Officials divided as nurses forced multitask in dispensaries

Officials in the health sector in Busia are divided over the duties of nurses deployed in dispensaries by the county government.

This happens even as nurses in various facilities are forced to work in multiple sections to serve patients whose numbers are growing.

Nurses who spoke to The Standard lamented having to discharge all medical duties including some that are beyond their capacity.

Most of the dispensaries that are functioning have two nurses with one serving as in-charge of the facility. None of them has a Clinical Officer.

They examine the patient, carrying out tests in the laboratory, prescribe, dispense the drugs in the pharmacy, keep records and provide nutrition services as well.

This has not gone down well with the association of the clinical officers in Busia.

According to the Secretary-General of the Kenya Union of Clinical Officers (Kuco) in the region Philemon Nakoche; nurses were doing jobs that are not theirs.

Mr Nakoche said examination of a patient and prescribing of the drug is the mandate of clinical officers.

He maintained that tests must be done by laboratory technician while pharmacists ought to dispense the drugs as nutritionist offers nutrition services in dispensaries.

The official warned that misdiagnosis was inevitable.

"Allowing nurses to execute all medical assignments in a dispensary borders on gambling with life of a patient,” he said.

“It is a clinical officer who should examine the patient, if possible send him or her to the laboratory technician, the result from the lab will determine the drug pharmacists should give the patient.”

He continued: "It concerns us when nurses are the one examining the patient, carry out tests and prescribing drugs in our dispensaries. If the county is honest that it wants to improve quality of medical services, then let everyone do what is qualified to do.”

The county has about 134 Clinical Officers with 50 more trained officers serving as as interns in referral and sub county hospitals.

Kenya National Union of Nurses (Knun) Busia branch chairman Isaiah Omondi differed with Mr Nakoche.

Omondi argued that nurses were justified to render all medical duties in dispensaries.

But the official confessed that nurses were doing jobs that do not fall under their job description like record keeping and inventory of drugs.

He regretted that nurses do donkey work but they are paid poorly.

Omondi observed that as per scheme of service, nurses posted in dispensaries are allowed to evaluate doctors, do some basic tests and prescribe drugs.

The union official disclosed that only nurses with diploma and certificates are posted to the dispensaries.

“It is called work-overload, nurses at the dispensary even keep records when it is not their work,” said Omondi.

“Nurses are always on strike because they do everything but poorly remunerated. Nurse is everything at the dispensary. Some works fall under them naturally,” said Omondi.

Chief Officer for Health and Sanitation Dr Isaac Omeri held that nurses are right to examine a patient, carry out test in the laboratory and prescribe drugs, the Kenya Union of Clinical Officers (Kuco) has stated that such assignments should be executed by Clinical Officers.

He however admitted that every laboratory and pharmacy must have a laboratory technician and pharmacist respectively.

“The law allows some nurses to examine patients and prescribe necessary drugs for the ailing person, because during their learning, they were exposed to wide trainings,” said Omeri.

He attributed the move to post nurses to run dispensaries to an acute shortage of staff in the health department. At the moment, there are 1,258 workers in the health docket.

“The demand for medical services in our public health facilities is increasing by day and yet we have limited workforce. We had to resort to take some nurses to be in charge of dispensaries and attend to patients,” said Omeri.

The Standard visited Malanga Level Two Dispensary in Nambale. There are two nurses with one Judith Matendechere being the Nursing Officer.     

Records show at least 40 patients seek treatment Malanga dispensary daily.  Inquiry on the responsibilities for the pair revealed that the two have obligation of discharging all duties from Monday to Friday between 8am and 5pm.

If one is away, on leave or attending seminar, the remaining nurse at the dispensary executes all tasks. They only refer cases that are beyond them to Nambale sub county hospital which is at least 10km away from dispensary.

The facility has a pharmacy and a laboratory room. “Here we do everything including examining the patients, testing and prescribing the drugs,” said Ms Matendechere adding that,” We only refer cases deemed beyond us to Nambale sub county hospital for further treatment.”

The facility was started by the community in 1989 after getting tired of commuting to Nambale in search of medication.

There are at least major projects including maternity wing, house for the staff and new laboratory structure that have stalled.

Omeri said some Sh2million have been factored in the current budget to facilitate the completion of the stalled projects.

At Bukalama dispensary in Matayos constituency the situation is similar. The two nurses are responsible for everything. The Nursing Officer Laura Sungu said there was need for each dispensary to have three nurses.

“We are the doctors, nurses, pharmacists, laboratory technician, nutritionists literarily everything in the dispensary,” said Ms Sungu.

She added,” It is strenuous for us but we have to do, it is difficult to send away the patient because you are tired.”

She said most of her colleagues are well equipped with knowledge on family planning, assisting expectant mothers to deliver and patients drugs clinical officers has prescribed. 

The county is currently battling a case at the Busia High Court where 28 children developed weak limbs, hands and spinal cord after receiving injection at the Akichelesit dispensary in 2015.

They were later airlifted for specialised treatment at Nairobi Hospital before they returned to nurse various injuries occasioned by malaria injection.

The then then Busia Resident Magistrate Josephine Maragia ruled in 2017 ruled that the children were victims of professional negligence and were not given proper diagnosis and treatment by a competent medical practitioner.

Recently the parents of the victims told The Standard that the injection was done by a nurse. Busia County government has failed to compensate 28 victims as per the ruling of Maragia.

It is against this backdrop that victims have moved to High Court to help them get their compensation by compelling county to effect the payment.