Nursing has come a long way in Cayman

Bush medicine was once the source of all cures

Nurses from the past would scarcely recognize the highly-educated, professional registered nurses of today in the Cayman Islands. 

Paid for with whatever families could afford, nursing was not looked on as a worthy profession in years gone by, but the image of nursing has moved from being viewed as somewhat less than honorable to a respected profession today. 

“We are into modern technology,” said Nurse Josie Solomon, 83. “Back in the day, nurses mostly depended on herbs and other bush medicine for a cure. 

The Bodden Town resident became a mid-wife in her late teens and later a general nurse. She said there’s a world of difference in the nursing care of patients today from when she first started in the profession. 

“In my day of nursing, if a bee stung you there was leaf to warm over the fire to heal it,” she said. “We did not have the equipment and the knowledge they have today. Bush medicine was either taken by mouth or used as a topical solution.”  

She said there were no top notch doctors at the time; the one doctor in George Town served the entire districts and nurses worked from their homes. When clinics started to spring up in each district, doctors would do home visits. If the patient could not go to the clinic, then the doctor would go to their house by foot. 

Today 250 nurses work at Health Services Authority serving the Cayman population, according to Health Services Authority Chief Nursing Officer Hazel Brown. 

How nursing differs today 

Mrs. Brown explained how nursing differs in Cayman from when she first started, starting with the fact that today there are more specialist services today. For example, she said today there are obstetricians, whereas midwives did all the baby deliveries in earlier years. There are also public healthcare and mental health services. 

Scientific knowledge is also much more extensive these days and as there are scientific advances, nurses must keep abreast of the advances, she said. 

Information is now available at all times, she noted. When she came home from her studies 35 years ago, nurses were reliant on the knowledge that they gleaned in nursing school and the few texts that they had available. 

“Patients today are very knowledgeable,” she said. “Nurses must be very alert to the sources of information and current in the science of nursing.”  

She said there is an amazing array of technology being utilized in the course of work every day. There are pumps for controlling the flow of IV fluids; before, she said they counted the drops and control the flow manually. There are monitors for vital signs which were carried out manually in the past. 

There are monitors for most bodily functions, today. Nurses in the past measured central venous pressure with a yard stick on a drip stand; today this is done electronically, she said. 

Simple equipment like glucometers, that are now readily availableto everyone, were not around in the past; nurses boiled urine and added chemicals to do specific tests. 

The documentation is electronic, as is all the other medical documentation; patient information is more readily and more quickly available making decisions much more timely. 

Before there was only one registered nurse on duty after hours to cover the entire hospital; today there are more nurses on staff and there are universal guidelines for staffing. 

There are many specialties of nursing that were not available then. Paediatric nurses care for children; neonatal nurses care for newborns; critical care nurses care for critically ill. When she started working, nurses cared for everyone, she said. 

There are also nurses with expanded roles and responsibilities nowadays, like nurse anesthetists and practitioners, she said, adding that there are many other specialty professions on the team taking on responsibilities that regular nurses carried out years ago – like nutritionists, respiratory therapists and biomedical engineers – with each filling their specialized role. 

Nowadays they have 24-hour emergency physician support; when Mrs. Brown first started nursing, physicians were on call for emergencies, but the nurses were alone in the hospital after clinics were done. 

Emergency medical services were not in place; porters drove the ambulance – a retrofitted VW van – and the nurses went to the scene of an accident, or alternately, the victim arrived at the hospital unannounced on the back of someone’s truck. 

There was no pathology staff; nurses assisted with autopsies and prepared bodies for burial. 

There was no dialysis service; today they have a fully functional service. 

Today specific medical and surgical supplies have been developed for most conditions; in times past, nurses often had to improvise, not because they couldn’t purchase them, but because many had not yet been developed. 

Much of what they now have as disposables, whereas supplies in the past were mostly reusable and had to be processed manually for reuse. 

Welcomes Caymanian nurses 

Mrs. Brown said the Health Services Authority welcomes Caymanian nurses, but they are not “desperate for nurses.”  

“In recent years we have had a steady flow of nurses returning to work at the hospital,” she said. “At the Cayman Islands Hospital, we are challenged to keep the balance between the experienced, largely expatriate workforce and the returning Caymanians who have to be supported for a few years as they acquire the skills and the confidence to practice in very complex environments with complex patient populations. Additionally, we are challenged to keep the young Caymanians engaged in a physically and emotionally demanding profession that operates with unsocial hours and more limited financial rewards than those available to other professionals in our economy.” 

Explaining the ongoing nursing program, Mrs. Brown said the University College of the Cayman Islands established a bachelor’s degree in nursing program. She said nursing schools globally are challenged with finding and keeping educators.  

“The compensation for nurse educators is much less attractive than the other arms [of nursing] so fewer persons choose to take that route, leaving schools with a great demand and a poor supply of instructors,” she said. 

According to Mrs. Brown, nursing is a good profession which has been rated by the Gallup Poll as the most trusted profession every year since 1999 [when it was added to the list of professions being rated] with the exception of 2001, when firefighters was No. 1.  

“The sense of doing worthwhile work, of having a life purpose, far outweighs the emotional and other challenges that one faces each day.” she said, adding that she has no memory of ever wanting to do anything else. “I worked at the hospital in the summer while I was in high school and I knew that it was the environment that I wanted to work in.”  

A nurses capping at the University College Cayman Islands in 2014. – Photo Jewel Levy