ENFORCING HIGH PROFESSIONAL STANDARD OF PRACTICE IN NURSING.

Nursing is a unique profession in the health team that recognizes the practice of the profession as a public trust. This puts a responsibility on the profession to protect the public. Standard setting is a crucial aspect of the functions of the Nursing and Midwifery Council of Nigeria established by the Nursing and midwifery Registration etc. Act cap N143 Law of the federation of Nigeria, 2004 as the statutory body charged with the responsibility of regulating the standards of professional nursing and midwifery education and practice in Nigeria. It also ensures that these standards are complied with. These standards are the yardsticks of measuring and evaluating the quality of the education and performance of the practitioners in the health care delivery system. Nursing standards are derived from core values which include respect for the dignity of persons, integrity in service, compassion, tolerance, intellectual and psychomotor competencies and accountability.

Unfortunately, various studies have revealed that the standard of nursing practice is gradually falling from what it used to be in the past. This is even evident from our day to day experiences in the clinical areas and in some of our training institutions. This trend must be checked because if nursing practice is poor, ineffective and inefficient, then quality health care cannot be achieved in Nigeria and especially in Ondo state where a lot of innovative heath care programmes are being established by  government. Maintenance of excellence is therefore the mainstay of the quality of service delivery system

THE ROLE OF STAKEHOLDERS:

The Nursing and Midwifery Council of Nigeria is in the fore front of enforcing the standards of nursing education and practice in Nigeria. The State Nursing and Midwifery committees of Council  also has the statutory responsibility of ensuring that nursing and midwifery standards are maintained in their respective health facilities and educational institutions . It is worth stating that the task of enforcing professional standards can be better achieved through collaborative efforts of all stakeholders; nursing leaders, nurse administrators , nurse clinicians and professional associations. As nurse leaders, you have the responsibility to report cases of indiscipline and malpractice to the Ondo State nursing and Midwifery committee which is  the statutory representative of the Nursing & midwifery Council in the State and leaders of different levels/aspects of nursing are represented on  the committee.

DOCUMENT ON STANDARDS OF NURSING- MIDWIFERY EDUCATION AND PRACTICE IN NIGERIA

The Nursing and Midwifery Council of Nigeria has developed a standard of practice document which was published in2010. The aim of this document is to inform and educate nurses and midwives  on the acceptable standards of nursing practice which is in line with global and local standards as well as health needs. Some of the guiding philosophy and concepts in developing the standard document include, holistic nature of man and right to life and dignified death, right to comprehensive nursing care, multidisciplinary nature of the health care system, and the autonomy of the nursing profession which makes a nurse responsible and accountable for her actions.

SCOPE OF NURSING PRACTICE

Nursing Practice is a dynamic, caring, helping professional relationship in which the nurse assists the client(s) to achieve and maintain optimal health by utilizing the nursing process and integrating knowledge and skills from nursing and other related disciplines. Every registered nurse is personally accountable and responsible for all her actions. The nurse is accountable to the Nursing and midwifery council of Nigeria for any acts of omission or commission.

The practice framework is as contained in the contents of training as guided by the basic curricula for the various programmes of N&MCN and the Nursing and Midwifery Act of 1979 as amended by the 1988 N&MCN Amendment Decree.

All registered nurses with the N&MCN are expected to demonstrate competence in the following:

§  Health Assessment and Nursing Diagnosis

§  Practice autonomously offering the full scope of primary health care practice

§  Support the treatment of clients with diseases or disorders

§  Implement strategies to promote health and prevent illness

§  Ensure that the pattern of care for use shall be the Nursing process

§  Ensure safety and promote the well-being of the patient/clients

§  Ensure confidentiality of information, reports and records concerning the welfare of his/her client

§  Monitor and report adverse drug reactions

§  Participate in clinical teaching and supervision of student nurses.

§  Maintain and improve professional knowledge and competencies through continuing professional development.

AREA OF PRACTICE

The practice of Nursing-midwifery in Nigeria shall be in both public and private sectors covering all levels of health care.Nursing and midwifery shall form the foundation of practice of nursing in Nigeria while other Nursing Disciplines shall be regarded as clinical speciality areas.

NURSING CARE DELIVERY SYSTEM

The prescribed nursing care delivery system is  “Total Patient Care” based on the principles of assignment of clients and accountability of a nurse to coordinate the provision of care to a group of patients during his /her working hours using the nursing process

NURSING SERVICES DEPARTMENT

The professional Head of  Nursing Services within the practice setting shall be called the Head of Nursing  Services as may be applicable.

