From trust to betrayal: imposter nurses and nursing quackery in Nigeria, their threat to patient safety, and the role of professionalism: a cross-sectional survey

Abstract

Background: Nursing quackery; the unlicensed practice of nursing by unqualified individuals poses a major threat to patient safety and nursing integrity in Nigeria. Despite a regulatory council, systemic enforcement failures continue to enable imposters to operate countrywide. Aim: To examine perceptions of nursing quackery in Nigeria, assess registered nurses' professional values, professionalism, trust, and ethical practice, and identify predictors of quackery awareness. Methods: A cross-sectional survey of 618 registered nurses recruited across all six Nigerian geopolitical zones used multistage sampling. Data were collected using the Nigerian Nursing Professionalism and Quackery Assessment Tool (NNPQAT), adapted from the Nurses' Professional Values Scale-Revised (NPVS-R), Hall's Professionalism Scale, the Trust in Nurses Scale, and the Ethical Behaviour Rating Scale. Chi-square tests, Spearman's rho correlations, and multiple linear regression were performed using SPSS version 29. Results: Participants demonstrated high professional values (M = 4.76, SD = 0.44), professionalism (M = 4.76, SD = 0.58), ethical practice (M = 4.84, SD = 0.59), and trust (M = 4.53, SD = 0.59). Quackery awareness was widespread (M = 4.53, SD = 0.58); 96.1% agreed quackery threatens patient safety and 97.1% agreed it damages public trust. Awareness did not vary by region (χ2 = 2.25, p = 0.814) or facility type (χ2 = 0.18, p = 0.915). Ethical practice (ρ = 0.421, p < 0.001) and trust (ρ = 0.361, p < 0.001) were the strongest correlates. Regression identified ethical practice (β = 0.541, p < 0.001) and trust (β = 0.215, p < 0.001) as the only significant predictors (R2 = 0.511); years of experience, professionalism, region, and facility type were non-significant. Conclusions: Nigerian registered nurses exhibit strong professional values, yet quackery persists as a system-level failure rooted in regulatory weakness rather than individual professional deficit. Ethical practice functions as professional vigilance, heightening sensitivity to quackery. Strengthening Nursing and Midwifery Council of Nigeria (NMCN) enforcement, investing in ethics education, and developing public awareness campaigns are essential to protect patients and preserve professional integrity.