As Nigeria’s health sector struggles with the migration of medical professionals to other countries, private hospitals, which provide 70 per cent of the country’s healthcare services, are increasingly turning to auxiliary nurses as a cheaper alternative to registered nurses. PUNCH Healthwise investigation reveals how the activities of these quacks have led to medical errors, avoidable deaths, and a lack of confidence in the sector. SODIQ OJUROUNGBE reports
It was the kind of morning that should have been forgettable: drizzling rain, muddy streets, and the muffled noise of Abeokuta, the Ogun State capital, slowly waking up. But for Fatima Adetoye, the memories of that Wednesday will never fade. It was the day her sister, Amina, walked into a hospital alive and never walked out.
Amina’s life slipped away in a flurry of beeps and sterile smells. The 26-year-old mother of one had trusted her life to the private hospital’s promise of quality care, but what she got was a lethal cocktail of incompetence and cost-cutting.
Speaking with PUNCH Healthwise, Amina’s sister, seated on a worn-out sofa in their family’s modest Ijaye apartment, her voice a blend of sorrow and disbelief, narrated how her sister came home the night before feeling weak.
Adetoye began, “Just body pains and a slight fever. We thought it was nothing serious. Malaria, maybe. Something she’d beat in a few days.”
The next morning, Amina was taken to a nearby private hospital, a small, neatly painted building that sat between a grocery shop and a barber’s stall. It was a familiar place, one that the community trusted. But inside its walls, Adetoye said, a quiet tragedy was already unfolding.
“She wasn’t seen by a doctor. A woman in a nurse’s uniform attended to her. She barely asked questions, no tests, no thorough examination. She just looked at Amina and said, ‘It is malaria. We’ll start treatment immediately,” she recalled.
What Adetoye didn’t know then was that the woman in uniform was not a registered nurse. She was an ‘auxiliary nurse’, a loosely defined role in Nigeria’s medical sector, with no formal training or licensing. And like hundreds of auxiliary nurses working in private hospitals across the country, she had been hired because she was cheap.
Adeloye continued with tears rolling down her cheeks, “They gave her an injection. Within hours, Amina started gasping. Her skin turned red, then blotchy. I ran to them, shouting that something was wrong, but they kept assuring us that she would be fine. They told us that she needed rest.
“By nightfall, Amina’s condition had deteriorated. She was restless, vomiting, and slipping in and out of consciousness. Then a doctor came and told us that we had to transfer her to a better-equipped hospital. But it was already too late.
“The doctors at the second hospital told us she was given a drug she was allergic to. They said a basic medical history could have caught it. A registered nurse would have known. She was dying from the moment that injection entered her body.”
Amina passed away hours later. No formal apology, no investigation. Just a quiet burial and a wound that Adetoye said had failed to heal.
“What hurts most is that she didn’t have to die. They are playing with people’s lives. My sister died because someone who wasn’t trained was allowed to take charge of her care,” she expressed bitterly.
Medical error
Nneoma’s eyes widened in pain as the auxiliary nurse’s needle pierced her skin, administering the injection with a confident flourish. But Nneoma’s trust was misplaced. Hours later, she felt a searing pain and numbness spreading through her leg, like a dark stain spreading through the fabric.
Nneoma recalled to our correspondent, “I thought it was just a normal reaction. But as the pain intensified, I knew something was wrong.
“Not until the senior nurse arrived did I realise the injection was given on the wrong side.”
She stated that while the argument that ensued between the auxiliary nurse and the senior staff was a blur for her, the consequences were all too real.
“I couldn’t move my leg properly, and the pain was excruciating. It wasn’t until a doctor intervened, correcting the mistake and administering the right treatment, that I began to recover.
“I am one of the lucky ones. I have heard stories of others who weren’t so fortunate. Patients who suffered paralysis, or worse, because of medical errors like this,” she stressed.
Nneoma’s near-paralysis and Amina’s untimely death are not isolated incidents. They are symptomatic of a deeper crisis unfolding in the private healthcare sector, one where desperation, economic realities, and poor regulation have birthed a dangerous workaround with the mass employment of auxiliary nurses in place of trained and licensed nurses.
At first glance, these nurses appear to be professionals, wearing white scrubs, attending to patients, and even issuing prescriptions in some facilities. However, behind the façade, our correspondent discovered a harsh reality that many are not licensed, certified, or medically qualified to perform the duties assigned to them.
