In this report, VINCENT KURAUN x-rays the new verification guidelines by NMCN and why the Nigerian nurses are calling for a reversal.
FOLLOWING the Nursing and Midwifery Council of Nigeria (NMCN)’s announcement of new verification guidelines for applicants seeking verification certificates to foreign nursing boards and councils, the Nigerian healthcare system is currently experiencing significant upheaval. Within the nursing community, these changes have sparked a contentious debate.
According to the NMCN, the guidelines include: “A non-refundable fee per application shall be paid for verification to foreign boards of nursing as specified on the portal. This shall cover the cost of courier services to the applicant’s institution(s) of training, place of work, and Foreign Board.
“Eligible applicants must have a minimum of two years post-qualification experience from the date of issuance of the permanent practising licence. Any application with a provisional licence shall be rejected out rightly.
“The council shall request a letter of good standing from the chief executive officer of the applicant’s place(s) of work and the last nursing training institution attended and responses on these shall be addressed directly to the registrar/CEO, Nursing and Midwifery Council of Nigeria. It said the council shall not accept such letter(s) through the applicant.
“Applicants must have an active practising licence with a minimum of six months to the expiration date.
“Applicants must upload certificate(s) of registration only. Notification of registration is not acceptable.
“Applicants will receive prompt notifications via email and dashboard regarding the status of their verification application.
“The processing of verification applications typically takes a minimum of six months. Incomplete documentation will not be processed, so applicants should ensure all requirements are met before initiating the verification process.”
According to the circular, the NMCN guidelines would take effect from the 1st of March 2024. It was also stated in the circular that all pending applications before this updated guideline would be processed accordingly.
But the revised guidelines for verification of certificate by the NMCN Registrar/CEO of the council, Dr Faruk Umar Abubakar, on Wednesday, February 7, 2024, have been generating reactions from nurses and groups who perceived this as a threat to the nursing profession and the health care system in Nigeria at large.
Nurses and other healthcare workers across Nigeria have protested the new guidelines through online and by staging demonstrations. The hashtag #NotoNMCNVerificationRules trended for days on various social media platforms as the NMCN was criticised for imposing strict conditions on all applicants seeking verification of certificates with foreign nursing bodies.
They said the new guidelines are a violation of human rights, emphasising that NMCN has never requested work experience or imposed years of service as a prerequisite for verification and, therefore, called for rectification.
Their main concern is with the two-year post-qualification experience requirement for nurses seeking validation of their licences for international practice, the introduction of a non-refundable application fee and a letter of good standing from their chief executive, usually a medical doctor, during the verification process.
They argued that the guidelines undermine their professional autonomy and neglect their legal status, saying the guidelines were outdated compared to international practices.
Sunday Tribune also discovered that nurses were paying a verification fee of N50,000 which has now been increased to N300,000 as announced by NMCN causing anger and call for a reversal of the policy and reform of the nursing agency.
“No government funding or support. No scholarships for nurses. No salary for nurses. No support for nurses. No good working conditions. No incentives. Nurses are resilient but there’s a limit to that. @Nigeria_NMC can’t stop us!
“Nurses in Nigeria are suffering. Nurses in Nigeria are poor. Nurses in Nigeria are jobless. This is unacceptable. This is unethical. This is unfair. This is unjust. This is unprofessional. This is illegal. NMCN can do better,” a lecturer and assistant professor at UCD School of Nursing, Midwifery and Health System Ireland, Olayinka Arenu, posted on her X handle.
Also speaking on the issue through his social media page, the founder and CEO of Nurses on Air, Josiah Jackson Okesola, described the new policy as inhumane and insensitive to the plight of nurses with an average salary of $50 and $100 per month.
He also mentioned that the policy lacks intellectual input from real stakeholders in the Nigerian nursing community.
He said “The attempt by NMCN to create a policy is not much of the problem. The real big issue is the shocking contents of the new NMCN policy. They are not only extremely inhumane and insensitive to the plight of our suffering nurses who have neither food in their stomachs nor money in their pockets with average salaries of $50 and $100 per month!
“Aside that the policy lacks intellectual input from the real stakeholders in Nigerian nursing sector, it is a huge international slap on the brilliant recommendations of global health experts like Tedros Ghebreyesus and Dr Elizabeth Iro of the World Health Organisation (WHO) and Howard Catton of the International Council of Nurses who have been hammering on the urgent need to invest in the nursing workforce!
“Nigerians are already hit hard by the effect of a nursing workforce that is mentally exhausted and psychologically drained from the COVID-19 impact and ongoing harsh economic realities. The policy is about to further unleashing a frustrated, hungry and angry nursing workforce on Nigerians!
“Unless the new NMCN policy is withdrawn immediately, it will have grievous consequences on the quality of healthcare and well-being of the Nigerian people who are already in dire straits!”
While speaking with Sunday Tribune, Chairman, of the National Association of Nigeria Nurses and Midwives, (NANNM) Ondo State, Orobode Felix Akintobi, said the revised verification guideline that was released by the regulatory body, (Nursing and Midwifery Council of Nigeria) has thrown the nursing community into chaos.
