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Spotlight Interview with Mr Michael Larui

Spotlight Interview

with Mr Michael Larui
National Head of Nursing, Solomon Islands

Currently the National Head of Nursing in the Ministry of Health and Medical Services in Solomon Islands, Michael has 20 years’ experience as a registered nurse working in both primary and tertiary health care in Solomon Islands and has held senior nursing roles in Honiara and Provincial centres since 2003.  He was appointed to the position of National Head of Nursing in 2007.

Solomon Islands comprise more than 900 atolls in the south-western Pacific, three hundred of which are inhabited. Its total land area of 28 370 square kilometres is scattered over 1.3 million square kilometres.

ICHRN: What are the main nursing workforce challenges which you have to meet in managing nursing services across this scattered population?

Mr Michael Larui:

  1. Nursing Manpower – The challenging situation about the current workforce is that according to the government’s manpower establishment, the nursing division is already overstaffed.  However, the actual situation indicates the need for more nurses to manage health centres given the government’s policy of making health services accessible to the rural and urban population. One of the strategies of the current government is to build more health centres and upgrade some of the existing centres to district hospitals.  This will certainly increase the demand for more nurses.
  2. Nursing Education and Development – There are officers who are long overdue for further training and continued professional development due to limited opportunities for training in country.  We have started work on continuing education for the nurses as well an HR Development Plan that will help analyse training and capacity-building needs.
  3. Nursing Regulation – The current Nursing Council Act is outdated and needs reviewing. The Nursing Regulation has just been endorsed by cabinet and work has begun on increasing nurses’ awareness of the Regulation and its implications so that it can be used to implement the Act and contribute to improving nurses’ competencies and conduct. 
  4. Nursing Practice – The practice of nurses in hospitals and health centres is increasingly coming under question by the public. A parliamentary enquiry in 2010 into quality of medical care at the National Referral Hospital (main hospital in the city) raised questions about the care given to patients by both doctors and nurses. These include issues such as long waiting times by patients and clients, shortage of nurses on duty during shifts, diminishing bedside care by nurses and attitude of nurses to nursing duties and patients.  

ICHRN: What do you see as the most important strategies for overcoming these challenges?

Mr Michael Larui:

  1. Development of a Human Resource Management and Development Plan for the Division to feature areas such as succession planning, workforce forecasting and analysis to determine recruitment needs in light of the projected number of retirements  and other departures from the workforce. This should also help us to devise a training needs analysis and plan nurse training based on need and fairness across provinces, hospitals and other levels of health centres.
  2. Development of courses for nurses in country as sending nurses overseas is expensive. Work on redevelopment of the Nurses Diploma Course in one of the nursing schools started in 2008 and is ongoing nearing completion. A Bachelor of Nursing degree course has been offered since July 2011. These developments were made possible through the World Health Organization’s financial and technical assistance. Mary MacManus, Principal Lecturer of Nursing, and Jo Conaglen, Senior Lecturer of Auckland University of Technology, assisted the local team in these achievements. Talks are also ongoing with James Cook University to train nursing leaders towards a Master of Nursing.
  3. Provide funding support to increase awareness of the Nursing Regulation and proposed review of the Nursing Council Act of Solomon Islands.
  4. In terms of Nursing Practice, one of the priorities of the Division is to conduct an in-depth evaluation of Nursing and Midwifery practice in Solomon Islands. One of the intentions of this study is to determine the current level of practice and look at ways of improving it both in hospital and primary health care settings. The proposed National Health Strategic Plan has an indicator for the Nursing Division to develop a model of care delivery that will improve nursing practice to provide more effective services to the people. With the redevelopment of the nursing competencies in line with the reviewed nursing curriculum, it is anticipated that nursing practice will improve as we assess nurses using the tools in the competencies.

ICHRN: What types of inter- country collaboration are being used in the Pacific to sustain nurse education and share ideas on nursing workforce policy?

Mr Michael Larui:

The formation of the South Pacific Chief Nurses and Midwifery Officers Alliance (SPCNMOA) which has its secretariat at the WHO Collaborating Centre for Nursing, Midwifery and Health Development based at the University of Technology, Sydney is a way forward for such collaboration on nurse education and policies among Pacific Island Countries including Australia and New Zealand. SPCNMOA has a reference group whereby members meet very often through Elluminate©  sessions and teleconferences.

The biennial South Pacific Nurses Forum is also another avenue whereby nurses meet to discuss similar issues.

The recently formed Asia Pacific Emergency in Disaster Nursing Network (APEDNN) is another forum for discussion of disaster situations as well as various policy issues relating to disaster and emergencies.

Pacific Island Countries also meet at WHO organized Human Resource for Health (HRH) meetings where HR issues are discussed.

Solomon Islands have been a long time beneficiary of Papua New Guinea and Fiji Nursing and Public Health Education Institutions. The University of Papua New Guinea offers Bachelor of Nursing and Bachelor of Clinical Nursing while Fiji National University offers Certificate, Diploma and Bachelor of Public Health.

