ACHL Collaborates with the Nursing and Midwifery Council and the Federal Minsitry of Health to Organise a Masterclass on Nursing Leadership During The Hospital Fair and Exhibition at Nicon Luxury Hotel on the 22nd October, 2014

Background

The Federal Ministry of Health in collaboration with its partners and key stakeholders in healthcare organized a Hospital Fair in Abuja on the 21-13 October 2014. The main objective of the fair was to showcase the giant strides made by the country in health care delivery and create awareness about the gamut of services available to the citizenry. Current research indicates many Nigerians travel abroad all the time for medical treatments and medical checkups on the perception that there are no competent medical facilities and competent medical personnel in Nigeria to provide safe and effective services of acceptable quality. It is estimated that the country loses over $500 million annually arising from costs accruable from its citizens seeking health care services abroad. It has been observed that most of these services are available in the country and provided by competent health personnel trained in some of the best healthcare institutions in Nigeria and abroad. The Hospital Fair was, therefore, an opportunity to correct this negative impression and the ignorance about what exists in the system and appreciate the current challenges and opportunities. It sought to kick-start medical tourism in Nigeria so that other countries can begin to consider coming to Nigeria for medical services.

As a key activity, during the Fair, the Nursing and Midwifery Council of Nigeria organized a Master Class on Nursing Leadership for nurses in the public and private sectors. Dr. Godwin Asuquo of the Africa Centre for Health Leadership was engaged by the Council to develop and implement the program. The MasterClass was an opportunity for nurses to brainstorm the issues, challenges, opportunities, and threats to their professions and share experiences and best practices.

With the theme” Strengthening Nursing Leadership for Improved Quality of Care,” the master class was a reorientation on modern leadership principles and practices to make a difference in a rapidly changing and sophisticated society.

The program was designed to provide emerging and evolving nursing leaders with the skills, knowledge, confidence, and relationships needed to be effective leaders in a complex, competitive and demanding healthcare environment. The health care environment in Nigeria is very challenging and characterized by inadequate infrastructure, drugs, supplies, consumables and working tools, inadequate human resources, overburdened and poorly motivated health workers. Client satisfaction with services provided has continued to be low in facilities where services are available.  Access to routine services is compromised by frequent stock-outs of essential drugs and supplies, high transportation cost, geographical, socio-cultural and religious issues amongst others. Also, competition among professionals in the industry for superiority and dominance has seriously relegated and compromised patient’s issues and concerns thus reducing client’s satisfaction and quality of care.

Goal of the Nursing MasterClass

The main goal of this program was to build the capacity of Nurses to become effective leaders and drivers of change who will challenge the status quo and make a difference in the health sector.

Specific Objectives:

The following objectives were achieved:

• Develop the skills, knowledge, and attitudes of nurses on a wide range of core leadership competencies essential for implementing client-entered and result-based nursing care
• Explore contemporary health care issues and challenges in the country and at institutional levels and build knowledge base on the key issues and on how nurses can contribute to addressing them.
• Share experiences and best practices in nursing leadership and management and agree on the way forward in enhancing effective patient care and interpersonal relationships among nursing and medical colleagues.
• Acquire team building, collaboration and partnership to function effectively in the interdisciplinary health care team members in prioritizing and coordinating quality/cost-effective healthcare.
• Appreciate the role of inquiry and research as a means to enhance knowledge base, facilitate change, and improve quality of care.
• Demonstrate professional accountability for effective leadership within nursing practice and for the advancement of the profession

Attendance

Nurses from secondary and tertiary health institutions from federal and states’ levels including the FCT were in attendance. These included nurse administrators, various clinical nurse specialists, nurse educators, public health nurses, representatives of professional nursing associations.

Opening

The Program commenced with a brief opening ceremony with the Director of Nursing Services at the Federal Ministry of health making and inspiring opening statement in which she updated participants on current developments in nursing and enjoined them to take their work seriously. Speaking in the same vein, the representative of the Nursing and Midwifery Council, Mr. Udontre, charged the nurses to effectively utilize the learning opportunity to improve themselves and to contribute in a more positive way to the nursing profession.

Technical Presentations

The following presentations were given during the Masterclass under the facilitation of Dr. Godwin Asuquo:

• Understanding Leadership and the relevance of the Nursing Profession in the Era of National Transformation and Change- Dr. Godwin Asuquo of Africa Centre for Health Leadership
• Health Care Leadership and Management Principles for Universal Health Coverage- Leadership Core Competencies- Dr. Godwin Asuquoof Africa Centre for Health Leadership
• Managing for Results, Stress Management, and Making a Difference-
• Nursing Leadership in Action: The DELSUTH Experience- Helen Mbornu, Head of Nursing, Delta State University Teaching Hospital
• Motivation, Team Building, and Collaboration, Managing Conflicts- RaphAyua of Raphadom Consult, Abuja

The presentations were very interactive; while Dr. Asuquo’s presentations focused on enabling nurses to assess their current status and helped them to generate ideas about how the profession can improve its status, Helen Mbornu’s presentation was a practical experience-sharing session on best practices in nursing Leadership using DELSUTH as a case study. Raph’s presentation provided titbits to nurses on how they can make the work environment motivating and how they can build effective teams and partnerships.

