International Journal of Educational Research and Information Science 2015; 2(4): 102-107 Published online December 17, 2015 (http://www.openscienceonline.com/journal/eris)
Appraisal of Barriers and Facilitators Associated with Advanced Professional Education among Nurses in Adamawa State, Nigeria Golfa Timothy1, *, Yunusa Umar2, Olatubi M. Idowu3, Ahmed Suberu2, Suleiman Dauda4, Dathini Hamina5 1
Department of Nursing Science, College of Nursing and Midwifery Yola, Adamawa State, Nigeria Department of Nursing Sciences, Bayero University, Kano, Nigeria 3 Department of Primary Health Care, School of Nursing Ondo, Ondo State, Nigeria 4 Department of Nursing Science, College of Nursing Damaturu, Yobe State, Nigeria 5 Department of Nursing Sciences, University of Maiduguri, Borno State, Nigeria 2
Email address
[email protected] (G. Timothy)
To cite this article Timothy Golfa, Yunusa Umar, Olatubi M. Idowu, Ahmed Suberu, Suleiman Dauda, Dathini Hamina. Appraisal of Barriers and Facilitators Associated with Advanced Professional Education among Nurses in Adamawa State, Nigeria. International Journal of Educational Research and Information Science. Vol. 2, No. 4, 2015, pp. 102-107.
Abstract The health care delivery system is rapidly changing in response to the nature of development in science and information technology. This requires nurses to possess advanced education. This study was carried out to explore types of advanced educational programmes pursued by nurses and to identify the barriers and facilitators associated with advanced professional education. Cross-sectional design was utilized using a multistage sampling technique to select 200 nurses from 6 hospitals in the state, 2 in each of the 3 senatorial districts of Adamawa state. The study reveals 1.10% are holders of university nursing degrees. Majority possess advanced diploma certificates in Midwifery (26.92%), Perioperative nursing (19.78%), Accident and Emergency Nursing (11.54%), and Anesthesia Nursing (9.89%). Earning more salaries/allowances (36.81%), recommendation by employers (25.82%) and promotion purposes (14.84%) are the major facilitators of advanced nursing education. Financial difficulties (23.63%), family pressure/commitment (21.98%), Poor remuneration after training (12.64%), Lack of entry requirement (11.54%), Distance from training institution (9.34%) and Lack of proper placement after training (7.69%) are the barriers to advanced professional education. Finding revealed that only few nurses have undergone university nursing education, majority are advanced nursing diploma programme, hence the study recommends that a scheme of service that reflects the acquisition of various advanced qualification should be put in place for nurses at various levels and Adamawa state universities should be encouraged to introduce advanced nursing programmes.
Keywords Advanced Education, Nursing, University Education, Nurses, Adamawa State
1. Introduction Nurses play an important role in the Nigerian health care delivery system as they constitute a large proportion of workforce in the health sector. The International Council of Nurses (ICN) claims that the nurse assumes a major role in determining and implementing acceptable standards of clinical nursing practice [1]. The health care delivery system is rapidly changing in response to the nature of development
in science and information technology. The rapidly changing health care system requires nurses to possess increasing knowledge, clinical competency, greater independence, and autonomy in clinical judgment [2]. Increase knowledge can be achieved through advanced professional education and continuous training of nurses. The Nursing and Midwifery Council of Nigeria took cognizance of the National Policy on Education in developing sound educational principles essential to the preparation of nurses to function independently and/or as members of interdisciplinary and
International Journal of Educational Research and Information Science 2015; 2(4): 102-107
intersectoral teams[3]. Globally nursing education has developed through several stages from the practical nursing and nightingale schools in the early 1900s to bachelor of science in nursing, Masters and doctorate of nursing sciences in the present day [4]. Formal Nursing education in Nigeria is very different from the Western nursing education, in that the major entry level of nursing is a diploma or certificate in nursing [5]. Nursing programmes in Nigeria includes; general nursing, basic midwifery, peri-operative, and psychiatry nursing amongst other programmes either as basic or post basic. Though some nurses regards the post-basic programmes as advanced professional education, nonetheless, advanced nursing education in Nigeria begins with the Bachelor of Nursing Science (BNSc) degree. Upon completion of the first degree, individual nurse may proceed for a Master’s programme to obtain M.Sc. (Nursing) and later a Ph.D. (Nursing). The university nursing programmes prepare nurses at different levels and competencies. As at now there are few nurses who have a single qualification, that is, only nursing, or midwifery or psychiatry nursing and so on. Most Nurses in Nigeria have “double qualification” as after the general nursing programme, most nurses add other nursing qualifications after a number of years of practice. This creates an unnecessary overlap and duplication of efforts in many areas. However, it can be argued that nurses in Nigeria are over trained especially in the diploma level while very few have advanced qualifications either in form of B.N.Sc., M.Sc. or Ph.D [6]. Nursing education at the baccalaureate level and beyond is still not popular and only offered by few universities in the country. For instance, of the 124 federal, state and private universities approved by the National Universities Commission (NUC) in Nigeria [7], 18 are offering nursing programme but only four have their nursing programme fully accredited[8]. Out of this four none are in northern Nigeria, and there is complete absence of advanced or university nursing education in Adamawa state where this study was carried out. The demanding role of the nurse of the future will require that a Registered Nurse possess an expanded knowledge base and mastery of competencies that will allow effective management of a highly complex patient care journey in collaboration and partnership with other members of the health team[9]. Therefore, there are positive gains for nurse educators who undertake postgraduate nursing related to professional and personal growth which may lead to an increased ability to be able to leave up to their expectations and perform their roles [10]. Nurses require sound knowledge and skills for handling the sick [11]. The American Association of Colleges of Nursing (AACN) believes that advanced education has a significant impact on the knowledge and competencies of the nurse clinician, as it does for all health care providers. Clinicians with Bachelor of Science in Nursing (BSN) degrees are well-prepared to meet the demands placed on today's nurse. BSN nurses are prized for their skills in critical thinking, leadership, case management, and health promotion, and for their ability to
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practice across a variety of inpatient and outpatient settings. AACN encourages employers to foster practice environments that embrace lifelong learning and offer incentives for registered nurses (RNs) seeking to advance their education to the baccalaureate and higher degree levels[12]. Certain factors such as age of the nurse, financial constraint, employers in service training policies, family commitments, lack of entry requirement and poor recognition after training are mostly responsible for nurses’ inability to acquire advanced education[13]. Financial constraints during a recession are huge barriers in persons pursuing advanced education in all professional fields. Many nurses are working parents, husbands/wives, and professionals trying to juggle school and work to support family and provide security for their future. Morgenthaler identifies that nurses often do not want to add economic burden to their family’s current financial situation. Nurses who are considering obtaining advanced degrees may not qualify for scholarships and will have to be responsible for the full amount of educational costs and these costs will have come from personal loans or saving [13]. Furthermore, Nursing education and work-force development had been beset by multiple challenges including health systems issues, and various structural push and pull factors which includes; the health system’s inability to create jobs and absorb nurse graduates, debilitated infrastructures, poor remunerations, poor working conditions, and occupational risk exposures that push the employed out and away from the system [14]. The path to higher degree is still complicated for Nigerian nurses, and according to Ndatsu, nurses have to go through routes that are not clearly defined to obtain higher qualifications [7, 15]. Registered nurses today work as a part of an interdisciplinary team with colleagues educated at the master’s degree or higher level. These health professionals, including physicians, pharmacists, medical laboratory scientist recognize the complexity involved in providing patient care and understand the value and need for higher education Since nurses are primarily responsible for direct patient care and care coordination, these clinicians should not be the least educated member of the healthcare team [12]. Lillibridge and Fox, addressed contentment of non-bachelor prepared nurses with their current roles. They discovered that the nurses understood the advantages of a BSN degree for increasing their base of knowledge and reaching their career goals. Ultimately, they did not value advancing their education because there appeared to be more emphasis on the level of education, and not the relevance to the changes in health care nor the contributions they could make with having an advanced degree. Moreover, some Registered Nurses feel intimidated by the thought of having to begin school again. Some school’s criteria for their nursing programme can have major differences and it can create anxiety [16]. Morgenthaler, addressed the attitude of effort when deciding whether or not non-bachelor prepared nurses should attend school and identified the need for nurses to have a plan and goals while pursuing an advanced degree. They have to be realistic and prepared for lifestyle changes
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Timothy Golfa et al.: Appraisal of Barriers and Facilitators Associated with Advanced Professional Education among Nurses in Adamawa State, Nigeria
such as lack of personal time, and restricted time for family and friends, all which can deter some nurses from pursuing advanced degrees [13]. Therefore this study is designed to identify the types of advanced educational programme pursued by nurses and ascertain the barriers and facilitators associated with advanced education among nurses in Adamawa state. Advanced level of education has been associated with improvement in standard and quality of care, while many advanced nations of the world have make concise effort to move nursing education from hospital based apprenticeship schools to the university level, deductions from this study therefore, will assist the Ministry of Health and Hospital Services Management Board in finding solutions to the problems affecting the educational status of nurses in the state. This will extremely facilitate towards improving the knowledge and skills that will guarantee the provision of quality nursing care to the public.
