Despite certain improvements over the past decades, Bangladesh's nursing sector is plagued with various issues.

In a bid to ensure accessible and equitable healthcare for the country's people, the current state of the nursing industry must be brought to light.

Nurses, often referred to as the backbone of healthcare, continue to struggle with outdated training, low compensation, gender bias, and burnout, among other issues.

IMBALANCE IN WORKFORCE

As of 2023, Bangladesh had only 85,000 nurses, whereas the number of doctors is way more than that of the nurses.

The imbalance points to a fundamental flaw in the healthcare system -- a skewed workforce with a disproportionate ratio of doctors and nurses.

Global healthcare standards recommend a doctor-to-nurse ratio of 1:3. In contrast, the ratio is 1:0.75 in Bangladesh.

There is also a shortage of skills in this sector.

Due to a lack of specialised nurses, critical areas like cardiology, oncology, and rehabilitation remain underserved.

This gap becomes even more concerning as Bangladesh's population ages and non-communicable diseases such as diabetes and heart disease develop severely.

INADEQUATE TRAINING AND EDUCATION

A major reason for this shortage is the lack of adequate training infrastructure.

Rural areas are especially disadvantaged, with most nursing institutions clustered in metropolitan areas.

Even in cities, the shortage of qualified instructors is a significant issue.

Without well-trained educators, nursing students fail to receive the necessary skills to perform their jobs effectively.

This issue is further exacerbated by outdated curricula that do not align with modern healthcare needs.

Nursing students receive minimal hands-on clinical training, particularly in private institutions where facilities are often inadequate.

The limited exposure to practical work leaves graduates ill-prepared to handle the complexities of patient care in specialised fields.

CULTURAL AND GENDER BIASES

Nursing has long been stigmatised as a low-status career in Bangladesh and it has typically been associated with women from underprivileged backgrounds.

This societal view not only discourages young people, particularly men, from joining the profession but also perpetuates a gender imbalance.

The participation of male nurses remains minimal, which limits diversity and representation in a profession that requires both genders to meet patient needs.

Cultural biases make it difficult for male nurses to enter the workforce, and female nurses often face challenges in situations where a male nurse would be preferred.

BURNOUT, LACK OF RECOGNITION

Nurses often undertake huge workloads, especially given the nurse shortage in public and private hospitals.

Private-sector nurses are particularly vulnerable, as they are paid significantly less than their public-sector counterparts.

This lack of compensation, alongside limited opportunities for career progression, leads to high levels of burnout and job dissatisfaction.

Despite being on the frontlines of healthcare, nurses rarely receive the recognition or financial incentives necessary to sustain their morale.

The burnout problem is furthered by the lack of specialisation opportunities in Bangladesh.

Most nurses are generalists, and they have limited access to programmes that would allow them to specialise in different areas.

EMPLOYING UNQUALIFIED PERSONNEL

Many hospitals, especially in rural areas, employ ward boys or "critical care associates" to undertake nursing duties.

These individuals lack the formal training necessary to provide proper patient care, which often leads to compromised health outcomes.

The use of unlicensed staff not only undercuts the role of trained nurses but also places patients at risk.

Moreover, corruption is rampant in public hospitals.

According to a 2021 survey by Transparency International Bangladesh (TIB), nearly half of the households that received health services reported being victims of corruption.

Bribery, lack of hygiene, and misinformation about COVID-19 vaccines were some of the common complaints.

GENDER-BASED VIOLENCE AND HARASSMENT

A survey conducted among 1,264 nurses found that 70 percent had experienced workplace violence.

There were incidents ranging from gender-based harassment to bullying.

Such a hostile environment only worsens the already stressful job, pushing more nurses toward burnout and early retirement.

GOVERNMENT ACTIONS SO FAR

In 1977, the Directorate of Nursing Services was established to manage public-sector nursing education and services.

Over time, key developments have included the reintroduction of the B.Sc. nursing course in both the private and public sectors and the elevation of nurses to second-class government employees in 2011.

However, these improvements have not been enough.

Calls are growing for better governance of the nursing sector, including removing non-nursing professionals from key administrative roles within the Directorate General of Nursing and Midwifery (DGNM).

Nurses argue that only experienced individuals who understand the ins and outs of the profession should hold such positions.

SHORT AND LONG-TERM SOLUTIONS

In the short term (1–3 years), the government must focus on optimising the existing infrastructure.

A full audit of nursing institutions should be conducted to identify unused capacity, and efforts must be made to modernise curricula and improve faculty training.

Also, private and public sectors should work together to enhance clinical training opportunities, especially in rural areas.

Over the long term (3–10 years), the government should prioritise expanding specialised nursing programmes.

By increasing compensation and creating career pathways for nurses, the sector can retain talent and reduce the current high turnover rates.

Also, the state must align its nursing education standards with international requirements and allow nurses to compete in the global healthcare market.

Addressing the challenges affecting the nursing sector, such as an undertrained workforce, cultural biases, and corruption, is crucial for meeting the country's healthcare needs.

In order to make the country's healthcare system thrive, there is no alternative to uplifting the nursing profession by investing in their education, improving working conditions, and offering the deserved recognition.

(The writers are MSS students in Economics at East West University.)