title: Facilitating the quality of care in a specialist Pacific ophthalmic nursing workforce.
abstract: BACKGROUND
  Sufficient, appropriately trained health personnel need to be retained in the workforce, and their performance maintained, to achieve quality care. Mid-level ophthalmic personnel in Western Pacific Island Countries and Territories (WPICT) are no exception.
  
  
  OBJECTIVE
  The study aims to assess influences on the quality of care provided by specialist mid-level ophthalmic personnel in WPICT and devise strategies to train, retain and maintain performance of these personnel.
  
  
  METHODS
  A situational assessment employed a checklist and semi-structured interviews with specialist mid-level ophthalmic personnel, nursing bodies and Ministry of Health representatives from seven WPICT. A selective literature review guided strategies to address the issues identified.
  
  
  RESULTS
  Appropriate training allows nurses to fulfill a mid-level role in WPICT as specialist ophthalmic nurses. Resources generally do not restrict practice. Nursing structures have generally failed to support professionalism: scope and conditions of service, clinical supervision, career structures, professional recognition and opportunities for continuing professional development are rudimentary. Ophthalmic nurses were dissatisfied with the lack of specialty recognition, career progression and salary increase. Regional and local strategies tailored to each country have been devised to establish sustainable processes for support.
  
  
  CONCLUSIONS
  Salary was a major cause of dissatisfaction. It should be addressed along with professional recognition and related processes. Without professional support, specialist and advanced cadres within nursing may cease to exist, nurses' performance may be affected or they may leave. Specialist ophthalmic nursing, recognized, situated within and properly supported by nursing structures can provide a model for specialist clinical care for other specialties and in other countries.
authors.affiliation: The Fred Hollows Foundation New Zealand, Auckland, New Zealand. rdutoit@hollows.org.nz
authors.forename: R
authors.initials: R
authors.lastname: du Toit
authors.forename: F
authors.initials: F
authors.lastname: Hughes
authors.forename: I
authors.initials: I
authors.lastname: Mason
authors.forename: B
authors.initials: B
authors.lastname: Tousignant
mesh_terms: D002322:Career Mobility; D057189:Checklist; D002983:Clinical Competence; D006801:Humans; D007407:Interviews as Topic; D009885:Ophthalmology / Q000193:education; D010139:Pacific Islands; D010563:Personnel Turnover; D011787:Quality of Health Care; D012456:Salaries and Fringe Benefits; D013041:Specialties, Nursing