Preamble

In Nigeria, pharmacy graduates are required to undergo a mandatory 1-year internship under the supervision of licensed pharmacists (preceptors) before full licensure by the Pharmacy Council of Nigeria (PCN). This internship is not merely a procedural requirement; it is a critical phase of professional formation designed to safeguard patient safety, ensure competency, and uphold the integrity of pharmacy practice. The PCN, as the statutory regulatory body, provides oversight to ensure that training institutions and preceptors meet minimum standards.

However, during prolonged industrial actions by the Joint Health Sector Unions (JOHESU), a recurrent and deeply concerning practice has emerged. Hospital managements routinely compel Pharmacy interns to continue providing pharmaceutical services without the supervision of preceptors or effective regulatory oversight. In many institutions, interns are threatened with loss of placement or delayed licensure if they refuse to work under these conditions. This practice, which has persisted over the years, represents a significant aberration with far-reaching implications for patient safety, public health, professional ethics, and health system governance.

This article examines the consequences of unsupervised pharmacy internship during strikes, with a focus on patients and public health, and outlines the implications for hospital management, the PCN, pharmacy interns, the pharmacy profession, policies, and the Nigerian public. It concludes with policy-relevant recommendations aimed at systemic reform.

Implications for Patients and Public Health

1. Compromised Patient Safety

Pharmacy interns are, by definition, professionals in training. While they possess foundational knowledge, they lack the experiential depth and legal authority required for independent practice. Supervision by licensed pharmacists is essential for preventing medication errors, inappropriate dosing, drug–drug interactions, and incorrect clinical decisions. In the absence of supervision, the risk of preventable adverse drug events increases substantially.

Medication-related errors are a well-documented cause of morbidity and mortality globally. In a resource-constrained health system such as Nigeria’s, unsupervised pharmaceutical care further amplifies patient vulnerability, particularly among high-risk populations such as children, older adults, pregnant women, and patients with chronic diseases.

2. Erosion of Quality of Care

Pharmaceutical care extends beyond dispensing medicines. It includes medication therapy management, patient counseling, pharmacovigilance, and interprofessional collaboration. Interns working without guidance are less likely to deliver optimal care, leading to substandard therapeutic outcomes, poor adherence, and diminished trust in health services.

3. Public Health Risks

Unsupervised interns may be ill-equipped to manage antimicrobial stewardship, adverse drug reaction reporting, or rational medicine use. These inadequacies contribute to broader public health challenges such as antimicrobial resistance, medication misuse, and underreporting of drug safety signals. Over time, these systemic weaknesses undermine national and global public health goals.

Implications for Pharmacy Interns

1. Exploitation and Ethical Distress

Compelling interns to work without supervision under threat of losing their placements constitutes professional exploitation. Interns are placed in ethically distressing situations where they must choose between patient safety, personal integrity, and career progression.

2. Legal and Professional Vulnerability

Interns are not licensed for independent practice. In the event of medication errors, adverse outcomes, or litigation, interns may face legal exposure without the protection afforded by proper supervision or institutional accountability. This creates a climate of fear and uncertainty that undermines learning and professional confidence.

3. Inadequate Training and Skill Development

The internship year is meant to consolidate clinical competence under mentorship. When supervision is absent, training becomes perfunctory, depriving interns of critical feedback, structured learning, and professional role modeling. This produces a generation of pharmacists who may be technically qualified on paper but insufficiently prepared for complex clinical practice.

Implications for Hospital Management

1. Institutional Liability and Risk Exposure

Hospital managements that knowingly allow or compel unsupervised interns to provide pharmaceutical services expose themselves to significant legal and reputational risks. In the event of patient harm, claims of negligence, institutional malpractice, and regulatory noncompliance may arise.

2. Breach of Duty of Care

Hospitals have a duty of care to patients and a responsibility to ensure that healthcare services are delivered by appropriately qualified and supervised personnel. Ignoring this obligation during industrial actions reflects systemic governance failures and poor risk management.

3. Short-Term Convenience, Long-Term Damage

While the use of interns during strikes may appear to sustain service continuity in the short term, it ultimately damages institutional credibility, staff morale, and public trust in healthcare delivery systems.

Implications for the Pharmacists Council of Nigeria (PCN)

1. Regulatory Credibility and Oversight Failure

The PCN is mandated to regulate pharmacy education, training, and practice in Nigeria. Persistent unsupervised internship during strikes raises serious questions about regulatory enforcement, monitoring mechanisms, and accountability.

2. Dilution of Licensure Standards

Allowing internship periods to proceed without supervision undermines the validity of internship completion certificates and, by extension, the integrity of pharmacist licensure. This weakens professional standards and public confidence in regulatory processes.

3. Missed Opportunity for Systemic Leadership

Industrial actions present an opportunity for regulators to issue clear directives, suspend internship training where supervision is unavailable, or mandate alternative accredited training arrangements. Failure to do so perpetuates unsafe norms.

