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Sub: In depth Country Assessment on Nursing & Midwifery in Bangladesh

10. How is the financial support to nursing & midwifery service?

For Service Govt

For Education

Commentary:
Financial support from the Directorate of the Nursing Services is not sufficient Inadequate govt support for nurse-midwives higher education in the country

11. What is the situation of turnover of nurses midwives in the health care facilities? Any information on the reasons of resignation? How many percents a year? In private sector rapid turnover due to: 1. Salary differences 2. Workload 3. Other related opportunities (govt posting, job offers abroad) 4. Personal reasons 5. Psychological Preparedness 6. Picture is similar but turnover is less than private

BD: 12. What is the working lifespan of nurses & midwives


Age limit for applying job is 18- 30 years and working lifespan is up to 57 years for non govt jobs usually there is no binding for age limitations as well as for working life span Equally applicable for all professions

12. What is the working lifespan of nurses & midwives


In the Philippine setting nursing is a 4 year course Midwifery is a 3 year course Needs licensure for both courses From 20 years of age to 65 years (retirement period)

BD: 13. How is the orientation programme, monitoring system & coaching system for new nurses & midwives?
There is no regular programme or probation for orientation & mentorship programme for newly employed nurses & midwives.

13. How is the orientation programme, monitoring system & coaching system for new nurses & midwives?
Apollo services system: (newly joined nurses for orientation purposes) 1. One week induction period 2. 3 weeks orientation in the floor 3. 1 month orientation program *we have in house clinical nurse trainers*

14. How is the effectiveness of the supervision system in clinical settings?


In BD setting: Depends on the quality of supervisors ratio of nurse Out of 911 post for nursing supervisors all over the country only 561 are posted Promotion system delayed Salary low training less Educational Qualification

14. How is the effectiveness of the supervision system in clinical settings?


*As a result, their qualities are not up to the expected level *

14. How is the effectiveness of the supervision system in clinical settings?


In Philippine setting: Very effective, as it requires close monitoring of the total delivery of care for more evaluation & analysis. It also addresses the gap in the clinical practice Supervisors qualification / 4 years degree, masters degree/leadership & management course/doctorate degree/scholarship funds

14. How is the effectiveness of the supervision system in clinical settings?


In Philippine setting:

Post Graduate Nursing Degrees: Masters Degree: MAN, MSN prepares nurses for more independent role such as Independent Nurse Practitioner, Nursing instructor and Nursing Supervisor

15. What is the working relationship of the members in the health care team? Are nurse & midwives recognized as equal partners? In Bangladesh, overall relationship between the nurses & medical practitioner/physician is not well recognized

15. What is the working relationship of the members in the health care team? Are nurse & midwives recognized as equal partners? In the Philippines, both should be a partner in the delivery of care but in most instances nurses are more advance in clinical practices which shows increase responsibilities in the area. Doctors & nurses are equal partners.

16. What is the relationship between nursing & midwifery education & service? In Bangladesh , as there is gap in nursing education & service in the country in terms of scope of practices, resource availability, lack of proper supervision & feedback, improper utilization of nurse-midwives placement, high workload include lack of proper monitoring & accountability.

16. What is the relationship between nursing & midwifery education & service? In the Philippines educational system , midwifery is incorporated in the 2nd year of their nursing curriculum. Nursing course is more advance & requires specific subjects areas which are clinically based.

17. What are issues, challenges, & gaps in relation to service?


Inadequate functional authority of the DNS Insufficient nursing manpower in the DNS office Absence of positions for nurses & midwives at national levels Huge vacancies against existing allocated posts for higher position of nurse-midwives (post are filled by either deputation or current charge)

17. What are issues, challenges, & gaps in relation to service?


Since the persons position as deputation or acting , they are reluctant to create change or take any sweeping decisions Promotions in nursing are not timely & deserve that resulted poor nursing leadership & strategic management. Create a regulatory board, enhancing tenureship.

17. What are issues, challenges, & gaps in relation to service?


Inappropriate nurse-midwives to population/patient ratio in all levels Inadequate recognition of the nurses status in the health care system

17. What are issues, challenges, & gaps in relation to service?


2. Poor quality of nursing & midwifery care in health care setting Shortage of nurses and midwives as per recommended staffing norms Improper placement of nursing personnel Inadequate number of Bachelors (minimum) and masters (mostly absent) nurses in the clinical settings

17. What are issues, challenges, & gaps in relation to service?


Absent of specialized nursing discipline. Absence of research utilization or evidence based nursing. Role ambiguity or role conflict of nurse midwives in performing the responsibilities in clinical setting Inadequate facilities and unavailability of patients care supporting resources including medications, linens, equipments etc.

