Very few institutions in Nigeria train and educate critical care nurses. As of writing this article, only the University of Nigeria Teaching Hospital (UNTH) trains cardiothoracic nurses. I trained as a cardiothoracic critical care nurse at UNTH.
It is a great institution, and I enjoyed every minute there.
There are three in northern Nigeria: the University of Jos Teaching Hospital, the University of Abuja Teaching Hospital, and the School of Post-basic Critical Care Nursing, University of Maiduguri Teaching Hospital.
There may be plans to commence training of critical care nurses in other Tertiary Healthcare Institutions in Nigeria, but for now, these are the institutions we are sure about that train critical care nurses in the country.
We will split this article into three parts to make it easy for our readers.
The first part will briefly discuss the Similarities between these two specialities; the second part will discuss the Differences, and the last part will discuss the local and international opportunities.
We have also added additional thoughts at the end of the article.
A Brief Definition or Description of What Critical Care Nursing Is
Critical care, the first word “Critical”, says it all.
Some prefer to call it “Intensive Care,” some have even tried separating the terms “Critical Care & Intensive Care” and given them unique descriptions and definitions.
In this article, we will not discuss different ideas about definitions and descriptions.
We will go straight to the point.
But before we go straight to the point, let’s talk briefly…
Critical care nurses work in very high-stress environments.
Because their nursing roles have advanced beyond the normal, they may be described as advanced-practice nurses in terms of training, autonomy and education.
The path to becoming an advanced practice nurse differs in more advanced countries and varies from country to country.
You need higher nursing degrees and training to become an advanced practice nurse.
There isn’t a solid legal cadre for advanced practice nurses in Nigeria yet. Though plans to create a career path for them exist, we have yet to see any tangible moves or actions.
Critical care nurses take care of critically ill patients.
Who Is The Critically Ill Patient?
Critically ill patients most times have severe organ dysfunction.
It could be a single organ or multiple.
These dysfunctions present with physiological abnormalities that need special 24/7 care.
For instance, a patient with impaired kidney functions [weak or failing kidney(s)] may need dialysis and other advanced treatments to support the kidney(s).
They will need to be monitored constantly: urine output monitoring (sometimes hourly or even every thirty minutes, depending on the severity), constant blood work to determine the effectiveness of blood waste removal or clearance, administration of vital medications, and a whole lot of other medical and nursing interventions needed to keep the patient clinically stable.
Or a patient with cardiac problems may require special medications like inotropes to support heart functions.
These inotropes are medications that must only be administered in a closely monitored environment because while they are necessary to help the patient, they can also be fatal if the dosage is too low or if the patient receives too much.
The critical care nurse is the most responsible professional in the critical care department when it comes to monitoring the patient, administering medications, providing nursing care, and implementing most medical plans.
“This is where the greatest breadth of knowledge, competency, and skill are required in order to keep the patient alive and comfortable with their dignity intact.”
Nicholas McGowan, Nursing Educator at Critical Care Academy
In Critical care medicine, sometimes, if not all the time, the critical care nurse is even more responsible for the patient than the Physician.
They are the patient’s eyes, nose, ears, hands, and everything.
Critical care nurses must be involved in all forms of medical interventions or plans. Nothing is done without their direct involvement.
They must understand why a particular medical intervention is being carried out on a patient and make them understand (if they are aware and conscious).
They are the ultimate advocate in critical care.
In critical care nursing/medicine, no one is going to stand on the podium and scream:
“Hey, I am the boss here, y’ll listen to me and follow my orders, or you get thrown out!”
No, nobody does that here.
We are a team, and your judgment passes through the eyes of many before it is accepted and carried out.
It’s all about the patient.
Remember, they can’t do anything for themselves, and you are the one primarily responsible for keeping them safe.
Ok, enough of too much talk.
Now, to business…Shall we?
Cardiothoracic Critical Care Nursing (CTN) & Critical Care Nursing (ICN or CCN) – Similarities
A cardiothoracic critical care nurse is an advanced practice nurse trained to specifically care for critically ill patients who require advanced care for pathologies affecting the heart, cardiovascular system, thoracic walls, and related organs or systems, such as the renal, neurological, or gastroenterological systems.
