1. Lack of Interest in Research: The nursing professional is at providing quality nursing care by providing a scientific base for the practice of nursing. Thus the input of research has become necessary. Unfortunately, only very few nurses are interested in research, even though it is the responsibility of all nurses to do research to improve nursing care. The introduction of research methodology as a course in schools of nursing has done little for now, to make students attach must importance to research projects, as most students believe that research ends after school.
2. Work Environments: Some work environments are un-conducive and non- supportive for nursing practice, as they lack sufficient facilities and equipment to work on and they also lack sufficient motivational input, such as housing transportation, incompetent supervision, poor working relationship, general moral laxity in the society, undue familiarity with subordinates, with a weakness in disciplinering staff, among others nurse are no longer in control of the immediate environment in which patients are nursed. If quality health care must be provided then we have to look conically unto some of the problems of the physical, social and mental environment.
3. Nurse Herself or Himself: The greatest challenge to nursing practice in Nigeria is the nurse herself or himself. Nurse in contemporary Nigeria are less caring, committed and dedicated to meeting the needs of clients. Most nurse are resistant to change, professional development and advancement. In nursing practice and education, some nurse tends to hold onto previous, knowledge and skills without making efforts to improve and maintain new skills. Many nurses are not willing to accept challenges of staying abreast with education and development of new skills in their areas and levels of nursing practice, similarly, the natural qualities expected to be found in nurses (punctuality, self less service, among others) is virtually absent these days. This has serious implication for nursing practice.
4. Advancement in Science And Technology: The advancement in science and technology will continue to affect the nursing profession. In the past nursing relied on their experiences, observation and intuition but today, nursing has a defined body of knowledge specific to the profession and continues to develop this knowledge through research and practice as they relate to new drugs, methods of delivery, disease control and prevention through sterilization and disinfections of equipments, and models in nursing, among others, for instance, the knowledge and implementation of the nursing process as a scientific and systematic approach to nursing care has been seen by many nurses as problematic. Some nurse has found it difficult to implement because some professionals in the health system do not understand what it is all about.
5. Non Implementation of Nursing Process: In addition, some nurse have attached a lot of constraints such as shortage of staff and lack of stationary as reasons hindering the implementation of the nursing process which is a tools for improve nursing care. The changing role of the nurse require continued competence. Many nurse are unable to maintain a high level of individual competence in nursing practice, skill and knowledge, recognizing and accepting responsibilities for individual action and judgment.
6. Non Participation in Making Policy: Policy making on health issues is a major challenge to nursing practice. Most nurses are women and therefore the position of nurse in Nigeria and the value given to nurse work are a hinged with their position in the society. The nurses of the past were grossly handicapped because of the type of training they received. They were maids and took their feminine submissive roles without questioning, after all, their husband is the head of the home. Nurses have traditionally been subordinate to physicians and these have affected their leadership roles in policy making on health issues. Nursing today is practiced in the midst of other health needs competing for the scare resources allotted to health. These poor representation and participation of nurses in decision making on health matters will not move nursing forward. This situation must change if our wonderful dreams about the future of nursing must be fulfilled.
7. Infections: Increasing number of infections, many Nigerians still very much patronize traditional headless and traditional birth attendants especially now that they have to pay for the health service they receive. Even if they come to the hospital acutely ill, they leave much sooner than they did in the past, thereby increasing the demand on nurse to ensure high quality comprehensive care before discharge. Some nurse are affected by nosocomal infection eg Lassa Fever etc.
8. Quackery: The incursion of quackery in nursing has been a big threat to nursing practice in Nigeria. Everybody in white answer a nurse. This cancer worm has eaten up the integrity and image of nursing. The masses cannot differentiate between a the quacks and scientific nurse.
9. Poor Media Projection of Nursing: The mass media eg newspapers, radio station etc do not project us very well to the general public.
a. The doctors, pharmacists even environmental health workers are being projected better to the taste of the people.
b. Notwithstanding, every everybody need the services of the nurses at all times. They project us as inferior or second-class citizens thereby demoralizing the regard, respect and trust the public have on us.
10. Academic Regulation: Most of our universities and schools of nursing do not have concrete curriculum for nursing education. The national university commission and nursing council suppose to sit and make the curriculum for nursing education common in Nigeria.
11. Politics: This has eroded the general system including nursing practice eg sitting of schools, hospital, health centers, and nurse’s wages! Remuneration for nurses has been politicized even today.
12. Lack of Equipment: Unavailability, lack of proper planning and budgeting due to non-involvement of nurses and many nurse leaders in management’s budgetary meetings. Poor knowledge of nurse leaders, knowledge about politics and the influenc
e of nursing administration on general hospital administration/ management
13. Lack of Continuous Training and Re–orientation: Nurses continues to practice in most hospitals without re-orientation to the needs of patients in the 21st century. Non attendance of clinical care workshops by nurses and non organization of seminar /workshop on clinical nursing issues are all inherent problems in many Nigerian hospitals.
