Communique issued at the End of a Meeting Between Corps and Allied Nurses League (CANL) and the Minister of State for Health and the Head of the Service of the Federation in Abuja OUR STAND ON THE UNIFIED SCHEME OF SERVICE Addressing the issues surrounding the controversial “unified scheme of service” which has resulted in protest, counter protest and disagreements among nurses in Nigeria recently, we want to draw attention to the ethics that has maintained and sustained professionalism in nursing till date. The preamble of the International council of nursing (ICN) code of ethics reads: It is the fundamental responsibility of a nurse to promote health, to prevent illness, to restore health and to alleviate suffering. To be able to carry out these responsibilities, the nurse is guided by four principle element that outlines his/her ethical conduct. Of the four principle element as outlined by the ICN “Nurse and practice” states that “the nurse carries personal responsibility and accountability for nursing practice and to maintain competence by continual learning”. Unarguably, Nursing is a field that transformed from a vocation to a profession. The nursing profession has emerged from mere actions of carrying out of dogmatic routine tasks to possessing its own unique body of knowledge that is guided by evidence based research and universal scientific principles. This is why in the third element of the ICN code of ethics, Nurse and Profession states that “The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge” (ICN code of ethics for nurses, 2005). It is an undebatable fact that developing core research-based professional knowledge can only be furthered within a rigorous university academic framework. For the same reason medicine, physiotherapy, medical laboratory science and every other science and social science discipline moved their base into the University. Most if not all of them started from the technical training, and even those that retained their technical training programs have strict regulations that ensures steady progression with academic advancement. Much more so, it should be the primary preoccupation of a professional organization to put structures and modalities in place to ensure that the professional aspirations and fulfillment of her members are within realistic reach without compromising the overriding interest of the citizenry. The third principle element of ICN code of ethics lastly states that “The nurse, acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing”. The quintessential responsibility of a professional organization should be to ensure and enforce the steady growth and development of her members to meet emerging challenges and responsibilities such that it continually asserts its relevance, value and meaning within its professional jurisdiction and space. It is therefore unprofessional for a member of such professional organization to fail to seek advanced knowledge within the discipline. The corollary is that such individuals cannot reach the peak of their career as they have not reached a minimum expected level of development for a knowledge based profession. It then becomes the core responsibility of the leaders of such profession to create systems that will motivate her members to seek advanced learning from graduate to postgraduate level with increasing level of responsibility giving to those with higher academic qualifications. We should therefore avoid promoting policies that will allow for mediocrity in a nursing profession and sector that can least afford such the luxury. The National Association of Nigerian Nurses and Midwives (NANNM) position on the unified scheme of service for nurses and the subsequent threat for strike action is not in line with the code of ethics guiding nursing practice all over the world. According to NANNM, a nurse with three years basic education can rise to the level of director of nursing services. This is an unacceptable proposal that is unheard off in Nigeria and in other climes of the world. The truth is that in our schools of nursing and post basic training programs, the nurse is giving technical training far below the quality of education received by others in the university, and these has resulted in the poverty of scholars which is conspicuously evident in the Nigeria nursing community today. The current argument on the unified scheme of service are based on the secular from NMCN to the ministry of health On July 2014 which states that all nurses are nursing officers upon registration with nursing and midwifery council of Nigeria. It also contains in the secular that only nurses with degree from a recognized university can get to grade level 17, while nurses with only RN stops at grade level 14 unless the RN holder obtains the degree. NMCN position was in line with the civil service rule in Nigeria which restrict diploma holders to grade level 14. NANNM on the other hand, finds this position discriminatory and demands that all nurses should be allowed to reach the “peak of their career”. According to NANNM, the same principle which is applied with chartered accountants in Nigeria should be applied to nurses. Because an accountant with diploma if chartered can rich grade level 17 in Nigeria civil service. However, it takes one to become an accountant (whether as a degree or as a diploma holder) before he/she can be chartered after about six rounds of rigorous academic examination which have taken many accountants years to overcome. Alternatively, RN is just a basic qualification that