This article intends to improve the image of nurses. This will need commitment, cooperation, mutual trust, respect and persistent action on part of all stakeholders. These include policy makers, health system planners and the nursing profession, with input from beneficiaries of health care. Whether total necessity will prompt these needed interventions remains to be seen, but whatever happens, the role of nurses in the development of health care will continue to be pivotal. They are the wheel and hub of health service.

The role of the nurse has intensified and diversified with the widespread integration of communication technology and information science into health care agencies. The nurse's role in providing of patient care is intensified by redefinition, refinement and modification of the practice of nursing. Nurses are now expected to function well and are held responsible and accountable for the systematic planning of holistic and humanistic nursing care for clients and their families. Nurses as individuals are supposed to be people with inherent dignity and are worthy of respect and care. Nurses should have freedom of choice and are responsible for those choices. Nurses deserve reciprocal caring relationships, which foster health, growth, enabling environment and self-actualisation. Nursing has developed an extensive body of knowledge and associated skills that require intensive study to master. There are a number of educational paths to becoming a professional nurse but all involve intensive study of nursing theory and practice and training in clinical skills.

Healthcare industry
The healthcare industry is one of the world's largest and fastest growing industries. Consuming over 10% of gross domestic product of most developed nations, health care forms an enormous part of a country's economy. In 2004, health care costs paid to hospitals, doctors, nursing homes, diagnostic laboratories, pharmacies, medical device manufacturers and other components of health care system, consumed 15.3% of the GDP of the United States. Nurses acknowledge that the nursing profession is an essential part of the society from which it has grown. The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability.

Safe staffing saves lives
The concept of safe staffing emerged as a result of changes in the healthcare system worldwide. Safe staffing means that an appropriate number of staff, with a suitable mix of skill levels, is available at all times to ensure that patient care needs are met and that hazard free working conditions are maintained.

A significant relationship between nurse staffing and overall patient care exists in hospital care setting. Nursing care is considered essential for providing healthcare in a variety of settings. Hospitals with an adequate number of skilled nurses and physicians are using the size of their staff to increase their competitive edge over other hospitals. Safe staffing has been shown to contribute to better patient outcomes which ultimately result in reduced health cost for individuals, families and communities and increased tax revenues as patients return to active workforce.

Safe and cost-effective staffing also requires an understanding of the differences in skill level, experience and education of various types of licensed and unlicensed personnel and a recognition that inadequate or marginal staffing levels can lead to higher mortality rates, greater morbidity, increased risk of injury to both patient and staff, and increased utilisation of both inpatient and outpatient facilities.

The factors to be considered in determining safe staffing include the IQ level of patients, the need for nurses to have adequate opportunity and time to exercise professional judgment with respect to patient care, and acknowledgement that patient needs can change from moment to moment. This will encompass physiological, economic, chemical, psychosocial, educational and spiritual requirements in addition to safety. Staffing practices are also causing the exodus of nurses and health professionals from hospitals and other facilities and leading to critical shortages in almost all health professions.

In the past few years, staffing practices have increased the probability that patients will not receive an adequate level of care. Late or missed doses of medication, delayed meals, responses to medication or vital signs monitored in a rushed fashion, hurried lab tests, too few staff to properly clean rooms have been reported by healthcare workers. Poor staffing levels do not only lead to worse patient care, direct-care workers such as registered nurses, interns, x-ray technicians and transport staff suffer from occupational injuries such as back problems, needle sticks and joint problems when staffing levels are too low. Healthcare workers also experience high levels of work-related stress, low morale and family problems.

Health professionals experience the staffing crisis directly and personally. Every day it reduces the quality of their work lives and reduces their ability to deliver quality healthcare. Yet given these results, it is clearly not a problem limited to certain facilities, professions or regions. There is a shortage of qualified professionals in all of these fields, and those working in the field clearly recognize it.

Current situation in Bangladesh
Nursing faces a divergence between supply and demand. This is evident in insufficient nurse staffing with significant implications for patient safety. In Bangladesh, many believe this shortage of nurses is entrenched in the long standing problems related to the value and image of nursing and the limited role nursing has had in identifying priorities within healthcare delivery systems.

Healthcare sector in Bangladesh, in recent times, has become a rewarding field for private investors. The private sector development mainly comes in the form of hospitals, clinics and diagnostic centers. The growth however has largely been chaotic, with little attention given to quality control, efficiency and competitiveness.

Although healthcare personnel, especially nurses, have an unquestionably vital role to play in the successful delivery of healthcare services, there is a scarcity of skilled nurses in Bangladesh. Inadequate training and insufficient skills result in poor service delivery. This definitely has an impact on the level of customer satisfaction.

Conclusion
Nursing as a culture began to experience a major paradigm shift and is still struggling to consistently demonstrate this shift. To become accepted as true professionals, nurses began to exhibit their ability to be active and powerful in their roles as client advocate, health promoter and teacher. And yet, nursing still struggles to shed the image of dependency on the medical profession.

Nursing is a rewarding profession that offers diverse career paths for men and women. Experienced nurses are in demand for a wide range of job opportunities and enjoy both national and international job mobility. Nursing is a humanistic, caring and altruistic profession. Nurses help individuals, families, groups and communities to achieve and maintain an optimal level of health consistent with their abilities and desires.

Dulce Corazon Z. Lamagna is an MBA student, American International University, Bangladesh