Posted on: Sun 27-05-2018

Nursing profession globally continues to evolve and play core role in ensuring access to quality health and health care. Nurses in many countries of the world constitute the largest population of the health care system working across primary, secondary and tertiary care all over places where human beings are. Nurses provide care along the life span and in their various areas of practice contribute significantly to healthy societies, reduction of burden of diseases and health care delivery systems. Reforms of Nursing education and practice in many countries of the world changed the health status of the people positively through quality access to professional practice. Learning from other people’s experiences, the Institute of Medicine in a 2010 report titled "The Future of Nursing: Leading Change, Advancing Health" derived from thorough examination commented on how Nurses' roles, responsibilities and education should change in order to meet the needs of an aging, increasingly diverse population and to respond complex, evolving health care system. More than any other time, Nurses in Nigeria have to play key roles in the achievement of sustainable development goals and will be strategic in assuring universal health care access. However, nursing as a profession in the Nigerian health sector faces daunting challenges and the process of regularizing the education problems associated with educational reforms continue to bring crisis with regards to placement, remuneration, recognition and career progression in the context and in comparison, with other health professionals. To do this, there are critical challenges with nursing education that inform practice and what accrue to Nurses in terms of remuneration, recognition and career progression in the health care system.

Nurses educated at the university to provide generalist and specialized care are essentially reflections of professional practice worldwide and Nigeria has progressed along this line in the last three to four decades. However, the pattern of progression of Nursing education, especially transforming from a certificate programme from basic schools of Nursing to becoming professional university education like any other profession in the health team has been particularly slow and fraught with challenges. Ayandiran, Irinoye, Faronbi and Mtshali (2013) have noted in particular that nursing education reforms in Nigeria has not been responsive sufficiently to meet the challenging and changing times to be able to play desired roles and responsibilities as desirable to meet the needs of a changing society and health care system. This paper presents a short summary of the issues with the pattern of nursing education in Nigeria, the implications and the need for immediate national action to redress the anomalies contributing to high level of marginalization, under-remuneration and unrest in the health care system.

Pattern of Nursing Education in Nigeria and implications for career growth, remuneration and professional recognition in the health care system

The pattern of nursing education in Nigeria is particularly inefficient, ineffective and not cost-effective for the individuals opting to study Nursing, for the government, for enhanced access to quality care for the citizenry and for professional emancipation. It takes a minimum of 8 years to have a first degree for anyone that is unfortunate to study nursing starting from a basic school of Nursing. Yet, a first degree in Nursing for a straight secondary school graduate takes 5 years after he or she can proceed to acquire higher education and specialize. It is also unfortunate that most courses for specialization that ought to be done at the postgraduate level are still currently run as certificate programmes registrable by Nursing and Midwifery Council of Nigeria. This gross inefficiency has been observed for years and for over a decade, efforts to correct this anomaly have not yielded the desired result. There used to be the excuse of few universities offering Nursing but in the last five years, universities running degree programmes in nursing has increased to about 27 across the six geo-political zones in Nigeria.

In recent times, experiences of inhuman and discriminatory treatment of some category of health professionals by government resulting to high level of crises, marginalization, discrimination in remuneration and other human right abuses calls for a profound and immediate reform of Nursing education to remove all barriers to mainstreaming nurses to equitable and respectable career structure like other health professionals who have moved all their education to the university. Whatever is the outcome of the JOHESU-Government negotiation, many nurses will still be marginalized among all the health care professionals in terms of remuneration and career progression.

Beyond the borders of Nigeria, the current patterns of nursing education in Nigeria also put the graduate of basic cum university education from the country at a disadvantage with employers of labour. The challenges and proposals for the way forward as seen by a victim of the Nigerian nursing education and his request for urgent intervention is as attached to this brief.

Our Observations, Experiences and Proposals

Please permit us to introduce ourselves, the authors of this rejoinder who have become victims (among several others) of the Nursing education system. We are: ‘Lekan Agunbiade, (a Registered Nurse and Registered Public Health Nurse with BNSc degree) and Kayode Joseph Ogungbohun (a Registered Nurse, Registered Psychiatric Nurse and Registered Occupational Health Nurse with BNSc degree). This call is to humbly solicit for your intellectual and influential assistance in addressing perhaps the toughest issue affecting Nursing profession in Nigeria.

