Health ministry to review nursing service guideline

Ministry of Health

Nurses are disappointed with the recent Samtse Dzongkhag office order to restrict them from taking leave on their accumulated non-working days

LHAKPA TSHERING | Thimphu

While nurses taking leave by compiling their working days after toiling during government holidays and Sundays have been a customary practice in the country, there are no clear guidelines on whether their day-off can be accumulated to take leave.

Following the recent decision of the Samtse Dzongkhag human resource committee (HRC) for the nurses in its dzongkhag to restrict from taking leave accumulated from working on non-working days, the Ministry of Health (MoH) will be reviewing the Nursing Services Administrative Manual 2018.

In the office order dated 7 February, Samtse dzongkhag administration stated that henceforth no dues for working during holidays will be considered in order to take leave while day-off accumulated thus far will be considered nullified.

The dzongkhag stated the decision was in accordance with the Bhutan Civil Service Rules and Regulations (BCSR) 2018 and guidelines of the health ministry as the day-off system is not in line with its provisions.

Bhutan Times learned that the issue was put up to the HRC meeting after they found a nurse was on leave when the hospital called for duty. It was found the nurse had taken her day-off dues without even applying for leave.

The health ministry’s chief human resource officer, Sangay Thinley, said the ministry is working to review the nursing service guideline. “The system is followed not only in Samtse but throughout the country,” he said, adding the ministry will review the guidelines and amend the necessary clauses at the earliest.

He added that the ministry has also asked the nursing superintendent of the national referral hospital (JDWNRH) to prepare a report for a way forward. “We will discuss the issue at the ministry following which it will be further deliberated with the Royal Civil Service Commission (RCSC) for the final outcome,” he said.

Even though the health ministry is the parent agency of the hospitals, the dzongkhag health sector did not write to the ministry for the consultations while a copy of the office order was also not shared with the ministry.

It was learned that this issue was deliberated several times at the annual health conferences in the past years but nothing concrete had come out of it.

Meanwhile, Samtse Dzongdag Pasang Dorji declined to comment on the decision saying he remains occupied and would be available to comment when the situation improves in the dzongkhag. The district health officer also did not comment on the issue.

RCSC Clarifies

The RCSC in an email response said MoH as the parent agency for health professionals should look into this issue and do the necessary follow-ups.

“The RCSC has decentralized the human resource (HR) management to the respective agencies as per the BCSR, and agencies may determine their own internal leave policies to limit the disruption to service delivery,” the commission stated.

In line with this provision, RCSC said the MoH has developed a Nursing Services Administrative Manual 2018 which permits weekly day-offs and on government holidays. “However, the manual is silent on the leave accumulated from off days.”

The commission said that while they are extremely grateful for the commitment and selfless service of health professionals, it is important to understand whether Samtse Dzongkhag had issued the office order in the context of potential emergencies during the pandemic or due to other public interest.

RCSC said the work schedule of health professionals with specific reference to nurses in this context is quite vague. “Their work schedule is quite different from other civil servants as they have to do night duty of 12-hours shift twice a week and 6-hours of regular shift on other days with 1-day off in a week.” 

The commission further stated that during lockdowns the nurses are required to work for 12 hours at a stretch in personal protection equipment (PPE) to reduce risk of exposure of the health staff.

Views from nurses

Following a copy of the Samtse Dzongkhag’s office order being shared on Facebook page “Nurses of Bhutan (NoB) on 10 February, many nurses commented revealing their frustration against the order.

They said no nurses have gone on holidays by accumulating off-day working hours from their normal working hours, and that they worked additional hours which can’t be compensated in financial terms or other remunerations.

A health worker in Samtse Dzongkhag said that nurses have been overworked to keep the healthcare system running during the pandemic. “It is not that the nurses deliberately wanted to accumulate the off days to take the leave. But we are being asked to work even on rest days as the situation demands.”

Another nurse said they have been working round the clock and responding to the need of the hour and to cover up the problem of understaffed healthcare centers. “Understanding the importance of our primary job, we have sacrificed even our day- and night-off, and other personal emergencies.”

The nurses said they feel disappointed with the office order. “With the number of coronavirus cases surging in the country and the outbreak in the district, some nurses have been doing their duty 24 hours a day without even a day’s rest. Unfortunately, the office order was issued like we failed to shoulder our responsibility. Many of my co-workers were demotivated.”

Another nurse said that a few nurses have to cover all the patients round the clock. “There is no nurse-to-patient ratio like in other countries. Even if we have accumulated day-offs, we have to come for work depending on patients’ needs. It is very difficult especially at the primary healthcare centers level.”

Nurses in Samtse Dzongkhag say the dzongkhag health sector issued the office order without consulting health workers on the ground and concerned authorities before taking up such a drastic measure.

Over the past months doctors and nurses have been undergoing extreme burnout amid soaring hospitalization and infection rates putting a strain on the health system.

Besides their regular duty, nurses in Samtse are also deployed on Covid-19 duty in the hospital and isolation, quarantine facility, vaccination, and medical escort during a patient referral to higher healthcare facilities, Further a few of them have been deployed to manage Covid-19 cases in Sibsoo and Phuentsholing hospitals.

Meanwhile, some nurses claim that such practices are mostly associated with regional and national referral hospitals. “Our hospital management will not even allow us to take leave for more than three days given the nature of our jobs. However, we are left with no alternatives,” a nurse said.