Suffering and smiling: Tales of Nigerian nurses’ endless sacrifice with poor pay
By Daylight
August 10, 2025
Nurses
Nurses working in government-owned hospitals across the country are groaning over poor remuneration, staff shortages, unpaid allowances, and unsafe working conditions amid brain drain in the health sector. PUNCH Healthwise investigation reveals how these frontline health workers battle exhaustion and collapse on duty caring for others. IDOWU ABDULLAHI reports
Under the dim fluorescent lights of the Accident and Emergency unit, where every second counts at a federal teaching hospital in South-West, IV bags dangling from metal stands, and nurses in scrubs move briskly between patients, when the unexpected happens.
One of the triage nurses on duty, simply identified as Nurse Adeyinka, suddenly collapsed midway into her 8-hour shift, becoming a patient herself. It was not the first time the 34-year-old had worked through fatigue, hunger, and aching legs. But that morning in May 2025, her body finally gave out.
When colleagues rushed to her aid, her blood pressure had dipped dangerously, and her blood sugar levels were low. She had not eaten in over 16 hours, and the hospital was critically short-staffed.
The night before, she had gotten home late due to working overtime, and her appetite had been battered after several missed meals due to the high patient load.
She retired early to her bed and returned for her shift duty before 8:00 a.m. the day she collapsed, forgetting to eat.
“She just slumped by the patient’s bed while checking vitals. We had to put her on a drip and monitor her right there in the Accident and Emergency ward. It was scary.
“Despite being one of our own, we couldn’t stay with her more than five minutes, as there are a lot of other patients that need our attention. As nurses, we’ve taken an oath to care for the sick. So even when we’re sick or one of us is sick, work still has to continue,” a colleague who witnessed the incident told .
It was just past 3:00 a.m. when Lucky, a registered nurse at a general hospital in Ondo, collapsed beside the stretcher he had been tending to all night.
For days, he had been battling malaria and diarrhoea, but had refused to call in sick since there was no one else to take his shift. The hospital, already short-staffed, was running on skeletal strength.
With more than usual patients that night in June 2025, Lucky was moving from bed to bed, pale and visibly weak, attending to patients when he collapsed to the cold tile floor, unconscious.
Panic rent the air as patients’ relatives screamed. But there was no doctor on duty, only a young health assistant, overwhelmed and untrained for such emergencies.
“I collapsed on duty about two months ago. It was in the middle of the night. I was having malaria and diarrhoea at the same time.
“There was no doctor on the ground. I was the only health worker available at that time,” Lucky told our correspondent.
It took over an hour before a medical team from a hospital in a neighboring local government arrived. By then, the registered nurse was severely dehydrated and barely responsive, left with just hope that he wouldn’t die on duty.
“We had to call another team from a different local government area to come and rescue me. I had to be admitted.
“I was rolling on the floor from pain. And yet, there were still patients waiting to be attended to. That’s the reality. That’s what nurses are facing across this country,” he said.
For Adeyinka and Lucky, their stories remain a reflection of the new normal that nurses across Nigeria face working in understaffed facilities, grueling work hours, and underpaid wages.
Their reality, our correspondent gathered, had turned nursing, once considered a noble calling for many in Nigeria, into a profession of endless sacrifice with little reward.
As thousands of nurses leave the country for better opportunities abroad, PUNCH Healthwise gathered that those left behind are stretched beyond capacity, risking their physical and mental health to uphold the crumbling system.
Brain drain is draining available nurses
Available figures from 2023 showed that the country’s healthcare system is losing skilled professionals at an alarming rate. According to data from the Nigerian Nursing and Midwifery Council, over 75,000 Nigerian-trained nurses and midwives are reportedly working abroad.
“As a result of poor wages and lack of decent work environments, over 75,000 Nurses and Midwives have migrated from Nigeria within a period of five years.
“Shortage of Nurses and midwives, especially in certain areas of specialisation and geographic regions, the increased rates of attrition and a chronic shortage of nursing personnel in the country increased workloads on nurses without an equivalent compensation, exposing them to more health hazards and compromising the quality of healthcare delivery,” the then NANNMC President, Michael Nnachi, said during the 2023 International Nurses Week.
Also, the 2021 State of the World’s Midwifery report puts the midwives shortage in Nigeria at about 30,000, which is six per 10,000 people.
“To close the gap by 2030, about 70,000 midwife posts are needed, but with current estimates, only 40,000 will be created by 2030. This shortage is particularly acute in northern Nigeria, where essential needs for maternal and reproductive health care are unmet,” said the then NANNM Vice President of NANNM, Israel Blessing, at the event.
