The
Head of Civil Service of the Federation (HCSF),
Federal
Secretariat Complex,
Shehu
Shagari Way, P.M.B. 248,
Garki,
Central Business Area, Abuja.
Madam,
Official
Response from the University Graduates of Nursing Science Association (UGONSA)
to the Nigerian Association of Medical and Dental Academics (NAMDA) position on
Consultant Cadre for other Healthcare Professions
To:
The Honourable Head of Service, Federal Civil
Service of the Federation, and to
all stakeholders in Nigeria’s health sector
UGONSA
has read with grave concern the petition written to your office by the Nigerian
Association of Medical and Dental Academics (NAMDA) tilted “PETITION ON THE THREAT TO PATIENTS SAFETY
IN THE NATIONS’ HOSPITAL SYSTEM: THE NEED TO STOP THE CREATION OF UNNECESSARY
AND ILEGAL CADRES OF HOSPITAL CONSULTANTS AT THE ONGOING NATIONAL COUNCIL ON
ESTABLISHMENT MEETING HOLDING IN KANO”.
We categorically reject the assertion that creating
regulated cadres of consultant nurses (or accredited advanced nursing roles)
will “derail clinical management” or inherently put patients at risk. On the
contrary, international evidence and authoritative policy bodies show that
enabling nurses to practice at the top of their education and training
strengthens health systems, improves access and patient outcomes, and is an
essential response to workforce shortages (Institute
of Medicine, 2010; Kennedy et al., 2012; Laurant et al., 2018; Royal College of
Nursing [RCN], 2021; World Health
Organization, 2021; American Association of Managed Care Nurses [AAMCN], 2025). Below, we state the facts, cite the
evidence, and propose safe, practical policy safeguards for Nigeria.
1. The “consultant” title is not the
exclusive preserve of medical doctors. It is used safely in other health
systems: NAMDA
argues that the title consultant in hospitals is unique to doctors and confers
exclusive ultimate responsibility for patient care. The international reality
is different. In the United Kingdom, for example, consultant-level nursing
posts (commonly called Nurse Consultant) are an established, regulated senior
clinical role with defined responsibilities, clinical leadership, service
development, education, research, and professional governance, operating within
multi-disciplinary teams (Royal College of Nursing [RCN], 2021).
2. Strong, high-quality evidence shows
advanced nursing roles are safe and effective, and improve healthcare access,
quality and satisfaction: Evidence-based
summaries reach the following conclusions: A major Cochrane review and
updates on nurse-led primary care show that substituting nurses for doctors in
many primary-care tasks produces similar or better patient health outcomes and
higher patient satisfaction, with no clear increase in harm (Laurant et al.,
2018). Nurses tend to have longer consultations, and evidence shows at least
equivalence for many conditions. Systematic reviews and mixed-methods
evaluations of nurse consultant roles (UK and international literature) report
improvements in service quality, patient experience, chronic disease management,
and workforce development, while noting that well-designed role specification
and outcome measurement are essential (RCN, 2021). Where roles are
well-structured and evaluated, benefits follow. Reviews of advanced nursing practice
reported consistent improvements in access, chronic disease self-management,
and patient satisfaction when Advanced Practice Nurses (APNs), Nurse
Consultants, or Clinical Nurse Specialists provide care (AAMCN, 2025). The
evidence supports expanding appropriately trained nursing roles to meet unmet
needs. Empirical evidence thus shows
that when nurse consultant roles are regulated, educated, and integrated into
team governance, outcomes are improved or equivalent to those of physician-led
care across many services (Kennedy et al., 2012; Laurant et al., 2018; AAMCN, 2025).
3. Leading global policy bodies
recommend nurses be enabled to work at full scope — Nigeria should align with
those recommendations: The
Institute of Medicine (IOM; now the National Academy of Medicine) landmark
report The Future of Nursing: Leading Change, Advancing Health (2010) concluded
that health systems must enable nurses to practice to the full extent of their
education and training, expand opportunities for nurses to lead and redesign
care, and increase the proportion of nurses with higher levels of education.
The IOM made clear that removing scope-of-practice barriers and supporting
advanced practice is vital to meet population needs. This remains a cornerstone
reference for global health system workforce reform. The World Health Organization’s Global
Strategic Directions for Nursing and Midwifery (SDNM) 2021–2025 likewise urges
Member States to strengthen nursing education, regulation, leadership, and
practice so nurses can contribute maximally to universal health coverage. That
policy recognizes advanced nursing roles as part of the solution to workforce
shortfalls and service gaps.
