[CCIH-Hospitals] Principles for establishing a nursing school at a mission hospital

[MartinRS at aol.com]

Here are 10 principles to consider when starting a nursing school, written  
by David Stevens, MD, MA (Ethics), based on his personal experience as Director 
 of the Tenwick hospital in Kenya.  He is now the executive director and CEO  
of the Christian Medical and Dental Associations, _www.cmda.org_ 
(http://www.cmda.org/) .   These were shared by CCIH member Susan Carter, who is CMDA's 
Director of  Medical Missions in their October e-Pistle.
 
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Many healthcare mission  institutions have the chicken and the egg problem. 
They need trained staff to  start a training school and need a training school 
to get the trained staff they  need. 

I know that was the problem we faced when I first got to  Kenya. Our 135-bed 
hospital had almost double occupancy year round with 250  patients for three 
doctors and six nurses to take care of it all, including  delivering over a 
thousand babies each year. The quality of nursing, diagnoses  and treatment was 
excellent, if you had the nurse or doctor taking care of you,  but with so many 
patients, it was unlikely they would for any length of time.  The biggest 
problem was nursing since it required a continual presence to insure  adequate 
care, yet our nurses were serving most of their time as surrogate  doctors. 

We made do with “ward attendants” and “medicine  dispensers” who we had 
given minimal training to. A lot of moment-by-moment care  fell back onto family 
members who had to watch out for the patient.  

That didn’t work too well. I can still remember trying to teach an  
illiterate mother how to suction her three-year old’s tracheostomy during the  night 
when there was only one trained nurse for the whole hospital. On the  second 
night, exhausted, she fell asleep and the child obstructed and died.  

We especially needed a nursing school in the worst way but how  could we even 
get started when we were already in such desperate straits? We  also needed 
laboratory, chaplaincy, community health and other training. The  fact that I 
could do good quick C-sections or see 75-100 inpatients a day wasn’t  going to 
solve our basic problems. We needed well-trained and fully committed  
healthcare professionals. 

Over a seven-year period, we started all  those training schools and they 
produced excellent graduates that transformed  our work and the work of others. 
Tenwek’s nursing school, out of dozes of  schools in the country, had three of 
the top 10 students on the national exam a  few years ago. Training has 
continued to expand. Today, there is family practice  training and the hospital is 
starting a surgical residency program in January  2008. 

Looking back, training was the most strategic thing we did  to improve the 
health of our constituency. Like having children, it is  reproduction and 
multiplication that influences other lives long after the  “parent” moves off the 
scene. 

I’ve been thinking of the key  principles I learned in creating teaching 
programs. Maybe you need a training  program or perhaps you already have some and 
want to add more. Maybe these  principles would be of help. 

Here they  are:

1.      Ask – “What You Are Training  People to Really Do?” Where do you 
want them to serve - at your facility, in  other Christian institutions or in 
secular facilities? Do you hope that they  will do pioneer work, train others or 
serve in rural facilities? What skills and  knowledge are they going to need 
to do this? How does that differ from the core  curriculum that may already be 
required by regulations? Clearly identify the  product you need and want to 
produce. Then work backwards to design the content,  length of training and the 
type of practical experience students will need to be  excellent in their  
profession. 

2.      Ask – “What Do  You Want Your Graduates to Be?” Character is more 
important than knowledge. Just  ask employers. It is not so much what is poured 
into students but what is  planted. You need to train people who will be 
leaders in their profession, which  will give them even more influence with others. 
You want to teach, model and  facilitate leadership development. By doing so, 
your graduates will influence  many more people. 

An education system is poor if it only teaches  students to make a living 
without teaching them how to make a life. You want  each graduate to have a solid 
Christian character based on Biblical truths. If  that is important enough to 
be made a goal, it is important enough to prioritize  in both the teaching 
and experiences that the students are exposed to. If  training in a mission 
facility, you really want graduates to be medical or  dental missionaries 
themselves wherever they work or whatever they do. You have  the unique opportunity to 
not only teach them competency but to disciple them  deeply into a closer 
relationship with  God. 

3.      Ask – “What Kind of  Leader Do We Need?” Training schools rarely 
rise above the quality of their key  leader. That person sets the tone for 
excellence, hard work, good management and  serves as a role model for the students 
and faculty. You may look around your  present staff and due to their 
individual passions and abilities, not see the  leader that you need for this new 
endeavor. A common mistake is to just “made  do” with what you have. Usually that 
is a mistake. You will have more problems  and poorer products if it works at 
all. Without the right leader, you will waste  time and money that could be 
better used elsewhere. Pray, be patient and go  looking for the right leader. 
Thei! r involvement is the key to success. I found  our principal for the 
nursing school working with a different mission on a  different mission field. She 
is the primary reason for the school’s success over  the last few decades. 

