Possibilities of enhancing standards of nursing profession to international level
On the evening of September 2011, an earthquake took place in Panchagarh. At that time, a nurse named Arjina Khatoon set a rare example of discharging her noble duties at a private hospital in Panchagarh. The hospital source stated that, on the fateful Monday evening, a Caesarian operation was being performed at the city general hospital on a woman named Sultana Begum. The mother gave birth to a boy, but the umbilical cord was not even dissected and detached when the earthquake hit.
When the surgeon Kamala Kanta Barman, anesthetist Arifur Rahman, and others were running out of the operation theatre in a bid to save their lives, the undaunted nurse Arjina Khatoon stayed behind alone in the OT with the newborn child praying to Almighty to save the mother and the child. Arjina Khatoon, aged 28 years at the time said, "I stayed back in the OT, thinking that the lives of the mother and child could be at stake if I left them there. Besides, the umbilical cord was still attached to the newborn and so I could not come out with the baby alone. I decided to stay back at the OT and face the eventuality at its worst. When all the instrument and apparatus were falling down from the operation table due to the tremor of the earthquake, I was trembling fearfully and was praying to God for his mercy."
Zahidul Islam, Director of the hospital, describing the incident afterwards, said, "When we all ran out of the hospital during the quake, the only nurse Arjina stayed back at the OT to save the lives of the mother and the newborn child. Such an incident is very rare as during such a disaster everyone wants to save his/her own life."
This is how a nurse can be noble by saving a life. If we follow the history of nursing, we find the life and work of the pioneer noble nurses Rufaidah Al Islamia and Florence Nightingale. The healing touch of such great souls have saved many dying men and women. We should thus think seriously about these Angels of Almighty and should find a way to respect their honour and dignity in society. In Bangladesh, nurses and the nursing profession are both largely neglected, resulting in the rich and poor alike being deprived of health care. We must find out the root of every problem and solve the problem at the very root. In Bangladesh nursing profession is stuck in a vicious cycle. These are: (1) Nursing is not socially esteemed, (2) Nursing profession is not financially lucrative, (3) Long-term career prospect for nurses in existing system is limited, and (4) Best students are reluctant to choose nursing as their career path.
A review of the history of nursing profession in South Asia and Europe reveals a contrasting picture. In Europe, the Roman Catholic Church leaders were doctors and nuns were nurses. Both these classes of people were highly esteemed in society and as such the society acclaimed the doctor and nurses in such esteem. In the Indian Sub-continent, there were many social hurdles in accepting nursing as a profession. Though such social hurdles have largely been removed, economic freedom has not yet been achieved and the vicious cycle has not been broken.
In Bangladesh, there exist 10 government nursing colleges and 37 nursing institutes. In the private sector, there are 7 nursing colleges and 54 nursing institutes. If more skilled and meritorious students are to be attracted to nursing education and profession, the standard of education and profession must be enhanced properly and financial solvency should be ensured for the professionals. For such drawbacks stated above, the profession of nursing is still socially not dignified and quality of the profession still remains unsatisfactory. Compared to the vast population of Bangladesh, the supply of nurses, like other professions, is very inadequate. The number of nurses for a population of 150 million or more is enough to barely provide healthcare service to one-fifth of the population. According to Bangladesh Nursing Council (BNC), there were 23,006 registered nurses as of July 2008. However, we require, at least1, 80,000 nurses at present. In developed countries, the ratio between doctors and nurses is 1:3, i.e. 3 nurses work with 1 doctor. On the other hand, the ratio is opposite in Bangladesh, i.e. 1 nurse for 2 doctors. We have only 23,000 nurses against the presently required 180,000 nurses. Thus there exists a demand of 153,000 nurses to meet the present requirement, but the way nurses are being trained to join the profession each year, the gap will not be filled even in next 50 years.
Let us now think about how we can solve this problem. The Pharmaceutical Industry is among the few promising, successful, and flourishing industries since the independence of the country. The Continuing Medical Education (CME) program for doctors by the pharmaceutical industry enables our clinicians to attend conferences all over the world to be exposed to latest innovations in the medical field. Since 60% to 70% of the workforce in a hospital consists of nurses, nurses in western countries need to complete certain number of on the job training each year through CME programs. In this regard, we may mention the name of Johnson and Johnson (JnJ) Medical that spends a lot of money each year to sponsor nurses' training and education in USA.
