(Established by Nursing & Midwifery Registration etc. Act. Cap. No.

143 Laws of the Federation of Nigeria, 2004)

A PAPER PRESENTED BY THE REGISTRAR NURSING AND

MIDWIFERY COUNCIL OF NIGERIA AT THE INTERNATIONAL NURSES
WEEK CELEBRATION ON 18TH MAY, 2011

TOPIC: NURSING EDUCATION REFORMS: A PIVOT TO

QUALITY SERVICE DELIVERY

PROTOCOL

INTRODUCTION

I must first of all thank the National Executive Council of NANNM and
the Planning Committee of this scientific workshop for organizing this
programme.
The topic of this paper, “Nursing Education Reforms: A Pivot To Quality
Service Delivery”, is an issue of top priority to the Board and
Management of the Nursing and Midwifery Council of Nigeria.
This to my mind may have informed the decision of the Planning
Committee of this Scientific session to assign this presentation to the
Nursing and Midwifery Council of Nigeria.

KEY TERMS
It will be necessary to identify and analyse the key terms in this topic
before going into the discussion.

 Reforms – refers to changes leading to a permanent improvement

in the quality or function of something.

 Pivot - a support upon which something rest on or revolves

around.

 Nursing education reforms – refers to changes and re-

organization of the conventional system of nursing education in
line with the National Policy on Education with the ultimate aim of
improving the quality of Nursing education and competences of practitioners
for effective delivery of quality care to the populace as a co-factor to poverty
reduction effort of government.

NEED FOR NURSING EDUCATION REFORMS

Nursing Education Reform is based on the Health sector reform in Nigeria

which is also based on the global health reform. As stated by the Health
Minister (FMOH 2004), the Health Sector reform is a broad based purposeful
and sustainable fundamental change in function, structure and performance of
health system in order to deliver efficient, quality, affordable accessible,
effective and equitable health care services to the populace and ultimately
improve the health status of the people.

The Current Nursing education reform therefore is a response to the changes

needed in the function, structure and performance of Nursing education and
practice in Nigeria so as to provide high quality care to the society.

Rao (2007) stated this basic fact, “there is no educational system in the
world that has not undergone some reforms and restructuring”.

The truth is that the more pragmatic the reforms embarked upon, the more
dynamic the educational system that evolves.

Brief history of Nursing Education in Nigeria reveals that formal Nursing

education in Nigeria started in 1930 (Adelowo, 1988).
This system was bequeathed to the country by the British Colonial
Administrators, in fashion with what was operated in Britain at that time. This
was the apprenticeship type of training obtained from hospital based of
training post.
This system of Nursing education metamorphosed from the apprenticeship type
of training to tertiary education in hospital – based Schools of Nursing,
Midwifery and Post Basic Nursing programme (Ndatsu, 1999; Adelowo, 1988)

Nursing education in Nigeria is eighty one (81) years old and therefore is
overdue for re-organization and restructuring.

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The weaknesses of this conventional system of Nursing education necessitating
reforms are as follows:

1. The students are not issued with any academic certificate from
the Nursing educational institutions but only receive their
professional certificates of registration from the Nursing and
Midwifery Council of Nigeria on passing the Council Final
Qualifying Examination. This situation can engender a feeling of
inadequacy in the professional nurses thereby affecting the
confidence and output of the practitioners.

2. Academic progression along already established educational line is

long and complex.

3. Is not in line with the National Policy on Education.

4. Employers have difficulty placing and remunerating nurses and

midwives because of system of education.

Preparation of student nurses and midwives in an educational system

whereby the graduates are awarded academic certificate provides the
following advantages:

 Promotes confidence of the professionals

 Guides employers on proper placement and remuneration of the

nurse practitioners thereby promoting job satisfaction and better
productivity.

 Promotes academic progression thereby helping the practitioners

to develop additional knowledge and skills in already established
education system, which are pre requisite for quality service
delivery.
 Promotes quality of education of nurses:
Prior to the Nursing reforms the conventional system of nursing
education depended on tutors with Diploma as the highest
qualification. This was a great variance with education in tertiary
institutions where M.Sc. degrees are the acceptable entry point for
lecturers.