Meanwhile, in 2024, data from the Nursing and Midwifery Council register from April 1, 2023, to March 31, 2024, showed that a total of 3,173 Nigerian-trained nurses and midwives were licensed to practise in the United Kingdom in one year.
The report, as at then, also showed that 13,656 nurses and midwives educated in Nigeria were practising in the UK.
“There were a total of 826,418 nursing and midwifery professionals on our register. Of this number, 13,656 were educated in Nigeria. In the 12 months to March 31, 2024, 3,173 people who were educated in Nigeria joined our register for the first time,” the NMC data showed as of March 31, 2024.
PUNCH Healthwise’s investigation revealed that these mass exoduses of nurses to seek greener pastures abroad have left several hospitals with fewer nurses to attend to patients below the benchmark set by the World Health Organisation.
In overcrowded wards of major hospitals across the country, PUNCH Healthwise gathered that nurses stretch themselves thin to bridge the massive staffing gap that haunts the country’s health system.
In some states, it was learnt that many nurses also lack health insurance or housing support and are forced to improvise for essentials such as gloves, scrubs, and stethoscopes, with some even buying from their own pockets.
Confirming this, the National Chairman, NANNM–Federal Health Institutions Sector, Morakinyo Rilwan, revealed that nurses have been subjected to working with inadequate tools and equipment, including gloves, without complaining for several years.
“If you go to hospitals in Nigeria, the working conditions are not up to standard. Yes, you may produce gloves and what have you, but it’s not enough. What is available is not sufficient.
“They expect nurses to improvise. And truly, nurses do. We use anything to take care of patients when the ideal tools are not available. And the authorities have capitalised on that. There is no state-of-the-art equipment. That’s what we are saying,” Rilwan told our correspondent during an exclusive interview.
He added, “I’m talking about using what is not ideal to carry out your duty. Like when you need surgical gloves or latex gloves, the proper gloves for medical use, and they’re not available, that’s what I mean.
“Or where you are supposed to use an electric suction machine, and instead, you use a manual one. Or you even have to use a basic catheter to suction a child’s nose instead of the proper suction device. You just look around and find local things to use.”
Despite the WHO recommending one nurse to four patients, an investigation reveals that a single nurse may juggle between 10 and 15 patients daily in Nigeria.
With patient loads triple the recommended ratio, the nurses hustle from bed to bed, dressing wounds, administering drugs, and monitoring vitals often without rest or support.
Burnout galore
The exodus, fuelled by the search for better pay and working conditions, has left Nigerian hospitals grossly understaffed. Many facilities now operate with skeletal nursing staff, increasing the workload on those left behind.
PUNCH Healthwise gathered that in several federal and state-owned hospitals, nurses rotate between grueling morning, afternoon, and night shifts, often lasting 8 to 12 hours or more.
It was learnt that the morning shift starts at 8 a.m., with a flurry of ward rounds, medication, and dressing changes. By afternoon, fatigue sets in for some nurses on duty. While at night, two nurses may cover an entire ward meant for six, checking vitals, handling emergencies, and soothing patients through the early hours.
With many colleagues having resigned or relocated abroad, our correspondent gathered that those left behind stretch themselves thin, sacrificing rest, meals, and their health just to keep the system running.
For patients, PUNCH Healthwise’s investigation reveals that the ripple effect of nurse burnout and shortages is leading to longer waiting times, limited attention, and lower quality of care.
“As a nurse, you’re not supposed to care for more than four patients at a time. With four patients, you can provide holistic care.
“But what do we have in Nigeria? We’re seeing nurses handling 40 to 50 patients at once daily. Across hospitals in Nigeria, you’ll often see one nurse managing 20 to 25 patients alone per shift.
“And it’s worse in secondary facilities located in remote areas. Some nurses are posted across multiple wards, even across different buildings. One nurse may need to run between wards that are not even in the same structure,” Lucky told PUNCH Healthwise.
The registered nurse revealed that, despite working beyond the shift hours most times, nurses are not getting paid for working overtime.
“Even the main salary is not fully paid or is often delayed, not to mention overtime pay. Working extra time has become the norm in Nigeria’s public hospitals. Personally, I have stayed up to four to five hours extra after my shift on several occasions.
“Sometimes, we even work morning, afternoon, and night consecutively, what we call ‘marathon shifts’, just to cover for staff shortages. I’ve seen nurses who are seriously sick on duty, but they keep working because there’s no one to relieve them,” he added.
