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Reforming Nursing/Midwifery Education And Practice In Nigeria by katty : April 10, 2017, 06:02:04 AM
Reforming Nursing/Midwifery Education And Practice In Nigeria: Legal Issues And Challenges By Barrister (Mrs.) H.A. Sawa

-All you need to know about changing your name, date of birth etc with Nursing and Midwifery council of Nigeria


Nursing as a profession should prepare practitioners who are well equipped to meet the challenges of care with the context of a complex society. The Doctors/Nurses owe a duty of care to their patients. Failure to show due care or skill in medical treatment resulting in death, injury or pain of the patient, gives rise to a cause of action in negligence.
In a judgment delivered at the Supreme Court of India in Dr. Laxman Balkrishna Joshi V. Dr. Trimbak Bapu Godbole, lays down the criteria for determination of the professional duty of a medical personnel in the following way:
 A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties viz a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give, or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree care.
A charge of professional negligence against medical personnel is serious. It stands on a different footing to a charge of negligence against the driver of a motor car. The consequences are far more serious. It affects his professional status and reputation.  With the best practices in the world, sometimes things may go wrong in cases like surgical operations or medical treatment. The medical man is not to be held liable for negligent simply because something went wrong. He is not liable for an error of judgement or for taking one choice against the other. He is only liable when he falls below a standard of a reasonably competent practitioner in his field so much so that his conduct may be deserving of censure or inexcusable.
A surgeon or anesthetist will be judged by the standard of an average practitioner of the class to which he belongs or holds himself out to belong. In essence, a person having studied one particular system of medical or nursing education cannot possibly claim deep and complete knowledge about the other system of medicine or nursing education. There is no doubt that there is a risk involved in medical treatment, but the question whether the risk is foreseeable is to be judged according to the knowledge possessed by the profession at the time of the accident, injury or damage caused since this could be the criterion for determination of the profession more likely capable of setting the boundaries of legal liability of the professionals. In this context, inexperience is therefore no defence for a person who holds himself out as a specialist though an inexperienced medical man may protect himself by seeking the advice and assistance of his experienced colleagues.
A nurse is required to act in accordance with the practice accepted at the time as proper by the responsible body of Medical Health Practices. In this regard, a Nurse charged with negligence can clear himself/herself if he/she shows that he/she acted in accordance with the prevailing professional practice. To a larger extent, medical malpractice is all about errors or negligence. Litigation and dispute in this context are often contentious and it is only natural that no medical personnel will like to be cut within the web of a malpractice suit. A Nurse who is negligent exposes himself to disciplinary action from the Nursing and Midwifery Council, to action for civil and criminal negligence. Many at times, such negligence results in death of a patient.
It follows therefore that a gross medical error will likely be treated as negligent.
. Administering wrong drug to a wrong patient
. Leaving some gauze bandage or swab inside a patient after an operation or surgery
. Switching of babies at birth due to multiple deliveries from the labour room/delivery ward.
However, to succeed in an action for negligence, the plaintiff must prove a direct nexus between the negligent act or omission alleged and the resulting damages as aforementioned. Causation remains a disputed question in law and it is generally difficult to prove especially in medical cases. It was held in a decided case that there was no nexus between the negligence and the death of the plaintiff because death would have nonetheless resulted to the deceased if the doctor was not negligent in the circumstances.
The facts of the case stated thus:
Three (3) fellow watchmen complained to a nurse on duty in the hospital of vomiting for three hours after drinking tea. The Nurse contacted the casualty doctor through a telephone call who instead of seeing the patients instructed her (nurse) to tell them to go home to bed and call their own doctor. The men left and after about five hours, one of them died of poisoning. The deceased widow failed in her action for negligence because the evidence showed that the deceased would have died in all and any event even if he was admitted into the ward and treated with care. Her suit was dismissed because it was not established that death was caused by the doctors negligence. It is for the plaintiff to prove both negligence and causation. The standard of proof is balance of probabilities.
Nursing education in Nigeria has witnessed various forms of reforms due to the imperative of health care delivery involved. This is geared towards the attainment of a standard nursing education whose objective is to produce quality nursing care through adequately equipped professionals. Nursing education therefore lays down the foundation for nursing care and practice which are evident in the promotion and maintenance of the nurse/patient relationship,  client wellbeing, effective and efficient clients/ patients management.
Practically the Nursing Reforms are aimed at improving the quality of nursing education as well as the health care delivery system through the enhancement of the competencies of the nursing professionals. Nursing education reforms therefore entails the improvement in the existing nursing education in order to meet up the challenges of the society. It is aimed at modifying and producing experts to render nursing care and services with expertise clinical decision making. The Nursing and Midwifery Council of Nigeria in her bid to reform the nursing education and practice in Nigeria is being faced with some challenges in certain areas that have become subject of legal tussle which are no doubt an impediment to the reform. Some of these legal issues and challenges in the emergence of the professional nursing in Nigeria have been articulated by the Council but not limited to the following:
Change of Name for Nurses/Midwives

It is a well-known fact that the Rules and Regulations Guiding Nursing and Midwifery Education in Nigeria has provided at paragraph 4.5 the only ground for change of name for nurses/midwives thus:
Change of Name can only be effected for female students on the condition of marriage/divorce and this will affect only the Surname.
Change of Name for a male student and a change of first name for a female student are not acceptable.

