Practicum Highlight: Jessica Ramcharan, MPH'25

Advancing Global Health through Nursing Workforce Sustainability and Capacity Building

Jessica Ramcharan is a Clinical Research Coordinator at NYU Langone Health and a candidate in Dartmouth’s Hybrid Master of Public Health program. In her practicum project, Enhancing the Sustainability of the Nursing Workforce in Guyana: Global Health Pathways for Capacity Building and Quality Improvement, Jessica explores the challenges of nursing care in Guyana, aiming to reduce nursing attrition and enhance the quality and sustainability of care.

Georgetown Public Hospital Corporation (GPHC), Guyana’s primary healthcare system, faces significant challenges due to a limited health workforce and the distribution of its rural population. As the country's population grows, the demand for skilled healthcare workers rises, but nursing retention is hindered by high attrition rates. Nurses often migrate in search of better pay and working conditions. GPHC’s nursing department currently faces a 55% shortage, and with a 40% increase in patient load, each nurse is responsible for the workload of three nurses. This strain results in delayed treatments, increased risks of adverse outcomes, and inequitable delivery of care.

To address these challenges, GPHC partnered with Northwell Health’s Center for Global Health to launch a longitudinal quality improvement (QI) project in April 2024. The goal was to establish pathways for capacity building and improve nursing retention. Capacity-building interventions included American Heart Association Basic Life Support (BLS) training and Clinical Competency Skills Stations. These initiatives aimed to close skills gaps and boost nurses’ confidence in clinical situations, empowering them to manage shortages more effectively. Retention-focused efforts included a mentorship program for nursing leaders and the presentation of DAISY Awards, which recognizes nurses who exhibit excellence in patient care. Research suggests that such recognition and opportunities for career advancement are essential for reducing rates of nursing attrition.

The programs were piloted on-site at GPHC over six days with 181 attendees. Competency changes were assessed using pre- and post-surveys. Participants expressed inspiration and a desire to engage in further learning opportunities, indicating the program effectively addressed knowledge gaps and fostered interest in professional development. These factors are closely linked to higher staff engagement. "Although Registered Nurses had not previously received formal BLS or CPR training, 94% of those who attended the sessions successfully passed the written and practical exams," explains Jessica. This result highlights that GPHC nurses are highly adaptable and capable of applying new clinical knowledge when given proper training. Jessica believes that regular training opportunities could help nurses at GPHC expand their skills, increase their confidence in handling critical situations, and improve job satisfaction, thus reducing the likelihood of migration.

Self-perceived confidence ratings for nursing support staff showed an average increase of 33.2% after the Clinical Competency Skills Stations, further suggesting that competency-based training and low-burden QI efforts can significantly improve readiness to perform key clinical skills. The program successfully addressed knowledge gaps and fostered personal investment in professional growth by allowing staff to practice and refine skills initially learned in nursing school. Jessica expects that this will lead to increased staff engagement and improved retention rates over time. “Reducing attrition and investing in nurse education and training are essential to providing high-quality, patient-centered care,” she says.

The findings indicate that targeted, low-burden QI efforts can help cultivate a sustainable nursing workforce. “We anticipate this project will serve as a model for similar initiatives in Guyana and other low-income countries, reinforcing the importance of prioritizing public health through workforce development,” Jessica concludes.

Reflecting on her experience as a Dartmouth student, Jessica shares:

"Growing up, one of my dreams was to become an Ivy League student. As a first-generation graduate student, I feel incredibly grateful to have had the opportunity to make this dream a reality at Dartmouth. The knowledge I've gained, the experiences I've had, the people I've met, and the lessons I've learned will stay with me for the rest of my life. I feel confident and equipped to tackle public health issues, and I'm excited to see where my new Master of Public Health degree will take me!"

Written by: Mia Soucy

POSTED 4/2/2025 AT 12:37 PM IN #education #practicum #mph