For a registered nurse at a Federal Teaching Hospital, Lokoja, who simply identified himself as Hassan, his shift duty allowance after working hours on his feet and moving between patients hardly reflected the toll.
“I do shift duties, and my shift duty allowance is not more than ₦17,000. Meanwhile, other health workers who do calls and don’t even stay with the patient make far more. They only do maybe two calls in a week and make over ₦60,000 to ₦100,000 in a month.
“But I, who is staying with patients for 8 to 12 hours, meeting their health needs, my shift allowance is just ₦17,000. Some nurses even earn ₦11,000, ₦10,000, ₦7,000 as shift allowance depending on their level. The money and the remuneration we get as nurses in healthcare are poor,” he said.
He lamented that nurses are the ones feeling the weight of a system in collapse.
“I’m currently working in the medical ward, and we are just nine people running shifts. Also, among the nine, the head of the unit is not actively involved in patient care. So, in reality, just seven nurses are doing the actual shifts; one person goes, another comes in, and that’s how we rotate.
“It’s not easy. Sometimes, I run a shift alone, managing 24 or 25 patients. And this is just the medical ward. If you go to the emergency ward, it’s the same. In all the units, it’s like that. We don’t have manpower. And people are leaving every time,” Hassan told our correspondent.
Impact of burnout on nurses’ mental health
A Consultant Psychiatrist, Dr. Sunday Amosu, warned that Nigerian nurses facing prolonged burnout are at heightened risk of developing a range of mental and physical health disorders, including depression and anxiety.
He explained that constant exposure to heavy workloads, poor welfare, and inadequate staffing leaves many nurses emotionally drained and physically exhausted, undermining both their well-being and their ability to deliver quality patient care.
“If you look at it, all of this will lead to psychological challenges and emotional issues, including burnout and emotional exhaustion. And if there is emotional exhaustion and burnout like this, then job satisfaction and job performance will go down.
“Statistically, all over the world, about 50–56% of nurses experience burnout, while about 64% are going through one form of stress or another. There are also physical health problems caused by the nature of their duty,” he told our correspondent during an interview.
Beyond burnout
Beyond burnout, poor remuneration continues to crush the morale of nurses across Nigeria. With inflation eating away at their stagnant salaries, some can barely feed their families or afford transport to work.
By 7:45 a.m., Nurse Mariam Ahmed (not real name) is already in her white uniform, keys jingling as she unlocks the doors of the ENT clinic in a government hospital in the North-East geopolitical zone in preparation for her shift, which starts by 8:00 a.m. daily from Monday to Friday.
She’s the only nurse and health worker assigned to the unit, a role that demands the strength of not least three nurses and ENT experts.
The 28-year-old Ahmed records vitals, sterilizes tools, educates patients on medication, and sometimes carries out procedures, all alone.
“Currently, in the facility where I work, I am alone. I’m the only ENT nurse in the entire hospital. Since we run a clinic, it means I consult patients, carry out procedures, and do everything all by myself.
“On a typical day, I attend to about 10 to 15 patients, depending on the season, because ENT conditions are often seasonal. Within the area I’m serving, there is no other ENT nurse in the entire local government, and even in the surrounding local governments. Patients come from far and wide, from Taraba State, Adamawa State, and other areas bordering this state, just to access ENT services.
“With the routine, I’ve battled with burnout and other health issues, including back pain, because our work involves standing a lot and bending when carrying out certain procedures,” she told our correspondent.
Despite being overstretched, she said her nursing salary can’t take care of her bills till the next payday.
Once the last patient leaves around 3:00 p.m., she rushes home and transforms into a tailor in her apartment. For her, the uniform may change, but the hustle never stops.
Ahmed, who has been practicing as an ENT nurse for about seven years, added. “I’m currently running my BNSc, and anytime I’m not in the hospital, the ENT department is closed.
“The salary is not enough. I can’t go through an entire month on my salary alone. That’s why when I get home, I have to sew clothes till late in the evening or into the night, and then I have to start the routine all over again the next day.”
Another nurse, who identified herself simply as Mary at a secondary healthcare facility in Enugu State, said that after her government job, she works shifts at a private hospital just to survive.
“After paying my rent, buying food items, and sending money to my parents, I have nothing left.
“I’ve started walking some distance before taking buses just to reduce the cost. I treated myself for typhoid recently and had to borrow from a friend. Imagine me, a nurse who cares for others, can’t afford basic healthcare,” she told our correspondent.
