Historical Development of the Nursing Profession in Bangladesh – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Historical Development of the Nursing Profession in Bangladesh
Prior to the independence of India and Pakistan, nursing education was an on-the-job training in the hospital (Bhattaacharya, 1998). During this period, nurses were trained in three junior schools of nursing under the Bengal Nursing Council. After division in 1947, a shortage of nurses crisis resulted in the East Pakistan health sectors (Nahar, 2011), as only 50 nurses opted to come to East Pakistan from India.
The first professional senior nursing school was established in 1947 attached to Dhaka Medical College Hospital and included very few sister tutors from India. A British nurse at that time worked as Matron, served as Superintendent of Nursing Services (Head of the Nursing Section under Directorate of Health) and also acted as a Registrar of the Pakistan Nursing Council as well (Harun and Banu, 1991).
During this period, a very small number of female students were admitted to the nursing schools, as young Muslim girls were not allowed to leave their homes and enroll in nursing profession (Harun and Banu, 1991). In 1949, the Government of East Pakistan sent eight women to London for training on nursing. Most of these nurse later occupied nursing leadership positions in Bangladesh.
According to the Ex- Registrar, Ms. Shamsun Nahar, these nurses can be considered “as pioneers of the nursing profession in Bangladesh. These women are Ms. Rahima Khatun, the first DNS; Ms. Shahzadi Harun, Ex-DNS; Ms. Akhtar Banu, Ex-deputy DNS; and Ms. Zohra Khatun, the first Bangladeshi Principal of Dhaka NTC and first Registrar of BNC.
Prior, to come into nursing education, Rahima Khatun, and Shahzadi Harun (Ex-DNS) were the students of LMF course for Doctors at Mitford Medical School and Ms. Zohra Khatun was a school teacher (Nahar, 2011).
In 1950, the Government aging offered fellowships to nurses to study abroad and in 1954 the World Health Organization (WHO) provided further technical assistance in nursing to upgrade the nursing educational programmes. With the help of WHO in 1952, the then East Pakistan Nursing Council was fully constituted as a regulatory body for nursing education and practice. After liberation in 1971, the name of the East Pakistan Nursing Council was changed to the Bangladesh Nursing Council.
In 1960, junior nursing schools were abolished and two more Senior Nursing Schools were opened in 1963. Nurse-leaders tried to attract more young women into the nursing profession through “Nurse-Week” activities which included slides shows, pamphlets, and career talks at the schools. The Trained Nurses Association of Pakistan (TNAP) held a number of conferences and seminars during that period to help nurses for professional development and continuing education for nurses (Harun and Banu, 1991).
In. 1970, a land mark event for nursing occurred with the creation of the College of Nursing, Mohakhali, Dhaka and the offering of the Post Basic Diploma in Administration and Teaching. Gradually Senior Nursing Schools also commenced in the remaining five Medical College Hospitals and 10 Districts Hospitals. At the time of liberation in 1971 there were about 600 registered nurses in the East Pakistan, 350 of them were in Government services.
Following liberation, the Government took several steps to increase the number of nurses for health services. The number of student seats and nurses’ pay scale were also raised. The matron of the hospital and the principals of Schools of Nursing were given first class gazetted status. Until 1983, a total of 38 Government and 5 non-government schools were established which were attached to the different Districts and Sub-Division Hospitals (Harun and Banu, 1991).
In 16 May 1977, the Directorate of Nursing Services (DNS) was established as a separate Directorate under the Ministry of Health & Family Planning creating another landmark in the history of Nursing in Bangladesh.
In the same year the College of Nursing, Dhaka became affiliated with and recognized by the University of Dhaka as a constituent college. During the 1977-78 sessions, the college of nursing has administered Post-basic B. Sc. Degree in Nursing and B. Sc Degree in Public Health Nursing (Harun and Banu, 1991; NPA, 1994).
The Senior Schools of Nursing (Nursing Institutions) offered a 3 year Diploma in General Nursing for all nursing students with an additional one (1) year Diploma in Midwifery for female students and I year Diploma in Orthopedic Nursing for male students. This curriculum was revised in 1989 and implemented since 1990.
From 2004 to 2006, with technical support of the WHO country office in Bangladesh the Diploma curriculum has been revised and upgraded to international standard by the BNC with the expert help from Thailand. This revision has resulted in some fundamental changes. The entry requirement increased from Secondary School Certificate (10 class) to Higher Secondary Certificate (12 class). Therefore, the four years diploma education has been reduced to three years.
