11 December 2009

We got something right!

One of my responsibilities, when moving to a new post, is to assess local medical resources. Most cultures are more formal than the American culture, so there are official introductions, sometimes the exchange of small gifts, often tea or coffee, and polite chatting before we get down to the business of me asking, “What can you do for the official Americans in your country?” Not in those words, of course, but that is the real purpose. I will visit the hospital or clinic and ask nosey questions to determine if the facility is acceptable to me, and those I serve.

I continue to be surprised by the hidden jewels I find in the most unexpected of places around the world. I remember the husband-wife MD team—Harvard residencies—working in a truly backwater clinic in Rwanda and, in Guinea, the tropical disease expert from Germany. I have never served anywhere that I couldn’t find at least a few excellent physicians.

Nursing is another matter. Frankly, most of the countries in which I have worked undervalue the nursing discipline, and a few—Guinea and Afghanistan come to mind—don’t recognize the discipline at all. Nursing in these places is an OJT technician job with little formal training and no respect. In more modern countries, nursing usually requires formal education but falls short of the critical thinking required in countries with the highest standards of nursing care.

I recently had dinner with a German nurse who was lamenting that nurses in her country, while highly educated, were underutilized as integral members of the health care team. She was intrigued by advanced practice nursing and commented on the ways in which the German system could benefit from such a program. Finally, she said, “You Americans have really got it right!” Now, there’s a comment I never hear. I usually have to listen to all the things we Americans have wrong.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

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