Professional Misconduct in Malawi’s Nursing and Midwifery Professions: A Descriptive Study of Trends, Causes and Implications

Professional Misconduct in Malawi’s Nursing and Midwifery Professions: A Descriptive Study of Trends, Causes and Implications | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Professional Misconduct in Malawi’s Nursing and Midwifery Professions: A Descriptive Study of Trends, Causes and Implications Ronald Nachipo Mlera¹, Mtondera Munthali¹, Eunice Nyirenda¹, Rodwell Gundo2 This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9119077/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Professional misconduct among nurses and midwives poses significant challenges to the integrity of healthcare systems, patient safety, and public trust. In Malawi, despite regulatory oversight by the Nurses and Midwives Council of Malawi (NMCM), cases of professional misconduct have persisted. This study aimed to analyse the trends, causes and implications of professional misconduct cases to inform policy and practice improvements in nursing and midwifery. Methods: The study employed a descriptive study design using secondary data extracted from NMCM records of reported misconduct cases between 2014 and 2024. A total of 126 cases were initially identified; however, 19% (n = 24) cases for 2014 and 2015 were excluded due to incomplete information. Consequently, 102 cases were included in the final analysis. SPSS was used to generate descriptive statistics, perform chi-square tests and run logistic regression analyses. Findings: Negligence was the most common type of confirmed misconduct, accounting for 82% (n = 77) of the cases. The highest number of cases occurred among nurses and midwives aged 20–39, with 0–5 years of experience, particularly among Nursing and Midwifery Technicians. Most incidents occurred in labour wards and district hospitals, with the Central Region reporting the highest number of cases. Significant predictors of negligence included poor attitude towards patients (p = 0.025), poor working conditions (p = 0.030), and poor decision-making (p = 0.042). Negligence was strongly associated with serious patient outcomes, including death (61%) and injury (19%). Conclusion: Professional misconduct among nurses and midwives in Malawi remains a significant concern. Negligence emerged the most common form of misconduct, mostly involving Nursing and Midwifery Technicians aged 20–39 with 3–5 years of experience. Professional misconduct in nursing and midwifery in Malawi is influenced by both individual and systemic factors. The study calls for targeted interventions such as strengthening ethics education, improving workplace conditions, and enhancing accountability mechanisms to address misconduct and improve healthcare delivery. Professional Misconduct Negligence Malawi Patient Safety Malpractice Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 27 Mar, 2026 Editor assigned by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 13 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9119077","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631778545,"identity":"552a2648-8afc-4b01-9779-8718e02bb3e8","order_by":0,"name":"Ronald Nachipo Mlera¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYLCCB2wgkofhAAODDZFaEhBa0kjUAgSHCas2b+89+CGhjCGPv/3swcMFFefzdNtPJzB83FPLoDsjAasWmTPnkiUSzjEUS5zJSzg848ztYrMzuRsYZzw7zmB2A7sWCYkcA4nENobEhhs8Bod5224nbrvBu4GZ58AxBrPbOLUY/wBpmQ/Rco4oLWZgWzZAtByAaanBrYXnjJlFwjmJxI1ncgyAfklO3Ab0y8EZBw7wmN1/gF0Le4/xjQ9lNonzjp8x/lxQYZe47fjZjQ8+HKiTMztzAKsWmE4wyQzjAtUe5sGnHg6Ykdh1ROkYBaNgFIyCEQEAJJln3gf1tEQAAAAASUVORK5CYII=","orcid":"","institution":"Nurses and Midwives Council of Malawi","correspondingAuthor":true,"prefix":"","firstName":"Ronald","middleName":"Nachipo","lastName":"Mlera¹","suffix":""},{"id":631778546,"identity":"a69ecc27-67ba-48a2-8e23-ad9c0efcce5f","order_by":1,"name":"Mtondera Munthali¹","email":"","orcid":"","institution":"Nurses and Midwives Council of Malawi","correspondingAuthor":false,"prefix":"","firstName":"Mtondera","middleName":"","lastName":"Munthali¹","suffix":""},{"id":631778551,"identity":"2d758e64-2bcf-47cb-b130-69e079fd7f3a","order_by":2,"name":"Eunice Nyirenda¹","email":"","orcid":"","institution":"Nurses and Midwives Council of Malawi","correspondingAuthor":false,"prefix":"","firstName":"Eunice","middleName":"","lastName":"Nyirenda¹","suffix":""},{"id":631778556,"identity":"1d3a832c-02d1-49bc-b25a-1184d0932acb","order_by":3,"name":"Rodwell Gundo2","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Rodwell","middleName":"","lastName":"Gundo2","suffix":""}],"badges":[],"createdAt":"2026-03-14 02:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9119077/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9119077/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108492120,"identity":"42e0167e-ba3d-4f44-afde-cf1fd6cd5039","added_by":"auto","created_at":"2026-05-05 09:56:54","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":376010,"visible":true,"origin":"","legend":"","description":"","filename":"ProfessionalMisconductinNursingandMidwiferyinMalawiManuscript25March2026.