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There is no denying the fact that nurses play a major role in delivering health care services. Their round-the-clock presence, observation skills and vigilance allow doctors to make better diagnoses and propose better treatments. They provide care and assist in cure, participate in rehabilitation of the patients, and provide support to the healthcare providers. No other health care professional has such a broad and far-reaching role. Yet, the irony is that in our part of the world, they are still struggling against the norms which have denied them their due place among the comity of professionals.
This sad state of affair has compelled a number of qualified nurses to migrate abroad for better prospects - creating a vacuum at home. With the exception of few private hospitals like Aga Khan, most hospitals deny them their due perks and facilities.
According to national statistics, on an average, there is one nurse against 3,822 individual patients. The ratio in context of doctors comes to one doctor for 1578 patients. There are only 50,000 nurses against 1, 20,000 doctors in the country which is contrary to the international standards. So it depicts that there is a wide gap between the demand and availability of nurses.
"This acute dearth of nurses is due to massive brain drain to the Gulf states and western countries. The situation calls for efficient and adequate training programmes besides a pragmatic approach to contain massive brain drain," says Dr. Khurshid Khwaja, Director Nursing Division at Aga Khan University Hospital.
"Pakistan needs to adopt a policy of retaining nurses through a provision for improved working conditions, better enumeration, quality education and training - above all recognition and respect to nurses," points out Dr Khurshid.
Dr Khwaja who is the first PhD nurse in Pakistan underlines the need of development in the social and cultural arenas for removing stigmas attached to the field of nursing. "The nursing profession demands respect and recognition. A conducive working environment is mandatory for nurses to do their jobs happily."
She admits that immigration of nurses in search of greener pastures is a worrisome situation that needs to be taken into serious consideration by the concerned authorities. According to available statistics, 15% of nurses from the developing countries like India, Philippines and Pakistan are moving to developed countries every year. Interestingly, every year western countries hire 33% nurses for their health care units only from AKU Nursing School.
Dr. Saeeda Malik, Minister for Education, Sindh, calls for coordination between representatives of nursing communities and women legislators and parliamentarians to bring about a meaningful change in the society. "We cannot ignore that nurses cater to almost 80% to 85% healthcare needs in any country while the rampant derogatory attitude would continue to further widen the already massive gap between local patients and nurses. Many lives have been saved because a conscientious nurse picked up early warning signs of an upcoming crisis like cardiac arrest or respiratory failure. There is a dire need for new nursing schools which can accommodate aspiring nurses."
She advises nurses to approach Women Crisis Centres, Complaint Centre, and Ombudsman Office in case of any gender discrimination or workplace harassment.
As for the issue of low wages and denial of required financial support to nurses in general coupled with their constant and un-protected exposure to diseases due to unsafe working environment, she says that the government with its limited resources is trying to address this important issue.
She has told You! that in a bid to balance the ratio of nurses against doctors, (11,000 doctors against 2000 nurses), the Sindh government has revised its salary structure so that the nurses can also enjoy the same benefits which were previously reserved for doctors.
Dr. Riffat Jan, eminent scholar and PhD in Nursing from USA, criticises forced duties of trainee nurses at night, and their negligible role in policymaking. She also deplores the pathetic living conditions of nurses in hostels, where they are exposed to diseases like tuberculosis and hepatitis.
"Florence Nightingale (the founder of modern nursing) had identified over-crowding, poor sanitary conditions, unhygienic conditions, lack of ventilation as major risk factors for nurses serving at hospitals some 160 years back, but the irony is that even after so many years the situation is more or less the same in general hospitals," she laments.
She also stresses the need of raising the standard of education and training of nurses to improve the skills of existing nurses. "Autonomous governance and administration as well as financial independence for nursing departments in every teaching hospital is the need of the hour as it can guarantee a secure future for nurses," she adds.
But the situation is not all dismal and there is still hope. Of late, the Government of Pakistan, the Pakistan Nursing Council and some major hospitals like Aga Khan have come up with recommendations for the improvement of general conditions of nurses. It is heartening that the Higher Education Commission is now focusing on the higher education of nurses and for the first time in Pakistan courses have been introduced at the postgraduate level. The government is also taking interest in creating job opportunities for nurses and recently 865 new positions have been created at federal level only, while 1500 scholarships have also been announced. It is hoped that the government and concerned authorities will come up with more comprehensive and persistent efforts to improve the prevailing conditions.
National Education Task Force
Minister for Health, Muhammad Nasir Khan, informs that a National Education Task Force will be formed for reforms in nursing profession in consultation with all stakeholders.
- The government will make sincere efforts for proper adjustment of those nurses working on contract basis with various government institutions.
- All vacant posts of nursing staff of Grade 17, 18 and 19 will be filled according to merit.
- Health Ministry has started two shifts in nursing classes while the government has also increased their seats to overcome the problem of shortage of nursing staff in the country.
- The Ministry has also directed the Pakistan Nursing Council to review the curricula of nursing courses and ensure the availability of educational facilities.
- A body will be made to keep a check and balance on the working of the nursing schools guaranteeing basic facilities to its students.
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