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Professionalism In Nursing: How Far Are We In Nigeria? By Taiwo Omotayo Alabi RN, BNSc, (MSc in view)
Date Posted: 13/Oct/2017
Introduction
Thinking of a professional can conjure up images of an individual well dressed with a briefcase. A person’s dress code is very important, nevertheless, right attitude, good knowledge and positive behavior all count in being a professional. Nursing is not simply a collection of specific skills, and the nurse is not simply a person trained to perform specific tasks. Nursing is a profession. Professionalism in nursing is evolving from autonomy to accountability, from expert opinion to evidence-based practice, from self-interest to teamwork and shared responsibility(Koppel, 2010). The status of nursing as a profession is important because it reflects the value society places on the work of nurses and the centrality of this work to the good of the society. Being a professional nurse means adhering to the code: standards of conduct, performance and ethics for nurses and midwives.  The code is the foundation of good nursing and midwifery practice and is a key tool in safeguarding the health and wellbeing of the public (Nicola, 2011)
 
Nursing as a profession
For many years, other scientists considered nursing as a semi-professional career (Adams, 2012). At that time some factors such as slow formation of scientific fundamentals of nursing, disagreement in educational requirements for nurses, lack of academic education at the entry level of nursing courses and lack of theory and theory-based research were considered as barriers for nursing as a profession(Etzioni, 2001).
 
Gradually, development of education standards and professional certificates led nursing move to professional status (Adams, 2011). Having stronger powerful basis for theory and practice and professional education in nursing discipline brought about the social cognition. Social understanding about nursing made the society consider nurses as cost-benefit health care providers and powerful independent decision makers. Some characteristics of nursing professionalism include accountability, autonomy, advanced education, adherence to code of ethics, service to public, group identity, and research to further knowledge base.In nursing professionalization, ‘the profession self’ that is self-identification that one is a professional is one of the most important attitudinal elements.Nursing as a profession embodies many values and attributes which should be inherent in those who pursue nursing career. These values include honesty, responsibility, altruism, belief in human dignity, equality of all patients and the desire to prevent and alleviate suffering. Professionalism in nursing will be judged based on individual personal behaviors and these values.
Components of Nursing Professionalism
1. Knowledge; A sound body of knowledge that is theoretical, practical and clinicalis of great importance. Nursing knowledge is the means by which the whole purpose of caring for patient is achieved because it underpins what is done.Knowledge is central to the issue of professional accountability, it is a vital component. In recent years, nurses have needed a considerable amount of new knowledge to provide the appropriate level of care for patients. Acquiring this knowledge necessitates the need for nurses to see beyond the RN qualification and desire more education and also get involve in research. Continued education in nursing is the basis for improved professional knowledge and is a vital component to providing our patients the best possible care.Once qualified, nurses have a duty to continue their education so that they can remain aware of and keep up to date with medical advancements and new researches. 
 
2. Skills; it is not enough to possess knowledge,ability to skillfully apply the acquired knowledge to improve patient’s care is the heart of professionalism in nursing. It is not enough to possess masters or PhD in nursing without translating the knowledge acquired to any meaningful improvement in nursing practice. Good communication skill, organization skill, listening, interviewing, questioning skills etc are very important in the delivery of professional nursing care.  
 
3. Right attitude; Attitude in nursing is everything. Personal issues need to be left at home and not taken into the work area. There are always going to be times when we face issues in our lives that threaten our positive outlook, it is helpful not to transfer aggression to our patients. Positive attitude demonstrated by a professional nurse increases patientstrust.
 
4. Accountability;  this has to do with demonstrating an ethos of being answerable for all actions whether to service users, employers, standard-setting/regulatory bodies or oneself. It involves understanding the meaning of self-regulation and its implications for practice, using legislation, standards of practice and a code of ethics to clarify one's scope of practice.
 
5. Autonomy; this has to do with working independently and exercising decision-making within one's appropriate scope of practice.Autonomy is the freedom and the authority to act independently. It implies control over one’s practice, and it applies to both decisions and actions.Autonomy acts not only as a buffer against stress but also acts as a means to empower and strengthen the sense professionalism in nursing.
 
6. Appearance; There is no way around the fact that people judge one by personal appearance. Clean scrubs, neat hair, clean shoes and a well groomed look makes the statement that the nurse care about himself or herself as a person and therefore have the capacity to care about others. People that look sloppy may be perceived by as unorganized, lazy, and uncaring. A little attention to how one looks goes a long way to display one’s professionalism
 
7. Values and a sense of personal responsibility; are considered core to nursing professionalism. Empathy is not the same as sympathy, and being able to put oneself in the patient’s position can be a hugely impactful reflective approach. Regular reflection on nursing practice is recognized as a way of developing and improving performance and nurses who regularly review and adapt their practice accordingly are more likely to be receptive to new developments in their field. They are also more likely to be responsive to feedback and more willing to adapt and change their practices and behaviors. 
 
Nursing Professionalism in Nigeria and way forward
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.The Nursing and Midwifery Council of Nigeria subscribes to the fact that Nursing is an inalienable right of citizens and as such the professional Nurse has the responsibilities of assisting them to attain the optimal level of health. The professional nurse has a responsibility to the health care consumer, nursing profession, nursing practice, to professional colleagues, to the public, and global health organizations.
 