In June 2010, a delegation from Solomon Islands including myself and the Head of School of Nursing and Health Studies of Solomon Islands College of Higher Education and the Permanent Secretary for Health conducted a study tour to Fiji to look at the Nurse Practitioners (NP) program offered by the Fiji National University (FNU) through the School of Medicine, Nursing and Health Sciences. Following on from the tour, two of our nurses are now being sent to FNU to undertake the course with the aim of introducing a similar program in Solomon Islands. This is the beginning of such collaboration with Fiji.

ICHRN:  In recent years the Solomon Islands has been able to increase the intake to nurse education. How has this been achieved?

Mr Michael Larui:

The increase was necessary to adequately staff nursing posts in hospitals and health centres. This was achieved following the opening of a third nursing school which is owned by the local United (Methodist) Church. However, a nursing workforce analysis done in 1999 revealed that the nursing workforce in Solomon Islands is young which means relatively few nurses will retire in the next five years. If the number of nurse graduates continues to be large, not all of them will have the chance to be immediately recruited by the government.

ICHRN:  Is nurse migration a significant issue in the Solomon Islands? If so, what are the advantages and disadvantages, and what can be done to ensure that Solomon Islands nursing and nurses benefit from this mobility?

Mr Michael Larui: Nurse migration is not an issue in Solomon Islands. The level of nurse mobility to other countries is very minimal.

ICHRN: The Solomon Islands has recently signed a bilateral agreement with Vanuatu for international recruitment of some SI nurses to Vanuatu. How will this work in practice?

Mr Michael Larui:

We are currently working with the Ministry of Public Service who is the government’s employing ministry to organize the administrative arrangements for recruitment of SI nurses to Vanuatu. The Ministers of Health for Vanuatu and Solomon Islands signed the agreement between both countries. This has been followed by signing of the technical agreement by the Chairpersons of the Public Service Commissions for Vanuatu and Solomon Islands and then the signing of the Memorandum of Understanding by the Chairpersons of Nursing Councils of both countries. Discussions are ongoing between the Ministry of Health and Ministry of Public Service to set arrangements for the recruitment.  

ICHRN:  You have recently updated the nurse register and moved from a paper-based to computer-based system. How will this help you in your job and how will it impact on nurses?

Mr Michael Larui:

This achievement will improve registration and record keeping. The paper based register will still be used as an alternate record as ICT in Solomon Islands is prone to frequent breakdowns and often requires repair.

ICHRN: With so few doctors employed in Solomon Islands, the role of the nurse is central to the delivery of services, particularly in more remote areas and islands. How have you been able to ensure that sufficient nurses with the right competencies are working in these areas?

Mr Michael Larui:

Primary Health Care is an essential part of the nursing practice here in Solomon Islands. Nurses are trained to be generalist in their approach to managing diseases and promote prevention of illnesses. This approach has helped us to work in any setting be it in hospitals or in the rural health centres. As a junior operating theatre nurse in the early 1990s and immediately being posted to Rural Health Centres very shortly afterwards, I find that my hospital experience has helped me administer interventions to curing diseases but the knowledge gained from my student years practicing rural health has not faded so I do not find any difficulty in health promotion and carrying out public health programs such as Expanded Program on Immunization, running antenatal and post natal clinics and going on outreach clinic duties. The knowledge acquired helped me to be innovative and creative in administering rural and family health at the health centres that I was posted to.

ICHRN: Are there any special measures in place to help nurses in remote areas to access professional support and development?

Mr Michael Larui:

That is a challenging area as professional support and development is not easily accessible by nurses. The National Nursing Administration at the Ministry of Health started some work on the HR Development Plan to ensure that nurses have opportunities to train and develop professionally and technically as well. The need to access professional support and development is a challenge not only to nurses in remote area but also nurses working in the urban centres as well.

ICHRN: Do you see a role in Solomon Islands for nurses as clinical specialists or nurse practitioners in the future? If so, how will this be achieved?

Mr Michael Larui:

The Nurse Practitioners program in Fiji is currently being explored to see if a similar program can be provided as alluded to earlier. However, we also see that the curriculum that taught in the schools of nursing in Solomon Islands and the way nurses work here can be seen as already doing some of the work that a Nurse Practitioner does. Feedback from the two nurses who are currently in Fiji for the training on NP confirmed to us that our nurses are already doing what is currently being taught at the school. In the partnership that we have with the Solomon Islands College of Higher Education (the country’s only tertiary institution), the post-registration Bachelor degree of Nursing is clinically oriented and one that can be easily used for clinical managers.

ICHRN: Are there any other points or comments you would like to make?

Mr Michael Larui:

The National Nursing Administration has identified priority areas to work on in its effort to improving nursing administration and practice. These include evaluation of the nursing and midwifery services in SI; review of Nursing Position Descriptions and Organizational Structure; review of the Nurses Scheme of Service; development of Human Resource Management Plan; work on the future of Nurse Aides; development of the Nursing Human Resource Development Plan;  ongoing review and redevelopment of Nursing Education Programs; review of the Nursing Council of Solomon Islands Act; and development of Nurses Procedure Books to improve nursing practice. Work has started in some of these areas while the rest is still pending resources to initiate implementation.

On behalf of the Nursing Administration here in Solomon Islands, I very much welcome assistance and support in the areas that are still unattended.

Last Updated on Thursday, 30 August 2012 09:43