International Nurses Week: Policies, Major Setback To Healthcare Delivery

A sector without a well-stated job description is standing like a building with cracked pillars, which can collapse at any time and no one knows upon whose head it will fall.

Over the years, there have been controversies among the health workers and, unfortunately, these are yet to be solved till today; not because there can’t be permanent solutions to these crises but because those in control of the system have refused to make policies that will cause a significant change and end the long-standing crisis.

In Nigeria today, doctors are the Alpha and the Omega in the hospitals, they have dominated all sectors of the hospital including the laboratories, pharmacies, etc. This had been the situation in our hospitals, where we have only medical doctors, acting as the head of the hospitals (Chief Medical Directors). This has not just stopped at the grassroots rather it extends to the federal level where the Minister of Health over the years has been a medical doctor. Does this mean that other health professionals do not have capable hands able to lead the health care industry? A doctor acting as the head of department or chief medical director of an institution can one day come up with a policy without adequate consultation of all the medical workers involved because he is the supreme being of the department in the institution.

Being a nurse, I can categorically say that no health care institution has survived 48 hours without us. It is, however, painful that nursing in Nigeria seems to have lost its value as nurses have been relegated to just giving oral medications, bathing patients, controlling the crowd on the ward, giving intramuscular injections and acting as the assistant of doctors during procedures. It is condescending that even midwives are not even allowed to take deliveries in many tertiary hospitals anymore, it is now a doctor’s procedure. I used to think midwives are specialists in child care and deliveries; what should a midwife know if not how to take deliveries? This is a question for all.

Thinking and searching through the degradation of the health sector in Nigeria, I came to a conclusion that a total reform, which includes specification of job roles, proper training for the whole health care team on what team works on what as well as improved training for health care workers should be put in place.

There are procedures, which are nurse-based procedures, such as catheterisation, cannulation, insertion of nasogastric tubes, wound dressing, giving of medications through any route, blood transfusion, etc but many of these procedures have been taken over by doctors in Nigeria, while the nurses are now left with duties such as oral/intramuscular drug administration, while the intravenous administration and blood transfusion has been taken by doctors, bed/patient bath, oral care, food service, etc. These are just nursing associate duties in developed countries and not a full-fledged nurse duty. Nigerian nurses have been relegated to performing just the role of nursing associates.

There are so many nursing specialities in the world but only a few have been explored in Nigeria. Despite having only a few explored, those who go into these specialities are often not allowed to practice what they have learnt effectively. Common examples are midwives and nurse anaesthetists.h

Specialities in nursing, which remain unexplored in Nigeria today and are seriously affecting the proper delivery of health care in Nigeria, include tissue viability nursing; diabetic nursing; respiratory nursing; heart failure nursing; cardiothoracic nursing; cardiology nursing, neuro nursing, etc.

Specialities in nursing, which have been explored but are being practised haphazardly in Nigeria, include accident and emergency nursing; intensive care; perioperative nursing; orthopaedic nursing; burns and plastic nursing; psychiatric nursing, etc.

Considering other health care professions, the medical laboratory department, I think, should be allowed to work as a free body that doesn’t need the signature of a doctor to have results approved, the big question is why a test carried out by a laboratory specialist be approved by a medical doctor who neither has the prerequisite knowledge nor wasn’t there when the test was carried out?

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Also, pharmacists working in teaching hospitals in Nigeria shouldn’t be limited to just drug dispensers, they spent years in school studying about drugs; a doctor will never know drugs more than a pharmacist. Pharmacists are also needed on the wards to help with proper drug prescriptions and the best route of administration per individual patient needs.

Furthermore, orthopaedic doctors are not the same as physiotherapists and occupational therapists when it comes to patient rehabilitation. Nurses and doctors can never do what a physiotherapist would do when it comes to getting a bedridden patient back to his feet. These sets of professionals should be on wards also and not limited to their offices, gyms and routine visits to the wards.

Finally, the leadership of the hospital in Nigeria shouldn’t be solely done by the doctors, can’t other professionals lead? Is this the same in advanced countries which are leading in the delivery of health care?

For health care delivery in Nigeria to be at its optimum form, a total reform of training practice and structure needs to be done. If these reforms are not done, no amount of money invested in the healthcare industry will significantly improve the standard of healthcare delivery. It’s international nurses’ week and we hope we can get both the recognition and value that we deserve, it is not a good thing that the best, young and most vibrant ones in the profession are running to developed countries where nurses are well appreciated and valued.

Nursing is a noble profession and nurses should be treated as nobles.

Orolugbagbe, a registered nurse in Nigeria and the UK, writes from England via joelorolugbagbe@gmail.com