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Success Of Internship: The Role Of The Nursing Elders By Dr. Saleh N. Garba - Upcoming Conference - Nurses Arena Forum

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Success Of Internship: The Role Of The Nursing Elders By Dr. Saleh N. Garba by Idowu Olabode : April 07, 2017, 06:34:36 PM
BEING A PAPER PRESENTED AT THE NURSING LEADERS CONFERENCE ORGANIZED BY THE NURSING AND MIDWIFERY COUNCIL OF NIGERIA HELD AT HOTEL SEVENTEEN, NO. 6 TAFAWA BALEWA WAY, LAFIYA ROAD, KADUNA ON 27TH-30TH MARCH, 2017.
 
Introduction
University nursing education in Nigeria combines both academic and practical traditions in the curricula emphasizing the goals of integrating theoretical and practical knowledge. In other words university nursing education attempts to bridge the theory – practice gap and enhance clinical competence by introducing different methods to enhance both the theoretical and practical teaching – learning experiences of undergraduate students (Ilesanmi, 2009). In the course of the training, the Bachelor of Nursing Science (BNSc) students are usually sent to the clinical areas for clinical exposures and practical examinations from the end of their second year of studies up till the end of their studies. This is to ensure that they acquire the necessary skills to practice as general nurses upon graduation. Despite these efforts, university nursing students and the graduates of the generic BNSc programme are often described as being inadequate in the necessary clinical experience and practical skills required for independent nursing practice.
 
Studies of graduates of baccalaureates nursing programmes have also showed that newly qualified graduate nurses in Nigeria lack the required practical competence when compared with the products of the diploma nursing programme (Greenwood and Wilfred, 1995; Ilesanmi, 2009). According to Jeffries (2011), nursing graduates who attended programmes with no internship opportunities do not acquire the necessary capacity to function efficiently in the clinical settings.
 
A similar report from Australia noted that new graduate nurses lack the necessary competence to function independently when undertaking clinical work, noting that graduates were not adequately prepared for clinical practice (Reid, 1994). Landers (2010) maintained that no matter how effective the theoretical input in the classroom and the short practical postings may be, it can never cater for the complexities of a clinical situation thus making it difficult for new graduate nurses to have adequate skills for clinical practice. It is important to note that this problem is not peculiar to university nursing education alone but it is common to all professional programmes in the university Medicine, Pharmacy, Law, Medical Laboratory Science, Physiotherapy etc     
 
In view of the criticisms about the skills of university graduates in most of the health sciences discipline, one year internship programme was introduced so as to bridge the gap between theoretical knowledge and practical skills of the graduates in the professional disciplines including of recent, the nursing profession. Unfortunately, in Nigeria internship for graduate nurses is yet to commence despite the fact that it is known all over the world that the best time to integrate theory and practice in nursing and to ultimately acquire the necessary clinical skills is during the internship programme.
 
What then is internship?
Internship is a period of time during which a student or new graduate gets practical experience in a job usually for a period of one year. It is the period of post qualification work experience and training. The term internship also refers to a period during which a fresh graduate in certain profession is receiving practical training in a work environment. An intern therefore, is one who works in a temporary position for a period of one year with an emphasis on on - the - job training rather than mere employment.  Osinem and Nwosi (2008) described internship as a kind of work experiences program employed for graduate professionals such as Law, Medicine, and Pharmacy among others with the aim of exposing the new graduates to a more conducive practical environment so as to enhance their practical skills.

Objectives of Internship Programme
The main objectives of the internship programme include;
1. To provide supervised precepted period of enhancing competency in practice
2. To sharpen the practical skills and clinical experience of newly qualified graduate nurses for the real life professional task of caring for the sick. 
3. To provide a period of transition from studentship to a full professional status
4. To assist new graduate nurses to socialize and integrate into the professional culture and health care organisational system
 
Types of internship Programme
There are two main types of internship programmes. These are the paid and the unpaid internship programmes. While paid internship programme is most common in the medical,   nursing, pharmacy, physiotherapy and medical laboratory science professions enables the intern to be paid while learning on the job, the unpaid internship programme does not give opportunity for the intern to be paid. This mostly exist in non profit organisations such as charities, volunteers and religious disciplines (Adejumo, 2009).
 
