Urgent reforms needed in nursing education and practice in Bangladesh

Dear Editor, Since gaining independence in 1971, Bangladesh has achieved significant developmental goals, such as achieving many of its Millennium Development Goals (Roy & Datta, 2021). Nurses are the key to the healthcare system, but nurses in Bangladesh still grapple with considerable challenges due to outdated educational practices and inadequate attention to nursing education and the profession (Lee et al., 2016). Nurses perform a crucial role in healthcare, but the academic infrastructure that supports them is often inadequate, affecting the preparation of professionals and consequently restricting their ability to provide high-quality care to patients. Outdated educational infrastructure produces significant barriers that impede nurses from realizing their full potential. Furthermore, there is a noticeable absence of literature aimed at assessing the current situation, and more research and funding are required to determine essential changes. The formalization of nursing in Bangladesh began shortly after independence with the introduction of a diploma program in nursing (Hadley & Roques, 2007). By 1977, the country introduced both the post-basic Bachelor of Science in Nursing (for diploma in nursing degree holders) and a four-year Bachelor of Science in Nursing (BScN) (Joarder, 2021). Unfortunately, the opening of the BScN program was met with criticism and was temporarily halted due to protests from diploma-holding nurses and students, who feared that BScN graduates would receive preferential benefits (Joarder, 2021). The program was reintroduced on a small scale in some private universities in 1980 and expanded to government universities in 2008 (Joarder, 2021; Khan Rony, 2021). In Bangladesh, government jobs are categorized into various classes, such as first, second, third, and fourth class, which determine status and pay. Nursing was recognized as a second-class profession in Bangladesh only in 2011, an upgrade from its earlier third-class status. While physicians and dentists are classified as first-class employees, the advancement of nurses to second-class underscored significant progress in acknowledging the importance and stature of nurses in the public sector (Joarder, 2021). A major obstacle in nursing education is the absence of established quality assurance for nursing education programs in Bangladesh (Lee et al., 2016). Most universities in Bangladesh typically offer accreditation to various public and private colleges to run BScN programs, with a BScN program seldom available on their main campuses. Furthermore, the absence of formal mechanisms and adequate research complicates the situation for nurse educators, who frequently face resource constraints, making it difficult to systematically identify and address issues within their programs (Berland, 2014). Consequently, most nurses in Bangladesh cease their education after obtaining a bachelor's degree (Lee et al., 2016). Due to limited opportunities for advanced education, only a small number of nurses go abroad to pursue a master's or more advanced education in nursing. Instead, most nurses opt for more readily available degrees, such as a Master of Public Health (Lee et al., 2016). Only very recently have a few colleges and universities begun to offer the MSc in Nursing in Bangladesh (Daily Sun, 2017). Because there are no PhD programs or research-based master's degrees in nursing locally, the potential of nursing research to enhance nursing education and practice in Bangladesh is limited. In addition to these educational limitations, nurses in Bangladesh are not permitted to prescribe medications, as the country does not recognize Nurse Practitioner degrees, even those obtained from abroad (Berland, 2014). Enabling nurses to become Nurse Practitioners and allowing them to practice independently, particularly in rural settings, could significantly enhance healthcare services. This situation warrants critical questions: Who is accountable for hindering the progress of nurses in Bangladesh? Why there seem to be a push to maintain lower educational standards for nurses in the country? What advantages does this approach offer, and who stands to gain from it? Additionally, how do these benefits impact patient health and well-being? These pressing questions need to be addressed by future research to help achieve the developmental goals of Bangladesh in the health sector. There is an urgent need for stakeholders in the health and education sectors to prioritize reforms in nursing education and practice. By tackling these academic challenges, Bangladesh could better equip its nursing workforce to handle the demands of modern healthcare and enhance the quality of care provided to its population, fulfilling the commitments made to the United Nations. Conceptualization: Shimpi Akter and Masuda Akter. Supervision: Humayun Kabir and Masuda Akter. Original writing: Shimpi Akter and Masuda Akter. Critical revisions for important intellectual content: Shimpi Akter, Masuda Akter, and Humayun Kabir. The author declared no acknowledgments for this work. The author declared no competing interest in this work. The author received no financial support for this work. Ethical approval is not required for this work.

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