BY COLLINS OGBOLU
Two major errors have aided the ongoing anomalies in the African Nursing community. One is lack of career progression; the other is poor structure of nursing education .
What is career Progression?
Career path, career progression, career ladder and career lattice are different terms used to describe how an individual makes progress in his job or career. While career path or progression is the universal terms for these movement irrespective of whether you adopt the old concept of career ladder that shows only a vertical movement or the modern concept of career lattice that shows both vertical and lateral movement. Career ladders display only vertical movement between jobs. In contrast, career lattices contain both vertical and lateral movement between jobs and may reflect more closely the career paths of today’s work environment.
Career ladders/lattices may be used in a variety of ways. For example, they may be used to:
- attract individuals to an industry by showing potential career progression beyond entry points,
- focus workforce development efforts,
- show workers how different jobs interconnect within careers in an industry, and
- inform workers about the training, education, and developmental experiences that would enable them to accomplish their career objectives
Have in mind that the above explanation covered all the industries, but the point that captures the structure of career path development for professional careers is the fourth point .i.e. informs workers about the training, education, and developmental experiences that would enable them to accomplish their career objectives.
Therefore, in a professional career, you must meet the following requirement to be able to progress your career;
- Continuous advanced education and training
- And corresponding “developmental experience”.
These two requirements were designed to ensure that knowledge and experience advanced with years of practice and to promote creative competitiveness that sparks up radical development. As a member of such profession, you are condemned to perpetual continuous learning and research to be able to remain relevant. Interestingly, that is the only structure that is generally adopted by elite professions like Medicine, Law, Management, Accounting, Nursing (in the developed countries) etc. Sadly, the nursing community in Africa lacked this beautiful career structure and thereby fell out of grace. We are simply not among the elite … yet.
In the developed countries, every class of nurse has a defined scope within which he is expected to function efficiently. “A movement from one scope to a higher position of responsibility and reward depends strictly on advancement of knowledge”. For instance, specialty programs like nurse anesthetic are only practice at MSN level. Masters program have taken over specialty courses as opposed to the outdated post-basic program which has remain almost the only available specialty programs in most African countries. If you move into practice in the developed countries with only RN, and hope to reach the pinnacle of your career with years in practice, then you must be in a very long hopeless dream. The diagram below shows what a career path in the developed countries looks like;
These structure works to ensure that professionals are not trapped in intellectual rut and that knowledge, sophistication and experience increases along the ladder. A situation where some chief nursing officer in Africa cannot identify a gastric juice during the insertion of a Nasogastric Tube (my embarrassing personal experience) cannot be witnessed in these climes. Nurses run the hospitals and are truly the pivot that holds the system together . Through demonstration of clinical excellence, research competence and efficient leadership skills that produces positive result in the clinics, health maintenance organization, public health etc they earned themselves a beautiful status and good financial reward. Some senior nursing officers who are excellence in Africa achieved that through personal motivation, as opposed to structural mechanisms that drives members of a professional group to a compulsory personal advancement. Personal efforts should only serve to separate the good, the better and the very best.
Most nurses in Africa are not aware that a movement from one civil service level to another does not correspond to a proper professional career progression. In Medicine, If you have no energy to pursue your professional residency program, you simply chicken out and become a “general practitioner (a.k.a hustlers). Similarly, You don’t become a senior advocate of Nigeria (SAN) by being the oldest person in the court. It is simply by virtue of your contribution in the body of knowledge in the administration of justice and by “kicking asses” of fellow lawyers in the court room.
Similarly, Our career structure must initiate the creation of nurses who would be best innovators and leaders in the health care industry. Knowledge is power, he who fails to embrace it rejects empowerment.
The curious case for most African Nurses: The Nigerian Situation
I love my profession, but let the truth be told, senior nurses in Nigeria are basically the laziest people in the health care industry. Most have failed to add value to their knowledge as a result of absence of a professional structure that links personal advancement to reward. Many of them are passing through what could be best described as intellectual decay.
A friend of mine called, praising God that he has finally left the clinical practice in Nigeria. According to him, they almost succeeded in initiating him into habitual lack of interest in intllectual pursuits. It seems that one becomes less intelligent and updated the more you spent time at most hospitals in Nigeria. All emphasis are in baseless scrutiny over uniform, how you greet the superior, how the cap hangs in the hair and “probably how the junior nurse inhales oxygen” . You see, when one have nothing to offer, he occupies himself with anything to remain visible and most of such things has no single intellectual or practical value. Also, I once encountered a nurse mocking a doctor who is studying for her residency in the ward. She said;
“I thank God that nursing does not give us this headache ooo, ah, what kind of stress is this?”
It became clearer to me that majority of nurses abhors any process that requires them to study.
Doctors too have civil service progression that starts from conhess 9 ( I hope I am still current). But they also have a professional progression that starts from Mbbs, through residency, to becoming a consultant. Every step involves a rigorous academic and research work. Same thing applies for lawyers and accountants. As an account, if all you have is your degree or diploma, you will never have a say in the financial world.