Nursing Internship program is an "earn while you learn" program designed to facilitate the role transition from novice/novice beginner to skillful and more competent professional (Benner 1984). Internship for Nurses in Nigeria becomes necessary following the introduction of the generic baccalaureate university education for preparing professional Nurses. The graduate nurse internship program is a transition from a student to a professional Nurse (Cleveland clinic Health system, 2006). New graduates who complete a nursing internship program have more professional self-confidence and job satisfaction and are less stressed because they are in a supportive environment (Casey et al. 2004; Owens et al. 2001). It has been estimated that it takes new graduates at least one year to master a job with successful organization and socialization (Tradewell 1996).
 
The Structure of the Nursing Internship Programme
In Nigeria the internship programme for the BNSc graduates designed by the Nursing and Midwifery Council of Nigeria is to cover the following areas over a period of one year:
1. Medical Department = 9 weeks
2. Surgical Department = 9 weeks
3. Obstetric/Gynaecological Department  = 9 weeks
4. Paediatrics Department = 9 weeks
5. Community Health Department = 4 weeks
6. Out Patient/Emergency Department = 4 weeks
7. Psychiatric Department = 4 weeks
8. Annual Leave = 30 days 
TOTAL = One year/12 months (N&MCN, 2016)   
 
Criteria for Internship
To be eligible for appointment into the internship programme, the candidate must:
1. Be a new BNSc graduate nurse who undergo a generic BNSc programme from a recognised and accredited Department of Nursing,
Note: An RN who had gone through School of Nursing before enrolment for the BNSc degree programme is exempted from the internship programme
2. Have passed all theoretical and practical examinations that are required in their university and must have been awarded that degree in nursing prior to internship.
3. Have entered for and passed the Nursing and Midwifery Council of Nigeria Final Qualifying Examination for General Nurses and has obtained temporary registration before internship
 
Career Entry Point
According to the new scheme of service approved by the Federal Government of Nigeria (2016) and the N&MCN (2016) the proposed career entry point and remuneration for nurse interns are:
• Nursing internship period -  CONHESS 8 Step 3 (Grade level 9 Step 3)
• After NYSC/ career entry point - CONHESS 9 Step 3 (Grade level 10 Step 3)
       
Benefits of Internship for Nurses in Nigeria
The internship programme will have the following benefits to the nurses, the profession and the health care system:
1. Internship will help sharpen the practical skills of graduate nurses and raise their confidence level as it is often said practice make perfect
2. It will help develop the fresh graduate nurses’ interest in various areas of professional specialisation.
3. It will open up job opportunities and provide for experience in the curriculum vitae/resume of new graduate nurses
4. The hospitals will have first hand information about the candidates they will finally want to employ on completion of the internship programme
5. Internship will make available competent and practically efficient graduate nurses to the hospitals which will improve the quality of nursing care in the health care institutions.
6. Internship will help solve the existing problem of placement at the point of entry into the  professional career already being faced by the graduate nurse 
7. Internship will place nursing profession at par with other professions in the health sector as all the others are already enjoying the internship programmes
8. It will help in ensuring excellence in nursing practice as not only issues related to nursing skills but the professional conduct and behaviour of the candidates will be addressed during the internship programme.
9. It will ensure continuous flow of qualified nurses into the health care system as all the graduates of generic nursing programme that intend go out of the country must have to serve for at least one year before getting final registration and license that will enhance their chances of travelling out. This will in the long run reduce the shortage of nurses in the country’s health care system.
10. It will reduce cases of nursing care errors, negligence, care complications and associated litigations against the hospitals in Nigeria that is related to shortage of nursing manpower. 
11. It will help in increasing life expectancy and quality of life of the general public
 
The nursing council in collaboration with NANNM recorded success in securing the approval of the internship programme in 2016 after several years of struggle. This has made it possible for the planned take off of the programme in January 2017. Various nursing elders and leaders of thought have contributed immensely in the final approval of the programme. They also have roles to play in sustaining the success of the programme and in ensuring its successful implementation.
 
