Ms Faosat O. Animashaun is the assistant director of nursing services at the Lagos State Health Service Commission (LSHC). In this exclusive interview with Temitope Obayendo, the vibrant, veteran nurse provides a comprehensive appraisal of nursing practice in the state, noting areas where progress has been made and those requiring improvements. She also reveals why nursing profession is dominated by females, while also giving valuable tips to nurses desirous of self-improvement principles. Excerpts:
On assumption of office as the assistant director of nursing services, what were your goals and vision for nurses in Lagos State?
On assumption of office, my goals were to enlighten nurses on their roles within the health care team; to reduce the gaps between theoretical and clinical nursing; to ensure conformity of LSHC nurses to N&MCN’s code of conduct of the profession; to ensure maximum utilisation of available nursing personnel, i.e. both senior and junior staff; to ensure adequate staffing of distant hospitals (e.g. Badagry, Epe, Ijede etc); and to encourage nurses to improve themselves through in-service training in different nursing specialties e.g. Peri-operative, Orthopaedics, and Accident & Emergency etc.
My vision for Lagos State nurses was to see them become leading initiators of health care services among the health care providers through early identification of clients/patients’ present or potential problems and ensuring collaboration with other health professionals to solve the identified problems in a conducive/therapeutic environment with empathy.
What is your assessment of nursing practice in Nigeria, compared to other countries?
Nursing is defined as protection, promotion and optimisation of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses and advocacy in health care of individual, families, communities and population.
Nursing practice in Nigeria is yet to get to the advanced level compared to other developed countries in terms of interest in research, conducive work environments, advancement in medical science and technology, implementation of nursing process and nurse-patient ratio.
What are the major areas requiring improvements in the profession?
The health care delivery environment is dramatically changing and nursing has found itself in the midst of these revolutionary changes. Health care providers are expected to be able to provide safe, competent care in a highly technical and digital environment. Today’s nursing requires nurses to be constantly aware of new developments, new medication and new technology among others.
The concerned areas for improvement in nursing profession include: One, higher education in nursing – nurses should engage in higher nursing education to improve their cognitive and skills development. This could be by way of Bachelor’s degree, Master’s degree and Doctor of Philosophy (PhD) degree in Nursing. Two, nursing informatics – with the era of technology, nurses should be versatile in digital environment, using technology in providing care to their patients. Three, quality assurance – quality assurance units must be established to ensure auditing of nursing services. Four, research – nurses must involve in research and be able to utilise research findings to improve nursing practice and to provide evidence-based practice. Five, continuing professional development – the profession can only improve if nurses involve in continuous training/workshop/seminar to keep abreast or update their knowledge.
Other areas include autonomy, nurse-patient ratio, gap in theoretical and clinical nursing, mind-set on nurses’ image, work environment and funding of health care delivery.
Nursing schools were said to start operating on their own some time ago. What is the situation now?
Nursing in Nigeria today is far different from what it used to be years ago and it is expected to continue changing during the 21st century. Like other health professions, nursing education started with little or no formal education and the nursing practice is mostly based on intuition and trial and error.
Presently, no nursing school can operate without accreditation by the Nursing and Midwifery Council of Nigeria which is the professional regulatory body in Nigeria that specified the curriculum code of conduct and ethics guiding the profession.
For any institution that runs nursing programme, the approval of this regulatory body must be sought and the said institution must meet the accreditation requirements to some extent before nursing programme can be instituted.
Previously, unwilling candidates with one or two ‘O’ Level credit passes were coaxed into the profession because nobody wanted to carry bedpan.Presently, however, all eligible candidates admitted into the schools of nursing must be willing, committed and meet entry requirements of five (5) credits in Science subjects before admission.
Nursing education has now gone beyond schools of nursing; it is presently incorporated into theuniversity education system.Candidates can be admitted either by Direct Entry or Unified Tertiary Matriculation Examination (UTME) of four and five 5 years programme respectively. After this first degree programme, nurses can proceed to Master’s degree, PhD degree, and even professorship.
This exposure of nurses to increased body of knowledge prepares them to use critical thinking in identifying clients’ problem and making plans to solve them. It also enables nurses to use evidence-based nursing practice, thereby edifying and strengthening nursing as a profession.
