WHY NIGERIAN DOCTORS AND NURSES ARE ALWAYS AT WAR

Much like Tom and Jerry that can’t do without each other, Nigerian doctors and nurses have a love-hate relationship. Our doctors and nurses have been in the news lately, not for making amazing discoveries or inventions to better the patient experience but for reasons one cannot readily fathom. First was a doctor assaulting a nurse for not performing duties he felt were hers, and then, a nurse unlawfully imprisoning and assaulting a doctor for duties she felt were the doctor’s. I will not go into or analyze the above incidents as concerned authorities are already addressing them.

Conflict in the Workplace

In any work environment, there will no doubt be conflict as people from diverse backgrounds come together in a confined space.

Babies do not come into this world hating other babies of different color, tribe, or religion, likewise the medical or nursing training curriculum doesn’t teach that doctors are the natural enemies of nurses or vice versa. Doctors and nurses have traditionally maintained a very harmonious working relationship with mutual respect. It is quite common to see doctors and nurses marry one another. In fact, the most popular spouse for a doctor or a nurse is another doctor or nurse. As a young doctor, I’ve learned a lot of valuable and eternal skills from nurses.

How did we get here?

The seeds of conflict have grown underground before manifesting as what we see lately.

Apart from personal conflict between nurses and doctors in Nigeria which is no different worldwide, there is also what can be termed professional conflict. Several years ago Nurses in Nigeria teamed up with other allied health professionals in a body called JOHESU. They pressed home certain demands:

• Members should be made consultants like doctors
• Correction of marginalization
• Members should head hospitals, a position traditionally held by doctors. The Association of Resident Doctors and the Nigerian Medical Association keenly fought against this.

Causes of Doctor/Nurse conflict in our Hospitals

1. No specific Standard Operating Procedures: Jobs are not properly defined. Everyone does what he or she learned from his immediate superior be it a senior house officer, registrar, consultant, or matron. Not necessarily what is in the books. There are no guidelines on what should be the function of a doctor, nurse, attendant, etc.

2. Blurred lines: In smaller or limited resource settings one person may carry out functions of different people/cadres. This is later erroneously taken as their assigned duty.

3. The Workload: there is an unbelievable amount of brain drain on the country’s health manpower presently. About 7000 nurses left the system in 2021 to places like the UK for a better life. About half the registered doctors in Nigeria have left. The health workers left are frustrated as they have to care for far more patients per person. Statistics show we have 1 nurse to 2500 patients. Some even cover more than one ward at a time. This situation can definitely lead to anger and frustration.

4. No line of Error Reporting: There is no distinct line for error reportage in most hospitals. Nobody knows who exactly to report to. Nothing comes out of previously reported grievances and there is no protection for a whistleblower.

5. Lack of a Team spirit/Unhealthy rivalry/ Ego: People are thrown to work together in a ward without any formal familiarization or introductions. Furthermore, Some find it hard to defer to others even if that person is in a position of authority. There is also the cultural aspect to it where an older person would not take orders from a younger person even when the younger is in a position of authority.

6. Home Palava: Our hospitals lack human resource management/ mental health counseling for staff. A lot of times people bring their home frustrations to work. You may trigger them at the wrong time.

Solutions:

1. There should be standard operating procedures for all cadres of staff
2. Establish procedures for reporting errors and conflict. Set up anonymous means for reporting colleagues and senior colleagues.
3. Independent disciplinary panels not made of colleagues/peers
4. There should be functioning human resources and mental health departments in our hospitals
5. We should take Labour laws seriously. There is a maximum amount of time a health worker should work daily. Likewise, there is a maximum number of patients one should attend daily
6. Take Worker burnout seriously
7. Regular out-of-office hangouts to foster good working relationships
8. Equity, parity, and balance in remunerations.