The Role of the Nursing Elders in the Success of the Internship Programme.
The nursing elders have the following roles to ensure the successful implementation of the internship programme:
1. Ensuring the smooth take-off of the internship programme by being excellent advocates of the internship programme
2. They should ensure full implementation of the circular on internship and the unified scheme of service in the country so that the intern nurses in particular and the other nurses will adequately remunerated
3. As the supervisors of the programme, the nursing elders should ensure that the intern nurses learn effectively throughout the internship period so that BNSc graduates will be clinically competent to carry out the required nursing tasks.
4. The nursing elders should ensure that adequate budgetary allocations are made annually by the relevant ministries, parastatals, agencies, institutions and departments regarding continued sustenance of the programme 
5. Nursing elders should assist the Nursing and Midwifery Council of Nigeria in ensuring the successful implementation and sustenance of the internship programme in the country by closely monitoring the implementation of the programme, offering useful advises and reporting any abnormality in the implementation to the nursing council for intervention. 
6. The nursing elders should ensure that only qualified nurses are appointed as preceptors and supervisors of the internship programme in all institutions approved for the programme.
 
Conclusion
In conclusion, the internship programme is a positive step forward towards the growth, development and improvement in the nursing profession. It will also help in the provision of quality nursing care in particular and health care in Nigeria. This is because the internship programme will enable the graduate nurses to be exposed to real practical experience in different sections   of nursing practice for 12 months. This will help sharpen their skills and give them adequate orientation in the hospital setting. It will give the graduate nurses the necessary confidence required in the provision of quality nursing care at all levels of health care.

References
Benner, P. (1984), Novice to Expert: Excellence and Power in Clinical Nursing Practice.
Menlo Park, CA: Addison-Wesley.Brian H.  (2012). Delay of internship. Available at www.google.com. Accessed on 1st May 2012
Casey, K., R. Fink, M. Krugman and J. Propst. 2004. "The Graduate Nurse Experience." JONA 34(6): 303-11.
Cleveland Clinic Health System (2006). Graduate Nurse Internship Program.  www.southpiontshospital.org
Mfuh AY, Lukong CS, Suleima D. (2011), Health workers perception towards the introduction of internship programme for the BNSC student’s in Nigeria. A Case of ABUTH Zaria. A paper presented at the 9TH National Scientific  Conference And Annual General Meeting At School Of Nursing , Babcock University, Ilishan-Remo , Ogun State, Nigeria. Date 20th-25th November 2011
Onyia, N.A. (1998) Survey of Factors Militating Against University Education of Nursing. A Project, University of Nigeria, Enugu Campus.
Nursing and Midwifery Council of Nigeria, (2016), Structure of the Internship Programme for Graduates of Bachelor of Nursing Science (B.NSc.) Degree programme
Tradewell, G. (1996) "Rites of Passage: Adaptation of Nursing Graduates to a Hospital Setting." Journal of Nursing Staff Development, 12(4): 183-9.
Yusuf, Z.Y. (2005), Bachelor of Nursing Science Graduate and the Issuing of Internship in Nigeria. A Paper Presented at Conference of Committee of Heads of Nursing Departments (COHEDNUR) in Nigerian Universities, Enugu, Nigeria.
 
BY DR SALEH N. GARBA, RN, PhD, FWACN
DEPARTMENT OF NURSING SCIENCE,
FACULTY OF MEDICINE,
AHMADU BELLO UNIVERSITY, ZARIA

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