Historically, developed under the British rule, nursing was one of the first profession to develop in India. This noble profession has witnessed tremendous evolution strides in all spheres including technology, medicine and medical equipment. From being considered as an art based human subject, it has evolved into the field of technology. However, the status of nursing in our country is still a subject of debate. With organisations coming forward in the leadership of influential public figures, will the status of this noble profession remain the same even in 21st century?
Historically, nursing in India had evolved under British rule. The British Medical Services, later known as the Indian Medical Services, were the first to develop nursing as a profession in India.
Nursing as a profession has evolved over the years from being an art based human approach to a technology oriented science subject. The role of nurses has changed dramatically over the last couple of decades. I have seen evolution in this field from the time I had entered this profession, exactly 40 years ago.
In any health system, the health worker determines the nature and quality of services provided. Data demonstrate that most health systems across the globe face nursing shortages, varying across regions and rural-urban distribution. Although nursing services are an integral part of both preventive and curative aspects of India's health system, the nursing estimates of the country shows that India has been facing a shortage of nurses since independence.
Earlier, nursing had little to do with formal training on clinical practices, infection prevention and patient safety. A few decades back it was more about following the doctor’s orders and comforting the patients and counselling them. Nursing curriculum didn’t include training & exposure to vital aspects to handle patients independently.Young nurses lacked confidence in infection control protocols, basic & advance life support measures and doing skill based procedures. The role of nurses was given prime importance in terms of basic still sets with a human touch.
However, over the last two decades,with technology playing a key role in healthcare and with hospitals adopting digitization, cloud data storage, and electronic documentation, nursing as a subject has become more science and technology driven. Nurses today are expected to hone their skill sets on the latest technologies. For instance, we at Columbia Asia Hospitals are completely paperlesswhen it comes to patient’s medical records and other documentation.Nurses very easily adopt technology once they are inducted & trained in the Hospital Information System.
This apart, now,focus is given on imparting knowledge to the nurses along with hands on skills in operating the newer medical devices and equipment for handling patients likesmart drug infusing pumps, drug delivery pumps, and patient’s monitoring systems. Nurses are using newer technology for assessing and monitoring patients
The good news here is that since majority of the nursing professionals belong to the younger age group, they are flexible with the evolving systems which never existed in earlier days.
However, we should understand that training of nurses should ideally go much beyond imparting technical and medical skill sets. As nurses anddoctors are the pillars of patient care in the hospital, it is vital for them to work in coordination. Thus, it is important for nurses to get trained to enhance their integration with the doctors. Also, nurses and doctors should be trained together in disease management, from the point of medical management and nursing management, so that they can work as a team with a common clinical goal which improves patient outcomes. This helps in ensuring that they all speak the same language with no miscommunication when they involve in patient communication.
Counselling plays a vital role in a nurse’s skill set today. Nurse Counsellors are trained to educate the patient and his family about a disease and how to handle it. Nurse Counsellors are also expected to counsel the patient’s family, educate them about patients’ safety in the hospital and at home, and focus on ways to maintain hygiene for the patient. These are new training guidelines which go much beyond the traditional nursing training.
A nurse in a private or a corporate hospital has to internalise communication etiquettes, communication content and other soft skills. At Columbia Asia, there is a standard script designed for nurses for all the communication that she must do with the patient. For instance, there are exact drafted words that she should speak to a patient on hospital bed or during discharge.
Another important factor today is grooming of the nurses. Nurses hail from various parts of the country, with many coming from smaller towns and many of them are not comfortable in communicating in English. Hence, they are trained in English communication and grooming. A little make over with knowledge about carrying themselves presentably, maintaining personal hygiene, adopting pleasing manners goes a long way in adding to their overall personality and service offered. They are also trained in body language and how not be rude to the patient.
Also, training is given on computer skills, keeping in mind the rising standards of the hospital. Now-a-days, apart from conventional nursing skills and nursing procedures, a customer also looks at a seamless experience or approach. Therefore, nurses have to be trained to work in integration with other departments for establishing inter-departmental coordination and communication.
