Devaluing the Ghanaian nurse: the role of nursing leadership

In most cases when nurses lay beds, they do it for patients. But this time round, this bed we have laid as Ghanaian nurses, is for our own use! Since yesterday when information about government's proposal to engage graduate unemployed nurses in its youth employment program hit social media, there's been a lot of hue and cry about its implications for the nursing profession in Ghana. I've read a lot of comments and opinions on the issue across different social media platforms. But for the purpose of this article, I want to share with you this comment that came from a respectable senior colleague of the profession: "My humble opinion is that they go for the youth employment whiles a permanent solution is being sought. For me I think it is better than sitting in the house. At least they will be earning something whiles other options are being considered."

Make no mistake; the senior who expressed this opinion is not alone in his thinking. It is a mentality that seems to be fairly common among nurses, especially nurses in leadership positions. And I am sure that as I've shared it here, there would be a number of nurses who would readily agree with his assertion. I don't begrudge him or those who share the same opinion, after all opinions they say are like noses.
However, I totally and completely disagree with this suggestion in particular, and that kind of attitude or mentality in general. And I dare say it is that attitude of compromise that has led nursing to the situation in which we find it today. For some reason that I can't quite put my finger on, nurses, especially our leaders are always willing and quick to make compromises on the profession for the "betterment of society". Meanwhile, we are all aware that the moment you make the first compromise, it becomes impossible to refuse more compromises in the future. That's why somebody told us never to allow a friendly fox into our pen/garden because one day it will become hungry! And you know what that means.

I have been reliably informed that, before 2007, government of Ghana had made proposals to the Nursing and Midwifery Council of Ghana to start the training of a lower cadre of nurses as health assistants. At the time, the training of nurses had moved through the hoops from enrolled nursing to diploma and was making strides towards a degree. And here was the government trying to take us back to the era of certificate (enrolled) nursing. Thankfully, the registrar at the time, Mrs. Ruth Gyan (God bless her) strongly refused on the grounds that such a move would constitute a backward step for the profession in Ghana.

However, when a new registrar took over after her retirement, the government revisited the issue with a promise that the program will only be a stop-gap measure, and will run for only five years after which it would be phased out. Unfortunately, instead of taking the stance of her predecessor, this new registrar quickly bought into this idea for reasons best known to her. Well it appears when she gave the politicians an inch, they took a yard. Then again, are you surprised? Today, the program is in its ninth year of operation (2007 to date) and still there is no end in sight. Not only that, we have Health Assistant Training Schools (HATS) dotted all over the country with some schools admitting close to 2000 students per year. Now can you imagine the number of enrolled nurses that are churned out each year? And when you complain about this huge numbers, people within the highest places of nursing in Ghana would tell you that if you don't admit all of them, they will become prostitutes and armed robbers. So as usual we make a compromise to make society better. Anyway I hope we don't have any more armed robbers and prostitutes in Ghana since we are admitting all the potential ones into nursing.

In the midst of all these, where was the Ghana Registered Nurses and Midwives Association (GRNMA)? I will tell you. They were there seriously trying to have their cake and eat it. In principle, they were opposed to the idea of Health Assistants, to the extent that the national president at the time, Mrs. Asare Alottey even called me as national GNMTA (Ghana Nurse and Midwife Trainees Association) president at the time and instructed me not to register the health assistant trainees as members of GNMTA. However, beyond this cosmetic opposition, all the HATS were being headed by nurses. Some of the principals of these institutions were even national executives of GRNMA. Now if you are allergic to monkey meat, why do you enjoy light soup made with monkey meat? I guess our executives were just tickling themselves.

Anyway fast forward to 2012 and the Ministry of Health made the sensible decision to raise the entry requirement of the program to include at least three credits in English, Maths and Science plus passes in three other electives. This measure saw the intake drop significantly because only the few qualified ones were admitted. Well it looked like the drop in admissions did not please some people in high places. So the following year, the entry requirement were dropped to include just passes in the core subjects and passes in three other electives. So all you need is to get E8 in six subjects and you can be trained to become an enrolled nurse. The Nursing and Midwifery Council (NMC) did not object to this bizarre directive; the principals complied with this directive without any protest; and the GRNMA just looked on helplessly as usual whiles the profession was being raped by politicians.

Now that we are gradually coming to terms with the HAC program, we are suddenly confronted with the springing up of all sorts of mushroom nursing schools training God Knows what caliber of nurses. These institutions are not been regulated by the NMC but rather the National Vocational Training (or is it technical?) Institute (NVTI). In which other profession can you have this nonsense happening? What does the NVTI know about nursing? And instead of uniting to flush this schools out of the system, nurses are rather helping them to grow. In some cases these schools are run by nurses and in all cases the students are taught by nurses.

Whilst all these is going on, it is important to note that almost all public and private universities offer a degree in nursing program. The traditional NTCs continue to train diploma nurses. So at the end of it all, put all these numbers together: the graduate nurses, the diploma nurses and the enrolled nurses and ask yourself the number of nurses produced each year. And out of that number, how many is government willing and able to employ? I don't have any figures but it is very clear from the happenings on the ground that government is unable to employ even half of the number we churn out each year. Now simple principles if demand and supply would tell you that when supply outweighs demand, the commodity becomes cheaper. Is it any wonder therefore when government offers to employ graduate nurses (who are trained to provide advanced nursing care) as community health assistants and pay them at a rate slightly above the minimum wage? We have laid our bed, and we must lie in it. My people say if you price yourself at 1 cedi, they will buy you at 1 pesewa (and that may even be on credit).

As nurses, we have shown time and again that we are more interested in pleasing policy makers than protecting the profession. So anybody can just dream up any kind of policy and try to force it down our throats by appealing to sentiments and emotions. Otherwise how on earth can you propose to employ someone with a degree or a diploma nursing to work at the level community health assistant who is trained for 3 months? That very suggestion is an insult to the profession and I am highly scandalized that people can actually suggest that we accept that offer. I mean how? Don't we ever learn? If you accept this offer today and tomorrow they come to tell you that now all nurses will be put under that program after their training, can you say no? Have you forgotten that if you give them an inch they take a yard? We should rather be making demands for the government to employ all nurses as dictated by their qualification. And we should back those demands with industrial actions if necessary. All principals can come together and decide that they are not admitting any new students until the backlog have been cleared and government demonstrates that they actually need nurses to work in this country. I expect GRNMA to issue a statement and condemn this proposal and demand for more dignified and respectful treatment of nurses.

Fellow descendants of Nightingale, what is happening now is only a tip of the iceberg. If we don't learn to allow the small fish to go so that can catch the bigger fish later; or we don't learn to keep the fox out of our pen; or we don't put more priority on sustaining this profession rather than doing charity with it, very soon, even the youth employment program would not be available for us.

Alhassan Hafiz
Senior Health Tutor
Nursing and Midwifery Training College, Kpembe
Northern Region - Ghana.
Email: alhafizmalcolmx@gmail.com
Tel: 0242886972