PUNCH Healthwise’s investigation revealed that as Nigeria grapples with the mass exodus of trained healthcare professionals to the UK, Canada, and the Middle East, the gap is being filled not with reform or investment, but with cheap, unqualified labour.
Migration of nurses abroad
With over 75,000 Nigerian-trained nurses and midwives reportedly working abroad, according to data from the Nigerian Nursing and Midwifery Council, the country’s healthcare system is losing skilled professionals at an alarming rate.
While public hospitals groan under pressure, private facilities, which provide up to 70 per cent of the country’s healthcare services, are quietly filling the gaps with cheaper, untrained labour.
An investigation by PUNCH Healthwise revealed that many private hospitals, in a bid to cut costs, are increasingly relying on auxiliary nurses, underqualified staff with limited training and expertise, to provide critical care to patients.
Auxiliary nurses, also known as nurse aides or healthcare assistants, are meant to support registered nurses with basic care tasks, such as bathing patients, taking vital signs, and maintaining hygiene.
Unlike registered nurses who undergo rigorous training in accredited institutions, pass licensing examinations, and are registered with NMCN, auxiliary nurses operate in the shadows of the profession.
They often learn on the job under the supervision of matrons or senior nurses and receive no formal or standardised training. In many cases, their education comes from experience alone, which includes shadowing, observing, and imitating qualified practitioners over time.
Despite not sitting for board exams or being licensed by NMCN, PUNCH Healthwise’s investigation revealed that in private clinics and hospitals across Ogun and Lagos, these auxiliary nurses now serve as frontline healthcare workers, administering injections, setting IV lines, managing medications, and even diagnosing patients.
Patients’ survival, a game of luck
PUNCH Healthwise’s investigation, which probed several private hospitals located in Ogun and Lagos, found that many of these health facilities are employing auxiliary nurses in droves, thereby putting patients’ lives at risk.
Many of these facilities operate under the radar, offering lower service charges than larger hospitals but at a dangerous cost.
Our correspondent learnt that the situation has led to many cases of medical errors, avoidable deaths, and other regrettable outcomes.
It was gathered that patients are offered poor-quality care, and the healthcare system is facing a crisis of confidence.
In an investigative sweep, our correspondent visited about 12 private hospitals across Ogun and Lagos States, specifically in the Obademi-Owode Local Government Area (Ibafo, Ascon, Arepo, Mowe), Abeokuta (Ijaye, Ake, Obantoko), and some Lagos communities (Ijegun, Bariga, Ikotun, Ikorodu).
During the visit to some of these private hospitals, PUNCH Healthwise uncovered a pattern of neglect, incompetence, and cost-cutting that puts patients’ lives at risk.
There were reported cases of medical errors linked to these private hospitals, with most of those cases involving unlicensed or underqualified personnel, primarily auxiliary nurses.
From wrongly administered injections to misdiagnosed illnesses, botched deliveries to medication overdoses, the trail of errors is as long as it is horrifying.
During the investigation, our correspondent found that many of these health facilities were employing auxiliary nurses in large numbers, often with little to no oversight or supervision.
32-year-old Hauwa Mohammed was another victim of some of the medical errors committed by these auxiliary nurses.
Mohammed visited a private hospital in the Ikorodu area of Lagos for a routine pain injection, but the procedure went wrong.
An unidentified woman in a nurse’s uniform administered the injection, striking Mohammed’s sciatic nerve and causing intense pain, muscle weakness, and partial immobilisation.
Despite her screams and warnings that something was wrong, the woman seemed unsure of what to do, and it took a senior nurse and a visiting doctor to stabilise Mohammed.
Speaking with our correspondent about her near-death experience, Mohammed, who spent two weeks in the hospital and three months in physiotherapy before regaining mobility, said she was healed by luck.
She added, “I was lucky; others haven’t been. All I know is that the woman who attended to me was not a real nurse. Just another auxiliary.
“It is unfortunate that they wear scrubs; they act confident, but they are not trained. They shouldn’t be allowed near patients.”
In many of these private hospitals visited our correspondent observed that these auxiliary nurses were employed to staff entire wards, intensive care units, and even emergency departments.