Some new subjects like computer training, fundamentals of nursing, health assessment, and pathophysiology, geriatric nursing, nursing inquiry, evidence-based nursing and research and biostatistics and nursing internship have been included. The pass mark has been increased from 50% to 60%. In addition, the academic system has been changed from a marking system to credit and grade system.
The semester system has been introduced replacing the year end system (BNC, 2006a; 2006b). According to BNC (201 le) since 2008, this Diploma in Nursing Science and Midwifery curriculum has been implemented into 43 Government and 31 Non-Government institutions (Annex-6).
Initially four nursing, institutes attached to Medical College Hospitals (Dhaka, Chittagong, Mymensingh and Rajshahi) were converted into Nursing Colleges for introducing four (4) year generic BSc in Nursing course. In 2011, three more nursing institutes were converted to Colleges. Eleven (11) private nursing colleges are also running this BSc in nursing course under different universities in the country (Annex-6).
In addition, two (2) more Post Basic Nursing Colleges have started for post-basic BNCe in 2011.
Under the Armed Forces Medical Services, one Nursing Institute was established in 1980s and one nursing college in 2009. Besides, in 2011 a Faculty of Nursing under the Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka was established to run the BSc in Nursing course (BNC, 2011; DNS, 2011).
Milestones of nursing and midwifery development up to today (year, key development, any relationship with country’s health system development, health needs, and education system).
Milestones of nursing and midwifery development in the country are given bellow (Harun and Banu, 1991; BNC, 2011; DNS, 2011; Nurses’ Convention, 2011; Akhtar, 2006 and personal communication):
From 1947-1949
➤ First Senior School of Nursing established at Dhaka Medical College Hospital (DMCH).
➤ Create the Post of Superintendent of Nursing Services under the Directorate of Health Services.
➤ Established Pakistan Nursing Council from Bengal Nursing Council.
➤ Superintendent of Nursing Services became an acting Registrar for East Pakistan Nursing Council.
➤ Government offered fellowship to study nursing abroad.
The purposes of such initiatives were related to:
➤ In 1947, due to separation of India and Pakistan, the demand of the professional workforce in health system was acute.
➤ Advanced education, training and fellowship in abroad encouraged and attracted the young women to come into the nursing profession as females were not allowed to work outside of home.
From 1960-1963
➤ Abolished Junior Schools of Nursing and opened another two Senior Schools of Nursing at Chittagong and Rajshahi. The gradual expansion of the hospitals requiring the increased in numbers of nurse-midwives for the health care services.
1971
➤ Established College of Nursing, Dhaka and offered one year Post-Basic Diploma in Administration and Teaching to meet the demand of administrator and teachers of East Pakistan Nursing. In the same year, 15 Senior Schools of Nursing established attached to 5 (five) Medical College Hospitals and 10 old district hospitals to increase the number of trained nurse-midwives..
From 1972-1974
➤ In 1972 the East Pakistan Nursing Council renamed as Bangladesh Nursing Council Iniru (BNC) as a regulatory body for nursing education & services in Bangladesh. In this year, the First Curriculum was developed for the Senior Registered Nursing Course.
➤In the same year, the pay scale for nurses raised and the Matron of Hospitals & Principals of the Schools of Nursing declared as 1st class gazetted position. Assistant Matron and Sister Tutor given 2nd Class gazetted status.
➤ As a professional body the Bangladesh Nurses Association (BNA) was established in this year.
➤ Besides some developmental activities, two more Senior Schools of Nursing established at the end of 1974.
From 1975-1976
➤ Started 3 years Diploma in Nursing for all and one year Diploma in Midwifery Nursing for female and Psychiatric Nursing for male instead of Senior Certificate in nursing course. In the same year, Schools of Nursing was renamed as Nursing Training Centre (NTC).
➤ College of Nursing, Dhaka began to train nurses to serve as trainers for family welfare visitors.
The key relationship were the
➤ Growing demand of Specialization of Nursing in health sectors, and
➤ Expand the role of Nurses in other disciplines
1977
➤ To recognize growing needs of professional enlargement, the Directorate of Nursing services (DNS) was established as separate directorate under the Ministry of Health and Family Planning.
