The hands that heal

Chahat Rana
World Health Organisation, Year of the Nurse and Midwife, Sukhpal Kaur, National Institute for Nursing Education, Post Graduate Institute of Medical Education and Research, PGIMER, indian express news

According to statistics shared as part of the campaign, nurses and midwives account for nearly 50 per cent of the global health workforce, yet the world needs at least 9 million nurses and midwives to achieve health for all by 2030. (Illustration: Suvajit Dey)

“It is most important for people to know that nurses are not the assistants of doctors, they are medical care professionals with their own role to play. They are neither below nor above doctors, they have a completely different but very sensitive set of duties to perform,” says Dr Sukhpal Kaur, the acting principal of the National Institute for Nursing Education (NINE) at the Post Graduate Institute of Medical Education and Research (PGIMER).

Kaur explains that though the role and qualifications of the nurses have evolved over the years, the public perception of nursing as a profession is yet to change. “Here at NINE for example, we train our nurses in so many specialties. Earlier, there were people who secured only a diploma and became nurses. Now we have BSc and MSc courses for nurses. Further the masters degree can be obtained in different medical fields, so that the nurse is best suited for a particular department. But despite their qualifications, there aren’t many avenues open for them,” adds Kaur, who has years of experience grooming future nurses for some of India’s premier medical institutes.

“Even the WHO has observed that nurses are the backbone of the healthcare globally, yet we are so undervalued,” claims a senior nurse from Government Medical College and Hospital in Sector 32, who requested anonymity. “I shouldn’t be worried about speaking to you about the conditions of nurses, but hospital authorities don’t like us to speak up no matter how exploited and overworked we feel,” she adds.

The WHO, as part of its campaign to promote 2020 as the “Year of the Nurse and the Midwife”, had stated that nurses and midwives are the backbone of the health industry. According to statistics shared as part of the campaign, nurses and midwives account for nearly 50 per cent of the global health workforce, yet the world needs at least 9 million nurses and midwives to achieve health for all by 2030. The WHO campaign states that “nurses and midwives often work in challenging conditions: under valued, under resourced and overworked”, but they need to be recognized and appreciated for their work to achieve healthcare goals globally.

In Chandigarh, nurses from the nursing colleges across the city, including NINE at PGIMER, GMCH 32 and the Army College for Nursing, came together and pledged to carry out activities commemorating the 200th birth anniversary of Florence Nightingale, the pioneer of modern nursing. However, despite these overtures made to celebrate the profession, many nurses Newsline spoke to in the Tricity said they felt increasingly undervalued, overworked and demotivated.

The Role of Nurses

Like Kaur, Dabkesh Kumar, president of the Nursing Welfare Association at GMCH 32, claims that people perceive nurses as assistants of doctors. “Yes, we do aid doctors in their work, but there is no hierarchy anymore, or at least there shouldn’t be,” claims Kumar. He adds that the stratification of nurses as second class citizens in the hierarchy of medical professionals is belittling and demoralizing. “Even though we are the ones who do most for the work, and spend most of our time taking care of the patients, which is at the end of the day our duty, we still face the brunt of anything that goes wrong,” adds the nurse.

According to Kumar, the duties of the nursing staff are not really defined, but vaguely centre around the holistic care of a patient. “There is no limit to our duties, we have to take care of all the patients assigned to us, no matter what that requires. This could be from administering medication to cleaning their bedsheets,” adds Kumar.

“There are attendants and cleaning staff as well, but when they are absent, we can’t just shy away from our duties and wait for them to arrive, whilst letting the patient suffers. What the patient needs, we have to deliver no matter what,” says the senior nurse from GMCH. “We are basically a multitasking force, at least in my time that is what we were trained to be, and because of acute short staffing, we have to constantly fulfill that role,” adds Kumar, who has more than 25 years of experience as a nurse.

In the busy emergency ward at PGIMER, where patients recuperating from serious surgeries and ailments are admitted, a little corner is inhabited by the medical staff consisting of a few nurses and a junior resident who takes care of the entire ward. “Once we are stationed at one place, there is no distinction between when our duty begins and when it ends. This little corner is where we take breaks, where we change our clothes and where we sit and do our paper work,” says Satbir Dagur, a nurse from PGIMER. “Typically an ICU ward needs to have an anesthesiologist, an attendant for each ventilator in the ward and some other medical professionals, but all we really have here is a few nurses and a resident,” adds Dagur.

