Nursing in Dominica

Nursing in Dominica has long been one of the most important pillars of the island’s health system. Nurses provide the majority of patient care across the district health system, working in hospitals, health centers, schools, and community outreach programs. Their role has been especially vital in implementing the Primary Health Care (PHC) model which emphasizes equity, accessibility, and preventive health services across both urban and rural communities.

Historical Background of Nursing in Dominica

The history of nursing in Dominica dates back to the colonial period, when religious missions and charitable institutions first introduced organized care. Formal training opportunities began to emerge in the mid-20th century with the establishment of the Dominica School of Nursing, which later merged into the Dominica State College to provide diploma and degree-level nursing programs. These institutions have been central in training generations of nurses to serve at home and abroad.

The passing of the Nurses Registration Act formalized professional regulation, requiring licensing, adherence to standards of practice, and oversight by the Nursing Council of Dominica. This ensured that nursing evolved as a regulated profession with accountability to the public and the state.

Workforce Numbers, Vacancies, and Trends

• The Ministry of Health maintains a nominal establishment of 420 nursing positions spanning both the Dominica-China Friendship Hospital and the Primary Healthcare system.
• Of these, 165 positions are allocated to the hospital and 139 to primary healthcare facilities.
• Yet, only 304 positions are currently filled: 85 in primary care and 31 in the hospital. This leaves 116 nursing posts vacant across the system.
• Between 2013 and 2024, 125 nurses resigned and 33 retired from service, contributing significantly to attrition.
• To manage shortages, Dominica supplements its workforce with Cuban nurses (Cuban Medical Brigade). At the time of reporting, there were 11 Cuban nurses at the national hospital and 10 in primary healthcare settings, totalling 21 foreign nurses in service.
• In terms of density, Dominica had 6.10 nurses and midwives per 1,000 people in 2017.

These figures illustrate a significant gap between staffing needs and available human resources, with vacancies, resignations, and reliance on external support as enduring challenges.

Education, Regulation, and Institutional Bodies

• Nursing education is primarily conducted through the health sciences division of Dominica State College, which absorbed the former nursing school after institutional reorganization.
• The General Nursing Council (or Dominica Nursing Council) is the regulatory body established in 1952 under the Nurses Registration Act (Chap. 152). It handles registration, standards, discipline, and oversight of nurses and midwives.
• The Dominica Nurses Association advocates for nurses, providing professional development, representation, and negotiation of conditions.

Roles and Scope of Practice

Nurses in Dominica serve in multiple capacities:

• In hospitals, they manage inpatient wards, critical care, operating theatres, emergency care, neonatal units, and specialized units.
• In health centers and district clinics, nurses lead maternal and child health services (antenatal, immunization), chronic disease follow-up, health education, and outreach.
• During natural disasters and public health emergencies (e.g. after Hurricane Maria or during COVID-19), nurses have been frontline responders, conducting mobile clinics, vaccinations, and emergency care.
• Many nurses are involved in community-based care, including home visits, school health programs, and preventive campaigns.

Historic studies (e.g. “District nursing in Dominica”) show that a small group of district nurses handled approximately 80% of all patient contacts, with only 20% referred upward to medical officers.

Challenges and Pressures

• High vacancy rates: With 116 unfilled positions, the system operates under strain.
• Attrition and migration: Many nurses leave the public service or the country entirely, resignations, retirements, and emigration are ongoing problems.
• Overwork in rural districts: Nurses often cover multiple communities and facilities, increasing burnout risk.
• Dependence on foreign staff: Substantial portions of current staffing derive from Cuban medical cooperation, reflecting local shortfalls.
• Resource and logistic constraints: Equipment, supplies, continuing education, and supervisory support are unevenly available.

Recent Reforms and Incentives

To ameliorate shortages and retain staff, the government has introduced several incentives:

• A one-time uniform relief allowance post-Maria (75% of regular allowance).
• Increased night duty, on-call, and special duty allowances.
• Duty-free concessions for vehicle purchases by nurses.
• Salary increases following organizational review and reclassification within the public service.

These reforms aim to mitigate attrition and improve retention, though systemic workforce challenges remain.

Outlook and Strategic Direction

• Expanding nursing education capacity, with more seats and specialized programs, to increase local supply.
• Strengthening retention via career ladders, continuing professional development, and improved working conditions.
• Integrating advanced practice nursing roles (nurse practitioners) to relieve doctor shortages.
• Enhancing rural deployment support, housing, mobility, incentives, to reduce urban concentration.
• Deepening collaboration with regional bodies (OECS, PAHO) and foreign partners (Cuba, China) to support training, exchange, and in-service mentorship.

By addressing vacancies, attrition, and training bottlenecks, nursing in Dominica can further reinforce the health system’s reach, resilience, and quality of care.