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.

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.

IMPLICATIONS FOR NURSING PRACTICE OR EDUCATION: These findings call for heightened regulatory vigilance among registered nurses, nurse educators, and healthcare administrators in identifying and reporting suspected nursing quackery. Pre-registration and continuing professional development curricula should embed ethics education that develops professional vigilance, recognising that ethical orientation, not seniority or years of experience, is the strongest driver of quackery awareness. Clinical and educational leaders should establish routine credential verification practices at ward and facility level, supported by safe, protected reporting mechanisms for nurses who identify unqualified colleagues. Nurse educators are encouraged to incorporate public awareness content into community health teaching, equipping the public to verify nursing credentials and recognise warning signs of fraudulent practice. These actions are relevant across all facility types and regions, given the uniform national distribution of quackery awareness identified in this study.

NO PATIENT OR PUBLIC CONTRIBUTION: This study did not involve patients, service users, caregivers, or members of the public in its design, conduct, data analysis, or manuscript preparation. The study population comprised registered nursing professionals only, recruited as expert informants on the phenomenon of nursing quackery in Nigeria. Patient and public involvement was not applicable to this study.