2. Research Methods 2.1. Research Design Cross-Sectional design was used to evaluate the barriers and facilitators associated with advanced professional education among nurses in Adamawa state. 2.2. Study Setting The study was carried out in Adamawa state, Nigeria from July –August of 2013. Adamawa state is a state in Northeastern Nigeria, with its capital in Yola. It has college of nursing and midwifery that offers training in basic nursing and midwifery. A nurse in the state who wishes to advance his professional education must pursue the admission elsewhere from the state. In the northern eastern region only Maiduguri offers post-basic programmes in perioperative nursing, psychiatric nursing and bachelor of nursing sciences only. Therefore the accessibility of nurses to advanced education is of a great challenge. Adamawa state consist of 21 local government area, which are divided into three senatorial district: northern, southern and central senatorial districts, with each of local government having a secondary health care institution own by the state government and one tertiary health care institution located in the state capital own by the federal government. 2.3. Target Population The target population of the study was all the registered Nurses (RNS) employed in government owned hospitals in the state who are about 1000 nurses.
randomly selected from the 18 hospitals spread along the three clusters. Therefore a total of six hospitals were selected as clusters; Specialist hospital Yola, Federal medical centre Yola, General hospital Numan, General hospital Ganye, General hospital Mubi and Cottage hospital Gulak. At stage three (3) 25 nurses were recruited from each of the clusters with exception to specialist hospital and federal medical centre where 50 nurses each were recruited for the study due to higher number of nurses in these hospitals. A systematic random sampling was utilized to select nurses from the sample frame provided by hospital Head/Chief nursing officer (I/C) using 5 as the sampling interval (k=5). Therefore a total of 200 respondents were recruited for the study. Inclusion criteria are all nurses who have spent a minimum of three years in service. 2.5. Instrument for Data Collection A self-administered Questionnaire (SAQ) adapted from Garba and Ajayi et. al. [11] were used as instrument for data collection with focused on the respondents sociodemographic characteristics, barriers associated with advanced nursing education and facilitators of advanced nursing education. The SAQ were then given to the respondents to fill and returned within 3 days. Finally, of 200 respondents, 182 returned completed questionnaires, with a return rate of 91%. 2.6. Data Analysis Procedures EPI-Info was used to analyze data. Frequency and percentage were used to describe demographic characteristics as well as to explore the barriers and facilitators of advanced nursing education. 2.7. Ethical Consideration Ethical clearance was obtained from the Adamawa State Ministry of Health. The rights and privacy of participants were protected. All respondents participated in this study based upon confidential and voluntary participation. Informed consents have been obtained from all participants in this study. Moreover, the study protocol, informed consent form, and questionnaire were reviewed and approved by the ethical committee to guarantee the respondents rights and interests.
3. Results Table 1. Socio-Demographic Characteristics of the Respondents (n=182). A
2.4. Sample and Sampling Technique Multistage sampling technique was used for the study. Stage one involved the division of the state into three (3) and the three senatorial districts of the state were used to form three (3) clusters. In Stage two (2), two hospitals were
B
AGE Age Range (years) 21 – 30 31 – 40 41 – 50 51 – 60 60 – above Total Gender
Frequency 12 29 70 65 6 182
Percentages 6.59% 15.93% 38.46% 35.71% 3.30% 100%
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C
D
e.
Males Females Total Marital status Single Married Divorced Total Religion Christianity Islam Traditional Total Educational Qualification Basic Nursing Certificate Post – Basic Nursing B.Nsc/B.Sc./M.Sc/Ph.D Total
74 108 182
40.66% 59.34% 100%
37 123 22 182
20.33% 67.58% 12.09% 100%
112 68 2 182
61.54% 37.36% 1.10% 100%
118 62 2 182
64.84% 34.07% 1.10% 100%
Table 2. Type of Advanced Qualification Obtained By the Respondents (n=182).
