Dr. Forqan Uddin Ahmed :
Nurses are entitled to independently assess and monitor patients. They provide care, and also alert doctors about the health conditions and any improvement in their patients. At the emergency department, they deal with incoming patients to coordinate with the doctors to deliver medical assistance. They also assist those patients with inadequate healthcare knowledge to protect their interests. They monitor patients’ intake of medicines, as prescribed by physicians. Overall, nurses and midwives work in providing preventive, curative and rehabilitative care.
Before independence from British colonial rule, nurses used to be trained at three junior nursing schools, under the Bengal Nursing Council. The first professional senior nursing school was established in 1947 at Dhaka Medical College and Hospital. The Nursing Council was established after independence. In 1949, a few local nurses were sent to England to receive basic training. They were later appointed in leadership positions in the nursing sector. In 1952, the East Pakistan Nursing Council was formed as a regulatory body for nursing education and services. After Bangladesh’s liberation in 1971, it was renamed as Bangladesh Nursing Council (BNC). In 1960, the junior nursing training schools were abolished. From 1962 to 1970, senior nursing training schools were established and attached to eight medical college hospitals, to provide diplomas in nursing and midwifery.
According to BNMC’s latest count, as of March 31, 2019, Bangladesh has a total of 56,733 registered nurses and midwives, working in different positions, including nursing superintendent, Deputy Nursing Superintendent, Nursing Supervisor, Senior Staff Nurse, and Staff Nurse. They are employed at different government, private, and army institutions, and NGOs. According to government rules, nobody can join the nursing service before registering with BNMC and that only after obtaining degrees in nursing and midwifery. There are 43 nursing institutions in the public sector across the country, each of which has 50-80 seats. These institutions offer three-year diploma course in nursing science and midwifery. Both male and female candidates can avail the course, after sitting for their Higher Secondary Certificate (HSC) exams. Additionally, there are seven nursing colleges at the Divisional Headquarters in the public sector, which provide bachelor’s degree after a four-year course in nursing (basic) education. Every year, 700 fresh nursing professionals from this program enter the workforce. Four nursing colleges provide BSc in Nursing (post-basic) education, each with places for 125 students.
In Bangladesh, nursing is considered as a second segmental job. That is why the work value and social recognition does not encourage the brilliant boys and girls to join the profession. It creates an ill impression and contributes as one of the major causes of shortage. In order to increase the number of nurse and fulfill the actual need both government and private sector should come forward with the initiative to open more nursing institutes, colleges to attract new generation to join in nursing. There is also urgent need to uphold the significance of this noble profession. Among other barriers negative social attitudes and more restricted policies, undefined status of nurses, lack of appreciations, cultural barriers and lack of financial supports for nursing education are also the central factors behind the shortage of nurses.
Although the question of whether nursing is a profession may not be settled, nursing possesses qualities that entrust education to institutions of higher learning, has established policies for practitioners while allowing the nurse to function autonomously in practice, has a code of ethics in which to practice and has clear set of educational standards for continuing education. So, the discussion is particularly important when it is viewed from the perspective of a RN with an ADN degree who is enrolled in a RN to BSN program, that is, the nurse is seeking to increase the current level of education under which he or she practices. Nurses have specialized education and training validated by professional licensure in each state. We have a code of ethics and established practice standards we are bound to adhere to, a violation of which can result in our license being revoked or sanctioned. We have our own body of ongoing research that shapes and governs our practice. Nurses work autonomously without our scope of practice. We formulate and carry out our own plan of care for clients (when applicable); we apply judgment, use of critical thinking skills, and make nursing diagnosis.
It is known that, ineligible persons are sent abroad in the name of study tour. It does nothing to do the job. A strong syndicate has been formed in the nursing training sector led by an officer in the Health and Education Department of Health and Family Welfare Ministry along with an officer in the Directorate of Nursing and Midwifery and an officer of the training project. In the meantime, investigation is going on against an officer of this syndicate for allegations of irregularities in posting and transfer of nurses.
Expert nurses training must be modern and necessary reformation must be taken into consideration. Prime Minister Sheikh Hasina has emphasiSed to take various measures to improve the quality of training with the world. But the syndicate allegedly has sent the non ineligible nurses for training in abroad who are not involved in nursing or teaching, they are nominally nominated for training of ineligible persons. In the back, billions of money of the training project went to the syndicate pocket.
It has been learned that government has announced the promotion of nurses, but the same syndicate has stuck their promotions for a long time raising various complications. Although there are higher degree holders in the country and abroad, they are recruited for their posts in important positions, including the Directorate, Nursing College. Their main terms are senior staff nurses. But none of them is acting Assistant Director, Deputy Director, Director, Principals and other posts. Many have already retired from the job. But they did the job of high level officer. Financial services have got as senior staff nurses. However, under the same Ministry, Diplomatic pharmacists get the selection grade. Despite the sincerity of the government, nurses have been deprived of getting their dues and selection grade for which the nursing associations of Bangladesh and its Dhaka Medical College Unit have expressed sadness, disappointment and anger.
A strong syndicate is in the control of nursing sector. The posting and transfer is being illegally regulated under the control of this syndicate. This syndicate is allegedly issuing diploma certificates too. Certainly, this will have negative effects on healthcare. Bangladesh Nurses Association (BNA) Secretary General stated that the nurses who have been approved by the government recognised nursing and midwifery council will only be registered. Apart from this, the registration of the applicants as a nurse cannot be given from the Nursing Council. Several sources of the Health Ministry said that a few days ago, complaints of transfer and posting related to a group of three to four influential officials and employees, including Director General of Nursing and Midwifery.
But the most awkward incident among these has become the ‘pilgrimage of India’ and ‘to allow pilgrims to travel to Saudi Arabia, under which the allegations of financial transactions are discussed in the face. In addition, the complaint has also been filed against the Director General in connection with the allegation of corruption, harassment, shopping and transportation. In particular, the names of several officials, including the PS of Health and Family Welfare, have been named for allegedly sending some of the nurses to Hajj and to some countries for training.
Now who is to bell the cat? Actually, the problem lies with co-ordination. There is most probably lack of co-ordination between Ministries of Health and Family Planning and Religion. Again, there is also gap in between concerned ministry and DGNM.
(Dr Forqan Uddin Ahmed, former Additional Secretary, Writer, Researcher and Columnist)
