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Higher Education in Nursing; Implications to Nursing Profession By Nurse Ojunekwu Felix RN, A&E
Date Posted: 18/Jan/2019
Being an Online Lecture presented by Nurse Ojunekwu Felix  to SON Agbor, Alumni Forum, on January 13th, 2019. 
 
PROLOGUE​: In today’s healthcare field, nurses are in higher demand than ever before. With the constant increase in population, the baby boom generation growing older, and the national emphasis on public health care, nursing makes for a stable, well-paying career. But more and more hospitals and health care settings are requiring their nurses to have an RN to BSN degree, and the competencies obtained from nursing degree program can help students ensure they won’t be turned away from employment because they lack the required nursing qualifications. According to a January 2014 study published by the American Association of Colleges of Nursing, the rate of student enrollment in RN to BSN programs jumped more than 12 percent from 2013 to 2014. Nursing is in high demand among students, as well as patients, and one main reason for this increase is the recognition of the role higher education plays in improving patient safety. In practice, higher education can make the difference in patient safety in many situations, including hands-on administration of medication and treatments, proficiency with new technologies, the ability to glean important clues from day-to-day contact with patients, and accurately and effectively communicating care instructions to families. Nurse staffing research is also on the rise as the healthcare industry looks for ways to save more lives while reducing costs. In fact, the National Institutes of Health found that for every 10% increase in nurses with bachelor degrees, the likelihood of patient mortality fell by 7% in hospital settings. Studies like this show that becoming a registered nurse isn’t always enough thus the need for the promotion of higher education in nursing with its long term impact to nursing profession.  
  
THE CONCEPTS NURSING 
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. a clean,well-ventilated, and quiet environment essential for recovery. Often considered the first nurse theorist, she raised the status of nursing through education. Thus,  Nurses were no longer untrained housekeepers but people ​educated in the care of the sick. While the views and submission of FNG serves as the basis for nursing, the definition by Virginia Henderson gave greater clue, encompassing in task, knowledge and holistic in responsibility: "The unique function of the nurse is to assist the individual,sick or well, in the performance of those activities contributing to health or its recovery(or to peaceful death) that he would perform unaided if he had the necessary strength, will,or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible"(Henderson,1966). The nursing of the past/present  has been shaped by quality education thus what the future holds can better be imagined through higher education. Therefore, keep improving because it can only get better!!!. 
 
NURSING EDUCATION Nursing education refers to formal learning and training in the science of nursing . This includes the functions and duties in the physical care of patients, and a combination of different disciplines that both accelerate the patient's return to health and help maintain it. This is done in either the traditional hospital based schools of Nursing, increasing department of Nursing in the universities or expanding online training. Whichever form it comes, theories and practical remains the bedrock of the curriculum. 
 
NURSING PROFESSION The nursing profession is one that is grounded in theories, sciences, math, biology, and anatomy and physiology. Nursing is a discipline that focuses on alleviating pain and suffering through protection, promoting health, wellness, and prevention of illness and injury. The nursing profession is an advocacy in the care of individuals, families, communities, and populations. The profession advocates education, prevention, collaboration, coordination of care, and adheres to a high standard of care. Today, the nursing profession transformation is a vision of Florence Nightingale’s showing in the hospital designs, evidence-based medical care, and holistic patient centered care. It is unique and different from others because nursing care is encompassing, integrating and more inclusive. It consists of registered professional nurses who work in various setting beyond the hospital scope. 
 
THE FEUD ON NURSING EDUCATION Nurses may be differentiated from other health care providers by their approach to patient care , training , and scope of practice . Nurses practice in many specialties with differing levels of prescription authority. ​Many nurses provide care within the ordering scope of physicians , 
and this traditional role has shaped the public image of nurses as care providers. However, nurse practitioners are permitted by most jurisdictions to practice independently in a variety of settings. In the postwar period, nurses education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.  This is where the dilemma among the stereotyped nurses with traditional nursing role quipped “is higher education necessary, afterall, a nurse is a nurse?”. Unfortunately, our profession and nation is reminisce with majority. 
 
