American level (cont.)

Publications Health

journals Online tools Books

Information exchanges

Internet accessibility to remote areas

and low-income

To translate publications into Spanish

Use online translators

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Pain Control

Palliative Care

Cervical cancer

Tobacco Control

ASC NHI

NCI

EONS

CANO

ONS

WHO ISNCC

Cancer Control

UICC 26

• ICN. Position statement, Occupational health and safety for nurses, 2007. http://www.icn.ch/es/publications/position-statements/

ICN demands fair remuneration that

corresponds to the level of expertise and adequate

career structures that support professional

development.

Raise nurses’ awareness of their rights (as workers) to a

safe environment and of their obligations to protect

their safety and promote the safety of others.

Urge governments/employers to ensure the access of nursing

personnel to protective measures (e.g. clothing) and equipment at no extra cost

to staff.

Position statement, Occupational health and safety for nurses

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Conclusion

References • Nájera Rosa María -Castrillón A. María Consuelo. La Enfermería en América Latina.

Situación actual, áreas críticas y lineamientos para un Plan de Desarrollo.2001

• Siantz, de Leon, M.L., Malvárez, S., (May 31, 2008) "Migration of Nurses: A Latin American Perspective" OJIN: The Online Journal of Issues in Nursing; Vol. 13 No. 2 Manuscript 2.

• Honduran Nurses’ Work-Related Rewards and Challenges: Implications for International Service Learning and Collaboration. http://www.nursingworld.org//Vol-19-2014/No2-May-2014/

• Laura A. Levit, Patricia A. Ganz Delivering High-Quality Cancer Care. Charting a New Course for a System in Crisis. Institute of Medicine of the National Academies. 09-2013. www.iom.edu/qualitycancercare

• Survey Working and educational conditions of oncology nursing in Latin America. Ayala de Calvo, Luz Esperanza. 2014

• Survey Working and educational conditions of oncology nursing in Latin America. Ayala de Calvo, Luz Esperanza. 2010

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Thank you very much! leayalace@yahoo.com

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