The situation in Bangladesh
Why is this project involved in Bangladesh?
Bangladesh is a priority country for the Canadian International Development Agency, with a per capita income roughly 5% of Canada’s average, and with poorly developed public services in critical areas, such as health and education.
Nursing leaders, physicians and outsiders have informed us that nursing education in Bangladesh suffers from several problems:
– Nurse educators may be remote from practice and not current with their clinical skills. In addition, although there has been international support for curriculum development, the teachers may simply continue delivering out-dated lectures.
– Education focuses on memorization and learning by rote. Self-directed learning, critical thinking and problem-solving are not emphasized.
– Modern teaching resources are available only in English, yet many nurse educators are not fluent English speakers.
What is the situation like in public hospitals?
Imagine going to the hospital in your community to visit a sick relative. The crowding is so bad that there are two people in many beds; some patients lie on foam mattresses on the floor. You help your relative into the washroom: not only is it dirty but you can find neither hand soap nor towels. The doctor has prescribed medicine but you learn that the nurse refused to give that medicine unless she first received a small tip. Most of the time the nurses stay in the nursing station, rarely touching or assessing any patient. Patients needing a bath are washed by an assistant with no nursing training. Sterile supplies are in short supply and even the limited range of medicines may be unavailable.
What is happening with nursing in Bangladesh?
For women in particular, nursing is not a preferred career. Nurses have low social status because of the hands-on aspect of their caring role. Nursing pay is poor, starting at about $C200 per month plus room and board – less than the earnings of a rickshaw puller. This is compounded by shift-work and a top-down organizational structure with no opportunity for professional development. Physicians are authoritarian, yet complain that they cannot rely on nurses for accurate assessment, treatment or communication. Nurses in turn are often uncaring towards patients, scolding or ignoring them, and leaving actual patient care to untrained assistants.
What is the scope of practice and skill level for Registered Nurses in Bangladesh?
We are not in a position to answer this very good question. IUBAT faculty have visited many public and private hospitals as we check out clinical practice sites for students. Practice varies across these sites depending on availability of resident physicians, organizational culture and nurse leadership in the agency. In most hospitals, RNs seem to work more like the Licensed Practical Nurses in the Canadian system. However, in some places, especially community settings, they take on more responsibility than in Canada.