These underqualified staff members were often left to make life-or-death decisions, administer medications, and provide critical care to patients without adequate training or support.
Further investigation revealed that many of these auxiliary nurses had little to no formal training in nursing.
Some had completed short courses or certification programmes, but many lacked the rigorous education and clinical training required to become a registered nurse.
Despite this, they were being tasked with complex medical procedures, including administering injections, managing medications, and monitoring patients’ conditions.
It was also discovered that many of these hospitals were found to be operating with inadequate staffing ratios, poor record-keeping practices, and inadequate quality control measures.
PUNCH Healthwise observed that this unprofessional conduct by hospital owners created an environment for medical errors to thrive, and patients were left at the mercy of quacks.
Cheaper labour
Probing why these hospitals employed auxiliary nurses instead of registered nurses, it was discovered that they offer cheaper labour, as an auxiliary nurse earns between ₦30,000 and ₦50,000 per month, depending on the location of the hospital.
While a registered nurse earns between ₦79,000 and ₦197,000 per month, it was gathered that the possibility of using the salary of one registered nurse to pay four auxiliary nurses is one of the key drivers pushing many of these hospitals in this dangerous direction.
Another finding by our correspondent is that in many of these hospitals, there are more auxiliary nurses who were trained by the same hospital and employed at a cheaper price, ranging from ₦25,000 to ₦35,000 monthly after they received their acclaimed certificate.
In many of these hospitals, it was discovered that there are more auxiliary nurses than registered nurses, with some facilities having up to five auxiliary nurses under the supervision of either one registered nurse and a matron or just a matron overseeing the activities of the auxiliary nurses.
A doctor in one of the private hospitals who spoke with PUNCH Healthwise on the condition of anonymity because he was not allowed to speak, said the use of auxiliary nurses had become a ‘necessary evil’.
“We are not proud of it. But what can we do? Government hospitals are crowded. Trained nurses are leaving the country. Our patients won’t pay what it costs to hire qualified staff. If we don’t use auxiliaries, we will have to shut down,” he said.
He claimed that many of the private hospitals provide in-house training and supervision for their auxiliary nurses.
He argued that with the right oversight, auxiliaries can function safely.
“Auxiliary nurses are more readily available and affordable. While they work under supervision, they play a crucial role in supporting healthcare services. In fact, their presence has helped mitigate the impact of the nursing shortage in private hospitals,” he noted.
A senior official at NMCN, who spoke under condition of anonymity, confirmed the illegal nature of this practice.
“Auxiliary nursing does not exist in Nigerian law. It is an informal arrangement that has been widely abused by private healthcare facilities. The council does not accredit auxiliary nurses and will never legitimise the practice,” the official said.
Systemic failure
According to the National Association of Nigerian Nurses and Midwives, only individuals trained in accredited institutions and licensed by the NMCN are legally permitted to practise nursing.
A copy of the Nursing and Midwifery (Registration, ETC) ACT, obtained by PUNCH Healthwise, prohibits any person from training an individual as a nurse or midwife or providing any course of training without the minister’s permission.
The Act, which establishes the Nursing and Midwifery Council of Nigeria, provides in Section 21(a) and (b) that anyone found culpable will pay a fine or be imprisoned for a certain number of months.
The Section reads partly, “It shall be an offence for any person without the approval of the minister, given on the recommendation of the council, to train or purport to train any person as a nurse or midwife or to provide any course of training or establish any school for such purpose or as one of its purposes; and any such person shall be liable.
“(a) on conviction otherwise than in a High Court, to a fine of N1, 000 or to imprisonment for a term of six months, or both such fine and imprisonment; (b) on conviction in a High Court, to a fine of N2, 000 or to imprisonment for a term of two years or both such fine and imprisonment.”
Despite this act, an investigation by PUNCH Healthwise revealed that thousands of hospital assistants, often with no more than a secondary school education and informal, on-the-job instruction, continue to fill the role of registered nurses under the unofficial title of ‘auxiliary nurse.’
It was gathered that these auxiliary workers often begin as cleaners or clerks, slowly absorbing skills through years of working under registered matrons or nurses. Eventually, many are handed syringes, stethoscopes, and life-and-death responsibilities.
Some auxiliary nurses revealed that they undergo a form of apprenticeship, lasting a few years, before being issued certificates that enable them to practice.
