‘Weird’ rules in nursing training in Upper East Region-who is responsible and accountable?

Lately Ghana web reported what to me, is professionally ‘weird’ orders/rules by the Upper East Regional Director of Health Services, Dr John Koku Awoonoor-Williams asserting that, there are rules within the Ghana Health Services which stipulates that a female student undergoing nursing training/orientation should abstain from becoming pregnant! With respect to Dr Awoonoor-Williams’ warning to our female nursing students, as a Senior Lecturer Researcher in Health Studies, I feel that issues of such nature can bring the nursing education into disrepute. The question is which section within our Health Service General Orders enshrines such bizarre rules in relation to female student nurses. This to me is a challenge for Dr Awoonor-Williams to substantiate! Further, what are our Nursing Officials both in Nursing Education and Management doing about Dr Awoonoor-Williams’ warning? One wanders whether Dr Awoonoor-Williams is aware of the implications his ill-founded rules/threats has on student nurses recruitment and retention especially female students for whom the profession dearly cherishes since Florence Nightangle era? You may argue that it is none of this writer’s business to subject a female student on the issue of as to how, when, and where questions about her pregnancy, let alone to seek for her dismissal on such natural grounds. But as a ‘personal tutor’ to some female nursing students within the Middlesex University it is one of my professional roles to direct a student with such a natural issue to the appropriate department concerned within the University. To the best of my knowledge, the pregnant student would be counselled and given leave of absence so that nature and nurture would take its due course. The student is at liberty to return to the University to complete her nurse training course after delivery-and that is as simple as that with no bottle-necks attached.

However, one should not over-blame Dr Awoonoor-Williams for what might be seen as some form of ‘unprofessional behaviour’ by a Senior Health professional with such a high status (in a United Kingdom National Health Trust and in other countries) for example, but rather the media! Worldwide, the media has been noted for perpetuating nursing’s poor public image, but, in reality, the media simply reflect public opinion. From my experience in health studies education, I can state that some nurses have often failed to take advantage of the opportunity to respond to media requests for information, saying such things as, “You’ll have to ask the doctor” even when the query relates to nursing education and practice! It can be argued that fully armed with some knowledge about the inadequacies amongst some nurses, I think Dr Awoonoor-Williams might have captured the opportunity to pour scorn on our female students and indeed, female nurses in general! It is unfortunate that the ‘venom’ has been injected by our Senior Medical Officer which does not augur well in the Health Service in general! It appears that the said Senior Medical Officer in this context has usurped the role of the Senior Nurse/s responsible for nurse education and management within the Upper East Health Services who probably has no knowledge that such rules exists thus indeed, ‘over-burdening Dr Awoonoor-Williams’ professional responsibilities. It can be argued that rules underpinning nurse education such as length of training, issues that relates to female students’ marriage/pregnancy ought to be best addressed by the faculty of nursing studies or in short, by the Ghana Nurses and Midwifery Board rather than a Senior Medical Officer in my view, as rules are best obeyed in response to the legality and transparency that it contains.
We need to remind ourselves that the development and empowerment of nursing and nurses have ‘travelled’ a long way in search of recognition by the public and indeed, other health care professionals such as the medical profession. It is interesting to state that the mere mention of the word ‘paradigm shift’ in health care services will have most folks scrambling for metaphorical off button, but don’t hit that button just as yet! It is not surprising that many practitioners both in the medical and nursing profession find the discussion surrounding differing paradigms challenging, if not confusing. To ‘let the cat out of the bag’, a paradigm is essentially a world view specifying the basic assumptions and beliefs about the nature of reality (Khun, 1970). Forgive me here for I just want to point out that nursing knowledge and skills are no longer static as has been perceived by some health care professionals hence the notion of ‘the paradigm shift’. Therefore a paradigm shift in nursing education and practice is reflected in the ongoing developments of nursing science in many parts of the world’s health care services and Ghanaian Nursing Education must not ‘deliberately’ exclude herself from this worthwhile professional development. As already shown the shifting nature of nursing knowledge does cause some ‘discomfort’ among some doctors (Stein 1978). Stein (1978) refers to this as ‘the doctor-nurse game’ which she describes how nurses learn to give advice or show initiative whilst appearing to bow to the doctors’ authority. Stein suggests that open confrontation with authority figures is avoided, which obviously is detrimental to communication between health care professionals and consequently impacts on patient care.
A review of Stein’s work and from my research experience in countries such as Saudi Arabia (King Khaled Hospital, Najran), Ghana (Bawku Presbyterian Hospital), Rwanda (Kigali University Hospital), Singapore, and lately Moi University Hospital in Kenya, I am comfortable to state that nurse-doctor relations is professionally has been recognised and acceptable. I attribute this to the doctors’ recognition of their fallibility, reduced public esteem for doctors and male nurses together with increased esteem of nurses in their own right rather than as handmaidens. I would strongly argue that if there has been an improvement, it is also a result of changed nurse education, with the emphasis on more academic training and being prepared for more autonomous role where the ‘handmaiden’ role does not play a part. However, as my own reflection indicates, although relationship may have improved in some of the Teaching Universities that I have visited/researched (and from the recent media reports about a stern warning delivered by The Senior Medical Officer in Upper East Region of Ghana, (of which might have numbed the spines of our female nursing students as it can be argued), on the consequences of becoming pregnant whilst in training or orientation), it clearly is not perfect!
Within the health care services it is important that we are aware of the image we portray to our clients and other professionals, as it is one of those, that, encourages or detracts the concept of ‘partnership in care’ or healthy working relationship by the array of health care professionals. Sometimes assumptions about us do not correspond with the perceptions of others, but when considering our own views and those of others the overall effect is to help us develop self-awareness. I have been informed by numerous professional literatures and journals on ssues where self-awareness and self-knowledge has helped me and this would, I hope, certainly be of help to health professionals in general. Further, while self-awareness is important for personal and interpersonal purposes, it is vital when work involves any form of leadership. If one is to become an effective leader then it can only be achieved by knowing oneself and the impact ones behaviour and attitude has on others. Occasionally it is useful to take a long, hard look at yourself and what better time than the start of your career in health care. It is relatively easy to identify your perceived weakness, but when it comes to strengths things are a little more difficult.
For the benefit of all colleagues within the health care services-doctors, nurses, physiotherapists, radiographers, etc, etc, there is continuing need in my view to seek and to undertake continuing professional development programmes in ones organisation in pursuit of nurturing the notion of self-awareness in the self through the process of ‘adoption and adaption’. However, self-awareness is not singularly defined but it may be seen as a dynamic state of mind that a person reaches after examining his/her strengths and weaknesses in the individual’s attributes, and roles. Psychologist York (1995), adds that it involves influences and reactions from significant others and may be dependent on a person’s time and place!

By: Asigri, D. Z (EdD, Med, MA, BscPsy, DipEd, S.R.N, R.S.C.N, R.M.N, R.N.M.H, Cert Ed, and R.N.T.)
Senior Lecturer/Researcher
Middlesex University
London