NURSING HIGHER EDUCATION: NIGERIA PERSPECTIVE 
Meaning​: Higher education in NURSING can be viewed as the acquisition of the art and science of Nursing rudiments in the university setting. The outcome of such education include: Bachelor degree; Masters Degree; Postgraduate diploma in NURSING education; Ph.D. While the clamour for degree as minimum entry to nursing in Nigeria increases, it suffices to say that many nation has long gone above baccalaureate achievement as opined from an extract in Ameritech College of Healthcare (2015) 
 
“Nurses with an RN associate degree are capable of performing all typical nursing duties in their hospital or clinic, but the Future of Nursing Report acknowledges that won’t be enough as healthcare needs in the country change. In addition to emphasizing RN-BSN degree completion, the IOM also concentrated on higher education, in particular doctorate degrees in nursing fields. By 2020, the IOM recommended that the number of nurses with a doctorate degree double from the count of 28,369 in 2010”. In furtherance from the FUTURE OF NURSES REPORT by Institute of Medicine (IOM) as posited by Ameritech “... that the nursing profession must generate leaders. All nurses must begin to think of themselves as important to patient care as any surgeon or physician. A leadership mindset, which a BSN education can help instill, improves teamwork, reduces medical errors, and increases job satisfaction among nurses.” If this America’s nurses vision reality is anything to envision, Nigerian Nurses must roll out plans above the RN entry point to Professorship clinicians that is in a gross dearth today!.  
 
HISTORICAL PERSPECTIVE OF NURSING EDUCATION IN NIGERIA
Generally, nursing education in Nigeria has gone through series of phases and still undergoing same. It has witnessed both precolonial and post colonial era.  According to Okorie, 2004, higher nursing education symbolically refers to nursing education programme which is beyond the level of a nurse generalist preparation. 
 
HOSPITAL BASED: Entails schools of Nursing/midwifery training and post basic nursing specialist training. 
UNIVERSITY BASED: This include all the generic and postgraduate nursing programmes.  Nursing at the university level took off in 1965 at Department of Nursing, University of Ibadan with the purpose of preparing registered nurse as professional nurse tutors and administrators to meet the needs of rapidly expanding health services in Nigeria. 1968 marked the beginning of another era in nursing in Nigeria when the first set of degree holders in nursing graduated from the university of Ibadan. In 1981, nursing was awarded the full- fledged profession by the industrial Arbitration panel, further pressure were mounted towards ensuring movement of hospital based nursing education to university based nursing education. 
 
CLASSIFICATION OF HIGHER EDUCATION TRAINING IN NURSING(Nigeria perspective) 
At the moment, this is include: 
-Conventional University programmes: Graduate and post graduate. 
-Online/Distance Learning University.  
-Open University System: This is pseudo-conventional and pseudo-online educational system.  
-Proposed Polytechnic transition for HND Nursing. While the above may be relatively peculiar to Nigeria system, in other climes, a lot of diversified educational programmes are  available for nurses to advance in their choosing career pathway.  
 
FACTORS AFFECTING HIGHER EDUCATION TRANSITION IN NURSING: THE NIGERIA PRISMS.
While the campaign for higher education is receiving greater applause and accolades, it is needless to say that such noble course has faced series of hurdles to attain.  According to extract obtained from Obot Bernaddette in his 2004 Seminar Paper, the following were some of the listed problems facing nursing education  
 1) Limited Department of Nursing in the Universities​: According to NMCN last accreditation update as regard schools that have the capacity to run nursing programmes, it is only about 22 departments have received NMCN approval with maximum student capacity of 50 in few schools. Thus the reason for the high competitiveness of the admission for both generic and direct entry. 
 2)Limited areas of specialization​: Especially at Masters level where only six specialties received the endorsement of NMCN: Maternal & Child; Medical/Surgical; Mental Health; Community Health; Nursing Education and Nursing Administration. This limitation has in no doubt compelled many to seek abode in another field.  3)Non-sponsorship of higher education opportunities. ​The working class nurses with higher education ambition have their bitter experiences with many dreams shattered. 4)Perceived as a Low Status Profession by the Society​. Much of what nurses do is considered dirty and unmentionable in a polite  society. Nursing work involves dealing with faeces, vomitus, urine, blood, sputum etc. As such the society still see nursing as doing menial 
work which does not need  academic study. With this, some many nurses do further in this career. 
 5)Feminization of Nursing Profession​: Females formed majority of Nursing workforce either in the academic, clinical, administration or others. With societal pressure and demand  on women, many female nurses with great ambition for higher education in nursing has been shaped out living them with nursing as a means to an end.  
 6)Policies and laws​. The civil service rules never consider nursing clinical proficiency and education thus the embargo and frustration in getting approval is a bane to higher education. More so, there is no prospective law other than promotional cap that puts demand on the need to acquire higher education for career growth and development. The lawmakers are not exploring laws in nursing as a whole despite the speed of technology, autonomy and franchise in other climes. 
 7)Cost of Education​. NURSING education is one of the most expensive programme to acquire globally. With dwindling financial fortune, many do not see the need to waste such unavailable money. 
 8) Poor research​: With limited paper works, nursing planners, administrators, government and the society do not see the need to equip the nurses that will cater for them. Available research are not being utilized by government, individuals and organizations 
 9)Poor Remuneration​: Being one of the least paid in the health sector despite herculean task, burden and injuries, many do not see the need to advance a career in nursing.  
 10) Low/poor funding​: Their is a dearth of scholarship for nursing in Nigeria. Close to zero allocation to departments of Nursing in the universities and even the philanthropist do not see the need to invest on the heartbeat of the health sector's education.  
 
