Our Nurses. Our Future. The economic power of care.

International Nurses Day is observed each year on May 12th to acknowledge the importance of nurses in healthcare systems. The theme for 2024 selected by the International Council of Nurses (ICN) is ‘Our Nurses. Our Future. The economic power of care’. “Despite being the backbone of healthcare, nursing often faces financial constraints and societal undervaluation. ICN has chosen to focus International Nurses Day 2024 on the economic power of care with the aim to reshape perceptions and demonstrate how strategic investment in nursing can bring considerable economic and societal benefits. Drawing from the lessons learned from the COVID-19 pandemic and recognising the increasing threat to the health of populations around the world due to conflicts, the climate crisis and financial instability, we believe the time is right to advocate for a shift in perspective and policy,” explains Dr Pamela Cipriano, president ICN.

In Pakistan, some of the challenges faced by nurses are exacerbated because of stereotypes associated with a women-dominated profession in a patriarchal society. The media also plays a role in shaping perceptions about nurses and there is a need to shift the perspective where nurses are objectified because of their gender while their professional skills and intellectual capabilities are ignored. At the national level, nursing profession is faced with a variety of challenges including insufficient nurse to patient ratio, shortage of nurse educators, lack of research opportunities, heavy workloads, and all these majorly stem from under allocation of GDP for health sector. Despite these challenges, nurses continue to be our heroes every day. In this regard You! talks to a number of professional doctors, nurses and leaders in healthcare who share their stories and experiences with our readers. Read on...

While speaking to this scribe, Dr Faisal Sultan, former SAPM (Special Assistant to the Prime Minister) on health and CEO of Shaukat Khanum Hospitals, says, “Nursing care is one of the most central and least appreciated links in the whole chain of medical care. There is a need for nurses to be a highly educated and trained section of the health work force. This also means they ought to have wages and work conditions that attract capable young women and men into the field.”

While reflecting on the sad state of affairs Dr Muhammed Aasim Yusuf, Regional Advisor to the Royal College of Physicians of Edinburgh and the Chief Medical Officer of Shaukat Khanum Hospitals, elucidates, “After the COVID-19 pandemic, there is a newfound appreciation of the critical role that nursing plays in delivery of healthcare the world over. Pakistan faces a tremendous shortage of nurses and over the last several years has invested heavily in trying to improve training opportunities as well as the number of places available to train nurses. Nonetheless, it is estimated that we are short of perhaps over a million nurses in this country. It is a sad fact that a number of nurses who train in this country are lost each year to better economic opportunities in the developed world. This is clearly something that we need to address going forward.”

“At the Shaukat Khanum Memorial Cancer Hospital and Research Centre, in Lahore and in Peshawar, where I work, we provide tertiary level cancer care services to all our patients, irrespective of their ability to pay. Nursing is key to all aspects of delivery of cancer care, starting from diagnosis and all the way through treatment to palliative and supportive care. We are immensely proud of our nursing colleagues. I remember speaking to one of our patients who was in the hospital for a diagnostic procedure. She told me that she was extremely anxious about the procedure beforehand and particularly about the fact that she was going to have an intravenous cannula inserted. She said she was so relieved when during the process of cannulation, the nurse told her that the needle had been removed and there was just a little piece of plastic in her hand now. It may seem like a small thing but it is indicative of the effect that nurses can have on patients and how a little word of comfort can go such a long way in allaying patients’ anxieties,” he elaborates.

While sharing her inspiring story Mussarat Parveen, a breast care specialist nurse and nursing lecturer practitioner, narrates, “I come from a village where girls often don’t go to colleges but it was my father’s dream that I become a nurse and a strong independent woman. I was determined to make his dream a reality even if it meant taking a train to reach college. In 1989, I completed diploma in nursing and started working at a hospital. Around one year later, I went to the Middle East after marriage, and worked at a hospital there. In 2005, I returned to Pakistan and decided to join the Shaukat Khanum Hospital in Lahore because of its high standard of care and the environment provided to healthcare practitioners. I wanted an environment where I could utilise my training to the best of my abilities. At this hospital, I had the opportunity to work on my professional growth and I specialised in oncology nursing.”

“I work as a breast care nurse now and I also teach students of our nursing education programmes. Some nurses opt out of seeing patients when they start teaching but I chose to continue with patient care because this is my passion. It is a great soul-touching feeling to be able to help patients directly after listening to their concerns. Sometimes, lending patients an empathetic ear can mean the difference between life and death. I remember a breast cancer patient who was hesitant to undergo advised treatment; chemotherapy meant loss of hair and surgery involved mastectomy in her case. She was also concerned about the society’s reaction to her altered physical appearance. I did not want to give up on her. I showed her ways in which support was available for her in the form of breast prosthesis as well as a wig, and I told her to take into confidence a trusted family member during this journey. After that discussion, she changed her mind and completed recommended treatment. She survived. Experiences like these during patient care process are priceless,” she adds.