The JOHESU Initiative: Some of us have followed the on-going JOHESU struggles with keen interest and we seem to have gotten to a stage that we could no longer remain tranquil while our profession gets compromised in the discourse of regularizing irregularities affecting the health professions in the Nigerian health sector. It is noted that the issues with Nursing profession in Nigeria far predates the JOHESU itself, our professional vulnerability and incapability have never been more naked than they are in very recent times. The moral vs. immoral sides of the present challenge is not the motivation behind this submission but NURSING is. Kindly permit us to use the current situation to trace backwards and present the crucial and to the essential matters.

JOHESU began the struggle and clamouring for various things for her members. Shortly into the struggle, the different arms of JOHESU began to come up with issues peculiar to their respective professions while Nurses through NANNM have been the loyal vast majority but just waiting for the largesse that cut across everyone on our hospitals’ corridors. There are no nurses among the top key players representing JOHESU and thus one may not be surprised that Nursing and Nurses are not sufficiently defended in the on-going agitations. NANNM seem to be very tranquil during one of the worst of crises. It has gotten too bad that for whatever debatable or noble reasons, even some of NMA’s recent writings seem to be kinder to nursing specifically and highlighting our disenfranchised situation than JOHESU’s common cause does.

Divisions, selfishness and dichotomies in Nigerian nursing have held us backwards and agelessly so. While doctors everywhere and anywhere in Nigeria, including those in the university settings are part of NMA, same is not applicable to nursing. This singular factor has meant that while our brain boxes and assemblage of intellectuals are comfortable amidst ASUU in their respective universities, some less endowed and haphazardly prepared persons represent our dear profession and of course, they have hitherto done so very averagely, just to put it mildly. We have pondered frustratingly on the prospects of this profession if one of our erudite and amiable leaders in the education area was to be representing Nurses at such a time as this, what would our portions have been?

We observed that extreme intra-professional animosity and name-callings exist in many areas and across several paths of our profession, especially between the university graduates and graduates from schools of nursing. While Medicine was able to transit from diploma to baccalaureate track and ensure that practice and education segments are meshed into same unit, we have maintained a very disjointed system that wastes several years of each and every nurse that seeks to be better. We have had the honour of listening to some of our great nursing leaders and most especially, we have enjoyed the mentoring of a few of the best nurses that nursing in Nigeria of today can boast of. Knowing how well stocked we are, one will be frustrated as to why we have not been able to navigate this transition, despite all the resourceful persons the Creator has endowed us with. The variations in our entry point into the civil service have not helped us at all, just as the partition between university-based nursing educators and clinicians have not done us any good as well.

Furthermore, one of our nursing mentors who began his career in 1977 recently explained that affiliating to degree pathway had been in the pipeline since his days in nursing school which coincides with the then early days of baccalaureate nursing programs in Nigeria. To remember that French President – Emmanuel Macron was born in 1977 perhaps explains the long wait in better terms. For the consumers of our care and the Nigerian health sector as a whole, one can only salivate at how better and greater our care will be if education and practice arms of our noble profession are married together. What a prospect to dream of! One of us currently practice in the Republic of Ireland and the seamless blend among the board, education and practice arms of the nursing there, is a realistic target if we will put nursing profession ahead of our painful past experiences and differences.

From the experiences of one of us, the Nursing and Midwifery Board of Ireland assessed his transcripts from Wesley Guild Hospital to be sufficient to register him as Registered Nurse in Ireland but other questions were raised when the transcript from Obafemi Awolowo University was turned in. One important question raised was "what explanations do you have for spending eleven (11) years for a 4-year program and why another 6-7 years?" The very concerned administrator explained that BSN in Ireland and England is a 4-year undergraduate program and that they just could not comprehend why it took him more than a decade to bag BSN, especially given that he had RN after the first three of those years. Unfortunately, we get into the Nigerian labour market and we are less valued, less remunerated and less placed. While it is easy to opine that RN – BSN pathway made one’s career path complicated, it is saddening to note that our straight BSN graduates also enter into the market in a disadvantaged position when compared to their mates from other professions also with a first degree in the health professions. We want to sincerely plead that our leaders across the several areas of Nursing in Nigeria come together and brainstorm on the strategies to rescue this dear profession from limitations imposed by historical mundaneness.

We have drawn encouragements for initiating this daunting process from the Nurses in OAUTHC. The agitation to affiliate or assimilate basic schools to universities and regularize Nursing education in line with what operates with other professional groups in health care has peaked. In our regular Nurses' forum, it has once been expressed by the Director of Nursing Education that nurse educators are committed to taking all actions to help transform nursing education. For us, if there is a time to get things right, it is now. While some people may want to use other countries with multiple categories of nurses as reference point to justify our current status, the educational system of such countries and the health care system entrench equity, fairness and do not use ambiguity and inter-professional rivalry to marginalize nurses. We will be doing ourselves double professional favour by reviewing the existing curricula and educational formats and we have everything it takes to achieve and break this record.

