Retaining nurses becomes arduous, health reforms being considered

The MoH is working on health reforms to retain the nurses

Despite the government making teachers and medical staff the highest paid civil servants in the country, it has become an arduous task for the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) to retain nurses with the hospital.

According to records maintained by the Ministry of Health (MoH), 29 nurses resigned in the year 2019, followed by 22 nurses in 2020 and some 27 nurses resigned from 2021-2022. Three nurses are on EOL (Extraordinary Leave) as of 2020 and one on EOL as of 2021-2022.

Since the opening of the international borders, 17 nurses have taken EOL, according to an official from the JDWNRH.

“In every Human Resource Committee (HRC) meeting held twice in a month, HRC gets applications from at least three nurses,” the official added.

However, the official said it is really not possible to gauge the actual reasons since the reasons stated in the applications for resignation and EOL are domestic and family reasons.

“Going by past experiences, almost all the staff resign upon completion of the EOL. Staff usually prefer to go on EOL instead of directly resigning probably because of initial uncertainties while charting a new career,” said the official.

However, the official said that their observation shows that they (the nurses) usually leave for third countries or as United Nations Volunteers (UNV). “It could be for better and wider opportunities including monetary advantages.” 

The MoH maintained that they are helpless to retain such professionals like nurses who are going abroad as health workers.

Tandin Dendup, Deputy Chief Planning Officer of the Planning and Policy Division, MoH, said, “They are entitled to pursue what they desire if they meet the conditions and requirements set by Royal Civil Service Commission (RCSC) and the government in the BCSR.”

According to the ministry, it cannot ascertain if the resigned nurses and those who availed EOL went abroad. Similarly, the ministry cannot comment on the EOL system as it is under the purview of RCSC where all the health personnel who are civil servants are entitled to such privileges as per the BCSR.

“However, to discourage people from availing EOLs, the RCSC has amended the BCSR to assure that the position of the individual is not protected in the civil service as it used to be in the past,” Tandin Dendup said.

Meanwhile, the JDWNRH doesn’t maintain record of where and how their ex-employees or staff are or have gone after availing an EOL and after resignation.  

However, the official from JDWNRH said that the reasons for resignation and EOL are to either pursue studies or accompany spouse on studies, followed by a few other cases like getting time bound employment with the agencies of the United Nations (UN).

The shortage of nurses, however, has a serious and major implication on the provision of equitable healthcare services in the country. 

The country is currently short of nurses going by the nurses to population ratio.

“The ratio for every 1,000 population is two nurses as per the OECD (Organisation for Economic Co-operation and Development), but we have a ratio of 8.8 nurses to 1,000 population,” said Tandin Dendup.  

Additionally, the overall attrition rate is not a huge concern for the JDWNRH given the internationally considered attrition rate of somewhere at 10%, but the hospital is losing experienced and trained nurses, which have to be replaced by fresh graduates.

“Most of the nurses taking EOL and resigning are those who have vast experiences in the field of practice and also a few are trained and experienced in the specialised field of nursing,” the JDWNRH’s official said. 

“It takes many years for an entry level nurse to achieve the expertise and skills of an advanced practising nurse both in terms of qualification and clinical experience in the special field of nursing practice,” the official said.

Additionally, the official added that a nurse has to undergo training to develop competencies to be able to practise independently in critical and specialised wards and units. Therefore, the hospital is not able to refill the gaps created by these expert nurses. The ad hoc and unplanned exit create a temporary shortage owing to the recruitment procedures and cycles,” the official said.   

Meanwhile, the MoH is currently training 71 nurses. It trained 75 nurses in 2021 and 47 nurses in 2020 at the Khesar Gyalpo University of Medical Science of Bhutan (KGUMSB).

Similarly, 38 nurses were trained as of 2022 followed by 21 and 15 nurses in the year 2021 and 2020 at the private training institutes. The figures do not include nurses graduating from India and other countries under private funding.

For instance, the government spends around Nu 22.7mn to train such professionals like doctors and nurses inside the country and outside the country like Bangladesh, Thailand, Nepal, Malaysia, and India.

Presently, there are about 1,635 nurses serving in regional hospitals and district hospitals across the country.   

According to the MoH, it is working on health reforms to retain the nurses.

Sherab Dorji from Thimphu