Arshad Munawar’s courageous story, a palliative care nurse, can be a source of comfort for many empathetic members of our society who want to go in palliative medicine field. “I am working as a palliative care nurse at a tertiary-care cancer hospital since 2017. Initially, I started working with adult patients. Then I joined the nursing training course at the Hospital: Diploma in Oncology Nursing (DION). It was a one-year course that I completed in 2020. After this, as part of job rotation, I worked at all four inpatient areas and had the opportunity to work with palliative care nurse. That was the time when I became interested in the palliative medicine field. I felt that this was a special area where patients were provided special care to improve their quality of life. It gave me a lot to learn and I had the chance to comfort both, patients and their families. Some patients stay in our thoughts for a long time. Especially, seeing young people suffering is painful. But when families of patients say words of appreciation, it is a source of un-matched motivation,” illustrates Arshad.

The dedication and perseverance of Rabia Muhammad Ali, a nursing lecturer practitioner/BMT specialist nurse, is an inspiration for many young nurses to follow suit. “Twenty years ago in 2004, I joined my current place of work where I take care of cancer patients. Cancer patients need special care according to their individual needs. BMT or Bone Marrow Transplant patients have very low immunity and face different sets of risks and complications compared to other cancer patients. For effective care and management of such patients, nurses need to have comprehensive knowledge about the field. For this reason, after specialising in oncology, I did further specialisation in BMT in 2015 and Shaukat Khanum Hospital supported me for my trainings,” expresses Rabia.

“I am a nurse by choice. When my mother was ill and being treated at a hospital, I witnessed a nurse taking care of my mother. I saw her and decided that I wanted to become a nurse and wanted to care for others. I changed my field from economics and went back to studying so that I could become a nurse,” tells Rabia.

“I have several memorable moments with patients; with some patients, we become emotionally connected and their loss feels like a personal loss. Then there are those patients who recover after cancer treatment and stay in touch; they continue to send prayers. I remember the first bone marrow transplant patient of Shaukat Khanum Hospital, Salman. I was part of the team that took care of him. He is doing well now and he sends prayers even now. Patients scheduled to undergo bone marrow transplant here often motivate each other and I remember that one patient said to the other that ‘Rabia takes care of us just like a mother’; it really touched my heart,” recalls Rabia.

Saad is a Pakistani-American working as a registered nurse in the US and his experience demonstrates some overlapping challenges in low and high-income countries and the importance of having an optimum nurse to patient ratio. According to Saad understaffing is probably one of the biggest challenges that we face. “If the floors are short of nurse technicians, we will have to take responsibility for those tasks as well. Another challenge I personally faced during my first job was high acuity patients (severely ill patients) on general medical/surgical floors. Some of the patients were not stable enough to be on those floors and should have been on the intensive care floors,” observes Saad.

“After working with adults at my first job, I suffered from burn out. From the high acuity to the unsafe patient ratios, I was almost always in a fight or flight state. It was a blessing in disguise when one day, I met my nursing school friend who worked at the children’s hospital where I work now. I work at Texas Children’s Hospital located in the Houston Texas Medical Center, which is one of the biggest and highest ranking hospitals in the nation. My job title is RN (registered nurse) and I work as a float pool nurse, which means an hour before your shift you get informed what floor you’ll be working on (depending on where most help is needed). The floors I go to include: behavioural medicine, oncology, haematology, neurology, transplant, cardiac and general medicine. This hospital has a much safer patient to nurse ratios, which makes everything simpler and easy to manage. Caring for sick children has reinvigorated my passion for nursing. I see them all like they were my own kids and feel empathetic towards each and every one of them,” shares Saad.

“To overcome shortage of nursing staff, it is important to remove barrier for all genders and we should encourage both men and women to serve in the nursing profession and give them due respect,” suggests Arshad Munawar.

“It is time that we put in effort to improve the opportunities available for our nurses, including opportunities for their academic and professional advancement, to remove societal and other barriers which prevent people from coming into this profession, and to optimise the working environment so that the patients can continue to be the priority for all our nurses in the years to come,” emphasises Dr Muhammed Aasim Yusuf.

The writer is a LUMS alumna and a community social worker with special interest in public health, philosophy, and human rights. She can be reached at mariamk27@hotmail.com. Her X handle is @mariamibkhan