Nursing many wounds

Florence Nightingale called nursing the finest of fine arts. But Molly Sibbichan would have disagreed. On March 16, Sunday, the 42-year-old nurse, employed with the All-India Institute of Medical Sciences (AIIMS) in Delhi, hanged herself inside her south Delhi home.

Molly’s suicide note said work pressure and stress pushed her to kill herself. She was working with the neurology department of AIIMS for the past eight years and was recently transferred to the private wards.

The out-of-the-blue move caught Molly totally unprepared. Also, she was reportedly harassed by certain superiors, pushing her into depression.

Following Molly’s death, nurses unions in and around Delhi, especially the ones in AIIMS, an autonomous institution, staged protest marches, asking the management to punish the officials who allegedly harassed Molly to death. To little avail.

More than 14 lakh registered nurses work in India today, according to the Planning Commission’s National Task Force Report 2012. Of these, more than 70 per cent are women.

According to a study, Human Resources for Health in India , published in The Lancet in January 2011, nurses and midwives constitute 30 per cent of the country’s total healthcare workforce.

Of these, many go through harrowing times at work, for reasons ranging from work pressure, poor pay, marathon work hours and absence of social security to administrative apathy. Many leave the profession midway. Some hold on, while some, like Molly, seek extreme solutions. Nurses unions say there have been many such suicides in the recent past.

Ironically, Delhi is one of the few places in the country where nurses enjoy better pay and a relatively better work culture. In other cities and small towns, hospitals pay only a pittance to healthcare staff, including nurses.

Most hospitals have abysmally high patient-nurse ratios, too. After the Joseph Bhore Committee (1946), which the Government of India set up to recommend improvements to the country’s public health system, no other significant panel has looked at the pay, status, and general working conditions of nurses in the country.

According to estimates of the Nurses Council of India, in some public hospitals, the nurse-patient ratio is a shocking 1:60. And in many hospitals, nurses end up working 18 hours at a stretch, without any over-time benefits.

Nurses wear many hats at work. Apart from assisting patients and doctors, they deal with the ire of patients, their families, even doctors, hospital management and visitors.

Unlike many other services, nursing demands from the worker a great range of skills and people management expertise. But nurses in India rarely have the avenues to spruce up their skills.

Take the example of Australia, a country to which many nurses from India migrate. Here, nurses get sufficient on-job training to deal with most problems. Importantly, they have to renew their registration every year, which leads to an audit of their skills and work practices.

Regulations insist that each nurse should dedicate certain hours of her work for education. From time to time, nurses get proper training to deal with work stress, demanding families, and so on. Many hospitals in Australia, says Tony Jose, an Indian nurse living in Cairns, Queensland, have a ‘nurse educator’, who runs short, useful courses for nursing staff on myriad subjects.

Nurses are also encouraged to do various mid to long-term courses offered by the neighbourhood chain of hospitals, at the hospital’s cost. The government offers up to $1,500-2,000 a year as an allowance to nurses who can use the money to do career enhancing programmes or, at least, buy books.

Nurses also get 40 hours (five days) of paid leave for professional development. The most important contrast, however, is the respect nurses draw in these countries.

In India, many nurses are ashamed to even talk about their profession, feels Jose. They are bullied and harassed, apart from being paid peanuts. Jose earlier worked with a Delhi-based private hospital chain.

Private hospitals in Indian cities pay a fresh recruit anything between ₹2,000-8,000 a month and those with five years or more experience may draw a maximum of ₹15,000 a month.

Again, in most cases, even this amount remains on paper. Managements use bizarre filters to cut pay. In Australia, while a doctor entering the profession is paid $30-32 an hour, a nurse too gets about $28-30.

In India, while an MBBS graduate is paid about ₹45,000 at the start of her career in private hospitals, a nursing graduate gets, if she is lucky, ₹8,000.

While doctors enjoy several other perks, nurses are often left with minimum facilities and zero benefits.

One of the reasons why nurses in the UK or Australia enjoy a better life is the presence of strong unions. In these countries nurses’ unions command immense clout. Australian Nursing and Midwifery Federation, said to be the largest in the country, represents registered nurses, enrolled nurses, midwives and nursing assistants in every state and territory throughout Australia. It has 230,000 dedicated members.

In India, there is no such strong organisation, even though bodies such as the Trained Nurses Association of India have been in existence for decades.

This lack of bargain power helps managements to muzzle demands for better pay and work atmosphere.

Such a situation is one of the many reasons why most nurses want to emigrate to other countries. Not much data exists on emigration of nurses from India, but experts say the number is substantial.

For instance, the Lancet study shows the number of new Indian nurse registrants in the UK grew from 30 in 1998 to 3,551 in 2005. Indians constitute the second largest group of visa seekers as nurses in the US.

But of late, India’s nurses have shown hitherto-unseen collective power. For instance, prompted by various incidences of oppression, nurses in Kerala in 2011 formed a collective, Indian Nurses Association, to act as an umbrella organisation of all nursing unions in the country.

Cities such as Delhi, Kochi and Chennai have seen several strikes in the recent past.

What is required at this juncture is a change in policy, says Siju Thomas, general secretary of Delhi Private Nurses Association. There should be a system that ensures minimum wages for nurses and the hospitals should be held responsible and penalised if they have alarmingly poor nurse-to-patient ratios.

The suicides of the likes of Molly, and the nurses’ agitation erupting in many parts of the country, signal that the time has come for an overhaul of India’s healthcare and labour policies.