Even though approximately 10,000 trained nurses are unemployed at the moment, lack of proper government monitoring enables private clinics and hospitals to use unskilled, untrained and non-

registered nurses, deteriorating the service.

A large number of private clinics in the country, especially clinics in the cities, arc running with nonregistered nurses (nurses without valid diplomas in nursing) violating condition for getting clinic or

hospital licences.

There are 1,005, according to stats of 2005, registered private hospitals in the country which received licences from the Directorate General of Health Services (DGHS) under conditions of having hygienic environment for patients, at least 80 square feet of floor space for each patient, air-conditioned operation theatre, essential life-saving equipment, adequate supply of life-saving and essential medicines, full-time registered medical practitioners, nurses and other staffs.

The hospitals and clinics should also have specialists for conducting operations, treatment and supervision of patients, reads the Medical Practice and Private Clinics and laboratories Ordinance, 1982.

However, very few private clinics and hospitals are fully complying. Experts say that in most of the private hospitals a large number of untrained nurses are working alongside trained ones.

Currently the country has only 22,555 registered nurses and public hospitals should be employing 14,689 of them.

The total number of beds in private hospitals and clinics of the country is 34,227 and according to regulations, around three nurses should serve 10 patients. Private hospitals and clinics should have 10,268 nurses, Director of DGHS (Hospitals and Clinics) Akhter I lossain Bhuiyan told Hie Daily Star.

However, owners of the private clinics and hospitals often recruit nurses without any diplomas to cut cost, leaving many trained nurses unemployed.

At die same time, the government's monitoring system being inadequate enables owners of clinics and hospitals to run their business freely. Quality service and satisfaction of patients is often neglected.

Talking to The Daily Star, die secretary general of a clinic in Dhaka said his 10-bed healthcare centre, with an operation theatre and outdoor treatment facility, has six nurses but only two of them have diplomas.

" It is very difficult to get registered nurses since only 1,200 nurses graduate from different government nursing institutes every year. As a large number of private hospitals have been set up in the last few years, registered nurses joined there," he claimed seeking anonymity.

"Although we offer Tk 6,000 per month, we do not get any registered nurses," he said adding that at his hospital the untrained nurses receive between Tk 3,000 and Tk 4,000 a month.

The nurses joined the healthcare centre after finishing their SSC or HSCstudies and they were "trained" at work, he said admitting that recruiting untrained nurses is definitely deteriorating nursing service quality.

Since untrained nurses do not know how to provide good care to patients and how to identify the needs of patients, they certainly fail to provide proper service and satisfy patients, said Rahima Jamal, nursing supervisor of Khaleda Zia Medical College Hospital in Dhaka. Nursing deals with physical, mental, emotional, social and spiritual aspects of an ill person, which is a huge responsibility for the nurses and it is not possible for unskilled nurses to deal with these, said Dolly Maria Gonsalves, national consultant of World Health Organisation (WHO) in Bangladesh.

Quoting a study, she said nurses with higher training can deal with patients in a more rational way as they grow a positive attitude and loyalty while the unskilled nurses often do not know how to push an injection and in which area of the body. They do not know that learning to check blood pressure and pulse is not everything, she added.

When emergency patient management is required, unskilled nurses remain busy calling doctors as they do not know the ABC of diseases and patients, a group of registered nurses said adding that there are nurses in private clinics and hospitals in the country who do not even know that nurses need a diploma.

Akhter I lossain Bhuiyan told The Daily Star that the DGHS has only a three-member team consisting a deputy director and two assistant directors for monitoring around 452 private clinics and hospitals in the capital. At the divisional level, there are committees under Divisional Director of Health to monitor the hospitals and clinics.

"The committees are supposed to visit five private healthcare centres every month and report to the DGHS. But the fact is, we get very irregular reports from the committees and also from our DGHS team due to manpower shortages," he said.

The Disciplinary Committee of the Nursing Council is indifferent towards the issue, even though it is supposed to take actions against these malpractices. The committee also has very little power and no budget is allocated to run the committee.

"Although it is partially the duty of the Nursing Council to deal with the issue of unskilled nurses, it is not possible for us to monitor whether they [private hospitals and clinics] are recruiting unregistered nurses since the government never tells us how many private hospitals and clinics are getting registered and where," said Registrar of Bangladesh Nursing Council (BNC) Shamsunnah ar.

If any private hospital wants to know whether the nurses they are going to recruit are qualified, only then the BNC intervenes, she added.

Although there are registered nurses unemployed, the country needs2.80 lakh nurses.

The shortage will not last long as over 2,000 nurses graduate a year from private and public institutes, she said adding that another seven institutes are going to be operational by this year, helping to ease the nurse crisis further.