4.      Ask –  “What Size School?” What staffing do you need now and in five 
or ten years? What  is your present attrition rate? How do other schools 
retain graduates and what  is their success rate? Build-in a cushion in case you 
underestimate. This will  give you guidance on the size of student housing, 
classrooms and faculty. If you  are creating great graduates, it will be a 
blessing to many even if they don’t  work in your healthcare system long term but on 
the other hand, each student  educated is an investment by you and your 
institution needs a return on that. In  the African context, each student was “
bonded” to the organization for one or  two years after graduation. This insured 
all! stayed initially and also gave an  opportunity to select the ones that 
performed best after graduation for  longer-term contracts. 

5.      Ask –  “What Equipment, Books and Facilities Do We Need?” This is of 
lesser importance  than many of the other things. With the right leadership 
and if you produce the  right product better tools, equipment and facilities 
will flow to it. All the  same, you are going to need to have the basics to get 
started and it should be  appropriate to your needs, culture and space 
limitations. The good news is that  supporters get excited about training nationals, 
as do corporations and  foundations that realize this is the key to 
sustainability and quality. Just  don’t allow people to donate “junk for Jesus” on you. 
Carefully screening gifts  in kind is important. For books check out the 
Interna! tional Book Project (_http://www.intlbookproject.org/_ 
(http://www.intlbookproject.org/) )  based in Lexington, KY. They will ship overseas and have 
good, used, next to the  last edition textbooks. We also used them to start a 
hospital staff  recreation-reading library and to help national students in our 
area’s schools.  They let me visit their site, pick books and then put them 
into a container we  were sending to save shipping  costs. 

6.      Learn from Others.  Find out what other Christian and secular 
institutions are doing. Sit down with  your leader and work on a set of survey 
questions focusing on what you need to  know to do the job well. Select the most 
important training institutions to  visit in your country and perhaps adjacent 
ones. Ask the questions in person and  record the answers. The ones you can’t 
get to, send the survey to them to fill  out. Sit down with the information you 
collected and ask these among other  questions: What is working everywhere 
else? What is not working well everywhere  else? What mistakes have people made 
that can be avoided? Who has an innovative  solution for a perplexing problem 
ev! eryone usually has? What things are you  going to have to figure out a 
solution for that no one else has yet? What would  work best considering your 
circumstances? The week or two of effort will  turbo-charge the start up of your 
program and help you to not make the same  mistakes. 

7.      Partner. If I was  doing this again, I would find one or more 
Christian institutions to partner  with who could provide expertise, volunteer staff, 
supplies and equipment. It  would be a great experience for their faculty and 
students to get cross-cultural  experience. The sister institution will be a 
place your faculty can go and get  more experience or training on home 
assignment. It will open up networks and let  you know where to find  resources. 

8.      Think Big Enough.  – The tendency is underestimate costs, facilities, 
funding, staffing and the  list goes on. Attempt great things if you know 
that God has laid this on your  heart. Actually, people are attracted to a bigger 
vision much more than a  smaller one. You want something that is worth 
investing time, energy and funds  into.

9.      Get Accredited. Too many  facilities don’t go through the work and 
frustration of getting accredited. This  leaves your graduates hamstrung and can 
end up causing you problems with the  authorities. Remember, you can have a 
great testimony to others involved in the  same sort of training if God blesses 
your new outreach. Accreditation puts you  in the in-country networks with 
people doing what you hope to do and is a great  witness. Start humbly asking 
for assistance and approval. Be willing to take  advice and act upon it. Work 
like it all depends on you and trust knowing that  it all depends on God. 

10.   Pray. Pray for the  assurance that God has directed you to start this 
training school, for wisdom in  designing and organizing it and for the right 
leader to make it work. Pray for  the finances and the new relationships that 
will be needed to make it  successful. Commit the whole project to the Lord and 
rest in Him.  

I’m sure other principles could be added but I hope this list  helps you 
think strategically. Training is a large commitment, but it’s well  worth the 
investment. 
_age_ (http://www.aol.com/mksplash.adp?NCID=AOLCMP00300000001169) .



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