They likened this process to learning a trade, such as tailoring, which typically lasts between two and four years.
PUNCH Healthwise gathered that the training is not structured, not guided by any curriculum, and not overseen by any regulatory authority. Yet, by the end of it, the supposed apprentice is no longer seen as just a hospital assistant; she is now considered a nurse.
Upon completion of this period, our correspondent gathered that a graduation-like ritual takes place, known in local parlance as ‘freedom.’
Borrowed from traditional Nigerian trades like tailoring or barbing, freedom is a symbolic rite marking the end of apprenticeship and the beginning of independent practice.
To earn her ‘freedom’, the auxiliary nurses said they must fulfill certain obligations, including paying the supervising matron or nurse a fixed fee, a kind of settlement for the training received, accompanied by a list of required items, including a stethoscope, a blood pressure monitor, and other basic medical tools.
One of the auxiliary nurses, simply identified as Ola, said, “These instruments are part of our ‘freedom package’, and they signify our transition from trainee to the full practitioner.
“I have not done mine because they asked me to bring ₦300,000 before I can do the freedom and get my certificate.
“After begging and all, she agreed to collect N100,000, while I will need to buy an ‘instrument’ worth N50,000 before the freedom can take place.”
Ola explained that her training as an auxiliary nurse focused mainly on practical skills, such as administering drips.
She revealed that some patients were used as practice subjects for these skills, raising concerns about patient safety.
She also stated that most hospitals offering auxiliary nurse training prioritise hands-on experience over theoretical instruction. Instead, they learn by observing experienced nurses and matrons on the job.
According to her, auxiliary nurses are trained in various procedures, including birth maintenance, stitching, and emergency care.
She emphasised that their primary role is to provide basic healthcare services and first aid, and they are not equipped to handle complex cases like surgery.
From cleaner to a nurse
Charity (not her real name) is one of hundreds, possibly thousands of young women across Nigeria who have become healthcare workers by informal apprenticeship, without ever entering a classroom or writing a licensing exam.
The 29-year-old auxiliary nurse working in a mid-sized private clinic in Ibafo area of Ogun State started as a cleaner in the same hospital before she was trained.
She recounted, “I started as a cleaner. Then I began helping with patients, cleaning wounds, setting drips, and giving injections. After three years, I was allowed to work fully as a nurse. I even did my ‘freedom’.
“It is like learning work. After the agreed-upon years, you do your graduation. Then you can work anywhere. People will just assume you are a nurse because you know the job.”
Evading regulators
Despite periodic inspections by government agencies such as the special committee established by NMCN and the Lagos State Health Facility Monitoring and Accreditation Agency, PUNCH Healthwise gathered that many private hospitals employ deceptive tactics to hide the presence of these unqualified staff.
Several auxiliary nurses admitted that, when their employers are notified in advance about an upcoming inspection, they are instructed to avoid detection.
In some cases, they are told not to wear nurse uniforms and to pose as cleaners instead. In other instances, they are simply asked not to report to work on the day of the visit.
One auxiliary nurse working at a hospital in Ibafo said, “Anytime they hear that inspectors are coming, our matron will tell us not to wear our uniforms. She’ll say, ‘Just dress like a cleaner and carry a mop.’ Sometimes, they even tell us not to come to work at all that day. They don’t want wahala.”
They are quacks -Stakeholders insist
Stakeholders in the nursing profession, however, maintained that auxiliary nurses are not recognised in the field, dismissing the term as misleading.
Instead, they argued that these individuals are unqualified impostors attempting to masquerade as legitimate nurses.
The Ogun State chairperson of the NANNM, Adejoke Bello, insisted that the existence of auxiliary nurses was not recognised in Nigeria’s healthcare system and described them as quacks.
Bello stressed that there was no such role in the nursing profession and that anyone claiming to be an auxiliary nurse is misrepresenting themselves.
“You are either a registered and qualified nurse or a quack. Many of those claiming to be auxiliary nurses are not qualified to practise the profession.
“There is nothing like an auxiliary nurse; it is either you are a qualified nurse or you are a quack. We all know that what we call quack is fake. Our association is fighting this quackery because they are destroying and damaging our profession.
“Also, we are concerned about the lives of people. Many people have lost their lives at the hands of these people, and we as an association are doing everything to tackle this quackery in our midst.
