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The Heart of Healthcare Systems

Every one of us has to see a doctor many a time in our life. However, when this needs become acute, we need another person besides a good doctor and that is a nurse, also called sister or staff. They are the main pillar of the whole edifice of healthcare in a society. And, to pay gratitude and show our reverence to nurses, International Nurses Day is celebrated around the world every year on May 12, the anniversary of Florence Nightingale’s birth. This observation calls our attention to the fact that encouraging and supporting nurses is indispensable to making an optimal use of education, training and skills the nurses are imparted. And, this encouragement and support can be given to them only by solving the problems they are mired in. These include excessive workload, violence at workplace, low wages, long working hours and other workplace risks. Owing to all these problems, the paucity of nursing staff is the most daunting problem today’s world is faced with. In 2013, the International Council of Nurses Workforce Forum found that most industrialized countries are, or will be imminently, facing a shortage of nurses due to the increased demand for healthcare. In addition, a survey performed by the World Health Organization (WHO) found that 77 percent of developed countries are facing a nursing staff shortage. This universal shortage adversely impacts not only the healthcare systems and the patients, but also the nurses themselves; with an increase in the number of patients they have to attend, workload increases manifold and to cope with this situation, they are made to work for late hours which creates in them depression and dissatisfaction with their work.

Studies suggest that long working hours lead to personal conflicts among nurses, perpetuation of agony for patients, clashes, dissatisfaction with the work and lethargy. A recent study conducted in the United States, Canada, Great Britain, Scotland and Germany has revealed that as many as 44 percent nurse have no job satisfaction while 22 percent are willing to leave the profession. The results further show that workplace pressure undermines nurses’ morale, causes job dissatisfaction in them and saps their resolve to work with their organization which often leads them to leaving the job. Moreover, when they are made to attend more patients, their responsiveness decreases, their diligence to improve a patient’s condition by according due care to him declines due to which they, knowingly or unknowingly, administer wrong medicine which can prove fatal to patients under their care. So, it is indispensable that the paucity of nurses be made up for. But, here arises a question: what number of nurses is sufficient to fill this gap?

In this regard, the WHO has set two standards. According to one standard, there should be at least 50 nurses for a 10,000 population whereas the second sets this number to 4 nurses with one doctor. When we see, keeping in view these standards, the number of nurses in Pakistan, a crisis situation comes before us. A brief analysis of the figures reported in the Population and Housing Census of Pakistan 2017, Economic Survey of Pakistan 2016-17, Punjab Development Statistics 2016, Development Statistics of Sindh 2016, Development Statistics of Khyber Pakhtunkhwa 2016 and Development Statistics of Balochistan 2016, as well as of the figures reported by Pakistan Medical and Dental Council reveals that, at present, the number of nurses in Pakistan should be 10,38,873, but we have only 99,208 of them which means we are facing a shortage of 9,39,645 nurses. And if we see the situation in terms of percentage, the paucity comes out to be 90.4 percent.

And, on the second standard, the number of MBBS doctors, specialists and foreign-qualified doctors, as on 28 February 2018, was 4,23,160 and the number of nurses needed to assist them was 16,92,640. Hence, on this standard, we are still in want of 15,93,412 nurses – 94.1 percent in terms of percentage points. Furthermore, if we analyze the situation regarding the availability of nurses in terms of population, there were, on average, only 5 nurses available for 10,000 population, in 2016 whereas that availability in terms of providing assistance to the doctors was only 0.51 per doctor. On the standards of WHO, Sindh comes out to be the province having the acutest shortage of them as it has 99.3 percent fewer nurses and 99.7 percent fewer doctors. Moreover, Sindh, again, is the worst province in terms of availability of nurses as the ratio of their availability till 2015 was only 0.20 per doctor and 0.35 per 10,000 population.

The first among the foremost reasons for this state of affairs in Pakistan is the limited number of nursing institutions. At present, there are only 128 nursing institutions, with a capacity of 9,468 students, which are offering general nursing diplomas accredited by Pakistan Nursing Council (PNC). Likewise, the number of those offering one-year post-basic specialist diploma is only 39 whereas degree-awarding institutions are 62 having a capacity of 3333 students. In addition, the number of institution offering licensed practical nurse course is only 18 and they can provide training only to 505 people. Hence, the total number of PNC-accredited nursing education institutions is 247 having a capacity to train 13,306 students. And, in a country where population grew, on average, by 39,60,000 people every year between 1998 and 2017, and where only 9,468 male and female students enrol themselves for nursing education, and that too of a diploma level, every year what could be the possible ways to make up for the chronically-acute deficiency of nurses?

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