The demand for nurses and midwives is growing across the globe due to expanding healthcare systems and the increasing need for healthcare. Huge numbers of nurses and midwives need to be trained and become qualified via nursing and midwifery education. This study aimed to explore opinions about advancing nursing and midwifery education in Bangladesh. This was a descriptive study featuring 70 participants who represented Bangladeshi nurses and midwives. They included directors, principals, and senior nursing instructors from government nursing and midwifery educational organizations. The data were collected from a one-day network meeting organized by the Directorate General of Nursing and Midwifery. The participants’ suggestions about how to improve nursing and midwifery education in Bangladesh were collected and categorized. The study discovered 12 recommendations for improving nursing and midwifery education in Bangladesh. These were categorized into three groups: 1) administrative, 2) academic, and 3) organizational. The present study proposes changes that will improve nursing and midwifery education in Bangladesh, thereby supporting the development of skilled and qualified nurses and midwives. Nursing and midwifery authorities and policymakers should focus on these suggestions.

Nursing and midwifery education is essential to producing competent nurses and midwives, and demand for these roles is increasing. This increasing demand may be due to expanding healthcare facilities and people’s increasing need for healthcare. Another reason is the sector’s drive to achieve the United Nations’ Sustainable Development Goal 3, which is ensuring healthy lives and promoting well-being for all at all ages.¹ Nursing and midwifery are ancient and well-recognized professions. However, there are shortages of nurses and midwives in many countries,² including the South East Asian country of Bangladesh.³ The development of nurses and midwives with proper skills remains a challenge in nursing and midwifery education.⁴ To try to overcome this issue, Bangladesh has introduced various strategies in nursing and midwifery education. The most notable of these strategies are: 1) increasing the number and capacity of nursing and midwifery educational institutes, 2) increasing the number of nursing and midwifery courses, 3) increasing the number of student places offered on individual courses, and 4) upgrading the nursing and midwifery courses’ curricula. Also, to increase interest in the nursing and midwifery professions, the government has upgraded nurses’ and midwives’ job status from 3^rd class to 2^nd class and upgraded their regulatory office from the Directorate of Nursing Services (DNS) to the Directorate General of Nursing and Midwifery (DGNM). As a result, several thousand nurses and midwives complete degrees each year. To further support quality nursing and midwifery education, the government has provided 510 nurses and midwives with one month of teacher development training, then deployed them in nursing and midwifery educational institutions. Other nursing and midwifery teachers were also given extra training.

The quality of nursing and midwifery education is a factor in the quality of nursing and midwifery care. High-quality education contributes to high-quality care and poor-quality education is an obstacle to providing high-quality care.⁵ Moreover, the scarcity of nursing and midwifery faculties and the use of inadequate teaching and learning materials and facilities undermine the effectiveness of educational organizations. Nursing and midwifery education also continues to suffer from inadequate investment, stagnant and overly rigid curricula, deficient inter-professional educational frameworks, a lack of harmonized teamwork, and a lack of support from investors. Also, the quality of education differs between organizations within a country and between different countries.⁶ Although these issues have been identified globally, there is scant research regarding nursing and midwifery education in Bangladesh. Therefore, this study aimed to gather nurses’ and midwives’ opinions about how to improve nursing and midwifery education in Bangladesh.

This was a descriptive study. The participants (n=70) included directors, principals, and senior nursing instructors from government nursing and midwifery educational organizations. They were chosen to present the opinions of Bangladeshi nurses and midwives. The data were collected from a one-day network meeting organized by the DGNM on 25^th May 2022. The participants were divided into 4 groups according to country administrative divisions, with two divisions represented in each group. Participants were asked to share their opinions regarding nursing and midwifery education in Bangladesh, including an assessment of its current state and possible ways it might be improved. They were asked to present their findings via PowerPoint presentation. These presentations were observed and their key points were recorded. Finally, the groups’ suggestions were organized and categorized.

