NURSING AND MIDWIFERY COUNCIL ESTABLISHMENT ACT: THE NEED FOR URGENT REFORMATION -By UGONSA.
A critical analysis of the NURSING
AND MIDWIFERY (REGISTRATION, ETC.) ACT revealed that the current established
legal framework for Nursing education and practice is riddled with myriad of flawed
sections that fall short of current trends and international best practices.
The Act
titled ‘An Act to establish the Nursing
and Midwifery Council of Nigeria for the registration of nurses and midwives in
Nigeria and State Nursing and Midwifery Committees and to provide for the
discipline of nurses and midwives and other ancillary matters [1979 No. 89. 1992 No. 83.]’ is now obsolete in scope, nature, content and timing. Some
flawed sections of the Act (attached herein as Annexure A) are presented below:
Offences and Punishments
The provisions of the Act is laughable on what
constituted punishment to offences such as unauthorized practice without
registration, employment of an unregistered person to practice as nurse or
midwife and forgery of the council’s documents such as practicing license. For
clarity sake Section 20 that borders on punishment for quackery, employment of
quacks and forgery of Council’s document is reproduced verbatim below:
(1) Any person not being a person duly
registered under this Act who- [1988 No.4.]
(a) for or in expectation of reward
practises or holds himself out to practise as such; or
(b) without reasonable excuse takes or
uses any name, title, addition or description implying that he is authorised by law to practise as
a nurse or midwife, is guilty of an offence under this section.
(2) Any person who employs any unregistered
person as a nurse or midwife is guilty of an offence under this section and
liable on conviction to be punished as provided in this section.
(3) It shall
be an offence under this section for any registered nurse or midwife to
establish a private nursing or maternity home without complying with the
provisions of this Act.
(4)
If any person for the purpose of procuring the registration of any time,
qualification or other matter-
(a) makes a statement which is false
in a material particular; or
(b) recklessly makes a statement
which is false in a material particular, he is guilty of an offence under this
section.
(5) If the registrar or any other person
employed by the Council willfully makes any falsification in any matter
relating to the register he is guilty of an offence under this section.
The
above sections that sound good at a blush are however over diluted and ridiculed
by subsection 6 below:
(6)
A person guilty of an offence under this section shall be liable-
(a) on
conviction in a court lower than the High Court to a fine not exceeding N1,000
and where the offence is a continuing one, to a further fine not exceeding N50
for each day during which the offence continues;
(b) on
conviction in a High Court, to a fine not exceeding N2,000 or imprisonment for
a term not exceeding two years or to both such fine and imprisonment and where
the offence is a continuing one, to a further fine not exceeding N50 for each
day during which the offence continues.
Note that in 6(a) above, no mention was made of imprisonment
upon conviction and after putting enormous resources to prosecute offenders at
the level of high court, 6(b), the outcome is a fine of N2000 on the offender.
This compared with prosecuting charges is demoralizing and discouraging. The
prison term of “not exceeding more than two years” is also ambiguous, amorphous,
misleading, and non-definite because “not exceeding more than two years” can be
interpreted to be an hour or a day depending on the presiding judge and the
connection of the offender. There is a need to specifically define the prison
term by stating its definite duration, e.g. two years, than leaving it at the discretion
of the judge with the attendant loop holes being exploited by well-to-do
offenders. Also cunning is “a fine not exceeding N50”. It is not only funny,
based on today’s economy, but also not definite as “not exceeding N50” can be
50 kobo or 1 naira. If the makers of the Act were sincere enough, they should
have inculcated the term “not less than” rather than “not exceeding”.
(7)
Where an offence under this section which has been committed by a body
corporate is proved to have been committed with the consent or connivance of,
or to be attributable to any neglect on the part of, any director, manager,
secretary or other similar officer of the body corporate, or any person
purporting to act in any such capacity, he, as well as the body corporate,
shall be deemed to be guilty of that offence and shall be liable to be
proceeded against and punished as provided under paragraph (b) of
subsection (6) of this section.
Section
21 that borders on unauthorized training is no less repugnant as what we have
above. It is also reproduced verbatim here for ease of appreciation of the
subject matter:
It shall be an offence for any
person without the approval of the Minister, given on the recommendation of the
Council, to train or purport to train any person as a nurse or mid wife or to
provide any course of training or establish any school for such purpose or as
one of its purposes; and any such person shall be liable-
(a) on
conviction otherwise than in a High Court, to a fine of N1,000 or to
imprisonment for a term of six months, or to both such fine and imprisonment;
(b) on conviction in a High Court, to a
fine of N2,000 or to imprisonment for a term of two years or to both such fine
and imprisonment.