1 2 3 4 5 6 7 8 9 10 11 12
Psychiatric Nursing 10(5.49%) and only 2(1.10%) had B.Nsc/B.Sc./M.Sc/Ph.D in Nursing Table 3. Facilitators to Advanced Nursing Education (n=182).
Table 1 shows the socio-demographic characteristic of the respondents. Most of the respondents 38.46% (70/182) were aged 41-50 years. 35.71% were age 51 – 60 years, while 15.93%, 6.59% and 3.30% were aged 31 – 40,21 – 30 and 61 and above respectively. Also 59.34% of the respondents are females and the remaining 40.66% are males while the majority of the respondents 67.58% (123/182) were married, 20.33% were single and 12.09% were divorced. Furthermore, the data in the table reveals that 64.84% (118/182) of the respondents have basic nursing certificate only, 34.07% (62/182) have post –basic nursing qualification in various field of specialization with only 1.10% are holders of degree in nursing sciences (B.N.Sc./B.Sc./M.Sc/Ph.D).
S/No
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Advanced nursing qualification obtained Accident and emergency Nursing Anaesthesia Nursing B.Nsc/B.Sc./M.Sc/Ph.D Ear Nose and Throat (ENT) Midwifery Nursing Admin. And Management Nursing Education Ophthalmic Nursing Orthopaedics Nursing Paediatric Nursing Perioperative Nursing Psychiatric Nursing Total
Frequency 21 18 2 7 49 3 2 17 8 9 36 10 182
Percenta ges 11.54% 9.89% 1.10% 3.85% 26.92% 1.65% 1.10% 9.34% 4.40% 4.95% 19.78% 5.49% 100
Table 2 reveals various Post-Basic qualification obtained by the respondents. Most of the respondents 49 (26.92%) have Midwifery Certificate. 36 (19.78%) and 21 (11.54%) of the respondents have Post-Basic qualification in Perioperative Nursing and Accident and Emergency Nursing respectively. Other Post-Basic qualification obtained by the respondents includes Anaesthesia 18(9.89%) Ear, Nose and throat (ENT) 7(3.85%), Nursing Administration and Management 3(1.65%), Nursing Education 2(1.10%), Orthopaedic Nursing 8 (4.40%) Paediatric Nursing 9(4.95%),
Reasons Because they don’t wear uniforms promotion purposes Influence by spouse Personal interest Recommended by employers To acquire more knowledge and skills To earn more salary and allowance To improve my professional status TOTAL
Frequency 5 27 4 16 47 11 67 5 182
Percentages 2.75% 14.84% 2.20% 8.79% 25.82% 6.04% 36.81% 2.75% 100
Table 3 shows the facilitators to advanced education among nurses in Adamawa state. In selecting the most motivating factor, most of the respondents 36.81% (67) indicates that earning more salary and allowances is a strong factor for undergoing advanced professional studies. 25.82% (47) respondents indicated that they were recommended by their employers, 2.75% (5) identify not wearing of uniforms as a facilitator, 14.84%(27) sees promotion as a cardinal indicator, 2.20%(4) were influence by their spouse, 8.79%(16) was as a result of personal interest, 6.04%(11) identify acquisition of more knowledge and skill while only 2.75%(5) see improving professional status as a facilitator to advanced professional education. Table 4. Barriers to Advanced Nursing Education (n=182). Barriers Change in working place Distance from training institution Family pressures/commitments Financial Difficulties Lack of entry requirement Lack of grading post–Nursing certificate Lack of in-service training programme Lack of interest for post-basic training Lack of proper placement after training Poor remuneration after training Total
Frequency 2 17 40 43 21 6 14 2 14 23 182
Percentages. 1.10% 9.34% 21.98% 23.63% 11.54% 3.30% 7.69% 1.10% 7.69% 12.64% 100
Table 4 indicates the rating of barriers associated with advanced nursing education by the respondents. Most of the respondents 23.63%(43), 21.98%(40) and 12.64%(23) indicated that financial difficulties, family pressures/commitment and poor remuneration after training respectively are the barriers that mitigate nurses from undergoing advanced professional education, While 7.69% (14) of the respondents indicated lack of proper place placement after training as some of the reasons that affects advanced professional education. Other reasons given by respondents includes distance from training institution 9.34% (7), lack of in-service training programme 7.69% (14), lack of entry requirement 11.54% (21), lack of grading of advanced nursing certificates 3.30% (6). More so, some of the respondents indicated lack of interest in advanced nursing education 1.10% (2), annual change in working place 1.10% (2) has also being a barrier to nurses inability to pursue advanced education.