Their training & education span the vast medical & surgical domains of care.
I like to call it a speciality within a speciality because a greater emphasis is placed on the Care of the Cardiovascular/thoracic System (which is the alpha system).
When we talk about critical care nursing or medicine in general, there is no way we will not place the cardiovascular system in the middle because it is almost always the central aspect of clinical attention in critical care, whether it be Neurological Critical Care, Orthopaedic Critical Care, Obstetrics & Gynaecological Critical Care, Oncology Critical Care, there will always be a need to support the cardiovascular system (do you understand that?)
As provided by law and the governing nursing professional body in Nigeria, an intensive care nurse is an advanced practice nurse trained and educated to provide critical nursing care for a broad and general spectrum of medical and surgical morbidities/pathologies.
So, an Intensive care nurse is a General Practice Critical Care Nurse trained to provide intensive nursing care at a more general level; their primary places of practice (or interests) can now afford them the opportunity to grow in various critical care subspecialties, like cardiac, renal, and other essential subspecialties of critical care.
If we had a neurocritical care nursing speciality, they would be in the same category as cardiothoracic critical care nurses because neurocritical care is a subspeciality of critical care nursing, i.e., a speciality within a speciality.
The training and education of any critical care subspecialty will still provide the clinical abilities needed to dispense nursing care to patients in any critical care setting, whether in the General Intensive Care Unit, High Dependency Unit, Trauma Unit, or Renal Critical Care Unit.
In Nigeria, there was a time when the Intensive Care Nursing training institution began to complain that the Cardiothoracic Nursing Training Institution in Enugu State was awarding a dual post-basic professional certificate in Cardiothoracic nursing and intensive care nursing.
At one time, their certificates and documents actually carried these two descriptions, until recently, when they had to stick with the Cardiothoracic Critical Care badge.
But if you take a critical look, you will see that it is almost impossible to separate these two specialities.
They are like Siamese twins joined at the brain; they are inseparable.
What I am trying to do with this article is to inform my colleagues out there seeking to start a career in critical care nursing in Nigeria that they can decide to start their careers as Cardiothoracic Critical Care Nurses or Intensive Care Nurses.
There are more similarities and almost no differences.
As of writing, we only have about 451 Cardiothoracic Critical Care Nurses trained and educated in Nigeria (a vast majority of them have left the country).
The yearly training slots for these super nursing specialities in every institution are about 30 (If I am not mistaken).
We have been clamouring that the nursing training body in Nigeria takes these post-basic specialities to the level of Masters In Critical Care Nursing/Cardiothoracic Critical Care Nursing while maintaining rigorous clinical training paths and incorporating universal standards in research and education.
This development may prolong the duration of training and maybe increase costs.
However, it will also give more value to the qualifications, inspire more nurses to stay and study for advanced nursing degrees in Nigeria, improve clinical outcomes for nursing care and pave the way to a more structured and respected advanced practice nursing programme or a doctor of nursing practice degree in Nigeria.
Cardiothoracic Critical Care Nursing (CTN) & Critical Care Nursing (CCN/ICN) – Differences
You may ask me, are there any differences between these specialities? There are differences. But these differences are almost negligible.
The cardiothoracic critical care nurse in Nigeria is trained in a traditional intensive care unit or a cardiothoracic critical care unit.
However, most of their training focuses more on surgical ICUs, caring for post-operative open heart surgery patients.
They are also exposed to the management of other critical cases (both medical and surgical).
Open Heart Surgery and vascular cases account for most of their clinical experiences.
That does not mean that they do not manage other critical care cases, but the number of Open Heart Surgeries done in UNTH, which has been designated a centre of excellence in cardiothoracic care, has greatly influenced their practice.
The Intensive care nurse trained in Nigeria also enjoys the cardiothoracic nurse’s exposure to caring for post-operative open-heart surgery patients.
In a “critical shell,” there are no evident and noteworthy differences between these unique nursing specialities.
They are both remarkable and have unique learning and career adventures waiting for you within their walls.
It’s also important to note that all speciality nurses were once general practice nurses.
