The fundamental responsibilities of Nurses according to the International Council of Nurses (ICN) Code of Ethics as reviewed in 2005 include: to promote health, to prevent illness, to restore health and to alleviate suffering. These can only be achieved maximally by keeping the pace of development of nursing practice in Nigeria viz a viz developing keen interest in nursing research, good management and leadership from the Leaders and personal/collective upgrading and keeping pace with Technology advancement as related to Nursing Professional progress.

 

The future of Advance Nursing Practice (ANP) is promising in the sense that Primary-care providers (Doctors) are currently in short supply throughout the nation as physicians continue choosing to practice in higher paying specialties and most especially travelling out of the country for green pasture, with increased alarming Nigeria population. Hence, primary-care nurse practitioner through advanced nursing practice programs will help to fill this deepening gap with quality health-care providers. It is time for nursing profession to stand in the forefront and have our voices resonate by health-educating the masses through sensitization and awareness program; development, implementation and evaluations of Government health policy on need for advance nursing practice etc.

 

CHALLENGES FACING ADVANCED NURSING PRACTICE IN NIGERIA

Yet numerous challenges continue to restrict scope of practice, and negative public relations campaigns from physician organizations skew the political debate, disseminating misinformation that patients are in danger of receiving substandard care from Advanced Practice Nurses (APNs). In order to break down existing barriers to APN scope of practice, Nursing Leaders need to be actively involved and support the professional organizations. Among the challenges facing advanced nursing practice in Nigeria includes:

 

LACK OF INTEREST IN RESEARCH:

We cannot put the old wine in new bottle and expect the refined taste, hence for advance nursing practice to come to stay in Nigeria, the input of research must become necessary, not only for study (class room) purposes but for proper implementation to the real life setting in the clinical area. Unfortunately, only very few nurses are interested in research, even though it is the responsibility of all nurses to do research to improve nursing care. The introduction of research methodology as a course in schools of nursing has done little for now, to make students attach must importance to research projects, as most students believe that research ends after school.

 

WORK ENVIRONMENTS:

Some work environments are un-conducive and non- supportive for nursing practice, such as lack of sufficient facilities and equipment to work on as obtainable in advanced countries and also lack sufficient motivational input, such as poor remuneration, housing transportation, incompetent supervision, poor working relationship, general moral laxity in the society, undue familiarity with subordinates, with a weakness in disciplinering staff, among others, nurse are no longer in control of the immediate environment in which patients are nursed. If quality health care must be provided then these limiting factors must look chronically unto.

 

THE NURSE HERSELF OR HIMSELF:

The greatest challenge to advanced nursing practice in Nigeria is the nurse herself or himself. Nurses specially in the Ward (based on my little experiences so far in Hospital Setting) and in contemporary Nigeria are less caring, committed and dedicated to meeting the needs of clients. Most nurse are resistant to change, professional development and advancement, some Nurses tend to hold onto previous knowledge and skills without making efforts to improve and maintain new skills, unwilling to staying abreast with education and development levels of nursing practice, as seen in some Matron that only believed Nursing education (Diploma) end in school of Nursing. This has serious implication for nursing practice.

 

ADVANCEMENT IN SCIENCE AND TECHNOLOGY:

The advancement in science and technology will continue to affect the nursing profession. In the past nursing relied on their experiences, observation and intuition but today, nursing has a defined body of knowledge specific to the profession and continues to develop this knowledge through research and practice as they relate to new drugs, methods of delivery, disease control and prevention through sterilization and disinfections of equipment, and models in nursing, among others, for instance, the knowledge and implementation of the nursing process as a scientific and systematic approach to nursing care has  been seen by many nurses as problematic. Some nurse has found it difficult to implement because some professionals in the health system do not understand what it is all about. Hence, through advance Nursing Practice (which is yet to be fully implemented in Nigeria) these challenges will be face out.

 

NON-PARTICIPATION IN MAKING POLICY: 

Policy making on health issues is a major challenge to advanced nursing practice as most nurses are women and society seen it as feminine/ female dominated profession. The nurses of the past were grossly handicapped because of the type of training they received, by taking their feminine submissive roles without questioning; after all, their husband is the head of the home. Nurses have traditionally been subordinate to Doctors and these have affected leadership roles in policy making on health issues. Hence, to achieve advanced nursing practice in Nigeria, Nurses must be actively involved and engaged in health policy and education at both Local, national and international level.

 

POOR MEDIA PROJECTION OF NURSING:

The mass media e.g. newspapers, radio station, movies especially Nollywood, Bollywood etc. do not project Nurses and Nursing profession very well to the general public as masses still seen the profession as Doctors servants. For example: The doctors, pharmacists even environmental health workers are being projected better to the taste of the people. Notwithstanding, every everybody needs the services of the nurses at all times. They project us as inferior or second-class citizens thereby demoralizing the regard respect and trust the public have on us. Hence, managing to obtain Diploma certificate via school of nursing is enough to become a Nurse. This impression need to change if only Nigeria Nurses want to meet up to the best globally practice advanced nursing program as seen in developed countries like Canada, USA etc.

