International Nurses Day is being observed today, Monday, amid a severe crisis in Bangladesh’s nursing sector.
The country currently needs 310,500 nurses based on its population, but there are only 56,734 nurses available—resulting in 82 per cent shortfall.
This alarming statistic was highlighted in the recent report by the Health Sector Reform Commission.
Healthcare experts say that the acute shortage of nurses is one of the main reasons behind the unsatisfactory quality of medical services in the country.
This year’s International Nurses Day has focused on the health and wellbeing of nurses themselves.
The central message is that protecting nurses and ensuring their physical and mental health is key to building a stronger healthcare system and, ultimately, a stronger economy.
The Health Sector Reform Commission submitted its report to the Chief Advisor on 5 May. In the section discussing manpower issues in the health sector, it specifically flagged the nurse shortage and called for immediate recruitment of healthcare personnel, especially nurses, to fill vacant positions in hospitals and clinics.
The role of nurses is crucial in reducing morbidity and mortality, ensuring patient satisfaction in hospitals, and preventing re-admission or complications in cases of illness. But nursing has yet to be made attractive as a respectable profession in Bangladesh. In addition, the country lags behind in nursing education.
Mallika Banu, a senior staff nurse at the National Burn Institute and a student at the National Institute of Preventive and Social Medicine (NIPSOM) told Prothom Alo, “Our job is not limited to just giving medicine and injections. The list of basic nursing duties is long. I may be assigned to care for six patients, but in reality, I often have to attend to 50. Naturally, it’s not possible to give each patient the attention they need. As a result, the patients are dissatisfied, and we get burned out from the excessive workload. The quality of care suffers. This is what’s happening.”
Lower Numbers, Higher Pressure
The World Health Organization says that the ratio of physicians to nurses in the service sector should be 1:3. That is, three nurses should work with one doctor, and five more allied health workers should be with them. If this ratio is maintained, there is a high chance that medical services will be comprehensive and of high quality.
This ratio is not maintained in Bangladesh. The Health Sector Reform Commission says in its report that the country of 180 million people needs 103,500 physicians, 310,500 nurses, and 517,500 associate health workers. There is a shortage of manpower in every field. Citing the figures for 2021, the report says that there are 86,675 physicians (16.5 per cent less than the requirement), 56,734 nurses (82 per cent less), and 230,219 associate health workers (55.5 per cent less). Nurses are the fewest in terms of percentage. And the ratio of physicians to nurses is 1:0.7.
Several nurses told Prothom Alo that hospital service is teamwork. Everyone has a specific job. Due to the manpower shortage, they have to take on the work of others.
Why Is This Situation
A research article published in 2021 in the Policy, Politics and Nursing Practice journal of the New York-based publishing house 'Sage' in the United States highlights some of the reasons why the nursing profession is lagging behind or neglected.
The article says that there is a kind of disrespect towards this profession due to social or cultural bias. Historically, nursing has been considered a low-status profession in Bangladesh. Girls from poor families have been seen entering this profession. Many people believe that touching dirty bodies is not appropriate for a respectable person.
The article also says that there are no posts for nurses below the Upazila Health Center (except for Union Sub-Centers), and there is no system for promotion. Despite having less clinical training and academic qualifications than nurses, Sub-Assistant Community Medical Officers (SACMOs) can treat patients and prescribe medicines, but nurses cannot.
Researchers have found a few nurses who hold PhD degrees. However, they observed that their positions and salaries remain the same before and after obtaining those degrees.
Ismat Ara Parvin, former president of the Bangladesh Diploma Nurses Welfare Association, told Prothom Alo, “Increasing the number of nurses, increasing their salaries, and placing them in decision-making positions—all these are the responsibility of the government. It is not right to expect quality care from a tired, dissatisfied nurse."