Nurses President Adeniji - Doctors have hijacked health care service in Nigeria
The white uniform worn by nurses attracts some people to the profession, but nurses have their share of controversies. In this interview with GBENRO ADEOYE, the President, National Association of Nigerian Nurses and Midwives, Mr. Abdulrafiu Adeniji, speaks about the controversies that seem to have put a shade of gray on the nurses’ traditional white uniform.
Why do nurses describe themselves as ‘Unsung heroes and heroines of our time?
What the nurses are doing, the members of the public don’t appreciate it. I say this because the nurses’ remuneration is not commensurate with their efforts. There ought to be adequate representation of nurses in the management of hospitals, but that is not the case.
How many nurses do we have in Nigeria?
It is difficult to state the exact number of nurses in Nigeria. Labour mobility or migration of nurses and midwives is more than that of any health professional. The difficulty in knowing the exact number of nurses in the country is also complicated by poor record of statistics in Nigeria. But the rate of attrition is more than the rate of retention of nurses. However, if we work by the figure generated by the Federal Republic of Nigeria National Human Resources for Health Policy 2006, the number of nurses and midwives put together in organised public sector in Nigeria is about 280, 414. The figure is not static as nurses and midwives are retiring, some are dying and a large number of them are travelling out of the shores of Nigeria. Another very close statistics provided by the World Health Organisation put the ratio of nurses to the population at 10 nurses to 170,000 Nigerians.
Earlier, you said nurses are not well appreciated. So how do you feel knowing that no matter how experienced nurses are in Nigeria, they cannot be made medical directors of hospitals?
It is a general knowledge that health care service is a joint venture with multi-disciplinary team approach. Normally, when a team of professionals of equal stake comes together, the leadership should not be based on a ‘right’ that has no justification. What we have in Nigeria today is an abnormal situation, which is very lopsided and highly discriminatory. Before the advent of Decree 10 of 1991, health care services management involved every stakeholder. But since the time Professor Olikoye Ransome Kuti midwived and protected a single professional leadership approach in the health sector, things turned the other way round. Every professional has a schedule of work and scheme of service based on individual training and professional skills acquired during the process of educational and professional preparation. The opportunity and chances of actualising one’s professional career progression will contribute to performances in the team work. If a professional is not sure of attaining the pinnacle of his or her professional career, definitely it will be a thing of concern and it will ultimately affect productivity. The position of chief medical director of a hospital and specialist medical centre is that of managing director and chief executive officer. A situation where in Nigeria, it is now only medical and dental practitioners that have colonised it is an aberration. This is largely the cause of endless crises in health sector. Health care service in Nigeria is in bondage and unless we collectively free ourselves from the fist of its hijackers- doctors, there cannot be peace and tranquillity and the team spirit required will not be attained. Elsewhere where health administrators are not the chief executive officers, the position is open to all bonafide front line professionals. In the present situation in the health sector, it is not only nurses that are not happy, other health workers whose interests are totally neglected or not being well represented are also sad.
Is this why nurses are often callous when they should be caring?
It is no news that some nurses are found guilty of this act you accused them of, but let’s be frank about it, what do you call callousness? In the practice of nursing profession, there is the principle of ‘stiffness and permissiveness’ that has to be utilised with utmost consideration that the person being attended to is a human being that is in need. Therefore, appropriate compassion has to be given to the extent that it will be beneficial to the client or the health care consumer. Though callousness is not supposed to be a feature of a nurse, if there are few ones that are guilty of this offence, the public has to be informed that it’s against the ethics of our caring profession of nursing. But there are also impatient teachers, doctors, journalists or even administrators based on the personality of an individual though this is not an excuse for nurses to be callous. But two things we have to quickly take note of is that in a hospital setting, Nigerians are not able to distinguish a professional nurse from a quack. You can conduct a search, your findings will confirm that most of the acts of callousness are being perpetrated by quacks.
But nurses are regarded as the most dreaded hospital personnel.
I do not know where the idea of dreading a nurse in the hospital comes from. Nurses are fundamentally known as friends of the client, solicitors and advocates of the sick, the surrogate mothers to orphans and defenders of the defenceless. Being dreaded is anti-thesis to the expected habit and attitude of a nurse in the public. In another sense, when an infant dreads a nurse, it may be traceable to the type of care being given to him/her, for example, giving of injection which is dreaded by children. Otherwise it may be a misplaced judgment and misrepresentation of the nurse. To dread the nurse is to dread the entire health care institutions as nurses are the symbol and reflection of the hospital. The angelic white uniform is a symbol of re-assurance, indicating that ‘I’m a friend if you are in need, come I’m ready to offer my help and assistance’.
But people say nurses often forget about their patients when they are busy gossiping?