Implications for Pharmacy Practice and the Profession

1. Normalization of Substandard Practice

When unsupervised practice becomes routine, deviations from best practice are normalized. This erodes professional ethics, weakens adherence to standards, and fosters a culture of compromise rather than excellence.

2. Devaluation of the Pharmacist’s Role

Using interns as substitutes for licensed pharmacists diminishes the perceived value of trained professionals and undermines advocacy for adequate staffing, remuneration, and professional recognition.

3. Long-Term Workforce Consequences

Poorly trained interns eventually become licensed pharmacists. The cumulative effect is a workforce that may lack confidence, competence, and commitment to patient-centered care, with long-term implications for healthcare quality.

Additional Implications for Pharmacy Practice: The Consultancy Cadre Controversy

1. Undermining the Case for Advanced Pharmacy Practice and Consultancy Roles

The persistent practice of compelling pharmacy interns to function without supervision during industrial actions has broader and more strategic implications for the evolution of pharmacy practice in Nigeria—particularly in the context of the ongoing agitation by the Nigerian Medical Association (NMA) and its various arms against the approval of the consultancy cadre for pharmacists.

Advanced pharmacy practice, including consultant pharmacist roles, is predicated on demonstrable competence, structured postgraduate training, supervised clinical exposure, and robust regulatory oversight. When the foundational internship year—arguably the most critical phase of professional development—is routinely compromised, it weakens the profession’s institutional argument for expanded clinical authority and consultancy recognition.

Detractors of pharmacist consultancy roles may leverage these systemic deficiencies as evidence that pharmacy training and regulation are insufficiently rigorous or inconsistently enforced. In effect, regulatory tolerance of unsupervised internship practice inadvertently reinforces narratives that portray pharmacists as inadequately prepared for higher-level clinical responsibilities.

2. Reinforcement of Professional Hierarchies and Interprofessional Inequity

The normalization of unsupervised internship also entrenches hierarchical imbalances within the healthcare system. By allowing interns to function as stop-gap labor during strikes—rather than protected trainees—the system implicitly devalues pharmacy expertise and positions pharmacists as auxiliary rather than autonomous clinical professionals.

This context emboldens resistance to pharmacist consultancy by reinforcing a perception that pharmacists can be substituted, improvised, or operationally downgraded without compromising care. Such perceptions are incompatible with global best practices, where consultant pharmacists play central roles in medication management, clinical governance, antimicrobial stewardship, and patient safety leadership.

3. Contradiction of Global Standards for Consultant Pharmacists

Internationally, consultant pharmacists emerge from systems with strict supervision at entrylevel training, progressive credentialing, and vigorous regulatory enforcement. In contrast,

Nigeria’s tolerance of unsupervised internship practice creates a discontinuity between stated aspirations for advanced pharmacy practice and the realities of professional training.

It is internally inconsistent for a health system to:

Depend on unsupervised interns for service continuity during crises, while

Simultaneously, it contests the readiness of pharmacists for consultant-level clinical responsibility.

This contradiction exposes systemic weaknesses rather than professional inadequacies and underscores the need for reform at the regulatory and institutional levels.

4. Strategic Damage to Professional Advocacy

At a time when the pharmacy profession seeks expanded clinical recognition, specialist career pathways, and has achieved consultancy status, the failure to protect training standards becomes a strategic liability. Advocacy for consultant pharmacist roles cannot be divorced from demonstrable commitment to patient safety, structured mentorship, and uncompromising professional standards from internship onward.

Allowing aberrant practices to persist provides ammunition to external opposition and undermines interprofessional negotiations, policy discussions, and legislative reforms aimed at strengthening pharmaceutical care in Nigeria.

Implications for the General Public

The public bears the ultimate burden of these systemic failures. Patients are unknowingly exposed to unsafe practices, while communities lose trust in healthcare institutions and regulatory bodies. In a country already grappling with healthcare access and quality challenges, such practices further widen the gap between policy intent and lived reality. Policy and Practice Recommendations

Immediate Suspension of Internship Training During Unsupervised Periods

Internship training should be formally paused during strikes where licensed preceptors are unavailable, with no penalty to interns.

Clear Regulatory Directives from PCN

The PCN should issue binding guidelines prohibiting unsupervised internship practice and enforce sanctions against defaulting institutions.

Legal and Ethical Protection for Interns

Interns should be protected from coercion, victimization, or loss of placement for refusing unsafe practice conditions.

Stakeholder Engagement and Policy Reform

Ministries of Health (Federal and State), professional bodies, unions, and training institutions must collaborate to integrate internship continuity plans into industrial action frameworks.

Conclusion

The practice of compelling pharmacy interns to work without supervision during industrial actions is not a benign workaround; it is a systemic failure with serious consequences for patient safety, public health, professional integrity, and regulatory credibility. Addressing this issue requires decisive regulatory action, institutional accountability, and a renewed commitment to safeguarding both the public and the future of pharmacy practice in Nigeria. Sustainable health systems cannot be built on compromised standards, coercion, or silence in the face of known risks.

A Concerned Nigerian Young Pharmacist and Victim Writes from the Ancient City of Benin City, Edo State.