makes one a nurse, before the nurse can proceed through degree to Ph.D. The RN program is completely different from the program at the institute of chartered accountant of Nigeria (ICAN) and should not be the standard for reaching the peak of a career unless the civil service commission changes their rule. Secondary, the IAP award of 1980 in its first term grants that “Nursing is a profession sui generis subject to no directions or control whatsoever by any profession so ever except in so far as its forms parts of an organic whole 1(a) and that in the health care delivery service of the country the nurse/nursing profession is on a parity with the profession of pharmacy as is the case of great Britain (1b)”. Since 1980, Pharmacist and others have upgraded their program while nursing seems to be crawling. A pharmacist cannot reach the peak of her profession unless he/she graduated from the university accredited to train pharmacist. Medical laboratory scientist and others have since followed the trend, shutting down their hospital based program and encouraging their members to join others in the university. This unified education automatically unified everybody within the profession and nursing should aspire to do same. In the health sector, professionals from hospital based programs and those from university based program have different level of entry and exit in the civil service. Such scheme exist between dentist and dental technologist, medical laboratory technologist and scientist etc. and all of them are regulated by the same council just like nurses are regulated by NMCN. NANNM’s actions will further reduce the competitive capacity of the Nigerian health sector in a fast paced system where the quality of health care delivery is in constant review. The university based nursing program has attracted better brains and better human and material resources that are needed to develop the profession and invariably the Nigerian health system. The civilized societies have converted all schools of nursing into a degree awarding institution, and NANNM can also direct their effort towards the same objective in Nigeria in corroboration with NMCN, federal Government and the associations of nursing in North America and United Kingdom who have indicated their interest to help with human resources. Achieving this end will put the belligerency within the sector to rest and our hospitals would at once be a place where our people can seek to further entrench their peaceful existence. Proposals and negotiations about a scheme of service does not require strike action, especially in a health sector that have suffered from successive strike action from different groups of healthcare providers. It is a policy issue that already has an existing blueprint and any proposed change or adjustment should be based on credible reasons and should be pursued administratively. As concerned professionals and stakeholders, we have unanimously resolve on the following positions and recommendations: · That the health sector does not need any other industrial action by any group especially nurses. · That effort should be made towards a unified university based education for nurses which will automatically give birth to a unified scheme of service. · That the scheme of service for nurses should follow the examples of other professionals in the health sector who also have both hospital based and university based members. · That an abridged BNSC program should be developed by the council in conjunction with other stakeholder to ensure a systematic absorption of nurses with more than 10 years of practicing experience. · That the structure of nursing education, practice and career progression should be overhaul to reflect continuous learning from one step to another so that the level of educational accomplishment with wealth of “evidenced based knowledge and updated experience” can increase along the chain of command. · That NANNM should support the NMCN in making progressive policies and recommendations that is in line with global best practice that can ensure a world class nursing practice in Nigeria. · That the Federal Government should grant RN holders study leaves with pay as incentive to speed up resolution of this loaming crisis. · That the federal Government should through her resources and her partnership with local and international organization, sponsor nurses for postgraduate programs to fill the human resources gap in nursing education further make available the man power for the absorption of schools of nursing into the university system. · That NANNM , NMCN and all other relevant stakeholder should as a matter of urgency, recover all nursing procedures such as deliveries, intravenous medications, catheterization etc. which we shamelessly relinquished to house officers at the teaching hospitals to further reduce our relevant in the system . No successful profession has ever separated educational advancement with experience. Experience becomes outdated without advanced research based education. Nursing must marry the two just as other profession did for the overall interest of the citizenry which we vowed to serve diligently and for the growth of the profession in line with global best practice. We appeal to NANNM to withdraw any intention to proceed on strike. Let us pursue policies that will motivate all nurses to receive the education and exposure necessary for improving the quality of healthcare delivery in Nigeria and to be united in one purpose
Posted on: Sun, 14 Sep 2014 21:14:05 +0000