Challenges faced by the Nurses in Current Indian Health System
Dr. Laxmi Verma* and Dr Dhananjay Srivastava
International Institute of Health Management Research, India
Submission: August 03, 2018; Published: August 09, 2018
*Corresponding author: Dr. Laxmi Verma, International Institute of Health Management Research, Delhi, India, Tel: 9958896964; Email: dr.laxmiiverma@gmail.com
How to cite this article: Dr. Laxmi Verma, Dr Dhananjay Srivastava. Challenges faced by the Nurses in Current Indian Health System. JOJ Nurse Health Care. 2018; 9(2): 555757. DOI: 10.19080/JOJNHC.2018.09.555757.
Abstract
Nursing is a distinctive profession which is at the cusp of the Arts and Sciences. Nurses and midwives constitute nearly half of the health workforce population around the world [1]. In India, nurses make two-thirds of health workforce. Nurses despite being a critical link between healthcare sector & patients, they are exploited, treated with lack of respect and dignity at workplaces and most importantly the compensation provided to them is very low & they have lack of job security. Accessibility to skilled, motivated and supportive nursing care within a robust healthcare system by all is of paramount importance. The role of nurses in healthcare sector is very important as we attempt to create a better task force for better quality care for all. In the present healthcare system the Nurses face a number of challenges. There are issues at every level: organizational level, state level & national level, affecting the morale of the nurses. In order to take care of the challenges firstly it is important to identify & understand all possible challenges. Next step after recognizing & understanding the challenges is to provide solutions to mitigate them.
Keywords: Nurses; Challenges; Health system; India
Introduction
Nurses have been described as the “sheet-anchor” in the healthcare system that aims to provide primary healthcare to all irrespective of ability to pay. There is a state of paradox in healthcare industry that on one end there is great demand for health professionals, while on the other hand it is evident that the nurses are not paid well & are forced to work in an exploitative environment in the unregulated private sector. Currently in India the Physician Nurse ratio is not satisfactory. The country needs 2.4 million nurses to meet the growing demand [2]. The HLEG (High Level Expert Group) group report on UHC (Universal health coverage India) 2011 is increased reliance on a cadre of well- trained nurses, which will allow doctors to focus on complex clinical cases [2]. There is a very complex clinical milieu with the nurse being in the center of this maze replete with multiple lines of control and responsibility and limited autonomy and authority. Nursing as a sector in India continues to experience several daunting challenges in terms of Availability, Distribution, Retention among others; leaving them less efficient in rendering quality care to the patient. These challenges act as primary motivators for nurses to leave their profession, less students opting for nursing profession. Alternative careers with better compensation, easy work hours and opportunities to migrate abroad tend to attract nurses better [3]. It has also become evident that the role of nurses is very limited in leadership, decision making & policy level at their workplaces.
Challenges Faced by Nurses
Workplace health hazards: Nurses are constantly exposed to rigorous physical and mental stress attributed to abundant workload and also they are not even provided with health coverage. Long working hours: Majority of the nurses have to work beyond the mandatory 8 hrs shift to more than 12 hrs. Apart from wages, nurses are not given employment benefits and gratuity and working in night shifts disrupts their work-life balance.
a. Shortage of Staff: As there is evident shortage of the staff in hospitals, nurses has to even perform non nursing task and this makes the nurse-patient ratio quite poor, and nurses attend patients in more numbers than they are expected to. Thus in many hospitals the average nurse-patient ratio is quite higher 30:1 in some cases, whereas the allowed ratio is 1:61. As nurses are overloaded with extra work, it hampers the Patient- Nurse engagement.
b. Lack of Recognition: Nurses, even after pursuing professional status, are not recognized by others, be it their superiors or the community, hence this creates a huge gap between how nurses understand themselves and the way community understand nurses.
c. Lack of Autonomy: India a nurse has limited autonomy and authority. In other countries, nurses play vital role in decision making, but in India it is lacking.
