The Healthcare sector in the Caribbean

The Healthcare sector in the Caribbean

The Healthcare sector in the Caribbean has been facing numerous challenges, particularly a shortage of nurses. The Caribbean has a majority of people who study nursing, but once done; they end up migrating to developed countries in search of better remuneration packages. The nurses migrate mainly to regions such as Canada, the United States, and the United Kingdom. This migration of nurses has become a significant concern for countries in the area as there remains an average of 40% in vacancies rates in the Caribbean countries. It is paramount that this massive human resource issue is remedied and feasible implementation strategies sort.

Background Information

Research shows that the primary motivation for nurses to migrate to other regions in search of professional growth, advancement in their education, and also financial incentives that are offered. These factors make the developed countries seemingly attractive for the nurses who are in search of better lives for themselves and their families. These factors are referred to as pull factors in that they attract the nurses to migrate to the developed countries. The push factors, on the other hand, include poor remuneration, which is usually the most significant challenge when it comes to attracting employees. Other issues include a lack of professional development and stressful working conditions, all of which are attributed to dissatisfaction. Developing countries often face massive challenges when trying to retain employees, especially in sectors being sensitive. According to Bakuwa RC, Chasimpha F, Masamba (2013), most employees leave an organization when there is a lack of job satisfaction. Job satisfaction is critical, and lack thereof can motivate an employee to leave an organization even when the remuneration is considered to be lucrative. These researchers from Malawi (Bakuwa, Chasimpha &, Masamba, 2013) determined that numerous issues can cause dissatisfaction in employees.

According to their research, the level of dissatisfaction amount the respondents was attributed to various aspects of their jobs and work environments. The highest level of dissatisfaction was due to the level of pay and benefits, which were quite low compared to standard market rates. For this reason, the employees would view other jobs as attractive and would actively try and find alternative employment (Bakuwa, Chasimpha & Masamba 2013). Still, employees also find dissatisfaction in their careers when their high performance does not get any form of recognition.

In the Caribbean, various issues have created for the high shortage of nurses in the region. Challenges are associated with multiple languages and connections within and outside the areas. These challenges are related to struggles for the countries in the region to attain social and economic independence. Countries facing massive nurse migration include the English-speaking states such as Bahamas, Jamaica, Barbados, Belize, Dominica, and Grenada, among others. Other challenges brought about by the shortage of highly trained nurses in these countries also affect the economic growth of the Caribbean states. This effect is because when there is this amount of scarcity, then businesses and retirees avoid investing in the region. After all, they believe there is a lack of quality health care (Caribbean growth hurt by nursing shortage). Nurses are paramount for a health system to be considered highly functioning in any country. This is because of the care they provide to patients and assistance to the doctors. Lack of this efficiency makes the health care system crumble as there may be risks involved.

Some of these risks include patients having infections after surgeries due to a lack of proper aftercare. This makes it extremely important for the states to come together and find solutions. Countries like Jamaica, in particular, are undergoing a critical shortage of nurses, whereby above fifty percent of nursing positions were vacant in 2003 while the rate of retirement and labor turnover continuously increase (Salmon et al. 2007). The Ministry of Health in Jamaica, the more nurses, graduates, the more experienced and highly trained nurses migrate to developed countries. This leaves the fresh graduates and untrained nurses to fill the positions. The nurses are reported to work extra hours and additional shifts to cater to the shortages and maintain continuous care for the patients (Salmon et al.

2007). The shortages create stressful working conditions for the nurses who are there, and this also compromises the quality of care offered to the patients.

The shortage of nurses does not just affect the Caribbean but also affects other developing countries. According to Lancet 2007, fifty-seven developing countries experience shortages in health workers. The states would need an additional four million health workers to address the health issues in the countries. The developing countries face challenges similar to the Caribbean brought about by the nurse migration to developed countries. Research shows that when these countries are drained of their skilled talent, they end up relying on loans and grants from abroad to sustain their health care system (Li, Nie & Li 2014). Still, they also face education expenditure where most developing countries subsidize nursing education only for these nurses to move to a new country carrying with them the skills and training.

For instance, in the Philippines, seventy percent of graduate nurses move abroad. These issues create a necessity for strategies to implement and tackle this issue (Li, Nie & Li 2014).

Human Resources Management Theories

When organizations face issues with their personnel, the most recommended direction is to look at it from a human resources management point of view. This would be the same recommendation for this issue facing nursing in the Caribbean.

The HR Value Chain Theory

Human resource management has various theories, when implemented, would be essential in solving issues in organizations. One such approach is the HR value chain theory. This theory is among the best-known models in human resources and is based on the work of Paauwe and Richardson (Vulpen, 2018). The theory explains that everything that takes place and can be measured in an organization can be divided into activities and outcomes. The primary purpose of human resources is to impact results positively, and it is this set of links between the HR and the results that are referred to as the HR value chain (Vulpen, 2018). The HR activities are the activities involved in the day-to-day operations of the department, such as recruitment, training, succession planning, and compensation. This theory rotates under the belief that the cheaper we hire, the faster we train, then the better for the organization. The outcomes, on the other hand, are the goals that are to be achieved through the HR activities. These outcomes can vary from employee satisfaction, motivation, and, eventually, retention. If an organization focuses on these activities, then the theory explains that the outcomes will be achieved.

