NURSING IS NOT THE PROBLEM: Nigeria Needs a Fairer Healthcare Pay System
NURSING IS NOT THE PROBLEM: WHY NIGERIA MUST REBUILD THE HEALTHCARE PAY SYSTEM BEFORE WE LOSE THE NEXT GENERATION OF NURSES
Doctors, nurses, radiographers, medical laboratory scientists and other health professionals should not be competitors for recognition—they should be properly valued according to responsibility, qualification, expertise and the needs of the Nigerian healthcare system.
Nigeria's healthcare system has a salary problem.
But it is not simply a problem of who earns more.
It is a problem of how healthcare professionals are valued, classified, rewarded and retained.
Across government-owned and private healthcare institutions, doctors, nurses, radiographers, medical laboratory scientists, pharmacists, physiotherapists and other professionals perform different but interconnected functions. Yet Nigeria continues to experience arguments over salary structures, professional relativity, allowances, career progression and the appropriate relationship between different health cadres.
The result is predictable: frustration among professionals, competition between professions, industrial disputes, migration and difficulty retaining experienced healthcare workers.
The question Nigeria should be asking is not:
"Why is this profession earning almost as much as that profession?"
The more important question is:
"Does our healthcare remuneration system adequately reward qualification, responsibility, expertise, risk, workload, scarcity and performance?"
That is the conversation Nigeria needs.
NURSING MUST NOT BE LOST IN THE SALARY WAR
Nursing deserves particular attention.
Nurses constitute one of the most important pillars of healthcare delivery. They work in government hospitals, teaching hospitals, specialist hospitals, private hospitals, clinics, primary healthcare facilities, schools, industries, home-care services, community health programmes and other healthcare settings.
A nurse may be the professional who spends the greatest amount of time directly observing a patient.
The nurse monitors vital signs.
The nurse administers prescribed medications.
The nurse provides bedside care.
The nurse identifies deterioration.
The nurse documents clinical events.
The nurse communicates changes in the patient's condition.
The nurse educates patients and families.
The nurse supports patients emotionally.
The nurse participates in emergencies.
The nurse coordinates aspects of continuous patient care.
This is not "just helping the doctor."
It is professional nursing practice.
Therefore, Nigeria must resist the temptation to measure the value of nursing solely by comparing it with medicine.
Nursing should be evaluated and rewarded as a profession in its own right.
BUT WHY CAN SOME RADIOGRAPHERS AND MEDICAL LABORATORY SCIENTISTS APPEAR TO EARN CLOSE TO DOCTORS OR NURSES?
This question requires a more sophisticated answer than simply blaming one profession.
In Nigeria, remuneration can vary according to:
government or private employment;
federal, state or local institution;
grade level;
years of experience;
specialist qualification;
managerial responsibility;
scarcity of particular skills;
location;
shift and call duties;
overtime;
allowances;
individual negotiation;
hospital revenue and financial capacity.
Consequently, a senior radiographer or medical laboratory scientist in a particular institution may earn substantially more than a junior doctor or junior nurse.
That does not necessarily mean that the profession has become "equal" to medicine or nursing.
It may simply mean that the two individuals are at different points on different career ladders.
Nigeria therefore needs to stop comparing professionals merely by their job titles.
A senior professional should be compared with another senior professional, and a specialist with a specialist.
That is the beginning of a rational salary system.
THE UNITED STATES SHOWS THAT DIFFERENTIATION DOES NOT REQUIRE UNDERVALUATION
The United States provides an important lesson.
According to the U.S. Bureau of Labor Statistics, the May 2025 median annual wage was approximately:
Physicians and surgeons — $275,930
Registered nurses — $97,550
Radiologic technologists and technicians — $80,110
Clinical laboratory technologists and technicians — $62,930.
The lesson is not that Nigeria should copy these dollar figures.
Nigeria's economy, healthcare financing and cost structure are completely different.
The lesson is the principle of differentiation.
A radiographer can be well paid without necessarily being paid like a physician.
A medical laboratory professional can have a strong career without eliminating the physician salary premium.
A nurse can be well compensated without creating an identical salary for every health profession.
