The story of African nurses has always been a story of resilience. Whether in bustling hospitals in Lagos, overburdened clinics in Nairobi, or underserved rural communities in Ghana, nurses are the backbone of healthcare. Yet behind the dedication lies a quiet crisis: the ethical dilemmas that define nursing practice in Africa — and the contrasting realities nurses encounter when they migrate abroad.
These dilemmas are not abstract theories from textbooks. They are lived experiences, shaping decisions every shift, every day.
1. Staffing Ratios: When Care Becomes a Numbers Game
The World Health Organization (WHO) recommends one nurse for every six patients. In many Western hospitals, this standard is enforced: a nurse may be responsible for just 4–6 patients during a shift.
In Africa, the reality is brutally different. Ratios can reach one nurse for 30, 50, or even 100 patients. The ethical dilemma is stark: when you cannot give each patient the attention they deserve, is “doing something” better than doing nothing? Nurses are forced to choose who gets care first, knowing full well that delayed interventions can cost lives. Abroad, failing to meet a patient’s need is unacceptable; at home, it’s often unavoidable.
2. Documentation: Accuracy vs. Exhaustion
Electronic health records abroad track every medication, every observation, every intervention in real time. Missing a step isn’t just frowned upon — it’s traceable, punishable, and can end a career.
In many African hospitals, documentation is still paper-based. Nurses may document hours after interventions, squeezed between emergencies and endless workloads. The ethical dilemma? Accuracy suffers not because nurses are careless, but because the system is designed to overwork them. Abroad, the nurse is liable; at home, the system is to blame.
3. Resource Allocation: Improvisation vs. Safety
In resource-rich settings, waste is minimized and protocol is followed strictly. Nurses are expected to use one device per patient, ensure all equipment is sterile, and never “make do.”
But in Africa, improvisation is an art of survival. One oxygen cylinder may serve three patients. A blood pressure cuff may be shared across wards. A single monitor may rotate between critically ill patients. Nurses are praised for ingenuity — but it also raises the ethical question: is improvisation safe care, or is it substandard care forced by circumstances?
4. Accountability and Blame
Abroad, accountability is individualized. Nurses face disciplinary panels, lawsuits, and license suspension for errors. In Africa, accountability is collective — the health system itself is often blamed, but the nurse still bears the emotional weight. The dilemma lies in carrying responsibility without power: how do you give safe care in a system stacked against you?
5. Loyalty: To Country or to Family?
Perhaps the deepest dilemma is not clinical but personal. Thousands of African nurses migrate abroad every year. The reason is simple: better pay, safer working conditions, more respect. But leaving behind already fragile health systems feels like abandonment. Staying home, however, often means financial struggle and burnout.
Is the nurse more responsible to their country, or to their family? Is choosing survival over sacrifice unethical? These questions have no easy answers — and they define the nurse’s dilemma more than any textbook case study ever could.
Why This Matters
These ethical dilemmas are not just problems for nurses — they are signals of broken systems. Burnout, brain drain, and compromised patient care are not isolated issues; they are symptoms of systemic neglect. Nurses should not have to choose between speed and safety, accuracy and exhaustion, improvisation and protocol, family and nation.
Until African governments and health institutions invest in staffing, resources, and fair compensation, these ethical tightropes will remain daily realities. And until global health discussions recognize the ethical cost of migration and brain drain, Africa’s nursing workforce will continue to shrink under impossible pressure.
Final Word
Nurses are not just caregivers; they are the conscience of healthcare systems. Their ethical dilemmas reveal deeper truths about justice, equity, and human dignity. To solve them, we must do more than praise nurses — we must build systems where the right choice is also the possible choice.
Because in the end, saving lives should never be an ethical gamble
Fellow Nurses Africa is the independent voice of African nursing. We educate, inform and support nurses across Africa.