·        The Head of Nursing services shall be assisted by deputies

·        The HNS shall be involved in all policy making of the institution

·        The HNS will prepare the annual budget for the department and defend it accordingly

·        The ratio of registered Nurse/midwife to patient is  1:5 on each shift

·        The HNS shall constitute the following committees

1.     Nursing Education

2.     Procedure

3.     Standards

4.     Disciplinary

5.     Appraisal

6.     Quality Control

7.     Welfare

The membership of each committee shall include the staff of any school within the institution

Each committee shall meet regularly to discuss issues related to their terms of reference and brief all nursing personnel about their activities.

§  All nursing personnel shall be encouraged to develop  themselves professionally and  academically

MINIMUM STAFFING FOR A 30- BEDDED WARD

Medical/Surgical Wards:

Chief Nursing Officer – 2

Assist. CNO                  - 3

Senior Nurses              - 4

Nursing Officers 1`&11 – The ratio shall be 1: 5  ( morning and afternoon shift)

-         30% of total number to fill the gap

Night Duty

Chief Nursing Officer – 1

A senior nurse not below the rank of a Principal nursing Officer- 1

Nursing Officers 1&11- 3

Adequate auxiliary staff should be provided for each shift

Paediatric  Ward/ Obs. & Gynae. Ward/ Accident& Emergency/Psychiatry ward/ Intensive care Unit

CNO                                     - 1 ( In Charge)

ACNO                                  -1 ( Assisting)

Senior Nurses                   – 4

Nursing officer  1& 11      -   There shall be a ratio of one nurse to three patient 1:3 for Paed./ Obs& Gynae  in all shifts   1:5 for  A&E / Psychiatry  dept. in all shifts while it shall be one nurse to one patient 1:1 at Intensive care unit in all shifts and the staff of this unit shall be specially trained.

Out Patient Department

CNO        -                   1 ( IN CHARGE)

ACNO      -                 1  ( ASSISTING)

PNO        -                 2  (

SENIOR NURSES   -        4

NURSING OFFICER 1 & 11  -  One nurse to four patients on each shift 1:4

Theatre Dept.

CNO          - 1 ( IN CHARGE)

ACNO       -  2

PNO          -  2

SNO          -  2

NURSING OFFICERS 1 &11 -   There shall be six per theatre unit per shift  1:6

POSTING OF STAFF TO WARDS

In determining posting of staff to the wards, nurses shall be deployed according to their specialty areas

NURSING AND MIDWIFERY PROGRAMMES

Nursing and Midwifery Council of Nigeria has  75 approved schools of nursing, 26 approved school s of Basic Midwifery, 44 approved schools of post-basic midwifery and 35 schools of post-basic  nursing of

Various specialties (Psychiatry,  ENT, Peroperative, Opthalmic, Orthopaedic,Cardiothoracic, Anaesthetist, A&E, Paediatric, Intensive Care, Burns& Plastic, Occupational)

The Basic programmes run for 3 years while the post -basic programmes run between 12-18 months

The Principal of the School of Nursing- Midwifery shall possess a minimum of a university degree in nursing and must be a registered Nurse- Midwife Educator. The person must also possess additional clinical specialty qualifications that are relevant to the area required in cases of institutions offering Post- basic Nursing Programmes.

Educator/ student ratio of not more than 1;10 for basic programmes and 1:6 for post basic programmes

UNIVERSITY PROGRAMMES

There are 15 departments of Nursing in Nigerian Universities offering BNSC degree which run for 5 yrs (UME) and 4 yrs( Direct Entry)

Graduates of the 5yr BNSC programme will undergo a year internship before registration as RN/RM. Graduates of the 4yr BNSC are exempted from internship.

There are higher degrees of Masters & Ph.D in nursing in some Universities.

ACCREDITATION OF TRAINING INSTITUTIONS.

The Nursing and Midwifery Council of Nigeria has categorically set out standards to be met by training institutions and areas of clinical practice. The council also has modalities of ensuring that these standards are complied with. Sanctions are promptly meted out when the standards are flouted. The State Nursing and Midwifery Committee of the Council has the statutory responsibility of regular inspection of nursing and midwifery training institutions and clinical training area. The must be sent to Council. Ondo State Nursing and Midwifery would soon commence the inspection of the schools in the state.