4. Nigeria has a demonstrable
workforce gap — task-sharing and advanced nursing roles are proven, necessary
mitigation strategies: Nigeria
faces a severe physician shortage and large regional maldistribution of
doctors. International comparisons and country data show physician densities in
Nigeria are far below WHO-recommended levels; health system resilience demands
complementary approaches. Deploying regulated advanced nursing roles is a
proven strategy to expand access (particularly in primary care and underserved
areas) without lowering standards. Example: where doctor supply is constrained,
nurse consultants/nurse practitioners/advanced nurses in many countries provide
primary care, emergency care, and chronic-disease management safely and
cost-effectively, reducing waiting times, improving continuity of care, and
improving outcomes.
5. The concerns NAMDA raises about
accountability, scope, and budgets are addressable — regulation, accredited
training, and governance can fix them: NAMDA’s letter raises three recurring fears: (A) loss
of clinical accountability, (B) role confusion and conflict, and (C) budgetary
bloat. UGONSA responds with practical, evidence-based policy solutions:
A.
Legal and clinical accountability — solution: embed advanced nursing roles in
statute and regulation. Define clearly (in law/regulation/appointment letters)
where medical ultimate responsibility lies and where advanced nurses have
autonomous authority (e.g., prescribing, diagnostics, counselling,
rehabilitation) under defined scopes. International models use collaborative
practice agreements, professional regulation, and hospital governance
(credentialing, privileging, clinical guidelines) to ensure clarity.
B.
Role clarity and team functioning — solution: adopt national competency
frameworks, accredited postgraduate programmes (MSc/Doctoral/APN curricula),
formal credentialing, and job descriptions that specify decision-making limits,
referral triggers, and escalation pathways. The UK, Canada, Australia, and the
US have used these governance mechanisms successfully.
C.
Cost/budgeting concerns — solution: pilot with objective evaluation. Where advanced
nursing roles reduce admissions and readmissions, improve chronic disease
outcomes, or increase clinic throughput, any higher grade pay is offset by
system gains (reduced avoidable admissions or readmissions, improved
throughput). Evidence from multiple health systems indicates cost-effectiveness
and cost reduction. Nigeria has the potential to cut healthcare costs through
nurse consultants/advanced nurse practice cadres, as data from countries that
have implemented it show.
6. International practice: how countries manage
consultant/advanced nursing roles (short examples): United Kingdom (NHS) — Nurse Consultant posts exist within
trusts with clear job plans: leadership, expert practice, education, and
research. These are senior clinical roles defined by employers and regulated by
the Nursing Council. They do not remove physician accountability for acts
requiring a medical license.
United
States & Canada — Advanced
Practice Registered Nurses (APRNs), Nurse Practitioners (NPs), and Clinical
Nurse Specialists (CNSs) deliver primary care, emergency triage, and specialist
clinics under state/provincial regulation; many jurisdictions have independent
prescribing and diagnostic authority after credentialing. Cochrane and other
systematic reviews find equivalent or better outcomes for many services
(Laurant et al., 2018).
Australia
— Nurse
practitioner roles operate with clear legislation and clinical governance;
outcomes and access improvements are documented wherever nurse practitioners
were introduced into underserved settings.
These examples show that titles
alone are not the threat. The threat (or benefit) is defined by whether roles
are accompanied by regulation, training and governance. Nigeria can adopt the best
practices to improve the fortune of our distressed health system.
7. What UGONSA proposes (practical,
safety-first roadmap): UGONSA
is not asking for ad-hoc titles or tokenism. We propose a staged, defensible
policy:
Legal/regulatory
framework —
the Federal Ministry of Health, working with the Nursing and Midwifery Council
of Nigeria (NMCN), National Assembly, and legal drafters, should define legal
scopes for Advanced Practice Nurses/nurse consultant-level roles (titles,
privileges, limits). This will remove ambiguity and make accountability
explicit.
Accredited
postgraduate training — all
consultant nurses and advanced practitioners must complete accredited
postgraduate programmes (master’s level or equivalent; doctoral capability for
consultant-level practice as required) with defined competency outcomes.
Federal
Ministry of Health Guided Credentialing & hospital privileging — hospitals must credential and
privilege based on competencies; the Federal Ministry of Health, in
collaboration with the Office of the Head of the Civil Service of the
Federation, should define staging protocols to guide referrals and escalations
to higher levels of care.
Pilot
programmes and evaluation — implement pilots in primary care
deserts and tertiary specialty clinics with robust outcome measurement (safety,
mortality, readmissions, patient satisfaction, cost) and publish results
publicly.
