Danger in the Ward: The Rise of Unlicensed Nurses in Private Hospitals
By Matthew Eloyi
Nigeria’s healthcare system is facing a quiet but dangerous crisis that deserves far greater public attention: the growing use of auxiliary or unlicensed nurses to perform duties that should ordinarily be handled by professionally trained and licensed nurses, alongside the widespread practice of non-pharmacists dispensing and administering medicines in some pharmacy outlets and private healthcare facilities.
What makes the development particularly disturbing is that it is increasingly becoming normalised. In many communities, patients walk into private hospitals, clinics and medicine outlets without knowing whether the person attending to them possesses the professional qualifications and licence required to provide the service being offered.
Healthcare is not an ordinary commercial enterprise where experience alone can substitute for professional qualification. A wrong decision in a hospital or pharmacy can have consequences that range from prolonged illness to permanent disability or death.
The issue, therefore, is not whether auxiliary health workers have a place in Nigeria’s healthcare system. They do. The question is where the boundaries of their competence lie, who supervises them and whether patients are being adequately protected from tasks beyond their training.
The nurse is more than the person holding the syringe
Professional nursing requires specialised education, clinical training, ethical preparation, registration and continuing professional development. Licensed nurses are trained to assess patients, recognise changes in their condition, administer medicines safely within their scope of practice, monitor treatment, provide health education and respond appropriately when complications arise.
An auxiliary worker may provide valuable support under appropriate supervision. But support is not the same thing as professional nursing.
The growing tendency of some private hospitals to place inadequately trained personnel in positions that require licensed nurses risks eroding the distinction between the two.
In a health facility driven primarily by the desire to reduce operating costs, an unqualified or inadequately trained worker may appear attractive because such personnel can be employed more cheaply. But what a hospital saves in wages can potentially cost a patient much more in complications, misdiagnosis, medication errors, delayed referrals and avoidable harm.
This is where healthcare regulation must confront commercial realities.
A hospital should not be permitted to treat the cost of employing a qualified nurse as an unnecessary expense. Professional competence is part of the cost of delivering safe healthcare.
Patients cannot be expected to police hospitals
One of the biggest problems is the information imbalance between patients and healthcare providers.
A patient who walks into a private hospital with fever, abdominal pain, high blood pressure, difficulty breathing or another serious complaint is usually not in a position to determine whether the person attending to them is a registered nurse, an auxiliary worker, a community health practitioner or someone with little formal medical training.
The patient assumes that the person wearing the uniform is competent and authorised to perform the task.
That assumption should not be exploited.
Private hospitals should be required to clearly identify the professional category of personnel attending to patients. A nurse should be identifiable as a nurse. An auxiliary or support worker should not be presented in a manner that leads patients to believe that the individual is a licensed professional.
Transparency would not solve every problem, but it would give patients a basic right: the right to know who is providing their care.
The pharmacy problem is equally troubling
The same concern extends to the dispensing and administration of medicines.
Pharmacists undergo specialised education and professional training in medicines, including their composition, indications, contraindications, interactions, dosage, storage and potential adverse effects. Their role is therefore much more than simply taking money and handing over packets of drugs.
Yet in some medicine outlets and healthcare establishments, non-pharmacists are reportedly performing functions that require professional pharmaceutical judgment.
This is particularly dangerous in an environment where Nigerians already practise widespread self-medication.
A customer may enter a medicine shop complaining of headache, stomach pain, cough, weakness or another symptom. Instead of being appropriately assessed or referred, the individual may be sold a combination of medicines by someone whose training does not qualify them to make that clinical judgment.
The consequences can be serious.
A symptom may be mistaken for a simple ailment when it is actually a sign of a potentially life-threatening condition. Two medicines may interact adversely. A patient may receive an inappropriate dose. An antibiotic may be supplied when it is unnecessary. A drug may be contraindicated because of pregnancy, age, allergy or an underlying medical condition.
The problem is not the existence of trained pharmacy support personnel. The problem arises when professional responsibility is transferred to people who do not possess the requisite competence or authority.
Cheap healthcare can become very expensive
There is an uncomfortable economic dimension to this problem.
Nigeria’s high cost of healthcare puts enormous pressure on private hospitals, pharmacies and patients. Facility owners face rising costs of rent, electricity, equipment, salaries and medical supplies. Patients, meanwhile, often struggle to pay their bills.
These pressures can create incentives to employ cheaper personnel or minimise staffing costs.