From the foregoing it is evident
that the Act does not fight quackery but rather encourages it. The ‘slap-on-the
wrist’ punishments prescribed by the Act has emboldened defaulters to keep
defaulting. No wonder most Private Hospitals had continued to constitute
themselves into quack breeding centres with unbridled impunity.
When punishment that is meant to
serve as a deterrent lacks weighty penalty, its essence is abysmally lost. A
fine “not exceeding” N1000 or N2000 in today’s economy is a heightened mockery
on the fight against quackery in Nursing, a profession that foresees health
promotion, health protection, health restoration, illness prevention and
alleviation of sufferings of the healthy, sick and disabled citizens. Quackery
is a crime against humanity whose punishment must be commensurate and hefty.
There is an urgent need for amendment of these sections to reflect adequate
penalty for the afore-mentioned crimes.
Power of the Minister of Health
The minister was mentioned 22 times
in the Act and has so much power vested on his office that no business of the
council is executed without his permission or interference. Even the training and
education of Nurses cannot be done without the Ministers approval as is seen in
the following declaration of section 21-“It
shall be an offence for any person
without the approval of the Minister, given on the recommendation of the
Council, to train or purport to train any person as a nurse or midwife or to
provide any course of training or establish any school for such purpose or as
one of its purposes”. What then has the council right to regulate as the
power to approve or disapprove Nursing education and training is solely vested
on the Minister? The power of the Minister to give directive to the council was
summarized in Section 4 as follow, “The
Minister may give to the Council directions of a general character or relating
generally to particular matters (but not to any individual person or case) with
regard to the exercise by the Council of its functions and it shall be the duty of the Council to comply with the directions”.
All Nursing activities, including education were therefore blankly placed under
the Minister with repeated use of the clause-‘Subject to subsection (4) of this section and to any direction of the
Minister under this Act’.
In a nutshell, as the NMCN is a
statutory regulatory body for Nursing education and practice so is the office
of the Minister of Health a statutory regulatory body to the council based on
the powers vested on the Minister by the Act. In other word the Minister of
Health is the regulator of the regulator of Nursing education without
consideration to the Ministry of Education that regulate educational activities
in the country. The emphasis here is not that the Minister should not have a
say in the affairs of the council but that such should not be in a way as to
erode the professional autonomy of Nursing which was defined and granted by
industrial Arbitration Panel (IAP) Award 1980 (herein attached as Annexure B).The
tribunal observed and granted that ‘Nursing is a profession sui generis subject to no directions or
control whatsoever by any profession. The enormous power vested on the office
of the Minister of Health to control every inch of Nurses’ professional affair,
in a country like ours where the position of the Minister of health has been
skewed as the birth right of Medical Doctors, smacks of interference with
professional autonomy of Nursing and therefore at variance with the provision
of the IAP award. Few examples of the
excesses of the Minister’s power are pointed below
v
Nursing Education: The Act for example vested
Nursing education on the ministry of health rather than ministry of education,
without any consideration to or consultation with the Ministry of education
that handles all education related issues. Designing and redesigning of Nursing
and Midwifery curriculum of training is vested on the Minister of Health so is the
accreditation of Nursing and Midwifery programmes and selection of committees
to lead accreditation and establishment of schools without recourse to
consultation with the Ministry of Education that foresees issues pertaining to
curriculum development and accreditation of educational programmes. Section 12
subsection 2 reproduced here reads “Where
the Council is of the opinion that a trial should, in the public interest, be
made on a scheme of training and examinations to be undergone and passed by
persons as a condition prior to registration under this Act (being training and
examinations which differ from prescribed training and examinations but appear
to the Council to be no less efficient), the Council may adopt the scheme for
such period and in relation to such institutions as may be specified in the
resolution; but any such resolution shall be subject to confirmation by the Minister”.
v
Appointment of Membership of the
Council and State Nursing and Midwifery Committees:
Section 2 subsection 1 of the Act, apart from vesting the sole power of
appointing the Chairman of the Council on the Minister, went further in
Sub-section 3 to elaborate that appointment of other members of the council is
the prerogative of the Minister (All
appointments under paragraphs (d) to
(i) of subsection (1) of this
section shall be made by the Minister). Section 13 on State Nursing and Midwifery Committees appointment
in sub-section 2 ended with the declaration that “Nothing in this section shall be construed so as to authorize the
appointment to a State Nursing and Midwifery Committee of any person not
registered under this Act, without the approval of the Minister”. Therefore, the minister is the summary of what
nursing is or is not, what it shall become and what it shall never be in
Nigeria.
