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state of emmergency on declining situation of nursing services in Nigeria
STATE OF EMMERGENCY ON DECLINING SITUATION OF NURSING SERVICES IN NIGERIA
Introduction: Nursing services has moved as a professional practice from the 19th century till the 21st century and many nurse practitioner/leaders have recorded significant land marks about nursing for example Florence Nightingale, Martha Rodgers, Lilian ward and Calistra Roy just to mention a few. Their principles and theories are used and continuously modeled till date, they form significant basis for nursing professional practice. They also have followers and made name for themselves in the field of science.
In this century in Nigeria Nursing Services under the present leadership is expected to improve because of level of training and current health reform programs. Nevertheless Nurses should see this article as a refilling pack and a challenge for their full potential to be attained.
However, this article will discus on relevant challenges, possible solutions to the identified causes of declining nursing care services and suggestion for improvement of the services to Nigerians.
General Overview on Declining Nursing Services
Nursing clinical practice cover the ranges of nursing services rendered in hospital setting. It includes all cares given in Accident and Emergency units and all wards both adult, neonatal paediatrics , Nursing Administration and nursing education. The specialty care given by theatre perioperative nurses and anaesthetic nurses plus critical care nurses are all inclusive. However, these care as they are, varies from unit to unit and from simple to complex/specialized areas, all cares are given by Registered Nurses and Midwives or Nurses in specialty areas such as orthopoaedic care, accident and emergency care, perioperative nursing care, anaesthetic care and community health departments/units.
The care given in the 21st century are suppose to be highly related to the principles and practice of nursing learnt in the basic, post basic institutions and universities where nursing training are offered in Nigeria.
The care given in some cases are found to be in aberration with the clinical training given to nurses in the institutions of training largely because of some or all of the following reasons:-
* Lack of Equipment:- Unavailability, lack of proper planning and budgeting due to non involvement of nurses and many nurse leaders in management's budgetary meetings. Poor knowledge of nurse about politics and the influence of nursing administration on general hospital administration/management.
* Lack of Commitment on the Part of Nurses:- Many nurses just practice for practicing sake, they do not see the intricacies of nursing as a care from nurse professionals, rather they are committed to other issues of life than nursing care practice. Many practice only for financial benefit not because nursing is a calling for them. Student nurses are also victims of this situation.
* Nurses seeing their professional training as Nursing Council requirement for Registration and licensure. Many nurses keep their notes inside their ward robes after training instead of them being their regular companion. Nurses seldom read their notes and text books while practicing .This had made them not to being able to pass knowledge to the young one in the clinical posting. A student in a teacing Hospital told me recently, that he has decided not to go to the ward because the matron have nothing to offer him except gossiping. What a mense! Teaching Hospital for that matter. Please let us change for the benefit of the profession. As nurse leader what knowledge had you add to nursing or you are just carring emblem of leadership for nothing? How many researches had you carried out since you have been practicing Nursing? * Nurses idea about improvisation:- In order to have the favor of management, most nurses are committed to improvisation to a faulty level, instead of asking for the right equipment and materials for nursing care services. Nurses seldom go on industrial action because of lack of equipment for nursing clinical works rather they continue to improvise to the detriment of their professional practice.
* Rural urban migration of Nurses:- Nurses idea about rural care and delegation of this care to untrained persons is a major problem that is causing declining nursing services in Nigeria. Many nurses don't like to live in rural settings.
* Leadership Problem/Brain Drain Leading to Poor Management:- Most nurse leaders lack experience and they retire away quickly as soon as they enter into nursing administrative arena because of age on entry and number of years in service. The experienced nurses are not also available in the clinical settings to render service rather they are kept in offices away from their patients and fellow nurses that need to learn from their past clinical experiences. They seek office allocation, good chair to seat on as soon as they have been promoted to higher ranks, this they claim is to show the level of their status instead of good clinical practice to be shown for the status.
Also nurses now migrate at alarming rate out of the country to seek greener pastures. Some experienced nurses also hide under the canopy of poor health not to render service yet they remain as leaders. All these are copied by the junior nurses and nurses in training and subsequently as soon as nurses become registered they form the association of nurses that seat round the table or in offices in different wards with their bags full of items that are on sale and latest materials in town (cloth and jewelries).
* Professional Rivalry:- (Inter/Intra Professional rivalry) Nurses not seeing themselves as the strongest pillar in health field, rather they practice other professions that are non nursing in order to seek personal/societal recognition. Most times many nursing independent activities are left undone the interdependent activities are done with much commitment. Bed bath, Bed pan, monitoring of vital signs and patient care reporting are fast leaving hospital setting. The relatives are made to carry Bed pans, Doctors to see patient alone on wards/clinics, and do patients vital signs themselves while in clinics, caterers also have to book meals for the patients themselves without the nurses participation. Nurses claiming to be too busy to perform these activities and making them to be less important activities of nurses.
With the nursing professional cadres in Nigeria the educational reform has made it possible for nurses with first degree to practice along with those with Diploma trainings. This is supposed to be a strength for nursing care in Nigeria. If intra professional rivalry are removed nurses would learn from each other and subsequently nursing care would be improved in this century. Nurses at leadership position should consult their learned and experienced fellows nationally and internationally to be able to acquire both theoretical experience and practical skill needed for improved services. Consultation now made easy with computerization. E-mailing each other on ideas about care in hospital settings that are more advanced than ours. Use of internet facilities to improve nursing care in Nigerian. – (Omotoriogun 1996).
* NURSES IMAGE
The nursing professional image in Nigeria is dwindling because of nurses inherent subservient behaviour in clinical settings even though nurses have been granted professional status in Nigeria they are still subservient in practice – (Omofuma 2007). The nurse leaders need to learn to regulate their own services not leaving it for others to decide upon.
* Nursing Procedure/Quality Assurance
There is need to review procedure manual nationally and steps in the procedures should be implemented appropriately in all hospitals. This would always improve the quality of care rendered by nurses. Quality assurance units must be established to ensure auditing of nursing services. Nurses need to be closely monitored to ensure quality care and accountability.
* Financial Problem/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 reliable 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.
As nurse will must not confine ourselves to nursing alone we must read wide, get involve in politics, socialization and work as assertive individuals to promote our image and the image of Nursing profession in Nigeria. We must be seen to be here and there in health services and must contribute maximally in our areas of interest or specialization in care apart from administrative skill used in office as Nurse administrators.
Nursing informatics are essential for application of computer into nursing care, lack of knowledge in this area can cause declining care as nurses will fail to utilize computer technology to the advantages of clinical nursing care recipients.
Summary and Conclusion
Nursing clinical services in Nigeria is a challenge to all nurses . The problem causing the declining clinical practice are enormous but few of them as being identified in this article.
instrument for use by leaders to move nursing care forward not for personal gain only, Stop saying that graduate nurses are Nurses problem". Self-centredness should be replaced , nursing profession is our own. Nursing is a noble profession!! let all of us come together to lift up Nursing profession to the next level. Live long Nigeria!!! And long live best profession on earth ( nursing) Am proud to be one!!! How about you?
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About the Author
OLORUNFEmi olaolrunpo (RN,RM,BNSC(HONS)M.SC IN View)
Lecturer: University Teaching Hospital, School of Nursing BeninCity,Edo State. (olaolorunfemi@yahoo.com).(lautech).08034694675