 

ACADEMIC REGULATION:

Most of Nigeria universities and schools of nursing do not have concrete curriculum for nursing education. The National University Commission (NUC) and Nursing and Midwifery council of Nigeria (NMCN) supposed to sit and make the curriculum for advanced nursing education common in Nigeria and enact law mandating the minimum entrance to Nursing practice as Bachelor Degree in Nursing rather than promoting and equalizing Diploma Nursing to Higher National Diploma (HND) as obtainable in emancipation of Medical Laboratory science Degree by eradication of Diploma school of Medical Laboratory.

 

POLITICS:

This is a cankerworm that has eroded the general system in Nigeria including nursing practice e.g. Setting of Nursing schools, Hospital, and nurse’s wages! Remuneration for nurses has been politicized even today. Hence, for Advanced Nursing practice to be realistic in Nigeria, Doctors and any privilege others in Nursing Profession at the leadership top level must see need to stop politicizing the need for advancement in Nursing Education in the Country.

 

LACK OF CONTINUOUS TRAINING AND RE-ORIENTATION:

Nurses continues to practice in most hospitals without re-orientation to the needs of patients in the 21st century. Non-attendance of clinical care workshops by nurses and non-organization of seminar /workshop on clinical nursing issues are all inherent problems in many Nigerian hospitals. This must be stop and Nurses must be mandated to attend Clinical seminar and need for upgrading of Diploma Certificate to Degree in Nursing as a yardstick for promotion both in the Hospital and other parastaltal working place.

 

THE EDUCATIONAL GOAL OF THE NURSE:

Nurses satisfaction with basic qualification and practice for financial reward in the 21st century is another major cause of declining care because it always amount to great competency in terms of advancement in education vise-visa in clinical nursing practice. Professional nursing educational now borders on continuous education and specialization. Continuous training and development leads to good leadership and better skills in nursing care services, it also promotes the image of nurse in the society. The status of nursing in our society has not promoted good professional image, for the nurses largely because of poor facilities in the training institutions and lack of commitment to practical teaching in the ward by all cadres of nurses. Nurses leaving professional care to student nurses or pupil midwives. Nurses must practice to show the learners how to do it, nursing professional training is hospital based. All cadres of nurse must be committed to these apart from clinical instructors and all these can only be best achieved through advance Nursing practice program execution in Nigeria University.

 

POOR INFORMATION SYSTEM:

Poor information system is another cause of declining nursing services, proper planning and budgeting plus  monitoring are essential information that have delayed the progress of nursing services in Nigeria. There are no realizable and accurate data in which care is planned. Information to patients is very poor. Interpersonal relationship between various professional in the hospital setting is poor and this also can cause a fall in care rendered and negative image of the professionals. Nurses need to read newspapers, journals and internet articles to be more informed about current issues in nursing services.

 

REORENTATION OF GOVERNMENT ON WAY OF REDUCING COSTS OF HEALTH CARE:    

Government needs to be reoriented through evidence based information on ways of maximizing the Value of Advanced Practice Nurses in providing Quality, Cost-Effective Health Care. According to David Vlahov (Dean University of Central Florida- School of Nursing ) moderated discussion with Susan Hassmiller, (Senior Adviser for nursing at Duke University School of Nursing) I’d like to raise another issue in health care that speaks to why we need more nurse practitioners: containing costs. If we look at the data from Massachusetts, Rand predicted that using nurse practitioners and physician assistants in Romneycare could save the state between $4.2 billion and $8.4 billion over a decade – again, that’s with a workforce equivalent to and in some areas better than physicians. And then if you look at time of training, cost of education…in the ACA section on workforce training, they set aside $168 million to train 500 new primary care physicians by 2015, $32 million for supporting the development of more than 600 new physician assistants and $30 million to train 600 nurse practitioners. That’s an interesting illustration of the comparative costs of education.

 

The Florida Office of Program Policy Analysis and Government Accountability reported that broadening the scope of practice for NPs could yield annual Medicaid savings of $7 million to $44 million. And in Texas, if nurse practitioners are allowed to practice to the top of their training, they could increase the state’s economic output by $8 billion.

 

There are a lot of these cost analyses. Decisions about allowing NPs to practice to the top of their education and training should be based on evidence about what is best for the cost, quality and access for patients

 

This kind of evidenced based articles need to be well presented to Government to imbibed internationally best practice in order to have cost effective Government towards healthcare in Nigeria by actively supporting advance nursing education system in Nigeria University through open ended scholarship grants etc. to facilitate emergence of Advance Nurse Practioners which is cost and remuneration effective compared with Physicians salary.

 

About the Author

Ibiyosi Ajibola is a Nursing Officer at LAUTECH TEACHING HOSPITAL OGBOMOSO OYO STATE.