Another nurse in FMC Kogi, a single mother of two, who gave her name as Bose, revealed she was considering leaving the profession entirely.
Bose said, “I can’t afford my children’s school fees, and my landlord is threatening to throw us out. I find it hard to sleep at night. I’m just tired of the whole situation.
“I am considering quitting and finding another thing to do since I am finding it hard to sort my bills. I won’t lie to you, the entry-level pay is nothing to write home about, even for a single person, let alone someone with a family.
“As a single person entering the profession, the salary is not enough to sustain even basic needs. Now imagine someone with a family, it’s almost impossible to cope.”
Also, Isioma Kelechi, a 33-year-old registered nurse who recently relocated to the UK, said the decision to leave was difficult but necessary.
“In Nigeria, I worked like a machine and earned peanuts. Now in the UK, I do fewer hours, get paid well, and I get value for the hours I put in.
“Though I am still trying to settle down and adapt to the system, I can now afford to live like a human being,” Kelechi said.
Sharing the nurses’ concerns, the consultant psychiatrist said chronic financial stress can impact nurses’ productivity.
Amosu, who is the Director of Research and Training at the Federal Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, said, “When people are not satisfied, when people are poorly paid, they are not happy. Those tasks that they should be able to do easily by reason of their training, they will not be able to do, and they will not be happy at their duty post.
“This problem of lack of satisfaction will push out conditions such as burnout, anxiety, depression, and other mental conditions. In fact, some nurses who already have a family history of mental illness may be triggered. So, sincerely and without mincing words, not being satisfied enough in terms of wages will affect anybody’s mental health. Not only nurses, but every health worker is affected.”
Tipping point
The experience of nurses across the country led to a recent nationwide strike that lasted a few days. During the industrial action, hospitals across Nigeria witnessed a significant disruption in medical services as nurses under the aegis of the National Association of Nigerian Nurses and Midwives crippled medical facilities’ operations for four days.
The industrial action, which started on July 30, 2025, and was planned for seven days, was called off on August 2, 2025, after the nurses’ leadership and the Federal Government team met. Before the strike, the union had, on July 14, 2025, issued a 15-day ultimatum to the federal government, demanding immediate intervention to prevent a total healthcare shutdown.
Some of the demands of the nurses are the upward review of shift allowance, uniform allowance adjustment, a separate salary structure for nurses, increased core duty allowance, mass employment of nurses, and the establishment of a nursing department in the Federal Ministry of Health, among others.
Meanwhile, rising from the meeting on August 1, the apex government pledged to gazette the long-awaited nurses’ scheme of service within four weeks as part of measures to address key demands of the nurses, particularly those related to career progression, welfare, and internship placements.
This pledge formed part of a Memorandum of Understanding reached at the end of a conciliation meeting convened by the Minister of Labour and Employment, Maigari Dingyadi, and attended by the Coordinating Minister for Health and Social Welfare, Prof Muhammad Pate, and the leadership of NANNM.
The gazetting of the nurses’ scheme of service, originally approved by the National Council on Establishments in 2016, in Minna, Niger State, is a document that outlines the career structure, qualifications, job descriptions, and progression pathways for public servants in Nigeria, including nurses and other professionals.
Heartbeat of the health system
A Professor of Community Medicine, Adesegun Fatusi, described nurses as the lifeblood of the healthcare system, stressing their critical role in delivering quality care and ensuring the smooth running of hospitals and clinics across Nigeria.
Fatusi, who is the immediate past Vice-Chancellor of the University of Medical Sciences, Ondo, noted that nurses often serve as the first point of contact for patients, providing several supports, especially in overstretched and under-resourced facilities.
He emphasised that without nurses, the health system would struggle to function effectively.
“Nurses are the central pillars that hold hospital services together. They are the linchpin that holds medical services together. I can say that anywhere. If you don’t have doctors but you have good nurses, your system can still perform very well. Because most of us don’t need doctors.
“Why do I say that? Most conditions that bring people to hospitals and that kill people are conditions that can be managed at the primary health care level. You don’t need doctors for the everyday running of primary care, particularly in developing countries. You can’t afford it. So you need well-trained nurses to run it. So nurses are critical. They are the heartbeat of the health system,” the don told PUNCH Healthwise during an interview.
Why burnout persists – NMCN Registrar
Meanwhile, the NMCN Registrar, Ndagi Alhassan, gave an insight into why there is a shortage of nurses across Nigeria, revealing that some states employ fewer than 100 nurses annually despite the growing demand for healthcare services.