HIGHER EDUCATION IN NURSING: IMPLICATIONS TO NURSING PROFESSION. 
1)Benefits of Higher Education​. 
-Quality Nursing Care: Through critical thinking and evidence based practice, the recipient of our care gets the best. 
-Job satisfaction/opportunities: Endless opportunities awaits the nurse with higher education qualification. Thus giving our patients the very 
-Better remuneration for services done. More academic certification increases ones financial fortune as pay scale differs. 
-Academic peer review: Gives room for competitiveness among the researchers, clinicians, and academicians from various institutions. 
-Improved knowledge bank: With increased knowledge, tasks are done with more confidence and autonomy. 
-Equipped Next Generation: Cross pollination of ideas from one generation to another will be easier as the room for gaps will be minimized. 
-Technological advancement: With telenursing gaining more grounds, higher education is the closest shuttle to it.
-Improved manpower: It helps to curb the growing shortage of skilled nurses. 
-Commendable health indexes: Nations with increased number of advanced nurse practitioners with high degree of autonomy has been proven to have best global health indexes. 
-Leadership and administration: Advanced nursing certification empowers his holder to be available and accessible for leadership. 
 
2)THE SOCIETY/CONSUMERS​: Despite appreciation of the importance of higher education in Nursing, the gains made by the recipient of this noble care are relatively insufficient. The gulf between the expectations of the society and Nursing care seems to be wider because the theory-practice gap is yet to be breached. The caregivers are not given enough opportunity to explore the better ways to alleviate the sufferings of their patient, promote health, prevent sickness, and Nursing the dying to a peaceful death!!!.  
 
3)THE HEALTH SECTOR​: The growing monopolization of the health sector and the increasing sidelining of Nursing education/profession by the administrator had spell down for our health care practices. Our global health indexes shows that Nigeria have more endemic cases, horrific maternal mortality, epidemic morbidity, decrease life expectancy; poor emergency response system, growing infant mortality, expanding genetic health disorders etc. This is discouraging considering the lives that are daily lost.  With decreasing educational funding, nursing autonomy will continue to reduce and care response attitude will deteriorate and the patient and consumer will lose out.  
 
4)THE SYSTEM (GOVERNMENT, POLICY): The government of Nigeria has not done enough to accelerate Nursing Education towards its needful transition with University education being the least benchmark. The urgent need to empower nurse educators through globalized cum technological training has not received the needed attention as individual nurses struggle through the ladder via self-sponsorship: this feat can only be attained by minority. It is appalling to say that our tutorship manpower with Ph.D & Professor in Nursing is less than 200 nationwide. 
 
NUC/NMCN many at times are helpless in salvaging the situation due to underfunding. Our civil service laws has remained a big constraint to the dream of ambitious nurses: the law is inconsistent with the trending need of working class nurses!!!. The unabating brain-drain where 9 of 10 nurses are dreaming of leaving Nigeria for a greener pasture elsewhere calls for a declaration of state of  emergency in other to save nursing profession from the brinks of extinction. Our best keep leaving us. Our think-tanks are no more comfortable with the stagnated system that do not appreciate quality and higher education. 
 