The participants made 12 suggestions for advancing nursing and midwifery education in Bangladesh. These were categorized into three groups: 1) administrative, (7 suggestions) 2) academic (2 suggestions), and 3) organizational (3 suggestions) (Table 1).

Administrative

Improve promotion opportunities for teachers

Promotion is a motivator for many employees. It rewards them for meeting organizational and personal goals.⁷ Bangladeshi nursing and midwifery teachers face difficulties achieving promotion. This is due to a lack of administrative initiatives, and a deficient and irregular promotion system. The lack of opportunities is a factor in their dissatisfaction with their roles, as has been found elsewhere.⁸ In Bangladesh, many senior and junior nursing and midwifery teachers work in posts with the same designation. Therefore, there is also a lack of chain of command among teachers. This undermines the accountability and management of the teachers. All of these factors affect nursing and midwifery education.

Deploy adequate numbers of teachers and support staff

Adequate numbers of nursing and midwifery teachers and associated support staff are key to making the best use of human resources in an organization. They are needed to teach the students properly in classrooms and clinical practices. The ratio should be 1:25 (1 teacher: 25 students)⁹ but is higher in Bangladeshi nursing and midwifery education. Therefore, more nursing and midwifery teachers should be deployed. Teachers and students also need the help of support staff and greater numbers need to be deployed in Bangladesh. In Bangladesh, the government has separated nursing education into nursing and midwifery. Both disciplines have their own diploma degrees, BSc degrees, and master’s degrees. The government has also increased the number of student places on these degrees. However, while access to education has been improved for students, the government has not approved an increase in the number of teaching and support positions. Educational organizations face problems caused by inadequate numbers of teachers and office staff.               

 Deploy clinical teachers

Clinical teachers influence their students’ clinical learning.¹⁰ For students, clinical practice promotes the assimilation of theoretical and practical learning based on curricula and its conversion into qualified impressions, abilities, and approaches.¹¹ Due to the lack of clinical teachers in Bangladesh, students don’t receive the clinical guidance that they need, hampering their education and later performance.

Monitor public and private nursing and midwifery educational organizations

Monitoring consists of three main activities: regular data collection, data evaluation, and institutional action based on the data evaluation.¹² In Bangladesh, there are two categories of nursing and midwifery educational organization: public and private. They must both follow the Bangladesh Nursing and Midwifery Council’s rules and regulations and also follow the same curricula. The quality of education provided differs due to the quality and quantity of teachers and the learning environment provided, including clinical learning and practice facilities. Most private nursing and midwifery educational organizations have a shortage of teachers and lack organizational facilities, including clinical practice facilities. Therefore, it is reasonable that both private and public organizations are monitored to ensure the quality of education.              

Deploy more subject teachers

Teachers who teach students individual subjects are known as subject teachers.¹³ As above, Bangladeshi nursing and midwifery educational organizations suffer from teacher shortages. As a result, individual teachers may teach and examine more than one subject. Teachers feel that the resulting workload prevents them from developing appropriate expertise in specific subjects. This undermines teachers’ performance, reducing the quality of education that students participate in.

Improve subject and curriculum training for teachers

Training increases teacher competency. In nursing and midwifery education, most teachers begin their role without any specific teaching practice training.¹⁴ This is true of most Bangladeshi nursing and midwifery teachers. Only 510 teachers received the teachers’ developmental training, while some also received pedagogy training. Subject-based training should be given to teachers to prepare them for their roles. This will contribute to effective theoretical and clinical training. Curricula include at least four components: objectives, content, methodologies, and assessment methods.¹⁵ Curricula-based healthcare education should develop students’ knowledge, abilities, and communication skills for the advancement of public health.¹⁶ Teachers should be given curricula training to understand and implement them. This will benefit nursing and midwifery education.