PROFESSIONAL LICENSE VERIFICATION

The Council embarked on “Operation show your license” in 2010 and during the exercise, practicing nurses were requested to present their nursing practicing licenses to the Council’s verification team. In Ondo state, the State Nursing and midwifery committee will soon embark on verification of the licences of practicing nurses in government owned hospitals. Hence all nurse leaders should ensure that nurses in their health facilities and training institutions have the current license to practice.

MAINTENANCE OF DISCIPLINE IN THE PROFESSION

Professional discipline and promotion of standard of professional practice are closely related. To this end, the Nursing and midwifery Council of Nigeria constituted the Nurses Disciplinary Tribunal. The Tribunal is responsible for handling all cases of professional malpractice and breach of professional standards of practice brought to its attention. Nurses and the general public have the freedom to report to the Council through the State Disciplinary committee any act of professional misconduct by registered nurses. Permit me to read to you excerpts of the speech of the Chairman, Nursing and Midwifery Council of Nigeria when this workshop was held at the national level this year in Kaduna.” “You will agree with me that the conduct of some professional nurses in Nigeria is below the expected standard and is different from what the situation used to be years ago.  The unprofessional conducts of some nurses both at clinical facilities and Nursing educational institutions have been brought to the attention of the Nursing and Midwifery Council of Nigeria.  These range from acts of indiscipline, unethical behaviour, incompetence, malpractice to mention a few.  There are reports of nurses reporting late to duty or not even reporting at all without permission, leaving incompetent and auxiliary health workers to man the wards and health facilities especially at the community levels.  Some Nurses do not appear in proper uniform to duty while some appear with heavy make-ups, hair do that are huge and offensive, dangling ear-rings, long painted nails, above the knee length uniforms, etc.  There are reports of medication errors, wrong timing of drugs administration, charting of vital signs without actually taking the indicators, poor documentation, reporting and referrals.

It is common to find nurses practicing without registration and a license to practice in Nigeria.  Last year during the “Operation Show Your Licence”, conducted by the Council, it was discovered that some nurses have been practicing for over twenty years without professional registration and practicing licences.  So many nurses practiced with expired licences.

There is a lack of discipline and respect among nurses.  Junior nurses no longer respect the older nurses because of the issue of “god-fatherism" and the fact that senior nurses are no longer role models to the junior ones.  Some senior nurses have cease to be role models as most of them have handed over nursing care to the junior ones while they come on duty only as observers.  There are a lot of complaints about improper handing over or taking over of the wards and poor reporting by nurses.  Some nurses even get involved in selling of drugs and other items to patients while on duty, thus not giving attention to their professional duties.  Some nurses are involved in the training of quacks particularly in private health institution.  More so, there are complaints of midwives shouting on patients or even abusing them.”

CODE OF CONDUCT

There is a Council document on professional code of conduct which is under review. This document is to inform professional nurses of the standards of professional conduct required of them in the exercise of their professional duties and also inform the public, other professions and employers, of the standards of professional conduct expected of registered Nurse practitioners.

The breach of any part of the code of ethics of nursing  practice shall constitute a misconduct, which shall attract appearance before the Nurses Disciplinary Tribunal. Acts of malpractice, negligence, or anything done to compromise the integrity of the nursing profession shall attract penalties such as withdrawal of license, suspension or removal of name from Council register.

CONCLUSION

Leadership in nursing is very crucial to the maintenance of nursing standards and attainment of excellence in professional practice and education. Leaders must demonstrate exemplary models of standard practice for the other nurses to emulate and ensure that standards are upheld. Without sanctions, there will be a breakdown of law and order in the profession. It is therefore in the interest of leaders, all professional nurses and the public that nurses practice professionally and ethically at all times and in all settings to ensure that the respect and nobility of nursing among the committee of professions is maintained.

I hope that this workshop will explore ways and means of enforcement of nursing professional standards in Ondo state.

                                                                       BY 

                                               DR. (MRS.) M.O. JEMILUGBA, NPOM, FWACN

                                    DIRECTOR, NURSING SERVICES, MINISTRY OF HEALTH, AKURE

                                                                          A PAPER PRESENTED DURING

                                                                   

                                             WORKSHOP FOR NURSE LEADERS IN ONDO STATE

                                                                                     AT

                                         PUBLIC SERVICE TRAINING INSTITUTE, AKURE