Hussain Maqbool Ahmed Khuwaja ( School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan. )
March 2021, Volume 71, Issue 3
Letter to the Editor
https://doi.org/10.47391/JPMA.463
Madam, On 8th August 2019, Pakistan Nursing Council (PNC) announced the ceasing of the three-year Diploma in Nursing which heralds a new era of the Bachelor of Science in Nursing (BScN) as the entry point for the nursing profession in Pakistan. This brings Pakistan in line with most developed and many developing countries.
This letter discusses the merits and implications of phasing out the three-year diploma in the nursing programme. The majority of practicing nurses who have completed Diploma in Nursing have been hampered in their challenges of going back to school and continuing their studies while being financially responsible for their families, as well as managing the demands of full-time nursing. The current evidence on health safety in hospitals reveals that a balanced ratio of bachelor prepared registered nurses to patients improves mortality and morbidity.1-3 The nurse to patient ratio in Pakistan is 1:50 against the standard benchmark of 1:5.4 According to the World Health Organization, Pakistan has 5 nurses and midwives (combined) as compared to 10 medical doctors per 10,000 population.5 The globally recommended ratio of doctors to nurses is 4:1, which is almost reverse in Pakistan (1:3).4
With the phasing out of the Diploma in Nursing, approximately 138 Nursing Institutes will be forced to cease Diploma enrollments from 2020 and will be encouraged to enrol four-year BScN students only.6 With the government’s desire to increase nursing numbers seven-fold by 2030 there is a dire need to promote conversion programme for these diploma graduates. However, the entrance criteria regulated by PNC for the diploma programme was ‘matric’ in science in the secondary school certificate exams, while the entrance criteria for the BScN programme is ‘intermediate’ in science (pre-medical).
To ease the nursing shortage, PNC and Higher Education Commission (HEC), must be flexible about entrance criteria for BScN degree programmes across Pakistan. Also, the PNC should actively plan to improve the standards of nursing schools across Pakistan so that these institutes could provide the standard of education required for undergraduate degree programmes. In short, flexible bridging programmes; innovations such as encouraging mature and second-degree applicants into nursing programmes, and progressive seamless career pathways are vital. The author propose that PNC and HEC have to consider candidates from non-science background for admission into BScN programmes, is one such innovation, and lessons can be learned from several developed countries who have taken this route.
Acknowledgement: The author wishes to acknowledge Ms Kiran Mubeen for sharing information on PNC notification.
Disclaimer: None.
Conflict of interest: None.
Funding disclosure: None.
References
1. Blegen MA, Goode CJ, Park SH, Vaughn T, Spetz J. Baccalaureate education in nursing and patient outcomes. J Nurs Adm 2013;43:89-94. doi: 10.1097/NNA.0b013e31827f2028.
2. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 2012;344:e1717. doi: 10.1136/bmj.e1717.
3. Liu X, Zheng J, Liu K, Baggs JG, Liu J, Wu Y, et al. Associations of nurse education level and nurse staffing with patient experiences of hospital care: A cross sectional study in China. Res Nurs Health 2020;43:103-13. doi: 10.1002/nur.22003.
4. Jafree SR, Zakar R, Zakar MZ, Fischer F. Nurse perceptions of organizational culture and its association with the culture of error reporting: a case of public sector hospitals in Pakistan. BMC Health Serv Res 2016;16:3. doi: 10.1186/s12913-015-1252-y.
5. World Health Organization. Global Health Observatory Data Repository: Health Workforce: Aggregated Data. [Online] 2017 [Cited 2021 February 10]. Available from URL: https://www.who.int/hrh/statistics/TechnicalNotes.pdf
6. Huda SU, Alisbinati AS. Nursing education in Pakistan: challenges and trends in degree program. Int J Nurs Educ 2015;7:59-62. DOI: 10.5958/0974-9357.2015.00194.4
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