Challenges and aspiration of nursing service in Bangladesh


Lt Col Nazmul Huda Khan, MBBS, MPH, MPhil :

International Nurses Day (IND) is celebrated around the world on 12 May, the anniversary of Florence Nightingale’s birth, the founder of modern nursing. This year, the International Council of Nurses (ICN) has announced the new theme for International Nurses Day 2023 — ‘Our Nurses, Our Future’ to focus nursing in the future in order to address the global health challenges and improve global health for all. Also, to translate the lessons of the pandemic into actions for the future those ensure nurses are protected, respected and valued.
Today, throughout the world, nurses are getting respect as one of the most trusted roles in society. In our country, the nation-wide vaccination programme against COVID-19 began with a senior staff nurse of Kurmitola General Hospital on January 27, 2021. In the COVID-19 pandemic, the nurses across the world have contributed incredible range of innovative work every day, as well as the wide variety of nursing that continued throughout the pandemic to care for those suffering from other conditions.
Nurses are indispensable part of clinical management in the most proximity to patient bedside in all healthcare settings. They remain present in hospitals for 24 hours by shifting duty, 7 days a week. In Bangladesh, nurses perform duties such as preparing bed, maintain personal hygiene, observe patient condition, administer medication, assess patient condition, explain the effects, observe the effects, take action for side effects and properly document all the records of medication. They have traditionally been assigned to hospitals or clinics, including making rounds, change order by physicians, changing wound dressings, and educating patients about care and conditions, compiling medical records, assisting physicians during, help physicians on prescriptions, performing and reading the results of routine examinations and operations.
In the field of nursing, the scenario was not soothing since inception. In the mid-1800s, the act of nursing consisted of women taking care of family members in their homes; establishing nursing as a legitimate profession was a challenge. In the 20th century, nursing care became more common in public facilities than in homes. However, the quality of care was inconsistent and depended on the hospital. As time went on, more standards were put into place to combat these inconsistencies and nursing challenges. Today, nursing is a vast and varied field, with a multitude of opportunities. Problems in nursing have been changed over time.
In our society, nurses and the nursing profession both are still largely neglected. The nurses are facing lot of problems regarding their status, dignity, work benefits, working environment and social stigma. Among other barriers negative social attitudes, lack of appreciations, cultural barriers and lack of adequate supports for nursing education are also the central factors. Multifaceted hindrances are prevailing in nursing education and training in our country. Imprecise recruitment of students, shortage of qualified teaching staff; lack of basic infrastructure, equipment and community-based learning; weak, non-standard and inconsistent accreditation process are few amongst those.
Nurses also face additional challenges through workplace hazards in a hospital or clinical environment. Workplace violence and bullying are serious issues and the nursing field is not immune to these. The risk of exposure to and contraction of infectious diseases, stress and a high rate of work-related injuries are common and intimate occupational ailments.
They don’t get due attention from media as well, when they report on the health sector, they always focus on the absence of physicians, lack of amenities, unavailability of essential drugs, lack of cleanliness and so on. As a result, nurses remain invisible both in the policy discussions and the public recognition. Even though there is a vast demand for nurses, there is no urge from society to meet it. Private investors also refrain from opening new nursing educational institutes as it would not be financially profitable.
According to the World Health Organization (WHO) guidelines, the ideal ratio of doctors to nurses is 1:4; that is to say, there should be four nurses against each doctor in a country to provide healthcare services expediently. In Bangladesh, each doctor is having only 0.74 nurses. There are 75,043 registered nurses in Bangladesh, where the country needs more than 3 lakh; having about 75% shortage and around 50 per cent of them work in the government sector. There are 5.8 nurses for every 10,000 people in the country’s urban areas, there are only 0.8 nurses for the same number of people in rural areas.
It is undeniable that, the nursing profession has come a long and arduous way in our country. One of the significant events for nursing in Bangladesh was that, the Nursing Council Ordinance was drafted in 1983, which helped to create a regulatory framework for nursing education. After being shut down in 1980, the B.Sc. course has been reintroduced in the government sector in 2008. Other instances of progress are establishing the Directorate of Nursing Services, College of Nursing, Nursing Training Institute and forming rules for recruiting nurses in government hospitals. In 2011, nurses were elevated as second-class government employees. 2016 was an important year for nurses in Bangladesh. In that year, midwifery was added to nursing and Bangladesh Nursing Council was renamed Bangladesh Nursing and Midwifery Council (BNMC). Additionally, the Directorate of Nursing Services was elevated to Directorate General of Nursing and Midwifery. The government has pledged to more post for nurses and midwives, establishing more nursing and midwifery educational institutions, increasing the seats for students and strengthen capacity development of nursing and midwifery professionals.
Most recently, more than 500 qualified nurses have been sent to Kuwait and they are appointed in various state-run hospitals, more expected to come. As a part of the government’s initiative to export skilled medical professionals abroad, sending Bangladeshi nurses to work at state-run hospitals in Kuwait has opened a new window to boost remittance inflow. The Bangladesh government also plans to send more nurses to five other countries – Maldives, Japan, Qatar, Germany and the United Arab Emirates.
However, to strengthen the existing situation, the quality of nursing education has to be improved and more students should be encouraged to enroll. An increase in budget is also necessary. Policymakers and health decision-makers should realize that the nursing profession’s problems are complex and socially embedded. It demands a multi-sectorial, long-term, socio-cultural intervention. Different stakeholders, such as the media, health professionals, public health experts, social scientists and educationists should be engaged in the process.

(The writer is deputed to Kuwait).