For the Caribbean countries to implement this theory, they would need to understand the HR activities that would be involved to attain the desired outcomes, which in this regard would be the retention of nurses recruited. The first activity, according to the value chain theory, is workforce planning, followed by recruitment and selection (Vulpen, 2018). In any organization, before beginning recruitment, it is imperative to ensure that the organization looks at the current workforce in place and identify the gaps that need to be filled. In this case, the gaps are evident; however, it is still essential to identify the specific areas that require recruitment in hospitals. These could range from intensive care to pediatric wings. The countries need to understand that the hiring of nurses needs to be quality hires. However, how do they attract the quality of nurses desired to have the health sectors operating at their optimum? This would be through attractive compensation and benefits.

Governments need to understand that investing in the health care sector is imperative for every country. This investment should also include the salaries and benefits of healthcare workers. Nurses are attracted to the developed countries due to the compensation that is given in these countries. The governments subsidize nursing education because they believe in the importance of the nurses to the health sector (Li, Nie & Li 2014). This reason should also be applied to their compensation and benefits. In Human resources, compensation and benefits should, at a minimum offered based on equal pay for equal work done. When an employee feels that their work is valued and their worth recognized, then they become incredibly productive.

Once the compensation and benefits are guaranteed, the Caribbean health sectors should then look into training. Once recruitment and selection are made, particularly the recruitment of students who graduate from nursing schools, training is paramount. This would ensure that the recruits have confidence in their skills and can be able to work well unsupervised. It is through training that employees gain skills and productivity increases (Vulpen, 2018). Given how delicate the health sector is, training of the recruits should be mandatory. This is because any mishaps or mistakes by unskilled staff can lead to catastrophic outcomes. Nurses are involved in the day to day care of patients and should be highly trained to avoid causing any harm to the patients. Training, however, can be expensive for a hospital that may be understaffed, and it is up to the governments to stand in and provide this support.

Still, another HR activity that should be practiced is talent management. Employees who are high performers should be recognized as this profoundly impacts the level of job satisfaction for the employees. Those who are deserving of promotions should be promoted or coached into leadership positions. This direction is not only beneficial for the employees but also assists the organization in its succession planning. Succession planning is a vital part of any organization and its HR activities. It ensures that the organization has a sense of direction for years to come, and those working in the organization in the future have a sense of direction.

The HR outcome that would be achieved by all these activities, according to the theory, is several beginning with employee engagement. Employee engagement happens when employees are trained and are confident with their skills. This engagement can, therefore, be accomplished through training of the employees to enhance their skills. Still, employee engagement happens when employees do not feel overworked and underpaid. Recruitment and fair compensation would be instrumental in ensuring employee engagement. When employees are engaged, they work more efficiently, and productivity in the workplace can be experienced.

Another outcome that would be achieved is employee retention. Employee retention means that the rate of turnover would be relatively low since employees would not be seeking to leave their place of work in search of better employment. This low turnover rate can be achieved through fair compensation, as mentioned early and also through ensuring job satisfaction. Job satisfaction, as earlier mentioned, can be achieved through recruitment and selection, which provides that no employees are overworked, and remuneration is fair. Still, recognition of performance is essential in employee retention. It makes employees feel adeqaute and gives them a sense of loyalty and belonging.

Another outcome that would be beneficial is a decrease in absenteeism in the workplace. Often when employees are disgruntled, there is increased absenteeism where employees call in sick or are always finding excuses not to come to work or getting to leave work early consistently. This can cause productivity to reduce massively and affect the organization through decreased revenue. All these would be achieved through ensuring the policies apply the HR value chain theory such that the activities take place and lead to the desired outcomes, with the primary goal being employee retention.

The Harvard Framework for Human Resources Management Theory

The Harvard framework for HRM is an HR model that involves six models that influence the HR policies in an organization. One of these components is the stakeholder interest. Stakeholders in an organization comprised of the management, the government, the shareholders, and the employees, among others. The stakeholders’ interest is paramount when it comes to the definition of human recourses policies.

According to this model, the stakeholders’ interest is influenced by situational factors comprised of employee unions and these characteristics of the workforce. The situational factors and stakeholders’ interests combined to influence the policies. The policies are the core human resource activities that are similarly mentioned in the previous theory to include recruitment, training, and reward systems. When these policies are affected well, they leave for positive human resource outcomes such as employee retention, commitment, competence, and cost-effectiveness. These outcomes are instrumental in ensuring that long term consequences for the individual employees, organization, and sector are positive.

An organization is bound to achieve its goals successfully when the human resource factor is well utilized. This is because the human resource is vital in ensuring the organization achieves its goals and objectives. The organizations need policies that provide employees and management with a sense of direction while all stakeholders believe that their interests are being considered. The Harvard framework model explains that for organizations to achieve the targeted performance, it needs to identify, gain commitment, and implement a set of practices such as reward management. It implies that employees need to be highly committed to their work to achieve set targets. The best collection of practices should also be implemented to ensure the commitment of the employees.