14. Lack of commitment on the part of nurses: many nurses just practice for practicing sake, they do not see the intricacies of nursing as a care from nurse professionals, rather they are committed to other issues of life than nursing care practice. Many practice only for financial benefit not because nursing is a calling for them. Student nurses are also victims of this situation.
15. Nurses idea about improvisation: In order to have the favour of management, most nurses are committed to improvisation to a faulty level, instead of asking for the right equipment and materials for nursing care services. Nurses seldom go on industrial action because of lack of equipment for nursing clinical works rather they continue to improvise to the detriment of their professional practice.
16. Rural urban migration of nurses: Nurses idea about rural care and delegation of this care to untrained person is a major problem that is causing declining nursing services in Nigeria. Many nurses don’t like to live in rural settings.
17. Leadership Problem Leading To Poor Management: most nurse leaders lack experience and they retire away quickly as soon as they enter into nursing administrative arena because of age on entry and number of years in services. The experienced nurses are not also available in the clinical settings to render service rather they are kept in offices away from their patients and fellow nurses that needs to learn from their past clinical experiences. They seek office allocation, good chair to seat on as soon as they have been promoted to higher ranks, this they claim is to show the level of their status instead of good clinical practice to be shown for the status. Also nurses now migrate at alarming rate out of the country to seek greener pastures. Some experienced nurses also hide under the canopy of poor health not to render services yet they remain as leaders. All these are copied by the junior nurses and nurses in training and subsequently as soon as nurses become registered they form the association of nurses that seat round the table or in offices in different wards with their bags full of items that are on sale and latest materials in town (cloth and jewelries).
18. Professional Rivalry: (inter/intra professional rivalry) nurses not seeing themselves as the strongest pillar in health field, rather they practice other professions that are not nursing in order to seek personal/societal recognition. Most times many nursing independent activities are left undone the interdependent activities are done with much commitment. Bed bath, bed pan round, monitoring of vital signs and patient care reporting are fast leaving hospital setting. The relatives are made to carry bed pans, doctors to see patient alone on wards/ clinics, and do patients vital signs themselves while in clinics, nutritionist also have to book meals for the patients themselves without the nurses participation. Nurses claiming to be too busy to perform these activities and making them to do less important activities of nurses. With the nursing professional cadres in Nigeria the educational reform has made it possible for nurses with first degree to practice along with those with diploma trainings. This is supposed to be a strength for nursing care in Nigeria. If intra -professional rivalry are removed nurses would learn from each other and subsequently nursing care would be improved in this century. Nurses at leadership position should consult their learned and experienced fellows nationally and internationally to be able to acquire both theoretical experience and practical skill needed for improved services. Consultation now made easy with computerization. E- mailing each other on ideas about care in hospital settings that are more advanced than ours. Use of internet facilities to improve nursing care in Nigeria. Entry level into nursing permits aspiration to top level in the career structure, not running from clinical setting to school of nursing or to teaching. Clinical setting requires nurse clinicians for appropriate rivalry inter professionally in the health care setting. Nurses are to teach themselves as well, as the public, these days the public is well informed, they need to inform nurses too. Omolade (2003) In all these our senior nurses or nurse leaders may be copied positively or negatively by the junior ones or nurses is training. It is necessary for nurse leaders to serve as good example by practicing appropriately having appropriate, education and ensuring same by others. Adequate dressing promotes the image of nursing so also is the professional rivalry- (Omotoriogun 1996).
19. The Educational Goal of the Nurse: Nurses satisfaction with basic qualification and practice for financial reward in the 21st century is another major cause of declining care because it always amount to great competency in terms of advancement in education vise-visa in clinical nursing practice. Professional nursing educational now borders on continuous education and specialization. Continuous training and development leads to good leadership and better skills in nursing care services, it also promotes the image of nurse in the society. The status of nursing is our society has not promoted good professional image, for the nurses largely because of poor facilities in the training institutions and lack of commitment to practical teaching in the ward by all cadres of nurses. Nurses leaving professional care to student nurses or pupil midwives. Nurses must practice to show the learners how to do it, nursing professional training is hospital based. All cadres of nurse must be committed to this apart form clinical instructors.
20. Image of the nurse: The nursing professional image in Nigeria is dwindling because of nurses inherent sub-servant behaviour in clinical settings even though nurses have been granted professional status in Nigeria they are still sub-servant in practice (Omofuma 2007). The nurse leaders need
to learn to regulate their own services not leaving it for others to decide upon.
21. Nursing procedure/quality assurance: There is need to review procedure manual nationally and steps in the procedures should be implemented appropriately in all hospitals, this would always improve the quality of care rendered by nurses. Quality assurance units must be established to ensure auditing of nursing services. Nurses need to be closely monitored to ensure quality care and accountability
22. Financial problem/ poor information system: poor information system is another cause of declining nursing services, proper planning and budgeting plus monitoring are essential information that have delayed the progress of nursing services in Nigeria. There are no realizable and accurate data in which care is planned. Information to patients is very poor. Interpersonal relationship between various professional in the hospital setting is poor and this also can cause a fall in care rendered and negative image of the professionals. Nurses need to read newspapers, journals and internet articles to be more informed about current issues in nursing services
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