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Leadership for nurses in India: A futuristic perspective

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Rosamma Jose, Head Nursing, BLK Super Speciality Hospital, gives insights on the evolving role of nurses in the healthcare sector and the need to boost the nursing profession in India

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Rosamma Jose

Nursing has assumed a pivotal position in healthcare today. This profession is on the cusp of a paradigm shift. It is no more a marginal profession. However, it still occupies subliminal space and is in need of robust leadership to get a fillip and occupy centre stage in healthcare.

Nurses form the backbone of patient care in the health sector. They are engaged in the treatment, safety and recovery of ill or injured people, health maintenance, and treatment of life-threatening emergencies in a wide range of healthcare settings. Nurses may also be involved in medical and nursing research and have to perform a wide range of non-clinical functions necessary for the delivery of healthcare. They develop a plan of care, in collaboration with physicians, therapists, the patient, the patient’s family and other team members.

So, nurses play a very crucial role in the medical system. The relation between a nurse and a doctor is similar to that of a general and a soldier. Like a soldier, the nurse has to do most of the work as they spend more time with patients. Nurses are the frontline soldiers while doctors are the generals.

But sadly, in India, this important component of healthcare is in dire straits. Nurses are highly exploited, with lack of respect and dignity at workplaces. They are paid extremely low salaries without any job security. Nurses are not only responsible for their clinical function, but  also adequate care for patients who deserve appropriate and safe care. They act based on the values they have been selected on. These values form a framework to evaluate their activities, influencing their goals, strategies and function. These values can also be counted as a resource for nurses’ conduct toward clinical ethical competency and their confrontation with contemporary ethical concerns. Values conduct human life priorities and form the world we live in. They act as one of the most basic parts of human life. Ethical values are inseparable components of the society and, as a result, of nursing profession too.

Nursing is governed through the National Indian Nursing Council (INC) and State Level Nursing Councils (SNCs) The INC advises the government on nursing matters prescribes national nursing education syllabi and specifies minimum quality criteria for educational institutions. SNCs inspect and accredit training institutions, conduct examinations, monitor rules of professional conduct and maintain an active register.

Trained Nurses Association of India (TNAI) was formed in the year 1908 and the INC was established in the year 1947, which thereafter upgraded the basic educational qualification requirement for candidates desiring to undergo nursing education. Women from the Christian community undertaking the nursing profession were more in number than women from other communities, since, as a profession, nursing did not have a proper status in the eyes of the society.

Great demand for nurses

As the nursing profession, being entirely job-oriented, there is great demand for qualified nurses all over the India. Since many corporate hospitals are being established and many more avenues like medical tourism, home nursing, industrial nursing etc. are available to better qualified and efficient nursing personnel, so migration of trained nurses to overseas countries, especially in the Gulf countries for higher salary and perks. It is a clear indication of increased demand for nurses.

However, in reality, nursing and midwifery profession is not honored as an autonomous body in spite of the fact that they are fully developed, qualitatively and quantitatively. The services rendered by them to ailing patients do not receive proper recognition from other health professionals in the medical field and even by the society at large. They are not accepted as leaders or administrators in their own fields without assigning any justifiable reason for such lack of recognition for the nursing profession.

Challenges to growth

The absence of direct links between the education sector and employment in the domestic sector is a major problem. The nurse who completes the course expects to be employed in India, but often finds herself underpaid and faced with poor working conditions. This gap between nursing education and employment is a consequence of poor planning. For decades, nurses from India, especially from states like Kerala, have been going off to foreign countries. The demand from nursing aspirants reportedly began in mid-2000. Nurses report misconceptions about job availability in India and abroad as one reason for their career choice. Nursing aspirants believed that the developed countries would experience a shortage and recruit nurses from India.

According to recent statistics, the total number of nurses available in India is 1,431,000 (+4.3 per cent) while nearly 30 lakh-qualified nurses are required in India. Compared to global standards there is huge gap between Indian and foreign nurses. Nursing education is at the crossroads in India. There has been a growth in the number of institutions of nursing education, but it has been unevenly distributed across regions. States where institutions have mushroomed need stricter monitoring mechanisms because the quality of training is often questioned. There is a lack of good quality nursing teaching faculties.

Regularisation and standardisation remain the greatest challenge for Indian nursing. Social and administrative responses to the nursing sector have varied across India. The sector will continue to grow, and in order to get the best results out of the system, regulatory bodies should function for the advancement of nursing education and the nursing profession.

The WHO defines health promotion as a process of enabling people to increase control over and to improve their health (WHO, 1986). To facilitate that process, we must provide people with appropriate information. Nurses have a key role in providing that information in the form of health teaching. Nurses are highly educated, experienced health professionals who are accessible through many settings. Telehealth Ontario is a great example of how anyone can access the expertise of a nurse. Anyone can call in with a question, concern or health issue and gain information while being advised of a plan of action right over the phone. Of course, without being able to use hands-on assessment skills, this can be limiting when it comes to dealing with an acute scenario. Telehealth is not for resolving situations that require immediate attention. Nurses can direct people to local resources and give out health and wellness information. It would be useful when parents seek well-baby/ well child information, information on vaccines, smoking cessation, addiction counseling, adolescent mental health resources, nutrition information etc. These are examples of situations where access to accurate health information can assist people in staying healthy.

A degree in nursing does guarantee a job, considering that the nurse-patient ratio in our country is still very poor, but one needs to acquire hands-on skills. They can be acquired by working in a good hospital for atleast three to five years. This is how one can become an efficient nurse and progress in life. Also, a huge gap exists between theory and practice when it comes to the curriculum of nursing colleges. A lot needs to improve. Nurses have to go through rigorous on-the-job training and put in more effort to unlearn traditional practices.

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