Prepare Bangladesh-specific subject textbook                  

A textbook comprises detailed information about a subject for people who are studying that subject. Well-designed textbooks can make learning more enjoyable, can increase knowledge retention, and may vigorously occupy students’ thoughts in several ways.¹⁷ A textbook play an influential role in guiding classroom, and encourage good teaching practices. Unfortunately, there are no Bangladesh-specific nursing and midwifery education textbooks, and teachers must follow textbooks designed for different countries with different healthcare contexts. It is sometimes difficult for students to find nursing and midwifery information appropriate to their country and they must therefore depend on teachers’ lectures. This undermines nursing and midwifery education so there is a great demand for a Bangladesh-specific subject textbook.

Academic

Engage students in more extracurricular activities

Extracurricular activities are part of the current curricula. Such activities are important to learners because they improve problem-solving skills, allow students to express emotions, increase their adaptability, and assist the development of interpersonal abilities.¹⁸ These factors are related to the development of self-regulatory methods which are particularly significant to younger students (both emotionally and socially) as they shift into adult roles.¹⁹ Students in Bangladesh may not have adequate opportunities to engage in extracurricular activities. They may also be reluctant to do so and may lack support when they do. The provision of extracurricular activities should be improved.

Increase coordination among teachers

Coordination may be defined as combined approaches, actions, and consequences in the pursuit of common goals.²⁰ The main goal of nursing and midwifery educational organizations is to produce skilled and qualified nurses and midwives. For this purpose, nursing and midwifery teachers should work together in a well-coordinated manner. Effective coordination encourages the dissemination of knowledge and techniques, supports the effective use of resources, minimizes course repetition, and helps to identify the specific needs of teachers.²¹ Coordination may be inadequate among Bangladeshi nursing and midwifery teachers. This may be due to their inadequate number, high workloads, lack of recognition, imbalanced work distribution, and lack of financial facilities (among other factors).

Organizational

Increase coordination with related organizations

Coordination integrates individual parts of organizations to accomplish shared objectives.²² Nursing and midwifery educational organizations need to coordinate with organizations such as nearby hospitals, local communities, and other organizations supporting students’ clinical and field practice. They also need to coordinate with Bangladesh Nursing and Midwifery Council, Concern University, and the education boards. Moreover, they need to maintain coordination with DGNM and the authorities of different local organizations. For students to develop clinical practice, active and effective coordination is important between nursing and midwifery teachers and hospital nurses. However, Bangladeshi nursing and midwifery organizations suffer from imperfect coordination with hospitals, particularly with nurses.

Develop and extend organizational buildings

In Bangladesh, nursing and midwifery education is expanding. At first, nursing and midwifery education were combined as one degree. Initially, education was limited to the division level; later it expanded to the district level. Educational organizations were also upgraded from nursing training schools to nursing institutes, and then to nursing colleges. Recently some colleges were further upgraded to nursing and midwifery colleges. The seating capacity has been doubled and some organizations now run four courses. However, these educational organizations’ buildings remain mostly unchanged and are at a crisis point. There is a huge lack of adequate classrooms, labs, dining rooms, kitchens, libraries, teachers’ rooms, common rooms, reading rooms, prayer rooms, guest rooms, auditoriums, storerooms, and student hostels. Such facilities are essential for a healthy educational environment. An organizational structure’s facilities positively influence the organization’s work²³ and can support routine work, effective planning and decision-making, relationships with similar organizations, students’ academic performance, and teachers’ performance and originality.²⁴

Ensure adequate teaching materials

These are the materials used by the teacher to explain concepts to students or evaluate their performance. They are considered key to effective teaching. As above, nursing and midwifery education in Bangladesh has expanded, but teaching materials have not developed in the number or quality required to match increased student numbers and organizational requirements. This undermines the quality of nursing and midwifery education. Educational organizations’ effectiveness depends upon providing exceptional worth, value-added service delivery, using up-to-date curricula, and applying modern teaching systems.²⁵

The authors were pleased to the Bangladeshi nurses and midwives representative to participate this study.

No conflict of interest has been declared by the authors.