17. What are issues, challenges, & gaps in relation to service?


Absent of quality assurances mechanisms in the hospitals setting Gap between the theory-practice due to the shortage of qualified nurse educators, absent of clinical nurse teacher and lack of coordination between education and services. Poor supervision and management in nursing due to :

17. What are issues, challenges, & gaps in relation to service?


= shortage of supervisors = Promotion based on service experience , not the education = Inadequate preparation of nurse managers = Lack of in-service education and administrative training for nurse supervisors and superintendent as well I

17. What are issues, challenges, & gaps in relation to service?


Lack of accountability for assigning responsibilities. 3. Lack of Job satisfaction of nurse-midwives due to: Low salary structure Involvement of nurse-midwives with non-nursing tasks.

17. What are issues, challenges, & gaps in relation to service?


Unfavourable working environment and lack of job security Poor organizational climate Delayed promotion and lack of career mobility Lack of welfare plan for nurses and absence of incentives for overworks Inadequate accommodation or vehicle facilities.

17. What are issues, challenges, & gaps in relation to service?


4. Issues related to higher education of nurse-midwives due to No opportunity for MSc. & PhD. In nursing in the country Limited scope for direct and post basic bachelor education for nursing No posting or promotion for higher educated nurses that resulted lack of interest for self development as well as professional development.

17. What are issues, challenges, & gaps in relation to service?


In adequate support for higher education in nursing.

BD: 17. What are issues, challenges, & gaps in relation to service?
Knowledge, skills, & attitude Dedication & commitment Technical knowledge on upgraded medical facilities Poor acceptance of the community towards the nursing course (cultural acceptance)

BD: 18. Any measures that are being implemented to improve the situation or what else should be done?

A. The measures that are being implemented to improve the situations: Revised and updated diploma & BSc. Nursing curriculum

BD: 18. Any measures that are being implemented to improve the situation or what else should be done? Increases the number of nursing institutes, basic & post basic nursing colleges and increases the number of student admission (nearly doubled) Specialized courses for various discipline in nursing (critical care, oncology nursing, emergency & trauma nursing, geriatric nursing etc) Create additional post like quality nurse manager, infection control , ratio 1 nurse to 100 patients, nurse clinician, nurse anaesthetist, IV therapist nurse, rehabilitation nurse, nurse educator

BD: 18. Any measures that are being implemented to improve the situation or what else should be done? To respond the MDGs 4 & 5 , 6 month midwifery course has been started & 3 years midwifery curriculum approved (not started yet)

BD: 18. Any measures that are being implemented to improve the situation or what else should be done?

3000 post has created for midwife to place them at community hospitals level. Approximately employed of 1747 new nurses in different hospitals 26 nurses sent for Masters in Nursing from Thailand and one for PhD in 2008 and 10 nurses for Masters in 2011.

BD: 18. Any measures that are being implemented to improve the situation or what else should be done?

Capacity building training for nursing research & evidence based nursing by the support of WHO Upgraded all diploma nurses from grade from 8th to 10th (Third class to 2nd class) Teachers development training occassionally supported by WHO

18. Any measures that are being implemented to improve the situation or what else should be done?

B. The additional activities or initiatives to address the existing situation in order to improve the following measures should be done: Change the current recruitment policy-the policy for higher position should be based on education and expertise. Creation for new post in all sectors of nursing services including administration , education and services

18. Any measures that are being implemented to improve the situation or what else should be done?

Create facility for higher education in nursing within the country (Masters in nursing & PhD in nursing gradually) Expand the scope for specialized nursing education Strengthening the nursing research & evidence based nursing

18. Any measures that are being implemented to improve the situation or what else should be done?

Provide accommodation facilities for nurses in all levels and develop Day Care Centre for nurses children. Since, 90% nurses are female. Build up quality development policy & the mechanism for continuous quality improvement (CQI) Develop strategic plan for improvement in all nursing fields.

18. Any measures that are being implemented to improve the situation or what else should be done?

Provide ethical training for nurses focusing on behaviour change Create the post for head nurse/ charge nurse and promote as qualification in education and expertise.

18. Any measures that are being implemented to improve the situation or what else should be done? Modify & enhance the nursing curriculum Some modifications in the content to the curriculum in relation to behavioural science and communications need to be incorporated In order to meet international standards in teaching and professional skills, some of the most important behavioural skills would include:

In the Philippine setting:


Bangladesh could follow the model of some of the nurse exporting countries like the Philippines where nursing schools have teamed up with northern partners to create, develop, promote and seek US based hospital and nursing home partners who wish to alleviate their nursing shortages.

In the Philippine setting:


The partnerships have created strategic alliances with the nursing schools and hospital system and other health care providers.

Suggestions/Measures:
Government of Bangladesh could come up with a special project to establish at least one international standard nursing college with technical assistance from development partners, with the standard of intake at par with western nursing institutes. *DG nursing & midwifery *independent university of nursing & faculty

Suggestions/Measures:
Furthermore private universities should be encouraged to set up international standard nursing institutes to primarily target the international labour market -should focus more on the skills development

Suggestions/Measures:
Laboratory equipment (skills laboratory) should be designed to international standards eg: dummies (resusci ann, Mrs. Chase,resus for adult & pedia), crash cart, OT surgical instruments

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