➤ In the same year, the College of Nursing received approval of from the University of Dhaka to start Post-Basic education in BNSc in Nursing and in Public Health Nursing branch.
From 1980-1981
➤ To increase nurses’ involvements in primary health care (PHC) based on Alma-Ata declaration the international conference of PHC, one year diploma in Community Health Nursing programme begun in 1980.
➤ Additional 18 (eighteen) Schools of Nursing attached to hospitals established at different new districts which was previously known as Sub-divisions under a crash programme for rapid expansion of nurse-in midwives manpower.
➤ In-country higher education opportunity for nurses in Masters of Public Health Science (Health Education) started in 1981 at National Institute of Preventive and Social Medicine (NIPSOM), Dhaka
1983
➤ Formalized the Bangladesh Nursing Council (BNC) under Ordinance No. LXI by Chief Martial Law Administrator of People’s Republic of Bangladesh to regulate the standards of nursing education & services in Bangladesh.
From 1985-1990
➤ Nursing training centre convered to Nursing institutes to bring uniformity with the other education system in 1985.
➤In 1986, a Situation Analysis on nursing education and services was conducted in collaboration with WHO.
➤ To match with the changes of advanced science and socio-economy, the senior nursing Curriculum revised in 1989 and focused on community oriented nursing education.
➤ To develop subject based nurse educators and prepare nurses with advanced knowledge of international nursing, three (3) nurses were sent to India to study Masters in Adult nursing. Maternal and Child Health, and Psychiatric Nursing sponsored by WHO and four (4) nurses sent to UK in 1990 sponsored by Overseas Development Authority (ODA).
From 1991-1994
➤ A journal (JOCONB) published from the College of Nursing (CON) twice a year to provide encouragement to the nurses for the development of research and other scholarly work and published only in 1991 and 1992.
➤ In 1992, 28 nurses were sent to UK for higher education in nursing sponsored by ODA.
➤ In 1994, one year Orthopedic, Midwifery and Pediatric Nursing Curriculum was revised and developed with the assistant from ODA. A SNESP Newsletter was published & funded by DFID during the year 1993-1994.
From 1995-1999
➤ In 1995, an opportunity created for Bangladeshi nurses, to work as Local Nurse Consultant for the Strengthening of Nursing Education and Services Project (SNESP) under DFID, Bangladesh.
➤ A quarterly Nursing Newsletter was published & funded by DFID during 1996 to 2006.
➤ Four Divisional Continuing Nursing Education Centres (DCEC) and two Rural Teaching Centers established for in-service educatio…
➤ Post-basic B.Sc. in Nursing and B.Sc. in PHN curriculum has been revised in 1998 and implemented since 2000.
➤ A Research Cell was established in 1999 in the College of Nursing, Mohakhali, Dhaka with the assistance of WHO to develop the capacity of nurse-midwives in nursing research.
➤ Middle Management Course for nurses held in Chittagong divisional continuing education centre (DCEC) to strengthen the capacity of nurse-midwives at management level.
➤ Created an opportunity for Bangladeshi nurses to get appointment as National Nurse Consultant for WHO in 1998.
From 2000-2005
With the purpose of increasing the number of Master degree nurses and strengthening nursing leadership & management, several initiatives were taken by the government with the help of different donor agencies such as-
➤ In 2000 centralized admission system introduced for Diploma in Nursing and Midwifery/Orthopedic Nursing. ”
➤ Introduced 1 Phase Leadership for Change (LFC) programme by ICN in September 2000 with 44 senior & mid-level nurses and involved in team activities by developed different project at different hospitals.”
➤ In three batches Twenty seven Nurses achieved Master’s degree in Clinical Nursing awarded from Adelaide University, Australia as an offshore programme sponsored by WHO during 2001 to 2003.
➤ In 2002 Six text books and teachers’ guidelines and two nursing dictionaries in Bangla have been published.
➤ In 2003 B.Sc. in nursing program was commenced by Bangladesh Open University (BOU) in 13 different Nursing Institutions of the country.
➤ Introduced renewal of registration system for the registered nurses and in id wives.
➤ During 2001 to 2005, a set of manual in different special areas e.g., Infection Control, HIV/STD. Nursing Management and Supervision, Gender issue and Violence against Wofnen, Midwifery and Nursing Standard, BCC, English and Arabic Language were developed and in-service training for nurses was provided.