How do we explain the increase output of illegal nurses in Nigeria? 
Lately there was a video on the media of nurses being trained by an organization not recognized by the nursing and midwifery council of Nigeria. That is just one out of several other organizations training nurses not recognized by the nursing body. Some private hospitals also specialize in training nurses, they call themselves ‘trainee nurses’, they graduate and call themselves nurses. When you get to some private hospitals, who you find are these acclaimed nurses with quack practices. There has to be a stop to this. I suggest Nursing and Midwifery Council of Nigeria take a close look into this and design a penalty for any doctor,nurse or organization found in the act of training nurses illegally. We cannot talk about professionalism in nursing in Nigeria if this continues. Individuals interested in studying nursing should apply to institutions approved for the training.
 
I observed nurses are beginning to see the need to further their education. Interestingly, we now have a fair number of nurses with degree, MSc and even PhD in nursing practice but the questions are; has that translated to improvement in nursing practice? Is our reason for further education not just based on ego and promotion? It is not only about acquiring qualifications but applying the knowledge acquired to better our practice that is professionalism. Some nurses feel they have gotten to the peak by just acquiring the registered nurse certificate hence I implore schools of nursing as well as departmentsof nursing to make their students see the need to desire more education and emphasize that education in nursing should not stop at  just been a registered nurse.Nurses should develop the spirit of inquiry and desire to explore new knowledge as well as been innovative.
 
Unprofessional attitude of some nurses are beyond imagination.At this point in time, we should not have nurses that scream at patients or even patient relatives. The Ethics and Disciplinary Committee of the Nursing Council should visit hospitals with a view of correcting or apprehending culprits of unethical and inhumane nursing practice. Some nurses are less caring, less committed, less concerned and non-dedicated to meeting the needs of clients.They are resistant to change, professional development and advancement. Some nurses tend to hold onto previous knowledge and skills without making efforts to improve and maintain new skills. Professionalization should be included in the professional training/curriculum program in nursing institutions.
 
Media especially Nollywood view of nurses needs to be greatly reviewed. I watch American movies and I so much appreciate the way the nurses are been projected in their movies but when it comes to Nigeria movies, they project nurses as individuals who cannot take any decision on their own but only carry case notes while following doctors, who cannot even regulate intravenous fluids until they call a doctor, as lazy individuals whose major duty is to gossipetc. It can be quite annoying sometimes when we watch these movies and see nursing profession been downgraded. Sometimes I wonder how the public who watch these movies view nursing.This media view of nursing/nurses need to changed. I suggest a committee be set up by the nursing and midwifery council of Nigeria whose sole responsibility will be to go through any movie featuring nurses by Nollywood prior to its release in order to ensure appropriate projection of nurses/ nursing.
 
From observation, the state of nursing professionalism in Nigeria is not encouraging as adherence to code of ethics is still poor. Self-identification of being a professional is still not evident in some nurses. A colleague of mine shared an experience of what happened during a consultant’s ward round where she humbly called the attention of a general surgeon on the need to place a patient on a certain medication. The surgeon appreciated her suggestion and explained it was an over sight on his part but her fellow professional colleagues ‘nurses’ were surprised and question her action. They were timid and felt it was rude to have such discussion with a consultant. The interesting response she gave them was ‘the consultant is a professional, I am a professional and the patient is not just his patient but our patient. Nurses should be bold, we should know what is expected of us, we should know when we need to speak out, we should know our limit, and be ready to advocate for our patients when necessary. 
 
Conclusion
Nursing is not simply a collection of specific skills, and the nurse is not simply a person trained to perform specific tasks. Nursing is a profession. A nurse is said to be a professional when he/she is conscientious in actions, knowledgeable in the subject, and responsible to self and others. Professional standards ensure that the highest level of quality nursing care is promoted. Excellent nursing practice is a reflection of sound ethical standards. Knowledge is a powerful tool in healthcare and a well-educated nurse can be the difference between a patient’s life and death A nurse must be able to think critically, solve problems, and find the best solution for client’s needs to assist clients in maintaining, regaining, or improving their health. Nursingas a trusted profession in the world, has so much to give. Hence, it is important for you and Ito display professionalism in whatsoever field we find ourselves. Nigeria nurses, lets show the world how wonderful we are by always putting our best foot forward not only for ourselves, but for all of us in this wonderful profession.
 
By Taiwo Omotayo Alabi RN, BNSc, (MSc in view)
Bowen University Teaching Hospital, Ogbomosho, Oyo State
Email: taiwoomotayoalabi@gmail.com
 
References
Koppel I, Reeves S, 2010.  A best evidence systematic review of interprofessional education: BEME guide number nine. Medical Teacher, 9:735–751.
Nicola R, 2011. Being a professional nurse: what it means. Nursing Times, Emap publishing Limited company.
Adam D, Miller B. 2012. Professionalism in Nursing: behavior of nursepractitioners J prof Nurs. 17:203-10
Etzioni, A. 2001. The semi professions and their organizations. New York: Mcmillian

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