Nursing - The backbone of healthcare delivery in the quest for universal access

Shankar Narang ,  Chief Operating Officer, Paras Healthcare, India

Nursing professionals play a vital role in all aspects of healthcare, be it nation-wide health campaigns such as polio eradication, mid-wife services and community education or serving the patients at an ill-equipped healthcare facility in rural India. With their commitment and care, nurses have established themselves as the backbone of the healthcare system and their contribution is critical in achieving the healthcare goals of a nation.

With over 75 per cent of India’s healthcare workforce comprising of nursing staff alone, the role of nurses in healthcare delivery in terms of promotion, prevention, treatment, care and rehabilitation is crucial to the smooth functioning of the system. Nurses are frequently overlooked and often under-appreciated despite their critical role in improving therapy outcomes and quality of care.

A short history of the nursing profession in India

Nursing as a formal practice did not appear in India’s healthcare systems until the 17th century. Most villages had an experienced individual practiced in the art of medicine, delivery of newborns and caring for the sick and the wounded. In the 17th century, the Portuguese military inducted formal nurses into their ranks at local bases. The English East India Company began the first hospital that applied the principles of Western medicine at Fort St. George, Madras, in 1664, and was meant to serve its soldiers stationed at the garrison. Gradually, other hospitals came up at Fort Williams (Calcutta), Neyyoor and other places.

No history of the nursing profession would be complete without a passing mention of the role of Florence Nightingale, whose efforts to highlight the importance of care in reducing mortality rates brought much needed reforms in both military and civil hospitals in India. The Government General Hospital at Madras began the first formal training for nurses and midwives in 1871. Thereafter, various other nursing schools took off across India between the 18th and 19th centuries. During this time, no uniform educational standards were being followed in nursing education. Then, between 1907 and 1910, the United Board of Examiners, for mission hospitals, was set up which formalized a set of training standards and rules. Later Central India (1926) and South India (1913) boards were set up which conducted regular examinations and handed out diplomas. The first school of Health Visitors was started in 1918 by the Lady Reading Health School, Delhi. Subsequently, a four-year B.Sc. program was instituted in 1946 at the RAK College of Nursing in Delhi and the CMC College of Nursing in Vellore. It was not until 1960 that a M.Sc. program was started at the RAK College of Nursing. A two-year ANM course was started at St. Mary’s Hospital in Punjab in 1951.

Improvements in nursing conditions through national policy

Around the time that India gained its independence from the British, hospitals were poorly staffed, nursing had not yet gained respect as a profession and living conditions for nursing staff were below acceptable standards. Nursing had already become a primarily “female occupation” by then. The girls who chose the nursing profession before the 1950s were typically from families with low income or low social status. It took several policy initiatives by the Union government, such as the Bhore Committee, the Kartar Singh Committee and others apart from the healthcare access components of various five-year plans that served to slowly transform career options in nursing or midwifery. In the 1940s, the government decided to introduce Primary Healthcare Centers (PHCs) to promote greater medical access in rural and remote areas. In 1996, it was mandated that every PHC staff 2 trained nurses. Along with fully trained nurses, an army of auxiliary medical personnel such as Accredited Social Health Activists (ASHAs), health visitors, Auxiliary Nurse Midwives (ANMs) etc. were gradually introduced to medical services in places where doctor densities were low or non-existent.

Nursing challenges and opportunities today

Contemporary challenges in nursing have been shaped by revolutionary transformations in technology, complexities derived through changing lifestyles, increased migration to urban slums, changes in weather and the environment, newer more resistant disease vectors, burgeoning population densities and consequent strain on resources.

Nursing professionals play a vital role in all aspects of healthcare, be it nation-wide health campaigns such as polio eradication, mid-wife services and community education or serving the patients at an ill-equipped healthcare facility in rural India. With their commitment and care, nurses have established themselves as the backbone of the healthcare system and their contribution is critical in achieving the healthcare goals of a nation. Nursing is a rewarding career that offers a bright and satisfying future to those who seek to work with people and live by a moral sense of service.

For a long time, nursing was considered to be a dead-end job. Today, its scope has widened not only in clinical care, but also in administrative and teaching positions. Nurses can work for international volunteering organisations such as the Red Cross Society, Nursing Councils or choose among PHCs (primary health centers) and MCHs (maternal and child health services). Those who are interested in a teaching may share their experiences with the upcoming batches of nurses at the Central Bureau of Health Education (CHEB), Trained Nurses Association of India (TNAI). With their first-hand knowledge of patient behavior, nurses can become a vital source of input to health information systems and policies.

Need more nurses that are qualified in days to come

However, there is a shortage of qualified nursing corps in India. According to an analysis of data from the Indian Nursing Council (INC) and the World Health Organization (WHO), India is short of 1.94 million nurses, mainly due to low recruitment, migration, attrition and inadequate working conditions. This is particularly worrying because, according to NHP 2016, India’s nurse-to-population ratio is 1:475.14, including registered nurses and midwives and lady health visitors, a figure that is way behind WHO’s recommended nurse-to-patient ratio of 1:500.

While nursing schools in India have a curriculum imparting the traditional knowledge, the growing influence of technology implies that nurses continuously upgrade their skills. A trained nurse with an elementary technical knowhow probably will be more sought after than those who have a formal training but no technical knowledge. Emerging global threats such as microbial resistance, infections, new pandemics, and natural disasters have added to the requisite skill set of a nurse, as they are the first responders. An educated and well-trained nurse adept at communicating with patients and connecting with citizens, communities and policy makers is an asset few will intend to part with. Much like any other field, nursing professionals too need to upgrade their skills at regular interval. They can join educational sessions and meetings to increase their understanding and keep their skills up to date.

Shankar Narang

With over 15 years of extensive experience in healthcare and operational delivery, Shankar Narang is a healthcare veteran who knows the Indian healthcare industry inside out. During his eventful career, he has been associated with several organisations of repute including Fortis, Max Healthcare and Columbia Asia, to name a few. His innings at Paras Healthcare as COO marks his second innings at the organisation with which he was earlier associated in the capacity of GM Operations & Quality for five years.

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