Healthcare minus competent nurses a travesty
The Nursing Council of India's effort to improve specialised training for nurses is a step in the right direction. Hopefully, the draft curriculum it has prepared for the two-year Critical Care Nurse Practitioner Programme will be approved and implemented at the earliest. The programme is in keeping with the National Health Policy of 2015, which calls for a greater focus on skill development.
If it’s implemented effectively, it will go a long way in improving India's healthcare sector. However, for measures such as this to reach their full potential, it is important to address the larger legal, administrative and socio-economic issues relating to the overall management of the nursing profession. For example, the average nurse today is legally barred from administering even a painkiller or anaesthesia. Not only does this put unnecessary pressure on the physician, it also under-employs the nurse in an already resource-starved environment. Another issue is that India is facing a phenomenal shortage of nurses. The numbers are overwhelming: In 2013, it was estimated that the country needed an additional 2.4 million nurses.
Today, the country has an average of one nurse for every 2,500 individuals, which is appalling compared to the ratio in developed countries, where there is one nurse for every 150-200 individuals. Also, while the nurse-doctor ratio is at three and five nurses per doctor in the US and UK respectively, it is 0.5 to one in India. Worse still, with every passing year, the number of nurses in India is dropping. According to one of the country's prominent cardiologists, Dr Devi Shetty, who also runs a chain of hospitals, India had 1.65 million nurses in 2009 but now has 1.56 million. Dr Shetty also estimates that, if the current trend continues, around half of the private hospitals and most Government hospitals in the country will have to shut down in the next five years.
But this is only one side of the story. On the other side, there is the fact that, despite the rising need for nurses, seats in nursing colleges are actually going vacant — so much so, that many nursing institutes are on the verge of closing down. An important reason for this is that most nurses are poorly paid, especially in the private healthcare sector. Government institutions pay better but they also deal with much larger number of patients — as a result of which nurses (and all hospital staff) are overworked. Unsurprisingly, most of those who train in India to be nurses, use their diploma or degree as a ticket to much better-paying overseas jobs.
This is especially true for the small number of nurses who undergo advanced training — they almost always move abroad or move out of clinical work and take up administrative or academic positions in India. This is something that the Government may like to keep in mind for its proposed critical care programme — which will only be available to the small minority of nurses who have BSc degrees (the vast majority have nursing diplomas).