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9119077/v1_covered_c9048b67-5fe1-42a8-b353-b6c8c83386a5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Professional Misconduct in Malawi’s Nursing and Midwifery Professions: A Descriptive Study of Trends, Causes and Implications","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Professional Misconduct, Negligence, Malawi, Patient Safety, Malpractice","lastPublishedDoi":"10.21203/rs.3.rs-9119077/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9119077/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eProfessional misconduct among nurses and midwives poses significant challenges to the integrity of healthcare systems, patient safety, and public trust. In Malawi, despite regulatory oversight by the Nurses and Midwives Council of Malawi (NMCM), cases of professional misconduct have persisted. This study aimed to analyse the trends, causes and implications of professional misconduct cases to inform policy and practice improvements in nursing and midwifery.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThe study employed a descriptive study design using secondary data extracted from NMCM records of reported misconduct cases between 2014 and 2024. A total of 126 cases were initially identified; however, 19% (n\u0026thinsp;=\u0026thinsp;24) cases for 2014 and 2015 were excluded due to incomplete information. Consequently, 102 cases were included in the final analysis. SPSS was used to generate descriptive statistics, perform chi-square tests and run logistic regression analyses.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eNegligence was the most common type of confirmed misconduct, accounting for 82% (n\u0026thinsp;=\u0026thinsp;77) of the cases. The highest number of cases occurred among nurses and midwives aged 20\u0026ndash;39, with 0\u0026ndash;5 years of experience, particularly among Nursing and Midwifery Technicians. Most incidents occurred in labour wards and district hospitals, with the Central Region reporting the highest number of cases. Significant predictors of negligence included poor attitude towards patients (p\u0026thinsp;=\u0026thinsp;0.025), poor working conditions (p\u0026thinsp;=\u0026thinsp;0.030), and poor decision-making (p\u0026thinsp;=\u0026thinsp;0.042). Negligence was strongly associated with serious patient outcomes, including death (61%) and injury (19%).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eProfessional misconduct among nurses and midwives in Malawi remains a significant concern. Negligence emerged the most common form of misconduct, mostly involving Nursing and Midwifery Technicians aged 20\u0026ndash;39 with 3\u0026ndash;5 years of experience. Professional misconduct in nursing and midwifery in Malawi is influenced by both individual and systemic factors. The study calls for targeted interventions such as strengthening ethics education, improving workplace conditions, and enhancing accountability mechanisms to address misconduct and improve healthcare delivery.\u003c/p\u003e","manuscriptTitle":"Professional Misconduct in Malawi’s Nursing and Midwifery Professions: A Descriptive Study of Trends, Causes and Implications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 23:32:21","doi":"10.21203/rs.3.rs-9119077/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-16T15:07:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69451909616338514188990451516404448169","date":"2026-05-04T08:23:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203751627070453082626279588335294456911","date":"2026-04-29T08:04:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T15:40:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196957624974320033243225984300813922821","date":"2026-04-21T14:28:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T13:25:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T10:19:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-26T09:29:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T09:29:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-14T02:44:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccb6c1a6-6812-4a4e-83d5-01483dd49713","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-16T15:07:49+00:00","index":70,"fulltext":""},{"type":"reviewerAgreed","content":"69451909616338514188990451516404448169","date":"2026-05-04T08:23:15+00:00","index":69,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T23:32:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 23:32:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9119077","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9119077","identity":"rs-9119077","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}