The Longest Night
At 10:50 p.m. on a humid Wednesday night in Chikun Local Government Area of Kaduna, Nigeria, Zichat, a 26-year-old daughter of Mr and Mrs David, who had just got married to the love of her life, Yatai, only a few months ago, felt a sharp contraction that would change everything.
Her husband, Yatai, had been timing them all evening, like a referee in charge of officiating the biggest match in his career; his timing had to be right.
They were coming faster now, just four minutes apart, he would whisper under his breath as he paced through the living room while getting her things into the taxi waiting for them outside.
This was it—their first child was on the way.
But as their taxi pulled up to Sabon Tasha General Hospital’s emergency entrance, the usual rush had been taken over by an eerie quiet.
On the glass entrance slide doors to the emergency room were taped a handwritten sign which read “Emergency services limited due to ongoing industrial action. Please seek alternative care”
Yatai’s hands quivered in fear as he helped his wife out of the car. “Alternative care?” he whispered. “This is the general hospital, for goodness’ sake. You are supposed to be the main and alternative care. Where else do we go?”
Inside the hospital, Dr. Haruna, the lone obstetrician on duty, was managing what should have been a team’s workload with a team of other tired doctors.
The nursing staff, exhausted from years of enduring harsh working conditions—very poor salary structure, limited supplies, lack of adequate medical equipment, welfare concerns and working standards, the refusal of the federal government to implement decade-long demands like gazetting of a Scheme of Service approved in 2016, implementation of a 2012 National Industrial Court Judgement, creation of a dedicated Department of Nursing within the Federal Ministry of Health, including nurses in policymaking bodies, governing boards, and centralised internship placements—amongs a myriad of numerous challenges the profession has endured for so many years, had just started their industrial strike action that day Yatai brought his wife to the hospital.
“Doctor— my wife— the baby is coming!” Yatai pleaded!
From another patient, Dr. Haruna looked up, his face etched with the fatigue of a man caught between two impossible situations.
“I’m aware”, Dr. Haruna answered, “We’ll take care of her. But I have to be honest with you; this night is going to be different.”
As Zichat was wheeled into the understaffed maternity ward, her story became part of a much larger question that healthcare systems across Africa, and parts of the world, struggle with: When healthcare professionals fight for better conditions that could ultimately improve patient care, who pays the immediate price?
The Moral Crossroads
A strike is always a last resort after all other avenues of negotiation have failed, and work conditions have become unbearable.
Zichat’s experience that night reflects a dilemma playing out in hospitals across Africa, from Nigeria to Zimbabwe, from Egypt to Kenya.
Her story raises fundamental questions that do not have easy answers:
- Given that their primary oath is to “do no harm,” can healthcare professionals ethically leave their positions?
- Will the purpose of nurses going on strike for improved working conditions and staffing ratios ultimately protect patients in the future?
- What becomes the fate of those in need of care?
Nurse Adewale, a healthcare veteran and the Director of Nursing Services at the hospital, as well as one of the longest-serving nurses at the General Hospital in Sabon Tasha, stood outside the hospital that night. Her once spotless uniform had now been replaced by a protest placard reading “Better Working Conditions = Better Patient Care.”
With her warm and caring eyes, she watched in the cold of the night as ambulances were being redirected to other facilities and felt the weight of every decision.
“A lot of people don’t understand what nurses are going through. We’ve been very silent for too long, and now is the time that we must speak up for the good of the patients we take care of, ourselves and the country we serve.” She told the reporter from a local radio station who came for interviews the next morning.
“How can we provide proper care when there are not enough supplies or equipment in the hospital to do so? When nurses are not being paid what they are worth, when we work long, hard shifts and calls and the pay is meagre. How can we serve patients in these conditions? Nurse Adewale answered the reporters.
Her voice broke slightly. “I’ve been a nurse longer than some of these doctors have been alive; a few of them were delivered right here in this hospital by me and my colleagues, who are no more here today. Do you think this was an easy decision for us to take?”
The Global Perspective: Legal Rights vs. Ethical Duties
Whether nurses can legally strike varies dramatically across different countries and healthcare systems:
Countries Where Nurses Can Strike:
- United Kingdom: According to the Trade Union and Labour Relations Act of 1992, nurses are legally permitted to go on strike, but they are still required to provide “life and limb” services (Royal College of Nursing, 2023)
- Canada: While there are some provincial differences, labour rules that mandate emergency services typically protect them (Canadian Federation of Nurses Unions, 2023)
- South Africa: Although emergency services must continue, healthcare professionals are legally permitted to go on strike under the Labour Relations Act 66 of 1995 (South African Nursing Council, 2022)
Countries With Restrictions:
- United States: According to state labour rules, certain states forbid public sector nurses from going on strike (American Nurses Association, 2023)
- Singapore: The Essential Services Act prohibits healthcare personnel from going on strike (Ministry of Health, Singapore, 2022)
- Many African Nations: Frequently ambiguous or constrictive legal frameworks (African Development Bank, 2023)
The African Context
Unsafe staffing ratios, low pay, and the 2016 Nursing Scheme of Service’s non-gazetting were among the reasons why the PSI members of The National Association of Nigeria Nurses and Midwives (NANNM) went on a 7-day warning strike on July 29, 2025.
Their demands were simple and straightforward:
- Gazetting of the Nurse’s Scheme of Service approved by the National Council on Establishment (NCE) in 2016 in Minna, Niger State.
- Implementation of the National Industrial Court (NIC) Judgment of January 27, 2012.
- Upward review of professional allowance for nurses and midwives.
- Employment of nursing personnel and adequate provision of health facility equipment.
- Creation of a Department of Nursing in the Federal Ministry of Health.
- Inclusion of nurses in the headship of health policymaking bodies.
