On the 21st June 2025, the internet and social health platforms across Uganda received news about the plan to waive the one-year mandatory Medical Internship, specifically, for graduate Nurses and Midwives prepared through the extensor program from various universities across the country.
The letter that was addressed to the Registrar – Uganda Nurses and Midwives Council from the Permanent Secretary, Ministry of Health, dated 20th June 2025, sparked off mixed reactions from all health workers, majorly Bachelors prepared graduate nurses and midwives, educators, leaders, researchers and more.
The Nursing and Midwifery profession in Uganda has various entry points for bachelor’s degree ie direct entry (for those specifically from senior 6 to university), mature entry scheme and extension (for those upgrading from diploma to bachelors).
Thus, extensor bachelors prepared nurses and midwives are those who have upgraded from diploma to bachelor’s in Nursing or Midwifery. For long, all medical interns (medical doctors, pharmacists, nurses and midwives (both extensors or direct entry) were subjected to this one-year mandatory medical internship prior to their registration and licensure with their respective regulatory bodies. They are deployed to selected hospitals across the whole of Uganda to cover national, regional and district hospitals, under the Ministry of Health.
Globally, nursing and midwifery are well known to be disciplines ingrained in evidence-based practice. Thus, nursing and midwifery universities take these students (both direct entry and Extensor Bachelors prepared Nurses and Midwives for clinical placements) during training. To note, <10% of the nurses and midwives employed in public health facilities hold a minimum of bachelors’ degree in Nursing or Midwifery, thus leaving a gap in grooming, teaching and mentorship of these students with the required advanced evidence- based nursing and midwifery clinical skills.
This now becomes worse when both direct entry and Extensor Bachelors prepared Nurses and Midwives are deployed for internship where some sites do not have the right clinical preceptors/educators and supervisors to help them bridge the gap between theory and evidence based clinical practice. Sadly, this has left some of the extensor bachelors prepared nurses and midwives with mixed feelings of whether this internship is necessary.
Important to note is that a good number of the extensor nurses and midwives have been practicing in lower-level health facilities with hardly any exposure to acute care settings, management of complex patient conditions, let alone direct patient care and use of new equipment. Furthermore, others have been working in one specific unit for long, other diploma nurses and midwives were unemployed before enrolling for the bachelor’s program while many were working in small clinics, drug shops and pharmacies etc.
Is it then worth waiving Medical Internship for Nurses, Midwives in Uganda?
As a Nurse-Midwife and Women’s health specialist, educator, practitioner advocate and researcher, I believe that when one has a wound, the main focus is to treat the wound so as to heal, but not to leave it and it rots, as this comes with complications which can be detrimental.
Thus, a plan to waive Medical Internship for Extensor Bachelors prepared Nurses and Midwives by Ministry of Health Uganda will not only be unfair, but it will be an injustice and sacrifice to the entire profession of Nursing and Midwifery in Uganda, which is growing steadily. This will consequently affect the quality of nursing and midwifery care provided to the patients of this country for that level of training.
In-fact, the Ministry of Health Uganda waiving Medical Internship for Extensor Bachelors prepared Nurses and Midwives would signify/portray that these nurses and midwives come to upgrade just to attain additional papers or get promotions thereafter, which we greatly condemn. Whereas its’s good to have papers or get a promotion when you advance, that should NOT be the major goal/driver of advancing career wise especially in a practical profession like nursing or midwifery.
Nurses and midwives need to advance for the right reason, which is majorly to acquire advanced and evidence-based knowledge, skills and competencies plus behaviours/attitudes so as to improve the overall quality of patient care.
Therefore, to improve the internship experience of bachelors prepared nurses and midwives overall, I urge the government of Uganda through the Ministry of Health and other relevant bodies to;
- Send bachelors prepared nurses and midwives to well-facilitated internship sites such as national and regional referral hospitals.
- Bring on board/employ experienced clinical hands-on educators, preceptors, instructors or practitioners (preferably bachelors’ holders or masters/specialized prepared nurses and midwives) in selected internship sites.
Remember, Nurses and Midwives are the backbone of the health care systems globally. We need to have a healthcare workforce with standardized licensure protocols that meet global standards. Specifically, bachelors prepared nurses and midwives who are trained to possess advanced knowledge and skills necessary to handle complex cases, provide comprehensive care, and contribute to education, leadership, and research, ultimately enhancing the overall quality and effectiveness of healthcare systems in resource-limited settings.
Supporting them during their internship to acquire the above skills is worth advocating for and a treasure to the profession, plus our country Uganda and the world at-large.
The writer is: Lilian Nuwabaine Luyima (Worlds’ Best Nurse Finalist 2024; Multi-Award-Winning Researcher 2023; Heroes in Health Award Winning Midwife 2021 & Outstanding woman of 2021)
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