Innovation: A day in the life of a humanitarian nursing team - the start

Nurses are key members of the Médecins Sans Frontières / Doctors Without Borders MSF team, providing vital medical care to patients in emergencies around the world. But staffing guidelines for nurses are largely based on experience and expert opinion rather than evidence.  Josie blogs from the start of a new project that’s aiming to change that…

Nurses are the largest group of healthcare professionals, delivering 80-90% of healthcare worldwide. They are the largest cohort of international staff that MSF sends to the field and they are considered the largest untapped potential for improving quality care. 

But do people really understand what nurses do? 

Nursing: holistic patient care

Being ill is horrible, even when you get to be at home, but when you are in hospital it’s even worse. 

Not only are you feeling terrible, in pain and a little frightened, you are also in a foreign place, surrounded by strangers and you seem to have lost all independence of when to sleep, eat, take medication and generally make decisions. 

Humanitarian nursing an exciting challenge, with nurses constantly coming up with new ideas to help fix problems

As nurses, through providing holistic patient care, we aim to make that hospital stay easier. We are with patients day and night, we get to know their habits, their likes, their dislikes, what’s important to them, what makes them laugh and what makes them cry. 

We get to know patients' family and friends. We see them at their best and their worst and often when they hit rock bottom. But through being there and building that relationship we can provide personalised nursing care, nursing care that fits each individual patient. 

Whether it’s helping patients to meet their basic needs (such as washing, dressing, getting around) with as much independence as possible; providing psycho-social support to help patients keep going in difficult circumstances; or providing the medication prescribed; each task is performed just for that patient. 

Doctors and other medical professionals often don’t have the time to build such a close relationship with patients, and are often focused on organising the best tests and treatments for patients’ illnesses. 

Humanitarian nursing

Humanitarian nursing is nursing without limits. It involves everything Western nursing does and more, as nurses put their skills to use in places like conflict zones, refugee camps, or places where healthcare would otherwise be non-existent. 

The patients in these settings are often more numerous and their illnesses more severe, with factors like long and dangerous journeys meaning patients often wait to travel to hospital until they really have to come. 


Florence Bindu, MSF nurse supervisor at Bambo general hospital in the Democratic Republic of Congo

Humanitarian nurses, even those on the wards, often have more hospital management responsibilities, such as managing stock levels for medication and materials, or carrying out diagnostic tests such as malaria and haemoglobin tests. 

Humanitarian nurses often work with minimal resources, which can mean fewer nursing staff and sharing equipment between wards. 

All this can make humanitarian nursing an exciting challenge, with nurses constantly using their initiative and coming up with new ideas and solutions to help fix problems. However, this excitement can wear off quite quickly and is replaced with the frustration of not being able to deliver the level of care we aspire to. 

Safe nursing levels

Humanitarian nursing is different from nursing in Western contexts, but often Western ideas are applied, which might not always fit. Is a safe number of nurses likely to be higher or lower than in other settings? By how many?

Unsafe nursing staffing levels have been seen to increase negative patient outcomes, mortality rates and the burnout of staff. As MSF nurses, both Lucky, project nurse, and I, nurse activity manager, have continuously strived to maintain nursing levels. 

Nursing itself, anywhere in the world is complex, continuous and often all about multitasking

In humanitarian settings, the work of recruiting nurses is continuous, as there always seems to be someone leaving. This means adverts, CVs, tests, interviews and training new recruits. As soon as you get through one cycle you barely have time to celebrate before you must start again. 

Having too few nurses risks patient safety and staff wellbeing, but overstaffing means using resources unnecessarily, both in terms of salaries, and the time it takes to recruit and train them.

The mission

To conduct research that will hopefully outline ways to ensure safe nursing staffing levels in humanitarian settings. Essentially, we want to understand the day in the life of a humanitarian nursing team and therefore understand the challenges MSF nurses face in ensuring safe nursing staffing levels are in place. 

Nursing itself, anywhere in the world is complex, continuous and often all about multitasking, which can make it very difficult to study. Then when placed in a humanitarian setting can make it even harder. 

The first step to knowing how to ensure safe nursing staffing levels is to really understand what humanitarian nursing involves. To do this the study aims collect data on the:

  1. Environment the nursing team is working in (hospital facilities, supplies, communication systems)
  2. Skill-set of the team (qualifications and experience)
  3. Frequency of nursing tasks and how long those tasks take
  4. Delivery of care

And to make it more exciting we are going to use smart phones to do it! 

Hopefully combined these results will show us what humanitarian nursing involves and provide ideas of how to work towards ensuring safe nursing staffing levels. 

The site

Two wards, one for children under five years old, and the other for children aged 5-14 years old, in Kutupalong Hospital in Cox’s Bazar District, Bangladesh. This is an 87-bed MSF hospital which offers care to the local Bangladeshi and Rohingya refugee communities in the area.

The team

Project manager: Vicky Treacy-Wong, an MSF nursing advisor based in Amsterdam

Study lead: Francesc Galban-Horcajo, senior development manager, Wellcome Sanger Institute

Study nurse: Josie Gilday, MSF nurse

Bangladeshi study nurse: Lucky, project nurse at Kutupalong hospital

And, most importantly, the participants: all the nurses working on the wards for patients aged under five years and 5-14 years. 

No study like this has been done before by MSF and we have six months to do it! Hopefully as a team we’ll be able to identify problems and create solutions to improve safe nursing staffing levels and ultimately patient care.

If you live in the UK, please donate to MSF UK’s winter 2018 appeal to support our work with Rohingya refugees in Bangladesh.

If you live elsewhere in the world, please click here to make a donation.