OPEN LETTER TO THE REGISTRAR, NURSING AND MIDWIFERY COUNCIL OF NIGERIA

Nursing and midwifery council of Nigeria,
Plot 713, cadastral Zone,
Life camp District,
Gwarimpa, Abuja.
7th December, 2018.

OPEN  LETTER TO THE REGISTRAR, NURSING AND MIDWIFERY COUNCIL OF NIGERIA

Dear Sir,

It is with great pleasure that Fellow Nurses Africa writes you at this point in time when nursing profession in Nigeria needs urgent attention.
We reiterate our sincere congratulations on your achievements so far since you assume office as the registrar, Nursing and Midwifery Council of Nigeria. Fellow Nurses Africa in particular, as well as all other progressive Nigerian nurses is very much proud of you for setting your sights high and making every effort for the development of nursing education and practice in Nigeria.
Fellow Nurses Africa believes that the present day Nigerian nursing profession is blessed with young, innovative, technologically and intellectually sound professionals with pools of idea that will bring solutions to the myriad of challenges currently slowing down the wheels of progress in the profession.
It is also our belief that an individual cannot help everyone at once, but he that cares can be a leader with listening ears and work with a lot of people to get things done. This fact prompted Fellow Nurses Africa to organize the first ever nursing essay contest tagged, “IF I WERE NMCN REGISTRAR”, to garner great innovations and ideas from brilliant and innovative nurses for the overall benefit of our dear profession.
As we pen down here our position regarding these ideas and innovations, we wish to state clearly that it is by no means an attempt to criticize or discredit you and your laudable ventures towards the promotion of nursing education and practice in Nigeria. We do believe that our thoughts reflected here will serve as a means of drawing attention of stakeholders in the profession to areas of focus for improvements so that we can maintain the nobility of our enviable profession.

   GREAT IDEAS THAT WILL LIBERATE THE NIGERIAN NURSING PROFESSION

NURSING CAREER PROGRESSION TO REFLECT ACADEMIC ADVANCEMENTS
Poor career progression in nursing without doubt has been a major setback to the nursing profession over the years. A situation in which there is no definite career path leads to brain drain in the profession. It is high time a nursing career progression is designed to reflect academic advancement. To achieve this, there would be the civil service advancement, which should give a nurse monetary increment as his years of service increases, and a professional career progression, which would give a nurse increased clinical role and leadership promotion with associated allowances as her knowledge and exposure advances from basic level to doctorate level. If this kind of model is adopted, a nurse who graduated from basic nursing school will have an urgent need to proceed to obtain his/her degree qualifications, or else, she will remain at the lowest cadre till retirement, even as she rises in civil service level. Also, a nurse with a degree qualification, with adequate years of experience, can rise to the position of assistant chief nursing officer but will be stalled at that point till retirement without further studies. Similarly, individuals with master’s degree in nursing specialties (nurse practitioner) can become a CNO which will make him/her a clinical, academic, research and administrative leader in such specialty. S/he 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 would provoke 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, medico surgical nursing, leadership in health sector, health economics, health statistics, innovative client advocacy initiative, etc. Nursing will have the capacity to carve out a niche 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.

CADRE/RANK PROMOTIONAL EXAMINATION
It is sad that in cases where nurses migrate from one hospital to another, they hardly retain their former post. A CNO coming from a government teaching hospital will be employed as NOII in another state teaching hospital. Why does migration from one hospital to the other means starting all over again? The best approach to this is to start a unified annual ranking examination for all nurses in Nigeria, whether in private or government setting. The certificate issued to this effect by NMCN will be used as authentication to retain the post from the former hospital in new area of appointment within Nigeria. All over the world, Senior Registrars and Consultants retain their post wherever they go; hence, this belittling de-ranking issue should be looked into so as not to hinder our colleagues looking for better offers in other settings.

INTRODUCTION OF UNIFIED STANDARD PROCEDURE MANUAL
Unified standard nursing procedure manual should be introduced for uniformity of practice. This will be subjected to review at specified periods by education department of the NMCN through raised ideas from research work. Each nurse will be entitled to a copy at the issuance of their license.

PROMPT AND EFFICIENT PROCESS TO FAST TRACK LICENSE RENEWAL
License renewal has been one of the major challenges nurses are facing on a daily basis with thousands of nurses unable to renew their licenses for years after paying necessary fees and meeting the various requirements for license renewal. The licensing unit of the council should be strengthened with both human and capital resources to ensure that those who have met the requirements for nursing licenses get them within the space of one week. The necessary machines for the production of these licenses should always be in good working conditions and additional ones procured where necessary. The use of information technology should also be strongly embraced in achieving this.