But healthcare cannot be safely managed solely according to the cheapest available labour.
When an inadequately trained worker makes a serious mistake, the patient may require additional treatment, referral or hospitalisation. Families may incur additional expenses, while the healthcare system bears the cost of correcting an avoidable error.
The apparent saving can therefore become a much greater social and economic cost.
Regulators must stop being reactive
Nigeria does not lack professional regulatory institutions. The challenge is enforcement.
The Nursing and Midwifery Council of Nigeria has responsibility for regulating nursing and midwifery practice, while the Pharmacy Council of Nigeria regulates pharmacy practice and premises within its statutory mandate. Other health professions are similarly governed by their respective regulatory bodies.
The existence of regulators, however, is meaningful only when their rules are consistently enforced.
Routine inspections should not be conducted merely after a complaint, media report or patient death. Regulatory agencies need credible, risk-based and continuous monitoring of healthcare facilities and medicine outlets.
Facilities found employing unqualified personnel for regulated professional duties should face appropriate sanctions. At the same time, genuine support workers should be properly defined, trained, supervised and prevented from being presented as professionals.
Private hospitals are healthcare institutions, not merely businesses
There is also a responsibility on owners and managers of private hospitals.
Private healthcare has become indispensable to Nigeria’s health system, and many private facilities provide excellent and professional services. It would therefore be unfair to portray the entire sector as irresponsible.
But precisely because private hospitals serve such an important public function, their commercial character cannot override patient safety.
A hospital owner who knowingly substitutes an inadequately qualified person for a licensed professional to save money is not simply making a staffing decision. That decision can affect the life of another human being.
Professional healthcare should never be reduced to a calculation of “How cheaply can this patient be attended to?”
The more appropriate question is: “What level of competent care does this patient require?”
Patients also have a role
The public must equally become more conscious of its rights.
Patients and relatives should feel empowered to ask who is attending to them and, where appropriate, whether the person is licensed to perform the procedure or provide the service.
Hospitals and pharmacies should not interpret reasonable questions about professional qualifications as an insult. In a properly regulated health system, verification should be routine.
The public should also resist the temptation to purchase prescription medicines simply because someone at a medicine outlet recommends them. Pharmacists and other qualified healthcare professionals should be consulted where professional assessment is required.
The government must address the root causes
Regulation alone will not solve the problem.
Nigeria needs a broader strategy to address the shortage and uneven distribution of healthcare professionals. The country must invest in nursing and pharmacy education, expand legitimate training opportunities, improve remuneration and working conditions, and create incentives that encourage qualified professionals to remain in the country.
The migration of Nigerian nurses, pharmacists, doctors and other health professionals has intensified concerns about workforce availability. But the answer cannot be to quietly replace professional workers with inadequately qualified personnel and pretend that the gap has been solved.
A shortage of professionals is a workforce problem, not a licence to lower professional standards.
Nigeria must also strengthen collaboration among healthcare regulators, state ministries of health, professional associations, private healthcare operators and law-enforcement agencies where necessary.
A dangerous normalisation must be reversed
Perhaps the most worrying aspect of the trend is its gradual normalisation.
When patients repeatedly encounter people performing professional healthcare functions without knowing their qualifications, society begins to accept it as normal. When medicines are routinely dispensed by unqualified personnel without consequences, the boundary between regulated practice and informal practice becomes blurred.
That is how a healthcare crisis becomes institutionalised.
Nigeria cannot aspire to universal health coverage while allowing professional standards to be compromised at the point where patients actually receive care.
Healthcare quality is not measured merely by the number of hospitals, clinics or pharmacies available. It is measured by whether the person providing care possesses the knowledge, competence, ethical standards and professional authorisation required to do so safely.
The country therefore needs a renewed national conversation about who is allowed to do what in healthcare.
Auxiliary workers have a legitimate place in the system, but they must operate within clearly defined limits and under appropriate professional supervision. Non-pharmacists may perform legitimate support and administrative functions, but professional pharmaceutical decisions must remain within the legally authorised scope of practice.
The principle should be simple: every healthcare task must be performed by a person with the appropriate competence, training, supervision and professional authority.
Nigeria’s healthcare system has enough challenges already—from inadequate infrastructure and high costs to brain drain and limited access to quality care.
We should not add another by allowing unqualified hands to gradually take over responsibilities that demand professional expertise.
A patient’s life must never become the price of cutting the payroll.
And in healthcare, the cheapest hand is not necessarily the safest hand.
