One Nurse, Twelve Patients, and a Lonely Battle: Listen to the Silent Screams of Pakistani Nurses on International Nurses Day 2025 “Our Nurses. Our Future. Caring for nurses strengthens economies"

ibrahim_shah · May 9

Yesterday, I received a call from one of my clinical nurse colleagues, Nasreen, who works in a private hospital's surgical ward. Her voice was filled with exhaustion and frustration. She had been assigned twelve patients in a surgical ward, each requiring intensive care, blood transfusions, pain management, and continuous medications. As her shift began, she was told that additional support would arrive shortly. But as the hours passed, no help came. She found herself single-handedly managing twelve patients, each with critical needs. The relentless pressure from patients, physicians, pharmacists, and physiotherapists compounded her burden. By the end of her shift, she was burnt out and deeply distressed in a state all too familiar to those in the nursing profession.

Nasreen's story is not an isolated incident. It brought back memories of my early years in nursing. When I graduated in 2014, I witnessed the same harsh realities. Despite a decade passing, little has changed. Nurses in Pakistan continue to face overwhelming workloads, poor working conditions, and a lack of institutional support. This has led to widespread burnout and a critical loss of nursing talent.

According to the Pakistan Nursing & Midwifery Council, Pakistan has around 107,643 registered nurses as of 2024. This number is starkly insufficient to meet the needs of a population of over 240 million, resulting in a nurse-to-patient ratio of 1:40, far from the recommended 1:10. Burnout is rampant. Studies indicate that 48% of nurses experience moderate stress, while 30% endure severe stress. A staggering 79% report severe burnout and a diminished quality of life. This not only impacts the well-being of nurses but also compromises patient care and overall healthcare outcomes. In addition to this, bullying in the workplace adds another painful layer to the burdens our nurses carry. In Karachi, a study of 458 nurses across public and private hospitals found that 33.8% had experienced bullying or "mobbing" behaviors, often from those in managerial positions, while on the job. Even where prevalence appears lower, such as the 8.0% reported in a Lahore survey, these figures likely underestimate the problem, given nurses' reluctance to speak up for fear of retaliation.

The challenges are not confined to clinical settings. In academia, the shortage of qualified nursing educators is also obvious. Many institutions prioritize profit over quality education, burdening students with high fees while providing inadequate training. Many private nursing institutions treat education as a profit center, imposing costs that are unaffordable for most Pakistani families. For example, the tuition of the Aga Khan University School of Nursing is PKR 620,400 per annum. At the same time, the nursing program at Pak International Medical College exceeds PKR 1,897,500 annual costs that force students to work part-time and jeopardize their studies and well-being. These financial pressures contribute to high dropout rates and deter talented individuals from pursuing nursing careers.

Beyond high tuition and limited clinical exposure, nursing students in Pakistan often enter training programs starved of genuine role models. Many faculty members lack recent hands-on experience in fast-paced hospital environments, having transitioned into academia years ago without opportunities to refresh their clinical skills. As a result, students rarely witness the art and rigor of bedside care demonstrated by seasoned professionals. Equally troubling is the minimal collaboration between nursing institutions and clinical facilities. In most colleges, academic calendars and hospital rotations operate in silos: curricula are designed with little input from frontline nurses, and clinical sites are used merely as venues for mandatory hours rather than dynamic learning labs. Moreover, the Pakistan Nursing Council (PNC), tasked with setting curriculum development and accreditation standards, has struggled to enforce compliance. Such systemic lapses compromise the quality of nursing education and erode public trust in the profession.

Despite nurses being the backbone of healthcare delivery, Pakistan allocates only 1.2% of its GDP to health, far below the WHO-recommended 5%. This chronic underfunding manifests in outdated facilities, insufficient supplies, and stagnant salaries, conveying that nursing is undervalued. Recently, government nurses in Lahore have launched a major strike to protest the proposed privatization of public hospitals, a movement that has been met with repeated tear-gas shelling and heavy-handed tactics. Despite official silence, the crisis has claimed lives: a nurse was tragically killed in an elevator collapse at Mayo Hospital, an incident deliberately downplayed by authorities. Meanwhile, staffing shortages persist across the province: although 3,000 new nurses were recently recruited, virtually all assignments have been concentrated in Lahore's district headquarters, leaving rural DHQs chronically understaffed. In these facilities, a single nurse may be responsible for as many as 65–75 patients, and even in intensive care units the nurse-to-patient ratio routinely exceeds 1:10 far above internationally accepted standards compounding fatigue, jeopardizing patient safety, and underscoring the urgent need for equitable staffing and transparent accountability. On International Nurses Day, 12th May 2025, under the theme of "Our Nurses. Our Future. Caring for nurses strengthens economies,” we must turn heartfelt applause into real, lasting change. First, our health systems need safe staffing guarantees, so no nurse feels abandoned on a ward. Enshrining minimum nurse-to-patient ratios (for example, one nurse for every four patients in acute care) isn't just a number on paper; it's a promise that every caregiver will have the support they need to deliver safe, compassionate care.

Education sits at the heart of nursing excellence, yet too many aspiring nurses teach themselves through fragmented lesson plans. We owe it to rebuilding our faculty pipelines: offering competitive salaries, robust scholarships, and ongoing professional development so that skilled clinicians can step into the classroom and students' lives as true mentors. At the same time, the Pakistan Nursing Council must be strengthened and resourced to regularly audit nursing colleges, update curricula with modern practice, and hold profit-driven institutions accountable when they cut corners.

Financial hardship should never stand between a passionate student and the nursing profession. We can roll out need-based scholarships, subsidize fees at public colleges, and cap costs at private schools so that no family must choose between food on the table and a nursing degree. And once nurses enter the workforce, their well-being must remain a priority: accessible counseling services, peer support groups, and practical burnout prevention programs can help them carry the emotional weight of care without carrying it alone.

Nasreen's story of a single nurse managing a dozen critically ill patients without support should not be our "new normal.” After more than a decade since my graduation, nurses in Pakistan still endure burnout, educational gaps, regulatory failures, and financial strain. On this International Nurses Day, let us honor nurses not with empty accolades, but with concrete policies and investments that restore their dignity, bolster their capacity, and secure the future of care for all Pakistanis. Please share this message, engage your peers, and demand accountability because when we uplift nurses, we fortify our nation's health.