“Before you can be described as a certified nurse, you must have attended a university to study nursing or any of these colleges of nursing, where you would be trained and certified.
“The Nursing and Midwifery Council of Nigeria must certify the person, and they will issue the person a licence. Anybody who does not have a license as a practising nurse or midwife in Nigeria is not meant to attend or care for the people,” she said.
Corroborating her statement, a Professor of Medicine at the Department of Nursing Science, University of Calabar, Cross River State, Mary Mgbekem, said she does not know where to categorise auxiliary nurses as they do not belong to healthcare professionals.
She noted, “I am a trained and registered nurse, and I can tell you that they do not belong here. They are people created by doctors for their own selfish interests and not for the interest of patients. Doctors train them so that they can avoid paying the right salaries to the registered nurses.
“This class of people should never get close to the patients if patients’ safety means anything to medical professionals. They are trained with the little knowledge acquired by their employers. They are not licensed and will be held liable for anything that goes wrong.
“They are not recognised anywhere and do not belong to healthcare professionals but only to the doctors who use them. Apart from that, they are not known among healthcare professionals.”
Daring consequences
Research has shown that the substitution of registered nurses with auxiliary nurses can have serious consequences for patient safety.
A study published in the Journal of Nursing Administration found that hospitals with higher ratios of RNs to patients had lower rates of mortality, failure to rescue, and other adverse outcomes.
Another study published in the Journal of Healthcare Risk Management found that the use of auxiliary nurses was associated with an increased risk of medical errors and patient harm.
Despite these studies, an investigation by PUNCH Healthwise showed that the trend towards relying on auxiliary nurses continues to grow.
Even the Lagos State chapter of the nurses’ association recently decried the alarming rate of nursing quackery, noting that it has resolved to clamp down on illegal training and unauthorised practice in the state.
The Lagos State Chairperson of the NANNM, Christianah Adeboboye at the association’s Nurses Summit, in commemoration of International Midwives Day and International Nurses Week, stated that, despite the nobility of the calling, widespread impersonation of nurses by unqualified individuals poses a danger to public health and damages the image of the profession.
“In Lagos, we have observed some of these impostors being enabled by certain health facilities and professionals,” she said.
She reiterated that NANNM Lagos has a zero-tolerance policy on quackery.
She noted that the association is working closely with the Nursing and Midwifery Council of Nigeria to clamp down on illegal training and unauthorised practice.
She called on the government and all stakeholders to support the association in upholding professional standards and safeguarding the integrity of the profession.
Expert warns of impending danger
The Executive Secretary of the Nigerian Academy of Science, Dr. Oladoyin Odubanjo, warned of impending danger over the reliance on auxiliary nurses in most private hospitals due to the migration of registered nurses and cheap labour.
According to him, employment of auxiliary nurses by private hospitals poses a significant risk to patient safety and healthcare outcomes across the country.
Speaking exclusively with our correspondent, Odubanjo stressed that while auxiliary nurses might seem like a practical solution to staffing shortages, especially as they cost less to hire, the danger they pose to patient care cannot be ignored.
He explained that many of these individuals lack the scientific and clinical training required to handle even the most basic medical scenarios safely and effectively.
“In reality, what happens is that hospitals try to manage the shortages by hiring a few qualified nurses and filling the rest of the roles with auxiliary staff who are trained on the job to perform certain basic tasks.
“But the real danger lies in the fact that they don’t understand the underlying science of diseases, human anatomy, or the nuances of medical conditions. They may treat two patients the same way based on superficial symptoms, unaware that their conditions are vastly different,” he said.
He likened this to the dangerous practice of self-medication, where individuals repeat a previous prescription for similar symptoms without a proper diagnosis, often leading to adverse outcomes.
Odubanjo warned that such practices not only compromise the quality of care but also endanger patients’ lives.
He highlighted a broader systemic issue, the mass migration of qualified health professionals seeking better opportunities abroad due to poor remuneration, lack of motivation, and harsh working conditions at home.
He added, “Government hospitals are advertising for doctors, and nobody is applying. Nurses, although more in number, are also leaving in droves.
“The few that remain are overwhelmed and underappreciated. There has been no significant improvement in their welfare, and many are forced to take multiple jobs just to make ends meet.”
