KARACHI: Pakistan is one of the five countries facing the largest deficit of nurses with the World Health Organisation also calling on the country to take steps to double its nursing workforce. This target could be achieved by giving a dignified status to the profession in society, making it safe, diversified and financially sound that could attract women to it in large numbers.

These points were raised by speakers at a seminar organised on Tuesday at the Aga Khan University in connection with International Day of Nurses and Midwives.

They also emphasised that nurses and midwives needed to be empowered in patient care that would help expand the availability of affordable care.

Speaking as the chief guest at the event, Sindh Chief Minister Murad Ali Shah acknowledged the front-line role nurses and midwives were playing during the ongoing pandemic despite a shortage of healthcare professionals in the country.

‘Pakistan needed 1.3m nurses even before the Covid-19 pandemic’

He said: “We are mindful of the fact that due to the global shortage of nurses, the demand worldwide has increased which is giving our nurses an opportunity to migrate to high-income countries to improve their quality of life. This is definitely something we don’t want to happen as in Pakistan there was already a shortage of 1.3 million nurses before the pandemic.”

Dr Faisal Sultan, special assistant to the prime minister on health, also highlighted the gravity of the problem and said Pakistan had one of the greatest shortages of trained high-quality nurses and that no healthcare system could deliver quality care without the input of trained and committed professionals in the nursing field.

“The government’s national health task force is working to expand the education and training of nurses to ensure that the country’s nursing workforce continues to grow,” he said.

In a recorded message, Sindh Health Minister Dr Azra Pechuho said that one of the reasons behind Pakistan’s shortage of nurses was that too few women were seeking admission to the profession.

Speakers at the event also noted that limited career pathways for nurses, inadequate compensation and respect, and unsafe work environments were some of the factors behind people leaving the profession or choosing to practise abroad. They added that Pakistan was one of the five countries facing the largest deficit of nurses with the WHO also calling on the country to take steps to double its nursing workforce.

“Nurses have grown used to double shifts, no days off and living at hospitals during the pandemic to keep the public safe,” said AKU’s School of Nursing and Midwifery dean Prof Rozina Karmaliani. “They are also working at vaccination centres, hosting capacity building drives for their colleagues, volunteering at field isolation centres, as well as managing tele-clinics, hotlines and home-health initiatives. Despite being stretched, they are striving to do their best.”

Higher education and empowerment

Commenting on the steps needed to retain and encourage nurses to stay in the workforce, experts highlighted the need to promote Advanced Practice Nursing (APN) qualifications that enhance the skills of nurses and enable them to widen their scope of practice. This would involve the granting of licences to nurses and midwives with specialist qualifications enabling them to run their own clinics.

For example, an advanced practice registered nurse, who has specialised in non-communicable diseases, would be able to run his/her own tele-clinic or community clinic to care for patients with high blood pressure. Holding a licence would enable them to provide a higher level of care by permitting them to diagnose and treat patients as well as prescribe drugs.

However, APN practitioners would continue to refer complications to specialists. Granting regulatory approval for APN would enable nurses and midwives to make a greater impact in fields such as maternal health, mental health, child care and non-communicable diseases, said speakers.

They added that if midwives could have run their own clinics during the pandemic, this would have eliminated the need for pregnant women to risk contracting Covid-19 by leaving their home to go to hospital. Similarly, APN practitioners could run tele-clinics for vulnerable populations such as the elderly, making it convenient for patients to access healthcare.

“Empowering nurses and midwives to take the lead in patient care would expand the availability of affordable care,” said Prof Rafat Jan, an associate dean at the AKU’s School of Nursing and Midwifery. “It would also boost timely access to treatment that would prevent the onset of complications which place a significant burden on tertiary care hospitals.”

While panellists at the seminar appreciated the federal government for setting up a task force on nursing, announcing measures to establish a new nursing university and to invest in expanding the nursing sector, they added that many other initiatives were needed to promote the education of nurses.

They highlighted the need to convert nursing schools into colleges and to encourage faculty development initiatives so that academic institutions would have enough teachers.

They also called on the government to invest in online learning to improve access to learning during the pandemic so that graduates could complete their education on time and join the workforce immediately.

In addition to online teaching and the use of digital platforms, introducing innovations in simulation can also help produce the best nursing graduates for the market, the speakers added.

“Nurses have left no stone unturned to support the healthcare system,” said Khairunisa Khan, deputy director of nursing in Sindh. “I salute their persistence, dedication and hard work which they have exhibited especially in the ongoing battle against Covid-19.”

Speakers at the event also recognised the achievement of milestones by their colleagues during the year such as Pakistan awarding its first nursing doctorate, and eight nurses from the country being named among the world’s 100 outstanding nurses.

Other speakers at the event included AKUH CEO Dr Shahid Shafi, AKUH chief nursing officer Salma Jaffer and AKU Medical College dean Dr Adil Haider.

Published in Dawn, May 12th, 2021