A professional nurse has no time to gossip, the nurse is the pivot upon which all the health care services revolve around. The nurse has access to a lot of vital information about his or her clients. He/she is a data bank for the necessary information needed by other health care teams to care for the patient. Nurses swore to an oath to keep in confidence all personal matters that come their way in the practice of their profession. However, if the judgment of the public is based on the maladies being shown on the electronic media where nurses are being misrepresented as an apprentice, gossips or doctors’ errand persons, then the allegation of gossiping is understood but not accepted because these are misrepresentations of a nurse.
But is it that nursing is so simple that many people become auxiliary nurses within three months?
There is no way a person can learn the art and science of nursing in three months. Nursing by all standard, is not as simple as it is being simply put. However, the gap within a professional nurse and a so-called auxiliary nurse is wide. The auxiliary nurse you are referring to lacks the knowledge of what you said they are practising. They cannot explain the scientific rationale behind the actions taken. When a doctor prescribes a drug in the hospital or clinic, a professional nurse by her training knows why such drugs are prescribed, knows about the pharmacokinetics and pharmaco-dynamics of the drug. Even if a laboratory investigation is requested on the patient, a nurse understands why and can interpret the laboratory result. The fact is, before you are registered and licensed to practise as a nurse you must have completed a course of training either in the university or school of nursing and go further to undertake a professional examination. This is the extent of the simplicity of the profession.
So how come we hear of cases where a young girl fresh from secondary school goes to ‘learn’ nursing for a few months in a hospital?
I beg to disagree with nursing being turned to an apprenticeship scheme. A duly qualified secondary school student can enrol as a student nurse but not in the sense of an apprentice. The period of training is stipulated and the only statutory body that oversees such professional education of nurses is the Nursing and Midwifery Council of Nigeria. All other pseudo-training schools are criminally motivated as both the trainee and the trainer are liable to a jail term. Nigerians are hereby warned to desist, and not be deceived or train as nurses in any private clinic run by either doctors or nurses because no unaccredited school can train people to become qualified or professional nurses in Nigeria.
In spite of all the training you have mentioned, people still think nurses are inferior to doctors
There is no basis for comparison between the doctor and the nurse. The issue of superiority or inferiority complex can only be relevant when using the same scale. Medicine is an aspect of health sciences, nursing is another one. If a nurse performs a doctor’s role, he or she cannot claim expertise and a doctor cannot claim expertise of nursing duties. There are three fundamental roles of a nurse, which are: dependent; interdependent and independent. The independent roles are those ones which a nurse does on her own after a careful assessment of a patient’s health condition leading to nursing diagnosis and the next stage of setting out his or her intervention to solve the patient’s problem. The nurse goes ahead to do appraisal or evaluation of the intervention. Dependent roles are those ones done along with other health professionals like medical diagnosis, laboratory investigations and so on that assist a nurse in her professional duties, while interdependent roles are those ones carried out as a joint venture with other health professionals. If nurses are objectively assessed by the three bound roles, where is inferiority? But if you subjectively appraise the nurse by dependent roles, then the assessor is not fair to the nursing profession. In summary, a nurse is not inferior to a doctor either by training, certification or practice.
Is this why senior nurses often clash with young doctors?
If there is anything like clashing in the care of patient between a nurse and a doctor, it is in the interest of the patient. A senior nurse has an age-long experience, professional skills, expertise and is capable of detecting a dangerous situation when a young doctor or nurse is attending to patients. In an attempt to ensure appropriateness of care, assurance of quality standard of care, patience, safety and prevention of injury to the patient, a senior nurse will not tolerate making human being an experimental object in the hand of a young professional like a young doctor, while sometimes a young doctor may act based on the indoctrination of the title, ‘medical doctor’. This may be a cause of what you called clashes.
Is it true that doctors look down on nurses?
This is largely true, but not applicable to all of them. It is also a function of our society, where we have faulty yardsticks of assessing and placing professionals. Nursing by International Arbitration Panel Award (I.A.P.) of 1981 and the latest 2012 National Industrial Court of 1981 as well as Professional Bodies (Special Provisions) Decree No. 3 of 1972 and as amended Act Cap P 33 Volume 13 Law of the Federation of Nigeria (LFN) 2010 is a profession among other bonafide professions in Nigeria. Where then lies the basis to look down on a nurse? As regards education, nurses today go to university with the same qualification required to study medicine, and graduates of nursing sciences are holders of a Bachelor degree in their own field of studies. Therefore there should be no ground to look down on nurses. But it is not only limited to medical doctors, some other people also commit this crime against humanity by believing that nursing is an appendage of medicine. You cannot still be judging nursing with the yardstick of the grade III midwives.
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