Way forward
Odunbanjo, however, stressed the importance of addressing both the ‘pull’ and ‘push’ factors in the healthcare brain drain.
While noting that overseas opportunities may offer better pay and conditions, the physician stated that the deteriorating environment within Nigeria, delayed salaries, poor infrastructure, and lack of recognition push even the most committed health workers out of the system.
He highlighted scenarios where highly skilled nurses chose to abandon their profession entirely to go into unrelated businesses such as cooking or retail, simply because their expertise is neither valued nor rewarded.
The physician recommended a multi-faceted approach to reform.
Beyond improving pay and welfare packages to retain skilled workers, he urged the government to regulate and standardise the training of auxiliary nurses.
Instead of banning them outright, he suggested they be enrolled in certified training programmes that clearly define their scope of practice and ensure they can perform their duties safely.
“There must be proper training and legal limitations to what auxiliary nurses can and cannot do. We must not allow the desperation to fill staff shortages to compromise patient safety,” he said.
Drawing a parallel with the recognition and training of traditional birth attendants in rural areas, Odubanjo said auxiliary nurses could also be trained through structured programmes administered by state or local governments.
This, he noted, would help formalise their role while ensuring they do not overstep critical boundaries in patient care.
Unwilling to pay professionals
Meanwhile, the immediate past registrar and secretary general of NMCN, Faruk Abubakar, dismissed the claim that there was a shortage of nurses in the country, insisting that private hospitals engage the services of auxiliary nurses because they were unwilling to pay professionals.
He described auxiliary nurses as quacks and warned that their increasing presence in private hospitals poses a grave danger to patients.
Umar, in a telephone interview with PUNCH Healthwise, condemned the use of unqualified personnel in health facilities, particularly private hospitals, which he said were in the habit of employing auxiliary nurses because they were cheaper than professionally trained and licensed nurses.
He stated, “There is nothing like auxiliary nurses. They are quacks. Nobody recognises them.
“All these private hospitals are using them because they want cheap labour. They train anybody and just give them a name, but they are not qualified.”
Umar stressed that the NMCN does not recognise auxiliary nurses, warning that their practice amounts to illegal quackery that endangers patient safety.
He revealed that during his tenure, nurse production in Nigeria increased by over 400 per cent from 9,000 annually to 45,000.
However, he lamented that less than 20 per cent of these qualified nurses were employed, largely because private hospitals were unwilling to pay professional wages.
“The real problem is employment, not shortage. Qualified nurses and midwives are available, but they are not being hired because of cost. That is why private hospitals prefer to promote quackery,” Umar explained.
He urged government agencies and regulatory bodies to enforce existing laws, highlighting the example of Enugu State, which formed a task force to combat the illegal practice of unlicensed nurses.
“The law is clear. The National Midwifery Act empowers state committees to flush out quacks and ensure only qualified nurses practise. It is a matter of enforcement,” he said.
Umar also called on the media and investigative journalists to expose unlicensed practitioners in health facilities, advising the public to verify nurses’ licences, which are available online via the NMCN.
We act swiftly when we get report – NMCN Registrar
The NMCN registrar, Ndagi Alhassan, said the council takes prompt action against illegal nursing practices whenever it receives credible reports from its monitoring teams across the country.
Alhassan explained that while the council has zonal offices meant to oversee state activities, enforcement depends largely on the flow of information from these offices to headquarters.
According to him, the council depends heavily on information from zonal offices and state-level monitoring teams before it can intervene.
He lamented that some states have yet to fully empower their inspectorate divisions, which he said slowed down enforcement efforts.
“We act swiftly when we get reports. We arrest and prosecute those found practising without proper licences. But as much as we rely on the reports from the states, some of these states have not started effective monitoring yet.
“We are waiting for reports from zonal offices and monitoring teams at the state level. Once we receive verified reports, we act swiftly to arrest and prosecute offenders,” he added.
The registrar, however, revealed that a significant number of qualified nurses remain unemployed across the country despite rising concerns over the illegal practice of unqualified auxiliary nurses in private hospitals.
Alhassan stated that unemployment, rather than the mass migration of health workers, is the main challenge facing the nursing profession in Nigeria.
“We have enough nurses on the ground who are unemployed. They are not being employed. It is not because of Japa. People are still available but are not being hired,” Alhassan stated. (Punch)