Nurses form the backbone of any medical services or patient care in the health sector. But in India, this important section of workers are highly exploited, with lack of respect and dignity at workplaces and more importantly paid extremely low salaries with lack of job security.
The demand and supply ratio of nurses in India is getting wider with trained nurses from India are settling for greener pastures abroad. For decades now, nurses are taking up jobs in Middle East, many European countries, Canada, and very minuscule numbers are relocating with jobs in the US.
The nursing profession in India lacks high professional status, has low and unattractive salaries, gets inadequate recognition from the community for the services provided by them and has little incentives for quality performance (Gill 2009). The institutions responsible for nursing training lack the required physical and human resources.
The nursing profession is given low social status because of the prevalent societal traditions. Nursing work involves rendering services on a personal level to the patient and has chances of being exposed to bodily fluids and contaminations. The work undertaken by nurses still has social stigma attached to it . This can be cited as one of the main reasons behind the low perception held by the Indian society towards the nursing profession. The nurses are considered to be secondary in position as compared to other health professionals in India. There is a vast difference in the prestige and recognition accorded to doctors as compared to nurses (Gill 2009). The nursing profession continues to be neglected in India. Some of the causes behind this neglect are more emphasis on medical education, political influence by the medical community and less allocation of financial resources on health by the Indian government (Rao, Rao, Kumar, Chatterjee, & Sundararaman 2011).
Thus, with time and experience, they prefer to move overseas as there is respect, good compensation with annual perks like free vacations, good living conditions and other benefits.
In India, most of the women in nursing would want to move to a government set-up because of job security, accommodation and medical benefits. They would choose to work for a government establishment even though there is not much professional growth, as they get various benefits which is not available in private sector. Experienced nurses in India also prefer taking up teaching jobs in nursing colleges as they get position of assistant professors which is of a much better social status as compared to nurse.
It is about time that various stakeholders seat together and decide on a standardization, when it comes to salary for nurses. There have been some efforts in the last two years where FICCI along with other stakeholders came up with an advisory panel to reforms nursing condition in India.We have worked for the last two years and have come up with a white paper for reforms including compensation, growth, speciality vacancies and many more.
Since healthcare is growing, demand for nursing as a profession is bound to grow. However, students choosing nursing as profession are dropping drastically. Younger generation is not motivated enough to take up nursing. They rather choose a career path with a BBA, engineering or MCA degree, where life is better with good salary to start with and a respectable social status. Today, as much as 30-40 per cent seats during enrolment are left vacant. Hence, India is going to struggle with availability of nurses, unless the working condition, compensation and social status of nursing professionals are elevated. This calls for an immediate change in the social framework at par with international standards.
Strong political commitment is required for improving the nursing situation in India. Good working conditions must be provided so that nursing workforce can be developed and deployed in the health services fulfilling the recommended staffing norms. Nurses should be considered as active members of the health team, in terms of not only providing services, but also as a part of the decision-making processes, so that it is possible for her to participate in providing holistic and comprehensive healthcare to the patient. The nursing education programme in India should be strengthened. The Indian Nursing Council should be vested with requisite powers, so that it can work with in tandem with the State Nursing Councils for the purpose of regulating and maintaining standard in nursing education and training. The government should take initiatives to create and empower leaders from the nursing fraternity itself. Moreover, there should be efforts to provide adequate infrastructure, remuneration and working conditions to the nurses. Efforts should be made by the government to retain qualified nursing personnel in the country. Reducing movement of nursing personnel outside the country must form one of the priority areas of the government. The nurses choose migration as a realistic option arising out the circumstances existing in the country. Adequate incentives, both financial and otherwise, need to be provided in order to retain health staff. Addressing the issues and problems faced by the nursing fraternity will help not only to in reducing migration of nurses from the country but also to some extent it will help in reducing the nursing shortages faced in the country.