Status Quo Of Nursing In India And The Way Forward

“You don’t build a house without its foundation, and so you don’t build a  hospital without its nurses”

Due to the COVID-19 epidemic, the healthcare landscape in India and around the world has  transformed. Care for people of all ages, families, groups, and communities—whether they are ill or  not, and in whatever setting—can be provided independently and in collaboration with other careers  through nursing. The care of the sick, the disabled, and the dying is included, as well as the promotion  of health and the avertance of disease. Nursing professionals work at the forefront of disease prevention, primary healthcare delivery, including promotion, prevention, treatment, and  rehabilitation, and are frequently the first to identify health emergencies.  

In order to improve patient experiences in the healthcare facilities, education is crucial in nursing.  Nursing mentors are aware of the necessity to educate students about changes in themselves as well  as the use of technology as a tool to supplement their knowledge and skills for better patient care.  Despite the crucial part nurses play in healthcare, there is a global nursing shortage that is anticipated  to worsen as the world’s population rises. More underprivileged areas are now able to obtain health  care services thanks to initiatives, especially in low- and middle-income nations, which increases the  demand for nurses with the appropriate training. The global push for universal health care necessitates a skilled, driven, evenly dispersed, and supported health workforce, and nurses are a key component  of these initiatives.  

The Finance Minister, Smt. Nirmala Sitharaman, announced the opening of 157 new nursing colleges  in co-location with the 157 medical colleges that have already been operational since 2014. A total budget outlay of Rs 1570 Cr will be earmarked for the scheme under which these nursing colleges will be established. The hundred B.Sc. nursing seats programme has been implemented as part of the new financial plan thereby adding more than 15,000 B.Sc. (Nursing) seats in total. 

Background

International outline: With approximately 59% of all health professionals working in nursing, it is  currently the largest occupational group in the industry. A deficit of 59 lakh nurses was predicted for  2020 according to the WHO’s State of the World’s Nursing (SOWN) report, while a shortage of 57  lakh was predicted for 2030. In a similar way, the International Council of Nurses (ICN) predicts that 17% of nurses would retire in the next ten years, creating a requirement for an extra 47 lakh nurses.  

National layout: Of the overall health workforce in India, 47% are nurses, with 82% of them being female. They are the driving force behind the healthcare delivery system and are acknowledged as highly skilled professionals, but their strength is below average by worldwide standards and has to be sufficiently improved. 

Unfair distribution of nursing institutions across the nation:

More than 85% of institutions and seats are in the private sector for a variety of nursing programmes, including GNM, B.Sc., M.Sc., and others, whereas the public sector has seen negligible development.  When compared to government-run nursing colleges, the growth of institutions in the private sector has had an impact on educational standards and quality of instruction. Because these colleges are concentrated in a small number of districts, many other districts in the states lack nursing colleges. The unfair distribution of college can be bridged by the proposed budget scheme.

Nursing education challenges

There are many nursing institutions in India today, however the majority are private. Only a few of the nursing institutions maintain the standard of nursing education as per the council and government  norms. Many of them were raised with the goal of accumulating funds, and their educational standards are far from ideal. The Indian Nursing Council is largely tasked with overseeing the country’s nursing education; however, state nursing councils are in charge of approving institutions’ requests to function as colleges  or schools of nursing. There are numerous standards and ongoing issues, including:  

a) the level of education being provided; private and public institutions are lacking infrastructure and  facilities for training qualitative students 

b) the availability of the necessary infrastructure (enough building space, laboratories, skill labs,  libraries, etc.;  

c) the caliber and quality of the nursing mentors  

d) inadequate practical skills, due to lack of clinical facility and many institutions lack parent hospitals  for the nursing institutes, low educational level, quality of education imparted is not as per the norms, and frequent inadequate facilities leading to a workforce of inexperienced nurses, which  could have negative effects on the nation’s overall health outcomes.

Addressing nursing education problems:

Campaigning : A flourishing world requires good nurses, good care, and good health. As the saying goes, our future  depends on the upcoming generation thus encouraging young people to pursue careers in nursing  fields to improve the emphasis on best quality care. To encourage students to choose nursing as a  profession, the nursing profession should be introduced to students in higher secondary schools. There 

are people who are unaware of the nursing profession; in order to educate them, the profession should  be advertised with all of its opportunities and potential applications, as well as the fact that nurses can  work in a variety of settings besides just hospitals, colleges, and the community, such as, school health  nurse, industrial nurse, occupational nurse, travel nurse, cruise nurse, space nurse, etc.  

One of the studies conducted shows that high school students’ perception about social recognition  and reputation of the nursing profession is poor as compared to other aspects of nursing i.e. education,  opportunities and career advancement. It acknowledges the knowledge and perception of the target  population with an awareness gap among them.

Advanced Teaching pedagogy : The environment of teaching and learning, includes but is not limited to technology-supported  learning, it is changing as a result of the expanding accessibility of technology gadgets or portable  digital assistant (PDA) devices.  