Strikes by resident doctors are not uncommon in this part of the world.To what extent can nurses work without doctors?
Whenever doctors are on strike, nurses will still continue to manage the admitted patients with their treatment regimen. Also, nursing care plan, based on critical thinking and evidence-based practice, will be applied to treat new complaints.
However, if a patient’s condition deteriorates or becomes an emergency that nursing care alone cannot solve, consultants are always around during strikes, and they will be called upon to see such a patient.
At the outpatient department, first aid treatments are given to new patients, depending on the severity of their conditions. All booked ante-natal cases are attended to, deliveries are taken by midwives, while consultants are called to see complicated cases. Patients on daily injections and dressings are also attended to.
In other climes, nurses are allowed to prescribe for patients in some situations. Is this applicable in Nigeria?
Yes, it’s applicable. To some extent, nurses,especially midwives,have the autonomy to prescribe drugs for patients under the legislation governing the use of drugs and medicines by the midwives in Nigeria. Also, nurses with public/community health certificates are allowed to prescribe drugs for patients with the use of standing order.
As nursing roles are expanding, new dimensions for nursing practice are being established, nurses with varieties of nursing specialties (e.g. critical care, mental health, accident and emergency, maternal and child health, anaesthesia, public/community health etc.) through education are now advanced practice nurses (APNS) and even nurse consultants in developed countries.
These categories of nurses provide direct client care as nurse practitioners, nurse-midwives, certified registered nurse anaesthetists, clinical nurse specialists etc. With their education and certification, which depends on state regulation, they are allowed to provide primary care and prescribe medications for patients in some situations.
Presently, there are few of them in Nigeria; hence, more nurses should be encouraged to further their education in order to broaden the autonomy which will enhance health care delivery in Nigeria.
Why are there so few men in nursing profession?
Globally, nursing is perceived as a profession exclusively for women and, as a result, it is not attractive to many men.There are misconceptions about male nurses, resulting in drastic reduction of admission quota of male candidates into Basic School of Nursing.
There are also unwritten policies about male candidates entering the profession, especially areas like midwifery. This is why men have not been admitted into midwifery schools.
There should be career enlightenment campaign in secondary schools. This will help to create more awareness about nursing profession among male pupils.
Are there challenges facing nurses in the state?
Nurses in the state are performing their duties diligently but this is not without some challenges. These include one, ever increasing population of the state – the population of patients in hospitals is increasing every day and putting more pressure on the available nursing personnel. Two, funding of health care industry – it is a well-known fact that funding of health care industry should not be the exclusive reserve of the government. Public-private partnership is required. Three, inadequate nursing personnel – there has been agitation by nurses for mass employment which was done last in 2004.There is acute shortage of nurses largely due to expansion of health care facilities such as construction of Maternal and Child Centres.Also, nurses are retiring from active service. Four, many nurses now reside in new sites around Ikorodu, Sango-Ota, Igando/Ikotun and, at the same time, working in Lagos Island/Lagos Mainland. This has resulted into many nurses requesting for transfer to hospitals that are nearer to the new sites.
In addition, with advances in health technology, there is need for the state hospitals to be equipped with new equipment that will enhance nursing service delivery. There is also the issue of welfare of nurses. Nurses are agitating for salary parity with contemporaries working at federal health institutes. Provisions of loan facilities such as car loan, mortgage loan are also being requested for by nurses. Nurses also want opportunity for advanced training, seminars and conferences.
What then is your advice to all nurses?
Nurses should be empathetic and ensure provision of quality nursing care to their patients; including the relatives.They should ensure that they maintain an effective and therapeutic communication with their clients/patients for better understanding and acceptance of care to be rendered.They should constantly ensure proper documentation of services rendered, as this will guide against litigation and will also ensure continuity of care.
Moreover, nurses should take it personally upon themselves to improve on their educational background by furthering their education. They should attend seminars and conferences. They must ensure that care rendered is according to the best available scientific evidence at all times using nursing process. They should show concern about socio-political security issues in the country.
Above all, they must be good ambassadors of the profession wherever they may be at any time by keeping to the code of conduct and ethics of the profession.