Discussion, issues generated and Recommendations

1. Job Description

It was observed most institutions in the country do not provide nurses with written job descriptions. It was agreed the Federal Ministry of Health and the Nursing Council should take steps to ensure that job every public and private institution provide nurses with written job descriptions. That there should be a regular review of job description by NMCN to accommodate the new trends of Nursing Care and practice. Participants also called for daily protocol which should be established, followed and supervised and monitored

2. Evaluation of Nurses Work:

It was observed that because most nurses do not have job descriptions, they do not set proper targets in APER forms for a valid assessment of their performances. Thus, assessment of nurses by their supervisors is very subjective. It was recommended that the Council, FMOH, and all institutions should ensure that performance evaluation of nurses is very objective through proper goal and target-setting and results-based management

2. Attitude of Nurses:

It was also recognized that nurses’ attitude is perceived to be generally very negative in the country. The Nursing Council and health care institutions are enjoined to address this through a combination of on the job training, leadership and team building programs and close monitoring, disciplinary actions and supervision. The need for all nurses to recognize that this is a major problem and take proactive steps to change their attitude was also stressed.

2. Discriminatory policies on Promotion for Nurses with Nursing Degrees and those with related degrees.

Nurses complained that the prevalent policy where only nurses with Nursing degrees were favoured in promotion while those with related degrees e.g Health Education, Social Sciences etc. cannot be promoted to managerial positions was discriminatory and not justifiable. It was observed that the opportunity for degrees in nursing in Nigeria was still limited as few universities offer degrees in nursing. Since the process of obtaining admission and release by employers to go for nursing degrees was very cumbersome, nurses who can access degree programs in related areas in nursing should be encouraged and accorded proper recognition since they already have nursing qualifications before proceeding on these courses. NMCN should recognize B.Sc degrees of related courses provided that these Nurses – have RN as a basic qualification. They should be allowed to be promoted to reach the peak in their career.

5. The issue of quackery and hiring of nurse especially by private clinics on very low pay was also discussed. Many participants believed that it debases the profession and casualizes nursing workforce. The nursing association was called upon to work in collaboration with the Council to ensure that the minimum wage for nurse applies both at the public and private sectors.
6. Nursing Curriculum Review

Participants suggested that the current basic nursing curriculum should be reviewed to incorporate contemporary nursing issues, developments in ICT and current leadership and management concepts.

7. It was also suggested that there should be a deliberate program implemented by the Council on the occupational safety of nurses. For instance, the paucity of basic equipment and supplies has exposed nurses to all sort of risk. Most facilities cannot safely practice universal precautions due to lack of basic working tools, water, reagents, masks, gloves etc. This is particularly important and instructive at a time like this when all hands must be on deck to prevent Ebola.
8. It was also suggested that all institutions should have a training plan and a retention plan for nurses. This is to ensure ongoing capacity building and job security.
9. Nurses also frowned at the fact there are no mechanisms in place to recognize and acknowledge nurses who have excelled in their specialties. It was noted that even nurses who die in the line of duty that the nurses we lost to Ebola are hardly mentioned by nursing leaders. Participants were of the opinion that Nurses do not recognize their own nor appreciate them. It was suggested that the Council and NANNM institute a mechanism to address this.
10. Nurses also asked for a review of the current Mandatory Contusing Education program to make it more accessible and flexible working with relevant academic and professional institutions thus ensuring that nurses earn credits for the courses they attend.
11. The issue of inadequate nurse educators/nursing lecturers in our basic and university programs was also discussed and the Council was requested to make deliberate efforts in this regard. An incentive program for all nurses who intend to pursue the nursing education specialty should be put in place for without nurse educators the vision to have more universities offering nursing courses will be a mirage
12. Inadequate involvement if nurses in policy making also came up as an issue. In one of the slides presented by Dr. Asuquo, 7 health policy documents were listed and nurses were asked to indicate their familiarity with document or involvement in their development. The response was negative for all nurses in the room. NANNM, the Council, and FMOH was enjoined to organize a forum to discuss how nurses can be better involved in policy making
13. Nurses also called on the Council and relevant authorities to design and develop programs working with the communities. Such community relations programs should benefit the communities and also enable them to understand the profession and its practitioners better and the issues and challenges we have in providing care. This will help to launder the image of the profession while also helping the communities to stand for the nurses, advocate to the authorities and contribute to the work we do

Outputs Achieved from the Master Class

• Participants acquired leadership and management skills for change and improved productivity
• Consensus Statements on key leadership actions for the nursing profession
• Participants identified leadership challenges in their institutions and how they can be overcome
• Participants were confident that change was possible in view of the landmark achievements recorded at DELSUTH through unified nursing action.
• Participants acquired skills and knowledge in teambuilding, conflict resolution, stress management and making a difference