“The educational institution is the only social agency that holds responsibility for the future” (Rossella, 1971).
For over five decades and perhaps more, the debate about the proper way to educate nurses has raged on. Yet again, News has been making rounds about a new educational pathway that has been approved for Nigerian nurses at the just concluded Nurses leaders Conference in Kaduna. The extent of participation and engagement on all media has been remarkably surprisingly and this rightly points to a more responsive nursing community occasioned by better educational preparation and opportunities. While it is noteworthy to most importantly appreciate the effort of the Nurse leaders who gathered to brainstorm on possible solutions to some of the most pressing challenges of the profession, it is also important to assess the merits of their policies.
To begin, we must understand the historical context in which nursing education has evolved both in Nigeria and in other climes. Much like any other profession, the nursing profession has passed through several stages to become a full-fledged profession. All through this process of evolution, different socio-political circumstances have dictated the extent of training required to become a nurse and might continue to do so. For this reason, we must examine the latest developments against what is possible and acceptable within our socio-political polity. It is also important to note that the Nursing profession plies its trade within a treacherous and competitive health sector where there is an unending jostle for scarce resources. Against this background, the fear of what the prospect of an HND nursing qualification holds against more sophisticated academic and professional qualifications can be appreciated.
But we must understand the uniqueness of our profession’s developmental trajectory. Nursing training has existed in Nigeria as a hospital based training without academic quantification or qualification for longer than is beneficial. It has ingrained a sharp divide among nurses, a problem that still haunts our growth and development till this day.Without doubt, a sustainable solution for the many woes of the nursing profession in Nigeria must be an educational one. What then does this new educational prescription mean for us?
One of the most distressing problems nurses have faced is the closed and narrow system of education which awards only a nursing professional qualification without an academic qualification. We must applaud the fact that this major debacle has been resolved by the proposed policy.With this educational qualification, the scope of practice and social involvement of nurses can even be widened beyond the hospital. This also means Colleges of Nursing would be regulated by a recognized educational body in Nigeria and become truly autonomous ,free from the imposing control of Hospital administrators. While this is a major gain, we must also understand the danger inherent in it. The Nurses leaders conference also mandated all stakeholders to have meetings with vice chancellors of university within their respective states before May 2017 to see how nursing department can be created. It is comforting that all stakeholders now agree that the university is the proper place for the education of a registered nurse and has made the absorption into the university a priority. We are aware two schools have chosen to tow this path and are confident more would choose to follow suite in the near future. For this reason, it is important that a mechanism to discourage the existence of the HND program longer than is necessary be built into the policy. We would recall that the Hospital based program which outlived its essence and eventually deterred the progress of the profession started to fill exigent health care needs of the time. The modern health system is a complex one and it would continually need a mix of skilled and semi-skilled professionals to function optimally. Also, there is an unmistaken move towards a knowledge economy where a lot more problems are solved utilizing the specialized knowledge in a particular field. Nursing must fulfil both demands on the knowledge front and the technical front as healthcare becomes even more complex. This is the reason why the license practical nurse cadre were created with an 18 months academic and technical training program in many developed societies to properly regulate the profession. It would not certainly be out of place to expect that once enough university nursing department have been created, the HND program can be restructured to a two Years ND1 and ND2 program for a like version of the LPN program in other climes to accommodate effectively the technical needs of the profession while all registered nurse are trained In the university. If this can be pursued effectively, it would ensure nursing HND holders remain in a tolerable minority who can pursue their advancement within the profession easily. Also, we can within the foreseeable future establish a single point of entry into the nursing profession as a registered nurse and eliminate the rivalry that comes with the multiple systems of qualification. The two year academically quantified and professionally qualified program for LPN can provide the army of purely technical practitioners we need while not stifling their aspirations if they want to be registered nurses in future. This new policy prescription might yet be the best ever if all stakeholders are held accountable for their roles in creating sufficient University Nursing departments and putting a time bound to the continuation of the HND program in its present proposed form. We can efficiently and effectively stem the ugly tide of quackery only by regulating it.
Of even more superior importance to the progress of nursing profession in clinical practice, is meaningful and commensurate placements for our Doctorate and masters holders who are growing in numbers without available placements within the civil service. We must work with the hindsight of the challenges we have faced with the proper placements of nursing graduates to avoid an unnecessary repeat of history. These set of nursing professionals hold the key to the dignity of nursing clinical practice and the regard and respect we deserve from other health care team members.
The Advanced Nurse Practitioner program which has been in planning for several years must be pursued with renewed vigour. We will be doing ourselves great disservice if stakeholders in Africa and Nigeria are not committed to establishment of advance Nurse practice program in our countries.
At a conference organized by Lead Nurse Africa International foundation on 23rd March 2017, Dr. Omolola Irinonye reminded the participants in her presentation that Nursing practice has evolved over time. These transitions must be taking into consideration in our thinking and policies so we can ensure that our actions are in tandem with current best practice.
Since we are in the era of “Professional Nurse”, we must ensure that emphasis is on educational program designed for the professional Nurse. These means that University must produce overwhelming majority of Nurses in Nigeria.
Advance Nurse practice program is currently the platform for training Nurses in specialty courses. Post basic program have outlived its time and relevance. Dr. Omolola Ironoye called Advance Nurse practice program a single path to dual outcome as it will not only restore our professional autonomy, but also create access to quality health care to numerous members of our population. This is the reason Lead Nurse Africa International Foundation is committing resources in mobilizing stakeholders to work for the success of the program in Africa.
The huge gap in the number of University lecturers needed to achieve University education for all nurses is still a challenge and an opportunity for the young University graduates who are now charged to fill the gaps. Hence instead of continuing with status quo, we must see the merit of a 4 years HND program that leads to acquisition of RN,RM,RPH and HND over the obsolete 3 years basic programs that leads to the acquisition of RN and Nil certificates at a time like this. If this is the thinking of Leaders behind the policy, then it is most commendable.
We must essentially assess all our educational programs periodically against set and emerging objectives to stay at the cutting edge of advancement. As time and circumstances changes, even the much glorified 5 years BNSc might give way to a “6 years DNSc” if it becomes a better alternative to the status quo. Already, virtually no University department completes all its qualification requirements within the stipulated five year period, with students coming back to take classes and write professional exams long after their professional induction.
It is for some of this reasons we believe that HND program may be to us after all a huge blessing, with the potential of curbing the unchecked influx and escalation of quacks without regulation or training within the profession. What is important is that mechanisms are built into the HND program that would ensure it does not become an end in itself but a means to an end.
BY: OLORUNTOBA ODUMOSU, COLLINS OGBOLU (LEAD NURSE AFRICA EDITORS)