Doctors working in both government and private hospitals said diploma nurses are not efficient enough. The hospitals need skilled nurses having BSc degree. They said the shortage is so acute that many private hospitals have now resorted to recruiting nurses from abroad.

Social taboos and misconceptions, good students' lackadaisical attitude towards nursing profession and the current nursing education system are the major reasons for shortage of skilled nurses.

Dr Abu Sayeed MM Rahman, consultant, surgery, United Hospital, said that it needs a lot of time to solve the problem of shortage of skilled nurses.

"The shortage of skilled nurses is a deep-rooted problem. Nurses come from families facing some kind of financial hardship. In our society there is a taboo on nursing profession and girls from respectable families are discouraged to come to this profession," said Dr Sayeed.

"No one writes in school essays that she wants to be a nurse. In other countries nursing is a noble profession. But we are yet to understand that. I think a campaign on the significance of nursing profession will improve the situation and the media can play a good role in this," he added.

He also said good students want to become doctors, not a nurse. Nursing course is taken up by the girls who are not good students. "This is a big reason for the slide in the quality of their work and lack of skilled nurses."

Dr Sayeed said: "If the nurses can do the graduation in nursing or BSc course [direct BSc] after passing HSC, in that case we could get good students. But most of them are diploma nurses. After recruiting them we have to give them a basic training on spoken and written English language and make them computer literate due to their poor quality,"

"We also train them for building up caring attitude and self-respect. Usually they come from the lower level of the society and it is our job to make them realise that their profession is noble," said the doctor.

"The situation has forced many private hospitals to recruit nurses from abroad. This cannot be a long-term solution. We have a few nurses from Malaysia to train them up. I think we should work to develop our own skilled manpower and send them abroad. Training the nurses is one kind of investment. If they are trained well they will get jobs abroad," he said.

According to Bangladesh Nursing Council every year on average 700 to 800 nurses pass diploma course. Till now there are 20,120 registered diploma nurses in the country and among them 19,489 are female nurses, according to Directorate General of Health Services (DGHS).

In 2006 the number of registered posts of nurses in the government hospitals is 15,154.

With the rapid growth of the sector demand for qualified nurses is rising rapidly.

There are 38 government nursing institutes (NIs) in the country with 1,135 seats which offer diploma courses. There are eight institutes in the private sector with around 163 seats.

Country's only nursing college is in city's Mohakhali that provides BSc course. Open University and some private universities have recently introduced BSc course in nursing but those courses are yet to be finished. Till now all the BSc nurses we have are from the Nursing College.

Affiliated with Dhaka University, the college has two courses -- BSc Nursing and BSc Public Health Nursing (PNS). It has one principal, 10 regular teachers and seven deputed teachers. BSc students are deputed here to do the course after doing diploma and three years in service.

In the last 28 years, the total number of nurses passed from this college is 1,176; among them 639 obtained BSc Nursing and 537 in BSc PNS course. Both are two-year course but normally students take five years to complete the course because of lack in coping capability.

For the dearth of good students sometimes the authority has to take students with lower marks. There is also a shortage of teaching staff. The college has the capacity to take up 125 students each year but this capacity is not properly utilised for the lack of quality admission seekers.

When the production capacity of this institute is 125 per year, only 28 students passed in the last batch passed from this college. Among them, 15 obtained BSc Nursing and 13 BSc PNS degree.

Therefore, this college remains grossly underutilised.

Azizun Nahar, principal, Nursing College, put emphasis on 'Direct BSc' course, where students will be admitted after doing HSC. At present, diploma nurses with lower marks in SSC are getting admitted and this system contributes to the slide in skill of nurses.

"Our main problem is the diploma nurses we take here cannot cope with the course, which is very standard and the medium is English. One effective step to solve this problem is introducing 'Direct BSc'. Under the present system, those who are doing better in SSC exam are not coming for a diploma course in nursing. So when we take diploma nurses we find most of them incapable to cope with their job. We need students with GPA 4 or 5 in SSC but we get those even with GPA 2.5," said the principal with regret.

"We cannot fill up all 125 seats because we do not get students who can meet our criteria [diploma plus three years in service]. On average we take 60 to 80 students. But still we do not want to compromise with quality students," she said.

"There is a good chance of BSc nurses getting jobs in big private hospitals with a salary range of Tk 30,000 to 40,000. But there is a misconception in our society about nursing profession, which should be eradicated through awareness building. Only then we can expect good students," she said.