TOPIC: Factors affecting nursing practice in Nigeria

Factors affecting nursing practice in Nigeria 2 years 7 months ago #1639

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High-quality nursing care depends on multiple underlying structure and process factors, such as the availability of sufficient supplies and equipment, facilities, nurse engagement and job satisfaction — all of which influence outcomes."

The Work environment plays a large role in the ability to provide quality care. A comparative analysis of the work environment in private and public settings exposes a lot of discrepancies. I don’t remember the light ever going off while at work in either of shell, total or LNG clinic. The hospital environment and medical equipments in these aforementioned clinics are at par with international standards and requirements.

On the other hand, the work environment in public hospitals adversly hamper quality nursing cares. Ranging from unhealthy nursing work hours, inadequate rest, Erratic power supplies, obsolete equipments, No running water, lack of work incentives, motivation and insufficient compensations; these unfriendly environments impacts everything from the safety of patients and their caregivers to job satisfaction. The picture below is of a nurse on a night shift with a torch light strapped to her forehead in a government hospital. How is she expected to give her best under such harsh conditions?


Registered nurses constitute an around-the-clock surveillance system in hospitals for early detection and prompt intervention when patients' conditions deteriorate. You would agree that the effectiveness of this surveillance is influenced by the number of nurses available to assess patients on an ongoing basis.

Nurses in our public settings have become an overburdened burned-out surveillance system. They experience job-related burnouts and low job satisfaction levels. The government isn’t recruiting more nurses whereas new wards are being built with more patients to care for. It therefore becomes almost impossible for these nurses to exhibit an overflow of empathy when they are over burdened with high patient loads and stretched to their breaking points on a daily basis. Remember, the World Health Organization recommends a nurse-patient ratio of 1:4 for general wards and 1:1 for specialist units like the ICU, most public hospital nurse: patient ratios range from 1:16 to 1:30.

Research has consistently showed that nurses in hospitals with the highest patient-to-nurse ratios like in the government hospitals are more than twice as likely to experience job-related burnout and almost twice as likely to be dissatisfied with their jobs compared with nurses in the hospitals with the lowest ratios (like in shell, Total hospitals)


Nurses are research oriented, versatile and polyvalent. Our practice is evidence-based with detailed theoretical background for optimal outcome of patients’ wellbeing. On the other hands, the quacks (as shown in the picture below) are a breed of individuals with no knowledge of the scientific rationale behind the practice of Nursing. They rob us of our pride and prestige, their actions and inactions have perennially brought disrepute and insult to the profession. The increasing menace of quackery is exponentially denting the image of our noble profession

Quackery of a truth is not peculiar to Nursing but Nursing have remained the only profession whose quacks have come out in broad day light to exhibit their criminal practices, even getting recognition and lucrative employments. Their ineptitudes and conducts have lent credence to the general notion that "nurses" lack empathy, contributing to the poor perception the public has of nurses. Imagine the effontry of the quack in the picture below, dressed as a nurse and proudly displaying an ilegal certificate from "TOLAJ GROUP HOSPITAL CLINIC AND MATERNITY" which is not licensed to train nurses. You would agree with me that any unprofessional act by this ogunsanmi morenike would be attributed to nigerian registered nurses.


The media continually undermines Nursing by its portrayal in the movies. Nurses have often been unfairly and unrealistically portrayed as lacking empathy and in negative light. These stereotypes demean our profession and are an affront to the years of education and hard work we have devoted for the privilege of delivering care to patients. The media's negative view of the profession acts as a powerful force to shape the public’s attitudes towards nurses and prejudice their mindset. An average Nigerian movie sells 50,000 copies, extrapolate this figure in terms of negative publicity of nurses in these movies and it becomes obvious how the media is killing our public profile and affecting our practice.


The exclusion of nurses from the Internship Schemes and deliberate under-placement of graduates of Bachelor of Nursing Science (B.Nsc) degree in the government hospitals is a grave injustice of monumental proportions to the nursing profession. The internship program is designed to blend theoretical learning with comprehensive clinical expertise, for enhanced and qualitative care delivery to patients, yet it is only graduates of nursing amongst the core health professionals that do not participate in the scheme. This has contributed immensely to depreciating levels of staff morale and job satisfaction


Recently, the federal government withdrew teaching allowance from Nurses and Midwives below the grade of CONHESS 09. Also despite having similar entry qualifications and program duration in the universities, Graduates of nursing are placed on CONHESS 07 post NYSC whereas their counterparts in other health professions are placed on at least CONHESS 09 in the civil service. Julz, you would agree with me that the amount of money in the monthly paycheck is often a factor in job satisfaction, factor in the level of work that we nurses do on a regular basis and the attendant exposure to clinical hazards that we face, the remuneration is non commensurate. At the moment, the Ebonyi state government has commenced plans to slash the monthly NYSC allowance of corper nurses to N5000 per month, yes! N5,000 per month! Ridiculous and absurd!


The current established legal framework for Nursing education and practice in Nigeria is now obsolete as it is riddled with myriad of flawed sections that fall short of current trends and international best practices. The nursing and midwifery act as a matter of priority needs to be reviewed to reflect a less rigid dichotomy between the autonomy of nurses and other healthcare providers for enhanced collaborative teamwork.

It is also high time that the Nursing and Midwifery council of Nigeria work in line with international standards to move schools of nursing from the ministry of health to the ministry of education. In collaboration with the national universities commission they must design and implement a curriculum for a bridging program for registered nurses to earn their BSc. This would go a long way in enhancing their knowledge and clinical skills to enable them discharge their professional duties in line with current trends and international best practices and standards.


A major challenge to nursing practice is the continuous exclusion of nurses from policy making on health issues. Nurses in the past were grossly handicapped because of the type of training they received which forced them to take on a feminine, submissive and subordinate role without questioning. Today’s breed of nurses brings a lot of expertise and professorial qualifications at PH.D and Masters degree level. The input of nurses at all levels of healthcare planning and financing must be encouraged and implemented.

Due to time factor, I would have to stop at these eight issues for now. I promise to call into the radio program and elucidate more on these issues and also highlight other pressing issues nurses and the profession face.

Kind Regards

Jude Chiedu FWACN, BNSc. SOURCE:
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