Spotlight Interview
With Professor Pelenatete Stowers Conducted May 2007
Pelenatete Stowers is the Chief Nursing Officer of Samoa and a prominent leader in health and nursing in the South Pacific region.
	ICHRN: From the perspective of a prominent nursing leader in the Pacific region, what do you see as the priority HR issues faced by health systems globally?
Ms. Stowers: The shortage of health professionals in active practice is critical and must be addressed. One of the contributing factors is demographics. The health workforce is ageing and in the coming decade, a significant proportion of our qualified staff will retire. The number of new entrants is insufficient to replace them. Other significant contributors are the often unattractive and poor working conditions and remuneration offered by our health systems. This situation is aggravated in our region by the migration of nurses and medical officers from the low-income to the high-income countries.
	ICHRN: What do you regard as some of the unique nursing human resources issues that small islands face?
Ms. Stowers: Nurses play a unique expanded role in the small islands of the South Pacific. Due to the scarcity of personnel, nurses tend to serve a multi-purpose function. In addition to providing health care – including prevention, promotion, treatment, and rehabilitation – nurses are responsible for environmental health. Often they also take on tasks usually assigned to social workers. In most cases, primary health care facilities and clinics are managed and directed by nurses. Similarly, rural health services are fully managed and led by nurses. While accepting these expanded roles, nurses may often feel frustrated by the lack of training to adequately prepare them for these additional responsibilities and the absence of recognition or reward for their contributions to the health system.
	ICHRN: What is the present state of nursing human resources in Samoa?
Ms. Stowers: Samoa is the only island in the South Pacific that has transferred all its nursing education programmes to its national university. That means the registered nurse qualification in Samoa is a Bachelor Degree (four years of study). All nursing students' tuition fees and allowances are covered by the Ministry of Health. Students who accept financial support from the government are bonded to work in the Samoa health system (public or private sector) – one year of service for every year of study financed. Annual Practicing Certificates are required for licensure renewal and license renewal is dependent on compliance with a mandated number of hours of continuing education. Nurses may also obtain Post Graduate Diplomas and specialist certification in a number of areas such as mental health, midwifery, acute care nursing and primary care. The number of nurses in Samoa is diminishing in the public sector. While retirement (nurses' average age is 47) and international migration affect us, we are also faced with a growing private health sector which is competing for the nurses presently residing in the country. According to the Ministry of Health's Annual Report (2005-2006), the ratio of nurses to population for registered nurses is 1:1390 while for enrolled nurses the ratio is 1:1563. The overall ratio 1:1483 is considered to be too low to meet the health needs of our population. The nursing and midwifery workforce is a component of Samoa's health human resources (HHR) Strategic Plan which is currently being reviewed to ensure conformity with the World Health Organization Western Pacific Regional HHR Strategy. Samoa also has a recruitment and retention strategy for nursing. Lastly, nursing as a career is now becoming competitive for school leavers as the salary for entry to practice is now equal to all degree level professions/careers in government services. While we are not able to compete with overseas destinations, we have been able to attract qualified students to become nurses in the Samoa health system, even if only for four to five years. The Northern Pacific, in particular, some island territories of the United States provide nursing education at the community college or university level. To facilitate reciprocity and standards of safe practice in the region, regulatory authorities are currently promoting the Western Pacific South East Asian Region (WPSEAR) Regional Common Competencies.
	ICHRN: The migration of nurses from Samoa to nearby countries such as New Zealand and Australia has been described as being significant in recent years. What is the situation today? How many foreign-educated nurses are employed in Samoa?
Ms. Stowers: The route for Samoan nurse migration is through New Zealand (NZ) via the NZ Government Quota System. The numbers are quite low but the steady annual emigration of four to five nurses per year takes its toll on our system as we have not yet reached an optimal staffing level. Emigration numbers must be added to those who leave the health system through natural attrition, retirement and resignations. Of those that have migrated, very few have returned to Samoa. Those who have returned have been employed primarily in the private sector. Currently we have five foreign-educated nurses working in Samoa – three in the public sector, one in the private sector, and one is a lecturer at the National University. Their countries of origin are the Philippines, India, Singapore and the United States.
	ICHRN: We understand that new occupational health and safety legislation has recently been passed in Samoa. What does this mean for nursing?
Ms. Stowers: In 1998, the International Council of Nurses initiated its Leadership in Negotiation Project in the South Pacific and the Nurses Association of Samoa hosted the first regional workshop. As their post-workshop project, the Samoan nurse participants undertook a survey to identify occupational health and safety risks in the health workplace. The results generated a great deal of attention within the health sector which then generalised to other services and industries and resulted in the establishment of a multi-disciplinary Ministry of Health Occupational Health and Safety Committee, the development of a Hospital Safety Manual, and supported Samoa's first occupational health and safety legislation. Workers, including nurses, became increasingly aware of occupational hazards and their right to negotiate safe working environments.
	ICHRN: Samoa has developed its own cultural perspective on the role of nursing and nurses. How is it unique and how was this achieved?
Ms. Stowers: The cultural perspective on the role of nurses is unique because it influences both the conceptual framework for nursing education programmes and the conceptual basis for the Standards for Nursing Practice. Official acceptance of this was achieved in large part because of the very strong collaborative working relationship between the National Nurses Association, nursing leadership at government level and the nursing education leadership.
	ICHRN: As Chief Nurse, what are the human resources planning challenges you encounter in Samoa and how are they addressed?
Ms. Stowers: Key HR challenges are ensuring an integrated approach to planning, promoting the nursing workforce as part of the health human resource package and, importantly, financing HR strategies. Other challenges include difficulties in marketing nursing as a career of choice, developing nursing education programmes to be on par with other like-professions at the university level, developing and facilitating the approval of career and salary structures that recognise education level as well as professional development. Finally, health sector reforms and their implications in roles and functions have led to the need to redefine roles and skill mix for different settings.
	ICHRN: Is there anything further you would like to communicate to our readers interested in health human resource issues?
Ms. Stowers: Again, close collaboration and cooperation between the National Nurses Association, nursing leadership at government level and the nursing education leadership are necessary to meet our HR challenges, making a difference so that health care delivery will continue to improve.