A hypothetical case on change of name-
Formerly Miss Linda Kura Sarki now married to Mr. James Adams and wished to be known and addressed as Mrs. Blessing James Adams. The applicant here has changed all her three (3) names and wants Council to effect the said changes in her Licence and records with immediate effect not taking into cognizance the Rules guiding change of name as aforestated.
The position of the Rules is clear and explicit as stipulated thereto but it is worrisome that despite these facts some nurses still apply to the Council requesting for a change of name outside the stated Rules and where such requests are not granted for obvious reasons, the subsequent result would be a legal threat/notice served on the Council for non-compliance.
Interestingly however, many of such applicants have sued the Council to various Courts of Law in Nigeria demanding for change in their names. Some of the cases are still pending while others have been struck out in favour of the Council for lack of merit.
Nonetheless, the Council in her difficult journey towards a goal to achieving the reforms would not unjustly refrain from granting such requests when it appears proper in the circumstances on the basis of non est regula quin fallit (there is no rule without exception) as provided in accordance with the Guidelines.
Change of Date of Birth

Section 465 of the Criminal Code Law defines forgery as follows:
i) A person who makes a false document or writing knowing it to be false and with intent that it may in any way be used or acted upon as genuine whether in the State or otherwise, to the prejudice of any person, or with intent that any person may, in the belief that it is genuine, be induced to do or refrain from doing any act, whether in the State or elsewhere is said to forge the document or writing
ii) On what amounts to making a false document in writing- the phase making a false document in writing includes altering a genuine document or writing in any material part, either by erasure, obliteration, removal, or otherwise and making any material addition to the body of a genuine document or writing any false date, attestation, seal or other material matter.
iii) The document includes a register or register books, or part of either, and any book, and any paper, parchment or other material whatsoever, used for writing or printing capable of conveying a definite meaning to persons conversant with them.
On ingredients of forgery-the offence of forgery can be committed without the element of fraud. All that needs to be established is that:
the document is false
knowledge that the false document or writing is false
intention that same be used or acted upon as genuine.
Precisely, the above basis is founded on the premise that candidates/applicants apply to the Council demanding for a change in their dates of birth which is different from the date they provided at the time of registration with same being entered into the Council register as the candidates correct date of birth.
A hypothetical case on change of date of birth-
- Moses Caleb- RN 1-1-80 RNT 4-3-81 RNAs 4-3-81
- Martha Jude- RN 10-11-82 RM 10-12-83 RNT 11-11-84
Both candidates have their first dates of birth with the Council upon registration as registered nurses i.e. 1-1-80 and 10-11-82 respectively. They are now claiming for their third dates of birth and demanding for a change with a legal threat upon which they eventually sued the Council to Court for not effecting the said changes.

Below are some of the challenging issues involved with demand on change of date of birth:
-  Where the candidate counter the earlier date of birth and re-present a Statutory Declaration of Age as the correct date of birth to serve his/her purpose.
- The candidate has two (2) differing dates of birth with the Council.
- The candidate on traveling abroad changed his/her date of birth to serve that purpose.
- The candidate altered the date in his/her original birth certificate.
- The candidate connives with his/her former School of training to alter the date of birth in his/her School record to serve for a particular purpose.
- The candidate has two (2) different copies of a Statutory Declaration of Age with the Council.
- The candidate connives with a Council Staff to get his/her date of birth altered from the Council register to suit a particular purpose. (Such cases are pending with serious investigation). This normally occurs when the candidates are seeking for accreditation with the Council and further claim that the mistake is with the Council.
It is pertinent to note that where cases of change in dates of birth are as a result of an error from the Council, such requests/demands are treated expeditiously.
Regrettably however, some candidates after carrying out these acts of forgery as stated, engage the services of a Legal Practitioner to demand with a legal threat a correction in their dates of birth within a limited period of time or face a legal action in Court. It is therefore on record that some candidates have instituted legal action against the Council for such acts while the cases are either still pending in Courts or some having been concluded or disposed of accordingly.
Forgery is a criminal offence, therefore the Council in her effort to reforming Nursing education and practice in Nigeria will not hesitate in prosecuting such offenders when it is established or having such offenders blacklisted from the register of Nurses/Midwives. As such Nurses/Midwives are advised to live by standard.

Quackery is dishonest practices and claims to have special knowledge and skill in that field, typically medicine. The Council has been having a serious challenge with the issue of quackery. Fake Nurses/Midwives are found almost in many nursing institutes with a fake or forged Nursing Certificates, Licenses, Notification letters, MCPDP Certificates and the like. Invariably, Council usually address issues of quackery with all seriousness and the offenders are consequently handed over to the appropriate Law Agency to be dealt with accordingly.
Establishment of an illegal School of Nursing/Midwifery
It is reported with dismay that some individuals or corporate bodies would want to establish a nursing institution illegally. Such individuals or corporate bodies normally evade the rules for a minimum requirement for pre-accreditation but would go ahead to advertise entry for students. nursingworldnigeria Where such instances are reported to the Council, the normal course of action is to seal up the institute while the offender is reported to the appropriate Law Agency for non-compliance with the laid down rules.
Absence of a Law establishing a School of training

It has been noticed that some Schools of Nursing/Midwifery do not have the backing of a law establishing such an institution. This has been one of the challenges recorded during and after an accreditation /visit of a School.  It is therefore noteworthy that any School that does not have a legal backing is operating illegally and Council is accordingly giving a serious warning for compliance or such Schools could be sanctioned appropriately.

At this juncture it is worth saying that Council frowns and wishes to vehemently express her state of vexation by some professionals whose object is to distract the efforts in reforming Nursing and Midwifery Education and Practice in Nigeria. There is the need to have a sustainable reform for quality assurance in the nursing profession.
Thank you in Promoting and Maintaining Excellence in Nursing Education and Practice.

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