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Recently the Federal Government of Nigeria quantified the General
Nursing (RN Certificate) and the Basic Midwifery (RM) Certificate as
equivalent to HND, for employment purposes. If this is the situation, it
therefore follows that the qualifications of core nursing tutors as well as
other lecturers in any Nursing institution must be reviewed upward. This
is logical since an educator must have a higher qualification than the
students he or she teaches. The quality of educators has direct effect on
the quality of the professionals produced while the quality of the
professionals ultimately determines the quality of service delivery. It is
therefore part of the Nursing education reforms that core nursing tutors
in schools of nursing , midwifery and post basic nursing programmes
must have at least first degree in Nursing while Heads of such
institutions should have higher qualifications. This will ensure that these
educators have the broad base of nursing knowledge, concepts and
theories to teach. However to ensure also that the teachers know how to
pass the knowledge across to the students, it is a requirement for them
to have a training in education. To further assist in the education of
qualified educators, the Nursing and Midwifery Council of Nigeria in
collaboration with the Department of Hospital Services, Federal Ministry
of Health set up a sub-committee of nurse educators and experts in
education to develop a curriculum for Post Graduate Diploma in nursing
education (PGDNE). The aim of this programme is to boost the
availability of competent nurse educators for the Nursing institutions.
This curriculum has been accepted by the National Universities
Commission (NUC) and is already for implementation by interested
Universities.

The Nursing educational system will withstand the test of time if it is

reorganized to meet the national policy on education, needs and
expectations of nurses, the labour market and the society, hence the
need for Nursing education reforms.

The focus of a sound Nursing educational system should be:

 Optimum academic and professional development of nurses who

are equipped to build a strong and virile profession.

 Effective and efficient health care delivery.

 Maximum satisfaction of societal needs and expectations.

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 A well structured Nursing education system will not only eliminate
difficulty in academic progression of nurses but will also promote job
satisfaction, build competence and confidence of practitioners; thereby
promoting quality nursing care delivery.

It is however worthy to note that the goal of nursing education reforms is

not just to produce nursing practitioners with educationally acceptable
academic qualifications, degrees and higher degrees. Higher or nationally
accepted nursing qualifications in itself alone cannot guarantee excellent
nursing care.

The unique objectives of Nursing education reforms therefore are to

equip individuals with:

 General and specialized nursing knowledge

 Scientific and practical skills required for excellent Nursing care.

 The age long ideals, virtues and attitudes that will enable them to
render professional nursing care to patients and clients with a
passion.

According to Leininger (1991) care is the essence of nursing while Watson

(2003) describes Nursing as a human science with the major focus being the
process of caring for individuals, families and groups. This means that no
nursing reforms will be complete if it does not translate into better patient care.
A successful nursing education reforms should translate into more humane,
more caring and mre conscientious nurses.
In all health care settings, the success of care is directly related to the quality
of Nursing care.
Sick people are usually anxious, afraid and suspicious even if they do not show
it and reactions to illness are not always logical or rational.
It takes a skillful and caring nurse to:

 evaluate circumstances critically

 bring to bear the needed inter personal skills required to keep the
patient in a relaxed state for treatment and care.

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  Adopt the most suitable attitudes in order to ensure the
patient/client receives effective, efficient and safe Nursing care at
all settings.
From the foregoing it is necessary to look at the various aspects of Nursing
education reforms and how these can translate into quality nursing care
delivery.

 Review of entry requirement/qualification into Nursing

educational institutions:
Entry requirements for nursing and midwifery education at all levels is
five O level credits in English, Mathematics, Biology, Chemistry and
Physics at not more than two sittings. This took effect in November 2006,
for General Nursing and March 2006 for Basic Midwifery institutions.
Higher and better entry qualifications into nursing institutions ensures
that the students admitted are trainable. Everything being equal, better
quality of student intake will lead to better quality of professionals turn
out and ultimately better quality of nursing care.

 Movement of nursing education into the University:

The Nursing and Midwifery Council of Nigeria in its position paper on
Nursing education reforms stated clearly that quality health care, client
satisfaction through utilization of evidence based practice, support for
research and research utilization among other things can be possible if
nursing education is moved into the University. This is so because
university nursing education is designed to produce polyvalent nurses
who are equipped through high standard of education to render effective
and efficient health care to patients/clients. The aim of the programme
is to improve the quality of Nursing care to citizens.

 Upgrading of Nursing institutions into full fledge

Monotechnics:
The National Policy on Education categorises Schools of Nursing as
Monotechnics. Such schools are designed as financially and
administratively autonomous tertiary institutions with the objectives of
preparing professionals to meet the manpower needs of the country. It
can be appreciated that this system has many merits. For one thing the
structure is clearly defined and academic progression is easier. The
schools that are accredited by the regulatory organ of the Federal
Government are authorized to issue academic qualifications to the
graduates. The Nursing and Midwifery Council of Nigeria is working with

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the relevant agency of the Government and stakeholders to ensure this
aspect of the reforms is embarked upon smoothly for better nursing
education to be achieved. This is expected to lead to better job
satisfaction and increased output.