Since Bangladesh does not have any specific rule for a nurse to complete on the job training each year, this does not imply that our nurses do not need the training. Therefore, the pharmaceutical industry can play a big role by sponsoring on the job training for Bangladeshi nurses. If the top 50 pharmaceutical companies spend 10% of their existing CME budget for the nurses, a large number of nurses can enroll in continuing education program at home and abroad.
This will reap benefits for the nation both in the short term and in the long term. In the short term, hospitals will ensure better patient care and the nurses will receive better compensation. In the long term smart youngsters will find the profession both rewarding and fulfilling. After meeting the local demand, if only 200,000 nurses work abroad, Bangladesh can earn in excess of USD 8.0 billion each year. Bangladesh can move from a low-income country to a middle-income one overnight just through the nursing profession.
Former Secretary of Health and Family Welfare Muhammad Ali said, "As told by our Prime Minister, much larger section of our people could receive healthcare through the implementation of public-private partnership in the health care delivery system. At present there are more than 10,000 community health clinics. If the nurses are better trained, then they would be able to fill the vacuum at these remote areas. They can take help of the technology to communicate with the doctors at the Upazila or District Hospitals through the Internet and deliver better health care to the people at the grassroots level at a reasonable cost. This will definitely help Bangladesh to achieve millennium development goals (MDGs) through a sustainable healthcare system."
President of Bangladesh Diabetic Association Professor AK Azad Khan said, "We require on the job training for doctors and nurses side by side so that along with the doctors nurses also can provide healthcare service with equal skill. Health profession is such a service where the doctors, nurses and other related technicians are required to update their knowledge through continuous education.
If the scope of CME is extended to all in the medical profession, only then standard healthcare service could be provided in totality."
To enhance the image of nursing profession, the media can also play an important role similar to that of doctors, hospitals, and pharmaceutical companies. Media highlights doctors through various talk shows, service shows and professional promotion shows. The media can highlight nurses in such ways also.
Good HEAL Trust, a not for profit organization, has recently launched its program to enhance the standard of nursing profession as a whole. Presently the Trust is conducting a 12-month training program for professional nurses adopting the curricula and syllabus of the Institute of Nursing Healthcare Leadership (INHL) and by expert foreign faculty. This program is enhancing the professional standard of Bangladeshi nurses to international level and the nurses are learning about various programs of modern medical science at the same time. Along with general module of training there are some specialized modules such as cardiac, oncology, ophthalmology, spinal cord injury, and gastroenterology and transplant modules.
Executive Director of the Trust Tanvir Raquib, said, "Good HEAL Trust (Good Health, Education and Life) believes that with the launching of this program the nursing care and healthcare service delivery in Bangladesh may attain the international standard. Better trained nurses will ensure better patient care that in turn will motivate the hospital administration to better compensate the nurses thus breaking the vicious cycle." The main problem faced for the implementation of this program is low salary of the nurses and availability of required fund to pay for the program. If the pharmaceutical companies allocate a small portion of their CME fund for training of nurses, then the program can be expanded to every hospital. The Government of Bangladesh, private hospital owners, and companies with CSR budget should also look into this matter. If we collectively contribute some funds for nurses' on-the-job training, the healthcare system of Bangladesh will see remarkable change within a decade.
The pay and allowances received by the Bangladeshi nurses are very insufficient considering the professional status and their livelihood. All the public and private hospitals need to be considerate and caring. Both skills and motivation will be enhanced if these basic needs are taken care of. Since nurses work together with doctors, there should not be much difference in the training and development initiatives and programs for doctors and nurses.
In a land of 160 million people, the number of sick and ailing people is equally vast. We require well-trained and skilled doctors and nurses to build a healthy nation. We should remember that along with skilled and trained doctors we should also train and develop skills of the nurses in large numbers to enhance the health status of the country and develop health care service in a people-friendly way.Mr. Ramit Azad and Mr. Suman Kar
Published : Saturday, 25 May 2013