➤ In 2004 Senior Registered Nurse (SRN) Syllabus has been changed to four years Course Syllabus for SRN curriculum (revised SRN Curriculum-2004) and Graduated as Diploma in Nursing Science and Midwifery.
➤ During 2005 to 2007, training manual was developed on Intensive Care. Psychiatric and Mental Health Nursing, Traumatology and Oncology.
➤ In 2005 the construction of the Bogra Nursing College completed & other two colleges in Chittagong (Fouzderhat) and Khulna was being started to construct.
From 2006-2010
During these periods, to enhance the professional leadership in nursing and to meet the changing needs of health care system, large scales development initiatives were taken by the GOB in collaboration with ICN, WHO and other donor agencies.
➤ 4-year Diploma in Nursing Science and Midwifery curriculum has been changed into 3-year in 2006 (both for male and female student) and implemented since 2008.
➤ Entry level education has been upgraded from 10 class to 12 class for Diploma in Nursing Science and Midwifery curriculum.
➤ The Nursing Leadership & Management Development Programme (LFC) Phase – 4 was lunched in collaboration with DNS, WHO and ICN.
➤ Established Model Ward for providing quality care to the patients (DMCH, RMCH & MMCH) in 2006.
➤ Developed Basic B.Sc. Nursing Curriculum in 2006 and implemented since 2008.
➤ 4 (Four) Nursing Institutes attached to Medical College Hospitals converted to Nursing Colleges in 2008.
➤ Since 2008 Basic BSc in Nursing Programme has been started into 4 Nursing Colleges of Dhaka. Mymensingh, Chittagong and Rajshahi.
➤ Policy has been developed and approved by the BNC for accreditation of establishing new nursing institutes and colleges for private sectors.
➤ 26 nurses awarded M.Sc in nursing in 2010 and one is currently doing PhD from Thailand.
➤ Since 2010 6-month advanced Midwifery course has been started for the nurse-midwife to become Certified Midwife as part of producing 3000 midwives by 2015.
Since January 2011 to date
➤ Introduced web facilities in Bangladesh Nursing Council,
➤ In 2011 a Faculty of Nursing under BSMMU was established for BSc in nursing course.
➤ In January 2011, three more govt. Nursing Institutes converted to Nursing Colleges for 4- year B.Sc Nursing course.
➤ Established twelve (12) new NIs attached to 12 district hospitals and started the diploma courses since January 2011.
➤ In July 2011, two govt. Nursing colleges have started 2 years Post-basic BSc in Nursing & Public Health Nursing courses with seat capacity of 125 seats for each.
➤ In January 2011, first comprehensive licensing examination was conducted by BNC for the graduates of Diploma in Nursing Science & Midwifery course to get Licensure as Registered Nurse-midwives (3rd January’ 11).’
➤ In July 2011, first comprehensive licensing examination was conducted by BNC for the graduates of B.Sc. in Nursing course from private sector to get Licensure as Registered Nurse-midwives (30th July’ 11).
➤ 10 (Ten) Nurses were sent for Masters in Nursing Science degree from Thailand.
➤ Declaration of Second Class position for all Diploma Nurses by the Prime Minister of Bangladesh.
Besides the above progress in nursing, four (4) private universities have started Masters in Public Health degree for health professionals including nurses and two private universities provides opportunity for nurses to study PhD.
One public University (Rajshahi University) offered M. Phil degree under the institute of Biological Sciences for the nurses with others. There is an opportunity that this M. Phil course leads to PhD.
Recently a 3 years Diploma in Midwifery curriculum is under process of development for producing a separate midwifery cadre with the technical assistance from WHO.
Government Policy on nursing and midwifery and the support in the last 5 years:
The Nursing profession is recognized as a vital component of the national health sector and is gradually being improved. During the last 5 years, several developments have taken place regarding nursing & midwifery education & services with the help of various donor agencies (WHO, DFID, UNDP, UNFPA. etc). Some of the key areas are highlighted below (BNC, 2011, DNS, 2011; Nurses Convention, 2011):
➤ Developed basic B.Sc in Nursing curriculum and revised diploma curriculum including upgraded entry requirements.
➤ Developed strategic directions for providing midwifery services for the nurse- midwives,
➤ Started 6 months advanced Midwifery course.
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