Please note, when I say professional advancement, I mean advancement in Nursing. A lawyer who instead of going to law school, chose to study medicine and become a professor in medicine will never have a say in law, neither can he handle a case in court. A doctor who also abandoned residency program to become a SAN cannot press to be called a consultant in medicine. It is however, a big anomaly for nurses to abandoned nursing profession after their basic program to become a master’s degree holder in management or economics and then return to insist that he or she must be recognized as a degree holder in nursing. Were they carrying out research in nursing while studying economics? It is a shameful argument that cannot be entertained in any sane society. There is nothing wrong for a nurse to seek knowledge in other fields, but that is only for your personal advantage as it better prepares you to function competently at global stage. A doctor in nursing who is also a doctor in management will have an advantage over the nurses who are only a doctor in nursing if both should be considered for a management position. That is the personal advantage, but the priority is to advance in nursing, before exploring other areas to be vast and differentiate yourself among your peers.
HOW IT SHOULD HAVE BEEN IN AFRICA
As a scientific profession, career progression should have been designed to reflect academic advancement. We have basically two types of advancement; the civil service advancement which should give a nurse monetary increment as his years of service increases. The second one should have been professional career progression which should give a nurse increased clinical role and leadership promotion with associated allowances as her knowledge and exposure advances from basic (nursing officer I), degree (Nursing officer II), masters (Advanced nurse practitioner) and doctorate levels (nurse consultant). Assuming that this kind of model was adopted, a nurse who finishes basic school will have an urgent need to proceed to degree etc or else, she will remain at nursing officer I till retirement, even as she rises in civil service level. Also, a nurse with a degree (officer II), with adequate years of experience can rise to the position of assistant chief nursing officer , but will stall at that point till retirement without further studies. Similarly, while individuals with masters degree in nursing specialties (nurse practitioner) can become a CNO which will make him/her a clinical ,academic, research and administrative leaders in such specialty , She will require a doctorate program in that same nursing specialty to become a consultant . A consultant who is also a professor in nursing will emerge the leader of the leaders.
This kind of career progression provokes healthy intellectual competitiveness. The battle will give birth to several nurse theorists, clinicians, leaders and innovators whose works will develop the body of knowledge in nursing practice. The fertilization of ideas among such intellectually engaged nurses will produce different kinds of stars in public health, emergency nursing, maternal and child health, medicosurgical nursing, leadership in health sector, health economics, health statistics, innovative client advocacy initiative etc. Nursing will have the capacity to carve out a ninch for themselves through science of caring which will automatically lead to professional “closure”, as what will be required to practice at any level cannot tolerate quackery and mediocrity. The quality of our service will automatically earn us respect and qualify us to be admitted into the society of professional elite.
Most importantly, There will be enough qualified registered nurses to practice at low level, as not all registered nurses will be intellectually fit to advance with others. Also, those who are exceptional can reach the peak of their career at a young age, making the profession more appealing to many young school leavers.
There are lawyers who are still on charge and bail practice for thirty years while their mate who are intellectually fit has gone ahead to become senior advocates of Nigeria. The same pattern is found in medicine, accountancy, management etc.
However, the tragedy for African nursing development is that her leaders are busy promoting mediocrity and sympathizing with those who lacks capacity to handle 21st century nursing responsibility while leaving the intelligent once to roast in frustration and intellectual boredom. There is a systemic administrative cluelessness and poor leadership that does not consult any empirical evidence on the development of a profession”.
Human beings hardly perform without a system where higher accomplishment is prerequisite to reward. For God’s sake, somebody should tell Nursing authorities that Nursing can never grow in docile and non challenging environment. Departments at Nursing council will continue to be dormant unless they embrace radical and innovative ideas. Directors of Nursing services at the ministries and hospitals will always be errand ladies and gentlemen unless there is professional structure to empower them.
African Nursing leaders must admit honorably that the current backwardness of the profession is as a result of their ignorant on how the paradigm of nursing practice have shifted over the years and their inability to visualize what nursing and who a nurse should be in the 21st century. It is not a matter of trying or not trying, but once an effort is not producing required result, those in charge must be flexible enough to accommodate new ideas and brave enough to promote radical changes.
For change to occur, there must be casualties, those who are not fit to follow the trend of time must sit and wave, while our professional train move on. Let us stop dragging each other backwards. We must encourage a robust debate on how to better our profession without victimizing those who opposes status quo that have constantly failed us for many decades.
Articulating and adopting a model for career progression and developing new curriculum that will implement it are a matter that requires an urgent leadership action. If not, we will remain like a group with enormous potentials and no future!!
We must join hand with Lead Nurse Africa International Foundation and other stakeholders in promoting the establishment of Advance Nurse Practitioner program. We must change the old narrative now!!
NOTE: This is strictly the opinion of the writer, Lead Nurse Africa encourages her writers to express themselves without fear or favor in other to encourage robust professional debate. Your comments and input is as good as the writers presentation. We encourage everyone to be professional in his or her comment and to subscribe to fact as opposed to negative sentiments. your inputs contributes in shaping positive opinion which will eventually results to progressive policies. Nursing Must be great in Africa.
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