5) LEADERSHIP AND DECISION MAKING​: If the maxim “Leaders are readers” is anything to come by, the gross exclusion of nurses from policy and decision making medium, makes it truer. For us to make more impact in policy making, take the centre stage in the health sector and society at large, we must then be conscious of “Readers will be Leaders someday” as we make a drift into the aqua of higher nursing education. We must create the future we want through higher education beyond the stereotypism of “physician assistant” adulation by the folktaled society. Our definition of self will redefine the perception of the society towards nursing.  
 
WAY FORWARD/RECOMMENDATIONS 
No doubt, concerted efforts has been made by our heroes past, while many are still unrelenting at getting nursing to work for the good of all.  The following germane submission are worthy of note according to Obot Bernadette (2004) in his Seminar paper:  -More universities in Nigeria should be encouraged and assisted tb start  nursing degree programmes,  - There should be affiliation of all schools of nursing to the universities. Kudos to Benue and Ondo State for setting the pace. Other states should adopt their model. 
- The government, private entities including companies, individuals and Alumni  organizations should help in providing funds for sponsorship of nurses, and building of libraries.  
- Nursing leaders and the universities should make provision for wider areas of  specialization for nurses. In order to help attain any level they intend to in any  area of specialty of their interest.  
-More opportunity for university education especially on part-time basis should  be explored and developed for nurses so that prospective professionals in  nursing will not be lost to other disciplines.  
-All nursing services department should implement as a matter of urgency  nursing process, nursing research and nursing audit, which are vital tools for a  qualitative, nursing care.  
- More men should be encouraged by the nursing leaders to change their attitudes  towards nursing profession to join the profession through media campaign campaign. Also career counseling should be instituted at all levels of the  educational system by nurses themselves. Regular education of the populace on the role of the nurse on journals, television, radio, jingles etc should be encouraged.  
-The National Association of Nigeria Nurses and Midwives (NANNM) should-be the embodiment of the resources, aspirations and professional  actualization of Nigerian nurse. She should be the veritable change agent  in the direction currently indicated in nursing education.  
-Nurses leaders should be involved in policy making bodies in order to  formulate policies that will effect a change in the nursing profession.  
-Cohesiveness of all registered nurses towards the implementation of the  new career structure in Nigeria.  
-Government should encourage graduate nurses to specialize in nursing  education by giving some incentives. 
-Administrators should be more liberal on working nurses with the ambition to further their study. Their education will significantly affect the job on the long run.  
 
CONCLUSION​: 
The place of higher education in nursing profession cannot be overemphasized in today's ever growing and technologically drifting health care system. The need to be equip above the possession of RN is gaining more ground while seeking diversification for the yet to be explored fields and opportunities has generated more concern. According to Dr Tedros, WHO DG during the 2019 Pakistani Nursing and Midwifery Summit “Nurses and midwives are not doctor's assistants. They are health professional in their own right, with specific skills and training that enable them to perform a wide variety of essential roles” shows the increasing greater nursing responsibility that can only be attained through quality higher nursing education. Therefore, adequate planning, implementation and  evaluation, much can be achieve. We must all follow the train and trend, otherwise, tomorrow may not have a place for us. 
 
References 
articlesng.com/nursing-education-nigeria 
https://www.nursingtimes.net/roles/nurse-educators/making-a-difference-the-implications-for-nur se-education/206457.article 
https://www.nmcn.gov.ng/apschool.html 
https://online.stmary.edu/rn-bsn/resources/higher-nursing-education-impact-on-patient-safety​.  
https://mobile.twitter.com/WHO/status/1082673160699 
https://www.ameritech.edu/blog/what-the-future-of-nursing-report-says-about-the-bsn/ 
Obot Bernadette (2004), Term Paper: UNIVERSITY NURSING EDUCATION: PROBLEMS AND PROSPECTS. 
 
About the Author:
Nurse Ojunekwu Felix N (OFN) Accident & Emergency Nurse Specialist Delta State University Teaching Hospital, Oghara. Delta State. 

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