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13 May, 2019 00:00 00 AM

Possibilities of enhancing the standard of nursing profession to international level

Nursing is not socially esteemed very much and the profession is also not financially appreciated. These low pay and lack of social status is not helping the profession to attract people to this noble job.
DR RAMIT AZAD
Possibilities of enhancing the standard of nursing profession to international level

In the evening of September 2011 an earthquake took place in Panchgarh. During 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, disclosing this rare incident, stated that on the fateful Monday evening a ceaserian operation was being performed at the city general hospital on a pregnant women named Sultana Begum.

A male child was born to the lady through C-section. The umbilical cord was not even dissected and detached when the earthquake hit the town. When the surgeon Kamalakanta Barman, anaesthetist Arifur Rahman and others were running out of the operation theatre in a bid to save their lives even then the undaunted nurse stood alone in the O.T. with the new born child praying to Almighty to save the mother and the child.

Arjina Khatoon 28, 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 not dissected yet. 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 tremour of earthquake, I was trebling fearfully and was praying to God for his mercy.”

Zahidul Islam, the director of the hospital describing the incident afterwards, said, “When we all including the surgeon and other doctors ran out of the hospital during the quake, this nurse Arjina stayed back at the OT to save the lives of the mother and the new born child. Such incident is very rare as during such disaster everyone want to save his own life.

In this way a nurse may become noble- can save a life. If we follow the history of nursing we find the life and work of the pioneer noble nurses Rufaida and Florence Nightingale. Heavenly touch of such great souls can save many dying men and women. We should then think seriously about these angels of Almighty and should find a way out to enhance their honour and dignity in the society. In our country – Bangladesh, nurse and the nursing profession, both are largely neglected. As such people, rich and poor, are deprived of real health care.

We must find out the root of every problem and solve the problem at the very root. In my view nursing profession in Bangladesh faces two problems. These are: (1) Nursing is not socially esteemed very much and (2) The profession is also not financially appreciated. These low pay and lack of social status is not helping the profession to attract people to this noble job.

If we review the history of enhancement of nursing profession in South Asia and Europe we would find that there exist some opposite and contrasting role in the background. In Europe the Roman Cathlic Chuch leaders were doctors and nuns were nurses. Both these class of people were highly esteemed in the 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.

 In Bangladesh now there exist 10 government nursing colleges and 37 nursing institutes. In the private sector there are 7 nursing colleges and 54 nursing institutes. But if we want to attract skilled and meritorious students to nursing education and the profession then the standard of the education and the profession must be enhanced properly and financial solvency should be ensured for the profession. For the lack of these facilities stated above, the profession of nursing is still socially not dignified and quality of the profession still remains unsatisfactory.

In comparison with the vast population of Bangladesh the supply of nurses, like other professions, are very much inadequate. Number of nurses for a population of 150 million or more is so much inadequate that can not be imagined to provide health care service to even one fifth of the present population. According to Bangladesh Nursing Council (BNC), there were 23006 registered nurse as of 31st July, 2008. However we require at least 1,80,000 nurses at present. In developed countries the ratio between doctor and nurse is 1:3, that is 3 nurses work with one doctor. On the other hand, the ration is opposite that is one nurse is for two doctors. We have only 23000 nurses against the presently required 1,80,000 nurses.

So there exist a demand of 1,53,000 nurses to meet the present requirement. But the way the nurses are trained and joining the profession every year, the existing vacancies, i.e. 1,53,000 will not be filled even in next 50 years.

However, when there is problems, solutions are also there. Let’s now think about how we can solve the current problem. Among the few promising, successful and flourishing industries after the independence of the country, Pharmaceutical industry is one of them. the continuous medical education ()CME) programme undertaken by the pharmaceutical industry is praiseworthy. In continuing the CME programme for the doctors, huge expenditure is incurred every year by the pharmaceutical industries by sponsoring such activities.

Now the pharmaceutical industry could sponsor higher training programmes for nurses by spending a part of the fund year marked for CME. This is not unnecessary or unimaginable proposal. In the developed country, such programmes are available for many decades. Incidentally, we may mention the name of Johnson & Johnson in this regards. They have reserved a major fund for development nurses training and education.

In a hospital 60% to 70% workforce are the nurses, therefore training the nurses is very important. If the pharmaceutical companies spend 10% of their CME (Continuing Medical Education) budget on the nurses’ training, both in the short term and in the long term nation will reap the benefits.

In the short term hospitals will ensure better patient care and the nurses will receive better compensation. In the long term smart boys and girls will find the profession both rewarding and fulfilling. After meeting local demand if only 200,000 nurses work abroad, Bangladesh can earn in excess of USD 8 billion every year. Bangladesh can move from a low income country to a middle income country overnight just through the nursing profession.

Former Health and Family Welfare secretary Mr Muhammad Ali said, “As told by our honourable 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 clinic. If the nurses and health workers of these clinics could better training then they would be able to deliver better health care to the people at the grassroots in the remote rural areas. In places where number of trained doctors and nurses are inadequate for proper healthcare delivery then emergency healthcare may be provided through tele-medicine. This will definitely help Bangladesh to achieve millennium development goals (MDGs).”

The president of Bangladesh Diabetic Association professor A K Azad Khan said, “We require on 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.”

In enhancing 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 profession promotion shows. The media can highlight nurses in such shows also.

Goodheal Trust, a not for profit organisation has recently launched its programme for enhanceing the standard of nursing and the profession as a whole. Presently the trust is conducting a 12 month training programme for the professional nurses adopting the curricula and syllabus of the Institute of Nursing Healthcare Leadership (INHL) and by expert foreign faculty.  

This programme is enhancing the professional standard of Bangladeshi nurses to international level and at the same time the nurses are learning about various programmes of modern medical science. Along with general module of training there are some specialised modules such as cardiac, oncology, opthalmology, spinal cord injury, gastroenterology and transplant modules.

The executive director of the Trust Tanvir Raquib, said, “Goodheal Trust believes that with the launching of this progamme the nursing care and healthcare service delevery in Bangladesh may attain the international standard.”

The main problem faced for the implementation of this programme is low salary of the nurses and availability of required fund for a sustainable programme. If the pharmaceutical industries allocate some portion of their earmarked fund for doctors CME for the nurses training then the programme could be spread out to every hospitals.

The pay and allowances received by the Bangladeshi nurses are very much insufficient considering the professional status and their livelihood. All the public and private hospitals need to be considerate and sympathetic. The skills and drive, both will be enhanced if these basic needs are taken care of Nurses work as helping hand with doctors.

As such there shouldn’t be much deficit in the doctors and nurses training and skill developments. On the other hand nurses need higher training and skill development so that they may understand the requirements desired by the doctors and give them proper support. The government, various hospitals clinics and pharmaceutical industries can play an important role to provide higher training fo the nurses through financial and administrative support.

In the land of 16 crore people, number of sick and ailing people are 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 delivery service in a people friendly way. 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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