Nursing Contradiction: Ideals and Improvisations in Uganda by Helle Max Martin

Factors that influence transition to advanced roles by RN to BSN nurses, in three selected hospitals of Central-Uganda

“…For a long time in Uganda, like other parts of Africa, RNs were trained in institutions attached to hospitals and they acquired a diploma in either Nursing, or Midwifery, or both [17]. After Uganda’s independence in 1962, being an RN was the highest level of education that a nurse/midwife could attain.…”

“…After Uganda’s independence in 1962, being an RN was the highest level of education that a nurse/midwife could attain. As an RN then, the nurses were expected to perform their roles under the physicians’ (doctors’) order with little independence [17]. In 1993, the first BSN course was introduced in Makerere University (Kampala, Uganda), with an expectation that the nurse leaders who were BSN graduates would increase public respect for the nurses’ work and provide a leverage to increase the independence of the nurses from the dominance of doctors in hospitals and health centers [17].…”

“…As an RN then, the nurses were expected to perform their roles under the physicians’ (doctors’) order with little independence [17]. In 1993, the first BSN course was introduced in Makerere University (Kampala, Uganda), with an expectation that the nurse leaders who were BSN graduates would increase public respect for the nurses’ work and provide a leverage to increase the independence of the nurses from the dominance of doctors in hospitals and health centers [17]. Whether this broad goal has been achieved remains a debate, but what is known is that since then, there has been an increasing shift from the hospital-based training of nurses to universities and thus many RNs have been able to acquire the BSN degree.…”

“…For instance, among other roles, BSNs are supposed to perform a comprehensive health assessment as compared to a basic health assessment, use nursing theories, and utilize a broad knowledge base to inform care plans, conduct research to provide evidence to health problems, and are to report and make suggestions on patients’ conditions to doctors/physicians. The comprehensive performance of those roles is rare among RNs only because of the depth of the training curriculum, which places less emphasis on knowledge and attitude components, but give priority to the skills’ aspect [17, 19, 20].…”

“…Besides that, nurses in Uganda, like those in other Sub Saharan Africa have an added burden of taking up extra tasks/roles, due to the shortage of other professional staff, and thus making their roles ambiguous and comparable to a nurse practitioner’s role in Europe and North America [23]. Patients, politicians, and nurses themselves were also dissatisfied with the quality of care services provided [17]. Additionally, those observations by health managers had further implications on the nursing image and investment in nursing education, which are still poor in Uganda [17].…”