Fairness does not mean sameness.
LUXEMBOURG: BUILD A SYSTEM, NOT A PERSONALITY CONTEST
Luxembourg offers another lesson that Nigeria can adapt.
Its labour system recognises collective agreements as formal mechanisms for establishing working conditions within businesses and sectors. Such agreements can provide a uniform framework and, under specified procedures, can even become generally binding across a sector.
Nigeria can learn from this principle.
Instead of allowing every healthcare institution to create completely different interpretations of professional value, Nigeria should develop clear national frameworks for job evaluation and remuneration, while still allowing legitimate differences between public and private employers.
The objective should be:
clear grades + clear qualifications + clear responsibilities + clear progression + clear pay bands.
SWITZERLAND: VALUE THE HEALTHCARE WORKFORCE AS A SYSTEM
Switzerland provides another important lesson.
Its healthcare system is highly developed but also expensive, and Swiss authorities recognise the importance of maintaining an adequate healthcare workforce while addressing dependence on workers trained abroad.
Nigeria should pay attention to this.
When a country continually loses experienced healthcare workers, the problem is not only that individuals are leaving.
The country is losing:
experience, institutional memory, mentorship, clinical skills and investment in professional education.
A Nigerian nurse who becomes highly experienced in intensive care, emergency nursing, theatre, neonatal care or another specialty is an asset.
So is an experienced radiographer.
So is an experienced medical laboratory scientist.
So is an experienced pharmacist.
So is an experienced doctor.
The salary system should therefore reward retention of expertise, not merely recruitment of new graduates.
SAUDI ARABIA: A VERY INTERESTING LESSON FOR NIGERIA
Saudi Arabia provides one of the clearest examples of using remuneration policy as part of healthcare workforce planning.
In 2025, Saudi Arabia implemented increased nationalisation targets for selected private-sector health professions, including 70% for medical laboratories and 65% for radiology. The policy also established a minimum monthly wage of SAR 7,000 for specialists and SAR 5,000 for technicians for the purposes of the programme.
This is important because Saudi Arabia did not simply say:
"Let the market decide everything."
It connected:
professional classification + workforce policy + minimum remuneration + national workforce development.
Nigeria could adapt this idea without copying Saudi Arabia's exact figures or policies.
For example, Nigeria could establish minimum professional salary floors for regulated healthcare occupations and link them to qualification and professional level.
WHAT NIGERIA SHOULD BORROW FROM THESE COUNTRIES
Nigeria does not need to copy foreign salaries.
Nigeria needs to copy good principles.
From the United States:
Professional differentiation.
Different professions and levels should have different earning potential.
From Luxembourg:
Structured collective and sectoral employment frameworks.
Healthcare workers should not depend entirely on arbitrary employer decisions.
From Switzerland:
Workforce sustainability and retention.
The system must make it possible to retain experienced professionals.
From the UAE:
Clear professional classification and internationally competitive healthcare workforce management.
From Saudi Arabia:
Minimum salary floors and deliberate workforce planning for strategic health professions.
Together, these principles provide a much better direction for Nigeria.
THE SOLUTION: CREATE A NATIONAL HEALTHCARE JOB-EVALUATION SYSTEM
Nigeria should consider establishing a transparent national job-evaluation framework covering all major healthcare professions.
Every job should be evaluated according to objective criteria.
For example:
Evaluation factor
Suggested weighting
Educational qualification
15%
Professional training
10%
Clinical responsibility
15%
Decision-making
15%
Patient risk and safety
10%
Specialist expertise
10%
Leadership responsibility
10%
Scarcity of skills
5%
Working conditions/occupational risk
5%
Night/on-call workload
5%
TOTAL
100%
The actual percentages should be determined through professional job evaluation rather than political negotiation.
The important point is that every profession should be measured using transparent criteria.
STOP PAYING ONLY FOR TITLES—PAY FOR RESPONSIBILITY
Consider two hypothetical employees.
A newly employed professional may have a university degree but limited experience.
Another professional may have 15 years of experience, a specialist qualification, managerial responsibility and highly scarce technical skills.
Should the first automatically earn more simply because of the name of the profession?
Not necessarily.
