n AONE delegation of 10 nurse leaders and
Three friends had a rare expertise in
Peru this fall. Our crew was numerous and included point-of-care nurses in graduate faculty, nurse managers, a nurse director, academicians, and nurse executives.
HEALTH CARE IN PERU
On our first day in Peru, we visited the Clinica Anglo
Americana in Lima. We met with Morayma Custudio,
director of nursing on the clinic, Veronica Ramos, subdirector, and Flor Vallejos, head of nurse safety (high quality
administration). This hospital and clinic characterize the non-public sector of well being care in Peru, 1 of three fundamental constructs
primarily based on insurance coverage protection. Public hospitals serve the
uninsured, social safety hospitals serve these with
employee insurance coverage, and personal hospitals known as clinicas present care to those that are privately insured. The general public
sector is open to anybody with out insurance coverage, overlaying
roughly 50% of the inhabitants. The uninsured
obtain fundamental well being care, which is roofed via taxes
paid by residents of Peru. The social safety hospitals and
clinics present take care of any citizen who receives a paycheck, representing about 40% of the inhabitants, however
particular hospitals present take care of the police and the army. These with employee insurance coverage have cash deducted
from their paychecks to cowl well being care. Lastly, non-public
hospitals present care to roughly 10% of the inhabitants, together with a small phase of staff with non-public
supplemental insurance coverage.
The Clinica Anglo Americana was one of many first in
Peru to obtain Joint Fee Worldwide accreditation, and it’s on the journey to obtain Magnet® designation. The nurse leaders we met there have been very
obsessed with their work, utilizing a “affected person first” philosophy developed on the Cleveland Clinic and a apply
mannequin primarily based on Jean Watson’s Principle of Human Caring.1
On touring the hospital, we noticed a really busy emergency
division (ED). ED employees see roughly 70,000 visits
yearly. The hospital itself has solely 91 inpatient beds,
together with 10 ICU beds and 10 pediatric beds. The ED
wait time will be as much as 2 hours within the non-public hospital, and
waits in public hospitals will be 6 days or longer. It is not uncommon for sufferers to attend as much as 6 months to realize entry to
care. Solely Three psychological well being services are in operation and all
positioned in Lima—so rural residents must journey
for this care. Peru additionally doesn’t have superior apply registered nurses, who’ve confirmed important in broadening
entry to care in the US.
The nurses typically work 12-hour shifts, with salaries
in public hospitals starting from $300 to $500 for 150
hours monthly and $750 to $1,000 monthly in non-public hospitals for a similar hours. Nonetheless, a restricted
variety of these jobs exist, so it’s onerous to realize a full-time
place. Most nurses work 2 full-time jobs to earn a
dwelling wage. And the turnover of nurses will be upwards
of 50% because of the challenges with the workload and
work surroundings. Leaders at Clinica Anglo Americana
appointed a chief nursing officer (CNO) for the primary time
this 12 months, equal to different leaders within the group. The
use of a CNO is comparatively new in Peru; in 2013, Clinica
Santa Isabel, a maternity hospital, was the primary group to nominate a CNO. At Clinica Anglo Americana,
leaders are making large strides within the skilled apply
of nursing within the non-public sector, however they’re experiencing
challenges. Though the group has sturdy leaders
advocating for evidence-based apply in construction and
processes, it didn’t seem to have a sturdy formal management growth program for nurses and nurse leaders.
Throughout the week, we additionally visited a distant indigenous
rural clinic, the Ollantaytambo Medical Middle, serving
the medically underserved. This small clinic had very
restricted assets. Employees primarily present maternal care,
delivering as much as 10 infants monthly. Elective inductions
and c-sections usually are not out there, and the clinic doesn’t
present many pharmaceutical interventions. Employees’s greatest
well being concern is post-partum hemorrhage, just like the
United States. They had been additionally involved about anemia
because of poor diets.