MORE MEN IN NURSING, MORE PROGRESS
One of the setbacks to the nursing profession globally is the lack of men entering into the profession. Typically, 5 – 10% of nurses in a given country are men, including Nigeria. Nursing is often seen as women’s job since it has always been traditionally. In Britain, the Royal College of Nursing did not admit men until 1960. Recruiting men into the profession is a huge challenge and if this could be surmounted, it will bring more innovations, developments, progress and respect to the profession.
The NMCN should start encouraging the influx of more men into the profession. To start with, 40% of admission slots into the departments of nursing sciences can be given to males based on distinctions while the 60% would be for females, as a form of encouragement for the men. There should also be a form of scholarship for male students nurses in partnership with Men in Nursing Assembly of Nigeria. This will encourage the influx of more men into the profession and the more men we have, the more progressive the profession becomes.

INCLUSION OF POLITICAL SCIENCE AS A CORE COURSE IN THE NURSING ACADEMIC CURRICULUM
Politics is power and nurses have been found wanting in this power play for too long. Nurses failed to participate in politics as a result of various factors, ranging from lack of interest and tight work schedule. Many even see politics as evil and a dirty game and this has profoundly affect the progress of the profession for a long time because we are not part of the decision and policy makers. Others determine the lots and progress of our profession for us. To solve this challenge, the NMCN should work directly with the National Association of Nigerian Nurses and Midwives to strengthen our internal politics. Political science should be included as a core course in nursing academic curriculum to produce politically sound nurse graduates that would be burning with political zeal after graduation from school. Students’ unionism in our universities should also be given full autonomy without interference.

ESTABLISHMENT OF LEAN ON ME CAMPAIGN
Lean on me campaign is going to be an indoor meeting with nurses alone in each state of the federation, in which the act of discriminating against one another will be politely discouraged while encouraging love, as a good asset we have missed. Through this campaign, nurses will be made to realize that we need each others’ shoulder to lean on if we must progress and collectively achieve a common goal of greatness. It aims at forgiving one another no matter how hard it must have been, for hatred thrives better where forgiveness is deprived. Lean on me campaign will also serve as an avenue to plead with nursing leaders to stop correcting their subordinates openly, as this depicts their value as caregivers. This campaign is the best way to start, as this will expose the hazard of intimidation, how far it has wrecked us as professionals and individuals will see the reason to inculcate a loving heart towards their colleagues instead of hatred and discrimination.

AFFILIATION OF SCHOOLS OF NURSING TO UNIVERSITIES
Nursing education has become a nightmare. The ripple effects caused by the dichotomy between diploma and graduates nurses cannot be overemphasized; hence, the public is confused about who we are and what it meant to be a nurse. Nursing is not clear on what the appropriate education for entry to practice is, and how to recognize and reward individuals who have achieved a higher educational level. Today in Nigeria, nurses continue to graduate with diploma, Bachelor of Nursing Science certificates, yet the distinction between the nurses who have the different level of preparation is virtually nonexistent. In our opinion, the major source of dichotomy in nursing is diploma nursing, which is a product of “Schools of Nursing” education. NMCN should as a matter of urgency ensure that the council enacts a policy that mandates all schools of nursing to be affiliated to degree-awarding institutions within the space of five (5) years, else they be scrapped. This will make the profession become a fully respected profession indeed in the country and reduce mediocrity as well. To achieve this, NMCN need to work out a plan with universities offering nursing education to make a considerable number of registered nurses get admission to pursue their degree program and for other nurses who cannot go through a full time study, a temporary part-time program for the period of just 5years, opened for them, in which after the period elapses, the program is stopped.
Also, the era of “pen and paper” system of learning should be bid farewell in our nursing institutions. Having the appropriate technology infrastructure and up-to-date resources is also critical to successful learning. With the impetus to expand the use of technology, NMCN should ensure that lecturers are prepared to use available resources, have access to needed support, and develop competency for using resources and support. Also, e-learning should be encouraged to thrive, making it one of the prerequisites to getting admitted in our training institutions.

CREATION OF NIGHTINGALE CALL CARE CENTRE
NMCN should partner with a trusted telecommunication company to create a toll free number “Nightingale Call Care Centre” for nursing customer care service in treating any nursing issue within and outside Nigeria. Personnel under this unit will provide 24 hours’ online services as they attend to various complaints that have to do with the profession, either from individual, group or school. This will make service delivery more accessible to all registered nurses home and abroad.