The salary should reflect the job being performed and the responsibility being carried.
This is why Nigeria needs a system that allows:
entry-level → experienced → senior → specialist → principal/advanced → management → executive
progression across professions.
NURSING NEEDS A STRONGER CAREER PYRAMID
For nursing particularly, Nigeria must make career progression visible.
A nurse should be able to develop from an entry-level professional into increasingly specialised and responsible roles.
Possible pathways include:
Staff Nurse
↓
Senior Nurse
↓
Specialist Nurse
↓
Advanced Clinical/Professional Role
↓
Nurse Manager
↓
Director/Executive Nursing Leadership
The exact titles and grades must follow Nigerian regulatory and institutional frameworks.
But the principle is clear:
A nurse should not have to abandon clinical expertise simply to earn a better income.
Experienced clinical nurses should be financially rewarded for clinical excellence.
PRIVATE HOSPITALS HAVE A ROLE TO PLAY
Private hospitals must also become part of the solution.
A private hospital that pays poorly may initially reduce its wage bill.
But if it continually loses experienced nurses and other professionals, it may pay a much higher price through:
staff turnover;
recruitment costs;
inadequate experience;
reduced continuity of care;
poor staff morale;
burnout;
lower patient satisfaction;
reputational damage.
A good private hospital should therefore view professional remuneration as an investment in quality, not simply an expense.
GOVERNMENT HOSPITALS MUST ALSO REFORM CAREER PROGRESSION
Government institutions have a different responsibility.
They must provide:
predictable career progression + fair remuneration + adequate staffing + professional development + safe working environments.
Salary reviews should not occur only after industrial action.
Healthcare workers should not have to threaten to leave before government begins discussing their economic value.
A functioning healthcare system requires predictability.
NURSING SHOULD NEVER BE PRESENTED AS A SECOND-CLASS CHOICE
There is another battle that Nigeria must fight: the perception that nursing is merely what a student chooses after failing to become a doctor.
That mentality is harmful.
Nursing is not failed medicine.
Radiography is not failed medicine.
Medical laboratory science is not failed medicine.
Pharmacy is not failed medicine.
Physiotherapy is not failed medicine.
Medicine is not failed nursing.
These are different professional disciplines that intersect around the patient.
A sophisticated healthcare system needs all of them.
BUT NURSING DESERVES SPECIAL PROMOTION
Nursing has enormous potential for young Nigerians.
It combines:
science + clinical practice + communication + leadership + technology + entrepreneurship + global mobility.
Nurses can work in government institutions.
They can work in private hospitals.
They can work in specialist areas.
They can move into education.
They can enter research.
They can work in community health.
They can develop home-care services.
They can pursue healthcare management.
They can build careers internationally, subject to the relevant licensing requirements.
Therefore, Nigerian parents and students should stop seeing nursing merely as a backup plan.
Nursing can be a first-choice profession.
THE BIGGER ISSUE IS NOT WHO IS WINNING THE SALARY WAR
The healthcare sector should not become a competition in which doctors, nurses, radiographers, laboratory scientists and other professionals try to prove who is more important.
The patient loses when healthcare professionals are constantly fighting one another.
The real competition should be:
Who can provide safer care?
Who can improve patient outcomes?
Who can reduce medical errors?
Who can improve access?
Who can retain skilled professionals?
Who can make Nigerian healthcare better?
A NEW NIGERIAN MODEL: PAY FOR VALUE, NOT JUST TITLE
Nigeria should develop a healthcare remuneration formula along these lines:
TOTAL REMUNERATION =
Base Salary + Qualification Premium + Experience Premium + Specialist Premium + Responsibility Premium + Scarcity Premium + Location Allowance + Shift/Call Allowance + Performance/Quality Incentive
This would create a much more rational system.
A highly specialised professional could earn more because of expertise.
A professional working in a difficult or underserved location could receive a location premium.
A professional carrying major managerial responsibility could receive a leadership premium.
A professional working frequent night shifts could receive appropriate shift compensation.
And an experienced nurse could progress financially without having to compete with another profession.
THE GOAL SHOULD NOT BE EQUAL SALARIES
This point deserves emphasis.