They all have basic nursing training and education from recognised academic institutions. And so they can easily adjust to any clinical environment or demand.
They are amazing critical care nurses who have never been certified in any institution, but they have the skills and exposure.
Certification exists to create a regulated and well-structured system of education, governance and training standards.
Cardiothoracic Critical Care Nursing (CTN) & Critical Care Nursing (CCN/ICN) – Opportunities
The opportunities are WOW!
Critical Care Nurses are in high demand all over the country and the world.
They are among the highest-paid nurses in Nigeria, alongside their sisters, Nurse anaesthetists, & Renal/Nephrology Nurses, especially in developed cities in Nigeria (Lagos, Abuja & Port-Harcourt).
And the international opportunities are also fantastic.
Your experience as a critical care nurse in an intensive care unit or any other critical care environment is rich.
It makes it easier for you to pass international nursing examinations, especially the almighty N-CLEX examinations, and it places you in a special category in the eyes of international recruiters.
During the pandemic, the surge in demand for critical care professionals, including nurses, physicians, and others, gave us a glimpse into the future of critical care nursing and medicine.
There will be more opportunities for critical care professionals in the future.
The advancements digital health brings to the critical care sub-ecosystem will also positively affect the healthcare industry.
In Conclusion
Whatever path you decide to take to become a critical care nurse in Nigeria will definitely be an adventure.
You will be introduced to a whole new world of nursing practice, where you have a certain degree of autonomy in caring for your patient, though with supervision and consultation, which are essential elements of autonomous practice for registered nurses.
Critical care nurses must know everything about a patient’s medical condition.
We are sucked into every aspect of their care.
You become a critical thinker.
Critical Care Medicine is 95% Nursing and 5% Medicine.
Yes, it’s amazing.
In the critical care setting, we do everything for the patient, from eating to breathing.
You can see that there’s a whole lot of work there. And that’s why anyone who wants to enter this world must be prepared.
Before I close the curtains, a little bonus information.
As regards cost, if you want to study conveniently, you will need about A Million Naira or more.
You know, that’s a lot, considering the country’s situation.
One singular factor that makes it this expensive is the external clinical experience in Ghana (though there are plans to discontinue this aspect of the training).
The external experience is a good bargain.
We have to look at it from various perspectives.
It also exposes us to how critical care nursing and medicine are done in other countries and provides a rich cultural experience.
I can tell you.
You get to interact with their medical & nursing culture and start looking for ways to improve your culture.
After Thoughts
Over the past decade, the number of basic and advanced cardiothoracic surgical cases done in Nigeria has dramatically increased.
Patient outcomes are also encouraging. This shows that the critical care landscape in Nigeria is drastically improving.
The government has to recognise what the private critical care sector in Nigeria is doing as they are doing most of the work in Nigeria, from cardiac to neuro, renal, and gynae, you mention.
Yes, private critical care in Nigeria is super expensive. Nevertheless, it’s still better than travelling to India, France or the United Kingdom.
Nigeria has the potential to end medical tourism for the better.
We have fantastic medical doctors, nurses, pharmacists, medical laboratory scientists, physiotherapists, and other healthcare professionals ready and willing to stay if the environment is conducive to career and professional growth.
I have known excellent healthcare professionals who have left the country, and it hurts—consultants, nurses, physiotherapists, and so on. When I see them leave, it looks like a big part of our healthcare substance leaves with them.
What is the government doing about it? Trying to stop nurses from leaving by creating verification guidelines that obviously look like what they are?
What should they be doing instead? It’s simple. Allocate what is proper to the healthcare ecosystem in Nigeria. Improve the welfare of healthcare professionals and ensure more healthcare institutions are equipped with enough equipment to take care of basic and complex medical cases.
We have the potential to end medical tourism forever.
Getting admission to study in any of the post-basic critical care institutions in Nigeria requires a lot of “putting your ears on the ground” and asking a lot of questions because admission details are not always published online, and the admission slots are very limited.
Most institutions have already put out forms for sale and are conducting qualifying examinations this month [June]. So, if you can’t get in this year, you should plan for next year.
The admission forms are available from February every year for post-basic cardiothoracic nursing.
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