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Bad career choice?
AS with so many other professions, nursing remains a neglected line of work, despite its practitioners being responsible for the treatment, safety and quick recovery of patients, as well as post-op management and specialised interventions. Doctors need them because no doctor can care for each patient.
According to the latest Economic Survey, there are 208,007 doctors and 103,777 nurses in the country. This reflects a ratio of one doctor to less than 0.5 nurses, while the recommended ratio is 1:4. This should not be surprising as 90 per cent of nurses here are females working in a highly misogynist culture, encountering sexual harassment and being treated as inferiors by doctors and hospital administrators.
They have long working hours and low wages. Their career trajectories are poor as they are inducted in Grade 16 after BSc in nursing, with prospects of promotions and perks like their officers in the public sector with similar qualifications. Many nurses are qualified from abroad but are not integrated at policymaking levels.
Nurses in Pakistan work in a highly misogynist culture.
In the private sector, nurses are paid between Rs12,000 to Rs20,000 per month with frequent double shifts due to shortage of staff. The quality of their qualifications varies as some nursing teaching institutions exist only on paper, while many others lack basic infrastructure. There is poor monitoring of benchmarks and discipline as the Pakistan Nursing Council is often hampered by the health bureaucracy and even by executive district officers who interfere in nursing recruitment, training, inspection and examination. Even transfers and postings of nurses are not controlled by directors generals of nursing in the provinces.
According to an Aga Khan University study, there is a highly skewed physician-centred culture in Pakistan with most nurses not being recognised as medical professionals in their own right. “The low socioeconomic status of nurses, unsafe work environment, lack of respect from doctors, and the very nature of nurses’ work create a dichotomy in society’s attitude towards the nursing profession.” It was noted that nursing shortage and the image of the profession had a reciprocal relationship: while most people appreciated the critical role of nursing in healthcare, very few considered it a suitable profession for their daughters or sisters, and even television portrayed nurses as handmaidens of doctors.
This is in complete contrast with the more feasible and affordable nurse-centred culture in developed countries, where public health is embedded in the nursing profession to reduce healthcare costs. Nurses work in a variety of settings in primary, secondary, community and social care services in hospitals, health centres, hospices and teaching institutions. They serve local communities in emergencies, work as midwives, nurse the sick and old, and also cater to persons with disabilities and mental illnesses. In the UK, despite NHS budget cuts, there are 300,000 nurses, while in the US, the ratio is one doctor to four nurses.
In India, high-powered institutional mechanisms such as the Bhore and Kartar Singh Committees have brought about major changes in the nursing culture, improving their working hours and recommending a minimum of Rs20,000 per month as starting salary. From 2000 to 2016, BSc colleges increased from 30 to 1,752 and MSc colleges from 10 to 611 in India. There are also eight institutions offering PhD programmes in nursing. Florence Nightingale Awards including medals and cash are given every year on International Nursing Day to 35 nurses for outstanding services.
In Pakistan, neither the legislators nor health professionals have effectively addressed the problems faced by nurses in the country. According to a Pakistan Medical Association office-bearer, it is an emergency situation and a special commission has to be put in place to review the entire system of nursing and align it with the requirements of not only the SDGs but the entire public health system. The number of nursing teaching colleges needs to be increased manifold and PhD programmes introduced. In order to improve the dismal doctor to nurse ratio, the government must take affirmative action to support nurses with higher salaries, a proper service structure and improve their image by publicly acknowledging through the media their services as a critical component of healthcare.
It is imperative that the bureaucracy of the health sector provide respect and space to the Pakistan Nursing Council to fulfil its mandate of training, inspection and protection of nurses without interference, providing modernised curricula, and ensuring access to foreign trainings which are usually used up by bureaucrats based in Islamabad. Other bodies such as the Pakistan Nursing Federation and Pakistan Nursing Association should also play their due role in empowering nurses, providing leisure facilities and encouraging the use of social media such as Twitter and WhatsApp to communicate with patients.
The writer is former federal secretary.
Published in Dawn, July 23rd, 2018