Equal dignity does not require equal salaries.
Doctors, nurses, radiographers and medical laboratory scientists deserve equal professional respect.
But their responsibilities, training pathways, scope of practice and job requirements are not identical.
Therefore:
Equal respect.
Fair evaluation.
Transparent progression.
Different remuneration where job value justifies it.
That is a much healthier principle than either extreme:
"Doctors must always earn vastly more than everyone else."
or
"Everybody in healthcare should earn exactly the same."
Both approaches are simplistic.
NIGERIA'S HEALTHCARE FUTURE DEPENDS ON RETAINING NURSES
The biggest danger is not that a radiographer earns too much.
The biggest danger is that Nigeria loses the nurses, doctors, laboratory scientists, radiographers and other professionals it has spent years training.
The United States' labour data illustrate how strongly healthcare occupations can be valued in a high-income economy: in 2025, median pay was $97,550 for registered nurses, $80,110 for radiologic technologists and $62,930 for clinical laboratory technologists and technicians, while physicians and surgeons had a median of $275,930.
Nigeria cannot simply import those numbers.
But Nigeria can import the logic:
Reward expertise.
Reward responsibility.
Reward specialisation.
Reward experience.
Reward difficult assignments.
Reward professional development.
And make staying worthwhile.
THE MESSAGE TO GOVERNMENT
Do not wait until healthcare professionals are leaving before discussing remuneration.
Do not treat professional associations as enemies.
Do not solve every salary dispute with temporary allowances.
Instead, conduct a comprehensive, independent national job evaluation of healthcare professions.
Then build a transparent remuneration structure around the results.
THE MESSAGE TO PRIVATE HEALTHCARE OWNERS
Your nurses are not merely payroll expenses.
Your radiographers are not merely machine operators.
Your medical laboratory scientists are not merely people producing laboratory reports.
Your pharmacists are not merely dispensers.
Your doctors are not merely consultants.
They are the human capital upon which the quality and reputation of your institution depend.
Invest in them.
THE MESSAGE TO NURSES
Do not allow salary debates to make you underestimate your profession.
Develop yourself.
Specialise.
Improve your communication.
Understand technology.
Develop leadership skills.
Acquire additional qualifications where appropriate.
Learn management.
Understand healthcare economics.
Protect your professional reputation.
And above all:
Never stop learning.
The future of nursing belongs not merely to those who can obtain a nursing qualification, but to those who can become excellent professionals.
THE FINAL MESSAGE
Nigeria does not need a healthcare system where one profession wins and another loses.
Nigeria needs a healthcare system where every competent professional can build a dignified career.
Doctors should be properly rewarded for their responsibilities.
Nurses should be properly rewarded for theirs.
Radiographers should be properly rewarded for theirs.
Medical laboratory scientists should be properly rewarded for theirs.
Pharmacists, physiotherapists, dentists, public-health professionals and other regulated healthcare professionals should receive the same fundamental principle:
fair pay for professional value.
The lesson from the United States is that differentiation can coexist with strong professional earnings. Luxembourg demonstrates the value of structured employment frameworks. Switzerland shows the importance of sustaining a high-quality workforce. Saudi Arabia demonstrates how salary floors can be linked with deliberate workforce policy. Nigeria can adapt these principles to its own economic realities.
The future of Nigerian healthcare should therefore not be built around the question:
"Who should earn more?"
It should be built around a much more important question:
"How do we make every essential healthcare profession attractive enough to recruit, fair enough to retain, and respected enough to inspire excellence?"
And in that future, NURSING MUST BE AT THE CENTRE—not at the bottom, not in the shadows, and not treated as a second choice.
NURSING IS NOT A BACKUP PLAN.
NURSING IS A PROFESSION.
NURSING IS A CAREER.
NURSING IS LEADERSHIP.
NURSING IS SCIENCE.
NURSING IS SERVICE.
NURSING IS ONE OF THE FOUNDATIONS OF HEALTHCARE.
Nigeria must invest in its nurses before the world recruits them all.
Strengthen the evidence disclaimer
Reduce repetition across sections
Make nursing advocacy more balanced
