Subject:
Who is killing off our Nurses ?
- Dr Devi Shetty
HEALTHCARE - Who's Killing Off Our Nurses?
| Dr Devi Shetty |
Delhi's dengue deaths have created a furore, highlighting the shortage of critical care beds in government and private hospitals. Within the next five years, half of private -and most of government -hospitals in India will close down due to acute shortage of nurses.
Without the prescribed number of nurses, hospitals cannot legally function. India is short of 2.4 million nurses. In 2009, India had 1.65 million nurses. The number has now dwindled to 1.56 million.
Admissions to nursing colleges have come down by nearly half across the country . Half of south Indian nursing colleges are in the process of shutting down. The demand for nurses in West Asia, Asia and Africa has increased tremendously . Soon, the gates are going to open to the US and Europe, which faces severe nursing shortage.
We can predict what the government's reaction will be. The health minister will announce a Cabinet decision to prevent nurses from leaving the country . Bullying nurses will result in the closure of the remaining half of the nursing colleges.
So why has the nursing profession lost its charm? It's simply because this profession has no career progression in India. Ours is the only country where a nurse who has worked in the ICU for 20 years is legally not allowed to prescribe simple painkillers or give an injection without the presence of a doctor. Even in litigation-happy US, 67% of anaesthesia is given by nurses, not doctors.
Nurses have absolutely no future in India. But how important are the nurses for healthcare delivery?
The time spent by a doctor in a hospital is less than 1% of the time the patient spends in the hospital. Especially in critical-care areas, nurses are the ones who manage the critically-ill patient on a ventilator. A medical intensivist supervises the patient and plans the treatment strategy .Nurses carry out the instructions standing on their feet day and night.
It was the British ICU nurses of the National Health Service hospitals who taught me how to manage a patient in the ICU. Our nurses could have taught future cardiac surgeons how to manage a patient in the ICU, the same way I learnt from British ICU nurses of the National Health Service. Unfortunately , we have reduced them to the level of a pair of hands to give sponge baths.
Nurse practitioners can address vacancies and absenteeism at our 25,000 primary health centres preventing hapless villagers getting wrongly treated and cheated by quacks.
Health ministry and the Indian Nursing Council should work together and create speciality courses in nursing. After receiving adequate training and certification, nurses should be legally empowered to perform the tasks in speciality fields like nurse practitioners and nurse anaesthetists. Legally empowered and trained nurses will attract significantly higher salaries, similar to their earnings in West Asian countries.
Two children dying in Delhi due to dengue has projected the `shortage of beds' as the primary problem.The truth is, it is not a shortage of beds but a shortage of doctors and critical-care nurses that has created the crisis. This is the only reason why private hospitals are not increasing the number of critical-care beds, especially for children.
Children are not miniature versions of adults. Even cities like Delhi will not have more than a hundred paediatric intensivists. It will have an extremely small number of paediatric critical-care nurses. The difference in nursing care of a child on a ventilator compared to standard nursing in the ward is like the difference between riding a cycle and flying an F-16 fighter plane.
The attrition rate of nurses in a typical Delhi hospital is to the tune of 75%. Patients should be scared and governments should be worried about patients' safety in an environment where 75% of the nurses are new recruits with very little experience.All that the government needs to decide on is to: Equalise undergraduate (UG) and postgraduate (PG) seats in medical education. India has 56,000 UG seats in medical colleges and only 14,500 PG seats in clinical subjects. Compare that with the US, which has 21,000 UG seats and nearly 38,000 PG seats.
Create speciality courses for nurse practitioners, nurse anaesthetists and nurse intensivists and provide avenues for career progression.
We can build and equip a 300-bed hospital in six months. But it takes at least eight years to train a nurse to manage a child on the ventilator.What Indian healthcare needs is not FDI, or increased budgetary allocation. All it requires is change in the policy of medical nursing and paramedical education.
The writer is a Padma Bhushanawarded cardiac surgeon
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