Reflecting on our visits to well being care suppliers,
delegation member Carol Watson, PhD, RN, mentioned a
AONE Delegation Learns
Challenges, Successes of
Peruvian Nurse Leaders
Bob Dent, DNP, RN, CENP, FAAN
www.nurseleader.com Nurse Chief 371
372 Nurse Chief December 2018
“doing higher with much less” philosophy. That is totally different
than “doing extra with much less.” In immediately’s tumultuous
well being care surroundings, we typically discover a want
to “do higher” with the assets now we have in assembly the fee, high quality, and entry points nurse leaders
We additionally visited with college of the varsity of nursing
at Universidad Norbert Wiener, a personal greater training establishment in Lima the place Patrick Palmieri, DHSc,
MSN, ACNP, FAAN, is the Margaret Jean Watson distinguished professor and dean for the varsity. Previous to
returning to academia in 2014, he led a crew that developed the most important vertically built-in non-public well being
system in Peru, known as SANNA. The college of nursing is
globalizing and advancing the nursing occupation
via its work to earn the primary worldwide accreditation in Latin America for a college of nursing with the
Canadian Affiliation of Colleges of Nursing. The ultimate
website go to is scheduled for October 2019.
On the faculty of nursing, we fashioned a circle with
our delegation and the school to have a dialogue
about nursing and nursing training. Many college students
attended and joined the dialog. The college
consisted of nurses with graduate levels, a lot of
them working to finish their doctorate levels.
Throughout these conversations, we discovered the nurse-topatient ratio within the medical/surgical surroundings in
public hospitals is as much as 30 sufferers to 1 nurse (and 5
to 1 in non-public hospitals). A nurse might have the assistance
of 1 nursing assistant. Within the surgical space, the ratio is
14:1, in crucial care items, 2:1. To handle these employees
challenges, the nurses ask households to be on the bedside
to help with offering fundamental care for his or her liked
ones. College added they didn’t have sturdy information
assortment on affected person outcomes, largely monitoring
for opposed outcomes.
Nursing college students from Universidad Norbert
Wiener obtain coaching at Lima’s Hospital Nacional
Edgardo Rebagliati Martins, a social safety facility.
Established within the 1950s, the hospital has 1,600 beds
and employs greater than 1,000 nurses. Potential
nurses have 2 major methods to enter the sector. A Three-
12 months, technical nurse diploma, just like the LPN, can
be earned. These nurses can delegate duties to the nursing assistants. The opposite manner includes a 5-year nursing
diploma, just like a bachelor’s diploma, with a analysis
thesis. For post-graduate work, nurses can earn a 1.5-
12 months specialization, a grasp’s diploma, and a doctoral
diploma in nursing. The college and nursing college students
voiced a want to create stronger relationships and
collaborate with nurse chief colleagues across the
world. They wished to know the methods by which
AONE and different organizations within the US nursing
group had been reaching out to them. We mentioned
alternatives to collaborate with AONE on nurse
chief growth, utilizing the AONE competencies as
a basis. Right here, too, college famous that nurse management growth was missing of their environments.
On the finish of the dialogue, the scholars had been requested,
“Why do you wish to grow to be a nurse?” Their
The AONE delegation visited the 91-bed Anglo Americana Clinica in Lima, Peru, a facility within the strategy of incomes
a Magnet designation.
www.nurseleader.com Nurse Chief 373
solutions had been the identical as we regularly hear from US
nursing college students—to care for sufferers and enhance
well being care within the communities they serve.
We met with skilled nurses from the Colegio
de Enfermeros del Peru, the Peruvian School of
Nursing, maybe equal to the Nationwide Council
of the State Boards of Nursing mixed with the
American Nursing Affiliation in the US.
The group’s function is to strengthen the skilled apply of nursing, together with a social and authorized
accountability to prioritize the event of competencies of the native nurses and nurse directors.
Peru has 28 areas, every with a company related
to US state boards of nursing, reporting to this central
physique. 9 elected members serve on the nationwide
board, which acts to defend nurses towards unjustified
hospitals complaints and preserve the moral requirements
for the occupation. In Peru, roughly 1.5 nurses
can be found for each 1,000 folks, whereas the
United States has 11.2 nurses for each 1,000 folks
(in contrast with zero.5 physicians for each 1,000 in Peru
and 1.1 per 1,000 in the US). Much like the
United States, 10% of nurses are males. The nurses
defined how final 12 months the Colegio Médico del Perú
(Peruvian School of Medication) tried to implement a nationwide legislation to ban nurses from holding
management positions in massive public hospitals.
Representatives from the School of Nursing additionally
famous on the native level of care the doctor/nurse
relationship is extra collegial than on the nationwide degree.
