(Abanti Gopan is a Nursing Consultant, Member, Board of Directors at Disease Management Association of India and Dr. Himadri Bisht works as a Research Associate, Health Parliament, Think – Tank)
Nurses are a critical part of healthcare, but the profession continues to face a shortage, lack of respect and recognition for their work, inequitable work distribution, burnout and abuse at healthcare facilities. The role of nurses is majorly limited to patient care and support and is not considered integral in decision and policy-making.
India is experiencing a serious brain drain as a high number of nurses are migrating from India to the USA, UK and Gulf countries, resulting in a grave shortage of nurses in India. The nurses are migrating because they enjoy better pay scales, a more relaxed work atmosphere and work recognition in these countries.
According to the 15th Finance Commission report, the shortage of trained nurses is even direr than doctors, with a nurse-to-population ratio of 1:670 against the WHO norm of 1:300. Various factors like low professional status, measly wages, lack of political will on the part of the government and unregulated private sector have led to a scarcity of nurses in India.
It is often seen that nurses don’t get respect and recognition for their work and efforts. Instead, they are overworked and underpaid. Cases of aggression, verbal abuse, bullying and horizontal hostility against nurses are not uncommon. Such incidents negatively impact the mental wellbeing and work efficiency of the individuals and also affects morale, satisfaction, and quality of care.
While globally, over 3000 deaths of nurses due to Covid was recorded in January 2021, millions got infected and got back on their feet even before they could restore full strength, and yet another 20 percent globally quit the profession. Eighty percent of nurses globally reeled under stress, burnout and feel traumatised having to witness helplessly as death ravaged the infected patients.
In the study conducted by a think tank, Health Parliament, in association with the Disease Management Association of India (DMAI), it was clearly established nursing as a profession is facing a crisis of Perception, Relevance and Existence. A shockingly high percent (75.80%) of nurses said they are bound to leave the profession due to low pay and overwork. Another major finding of serious concern is the violence and bullying at the workplace against the nursing staff. On further extrapolation, it was found that 30% of the nurses have faced some kind of abuse in their nursing career. This included abuse from patients, patient attendants, workplace seniors, doctors, and administrators. All the participants expressed a lack of a system in place to address the abuse and even a lack of support from colleagues or the administrators if they wanted to make a complaint against the abuse faced. Nurses also reported being threatened by patient attendants in case of patient death or unavailability of resources and sadly, management took no steps to ensure their safety.
In the study majority of the respondents (57%) identified patient care as their primary job function. However, a significant percent (17.83%) of nurses mentioned they have no clear or defined roles. This clearly shows the system does not realise the importance of nurses in delivering healthcare services, which could be one of the major reasons affecting the quality of healthcare in the country. The study revealed that 60% of nurses feel their potential as a nurse is not being utilised to the full currently and they are competent and capable of taking up additional roles and responsibilities.
In the study, 62.42% of the respondents said they received training in using digital tools, of which 74.52% were trained in institutions they are working. Different institutions setups provided the digital technology and tool training based on the availability of such systems in the institutions. Nurses were mainly trained in using and managing Electronic Medical Records, Electronic Health Records, and Personal Health Records. With the push for digitalisation of healthcare from the government in India, it becomes all the more important for healthcare professionals to be proficient with the use of digital health tools and technology. Also, when asked about reorienting the role of nurses in healthcare, 69% of the respondents concurred that they could contribute more than their current job roles if given an opportunity. Nursing information specialist, leadership, administration, decision making and hospice coordinator were the top five roles that the nurses identified for themselves in the future.
As the nation has woken up to the significant contribution nursing professionals have in the health care system, their voice needs to find a place of prominence among health care policymakers.
We need to ensure a safe working environment and stringent institutional mechanisms to address workplace abuse and violence. Re-orienting the role of nurses by involving them in decision making and leveraging their skills and expertise in managing chronic & acute illnesses and Accident & Emergency department, so that they can contribute more effectively in transforming healthcare. Nurses should be empowered by providing them with hands-on training in using and managing the latest digital health technology and tools. Nurses should be authorised to prescribe non-emergency drugs under supervision. These are some of the most promising action points from the study.
There is an urgent need to address these issues through appropriate policy intervention. The beginning in this direction can be made through appropriate policy changes by the Ministry of Health and Family Welfare.
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