He noted that Nigerian nurses, both at home and abroad, saw the guidelines as “an infringement on their fundamental human rights and it was vehemently condemned by everyone.”
In his words, “Let me quickly set the record straight that verification of certificates is a global process where a request is being made to the organization that issued a certificate/licence to prove the issuance. Nursing is also not an exception.
“Verification has been part of the responsibilities of the Nursing and Midwifery Council of Nigeria. So, it’s not just starting, it has been in existence for a long time.
“In the past seven to eight years ago, the process of verification took months or years, but with the engagement of new technology where all the processes are done digitally, it now takes weeks or a maximum of a month.”
Speaking on the new policy, he said “In modifying a policy/guideline, it’s done to make life more comfortable/convenient for the citizens and not to add to the people’s burden. The question is, what was wrong with the previous verification guidelines that necessitated the adjustment? And if it’s to be modified, should it not be in a positive direction? As we can all see, the circular is against the progress of nurses and the mere reason all Nigerian nurses, friends of Nurses and parents of Nurses are against it.
“Since the release of the circular, the social media space has been agog with progressive Nigerians condemning the guideline. The morale of the nurses including that of the parents that financed our training was reduced to zero level. As it is today, Nursing remains the fastest-growing profession globally. It is well recognized and respected with better remuneration in developed countries. That is why you see a medical doctor in Nigeria willing to study nursing again and parents trying to encourage their children to develop an interest in Nursing.”
On one of the new guidelines that state that the verification process will take a minimum of six months, he said “Why the long period when the regulatory body claimed all their activities have been digitalized. Is this not an avenue to discourage people?”
“On the guideline that states that nurses must obtain a letter of recommendation from the CEO of the institution where the nurse is practising, what relationship verification of certificates has with recommendations from the present place of work, when the majority of the CEOs are medical doctors.
“If any recommendation letter is needed, it should be on the request of where one is going and not the body that issued us the license to practice. Is our regulatory body doubting the certificate issued to nurses? It’s just like requesting a transcript and the university is requesting a letter of recommendation from where the person is working. It’s so barbaric.
“The third one is that the individual can only apply after two years post-graduation. What if the person wishes to proceed to postgraduate programs immediately? Is our regulatory body/government trying to bind us when they are not the ones that financed our training?
“Do you know in recent times, nursing was intentionally removed from the health professions that are benefiting from NNPC and other oil companies scholarships? Nursing training in any Nigerian university costs nothing less than two million naira per session. Parents are the ones responsible and not the NMCN or the government. Why the indirect binding of nurses for two years?”
Speaking on the plight of nurses in Nigeria and highlighting their reasons for migrating to greener pastures, he mentioned insecurities, the Nigerian economy, decaying infrastructures of health institutions and poor remuneration.
He further explained that “nurses now experience different kinds of assaults from patient and patient relatives due to the systemic failure, because they are the only health professionals that stay with patients for 24 hours. The respect for the profession keeps going down the drain. Why won’t Nurses migrate to where they would be respected and remunerated appropriately? It is a thing of shame that newly employed university graduate Nurse earns below N120,000 while College of Nursing graduates earn below N80,000. We still have many Nurses in the private sector that earn less than N40,000, in this present economy.
“The salary quoted was for federal workers. States pay less than that. Newly employed university graduates in states earn less than N100,000 while that of the colleges earn less than N70,000.
“Even with little allowances approved, many states are not paying. For example in Ondo State, the hazard allowance that was approved for all health workers since last year is yet to be implemented till date while our counterparts in federal and some neighbouring states have been enjoying it for over two years.
On the claim by NMCN that there is a shortage of nurses in Nigeria, the chairman stated that there is no shortage of nurses in Nigeria, it is just that the government refuses to employ them.
He added that “In Ondo State, the last time nurses were employed into the hospital management board was in the year 2019 while that of the local government should be more than ten years, the total number of nurses in the 18 local government areas are less than 100 and the last set of people are on grade level 13 and my state produces nurses every year. Are we saying all the nurses who graduated in the last five years have left the country? When I know that the nurses that have left from my state are less than 70.
“Years ago, NMCN produced fewer than 10,000 nurses in a year, but for last year alone, the council produced almost 28,000 nurses and since 2017, the production rate has always been on the increase. Nurses are still out there looking for jobs. The government should employ them.
“Let me refer you to the recent incident at OAUTHC where there was the recruitment of staff, nurses inclusive. The story had it that they employed in excess and those extras were not paid salary for almost a year before they were told to leave.
“If there are no nurses, would there be excess employment? The embargo has been on employment for long until this year when the government lifted it and since it was lifted, how many health institutions have advertised for the employment of nurses?,” he queried.
Akintobi also mentioned that the national headquarters of the association has condemned the new policy as well as all state organs and other bodies in the profession. He said they are all clamouring for the reversal to the old guidelines.