Collaborative
practice & clear patient safety protocols — define where medical ultimate
responsibility applies (e.g., certain surgical interventions), and where
advanced nurses may autonomously manage care (e.g., chronic disease clinics,
triage, wound care, palliative care) with mandated referral and escalation
rules.
National
workforce planning —
use the WHO SDNM and IOM recommendations as frameworks to scale advanced
practice where workforce shortages are most acute.
8. Direct rebuttals to some specific
claims in the NAMDA petition.
NAMDA:
“Consultant
pharmacist/nurse roles add no clinical value in hospitals.”
UGONSA
Response:
International empirical reviews show that pharmacist/nurse consultants add
immense value in clinical leadership, service redesign, medication management,
diagnostic leverage, system thinking, and patient-centered care that improve
access, outcomes, and satisfaction. Where roles are poorly implemented,
benefits are muted. Therefore, the remedy is better role design and evaluation,
not prohibition.
NAMDA: “Appointment to consultant rank is
a political back-door and will create role confusion.”
UGONSA
Response: Nursing
is a globally trusted profession. The trust is why the care of humanity is
entrusted to nurses. Nurses must be allowed to advance professionally and
academically to continue to add value to the care mandate entrusted to them. NAMDA should have rather emphasized transparent
job criteria, advertised vacancies, competency-based appointment, and statutory
regulation for the nurse consultant cadre, and not the denial of role evolution.
The RCN/NHS model shows that formalized appointment and job planning are
workable safeguards.
NAMDA:
“We will not work
in an environment with these roles.”
UGONSA
Response: UGONSA
urges constructive collaboration, not threats. Multidisciplinary teams are the
future of safe, quality health care; clinical governance frameworks protect
patient safety and professional responsibilities for all cadres (IOM, 2010). UGONSA
stands ready to discuss specific NAMDA concerns in a joint stakeholder forum.
Conclusion
Nigeria’s
health system faces real shortages and growing demand. The Institute of
Medicine and the World Health Organization are explicit: nations must enable
nurses to practice to the full extent of their training and education, educate
nurses to higher levels, and expand nursing leadership in the health system and
care redesign. The international evidence shows that advanced nursing roles are
safe and often advantageous when implemented with robust regulation and
governance. UGONSA therefore reaffirms that we strongly support the creation of
regulated, accredited consultant/advanced nursing roles where those roles are
defined by law, backed by accredited education, and integrated into hospital
governance with clear scopes and accountability. We invite the Office of the
Head of Civil Service to galvanize the Federal Ministry of Health, the Medical
and Dental Councils, the Nursing and Midwifery Council, NAMDA, Nigeria Medical Association,
National Association of Nurses and Midwives, Pharmaceutical Society of Nigeria,
and other stakeholders to establish a
joint technical working group to draft legal/regulatory frameworks, an
accreditation pathway, pilot sites, and outcome metrics for the consultant
cadres of other healthcare professions and to do so in full public view. UGONSA
is ready to lead and collaborate on this evidence-based reform to ensure
Nigeria’s hospitals deliver safe, accessible, efficient, evidence-based, and
modern care for all Nigerians.
Signed:
Nurse
Opeyemi Ojo
Nurse Eteng Philip
UGONSA
National President
UGONSA National Secretary
References
American Association of Managed
Care Nurses. (2025). Nurse consultant job description. https://careers.aamcn.org/career/nurse-consultant/job-descriptions
Institute of Medicine. (2010). The
future of nursing: Leading change, advancing health. The National Academies
Press. https://pubmed.ncbi.nlm.nih.gov/24983041/
Kennedy, F., McDonnell, A.,
Gerrish, K., et al. (2012). Evaluation of the impact of nurse consultant roles
in the United Kingdom: a mixed method systematic literature review. J Adv
Nurs., 68(4), 721-42. https://doi:10.1111/j.1365-2648.2011.05811.x.
Laurant, M., van der Biezen, M.,
Wijers, N., et al. (2018). Nurses as substitutes for doctors in primary care. Cochrane
Database System Review, 16, 7(7):CD001271. https://doi:10.1002/14651858.CD001271.pub3.
Royal College of Nursing. (2021).
Consultant level nursing. https://www.rcn.org.uk/Professional-Development/Levels-of-nursing/Consultant
World Health Organization. (2021). Global
strategic directions for nursing and midwifery 2021–2025. https://www.who.int/publications/i/item/9789240033863
