Problems Facing Nursing and Midwifery Profession in Nigeria and Way forward by Salihu Usman

Before I jot down the phrases and allow my ink to flow, let me start with the brief explanation of Nursing; Nursing is the process by which sick individuals are giving optimum social, physical and psychological care, either at the hospital or any other place, or aiding the unhealed to be relieved of pain, trauma or to have a peaceful death. Virginia Henderson defined nursing as “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” (first published in Henderson & Nite 1978, p. 5, 1955 ed.).

Nursing profession is as old as the origin of human being but was just informal, unscientific and trial-and-error, until when the mother of modern nursing Florence Nightingale modifies its practices during the crimean war, this modification indicate the ingenuity and gargantuan sacrifices nurses can make since from the olden days where there were no scientific based practices. As time goes by several people became into existence and these people sacrificed a lot of which some left their teaching career to indulge in caregiving, some engaged themselves into active war and some made some series of innovation like books, theories regarding nursing profession, some of them are even the founders of internationally recognized philanthropic associations, such people are naturally gifted, talented and very creative with deep devotion to make nursing profession prosper, example of such people are Florence Nightingale, Virginia Henderson, Parker Theoder Fliedner, Margaret Sanger, Clara Barton, Mary Beckinridge, Dorothea Dix, Mary Mahoney, Mary Seacole, and others. These people have shoulder nursing profession and laid a solid foundation for its growth which we suppose to hold still onto.

In Nigeria, Though traditional form of nursing and midwifery have existed even before the arrival of the colonialists. Formal and modern nursing was introduced by the colonial masters. The first nursing home in Nigeria was established in Jericho, Ibadan by the British colonial government. Nursing was later fully established in Nigeria when missionaries established mission homes, Dispensaries e.t.c. and commenced training of nurses in Nigeria and in 1949, the School of Nursing at Eleyele, Ibadan was established.

In 1949, the Nursing Council of Nigeria was established to set standards for nursing in Nigeria. ln 1952, the University College Hospital Ibadan started training of nurses as well, and by 1965, a Department of Nursing was established in the University of Ibadan to commence a degree programme in Nursing.

In all these, there’s a whole lot progress, but the birth rate keeps inflating, the cycle of life keeps running, our population seems increasing and the demand of care by the people seemingly unachievable, may be that’s why so many problems arises to face nursing and midwifery profession.

• Lack of motivation: this is one of the major problem affecting nursing and midwifery profession, so many nurses and midwives lacks motivation to work as nurses, and there’s no way someone could work optimally without passion and love for what he does, before a nurse can work to save someone’s life he/she must first be happy with his/her life. Most of Nigerian nurses work in a very hostile environment where a lot of naive doctors look down to them as maid or just assistance useful for running errands, harass them when they made mistake, may be that’s because of the believe that nursing and midwifery profession is mostly dominated by female, and females are believed to be submissive all the times. A nurse looked down by doctors, patients, patients relatives, or any other person will lack motivation for what he’s doing.

A solution to the above is that, nurses should make sure that they advanced their knowledge, be up-to-date on the trends of nursing and patients conditions to avoid making unnecessary mistakes, once a nurse/midwife knows what she’s doing, he/she will miraculously gain the trust, respect and confidence of anyone who come across his/her care. And the doctors should also know that as I believe it was thought to them in their school that, nurses are co-workers not their juniors, assistance or maid to give command to, they can not achieve what they want to achieve in the hospital without nurses, neither do nurses/midwives, so in the health field, even the ward servant is of great importance and can never be disrespected or downgraded.

• Lack of equipment and standard facilities: Most of our hospitals lack necessary equipment and facilities to help the nurses/midwives perform their job effectively. A lot of hospitals, including the government hospitals and even private are under-stocked.

This directly affects a nurse’s efficiency as he or she is always looking for improvised solutions to the problems presented by lack of necessary equipment and facilities.

This is also an impediment to the growth of our nurses/midwives, because with lack of proper equipments, even our students will have less practical skills therefore given birth to incapable and under-able fresh nurses/midwives.

What I suggest to be the solution to this is; our governments (both federal and state) should work hand in hand to stock their various health institutions including colleges and universities with adequate useful equipments, and when provided, the management of each facility should ensure proper preservation and repair of such equipments.

• Indolence: As I use to see in the current trends on social media that a lot of people had a nasty experience with one nurse or another, they met a nurse who is unkind, unfriendly, harsh and some even unwilling to attend to patients because of the laziness or feeling of superiority. This disastrously affect nursing and midwifery profession, because it’s putting on the spotlight a negative image of nurses/midwives, it hurts me whenever I saw someone castigating our very own image, just recent weeks back a soldier humiliated a midwife at her working place, but when the video circulate on media, most of the comments were in favor of the soldier despite his terrible and unbecoming act on the midwife.

A nurse/midwife should be nice, caring and friendly. The opposite, lack a very important qualities of a good nurse/midwife and deserve not to be a nurse, whoever act so lackadaisical supposed not to be part of us, because we were thought to be humble, sympathetic towards our patients.

