As two in­ves­ti­ga­tions con­tin­ue in­to the death of six-year-old Jash­er Fran­cois, the T&T Na­tion­al Nurs­ing As­so­ci­a­tion (TTNNA) has ex­pressed full sup­port for the gen­er­al-trained nurse in­volved, say­ing its pre­lim­i­nary re­view found she act­ed pro­fes­sion­al­ly de­spite man­pow­er short­ages.

In a state­ment is­sued on Tues­day, the as­so­ci­a­tion said:

“The in­volved gen­er­al-trained nurse fol­lowed all pro­fes­sion­al in­struc­tions and per­formed all du­ties to an ap­pro­pri­ate stan­dard giv­en the sys­temic con­straints in our health­care en­vi­ron­ment. The nurse's pro­fes­sion­al­ism, com­po­sure, and ad­her­ence to pro­to­col are to be com­mend­ed, and we stand firm­ly in her de­fence.”

The TTNNA said it had re­peat­ed­ly raised the need to im­prove pa­tient-to-staff ra­tios and called on the Gov­ern­ment to in­tro­duce safe staffing ra­tios across all health fa­cil­i­ties.

“We are en­cour­aged that the cur­rent Min­is­ter of Health, Dr Lack­ram Bo­doe, has on­ly last week com­mit­ted to ad­dress­ing these ra­tios by fill­ing 1,800 va­can­cies—a re­form that is ur­gent­ly need­ed to en­sure safe and sus­tain­able nurs­ing care,” the TTNNA said.

It al­so urged the Min­istry of Ter­tiary Ed­u­ca­tion to grant schol­ar­ships for nurs­es to train in spe­cialised pro­grammes abroad un­til lo­cal schools can of­fer such cours­es.

It rec­om­mend­ed that the South West Re­gion­al Health Au­thor­i­ty (SWRHA) up­date its crit­i­cal care pro­to­cols and en­sure prop­er staffing and re­sources for con­tin­u­ous mon­i­tor­ing when ad­min­is­ter­ing high-risk drugs.

The As­so­ci­a­tion said it de­lib­er­ate­ly de­layed pub­lic com­ment fol­low­ing Jash­er’s death, out of re­spect for his fam­i­ly and to en­sure ac­cu­ra­cy, and is­sued its de­fence of the nurse on­ly af­ter an ini­tial fact-find­ing.

It ex­plained that mag­ne­sium sul­phate is nor­mal­ly giv­en to crit­i­cal­ly ill pa­tients and re­quires pre­cise ad­min­is­tra­tion.

“This drug re­quires strict dos­ing pro­to­cols, care­ful di­lu­tion, slow in­tra­venous ad­min­is­tra­tion, and con­stant pa­tient mon­i­tor­ing for po­ten­tial side ef­fects such as res­pi­ra­to­ry de­pres­sion, hy­poten­sion, and loss of re­flex­es,” the TTNNA said. “These re­quire­ments are par­tic­u­lar­ly de­mand­ing, and near­ly im­pos­si­ble, in en­vi­ron­ments where nurs­es are tasked with mul­ti­ple high-acu­ity pa­tients at the same time.”

Ex­tend­ing con­do­lences to Jash­er’s rel­a­tives, the TTNNA said, “The loss of a child is im­mea­sur­able, and we grieve along­side his fam­i­ly dur­ing this pro­found­ly dif­fi­cult time.”

It added: “The TTNNA reaf­firms our com­mit­ment to both pro­tect­ing the in­tegri­ty of our nurs­ing pro­fes­sion­als and ad­vo­cat­ing for sys­temic re­forms that safe­guard pa­tient lives. We stand ready to work along­side all stake­hold­ers to en­sure that the les­son from this heart­break­ing loss leads to mean­ing­ful, last­ing change in the de­liv­ery of health­care in TT.”

It said its re­marks re­late sole­ly to the nurs­ing role, and not to the con­duct of doc­tors or oth­er health work­ers.

De­fend­ing the nurse’s con­duct, the As­so­ci­a­tion called on its mem­bers to act with due dili­gence when han­dling med­ica­tions.

“If a nurse has any clin­i­cal con­cern about a med­ica­tion or­der—whether re­lat­ed to dose, suit­abil­i­ty, or mon­i­tor­ing ca­pac­i­ty—they must es­ca­late that con­cern im­me­di­ate­ly to a su­per­vi­sor or physi­cian be­fore pro­ceed­ing,” it ad­vised. “They should con­tin­ue to keep fam­i­ly mem­bers in­formed of the pa­tient's con­di­tion and the se­quence of clin­i­cal in­ter­ven­tions to en­sure they have a full ap­pre­ci­a­tion of the care be­ing pro­vid­ed.”

Two sep­a­rate in­ves­ti­ga­tions are on­go­ing—one by the South West Re­gion­al Health Au­thor­i­ty, and an­oth­er by an in­de­pen­dent com­mit­tee set up by the Prime Min­is­ter.

Jash­er died ear­ly Thurs­day morn­ing af­ter be­ing giv­en an in­tra­venous drug.

Two au­top­sies have been done, and Prime Min­is­ter Kam­la Per­sad-Bisses­sar re­vealed that a third au­top­sy may have to be con­duct­ed.

The TTNNA said Jash­er’s death again high­lights the need for bet­ter pa­tient-to-staff ra­tios, an is­sue it has been rais­ing for more than ten years. It not­ed that the coun­try has an acute short­age of spe­cial­ist nurs­es, in­clud­ing pae­di­atric nurs­es, as no lo­cal in­sti­tu­tions of­fer spe­cialised pae­di­atric train­ing.