Critical Shortage of Nurses

The shortage of nurses in Iran has reached critical levels. At present, there is a deficit of 140,000 nurses in hospitals across the country, and the average nurse-patient ratio is 1.5 per 1,000. In order to achieve the minimum standards of nurse-patient ratio, the figure should at least double; in some countries like the US, the figure is 9-10 nurses for 1,000 patients.

The reasons for the shortage as stated by Mohammad Mirza Beigi, deputy director for nursing services at the Health Ministry, are due to the fact that nursing staff normally leave for better paid jobs, lack of young people entering the profession, increasing demand from a growing population with high risks of non-communicable diseases (NCDs), and migration of health workers abroad in search of new or better opportunities.

“But measures have been taken to address the shortage. Recruitment of 7,500 final-year nursing students as well as providing them with the opportunity to continue working in the same hospital after graduation is one of the measures taken to resolve the issue,” ISNA quoted him as saying on Monday.

Nearly 10,000 assistant nurses have been also trained by the ministry and in the second half of the current fiscal year (started in March) they will be recruited gradually at state-run hospitals. “For every four professional nurses, one assistant nurse will be employed.”

Pointing out that the number of seats at medical universities for nursing students has increased from 6,000 in 2014 to 12,000 in 2016, he said, the aim of the two-fold increase is to compensate the shortage in nursing staff.

Mirza Beigi referred to nurses’ salary and said from now on “all officially employed nurses would receive a minimum wage of $570 (20 million rials).”

In April he had said that nearly 40,000 trained nurses had quit the profession due to the low wages and difficult working conditions.

  Quality Improvement

The official pointed to another measure taken to improve the quality of nursing. “Nurses with bachelor degrees can take 3-6 months courses in various subcategories of nursing specialties such as care of patients with neurological disorders, nursing care in ICU, wound care, etc. The job descriptions for these nurses will be announced by the Iranian Nursing Organization (INO) in the near future. He hoped that the measure would help improve the quality of nursing services. The INO is an independent legal entity with a membership of 70,000 nurses.

For the first time in May this year, the graduate degree in nursing management was designed and offered in universities with an aim to prepare head nurses to make a more effective contribution to successful implementation of healthcare policies and programs.

Nursing, as an integral part of the healthcare system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all healthcare and other community settings.  The unique function of nurses in caring for individuals, sick or well is to assess their responses to their health status and to assist them in the performance of those activities contributing to health or recovery.

Well-trained nurses also play an important role in reducing medication errors and preventing healthcare associated infections.

Annually, thousands of patients (10-15%) are affected by hospital-associated infections (HAI). Last year that ended in March, 600,000 people in Iran were affected by HAI.

Urinary tract infections (UTIs) account for about 40% of all hospital acquired infections and more than 80% of those infections are associated with catheters. Nursing staff can be instrumental in preventing urinary catheter-related and other infections.

  Addressing Challenges

David C Benton of the International Council of Nurses in Geneva says in his article in the Online Journal of Issues in Nursing published after his visit to Iran three years ago, that the Iranian Nursing Organization has achieved “an enormous improvement in a relatively short time.”

They are active across the country and reach out to their colleagues in other parts of the world and importantly they work regularly with all forms of mediums in the country. But with the support of the government they could do more.

“The INO can have a much important role in the registration of nurses and as a consequence provide the basis for coherent workforce planning and capacity development.”

Nurses in Iran who are competent, enthusiastic and innovative, are confronted with some common challenges, Benton noted. He referred to nursing shortages, job dissatisfaction and poor social position, the gap between theory and practice and lack of community-based nursing care. “These challenges need to be addressed.”