By Dr Etuna Simon
A friend of mine told me something recently that I have not been able to put down.
She is a registered nurse who now teaches nursing, and she has spent years helping to design curricula for nursing science and social work.
Part of her work is following students into hospitals to see how what they learned in the classroom holds up on a real ward.
Her latest follow-up visits took her to the maternity departments of three public hospitals: Windhoek Central, Intermediate Katutura and Okahandja District.
She started with the good news, which I appreciated. Windhoek Central, she said, was comparatively clean and well equipped on the day she visited.
Katutura was different. Mothers who had not brought their own pillows and blankets had to go without.
Okahandja troubled her most. She saw shortages of bed linen and cleaning supplies. Patients were expected to bring their own cups, plates and spoons.
Some had no identification bands. The walls were visibly unclean, the rooms were overcrowded, patient records were hard to get hold of, and essential supplies, medication included, were running short.
She was careful to say that this was a snapshot, one department in three hospitals, and not a full assessment of any of them. I will keep to the same standard here.
But as she talked, I kept picturing a student nurse standing in the middle of that ward.
The ward is also a classroom
Think about what that student has been taught. Keep the patient’s environment clean. Practise infection prevention. Identify every patient correctly.
Provide proper personal hygiene. All of it is sound, and most of it was practised first in a well-equipped simulation laboratory.
Then she walks onto a ward where the identification bands are missing, the linen is short and the cleaning materials have run out. What does she do with what she learned?
In curriculum development we talk about the hidden curriculum; the lessons students pick up from what they see around them rather than from what is written in the syllabus.
Clinical placements are where it is strongest. Students learn from what they observe, sometimes more than from what their lecturers say.
If the standard in the textbook cannot be demonstrated on the ward, a student may struggle to tell a safe adaptation from a practice that has fallen below the standard.
Improvisation has always been part of healthcare. It has to stay safe and evidence-based, and it should never become a substitute for supplies that ought to be there.
There is a patient on the other side of this too. Overcrowding erodes privacy. Missing cleaning materials make infection prevention harder.
Without identification bands, the risk of error goes up. In a maternity ward, too little bedding can leave a mother and her newborn cold at the moment they are most vulnerable. A clean ward, adequate bedding and proper identification are not luxuries. They are the minimum of safe, dignified care.
The regulator has already seen part of this
This is not an unknown problem. In October 2024, the Health Professions Councils of Namibia (HPCNA) announced that from 2025, nursing and midwifery institutions could enrol no more than 50 students per campus each year.
The pressure has not eased. In June 2026, the Namibia Nurses Union (NANU) told a parliamentary committee that too many student nurses are placed in too few clinical settings, compromising patient privacy, dignity and infection control as well as the quality of learning.
The Council has since told parliament that more than 2,600 graduates have failed its national evaluation.
I think that was the right call, and it shows the regulator understands clinical placement capacity as a real limit. But a cap on how many students enter a hospital says nothing about what they find when they get there.
A ward can have room for fifty students and still lack the linen, the supplies and the supervision that make a placement worth having. Numbers are half the question.
The condition of the placement is the other half. Until we address both, a smaller intake will only mean fewer students learning in the same conditions.
Are nurses to blame for being rude?
Patients do complain about the attitudes of some nurses, and those complaints deserve to be taken seriously. Every patient is entitled to respect and compassion. A shortage of supplies is not a licence for neglect.
Still, picture the shift. A nurse is responsible for more patients than she can give proper time to. She is hunting for linen and medication, and she will be doing the same tomorrow. Fatigue, frustration and burnout follow.
That does not excuse rudeness, and my friend was firm on the point. It does mean accountability has two addresses: the individual professional, and the institution that sets the conditions she works in. We cannot demand excellence from nurses while ignoring the conditions in which they work.
What needs to change
My friend’s recommendations are practical, so let me put them plainly.
Hospitals need reliable supplies of the basics: bed linen, cleaning materials, identification bands, protective equipment and medication. Allocation should follow what each facility actually needs, and someone should check regularly that it arrives.
Where shortages stop students from developing the required competencies, hospitals and training institutions should agree on alternative supervised learning, so that a student’s education does not stall because a storeroom is empty.
Nurses themselves need adequate staffing, supportive supervision and continuing professional development if we expect them to hold standards. And government, hospital management, regulators, health professionals and educational institutions have to work on this together, with accountability that is shared and clear.
I would add one simple tool from my own side of the fence, which is quality assurance. Before a placement site is used, the training institution and the hospital could sit down with a short, shared checklist of what a student needs in order to practise safely: linen, cleaning supplies, identification bands, supervision. It would take little time to compile, and it would turn a vague worry into a document both sides can act on.
Protecting the future of nursing
My friend was clear that she is not writing to condemn government or discredit our hospitals. Many health professionals serve with dedication in difficult circumstances, and I have no wish to take that away from them.
Her concern, and now mine, is that we risk compromising the future of nursing if we keep separating the standards taught in our institutions from the conditions in which they must be practised.
Florence Nightingale understood this more than a century ago. Her Notes on Nursing, published in 1859, put fresh air, cleanliness, warmth and quiet at the heart of nursing, and in 1860 she opened the world’s first secular nursing school at St Thomas’ Hospital.
Nursing scholars have long read her as a champion of caring for the whole person. For her, a healing environment was not an extra. It was the work.
Well-equipped simulation laboratories matter, but they cannot make up for a placement that lacks the basics. Dedicated nurses cannot keep delivering the care we expect of them without the institutional support to do it.
If we ask students and nurses to uphold these principles, we owe them the tools and the environment to do so. Otherwise, practising nursing in Namibia will keep feeling like mission impossible, for the student trying to reconcile what she was taught with what she sees, and for the nurse trying to give quality care with too little.
A healthy nation is a wealthy nation. Investing in our hospitals, supporting our nurses and protecting the quality of nursing education are investments in Namibia’s future.
Dr Etuna Simon is a researcher, strategist and writer with a keen interest in education, innovation, artificial intelligence and national development. The views expressed in this article are solely those of the author. She can be reached at etunasimon@icloud.com
