Lt Col Nazmul Huda Khan :
May 12th is an important date to all nurses, as it is the anniversary of the birth of Florence Nightingale (12 May 1820 – 13 August 1910), an English social reformer and statistician and the founder of modern nursing. Since 1974, this day was officially made International Nurses Day. Nightingale came to prominence while serving as a manager of nurses trained by her during the Crimean War, where she organized the tending to wounded soldiers. She gave nursing a highly favorable reputation and became an icon of nurses, especially in the persona of “The Lady with the Lamp” making rounds of wounded soldiers at night.
This year, the International Council of Nurses (ICN) has announced the new theme for International Nurses Day 2022: Nurses: A Voice to Lead – Invest in nursing and respect rights to secure global health, focusing on the need to protect, support and invest in the nursing profession to strengthen health systems around the world.
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. From birth to death, non-communicable diseases to infection disease, mental health to chronic conditions, in hospitals, communities and homes, nurses provide accessible, affordable, person-centred, holistic care for all.
Nurses are the healthcare provider most proximal to patient bedside in acute care settings. Nurses are present in hospitals for 24 hours by shifting duty, 7 days a week, observing, intervening, and reporting changes in patient condition. They play organized roles such as care giver, communicator, teacher/client family educator, counselor, decision maker, leader/manager, comforter, rehabilitator, protector and advocator/client advocate and career roles.
In bed side care responsibility, nurses perform multiple tasks such as preparing bed, maintain personal hygiene, observe patient condition, administer medication and assist to meet need of the patients during providing care. Likewise, for ensuring quality medication, the respondents follow five rights (right patient, right drug, right dose, right route and right time) of medication, direct administration of medicine, assess patient condition, explain the effects, observe the effects, take action for side effects and properly document all the records of medication.
During admission of patient, as indicators of quality service they prepare bed, receive and assess patient, provide emergency care, inform the doctor and administer medication. During transfer, important activities they perform are: obtain written order form doctor, inform patient and family, communicate with staff of concern ward, help the patient to arrange thing and keep transfer records. Likewise, during discharge, they obtain written order from doctor, inform patient and family and explain the prescription, give health teaching to patient and family and advice to attend follow up.
They also communicate with their colleagues on issues like care to the patient, treatment and condition of patients, caring plan and nursing diagnosis, working environment and duty roster. For providing quality care, nurses also make effective communication with other departments like administration, dietary section, pathology, pharmacy, radiology, social welfare, laundry and housekeeping.
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.
In the field of recruitment of nurses, the scenario was not soothing since colonial period. Only women from the bottom of the society took up nursing as a profession. This mindset was not only present among the general populace but also among educated people. 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.
In our society, nurses and the nursing profession both are still largely neglected. The nurses are facing a lot of problems including their status, dignity, work benefits, working environment and social stigma. Among other barriers negative social attitudes, lack of appreciations, cultural barriers and lack of financial supports for nursing education are also the central factors behind the shortage of nurses.
But amidst all these limitations, 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 upgrade the status of nurses and midwives, creating midwifery posts, establishing more nursing and midwifery educational institutions, increasing the seats for students and increasing capacity development of nursing and midwifery professionals.
To improve 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.
(Lt Col Nazmul Huda Khan, MBBS, MPhil, MPH is Assistant Director, Kurmitola General Hospital).