However, the last decade has seen an increasing number of professionals entering the nursing sector
Nursing professionals – considered as frontline members of health care delivery teams, alongside doctors – are still struggling to get the recognition they rightfully deserve.
Nurses and midwives serving in government hospitals and medical centres are included under a proper salary structure, with benefits. However, their counterparts in private hospitals and clinics do not have it so easy; they have to continuously struggle for better salaries.
Insiders in the profession said nurses and midwives might start their career with salaries as low as Tk12,000 per month at most private medical centres – although a handful of these establishments do offer much higher salaries.
There are no effective organizations or platforms through which the nursing professionals can voice their demands to the authorities, Shuriya Begum, registrar of Bangladesh Nursing and Midwifery Council (BNMC), said.
Despite these constraints, nearly 7,000 new professionals join the nursing workforce every year, after obtaining their registrations from the BNMC.
The number, however, still does not fulfill the required number of nursing professionals in the country.
Deficit in the number of nurses
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.
"The number of hospitals and clinics is 68,000, which means there are health care institutions which have nursing professionals without institutional degrees," said Shuriya.
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.
Md Kamal Hossain Patwary, president of Bangladesh Nurses Association, told Dhaka Tribune: "The slow government recruitment process has long been an issue, which forces thousands of young nursing professionals to either remain unemployed, or join private medical institutions at nominal salaries."
He added: "However, the situation is slowly changing, as evidenced by the 21,000 nurses entering senior positions in government jobs in the last decade."
Nurses, who used to be third-class employees, have recently been upgraded to second-class employees, Kamal said. "It used to be, nurses did not get any promotion. But a few months back, 243 nurses were recruited in first-class jobs. If this continues, then it will keep on attracting more newcomers to the profession."
The colleges and institutions offer courses on several subjects, including nursing, midwifery, orthopaedic nursing, public health nursing, psychiatric nursing, ophthalmic nursing, paediatric nursing, and others. These courses all range from six months to four years.
BNMC Registrar Shuriya further said that diploma in midwifery was introduced in the country in 2013. "Students can join the course after passing their HSC. Before that, we only had three years of nursing and one year of midwifery course.
"Since 2010, we have also introduced four-year BSc programs," she added.
Currently, there are 15,000 students doing different courses who will join the workforce after completing their studies.
According to World Health Organization (WHO), there are an estimated 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population, which indicates that the number of nurses in the country is even lower than the physicians.
Nursing professionals, meanwhile, believe that in our society, people have negative ideas about the social and education status of nurses, which should be changed.
Kamal Hossain Patwary said that ever since nurses started to be appointed through competitive exams – conducted by the Bangladesh Public Service Commission – well-educated people, with good family backgrounds, began to enter the profession.
What is a nurse's job?
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.
The journey of nursing profession in Bangladesh
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.
The College of Nursing in Mohakhali, Dhaka, was established in 1970, to offer post-basic diploma in administration and teaching.
Between 1970 and 1971, senior nursing schools were established and attached to 12 district hospitals. These schools introduced several crash programs, without having any sanctioned posts for peer tutors, practical facilities or teaching-learning resources.
However, in a span of 23 years – from 1947 to 1970 – the number of nurses increased from 50 to 600.
After 1971, the number of hospitals, medical colleges, nursing schools and institutions increased. Prior to the creation of the Directorate of Nursing Services (now DGHS) on May 14, 1977, the former Director of Health Services used to manage the nursing education and services.
The Directorate of Nursing Services (DNS) has been the central government body to manage public sector nursing education and services, constituting a significant force in the health care delivery system, congruent with national health goals.