The schools, colleges and universities teaching nursing and midwifery profession should work tirelessly in seeing that their students before graduation knows the worth of their patients, they should teach them to work based on the reward not on worldly gratification.

• Shortage of Nurses/Midwives:
As the world’s population rises each day, so is the demand of nursing care, with the olden believe and ideology that nursing profession is mainly for women, the nurses become shortage to meet the demand of the health care thereby affecting the small active number and making them exhausted, this also cause a work under pressure.

In Nigeria a step is taken to combat this by provision admitting two consecutive sets in a year in various colleges and schools of nursing, despite that, a further method should be applied to feel the vacuum of health care demand, we should keep up to that until the ratio of a nurse/midwife to patients is tenable.

• Low remuneration: In all the health care system, nurses do the hard and most stressful work that requires commitment and determination, nurses/midwives work 24/7 to ensure stability and comfort of the patients. Nurses are seriously underpaid, those that are in the private health sector suffer worse fate, they are usually underpaid and overworked.

Those in the public health sector are also not left out, salaries are not paid as at when due and sometimes they are forced to take percentages of their normal take home. This has had a negative effect on their service delivery.

A guide to sorting this out is that; nurses/midwives salary wage should be regulated by a body or associations that will ensure the tangibility and reasonability of the monthly salary including the hazard allowances, the government should also consider the fact that, of all it’s civil servants, nurses/midwives works the best.

• Risk of infection; Every profession has a hazard, but nursing and midwifery encounter much because they work in a place where there is much risk of getting infected, imagine when Covid-19 came in 2019, everyone was panicked, people got home, locked themselves, leaving our angelic nurses in a tête-à-tête with suspected and confirmed cases, that is why some nurses/midwives fear the fact that they are highly exposed to the risk of contracting an infection. Even with the preventive methods available, they are always withdrawn when it comes to caring for patients with serious health problems, thus leaving the patient in agony and dejection. What of those who work in Trauma centre, in the theatre, surgical words and dealing with variety of bloods probably containing viral transmitted diseases, some in Isolation with TB patients who can get you infected by merely a sneeze? And lot more, There’s a lot of risk of infection and this affect nursing/midwifery profession.

Way out to reduce the risk of infection is providing all the PPEs (Personal Protective Equipments) without compromise, frequent seminars concerning preventive care and proper discard of used equipments, sterilization of the un-disposable and non-stop hazard allowances.

• Politics and Favouritism: Politics, favoritism and tribalism are also some problems that affects nursing in Nigeria, not only nursing and midwifery profession but almost every sector, The right candidates for a nursing job are sometimes overlooked because of his or her political class or cultural affiliation. Now even to get admission into various colleges of nursing needs some connections, that’s why we end up producing unqualified, unskilled and incapable nurses, when the unqualified are employed, they go on to deliver poor services as well as exhibiting high levels of quackery. When the public notices one unskillful nurses they tend to generalize that all nurses are reckless, this cause a lot of damage to our renowned reputation.

The only way to bring this on line is to reduce favouritism to minimum, let only the ones that can practice good qualitative nursing care should be employed, let’s draw back to admission process into colleges and schools of nursing, the entrance exam we carry-out should be strict and only the ones who passed it and the physical interview should be admitted, let’s not make any favor to any students during any exam from introductory to council final exam, only that way will let us usher a new dawn for new nurses that are capable both theoretically and practically.

• Rural urban migration: Another problem is the urban migration of nurses. A lot of nurses don’t want to work in the rural areas due to the poor standard of living when compared to the urban areas. This leaves the rural areas with inadequate nursing care. This leaves the rural areas with quack and unqualified health officers that will keep endangering the health care of the people of the community areas, their health care is at stake and with highly charge of money. When this keeps occuring and the people of the community noticed and become obsessed, they don’t know which exactly profession is doing worse to them, they will generalize and nursing and midwifery profession will be involved.

Nurses/midwives who came from the community areas from the first, when qualified should go back to their community and work, may be that’s why the nursing council created Community Nursing Program and Community Midwifery Program, even though these two profession weakens the general nursing and basic midwifery program, only if we would work in community as registered nurses, then there’s no impact for creating the two new community programmes.

• Lack of periodic training; Seminars, workshops and some other forms of periodic training aimed at sensitizing, training and informing the nurses of modern nursing practices are seldom conducted leaving the nurses tied on outdated methods.

The MCPDP program covers this, every time I attend this program I got excited and updated, in Sokoto, the MCPDP program always amaze me, because it’s well presented all the time by the highly skillful nurses/midwives, who make most of their time in research of the current nursing update, the likes of this MCPDP should be invented more and should be happening time after time, that will make our nurses up-to-date and confident on the care they give to their patients.
At the last phase of this article; I will like to, in conclusion call out to NANNM as our only association to keep fighting for nurses all across the country, the humiliation nurses/midwives faced from the people in nasty way shouldn’t be happening, if it does happen, necessary action should then be taken.
Nurses always cares.
Nr. Salihu Usman Shuni writes from Sokoto State, Nigeria.
10th November, 2021.
He can be reached via

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