Some of the innovative ways we can use include encouraging partnerships and learning  opportunities, identifying and disseminating information about the advantages of nursing, and  working with universities and community colleges to allow students to transfer from an associate  degree to a Nursing degree without having to repeat coursework. We can have an association with  the IIT sector, wherein small crash courses on technology can be provided to the teaching faculty or  to the nursing students. Digital libraries should be built in the nursing colleges to enhance the  knowledge of both the faculties and students. 

Development of teaching faculties: The present teaching staff can enroll in updated courses in teaching simulation-based instruction and  teaching reflective skills. Both nursing students and nurse practitioners will develop new skills, such  as communication, soft skills, and Technological skills. To preserve industry standards, universities  must maintain high levels of accreditation. The state nursing council can take initiative for organizing the faculty development programme at the state level. In order to improve the faculty’s  pedagogical abilities and capabilities, colleges should have a faculty development cell. The quality  accreditation of the colleges is necessary to uphold the industry requirements. 

Promoting the specialization course : The INC has launched a programme for nurse practitioners including nurse practitioner in critical care  and nurse practitioner in midwifery. With the aid of nurse practitioner courses, nursing students or  staff nurses can be equipped to work in tertiary care settings. Thorough educational preparation will  enable them to diagnose and treat patients with critical illnesses as well as provide preventative and  promoting care pertinent to such illnesses and patients’ reactions to illness.

Obstacles to nursing practice

Both private and state hospitals fail to pay the minimum salary as per the set standards by the  government. According to Indian Nursing Council (INC) figures, there are approximately 24.74 lakh  registered nurses (GNM and B.Sc.) and 10.4 lakh ANM/LHV in the nation, resulting in a nurse to  population ratio of 2.06 per 1000 people compared to the WHO norm of 3 nurses per 1000 people. In  its report Investment Opportunities in India’s Healthcare Sector, 2021, NITI Aayog predicted that  India will need an additional 30 lakh beds to reach its goal of 3 beds per 1,000 people by 2025, as  well as an additional 24 lakh nurses to keep up with demand. Extended work shifts of twelve hours  or longer are common and even popular with hospital staff nurses, but little is known about how such  extended hours affect the care that patients receive or the well-being of nurses. Nurses also complain about their work environment such as; work overload, lack of resources, support, cooperation,  participation, and flexibility at work, weak leadership, role ambiguity lack of respect from others, and  exposure to infection, which in turn affects their professional commitment.

Overcoming obstacles in nursing practice: If the needed wage is provided to the nursing fraternity in accordance with the rule set forth by the government, the nurses’ pay would grow. Opening new  nursing colleges is a good step because it will contribute to the development of a new pool of needed  healthcare personnel. Policies should be made for regulating work hours for nurses and incentives  can be provided for the extra working hours. By providing a positive working environment, hospitals  can attract and retain highly skilled professional nurses which in turn promotes high job satisfaction  for nurses and excellent patient care. Before nurses are deemed qualified to obtain their license to  operate as an RN or advanced nurse practitioner, the licensing system should be improved to include  standardized skill assessments and stagnant exit or licensing exams like America’s National Council  Licensure Examination for RNs exam.  

It is important to offer in-service training to hospitals and colleges alike. In order to prevent hospital  nurse shortages, it is necessary to require newly graduating nurses to sign contracts for at least a year.  They should also be given access to private sector health insurance plans.  

Roadmap for future nurses: To overcome the enormous gap and seize this fantastic opportunity, the public  and private sectors must work together. There should be more nursing schools built in a way that will give isolated areas or districts opportunities to connect with one another. This will make it possible for those who are unable to travel to a nearby or distant institute to participate in elementary-level  learning experiences. The standards and caliber of nursing education should be the same across all  nursing colleges, not just in terms of the curriculum. There should be a centralised council that can maintain the uniformity in both the nursing education and nursing practice area. Great nurse leaders  are required due to the dynamic nature of the healthcare industry and the rapid rate of advancement in patient care. To develop future nursing leaders, nursing students should be trained in  communication, should be trained for high self-confidence, and deliberate mentoring. 

In India, the bodies that make decisions ought to involve the nurses. The Lok Sabha, the Lower House  of Parliament in India, as well as all state legislative bodies would be required to reserve one-third of  all seats for women under a proposed amendment to the Indian Constitution. A seat for a nurse to  represent the nursing fraternity should be allocated from this one-third of the seats. The establishment and strengthening of the state health directorate will allow nurses to make decisions at the state level. The nurses should be given a position at the public and private level, which will allow them to earn respect in the eyes of people. Both colleges and hospitals should support community involvement and clinical nurse consultant initiatives. To raise patient safety, care quality, and academic standards,  clinical nurses might be given additional speaking opportunities.  

“Nurses are the hospitality of the hospital.”