Opinion: Beyond General Nursing: Somalia Urgently Needs Specialist Nurses

“Investing in specialist nurses is not a professional luxury; it is a practical investment in safer hospitals and better care.” Abdullahi Hassan Elmi

Somalia cannot build a safer and more resilient health system while treating every nurse as interchangeable. It needs formal pathways that prepare, recognize and retain nurses with advanced expertise in the areas where patients are most vulnerable.

In a busy emergency unit, a patient can deteriorate within minutes. In an intensive care unit, a small change in breathing, blood pressure or consciousness may be the first warning of a life-threatening complication. In an operating theatre, safe care depends on disciplined teamwork, infection prevention, anticipation and technical skill.

These settings require nurses who have received focused preparation and sustained clinical mentoring. Yet across much of Somalia, nurses are still expected to move between highly demanding departments without a nationally recognized specialty pathway matching the responsibilities placed upon them.

This is not a criticism of Somali nurses. Many work with remarkable commitment under difficult conditions, often learning through experience and short courses while carrying heavy workloads. The problem is structural. We depend on individual effort to fill a gap that should be addressed through education, regulation, hospital policy and national workforce planning.

General nursing education provides an essential foundation, but it cannot by itself prepare every nurse for the full complexity of critical care, emergency nursing, neonatal care, perioperative practice, oncology, mental health, dialysis, infection prevention and other specialized services.

Specialization Is a Patient Safety Issue#

When specialist knowledge is absent, the consequences are felt at the bedside. Early warning signs may be missed, medicines may require closer monitoring than staff can provide, infection-control practices may vary, and communication during emergencies may become less reliable.

New equipment can be purchased, but its value is limited if staff are not prepared to use it safely and interpret the information it provides. A ventilator, cardiac monitor, dialysis machine or neonatal incubator does not improve outcomes on its own. Skilled professionals do.

Specialist nursing also strengthens continuity of care. A critical care nurse learns to recognize subtle signs of deterioration and coordinate complex treatment. An emergency nurse develops competence in triage and rapid stabilization. A perioperative nurse protects sterility, helps prevent avoidable surgical harm and supports safe teamwork before, during and after an operation.

A neonatal nurse understands the distinct needs of premature and critically ill newborns. Mental health and oncology nurses provide forms of assessment, communication and support that cannot be reduced to routine tasks. These roles are different, and our health system should formally acknowledge those differences.

Why the Gap Persists#

Somalia’s nursing workforce has expanded through universities and training institutions, which is an important achievement. However, the path after graduation remains unclear for many nurses.

There are limited accredited postgraduate specialty programs, uneven access to supervised clinical placements and few nationally standardized specialty credentials. In some facilities, departmental assignments are driven more by immediate staffing needs than by structured preparation. A nurse may be transferred to an intensive care unit or operating theatre and expected to learn while working, even when experienced mentors are scarce.

Career incentives are another concern. Nurses who invest time in developing advanced competence may not receive a distinct title, defined scope of practice, greater responsibility or meaningful career progression.

When specialist ability is neither formally recognized nor rewarded, health institutions struggle to retain experienced staff. Some nurses leave clinical practice, move between organizations in search of better opportunities or seek employment abroad. Somalia then loses not only an employee but also years of practical knowledge that could have been used to mentor the next generation.

A Practical National Response#

Somalia does not need to establish every nursing specialty at once. It needs a phased plan based on disease burden, service growth and patient-safety risks.

Critical care, emergency nursing, perioperative nursing, maternal and neonatal care, paediatrics, mental health, infection prevention, dialysis and oncology are reasonable priority areas. The precise sequence should be determined through national consultation and workforce assessment rather than by copying another country’s model.

Universities, hospitals, nursing regulators, professional associations and government institutions should jointly develop competency-based postgraduate diplomas and master’s degree pathways. Classroom teaching must be linked to supervised practice at approved clinical sites.

A certificate issued after lectures alone is not enough. Nurses need protected learning time, qualified preceptors, skills assessments, case-based evaluations and clear evidence that they can practise safely in the relevant specialty.