1. United Nations. Sustainable development goal 3: Ensure healthy lives and promote well-being for all at all ages. 2018.
2. Slattery MJ, Logan BL, Mudge B, et al. An undergraduate research fellowship program to prepare nursing students for future workforce roles. J Prof Nurs. 2016;32(6):412–420.
3. Press releases. Signing of record of discussions on technical cooperation project with Bangladesh: contributing to improving the quality of nursing education. JICA. 2021.
4. Bvumbwe T, Mtshali N. Nursing education challenges and solutions in sub saharan Africa: an integrative review. BMC Nurs. 2018;17(3):272–274.
5. Filby A, McConville F, Portela A. What prevents quality midwifery care? a systematic mapping of barriers in low and middle income countries from the provider perspective. PLoS One. 2016;11(5):e0153391.
6. Castro Lopes S, Nove A, Ten Hoope, et al. A descriptive analysis of midwifery education, regulation and association in 73 countries: the baseline for a post-2015 pathway. Hum Resour Health. 2016;14(1):37.
7. Lazear EP, Sherwin R. Rank order tournaments as optimum labor contracts. Journal of Political Economy.1981;89(5):841–864.
8. Hussami M, Saleh MYN, Abdalkader RH, et al. Predictors of nursing faculty members’ organizational commitment in governmental universities. J Nurs Manag. 2011;19(4):556–66.
9. Rules and regulations of the state of Georgia.
10. Heshmati NF, Vanaki Z. Professional approach: the key feature of effective clinical educator in Iran. Nurse Educ Today. 2010;30(2):163–068.
11. Papastavrou E, Dimitriadou M, Tsangari H, et al. Nursing students’ satisfaction of the clinical learning environment: a research study. BMC Nurs. 2016;15(1):44.
12. Kiesler, Sproull. Managerial responses to changing environments: perspectives on problem sensing from social cognition. Administrative Science Quarterly. 1982;27(4):548–570.
13. Wettstein A, Ramseier E, Scherzinger M, et al. Class- and subject teachers’ self-efficacy and emotional stability and students’ perceptions of the teacher–student relationship, classroom management, and classroom disruptions. BMC Psychol. 2021;9(1):103.
14. Corrêa AK, Sordi MRL. The secondary technical-professional education in the unified health system and the teacher training policy. BMC Med Educ. 2018;18(1):263.
15. Asgari P, Navab E, Bahramnezhad F. Comparative study of nursing curriculum in nursing faculties of Canada, Turkey, and Iran according to SPICES model. J Educ Health Promot. 2019;27(8):120.
16. Akram A, Rizwan F, Sattar K, et al. An approach for developing integrated undergraduate medical curriculum. Pak J Med Sci. 2018;34(4):804–810.
17. Morgan KE. Decoding the visual grammar of selected South African history textbooks. Journal of Educational Media, Memory, and Society. 2014;6(1):59–78.
18. Fares J, Saadeddin Z, Al Tabosh, et al. Extracurricular activities associated with stress and burnout in preclinical medical students. J Epidemiol Glob Health. 2016;6(3):177–185.
19. 19.           Guilmette M, Mulvihill K, Villemaire KR, et al. Past and present participation in extracurricular activities is associated with adaptive self-regulation of goals, academic success, and emotional wellbeing among university students. Learn Individ Differ. 2019;73:8–15.
20. Castaner X, Oliveira N. Collaboration, coordination, and cooperation among organizations: establishing the distinctive meanings of these terms through a systematic literature review. Journal of Management. 2020;46(6):965–1001.
21. Gjedia R, Gardinier MP. Mentoring and teachers’ professional development in Albania. European Journal of Education. 2018;53(1):102–117.
22. Bakanauskas A. Management of organizations. Lithuania: Vytautas Magnus University. 2011.
23. Lunenburg FC. Leadership versus management: a key distinction—at least in theory. International Journal of Management, Business and Administration. 2011;14(1):1–4.
24. Bhebhe, Sithulisiwe. Organisational structure and teachers' performance. International open Journal of Educational Research. 2020; 2(5):1–12.          
25. El Hilali N, Al Jaber S, Hussein L. Students satisfaction, achievement and absorption capacity in higher education. Procedia- Social and Behavioral Sciences. 2015;177:420–427.