The organization, according to this framework, needs to find ways in which employees remain motivated to improve employee output and accomplish organizational targets. All these are vital in the achievement of employee retention. Retention is particularly essential because it assists in reducing turn over costs, which are often incurred when organizations have to recruit and train. Turnover costs usually include the costs of hiring, training, and productivity losses. Productivity losses are the losses incurred when an employee is less productive in the workplace due to a lack of motivation or other underlying factors. The lack of productivity can be due to absenteeism, lack of competent skills of inefficiency in the employees. Retaining talented employees from getting poached can be an organization’s biggest challenge, but when policies are well implemented, it can be very cost-effective for the organization.

HR activities such as recruitment, training, and reward management, are vital in that the recruitment, as mentioned earlier, attracts talent to the organization. Training is essential as it ensures that the employees gain the required skills and become competent in their work. Reward management is also paramount and, as mentioned in the previous, as it pertains to rewarding employees for their performance. Reward management may require investment from the organizations when it comes to promotions and salary increments. The reward may also mean allowing employees to advance their skills through job enrichment or job enlargement. All of these would have to be included in the policies which would not only apply to the organizations currently but also in the future employees would be able to maintain the culture.

When applying to the health sector, it is evident that these two theories and models would be instrumental. Both theories agree that human resource activities such as recruitment, selection, and performance or reward management are vital in ensuring the retention of employees in any organization. The policies implemented should discuss the activities above. These would be paramount for the sector to achieve the desired outcomes. However, financial input is vital for the implementation of all these. Financial input would be instrumental in since there would need recruitment costs, which entails the advertising of jobs and the salaries that would be required for the recruits. Financial input would also be necessary for the training costs whereby the recruits, as mentioned, would need the right guidance when joining the sector. Most organizations may opt to train their recruits internally if they have a robust learning and development industry, but in most cases, training is often outsourced. For the health sector, learning on the job is usually part of the training, but it still requires financial input to have trained nurses training the recruits.

Financial input is also paramount, whereby good motivators for employee retention include incentives perks and cash prices. Sandhya explains that performance appraisals are also essential in motivating employees. Increased performance assists in high productivity, while Maslow’s theory knows as Maslow’s Hierarchy of needs explains that motivation helps the employees to satisfy their needs. The theory illustrates that the lower the need the higher the need to influence their behavior. These are needs, such as food, shelter, and air. When these needs are satisfied by the job at hand, then the individual becomes motivated.

This theory particularly applies to the nurses, whereby the Caribbean countries being developing countries, means that the livelihood of the people in the region could be difficult in terms of having food and shelter. The people struggle to find means of satisfying their basic needs and may find it necessary to travel to foreign lands to assist in taking care of the family. According to Maslow’s theory, the next level is usually safety needs, which include personal security, job security, financial security, health, among others. This is particularly the same for most people in employment where their jobs are usually a means of satisfying these needs. Employees use these jobs as a means to meet these needs and build a sense of security for their lives. When an employee is guaranteed this safety and securities, they are bound to remain in their current employment. This ideology dramatically applies to the nurses in the Caribbean, whereby they are looking for ways to survive and take care of their families.

Esteem needs are also part of the hierarchy whereby they are derived from the need for acceptance and recognition, prestige, and status. When employees are satisfied in terms of feelings of adequacy, competence ad confidence in their work, then employee retention can be achieved. This theory, when connecting to the other theories, explains that employees, even nurses, need to feel appreciated for their hard work. This can be achieved through employee rewards. Rewards make the employees feel adequate and competent and eventually impacting confidence in their work. Still, training is vital for the employees as it is a sure way of ensuring competency and also instilling confidence in the employees.

Maslow explains that the need for growth usually has an everlasting effect on employees and can significantly impact their motivation. The hierarchy of needs from top to bottom is al psychological needs. Still, the most important of all is influencing the behavior of the employees, even when the needs are deemed as low-level needs in terms of priority, they are still relevant. This is because they have a massive impact on the employees’ interest and commitment. Evidently it is important to be aware what the employees in any organization needs and where their needs fall in the hierarchy. Having this knowledge would be paramount as it is part of the stakeholder interest and would be vital when creating the policies. The stakeholders’ interests, however, should also ensure that the management interests are taken into account, which mainly entails profit maximization. This means that all policies, strategies, and implementation of strategies should work towards the main goal being profit maximization. The policies should not lean on one side while ignoring the interest of the management who are the employers or even the interest of the government, which implements the laws of the country.

Conclusively, it is evident that the nurse migration from the Caribbean to the developed countries has had a massive impact on the Caribbean countries, especially countries like Jamaica. However, it is up to the health sectors and the government to implement substantial human resources policies that would curb the issue. The HR value chain and the Harvard frame both discuss the same strategies that would be vital in ensuring that employee retention is achieved. All these strategies, however, require financial input, which would need the government and government bodies to provide the same. When these are implemented, then they would ensure that nurse migration reduces, and the health sector is saved.