 Accreditation of Nursing Training Institutions and Areas of

Clinical Practice.
The Nursing and Midwifery Council of Nigeria as part of its Nursing
education reforms has embarked upon series of accreditation and
re-accreditation exercises to ensure Nursing educational
institutions have adequate physical and human resources to meet
the required standard for education of nurses and midwives.

Emphasis is placed on the standard of the School because it has a

direct correlation with the performance and competence of the
professionals that graduates from such Nursing institutions.

 Review of the curriculum

As part of the current reforms the various curricula for Nursing
and Midwifery education have been reviewed and updated in line
with current trends in the health care delivery system. The review
takes cognizance of new trends in the clients/patients care,
national health care needs and demands and as global best
practices. This aspect of nursing education reforms is very critical
for producing competent nurse practitioners who are equipped to
render qualitative Nursing care in a dynamic society like ours.

 Manpower Development and Capacity Building

As part of nursing education reforms the Nursing and Midwifery
Council of Nigeria has:
-Collaborated with various local and international
agencies/organizations for capacity development of nurses and
midwives in areas geared towards better service delivery. Among
these areas are: Obstetric Emergency Care /Life Saving Skills,
Integrated Management of Childhood Illness, use of Anti-
Pneumatic Anti Shock Garment in the management of post partum
haemorrhage, HIV testing and Counseling, Infant and Newborn
Feeding, etc.

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 - The Council is also exploring ways of further parthnership aimed
at boosting nursing manpower capacity development particularly
in area of preparation of Nursing lecturers/tutors. This is critical
for qualitative service delivery because the various nursing and
midwifery schools and departments need highly qualified
educators if competent professionals are to be produced.
The Council has also encouraged more nurses to undertake
degrees and higher degrees in Nursing. This is not necessarily for
teaching in schools alone but also for the clinical areas. Nursing is
a practice profession, full impact of higher education in Nursing
will be felt when nurses with degrees and higher degrees in
Nursing work hand in hand with other health care professionals in
the clinical setting to render care to patients/clients. Currently the
nursing profession is rated by the input of the nurses at clinical
areas of which majority are Diploma holders.

 Internship Scheme for Nurse graduates

The Nursing and Midwifery Council of Nigeria as part of the
Nursing education reforms is working with all stakeholders to
ensure that internship scheme for fresh Nurse graduates is
commenced in Nigeria. This is necessary to improve the
competence of these new nurse practitioners thereby contributing
to excellent Nursing care. This is necessary because in University
based education there is demand for liberal knowledge acquisition
from undergraduates and they are usually under intense learning
pressure with inadequate time for integration of theory and
practical knowledge. The period of internship will therefore help to
strengthen the skills of the practitioner leading to quality service.

 Mandatory Continuing Professional Development

Learning is a lifelong process, therefore for quality Nursing care to
be maintained the Board of the Nursing and Midwifery Council of
Nigeria has directed that nurses must keep up to date with current
trends through mandatory continuing professional development
programme. This form of education is part of the Nursing reforms
which is required from the nurses in order to ensure competence is
maintained. Nursing is the art and Science of using clinical
judgment and the provision of care to promote, improve and
maintain health. Caring is the fundamental and critical component
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of nursing practice. It is accomplished with wisdom, knowledge,
compassion and competence. These knowledge, virtues and
attitudes cannot all be acquired in school but must be while in
professional practice. It is based on this that from January 2012
evidence of attendance of MCPDP shall be required for renewal of
licence.

CONCLUSION
The quality of nursing is dependent on the quality of education
given to nursing students. A poorly educated nurse cannot provide
the quality health care needed for the highly technological health
care system and complex society of today. It is on this note that
the Nursing and Midwifery Council of Nigeria is committed to
implementation of the Nursing education reforms. This will surely
not only promote excellence in Nursing practice but will stimulate
the much needed growth and development of the Nursing
profession in Nigeria.

Thank you for listening.

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 References

Adelowo E. O. (1988) The Nursing Profession In Nigeria. Lagos:

Lantern Books.

Bryan Brown, C. & Dracup, K. (2003) Professionalism, American

Journal of Critical Care, 12 (5), 394.

Federal Ministry of Health (2004) Health Sector Reforms.

Leininger M. M. (1991) Culture Care Diversity and Universality: A

Theory of Nursing. National League of Nursing Press New York.

Ndatsu, P. N. (1999) Practicing Nursing andc Midwifery in Nigeria

(Ordinances and Laws 1930 -1992) Lagos: Nursing and Midwifery
Council of Nigeria.

Rao, E. (2007) The Sociology of Education. London: Oxford

University Press.

Watson J. (2003) Jean Watson and the Theory of Human Caring.

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