Our Proposition

The current situation begs for inclusive commitment of all arms of nursing profession in Nigeria and it is with utmost humility and modesty that we wish to recommend an emergency National Summit involving the leadership of Nursing and Midwifery Council of Nigeria, National Association of University Nursing Programmes, all Nigerian Professors of Nursing currently within and outside the country, all the stakeholders in our universities, schools of Nursing, post-basic programmes, the leaders of Association of Nigerian Nursing Educators (ANNE), the professional associations, NANNM leaders, and leaders of UGONSA and others. Nigerian nurses in the diaspora will also need to be part of the summit to share their experiences in other countries of the world. We need to proffer solution and measures to solve this long overdue task of affiliating or assimilating our Schools of Nursing into the departments of Nursing. Where possible, affiliate or assimilate these nursing schools and close down those that cannot be salvaged. We have no doubt whatsoever that some universities can have up to five colleges under them; this is obtainable in other countries and in a few Nigerian universities as well. Although the experience of Medical Laboratory Scientists may not totally apply to nursing, but we will recommend that their model be keenly looked at during this National Summit for few guiding points.

Moreover, given that our university based systems cannot not sufficiently meet the current demand and supply statistics and in the face of the high rates of quackery in Nigeria (most of which our colleagues contribute to by training quacks to work as nurses in their privately owned hospitals), and also the watching CHOs, we will dearly plead that the assembly of our able leaders liaise with NUC and look critically at assimilating the Schools of Nursing so as not to deprive the labour market a constant supply of nurses. From the scheme that will emanate from these decisions, our colleagues in the nursing schools who are not qualified to retain their present positions in the new structure will have to sacrificially accept a lower position or be moved to the clinical areas, as each unique situation will decide. Moreover, the outcome of this professional reorganization will also need to review the possibilities of the existing post basic nursing programs being morphed into postgraduate programs – either as diploma or Master’s degree.

More importantly, if entry requirements for Schools of Nursing in Nigeria can be changed from one science subject to Physics, Chemistry, Biology, English and Mathematics, also, if accreditation of schools of Nursing departments of nursing in our universities can be done on regular basis, we can’t imagine why the Schools of Nursing cannot be colleges of Nursing and award degree while the Nursing and Midwifery Council will still be administering the professional examination - as it currently obtains in other countries. If we are agreeing to take this essential leap, one can easily anticipate a scenario of the tutorial staffs in the Schools of Nursing who don't have their MSc yet acquiring their Master's degree in nursing and fit into the new system, within three to five years.

Who hosts such a decisive meeting as this? Those of us behind this move are too few and too young for such a task but fortunately, we have the unanimous support of OAUTHC Nurses to represent the interest of all nurses yearning for progress and the generations yet unborn. We strongly believe that through the progressive passion currently brewing in OAUTHC, nursing in Nigeria can at last begin to fulfil her destiny. We have been reassured by several colleagues that they will be ready to voluntarily donate towards this cause, just as the recent radio awareness by OAUTHC Nurses to represent Nursing in the current JOHESU efforts have been funded solely on voluntary monetary contributions. Likewise, being part of the executives of the Obafemi Awolowo University Teaching Hospitals Schools of Nursing, Midwifery and Peri-operative Alumni Association, which is registered by Corporate Affairs Commission and are full of vibrant minds who wish to see nursing proper in Nigeria, we have the association’s commitment to contribute financially to this breakthrough. And, if God allows us this chance, we will count it extreme honour to come home and learn at the feet of elders in this forum. The zealous President of the aforementioned alumni association is one other person who has been working hard to build supports from our colleagues in the diaspora and he will equally be glad to be in Nigeria for the Summit. From the encouraging feedbacks thus far, we are very sure that some other colleagues from the diaspora will be willing to be part of the rebirth of our dear profession. To this end, please permit me to suggest a 3-DAY NURSING EDUCATION SUMMIT to take place between January and May 2019, or as it may be advised by our able stakeholders and professional leaders after due consultations.

We will be very eager to receive responses to this proposition for us to take the plan forward

Thank you.

With high regards,

               

'Lekan Agunbiade (RN, RPHN, BNSc)                  Kayode Ogungbohun (RN, RPN, ROHN, BNSc)

+234 803 944 7262 (WhatsApp)                           +971 50 102 1625 (Calls and WhatsApp)          

+353 89 228 6165 (Calls)                                        [email protected].

[email protected].                             [email protected].   

[email protected].                      

---

---