Afew hundred years back, the wounded and sick were catered to nursing-like services b

y the nuns and military personnel. It was the Crimean war (1853-1856) that a significant development took place when an English Nurse Florence Nightingale laid the foundations of professional nursing. Since then the

 profession has grown into a respectable one. Historically, the profession had a heavy gender-bias but in the past 50 years, many males have joined it too.

Nurses are the backbone of the medical profession and the modern health system cannot function without them. The nurses interact with the patients on a more personal level and provide the highest quality of care to the patient.

The Pakistan Nursing Council (PNC) controls and regulates nursing in Pakistan. They are responsible for permitting schools for operating, coming up with the curriculum for nursing education, licensing nurses to practice, maintaining standards of education to practice, and maintaining an advisory role to the Federal and Provincial governments regarding nursing education and nursing services. They also communicate policy decisions regarding nursing to other parties. Besides the PNC, there are no other associations or groups that deal with nursing.

There are around 136 institutes that offer degrees, diploma and certificate programmes of nursing in Pakistan. Unfortunately these colleges are not enough to produce the desired number of nurses. According to Prof Najib ul Haq, principal of Peshawar Medical College (PMC), there is approximately one nurse for 31,579 patients in Pakistan against World Health Organisation's recommendation of one nurse for 10 patients. The international standards of patient care require eight nurses for every single doctor but in Pakistan there is only one nurse available for three practising doctors and in some areas this ratio is as low as 1:6. One wonders why with such a population explosion the shortage of nurses exists. The staffs of nursing colleges and senior practicing nurses blame the government for the malfeasance. They claim that the government doesn't hire enough nurses and also acts lazy in promoting them. There are still many vacancies for the Minimum Service Delivery Standards (MSDS), which call for having at least one nurse for eight patient beds, one charge nurse for two Intensive Care Unit beds and eight charge nurses for four Coronary Care Unit beds.

Although nursing colleges are improving their facilities, they are far from satisfactory. Set up in the 1980s, Agha Khan University's School of Nursing has been the first in the country to impart Master's Degree in Nursing and has an active international collaboration. It is also involved in capacity training and research. There are a few other private colleges such as Liaquat but the bulk of the nursing population comes from public schools of nursing.

While medical is one respected profession for women, it usually pertains to doctors, not nurses. In Pakistan, nurses are treated as blue-collar workers. The girls who join nursing colleges mostly belong to lower-income groups. Perhaps that is the reason society treats them with little respect. Many nurses face harassment at the hands of patients, who come for treatment or the relatives who escort the patients. They ask personal questions and phone numbers from the nurses and take their pictures while the nurses are busy. Some people even poke the nurses or slightly brush their hands across the nurses' bodies. While in private hospitals, the nurses have somewhat protection, in public hospitals, the nurses have no one to turn to. And the case of rape of a trainee nurse by a medico-legal officer at Jinnah Postgraduate Medical Centre (JPMC) in 2010 shows that the nurses are not even safe from the paramedical staff and the male physicians of the hospital. Last year in August, a staff nurse appointed at Kahna Nau Rural Health Centre, Punjab, set herself ablaze after her complaints against dental surgeon at the centre, who was forcing her to have illicit relationship with him, went unheard. Many nurses leave the profession due to this fear of further abuse while many others have vowed not to let their daughters choose this profession.

In Pakistan, the profession of nursing is not without its share of hullabaloo. We witnessed the nurses along with doctors boycotting their duties to protest against their unmet demands. The demands included Rs10,000 allowances for food and clothes, high risk and hard workers allowance, promotions, increased stipend for nursing school students and professional health allowance. The strike ended through negotiations with the government but it caused immense hardships for those who had come to seek treatment for their ailments. Even last year in November, nurses throughout Punjab went on strike, which included a sit-in outside the Prime Minister's house in Multan. During their strike in Lahore, they were beaten by the police, much to the disgust of the civil society. When a baby was abducted from JPMC in November, last year, it was the nurses who highlighted the issue. Unfortunately, the staff at JPMC charged them for inviting media and politicising the issue. In early March, this year, some 40 nurses at Benazir Bhutto Hospital, Rawalpindi suffered from food poisoning after consuming the food from the hospital canteen.

The stories of hardships do not end here. Patients complain that the nurses are often cranky and rude to them and don't give them the due attention that they need. Their shifts last from 12 to 24 hours and often they have to attend 30 patients at a time. Many a time, the students of nursing colleges are left unsupervised in the medical wards. And after all the hard work, all they make is Rs 4000 to 20,000, depending on their designation. This severely affects their performance; it is only natural for them to get in a bitter mood. The situation gets worse when emergency is declared anywhere in the city and the nurses have to put in extra hours to their shifts without any security. The Lady Reading Hospital (LRH) in Peshawar is one such hospital that frequently receives the wounded from terrorist activities taking place in the city. "Our profession is not respected and people still discourage their daughters to choose nursing as a profession. Besides relatives of wounded or dead vent their anger out at the nurses," shares Dilraz, the head nurse at LRH. Terrorist activities throughout the country is increasing day by day and so is the number of injured, who require medical assistance. This has increased the demand for nurses but the supply stays at a standstill creating many problems.

However, there is good news for the nurses in Sindh. Last month, the Health Minister for Sindh, Dr Sagheer Ahmed has issued a notification to increase their allowances. According to the notification, nursing instructors of BS-18 will get Rs 4,000 per month, nursing sisters of BS-17 will receive Rs 4,000 per month, nurse staff of BS-16 will be entitled to Rs 6,000 per month, lady health visitors of BS-9 will get Rs 2,000 a month, and midwives of BS-6 will get Rs 2,000 a month. Besides a casualty allowance of Rs 2,000, rural incentives of Rs 2,000, and a hard work allowance of Rs 2,000 will also be paid, says the notification. The Health Minister has also said that the stipend of student nurses have been increased from Rs 2,000 to Rs 6,860.

Nursing is a very noble profession but our gender prejudices, mismanagement and ill-treatment has caused immense damage to it. This has also caused an exodus of nurses from Pakistan to various other countries where nursing is given its due respect. It is important that we give the recognition, respect and facilities this profession requires as it will benefit the society at large.