Jasmine Nibali was anything but confident during her first few days as a registered nurse.

“I remember doing my first dressing here,” Ms. Nibali said, sitting in the nurses’ lounge on the surgical ward at Cayman Islands Hospital. “My hands were like this.”

She extends her arms, letting her fingers shake slightly.

“I was really nervous,” she said. “I had been out of school almost a year.”

Fortunately, she had help.

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Ms. Nibali, 34, is one of eight nursing graduates from the University College of the Cayman Islands who are going through a year-long residency program designed to reinforce what they learned in school and build their confidence and competence in dealing with patients.

Monty Gross, senior nurse leader for professional development at the Health Services Authority, was hired late last year to oversee the program. A former nursing educator at the U.S. Veterans Affairs hospital in Las Vegas, Nevada, he said many hospitals and health agencies in the United States are establishing more extensive training programs for first-year nurses.

The movement, he said, grew out of a response to the 2000 Institute of Medicine book “To Err is Human,” which estimated at the time that 98,000 patients were dying each year in the United States due to medical errors.

Registered nurse Cynthia Powell, left, consults with Camile Beckford-Johnson during a triage session at Cayman Islands Hospital’s emergency room. Ms. Powell is one of eight UCCI graduate nurses in a residency program at the hospital. – Photo: Taneos Ramsay

“It’s relatively small,” he said of the movement to build residency programs, “but it’s growing.”

While Mr. Gross said the program was not designed exclusively for nurses educated at UCCI, all eight of the new residents are from the inaugural class of UCCI’s nursing program. Ten nurses graduated from the school last year with bachelor’s degrees.

Health Minister Dwayne Seymour said at the time that it was important for the Cayman Islands to have homegrown nurses.

“Now that you’re about to graduate, [you] will play a vital role in the delivery of healthcare in our country,” Mr. Seymour told the new nurses.

Mr. Seymour did not respond to requests for comment on why the residency program was not designed to accommodate all the graduates.

Mr. Gross said he did not know why the program was only funded for eight nurses, rather than 10.

“Maybe next year we’ll have more,” he said. “I don’t know.”

Building the program, he said, did not happen overnight. Veteran nurses who work with the residents had to be trained for those roles. They attended a series of classes in order to teach the new recruits more effectively.

Khichala Robinson, 45, is a charge nurse at Cayman Islands Hospital and one of the program’s clinical preceptors. Before coming to Cayman in 2007, she helped train new nurses at the hospital she worked at in the Bahamas. She is overseeing Ms. Nibali during the new nurse’s rotation in the surgical ward. When she began her own nursing career, Ms. Robinson said, she worked with a registered nurse, but it was not a formal program like the one that has been established at Cayman Islands Hospital.

“I like this program,” she said. “It’s teaching you, giving you that sense of empowerment and leadership. It’s a definite plus in training [the nurses] to be leaders and trained clinicians. It allows them to be confident and skilled.”

It’s not an easy task, she said.

“I had to work feverishly with them on how to handle the tools, sterilization and dressings,” she said. “They know the theory, but they have to put the theory into practice.”

She works as an extra set of eyes and hands for the new nurses, letting them do their job, but stepping in when needed. New nurse Ms. Nibali appreciates the safety net.

“With this, you’re now on your own, but you have someone to help when you need it,” Ms. Nibali said. “If anything changes, we as a nurse have to intervene for the patient. We had a patient whose blood pressure was rising. [Ms. Robinson] was kind of waiting for me to see what I was going to do.”

Ms. Nibali made the right move, said the veteran nurse.

“She said, ‘We need to decrease the IV rate,’ and that was good,” Ms. Robinson said.

She later watched as Ms. Nibali established a new IV line in a patient’s arm. The new nurse said being a student on a small island sometimes limits the opportunities to perform certain procedures. She only had the chance to put in an IV twice as a nursing student.

Add that to the nearly year-long span between finishing her clinical training as a student, taking the nursing exam and waiting for the results, going through the process of registering as a nurse and then getting accepted into the residency program, and it is not surprising she felt rusty and unsure of herself when she walked back onto the hospital ward.

Stephanie Bodden, 22, is doing a rotation in the specialist clinic. She shows off the nubs that were once her fingernails. She chewed them off out of nervousness, she said.

“It’s been so long,” she said, since she was working with patients. “Something as simple as putting up IV medications – it was a little anxiety. But once you’re on the unit and doing it, you feel better. All the anxiety has for the most part gone away.”

Cynthia Powell, 34, worked as a practical nurse before and during the time she was earning her nursing degree. As a registered nurse, she said, she is not nervous, but she has had to adjust to her new role. In the past, when there was a question, she could turn to the senior nurse. Now, she is in a senior nursing position.

Her first rotation in the residency program was in dialysis. Patients there are fragile, she said, and can have problems at a moment’s notice.

“We had a patient who was beginning to crash and I had to take the lead,” she said. “I was able to delegate some duties out and made phone calls to the doctor.”

Registered nurse Jasmine Nibali, left, gets guidance from her preceptor, Khichala Robinson, on the best way to set up an intravenous line. – Photo: Mark Muckenfuss

Not everything goes smoothly, however. On a recent day in the emergency room, she struggled to find a patient’s vein to draw blood and start an IV.

“I have this problem all the time,” said Jacquelyn Jackson, 46, Ms. Powell’s patient who was suffering from a severe migraine. She was looking at the intermittent flow of blood from the needle in her arm.

Eventually, Ms. Powell’s preceptor, nurse Marsha Eleweanya, 46, took over and was successful in tapping Ms. Jackson’s arm. She talked to Ms. Powell about technique while she did the procedure and said it was an important illustration of the need for residency programs, such as this one.

“They are vital,” Ms. Eleweanya said. “At the end, we have a nurse who is competent.”


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  1. Just trying to understand how it works.
    Registered nurses must usually meet a minimum practice hours requirement . So…
    These things should be learned in school, not on the job. If new grads being ill-prepared for independence on the floor, then nursing education needs to change.

    As a side note, St.Matthew university, the school of medicine, has a bad reputation among students. Someone should pay attention. Learning from power point slides is frustruting for students.

    “Let’s ban PowerPoint in lectures – it makes students more stupid and professors more boring.” Just go on youtube and see for yourself what a typical lecture in SMU is. Depressing, to say the least. MDs and PhDs who never practiced medicine shouldn’t be teaching medical students. There should be a requirement for medical schools professors to actually practice medicine from time to time.


  2. To support my above comment, here is an article, “An MD’s thoughts on medical education”.

    “If I hear, one more time, from a PhD, who has never seen, treated, or managed an acutely-ill patient, that “The students need to know THIS (this = piece of anatomical, microbiological, or pharmacological minutiae), I am going to go ballistic. ”
    “I am also tired of hearing: “Cadaver dissection is the GOLD STANDARD by which anatomy is taught!….Every medical school PhD anatomist thinks this is important for EVERY doctor to know. THIS CRAP MUST STOP.”