CHALLENGES FACING NURSING PRACTICE IN NIGERIA
“To stand still is to move backwards”. This statement is true of life’s existence where man aspires to grow, develop progress, invent, and initiate actions that would bring about changes. For without changes, there would be no progress. Nursing has over the decades, gone through changes. As time and situations change so has nursing, thereby bringing about challenges facing the practice of nursing even in Nigeria.
However, before this detailed discussion, the definitions of the following terms are relevant. Challenge is defined by Oxford Advanced Learner’ Dictionary as “A new or difficult task that tests somebody’s ability and skill”. Nursing practice is a dynamic, caring and helping relationship in which the nurse assists the client and society to achieve and maintain optimal health. Amidst various definitions, Nursing was defined by Virginia Henderson as “A learned humanistic and scientific discipline whereby a nurse assist the patient, sick or well in the performance of those activities contributing to his/her recovery or to a peaceful death that he or she would have performed unaided if he had the necessary strength will or knowledge and to do those things in such a way to help him or her gain independence as rapidly as possible”.
Having defined the basic concepts, I will in this essay address the challenges facing nursing practice, their effect and possible solution to overcome these challenges. The greatest challenge to nursing practice in Nigeria is the nurse herself. Nurses in contemporary Nigeria are less caring, committed and dedicated to meeting the needs of clients. Most nurses are resistant to change, professional development and advancement. In nursing practice and education, some nurses tend to hold onto previous knowledge and skills without making efforts to improve and maintain new skills. Many nurses are not willing to accept the challenges of staying abreast with education and development of new skills in their areas and levels of nursing practice. Similarly, the natural qualities expected to be found in nurses (punctuality, selfless service, among others) is virtually absent these days. This has serious implication for nursing practice.
Related to this is education; an essential element in all treatment activities and a means of keeping current or progressing aimed at developing individuals who are open to change. Regrettably, a large percentage of nurses are not open to change. This can be stretched into the training of both student nurses and professional nurses creating an environment where there are no checks and control, i.e. failure to abide by rules and regulations, leading to a crop of poorly trained nurses. Undue favour to some nurses in training by trainers of nurses which is commonplace in the society is an additional challenge. This has direct implication for the nursing care provided by such half-baked nurses. In fact, they become dangerous to patients, society and themselves. The hitherto unqualified educational standard of the basic nursing certificate is also a challenge. This in turn affects nurses’ remuneration which is another obvious concern for nursing practice.
Secondly, the advancement in science and technology will continue to affect the nursing profession. In the past, nurses 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 disinfection 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 nurses have found it difficult to implement it because some professionals in the health system do not quite understand what it is about. In addition, some nurses have attached a lot of constraints such as shortage of staff and lack of stationery as reasons hindering the implementation of the nursing process which is a tool for improved nursing care. The changing role of the nurse requires continued competence. Many nurses are unable to maintain a high level of individual competence in nursing practice, skill and knowledge, recognizing and accepting responsibilities for individual action and judgment.
Thirdly, a major challenge to nursing practice is policy making on health issues. Most nurses are women and therefore the position of nurses in Nigeria and the value given to nurses’ work are aligned with their position in the society. The nurses of the past were grossly handicapped because of the type of training they received. They were maids and took this feminine submissive roles without questioning, after all, the “Husband is the Head of the Home”. Nurses have traditionally been subordinate to physicians and these have perhaps affected their leadership roles in policy making on health issues. Nursing today is practiced in the midst of other health needs competing for the scarce resources allotted to health. The poor representation and participation of nurses in decision making on health matters will not move nursing forward. This situation must change if our wonderful dreams about the future of nursing must be fulfilled.
According to WHO at the World Health Assembly in May 2004 (ICN, 2004), some advanced countries have approximately 1000 nurses per 100,000 population while many developing countries, including Nigeria, have 10 nurses per 100,000 population or even less. Registered nurses are leaving Nigeria either for family reasons or for greener pastures giving the advanced countries chances to gain while Nigeria stands to loss through this brain drain. The shortage of nurses in rural areas is particularly another constraint. In Nigeria, nurses posted to rural areas feel that they have been forgotten. Many a time, such nurses perform far below expectation. Furthermore, the nursing profession aims at providing quality nursing care by providing a scientific base for the practice of nursing. Thus the need for research has become necessary. 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 much importance to research projects as most students believe that research ends after school.
It must also be pointed out that some work environment are un-conducive and non –supportive for nursing practice as they lack sufficient facilities and equipment to work with. They also lack sufficient motivational input such as housing, transportation, incompetent supervision, poor working relationship, general moral laxity in the society, undue familiarity with the subordinates with a weakness in disciplining erring staff, among others. Nurses are no longer in control of the immediate environment in which patients are nursed. If quality health care must be provided, then we have to look critically into some of these problems of the physical, social and mental environments.
We must not forget that despite the increasing number of infections, many Nigerians still very much patronize traditional healers and traditional birth attendants especially now that they have to pay for the health service they receive. Even if they come to the hospital acutely ill, they leave much sooner than they did in the past there by increasing the demand on nurses to ensure high quality, comprehensive care before discharge. These challenges indeed have a lot of effects, among which are relapses and complications which are they further challenges to nursing. These have affected nursing care to clients, families and the community at large; many nurses are unable to set priorities for care and assist client in meeting their needs in the most time- and cost-effective manner possible, while ensuring excellence in client care.
Additionally, most government policies do not focus on meeting the needs of the profession because nurses do not fully participate in policy making. Nevertheless, nurses occupy a central position in the health care delivery system. The shortage of nurses in Nigeria and lack of sufficient facilities and equipment to work with are not just a “problem of nursing” but a health system problem which undermines health system effectiveness.
The solutions to these challenges lie in nurses’ hands and in those of policy makers. It is the responsibility of all to join hands to provide adequate funds for regular in-service training and seminars to update nurses knowledge and skills, provide funds to improve existing health institutions and modern equipment, continually focus on delivery of care that is safe, comprehensive and effective, appropriation of funds by the government to Departments/Schools of Nursing for scholarship for nursing students in order to attract more people into the nursing profession, as well as help those already in the profession to have higher education without much financial burden. A blueprint targeted at quickly situating all nursing education programmes in higher institutions will greatly enhance the educational image of the profession and consequently improve remunerations. Nurse researchers should continue to develop and refine nursing knowledge and practice through the investigation of nursing problems.
Finally, I must stress that the nursing profession must remain dynamic in its attempt to meet health care needs of the society. In an address by His Excellency, Chief Olusegun Obasanjo, ex- president of the Federal Republic of Nigeria at the West African College of Nursing Conference on the Theme: Reforms in Nursing Practice in the 21st center Abuja, March 2005, stated that “the 21st century nurse should be one that is equipped not only with the basic requisite knowledge and skill to function in the clinical aspect of health care provision, but must also possess the requisite knowledge and skill to function as a team leader, manager of resources, counselors and advocate to patients”. With this in mind, let us strive to make nursing practice in Nigeria, a supportive profession that is interested in meeting the health care needs of its people. There is also a need for nursing to fashion out its own philosophy in the light of this present challenges to quality nursing practice and high level of professionalism. This includes all nurses, irrespective of their qualifications, to come out and speak with one voice