LEARNING ABOUT HEALTH NEEDS
We had the chance to go to a major faculty in a
rural space with kids ages Three to six years. The lecturers
are very compassionate and appear to like their work,
with some serving on the faculty for 25 years. The
college students sang to us, performed with us, and gave us large
hugs. It was an emotional go to for some within the delegation. Though the scholars had few assets, they
had nice attitudes, large smiles, and even larger hearts.
When the educating employees was requested about college students’
well being care wants, Three large considerations surfaced: dental care,
parasites, and anemia. Earlier within the week, Palmieri
famous Peru has a nationwide marketing campaign to eradicate anemia, as this can be a severe well being drawback. The primary nurse
to grow to be a minister in Peru, Liliana La Rosa, was
appointed this 12 months and is working to eradicate this
TAKING IN THE CULTURE
When not gaining insights about well being care, we
discovered about Peruvian tradition and historical past. For
occasion, Palmieri defined kiss on the cheek is a
basic customized for greeting buddies and colleagues,
and it helps help relationships. He discovered this lesson shortly after he arrived in Peru some 10 years in the past,
when he was scolded at work for neglecting the customized. As a result of relationship administration is a crucial
competency for nurse leaders, our group paid consideration!
We had alternatives to get pleasure from many Peruvian
websites, together with the Larco Museum, the Sacred Valley,
Pisac Market, Cusco, and Machu Picchu. On the final
day, we had a personal guided tour of the Casa Concha
Home, studying in regards to the rise and fall of the Incan
empire with anthropologist Jean-Jacques Decoster,
PhD. Decoster talked about the Inca’s engineering
strategies had been outstanding in adapting to their surroundings. He said, “Tradition is a folks’s adaptation
to an surroundings.” I requested him if this may very well be associated to settings the place skilled nurses apply. He
confirmed that sure, nurses would adapt to the surroundings created. This delivered to thoughts the nurses I
had seen in numerous environments on our journey, skillfully utilizing assets to supply compassionate care. It
additionally jogged my memory of the some nurse workplaces in
the US. Are we creating constructive and
wholesome office environments?
AONE delegation member Joan Osborne, EdD, MSN,
ARNP, hugs a brand new good friend throughout a go to to a rural
Peruvian major faculty.
374 Nurse Chief December 2018
Reflecting on my expertise, listed here are steps nurses
can take to achieve out to their worldwide colleagues,
nearly kissing them on the cheek:
• Disseminate analysis and evidence-based practices in venues and publications accessible to our
worldwide colleagues. Contemplate copresenting
with a world colleague.
• Contemplate having a sister facility abroad. Collaborate with nurses there to enhance
• Assist to bridge the hole between innovation
(analysis) and nursing apply with our skilled colleagues globally.
• Create constructive and wholesome office environments the place nurses can adapt, making a tradition
the place nurses and their interprofessional
colleagues can “do higher with much less” to enhance
international well being.
We had an expertise of a lifetime in Peru. This
article and the 1000’s of images taken by the
crew can’t categorical the feelings felt nor depth of
the experiences we had on our weeklong tour.
The folks had been welcoming, and the meals was scrumptious. Our expertise additionally confirmed a starvation from
these we met to proceed the dialog past
this journey. I hope the discoveries we made in Peru
will inform our work as nurse leaders, making the
finest use of assets and striving to make a distinction
for sufferers and one another. NL
1. Watson Caring Science Institute. Core ideas of Jean Watson’s
Principle of Human Caring Science. 2010. Obtainable at:
https://www.watsoncaringscience.org/information/PDF/watsons-theory-ofhuman-caring-core-concepts-and-evolution-to-caritas-processeshandout.pdf. Accessed October 24, 2018.
Bob Dent, DNP, RN, CENP, FAAN, is 2018 president of
the AONE Board of Administrators. He’s senior vice chairman,
chief working and chief nursing officer at Midland
Memorial Hospital in Midland, Texas. He will be reached at
1541-4612/2018/ $ See entrance matter
Copyright 2018 American Group of Nurse Executives.
Revealed by Elsevier Inc.
All rights reserved.
The AONE delegation took within the surroundings of Machu Picchu, a 15th century Inca citadel.