The unique functions of the nurse, in addition to giving patients skilled bedside nursing care, are to coordinate the activities of all health personnel regarding patients' care, to conduct field assessment of patients' overall situation, and to be sure that patients are referred to the proper place for services. With appropriate training, facilities and opportunities, nurses can make significant contributions towards health policies as well as towards general development thrusts that the Government is committed to, including ensuring healthcare for all the people of Bangladesh.

In Bangladesh, although the nursing profession has yet to receive its due status and remuneration, there has been remarkable development in both nursing education and services.

Before partition, in East Bengal there were only three Junior Nursing Schools. After the partition in 1947, only about 50 nurses opted to come to what was then East Pakistan from India. Apprentice nurses and nursing attendants were employed to run most of the hospital services. In 1947, the first Senior Nursing School was opened at Dhaka Medical College Hospital. A British nurse at that time worked as the Matron and also served as Superintendent of Nursing Services and as the Registrar, East Pakistan Nursing Council. Bangladeshi nurses now hold all these positions. The East Pakistan Nursing Council, separated from the Bengal Nursing Council at partition. Eight women were sent to London in 1949 for their Nursing training. Most of them later took up leadership position in nursing profession.

The Junior Nursing Schools were abolished in 1960. Two more Senior Nursing Schools were opened in 1963. The number of students who sought admission in the nursing schools during this period was very low. Young Muslim women were very reluctant to come out from their homes and to accept the nursing profession as their career. Nurse leaders through "nurses week" activities including slides show, pamphlets, and talks in the girls schools tried to attract more young women into the nursing profession, with good result. The Trained Nurses Association of Pakistan (TNAP) held a number of conferences and seminars during this period to help the nurses with their professional development and continuing education.

Trained nurses from East Pakistan used to be sent to the College of Nursing, Karachi, West Pakistan, which was established in 1956, for post basic training in Administration and Teaching. Some nurses were sent abroad for similar courses. Several nurses took BSc and MSc programs in the United States.

In 1970, a landmark event from the nursing occurred with the creation of the College of Nursing, the nurses from East Pakistan could obtain post-basic training in Administration and Teaching. They could meet the needs for nurse administrators and nurse teachers in East Pakistan. Mrs. Shahzadi Harun was the first Principal to College of Nursing.

Senior Nursing Schools were also started in the five remaining Medical College Hospitals and in 10 District Hospitals. At the time of Liberation, there were about 600 registered nurses in East Pakistan, 350 of whom were in government service.

After liberation, the Government took several steps to increase the number of nurses for its health services. The number of student seats for nurses was increased due to socio-economic and cultural reasons that resulted in more young women coming out and taking general education. Nurses' pay scale was raised. Matrons of Hospitals and principals of Schools of Nursing were given first class gazetted status.

The Bangladesh Nurses' Association (BNA) was established in 1972 as a professional organisation separated from the Trained Nurses Association of Pakistan. The BNA played an important role in nursing professional development and in increasing nurses' pay scale and status.

In 1977, the Directorate of Nursing Services (DNS) was established by a Presidential order as a separate Directorate within the Ministry of Health and Population Control. Mrs. Rahima Khatoon was the first Director of Nursing Services. This event was another landmark in the history of Bangladesh Nursing. Since then development projects, such as the construction of nursing school building and revisions of the basic nursing curriculum have been carried out.

In the same year the College of Nursing became affiliated with the University of Dhaka. Since the 1977-78 sessions, the College of Nursing has been giving BSc degree in Nursing and in Public Health Nursing.

The one-year post basic diploma course in administration and teaching continued to be offered by the College of Nursing. In 1980, a one-year diploma course in community health nursing was begun with the intention to materialise the decentralised program of the Government for health services and to increase nurses' involvement in Primary Healthcare.

In 1981, two additional Schools of Nursing in District Hospitals and 18 Schools of Nursing at Sub-Division level were opened. Long and short courses offering in-service and continuing education in specialised areas were organised throughout the country. Nurses were being sent abroad for training and on study tours.

Off-Shore Masters course started with the help of Adelaide University, Australia to produce Master Degree Holder. Nursing Research Cell has been established at the College of Nursing. Nurses were gradually serving in remote areas of the country. 4 posts of Division Assistant Director of Nursing Services (ADNS) and 64 posts of District Public Health Nursing (DPHN) were created. An ADNS in each of the four Divisions is in charge of supervising nurses in her Division. Nurses had BSc Degree in Public Health Nursing have been placed as DPHN to supervise in Upazilla Health Complexes and in the community as well as serve as Sister Tutors in Schools of Nursing in the Districts. Nurses who have completed the BSc Degree in Nursing at the College of Nursing are involve in teaching in school of Nursing.

The Bangladesh Nursing Council (BNC) is the registering and regulating body for nurses in Bangladesh. All the nurses of Bangladesh must be evaluated by and registered with the BNC before they are eligible to practice nursing. The BNC also is responsible for the registration of all foreign nurses working in Bangladesh. The BNC maintains liaison and collaborates with its sister nursing registration bodies throughout the world, such as the Indian Nurses registration Board, the UKCC in England, and the States Registration Boards in the United States, for the purposes of reciprocity and accreditation. Ms. Zohra Khatun was the first registrar.

Now many more young women are interested in taking up nursing as their profession. There are 38 Government Schools of Nursing and 6 Schools of Nursing are attached to the private hospitals, a total of 44 Schools of Nursing in Bangladesh.

The Nursing Education Programme is producing one professional category of nurses, the Senior Registered Nurse (SRN). The duration of education is four years, three years of general nursing and one year of midwifery (Orthopaedic/Paediatrics for male students, at present 10% seats are reserves for male students).

Total registered Nurses at present are approximately 21,000 (about 15,000 are in Govt Sector).

Nursing in Bangladesh has had continuous material and or technical support and assistance for the development of nursing services and education programmes from a number of international organisations including WHO, UNICEF, UNDP, UNCDF, World Bank, British Council, UNFPA, USAID, DANIDA, UNESCO and ICN. WHO is providing continuous maximum support.

The Bangladesh Nurses Association (BNA) continues to function as the recognised professional organisation for professional organisation for nurses in Bangladesh. The BNA is a member of the Commonwealth Nurses Federation (CNF). In 1986, BNA was elected to membership of the International Council of Nurses (ICN) that is an honour for Bangladesh and recognition of the growth of nursing in Bangladesh.

The Directorate of Nursing Services under the Health Wing of the Ministry of Health and Family Welfare in coordination with the Directorate General of Health Services is responsible for the overall planning and development of nursing services and nursing education in the country and is administratively responsible for the appointment, promotion, transfer, and disciplinary action for nurses and supporting staff in schools of nursing and in hospitals. There is government sanction for four lac taka every year to reward excellent nurses for their outstanding performance.

Nursing education and services in Bangladesh has been primarily institution oriented. Now nursing education and services are becoming more community-oriented. A major curriculum revision developed with the technical assistance of WHO Senior Nurse Educator implemented in 1990, and kept revising then on. In 2004 the basic nursing curriculum has been revised with the technical support from the Prince of Songkla University, Thailand which is going to be implemented in 2006.

Nurses are now working up to the Upazilla level. There is a need to create posts at the Union levels to deliver primary health care services.

The National Education Commission is updating the education system throughout the country, including medical and nursing education. The Parliamentary Committee on Health Manpower Planning is continually studying health facilities in urban and rural areas and needs for and functions of all categories of health personnel. The DNS and BNA in response to request from this Parliamentary Committee submit recommendations for nursing manpower development in Bangladesh.

Akhtar Banu is Ex-Deputy Director of Nursing Services.