Blanket Restriction on the roles of Nurses and Midwives
Section 22 under this Act placed a blanket restriction on the
professional roles of Nurses and Midwives as evidenced by its provision that “Registration under this Act shall not confer the right to assume any
name, title or designation suggesting or implying that the person registered is
by law entitled to take charge of cases of abnormality or disease in or
relating to any pregnancy requiring medical attention”.
This hold back reins is a limiting
constraints that keep Nurses and Midwives from performing with the full set of
competencies for which they were educated, trained, and licensed. This
regulation had often prevented nurses from exercising their full knowledge and
skills.
Contribution of Nurses and Midwives
to primary healthcare can be strengthened and enhanced based on a reorientation
of the Act through legislation to allow Nurses and Midwives to practice to the
full extent of their education and training. Until this regulatory and
institutional obstacle is removed, our healthcare system, especially the
primary healthcare, will never reap the full benefit of Nurses and Midwives
training, skills and knowledge.
In a country facing a shortage of
primary care physicians like ours, one way to fill the gap is to permit nurses
with advanced degrees and experience to practice with minimal or no doctor’s
oversight, order and interpret diagnostic tests, prescribe medicines, and
administer treatment. Unfortunately, this obvious solution that now constitute
international standard and best practices faces stiff opposition from the
Nigerian Medical Association (NMA) in our country.
NMA had continued to believe that
expanding the scope of nursing practice in Nigeria will have an adverse effect
on the quality of patient care but had refused to look at the evidence.
Mounting evidence shows that this opposition is more about competition than
competence.
It has been evidenced that Hospitals
with a higher ratio of nurses to patient have lower mortality rates. Studies
also underscored the quality of care provided by nurses, including preventing
medical errors and medication mistakes, reducing or eliminating infections,
shortening hospital stays, and easing the transition of patients from hospital
to home. Nurses using new technologies to care for patients, including the
elderly, in their homes have been shown to reduce the number of hospital
readmissions and visits to emergency wards. All of this cuts costs, of course,
but it also improves the quality of life for patients. What is needed at this
material time is therefore a less rigid dichotomy between the autonomy of
nurses and doctors, and more collaborative teamwork. Hence, there is an urgent
need to review and lift of this blanket restriction.
Composition of Membership of the
Council
Among the
membership of the council as defined by Section 2 subsection 1 of the Act included in subsection 1 (f ) one person who is
adviser on secondary education; and subsection 1 (i) one registered medical practitioner who shall be a qualified
gynaecologist and obstetrician.
Since all Nursing Programmes, whether
diploma or baccalaureate, are done at post-secondary school level the adviser
should rather be one on tertiary education instead of secondary education. Gone
are the days when admission into schools of Nursing and Midwifery was done
without O’level. The current trend is not only that a candidate for admission
must possess O’level but that the O’level must bear at least credit pass in
English, Mathematics, Biology, Chemistry and Physics. The Act goofed by
portraying Nursing and Midwifery education and training as secondary rather
than the tertiary, that it is, and should be urgently amended to reflect the
current trend.
For an autonomous profession, the
inclusion of a Medical Doctor, who is not a member of Nursing/Midwifery
profession, as a compulsory membership of the Nursing and Midwifery council
does not only smack of hegemonic interference by Medical practitioners but
highly repugnant and contempt of the IAP award 1980. No nurse or midwife is a
compulsory member of the Medical and Dental Council of Nigeria. Why then should
Nursing and Midwifery Council of Nigeria be invaded by Medical Practitioners
whose past and present demeanor towards the Nursing profession and her members
are more or less at variance with having her interest at heart?
Citation
This work should be cited as follow:
University Graduates of Nursing Science Association
[UGONSA]. (2015). Nursing
and Midwifery Council Establishment Act: The Need for Urgent Reformation. Abakaliki.
National Professional Conference.
REFERENCES
An Act
to establish the Nursing and Midwifery Council of Nigeria for the registration
of nurses and midwives in Nigeria and State Nursing and Midwifery Committees
and to provide for the discipline of nurses and midwives and other ancillary
matters [1979 No.
89. 1992 No. 83.]
WHO
(2015). WHO Director’s address at ICN conference. Seoul, South Korea.
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