- Fair representation by the Association on the board and membership in Federal Health Institutions.
- Centralisation of internship postings for graduate nurses.
- Consultancy for nurses and midwives.
Initial attempts by the Association to get the government to adhere to these demands fell on deaf ears, hence their resort to strike.
Their strike proved productive, as it successfully pushed the government into commencing the implementation of their demands within four weeks from the sign-off date of the MoU.
Prior to this, the National Association of Nigeria Nurses and Midwives, Lagos State Chapter, in January 2022, also declared a three-day warning strike from January 9 to January 12, 2022, to demand better working conditions from the Lagos State Government.
The chairman of the State Chapter, Comrade Julius Awojide, made a statement where he lamented the state government’s insensitivity to the plight of the Nurses in the state.
Awojide reiterated that the warning strike was necessary to inform the government that nurses would no longer be overworked, undervalued and underpaid without any consequences.
Seeing a pattern of negligence and unconcern by government bodies towards addressing vital needs of nurses in the healthcare sector makes one wonder… do they really want what’s best for the people?
Must there always be an act of strike for them to do what needs to be done in ensuring nurses are treated fairly, and their legitimate complaints listened to?
In Kenya, on Tuesday, August 26, hundreds of nurses took to the streets of Kitale town carrying placards demanding a pay rise, signing and registering the 2025-2029 Collective Bargaining Agreement (CBA), remittance of their third-party deductions, and the promotion of all nurses who are due for promotion.
The nurses submitted petitions to the Office of Governor George Natembeya of Trans Nzoia and the County Assembly of Trans Nzoia.
Their plight was simple, but in order for the residents of Trans Nzoia to exercise their right to high-quality, reasonably priced healthcare, the nurses petitioned the legislative branch of government to pressure the executive arm to adopt all the problems that were agreed upon.
Back To Zichat’s Story
As dawn broke over Kaduna, Zichat delivered a healthy baby girl. She was named Kuyait, after Yatai’s mother.
Dr. Haruna had worked through the night with minimal support. At the same time, the few nurses on duty (who were mainly senior nurses and a few interns) had stretched themselves thin across multiple units.
“We were lucky,” Haruna reflected weeks later. “But I couldn’t stop thinking about the woman in the bed next to us whose surgery had to be postponed, or the man in the corridor waiting for his dialysis.”
The nurses’ strike at Sabon Tasha’s General Hospital lasted six days. During that time:
- Three elective surgeries were postponed (all patients recovered fully after delayed procedures)
- Average emergency room wait times increased by 240%
- One elderly patient with diabetes complications was transferred to a private facility his family couldn’t afford
- Hospital management agreed to hire 30 additional nurses and provide back pay
The Ripple Effects: Who Really Pays?
Zichat’s story shows the complex ripple effects of healthcare strikes:
Immediate Impact:
- Patients face delays, uncertainty, and sometimes suboptimal care
- Families experience financial strain from seeking alternative care
- Healthcare workers carry the emotional burden of difficult choices
Longer-term Consequences:
- Strikes often lead to improved working conditions
- Better staffing can mean better patient outcomes
- Addressing systemic issues prevents future crises
The Economic Reality:
According to the World Health Organisation (2023), inadequate healthcare staffing leads to:
- 40% higher rate of patient mortality
- Increased medical errors by 23%
- Higher turnover rates
Finding Balance: Models That Work
Fortunately, some countries have found middle-ground approaches that work; a few of them are:
Norway’s Model:
Nurses can strike, but they must continue to provide essential services. Independent arbitration resolves disputes quickly, typically within 30 days (Norwegian Nurses Association, 2023).
Rwanda’s Innovation:
Invested heavily in nursing education and competitive salaries, resulting in stable staffing and minimal strike activity (Rwanda Ministry of Health, 2023).
Botswana’s Approach:
Created formal channels for healthcare worker grievances with binding arbitration, reducing the need for strikes (Botswana Nurses Union, 2022).
The Human Cost and the Human Solution
Six months after that unforgettably difficult night, Zichat, now a young mother, visited Sabon Tasha’s General Hospital for her daughter’s check-up. This time, she couldn’t help but notice the difference in the maternity ward, now better staffed with nurses who seemed less hurried and more present.
Nurse Adewale, now back in her uniform, smiles as she weighs baby Kuyait. “She’s perfect,” she tells Zichat. “Growing beautifully.”
“I remember you,” Zichat said quietly to Nurse Adewale, “You were outside that night…”
Nurse Adewale nods with a smile on her face. “I was, and I thought about you every day during those six days. Constantly wondering whether we were doing the right thing.”
“Were you?” Zichat asked.
With one quick glance around the maternity ward, Nurse Adewale couldn’t hold back her smile of fulfilment at the adequate staffing levels, the restocked supply rooms, and the nurses who no longer work dangerous overtime hours.
“I think so,” She responded to Zichat. “But I also know it shouldn’t have taken a strike to get here.”
The Way Forward
The question “Are nurses permitted to go on strike?” cannot be answered with a simple yes or no. It calls on us to pose more profound queries:
- How do we create healthcare systems that don’t force workers to choose between their own welfare and patient care?
- What responsibility do governments have to adequately fund and staff healthcare?
- How do we balance immediate patient needs with long-term system improvement?
Instead of outlawing strikes or permitting unrestricted action, the solution is to establish mechanisms that address the legitimate concerns of healthcare professionals before they escalate.
As Nurse Adewale puts it: “The best strike is the one that never has to happen because the system works for everyone, patients, families, and the people who dedicate their lives to caring for them.”
Zichat’s story reminds us that behind every policy debate are real people facing real consequences.
Strong healthcare systems should be the aim, so that no one, whether patients, nurses, or families, must make difficult decisions on the most challenging nights of their lives.
