Paulette Cash's journey in nursing she says has not been easy, but if she had to choose a career all over again, she says she would still choose nursing. To Cash, nursing is a ministry.
"It is a noble profession that prepares you for service and for life," said Cash, a senior nursing officer at Princess Margaret Hospital within the Strategic Nursing Services Unit, contributing to the strategic direction for nursing, policy development, and strengthening of services of the Public Hospitals Authority (PHA) and by extension, national health system strengthening.
She said she has had so many meaningful opportunities and experiences related to her profession.
"I recall sitting in a forum at the World's Health Assembly in Geneva, Switzerland, smiling and saying to myself in reflection - 'Look at me, little girl from Lower Bogue [Eleuthera], sitting among the world leaders in healthcare, having contributed to the communique to be presented at the Assembly on behalf of the International Council of Nurses (ICN).'"
Cash said she has always wanted to be a nurse. And remembers having that aspiration from as far back as she can recall during her formative years.
"As a child, I was fascinated with the white uniform - but as I grew older, I realized that my desire to become a nurse was innate and aligned with my caring and compassionate nature - as well as my desire to make a difference in the lives of others."
Cash has had opportunity work within the Special Care Baby Unit/Neonatal Intensive Care Unit for 20 years. She is qualified as a neonatal nurse practitioner and clinical nurse specialist.
"I would consider my experience of caring for sick, premature babies and other high-risk newborns as most rewarding. It is so precious to see a mom or parents leave the unit with their baby in their arms, after sometimes a very challenging, roller-coaster experience. Knowing that I played a role in making that happen was most gratifying."
Cash grew up in what would be described today as a "socially-economically challenged home."
She recalls the principal at the school on the island at the time paying for her to write her Bahamas Junior Certificate (BJC) and General Certificate of Education (GCE) examinations so that she "did not fall through the cracks academically."
To this day, she says she is thankful to her former school principal.
"We were relatively poor – I never had the luxury of having my own bed, or my own dresser in which to place my clothing – but there was a lot of love and regard for what we possessed as a family. In fact, my family meant everything to me and still do."
Cash said she had aunts who took her under their wings and provided a supportive upbringing. She recalled her brother who graduated high school the same time as her, paying for her to spend another year at a private high school, until she attained her 17th birthday to enter nursing. To all of her relatives who assisted her along the way, she said she is grateful.
"Although we had little, I was always a highly ambitious child, very focused and very disciplined. I always had big dreams," said Cash, a registered nurse (RN).
"My brother-in -law brought me from the family island on the local mailboat to live with his family in [New Providence] to enable me to pursue my career in nursing. To this day, we make jokes about the experience and about how my mom was not happy about her baby moving to the big city at that time. She now beams with such pride.
"As a child, I was determined not to allow my circumstances in life determine my destiny. As I grew into young adulthood, I began to absorb myself into books on purpose and potential by my pastor, the late Dr. Myles Munroe. These books helped me to stay focused and sustained my drive to succeed in life. I had come to an understanding at a young age that God has placed within me all that I need to succeed in life, and that whatever God calls for, he provides for," she said.
After completing her diploma in general nursing, she obtained an associate of arts degree in nursing; bachelor of science degree in nursing; master's degree in nursing; and a doctor of philosophy degree in public health administration.
The 2023 Nurse of the Year for the Princess Margaret Hospital 2023 National Nurse of the Year said being awarded the title was a "rejuvenating experience."
"I was so humbled, as there are so many other deserving nurses."
The honoring also came at a time when she said she felt she needed a boost.
"I had recently returned to The Bahamas from the United States, after investing much time and money into qualifying myself to become an advanced practice nurse, (neonatal nurse practitioner/clinical nurse specialist) and unfortunately, there was no legislation in place in The Bahamas to support my scope of practice. I am so excited that the Nurses' and Midwives' Bill is finally moving through the legislative process in The Bahamas and has such provisions which will allow nurses to function to the fullest extent of their education, training, and experience."
In 2005 she was named Caribbean Nurse of the Year (Bahamas) from the Caribbean Nurses Organization (CNO) an organization which she currently leads.
Cash, the first Bahamian president of CNO said she is humbled and honored to have the opportunity to serve the nurses of the Caribbean Sea and diaspora.
"As president, it's a great opportunity to work with the other members of the Board of Directors and our member national nurses' associations to advance nursing education, nursing practice, and the health of the people of the Caribbean region," she said.
As for the reported challenges in nursing, she said for the most part they are the same in The Bahamas and across the Caribbean region.
"As one review findings from focus group discussions and research conducted in the Caribbean region, and dialogue with nurses from across the Caribbean, it is noted that within our territories, the challenges are very similar and include nursing shortages related to migration of nurses and in some cases inadequate local supply of nurses, concerns about burnout, working conditions, workplace safety, inadequate salaries and benefits, lack of engagement in critical decision-making, lack of professional respect and recognition, lack of managerial support and inadequate supplies, lack of autonomy, and limiting career paths with resultant inadequate opportunities for advancement."
Cash said there are still some countries in the Caribbean region without nursing councils and government chief nursing officers which she said are real challenges that must be addressed if the region is to have a productive, sustainable nursing workforce that can meet the needs of health systems.
"There is global consensus that the contribution of nurses and midwives are vital to the achievement of local health priorities, as well as the global health agenda, inclusive of achievement of the sustainable development goals (SDGs), universal health coverage (UHC), global strategy for women's children's and adolescent's health (2016-2030), and health in all policies. Therefore, the CNO reverberates the call of global partners in health for greater investments in nursing and midwifery education and training, service delivery, nursing and midwifery leadership development and nursing and midwifery jobs."
Cash said there must be greater efforts to not only produce more nurses and midwives but to retain them in workplaces and in the region.
"Strategies to strengthen the nursing and midwifery workforce and by extension our health systems must therefore involve all key stakeholders (nurses and midwives, policy makers, nursing regulators, employing agencies, schools of nursing and nurse educators, patients/clients, community representatives, and collaborators for healthcare)."
Cash's other awards include Distinguished Nursing Service Award (2010 and 2022) and Zenith Award (2014) by the Nurses Association of the Commonwealth of The Bahamas (NACB); the Mavis Harney Award for Clinical Practice by CNO (2010); and the Clinical Excellence Award by the Public Hospitals Authority (PHA).
A former NACB president (2014-2018), Cash has represented The Bahamas at a number of local, regional and international forums; served on the Regulatory Board (Nursing Council of the Bahamas), and on several task forces, advisory boards and special committee for nursing and health services.
"Having the opportunity to serve as a facilitator for the ICN Leadership for Change (LFC) Programme, participating in the Global Nursing Leadership Institute (an advanced nursing leadership program of the International Council of Nurses) and serving as a member of the expert panel for the revision of the ICN Code of Ethics for Nurses are indeed treasured experiences that I also hold dearly," she said.
Cash, who was among nurses recognized during Nurses Month in May, believes in the stance of the ICN for nurses: "Together our future depends on every nurse, every voice, to not only be on the front lines of care, but also be on the front lines of change."
She said she looks forward to a future in which all nurses are protected, respected, and valued.
Nurses Month is celebrated to recognize the impact nurses make on healthcare and allows for greater opportunities to promote understanding and appreciation of the invaluable contributions nurses make.
International Nurses Day is observed on May 12; the day commemorates the birth in 1820 of Florence Nightingale, the foundational philosopher of modern nursing.
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