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Timothy Golfa et al.: Appraisal of Barriers and Facilitators Associated with Advanced Professional Education among Nurses in Adamawa State, Nigeria
4. Discussions of Findings The result of this study indicates that most of the respondents are within the age of 41-50 years (38.46%) most of whom are females 108(59.34%) and are married 123(67.58%) and have basic nursing certificate (RN) 118 (64.84%). These findings established the dominance of nurses with only the basic nursing certificate in the service site. And with respondents age 41-50, approaching the age of retirement, pursuing advanced professional education could be a serious challenge to the profession, especially in mentoring of the younger nurses, it implies that they are older nurses in service more than younger ones which can have serious implications on productivity. On the type of advanced qualifications obtained by the respondents, most of the respondents acquired advanced diploma certificates in midwifery (26.92%). perioperative (19.78%), Anaesthesia (9.89%) and Accident and emergency (11.54%). This finding agrees with findings of Garba et.al that being a female makes them acquire a midwifery certificate at post –basic level which is virtually compulsory for female nurses [11]. This also implies that the health care service of the state is deprived of specialist nurses in many other areas that are essential to humanity. More so, there are more holders of perioperative nursing certificate which could be attributed to the nature of work and special allowances attached to it, because health institutions in study area usually pay call duty allowances to perioperative nurses, accident and emergency nurses, anaesthesia nurses and ophthalmic nurses while shift duty allowance that is lower in value is been paid to nurses in other cadres. These have revealed to be a motivating factor to advancing professional education among the respondents. Furthermore, the findings reveal only 1.10% with B.Nsc/B.Sc./M.Sc/Ph.D in Nursing. This could be due to policy issues in the nursing and midwifery council of Nigeria where by the minimum requirement to practice nursing is the basic nursing certificate. With the basic nursing certificate nurses could move from Grade Level 07-14 in the civil service. Many may just opt for post basic training in nursing which is seen as an advanced professional education in Nigeria where one specializes in an area of choice. The policies in Nigeria regarding nursing do not favors acquisition of advanced degree, only at the directorate cadre that first degree is a prerequisite. This is clear indication of absence of nurses at high bureaucratic hierarchy of the civil service or at policy making position. With competition among health care professionals non acquisition of university degree could definitely not put nurses at par with other professional whose minimal qualification is the first degree. In exploring the facilitators for advanced nursing education, majority of the respondents indicates earning more salary and allowances, others attribute it for promotion purposes while others indicated that is recommended by employers. If a goal that is attached to higher education is important to an individual, there is likely hood that the individual will pursue higher education. Megginson stated
clearly that registered nurses are more apt to advance their professional education if increases in pay are significant[17]. Even though, Bellfield and Gessener believes that earning more money is critical to advancing education[18], majority of their respondents (64.3%) chose personal satisfaction as a major facilitator. The study further identified barriers militating against advanced education among nurses. Most of the respondents attributed it to family pressures/commitment and financial difficulties. This agrees with Bellfield and Gessien where they discovered that 40% of the respondents had family obligations and time constraints. More so, they reveal that financial concern and cost of the programme are major barriers to advancing professional nursing education. These findings connotes further proofs that returning to school requires a lifestyle change which some are not willing to accept [13, 18]. Additionally, the findings indicated poor remuneration after training and lack of placement after training, this agrees with Megginson, that there is no significant impact in pay between advancing education or not. As pay differentials is not always significant between different educational levels. In Nigeria there is no clear impact of possessing higher qualification in nursing or not, this can thwart the desire towards advanced professional education especially Bachelor degree in Nursing or higher. Many employers in Nigeria place holders of Bachelor degree in Nursing at par with other with diploma certificates. Furthermore, lack of in-service training programme and lack of entry requirement into university are some of barriers indicated by the respondents. An efficient and effective in service programme is crucial to advancing professional education. The requirement for five o level credit in major science based subjects are prerequisite to advancing professional education in which many respondent are not willing to resist their papers as many claimed they are aged or they can’t cope writing another examination. However, some indicated that distance from training institution and lacks of grading of advanced nursing certificate are some barriers militating against advanced education. With most of the advanced nursing programmes located in the southern part of the country, distance from the training institution can be a major setback and getting admission in to these programmes due to scarcity of training institution is another bigger challenge for advance professional education in Nigeria.
