On April 18, 2020 as the minister of health addressed the country about the situation of COVID 19, a journalist asked a legitimate question, “Where are the nurses in all this?”
While it did not attract the due attention from the panellists, it’s prudent to examine the spirit behind the question. A simple explanation is, as a patient (and I have been one before), you are more likely to believe the information given to you by the health worker who gives you direct care than any other person because it comes with real practical context.
Unfortunately, one of the members tried to “thoughtlessly” argue that it’s because they came as a scientific team, which alludes to mean that nurses are not scientists, therefore let’s first settle this.
Nursing profession in Uganda has various entry points depending on the level of education. They include enrolled nurses who have a certificate in nursing, registered nurses with a diploma in nursing and registered BSN nurses with a Bachelor of Science in Nursing.
I will emphasize on degree program to match the degree program that makes one to be a doctor.
Bachelor of Science in Nursing as the nomenclature suggests, is a science. It is four year course of intense training at university, followed by a one year supervised practical training (internship) in a hospital setting under the ministry of health.
This makes it 5years of training before one can be registered by the Uganda Nurses and Midwives Council (UNMC) to practice at this level. It should be noted that this degree shares a lot (more than 12 basic science course units) in common with a bachelor of medicine and surgery (MBChB) in terms of course content and depth, and that’s why universities with the two programs often combine the two classes for 2-3 academic years. Therefore with all due respect nursing is a scientific profession, if MBChB is also science.
After the basic degree level, nurses in Uganda face a major challenge of nursing-specific post-graduate education. This is largely because the government is adamantly unaware of the impact of having specialized nurse programs.
This frustrates many and end up changing professions or moving out of the country, where more chances for advancement is guaranteed. Currently, there are only two nurse-specific post-graduate programs in Uganda; master of critical care nursing and master of midwifery. Even with these few, they are not treated as the other medical post-graduate courses that are given a stipend for their contribution in providing healthcare while learning!!
That aside, in the annual health sector performance report 2018/19, out of the 26 educational programs considered by ministry of health, only two were nurse-specific (diploma in paediatrics and bachelor of midwifery), of which all were in support of horizontal growth. This exactly depicts the government’s ignorance of the importance of advanced education of this cadre in improving the quality of health care.
According to the ministry of health, nursing care is largely made of enrolled nurses (about 60%) followed by registered diploma nurses. Less than 5% are BSN nurses or above, and who most times occupy managerial positions, especially in the ministry and Assistant District health officer position.
A recent Ugandan published study reports that BSN nurses are supposed to perform a comprehensive health assessment, use nursing theories, utilize a broad knowledge base to inform care plans, conduct research to provide evidence to health problems, and are to report and make suggestions on patients’ conditions.
The comprehensive performance of these roles is rare among lower cadre nurses because of the content depth of the training curriculum, which places less emphasis on knowledge and attitude components.
Despite the fact that the UNMC has registered over 2000 BSN registered nurses, government has been slow in recruiting this cadre in the public service, and the schemes of service which included BSN nurses was just approved last year (2019) amidst strikes from other health care workers. The schemes also provided for consultant nurses, who are yet to be recruited in public service
Link between education and practice
Nurses prepared at degree level have been shown to improve the quality of health care, especially in developed countries. This is so because they have taken a keen interest in supporting nursing education and practice through various policy changes. Quality health care is an essential human right.
In the USA, and other developed countries, where many of our “big wings” go for medical care, you are more likely to access an advanced practitioner registered nurse compared to a physician. These nurses occupy most care positions and give an equally better quality of care according to various studies.
For starters, the nursing cadre provides more than 80% of the health care needs of the population in Uganda and most of sub-Saharan Africa. Besides, nurses spend more time with patients and implement most care plans than any other health care professional in hospitals.
Therefore, if there are any efforts to improve quality of care, they should be directed to improve the quality of nursing care. Nursing education plays an important role in enhancing nurses’ confidence to provide quality health care.
Therefore, if the equality in vulnerability that has been witnessed during this COVID 19 situation is to go by, improving the quality of healthcare for all is cardinal. This comes with taking bold steps to recruit a competent, trained, knowledgeable and skilled human resource, and with this context strengthening the nursing profession, not only in providing care but also in designing methodologies, policies, community mobilization and research!!!!!!!!
Gladly, the COVID 19 task force was structured to included health systems policy experts and I hope they will acknowledge the importance of closing out this policy gap.
About Author: Muteebwa Laban (RN, BSN) is a Member of the Association of Graduate Nurses and Midwives of Uganda, and Member Uganda society for health scientists.