The profession of nursing in Pakistan

Nursing is a very noble profession but our gender prejudices, mismanagement and ill-treatment has caused immense damage to it. This has also caused a migration of nurses from Pakistan to other countries where nursing is given its due respect. It is important that if we had given the recognition, respect and facilities this profession requires it would benefit our society at large. Nurses have been always the backbone of the medical profession and the modern health care system cannot function without them. The nurses interact directly with the patients on a more personal level and provide the highest quality of care to the patient.

The profession of nursing in Pakistan is not without its share of noise. Nurses struggled along with the doctors boycotting their duties to protest against their unmet demands. The demands included allowances for food and clothes, high risk and hard workers allowance, promotions, increased stipend for nursing school students and professional health allowance. The strikes always ended through negotiations with the government but it caused immense hardships for those who had come to seek treatment for their ailments. During previous years, nurses throughout Punjab went on strike. During their strikes in different cities of Punjab, they were beaten by the police, much to the disgust of the civil society.

Nurses in Pakistan are treated as blue-collar workers. While medical is one respected profession for women, it usually pertains to doctors, not nurses. The girls who join nursing colleges mostly belong to lower-income groups. Perhaps that is the reason society treats them with little respect. Many nurses face harassment at the hands of patients, who come for treatment or the relatives who escort the patients. They ask personal questions and phone numbers from the nurses and take their pictures while the nurses are busy. Some people even poke the nurses or slightly brush their hands across the nurses' bodies. While in private hospitals, the nurses have somewhat protection, in public hospitals, the nurses have no one to turn to.

The nurses are not even safe from the paramedical staff and the male physicians of the hospitals. At one of the Rural Health Center in Punjab, a doctor tried to force the nurse to have illicit relationship with him. The victim nurse submitted her complaint to the concerned authority, but she went unheard. Many nurses leave the profession due to this fear of further abuse while many others have intended not to let their daughters choose this profession.

Responsible authority concerned to the nursing in Pakistan is the Pakistan Nursing Council (PNC), which controls and regulates nursing in Pakistan. It is responsible for permitting schools for operating, coming up with the curriculum for nursing education, licensing nurses to practice, maintaining standards of education to practice, and playing an advisory role to the Federal and Provincial governments regarding nursing education and nursing services. It also communicates policy decisions regarding nursing to other parties. Besides the PNC, there are no other associations or groups that deal with nursing.

Around 136 institutions are working in Pakistan, to offer degrees, diploma and certificate programmes of nursing. Unfortunately these colleges are not enough to produce the desired number of nurses. According to an estimate, there is approximately one nurse for 31,579 patients in Pakistan against World Health Organization’s recommendation of one nurse for 10 patients. The international standards of patient care require eight nurses for every single doctor but in Pakistan there is only one nurse available for three practicing doctors and in some areas this ratio is as low as 1:6. One wonders why with such a population explosion the shortage of nurses exists. The staffs of nursing colleges and senior practicing nurses blame the government for the malfeasance. They claim that the government doesn't hire enough nurses and also acts lazy in promoting them. There are still many vacancies for the Minimum Service Delivery Standards (MSDS), which call for having at least one nurse for eight patient beds, one charge nurse for two Intensive Care Unit beds and eight charge nurses for four Coronary Care Unit beds.

Nursing teaching and training institutions are not only providing un-reasonable leaning environment to the student nurses but they lack the facilities required to their students. Although nursing colleges are improving their facilities but they are far from standard satisfaction. Agha Khan University's School of Nursing set up in 1980s, has been the first in the country to impart Master's Degree in Nursing and has an active international collaboration. It is also involved in capacity training of nurses and research. There are a few other private colleges imparting nursing education and training but the bulk of the nursing population comes from public schools of nursing.

Patients complain that the nurses are often cranky and rude to them and don't give them the due attention that they need. Their shifts last from 12 to 24 hours and often they have to attend 30 patients at a time. The stories of hardships do not end here. Many a time, the students of nursing colleges are left unsupervised in the medical wards. And after all the hard work, all they make is Rs 10,000 to 20,000, depending on their designation. This severely affects their performance; therefore it is only natural for them to get in a bitter mood. The situation gets worse when emergency is declared anywhere in the city and the nurses have to put in extra hours to their shifts without any security. The Lady Reading Hospital (LRH) in Peshawar is one such hospital that frequently receives the wounded from terrorist activities taking place in the city. Terrorist activities throughout the country have been increasing day by day and so is the number of injured, who require medical assistance. This has increased the demand for nurses but the supply stays at a standstill creating many problems.