NIGHTINGALE F.M.
Nightingale F.M as the topmost success of Nightingale Call Care Centre majorly will be trashing nursing health related issues, recent discoveries through research and updates on management of certain condition. This is another tool that will be useful to rebuild our reputation on what nursing is and what it is not. Nightingale F.M. will also be used to source for talented ones among nurses, who have developed their latent ability in media as presenter, musician, instrumentalist, poet and other vocations, all for nursing and by nurses.

ON QUACKERY
The regulation of the training of auxiliary nurses in Nigeria, which most times are perpetrated in privately-owned hospitals, becomes pertinent, as this constitutes one of the major avenues through which quackery thrives, rather than the all-comers affairs that nursing practice in Nigeria has become for years, a situation in which most privately-owned hospitals and of recent, religious organizations, etc. unabatedly train and churn out quacks, glamorized as auxiliary nurses in hundreds. The N&MCN can help in standardizing this sub-sector in the Nigerian nursing in semblance to what is obtainable in the advanced world.

It is important that through adequate legislation, the leadership of the N&MCN institutionalize a program in Nigerian nursing, similar to what operates in the western world. The Health Care Assistantship (HCA) program in the United Kingdom and the Licensed Practical Nurse (LPN) in the United States of America are very unique in their own rights and had immensely impacted nursing practice in those countries. If such programs are meticously implemented in our nation’s health sector, through a system in which the N&MCN in conjunction with the Federal Ministry of Health (FMoH) design a program for the training of individuals, interested in this career path, by defining the requirements, scope of practice, renumeration, outfit (uniform), job specifications, etc. for the so-called auxiliary nurses, the monster of quackery would be duly destroyed, as this will help in stemming the tide of every tom, dick and harry who wear the white uniforms, being reverence as nurses. Similarly, it will also help in curbing the menace of quackery in nursing with quantum cases of unwholesome practices and litigations resulting from such venture, while at the same time, considerably help in supplying a sound and vibrant ancillary workforce to the nursing profession, in both the government and private health care settings in the country as obtainable in the advanced climes.

PUBLIC SENSITIZATION AGAINST MEDIA MISREPRESENTATION OF NURSES
Observations all over the world have records of nurses always being at the receiving end for most negligence cases because of how we have been mis-represented by the media. To make things worse, the Nigerian film industries have really bastardized our unique image through their interpretation of nurses in most of their home videos. Some portray nurses as prostitutes, husband snatcher, kleptomaniacs, manager of baby factory, doctor’s errand girl or boy and the likes. This sensitization will be in form of stakeholders’ meeting in the media and film industry and start a campaign tagged, “Nursing: What it is, what it is not.” The concept of this campaign is to come up with numerous selected slides used on media and home videos to depict the value of the profession. This will unveil to the general public our stand on this subject and a communiqué will be released at the end of the meeting for expedite action by the government.

THE USE OF INFORMATION TECHNOLOGY (IT)
Information technology, IT, is the use of computer to store, retrieve, transmit and manipulate data or information. It is the subset of information and communication technology. The NMCN should ensure the use of ICT is embraced to better the lots of the profession. The NMCN website should be designed in a way that would make it easier for the consumer of health and the entire public to have direct contact with the council and make report of abuses when necessary. This will give them access to verify the professional status of anybody impersonating nurses.
Similarly, it is high time the NMCN becomemore active on the social media platforms. Social media platform is becoming the widest space in dissemination of information and influencing people while at the comfort of their homes. NMCN should ensure that the council have a viable and active social media platforms to bring the activities of the council to the fingertips of professional nurses and the entire public. The social media platforms shall also be serving as a medium to changing the poor public perceptions of nursing and nurses in Nigeria. For example, a single twitter thread can be used to push for policy changes in nursing if strategically twitted.
Above all, we are confident that this letter will appeal to your sensibilities as a respected leader who can facilitate productive collaboration to reach an amicable solution. We believe that if these ideas and innovations are put to test, the Nigerian nursing profession will in a matter of years from now become an enviable one.
We live in a time of rapid changes, monumental achievements, profound knowledge and discoveries. It is imperative that we evolve as a profession, adapt and learn at the same pace as our world is transforming. Also, we must learn in our own culture.
Yours faithfully,
Nrs. Oluwatosin K. Odunayo
CEO / Editor-in-Chief, FNA.
For Team Fellow Nurses Africa.