According to Dagur, in the absence of adequate number of professionals stationed at Intensive care units, often one nurse has to not only operate three ventilators, but also look after seven to eight patients in the ward. “We are developing in terms of our equipment and infrastructure, but at the end of the day, if we have a ventilator we need a specific attendant to look after its operations. For now, all of this work is carried out by nursing staff, with the help of one resident doctor,” claims the nurse.

Overburdened & short-staffed

Earlier this year, GMCH authorities and the nursing staff had a standoff over the suspension of the Nurses’ Association president Dabkesh Kumar, over his alleged “misreporting to the media” on the negligent behavior of hospital staff with patients. Nursing unions from across the city lent their support to Kumar, who was suspended, after which he was finally reinstated. “Even my family tells me to stop indulging in all this, to put my head down and keep doing my job quietly, but someone has to speak up for the welfare of the nursing staff. Because only when our morale is up will we work to best of our capabilities and deliver to our patients,” says Kumar.

After Kumar’s suspension was revoked, the nursing association’s demand for hiring more nurses were also partially addressed. The hospital hired 112 nurses on a contract basis. Still, members of the association claim that the hospital needs a lot more nurses in order to function to its optimal capacity. “Though the temporary hiring of nurses on a contractual basis has helped complete our sanctioned strength, according to norms of the Indian Nursing Association, we still need many more nurses,” claims Kumar.

At PGIMER as well, director Jagat Ram has claimed that as they expand in terms of infrastructure, the hospital will continue to face an acute shortage of nursing staff. “But we are working towards getting more posts sanctioned by the ministry,” says the Director.

On March 2, the hospital will hold exams for filling 84 posts advertised for nursing staff. Yet, nurses from the hospital say they are short of thousands of nursing professionals according to the ratio prescribed by the Indian Nursing Academy. “At least 1800-2000 more nurses are needed here for the hospital to function to its capacity and to cater to the hordes of patient that visit PGIMER every day,” claims Dagur.

PGIMER has also been asking the government to sanction 1500 posts, reportedly since 2015, which are yet to be sanctioned. “The government has, in turn, asked PGIMER to fill the already sanctioned posts before they sanction more posts, so right now those 1500 posts are stuck for the foreseeable future,” adds Dagar.

As a result of the acute short staffing, nurses face high levels of stress as well as exposure to all kinds of illnesses due to amount of multitasking they have to resort to, in order to perform the workload meant to be distributed amongst a larger pool of healthcare professionals. “Burn out syndrome is quite common in our nurses, in fact we have done many reports on that in PGIMER itself and found out that a lot of our nurses get burnt out quite early,” claims Dr Sukhpal Kaur, acting principal of NINE.

The nurses also face exposure to various infectious illnesses as they are constantly in direct contact with patients. “You are overworked. You don’t even get proper supply of preventive material like good quality gloves, or spaces to change out of your uniform before going home. You often not only put yourself at risk (of contracting infection and diseases), but also your family members and children,” says Dabkesh Kumar.

Kumar adds that often no matter how many preventive measures nurses take, the risk of catching a disease remains high since proper procedures for eradicating septic conditions are hard to follow when there aren’t enough facilities and staff to cater to the burden of patients at government hospitals. “If it weren’t for either a sense of duty, and now the fact that there is rampant unemployment in the country, no nurse would have stuck around to work in these conditions,” adds Kumar.

Kaur also claims that many high qualified nurses prefer to go abroad to find work after obtaining their degrees because they do not receive gratification in the job roles available to them in India. “India is producing some of the most qualified nurses trained in the excellent curriculum prepared by the Indian Nursing Council. However, a vast majority of the them prefer to go abroad for better recognition of their competence leading to acute shortage of nurses in the country,” explains Kaur. “So, it is the need of the hour to have a system that places these learned nurses in a dignified manner in the Indian setting,” she adds.