LAST WEEK'S THREAT BY NURSES to strike has triggered debate as to why nursing professionals in developing countries are migrating to wealthier nations.

While the popular reasons floated to explain this exodus include poor pay, instability, lack of research facilities and poor work conditions, I disagree.

In Kenya, like in most African nations, nurses are seen as peripheral health workers with only basic physician skills, rather than members of a distinct profession with unique skills and approaches to heathcare.

Health ministries in the developing world regard nurses as qualified to care only for patients with illnesses that are not life-threatening.

In the course of my research as a nurse in the United States, I have found that the severe shortage of nurses in Africa has received significant coverage, notably in the UK and the US.

NOW THAT NURSES HAVE THREATened to down tools, it would be important diagnose the causes of this flight, with its attendant severe negative effects on Africa's fragile health systems.

Most analyses of the Kenyan paramedical work-force glorify clinical officers and forget nurses. Without explaining what training clinical officers boast, they note that these officers can carry out surgery but not Caesarean section.

Most researchers state, without evidence, that a clinical officer is "not quite a doctor but more than a nurse." This is like saying someone is not quite a doctor, but more than a medical journalist.

Most nurses undergo a rigorous education and training with emphasis on clinical judgment for diagnosis as opposed to the use of technology to make diagnosis as is common in the West.

Though Kenyan nurses have less formal education than physicians, nursing in Kenya just like in the West, is an autonomous profession with a unique, holistic approach to healthcare.

And although there are obvious overlaps, Kenyan nurses have skills and expertise that physicians do not possess.

The belief that clinical officers are the "backbone of Kenya's health system" must be discarded. In fact, a recent report relying on Government statistics suggested that the number of clinical officers was equal to the number of physicians, and that there were roughly 10 times as many nurses and nurse/midwives in Kenya.

I am not saying nurses are the "backbone" either. I have been ambivalent when others have said as much, as it tends to suggest that nursing is only about reliability - not thinking.

And the somewhat condescending measurement of clinical officers against physicians appears to reflect the view that serious healthcare consists only of whatever physicians do.

One research states that for now, Kenya's rural poor will "probably have to depend on clinical officers, and comprehensive health nurses, because they have broader skills."

Of course physicians have unique skills, but so do nurses. But in most cases, patients will have to settle for nurses because physicians are not always available.

The distortion starts with an indisputable fact: physicians have some medical knowledge that most nurses do not have. From that limited fact, it becomes obvious that nurses can care for most illnesses by themselves, but they cannot handle the most serious of illnesses.

This leads to the unfortunate conclusion that nursing in Kenya is merely a subset of medicine, and that nurses are inferior assistants to physicians.

HOWEVER, SERIOUSLY ILL PATIENTS need both medical and nursing care, and neither group has all of the knowledge or skill that the other has.

Patients will die just as quickly without nursing care as without medical care - and thousands do. It is nurses who are the critical sentinels; they are the ones who use advanced skills and technology to monitor patients' conditions day and night, who assess and intervene with skilled care, and who teach the patients how to cope with their conditions.

Hospitals exist primarily to provide nursing care. Diagnosing a problem and recommending treatment does not solve the problem.

In any case, no patient is healthy 10 minutes after a serious operation. Nurses are irreplaceable at every stage of patient care.

Ms Melanie is a registered nurse working in the US