d. Societal Challenges: Nurses are skilled professionals who undergo training and undertake professional course to attain professional status. Still, they have often been seen by others as unskilled, morally suspect women who works as servants do. The recognition that they feel they deserve has not been given to them. This gap between what they are and what other thinks of them has caused a painful distress among them about status, and has made them quite aware of the injustice of it [4].
e. Ethical Issues: Another aspect that has not been highlighted much anywhere is of human rights in the form of sexual harassment to them (female nurses). Lack of work place ethics and lack of respect, with harassment by either doctors or the management by constantly accusing them of dereliction of duty make it more difficult for them.
f. Lack of Growth Opportunities: In India seats in nursing colleges are increasingly falling vacant and the annual supply of nurses is short. Furthermore, qualified are eagerly looking for better paid jobs in richer countries. Most of the nurses migrating to the high income countries come from the developing countries such as India [5,6]. India with an already dismal health system is suffering more as nurses are migrating to other countries.
g. Financial Issues: In the private sector, pays are pathetically low and lacks standardization. Many have to sign a bonded contract that inevitably binds them to that facility and breaking the contract often involve paying huge amount for obtaining their release. Otherwise, all their certificates are held by the hospital management.
What can be done?
To achieve universal health coverage and to ensure access to the essential services, the prime focus should be on health workers. So pragmatic solution of the above discussed critical issues for better utilization, working conditions and career track of nurses are:
a. Positive Practice Environment: An environment in which all health care workers have a responsibility as part of the patient centered team to perform with a sense of autonomy, professionalism, accountability, transparency, involvement, efficiency, and effectiveness. All must be mindful of the health and safety for both the patient and the health care worker in any setting providing health care, providing a sense of safety, respect, and empowerment to and for all persons [7]. Effective interpersonal communication in work settings serve as motivation to the nurses. It is the need of the hour to retain the nurses by creating a healthy and nurturing environment where they have abundant opportunities to learn and grow. Implementation of nurse centric, physician guided healthcare model in which nurse and physicians works as a team. Nurse also gets autonomy and is a part of decision making. Workload balance: Removal of redundant & non-productive tasks from the lists of jobs assigned to nurses to give them more time for patient engagement. Also providing them with incentives and rewards time to time. Nurses should be seen as leaders & administrators, they should be provided with Finance & management trainings. Providing technology to support the nurses for the requisite clinical support and inventory backup. The health ministry and the Indian Nursing Council should create specialists courses to train nurse practitioners, nurse intensivists and nurse anesthetists. This will enable them to earn higher salaries to prevent their attrition to West countries.
b. Evidence based Practice: Best practices should be shared by organization with the nurses so that they will get a hand on what works and what not for quality service. Research should form an integral part of their practice. Some urgent strategies need to be implemented now because the growing attrition and reduced enrolment rates will adversely affect healthcare system. We need to cultivate good governance backed by exemplary leadership. Hence it is urgent now to focus on creating transformational leadership at all levels of Nursing by utilizing the leadership capacity of senior nursing executives as well as bedside nurses.
Conclusion
Patient and the public have the right to receive the best treatment & services from healthcare professionals. And this can only be achieved by a motivated and well-prepared workforce. Sufficing to the requirement of nurses and facing their challenges can make nurses empowered, encouraged, challenged and affirmed to continue to excel to do best without any barriers.
References
- WHO (2018) Nursing and midwifery
- FICCI Report (2016) Nursing reforms Paradigm shift for a bright future. FICCI: New Delhi.
- James, Merlin (2017) Challenges faced by Nurses in India - The Major Workforce of the Healthcare System. International Journal of Nursing & Amp; Midwifery Research 4: 23-27.
- Sreelekha Nair, Madelaine Healey (2009) A Profession on the Margins: Status Issues in Indian Nursing. e Social Sciences, p. 1-24.
- Buchan, J, Scholaski J (2004) The Migration of nurses: trends and policies. Policy and Practice, Theme Papers. Bulletin of the World Health Organization 82 (8): 587-594.
- Reema Gill (2011) Nursing Shortage in India with special reference to International Migration of Nurses. Social Medicine 6(1): 52-59.
- Healthy Work Environment: The American Nurses Association (ANA).