Aside from the states, he raised concerns over the low rate of nurse recruitment across the country, adding that the persistent shortfall in nurse employment is contributing to burnout among existing staff and weakening the capacity of the health system to deliver quality care, especially in rural and underserved communities.
Speaking exclusively to PUNCH Healthwise, Alhassan said, “The truth of the matter is that the government needs to face its responsibility and employ unemployed nursing graduates. If you check the statistics of employment from all the states and teaching hospitals in the last three years, it’s a very bad record.
“In fact, if you go to many of the healthcare institutions, particularly in some states, they barely employ up to 100 nurses in the whole state yearly. Those are the issues. We are turning these people out en masse. The problem is not production. The problem is employment.”
Alhassan stated that unemployment, rather than the mass migration of health workers, is the main challenge facing the nursing profession in Nigeria.
“It’s simple: nurses are not being employed. We tried to look at it from the rural perspective and created a Community Nursing, Community Midwifery programme so the graduates from these progarmmes can serve in remote and hard-to-reach areas. When they bring their ward for training and he or she is trained and returned to the community, because that is their base, they will have the desire and eagerness to serve their people.
“But even after we produce these graduates, they are not being employed by the local government. The primary healthcare facilities are there, but there is no personnel to serve. That is the essence of producing these people. But no one is engaging them. Those are the issues,” he added.
Nurses’ recognition just lip service
Alhassan said talks about nurses’ recognition across the country are just lip service, maintaining that agreements on paper are not being turned into actionable moves.
“The truth of the matter is that the recognition is just lip service. If it’s not lip service, it should translate to appreciating their work, bringing them to the table for policy decisions, because these are people who serve directly with the patients. On matters related to patient care and requirements, the system should work by involving them. The government needs to bring them to the table for policy formulation. Nobody is doing that.
“So, if the government truly recognises their service and it’s not lip service, they should involve them in policy formation and execution. That is one aspect. Also, on remuneration, it should reflect the risk. You saw what happened during the COVID-19 period. Not many of the other health workers were in the wards with patients. It was mainly nurses who risked their lives.
“Go to the IDP camps, you don’t see any other person than the nurse. Apart from being educators, they coordinate and supervise, but nobody is recognising them through remuneration. If there were better welfare packages, it would help, particularly a hazard allowance. Nobody has exposed their lives to danger like nurses have, yet nobody is recognising that. It’s not encouraging,” he said.
FG reacts
Meanwhile, the Federal Government admitted that nurses are battling an increased level of burnout due to a shortage of staff, adding that plans are underway to change the narrative and improve frontline healthcare givers’ welfare and provide a conducive environment.
Speaking with PUNCH Healthwise in an exclusive interview, the Director of Nursing Division, Hospital Services Department, Federal Ministry of Health and Social Welfare, Dame Okafor, said the government had rolled out several initiatives to curb brain drain and improve nurses’ welfare.
“It’s true that nurses across the country are experiencing increasing levels of burnout due to chronic staff shortages and overwhelming workloads, and it’s important to also acknowledge the ongoing efforts by the government to address this crisis,” Okafor said.
She listed some of the policies the government has put in place to mitigate the shortage of the nursing workforce to include doubling the intake of nursing students by 100% and approving new training institutions, marking an immediate 35% growth in nursing education capacity.
Aside from that, she said Nigeria added about 80 new nursing and midwifery training institutions, leading to a significant increase in school counts in just two years.
“In addition, the government has approved the Nigerian Strategic Direction for Nursing and Midwifery, which cuts across four pillars—education, job creation, leadership, and service delivery. The Federal Ministry of Health has also intentionally approved a steering committee with diverse stakeholders to drive the implementation of this NSDN. When fully implemented, it has the capacity to reverse the tide of challenges facing the nursing profession in the country,” Okafor said.
On nurses’ welfare, the director maintained that, “The government, particularly this division, is working to standardise and ensure that nurses’ welfare is met. This includes salary scales, compensation, motivation, and related matters.
“The Coordinating Minister is in support of improving nurses’ welfare packages, which is why we are facilitating the full implementation of the NSDN and migration policies. Once implemented, these will address welfare concerns such as delayed promotions, inadequate compensation, and workforce attrition. The NSDN will also promote sustainable dialogue between the government and professional bodies, such as NANNM.
“If the NSDN is fully implemented, all these problems, overtime pay, inadequate allowances, and heavy workload will become things of the past. The minister has just approved the policy, and we are set to launch it. Once launched, likely before the end of this month or early next month, implementation will begin immediately.Punch
