Tough working conditions and the lure of better-paid jobs abroad have shrunk Fiji’s nursing workforce.
Fiji’s nurses go to extraordinary lengths to care for remote communities across 100 inhabited islands.
Filomena Talawadua, general secretary of the Fiji Nursing Association (FNA), provided a snapshot of the challenges her members face when she addressed NSWNMA annual conference.
She said 98 of Fiji’s 223 government health facilities are in very remote locations.
Via a series of slides, Filomena showed her members walking along rough tracks, riding horses and wading and rafting across rivers in order to reach their patients.
“Even if you’re not familiar with [horses] you have to find a way to be able to get on that horse. I’ve been there, I’ve done it and I tell you it’s an experience you wouldn’t want to talk about,” she said.
Showing a photo of a nurse wading a river, Filomena said, “To reach one of his villages he has to cross that same river 28 times with the depth of the river varying from ankle height to up to his neck.”
Another picture showed a nurse’s husband carrying a baby in a sling carrier and a box of medical supplies while accompanying his wife on her rounds.
A third photo showed two nurses ferrying vaccines across a river on a bamboo raft.
Fiji has to meet such challenges with fast-diminishing nursing workforce.
SKILL DRAIN
Nurse numbers fell by 807 or 23 per cent between 2022 and 2023 after steep declines in previous years.
Ministry of Health figures show the number of nurses “actually on the ground now” is only 1826, indicating 984 nursing positions are currently vacant, Filomena said.
The country’s sole psychiatric hospital, St Giles, has only 53 nurses instead of the required 178, she added.
“Right now, we have a skill drain. We have even had lecturers who have left Fiji to come to Australia to work as caregivers.
“We now have a population of nurses who are very young because most of our senior nurses and middle managers have left.
“If the system undervalues them, we cannot blame them. If they are happy to be here, we are happy that they are here. But we would be happier if they could work [in Fiji] as RNs sometime soon.
“ The exodus [of nurses] has completely depleted the system in so many ways.”
She said the skill drain had weakened child health services resulting in an increase in morbidity among children under five.
NATIONAL CRISIS
The FNA is urging the government to declare a national nursing crisis.
“When [the government] declares something as reaching a stage of national crisis they have reserve funds for it and they need to pull out those funds and address the situation.
However, they continue to say we are managing, so for us it’s been hard. But we say, OK we’ll see how long you will wait.
“That is what we’ve been doing since 2022. We feel that there needs to be policy intervention. We need to have workforce retention strategies that we are part of.
“But when it comes to top level government policymaking we are shunned as an organisation.”
Filomena said nurses sometimes forgot the importance of their role and “we have allowed our systems to bully us and to undervalue us”.
She said experienced nurses were educated and trained at Fiji’s expense “and then we lose them through the lucrative offers that other countries offer them”.
She said Australia and New Zealand were “top of the list” of receiving countries.
She called for collaboration between Fijian and Australian nursing unions to lobby governments to find ways of encouraging nurses to remain in Fiji.
BIG WAGE GAINS
On a positive note, Filomena said more than 80 per cent of public sector nurses had joined the FNA, which recently won pay increases ranging from 15 per cent to 41 per cent.
Nurses achieved the increases after voting for industrial action in a secret ballot in November 2023 and following a series of mediation sessions.
“There were times when I really just wanted to throw in the towel. But I’m a nurse – a community health nurse for that matter and a nurse educator for 15 years before I retired.
“I’ve been there when you’re not appreciated, when you’re undervalued, when they take you for granted.”
Eventually, the union achieved big wage increases thanks to “commitment, courage, teamwork, patience and perseverance” and she hoped these gains would attract nurses back to Fiji’s healthcare system.■