The presidential candidate of the Labour Party in the last general election, Mr Peter Obi, on his X handle, also called on NMCN to reverse the rules. He said, “I call on the NMCN to reverse these measures promptly for the benefit of Nigerian nurses and our nation as a whole.”
Also speaking on the same issue during his visit to the College of Nursing Sciences at Our Lady of Lourdes Hospital, Ihiala, Obi urged the NMCN to reverse their recent student conditions for the nursing personnel working overseas, adding that nurses should not be denied global employment.
He said: “I’m urging the NMCN to reverse their recent conditions of our nursing personnel working overseas. We cannot restrict our young ones from the opportunities of global employment that are readily available.
“Today, Nigeria has the third most wanted nurses globally. And they should be allowed to see the opportunities that are global for them.
“What we should do as a nation is since we have these young and productive ones, and everything is to invest more in the colleges of nursing sciences all over Nigeria in every local government, produce more, ensure that we give them the fastest support to get job globally and become a brand we should celebrate because they are the one that is going to invest in Nigeria.
“Through their remittances and everything we would generate the required foreign exchange for our businesses. So we need to invest more in them. That investment is what is critical.
“So please reverse these conditions and support them and our government should go round and support all the schools of nursing, college of nursing that is all over Nigeria,” he advised.
NMCN’s justification for the guidelines
The NMCN Registrar, Abubakar, during his interview on Channels Television had spoken on the issue surrounding the new verification rules, disclosed that in 2023, more than 15,000 nurses and midwives left Nigeria in pursuit of better
opportunities abroad.
According to him, the number of nurses leaving the country is increasing annually. He revealed that over 42,000 nurses left the country in the last three years. “Last year alone, it was over 15,000, the number is increasing year by year,” he said.
Speaking on efforts to safeguard and improve nurses’ welfare, the registrar pointed out that the Federal Ministry of Health is working towards enhancing working conditions, allowances, and salaries for nurses.
He said “The Federal Ministry of Health is working towards improving the nurses’ working conditions, allowances, and salaries.
“The FMoH and the Minister of State for Health are working hard to ensure a very conducive working environment, with the provision of state-of-art equipment, and instruments that will help them provide quality care for Nigerians.
“And I want to assure you that within a couple of months; a lot has been integrated and provided in 2024 that will improve the welfare of the nurses that we are talking about. On the issue of the salary that has been raised, I believe it’s a general thing.
“There is a lot of progress that is going on to review the salary and nurses are also included in that policy. I think it’s a general phenomenon, all other sectors are also complaining, and the government is doing a lot.
“Our responsibility is to ensure that nurses are regulated to better education and practice for Nigerians,” he stated.
Intervention of lawmakers
The controversy surrounding the new certificate verification has also caught the attention of the country’s lawmakers.
A member of the House of Assembly, representing IkotEkpene/Essien Udim/Obot Akara Federal Constituency, Akwa Ibom State, Patrick Umoh moved a motion of urgent public importance on Tuesday, February 27, 2024.
Mr Umoh, while condemning the requirement for two years of post-qualification experience before verification, described it as unreasonable, arbitrary and unfair.
The lawmakers have now called on the NMCN to suspend its plan to implement the new guidelines on the 1st of March as the house investigates the controversies surrounding the new guidelines.
Waiting game……?
For now, Nigerian nurses wait expectantly, hoping that the investigation so directed by the national lawmakers would be speedily conducted.
But a concerned Nigerian citizen Okesola on his media handle offered a way forward. According to him, government must first withdraw the controversial policy.
, He said: “Withdraw the NMCN policy and compel @NMC_Nigeria and @NANNM_NGR to leverage on the pool of diaspora nurses, scholars and stakeholders at @nannna_org @NNCAUK @ANNI_Nurse @inrnigeria in developing a progressive and proactive policy that addresses the nursing workforce challenges.
“Urgently constitute a new nursing board with a bulk of stakeholders from diaspora-based nursing leaders, policymakers, researchers, and scholars who are ready to return to the country to serve to help develop and implement nursing policies that will truly protect Nigerians.
“Implement the brilliant recommendations from the Triple Impact Report by All Party-Parliamentary Group on Global Health.
“Implement the brilliant recommendations from the State of the World’s Nursing by the World Health Organization.
“Take more seriously the recommendations of the Abuja Declaration of 2001 by the African Union Member States on budgetary allocation to healthcare.
“Implement recommendations of the United Nations Conference on Trade and Development 2023 Report and @UNmigration on international migration.
“Invest in young students and graduate nurses through scholarship and overseas exchange programs. Train, upskill and equip retired nurses to help strengthen the depleted workforce at the primary level. Engage willing diaspora nurses who are ready to serve to help strengthen nursing training and education.”
Similarly, the NANNM Ondo State chairman recommended that the government should expedite action in improving the security of the country, equip the health institutions and improve nurses’ remunerations. He added that “NNPC and other oil companies operating in Nigeria should recognise the nursing profession as one of the health professions that must benefit from their scholarships.”
- Additional reporting by Funmilayo Aremu-Olayemi