5. Conclusion and Recommendation The findings of this study discovered that a sizeable number nurses in Adamawa State have advanced nursing diploma certificates and an extremely small number of 1.10% have the nursing degree certificate. This has immense implications for the nurses, the nursing profession, and the public in provision of quality and effective care and interprofessional competition among health care providers in Adamawa state. Therefore the following recommendations are made; Special salary/Allowances should be paid to
International Journal of Educational Research and Information Science 2015; 2(4): 102-107
holders of various additional nursing qualifications appropriately so that others will be encouraged to acquire the qualifications, a scheme of service that reflects the acquisition of various advanced qualification should be put in place for nurses at various levels, this should be at par with other profession in health care with similar level of education and training, all promotion for nurses at various career levels should consider the acquisition of relevant knowledge and skills obtained through advanced education programmes, there should be provision of adequate in-service training programmes for nurses by their employers so that they can be up to date in their professional practices, Adamawa state universities should be encouraged to introduce the advanced programmes so that nurses will have access to the programmes, and/or conversion of College of Nursing and Midwifery Yola to degree awarding institution, the basic nursing training should be university based so that the basic nursing certificate will be first degree in nursing so that nursing will be educationally equivalent to other health professionals.
References [1]
International Council of Nurses ICN The ICN code of ethics for nurses. 2006.
[2]
Agbedia, C., Re-envisioning nursing education and practice in Nigeria for the 21st century. Open Journal of Nursing, 2012. 2: p. 226-230.
[3]
Dolamol, B.L. and S.K. Olubiyi, Nursing education in Africa: South Africa, Nigeria, and Ethiopia experiences. International Journal of Nursing and Midwifery, 2013. 5(2): p. 14-21.
[4]
Scheckel, M., Nursing Education: Past, present, future. 2010: Jones and Barltett Publishers.
[5]
Nursing and Midwifery Council of Nigeria NMCN Functions. 2014.
[6]
National Universities Commission NUC, Curriculum for General and Post Basic Nursing Education. 2009, Abuja: NUC.
[7]
National Universities Commission [NUC] Universities: List of Nigerian universities and years founded. 2012.
107
[8]
Nursing and Midwifery Council of Nigeria [NMCN] List of approved schools of nursing, midwifery, post basic nursing programmes and departments of nursing in Nigeria and their accreditation status as at 31st July, 2010. 2012.
[9]
American Organization of Nurse Executives, AONE’s Guiding Principles for future patient care delivery; Nursing care across provider settings. Presented at the 118th meeting of the National Advisory Council on Nurse Education and Practice. 2008: Rockville, MD.
[10] Dipo, O.F., I.A. Segun, and S.K. Olubiyi, Establishing a gold standard for nurse educators in Nigeria. Sky Journal of Medicine and Medical Sciences, 2013. 1(4): p. 15-19. [11] Garba, S.N., A.D. Ajayi, and A.J. Adul, Factors influencing post basic and university education among Nurses in Kaduna State. the journal of west African college of Nursing 2007. 18: p. 94-100. [12] The American Association of Colleges of Nursing (AACN) Fact Sheet: The Impact of Education on Nursing Practice registered nurses. . 2014 [13] Morgenthaler, M., Too old for school? Barriers nurses can overcome when returning to school. AORN, 2009. 89(2): p. 335-345. [14] Nursing and Midwifery Council of Nigeria [NMCN] Nursing as a career: Nursing education programs in Nigeria. 2007. [15] Ndatsu, P.N. Nursing and midwifery council of Nigeria’s role in maintaining standards in nursing education and practice. A paper presented at the conference of the committee of principals of schools of nursing, psychiatry and midwifery (COPSNPAM). Ilorin, Nigeria. 2004. [16] Lillibridge, J. and S.D. Fox, RN to BSN education: What do RNs think? Nurse Educator, 2005. 30(1): p. 12-16. [17] Megginson, L., RN-BSN education: 21st century barriers and incentives. Journal of Nursing Management, 2008. 16(1): p. 47-55. [18] Bellfield, S. and G. Gessner, Factors Influencing the Advancement of Professional Education of Nurses at a Magnet Hospital, in School of Nursing & Health Studies 2010, Georgetown University, Washington, D.C.
