Away from India, it’s a good time to be a nurse

A year and a half later, she is a registered nurse at a senior living home in New Castle, earning five times more than in India. Above all, his work is respected by his employer and those who care for him.

“We are not angels, we are humans. In India, nurses are not remunerated and respected for their work. I have found that here,” she told Mint in a phone call from New Castle. “I miss my family – I have left my child in India, but I know by working here I can give him a good future. I am earning,” says Ashwathi.

Earlier nurses had to bear the burden of poor wages and working conditions in the country, but now they have the opportunity to explore better prospects abroad. And thousands of people like Ashwathi are choosing to do the same. The exodus has left the country facing its worst shortage of nursing staff in recent years. Exhaustion from the pandemic, poor pay and lucrative opportunities has prompted these experienced nursing professionals to carve a way for developed countries.

Before the pandemic, around 50,000 qualified nurses from India used to migrate every year in search of better prospects. But according to Roy K George, national president of the Trained Nurses Association of India (TNAI), the number has more than doubled since the outbreak of Kovid. “This migration is happening because nurses are not treated well in India. Calling them angels but not recognizing the demands of the profession isn’t helping either,” George tells the Mint.

The brain drain comes at a time when India’s exhausted healthcare system is transitioning from the Covid-19 pandemic to a focus on other ailments. Policy makers need to address the systemic issues associated with the profession as the shortage of quality nursing staff has a direct impact on the quality of healthcare in the country.

There are currently over 30 lakh registered nurses and midwives in India. Although it leads the world in laying off thousands of nursing staff every year, the number is still not enough given the pressure on the country’s healthcare system. India has 1.7 nurses per 1,000 people, while the World Health Organization’s norm is 3 per 1,000. The latest exodus could further reduce that proportion, especially as projections indicate that by 2024, India will need at least 4.1 million additional nurses to meet the growing demand of its aging population.

in demand around the world

Once trapped on the margins of India’s healthcare system, trained nursing workers are making their presence (and absence) felt in much of the world. All the rich countries facing shortage of nurses have turned to India to bridge this gap. Those who are observing this trend say that Indian nurses have become like the IT professionals who were in demand in the West a few decades ago.

In the UK, there is a shortage of around 40,000 nurses in the National Health Service (NHS). The American Nursing Association estimates that 500,000 registered nurses will retire this year and the country will urgently need 1.1 million new nurses to fill the gap.

The NHS is on an aggressive recruitment spree to hire thousands of nurses from India. It is offering a range of incentives including payment for English language assessment tests, visa fees and air tickets for qualified nurses. Between April and September 2021, the UK registered 4,500 nurses from India.

The healthcare system in the West treats a nurse as a professional, unlike India, where a nurse is seen as a patient attendant, similar to a general practitioner. “I get to make evidence-based decisions and I am encouraged to make those decisions independently, and my decisions are supported by general practitioners,” says Ashwathy.

The pandemic has been hard on healthcare workers around the world. Burnout, exhaustion, and increased health risks due to COVID are a common thread in the healthcare community. In wealthy countries, some nursing staff are also leaving the profession because of vaccine mandates. Most governments in the West provide income support to their population, and because of this financial security, many nurses have chosen to retire early or leave the profession altogether. As a result, the demand for Indian nurses has increased.

“Historically, most nurses are going to the Bay Area. But this trend has changed in the last five years and now the pandemic has opened up new opportunities as our nurses are trained to handle the most difficult cases,” says Georg. In the past, citing ethical grounds, Germany did not hire nurses from such countries as India, which faces a nursing deficit. However, it has now changed that rule to address the internal shortage.

health care system under pressure

Shashi Bala Kalra, 48, senior nurse at New Delhi’s RML Hospital, who has 35 years of experience, said the high pressure, excessive work, low pay and even lack of gratitude from patients has boosted the morale of the nursing community. on the injury. “Most nurses are the sole breadwinners of their families, and they have a poor work-life balance. Yet there is no reward, monetary or otherwise, for their sacrifice,” says Kalra.

There is also a feeling that senior doctors add to the stress of the nursing staff. Depending on the operation, nurses, 90% of whom are women, have to do triage (the process of deciding how seriously ill or injured someone is so that the most serious cases are treated first), Sometimes leaving other patients and their families feeling neglected. The result is additional stress leading to higher temperatures in medical wards.

“Our profession is not something that we can do sitting in an office. And there is no work from home for us. If a patient is going to the ICU or undergoing an operation, we have to increase our working hours,” Kalra says.

Over the years, nursing unions have demanded adequate monetary compensation and respect for the grueling demands of the profession, but little has changed on the policy front. Most healthcare workers have to labor in poor working conditions, where even having a proper washroom seems like a luxury. Hospitals run by the central government and state governments pay better salaries than private hospitals, but still, the compensation is inadequate.

Poor record of private hospitals

Several nurses and industry representatives Mint spoke to said that private hospitals are the worst offenders when it comes to violations of the rights of nursing staff. If the average salary of nursing staff in government hospitals is around 40,000, it is only in private hospitals 10,000.

Nurses here have to work more than 13 hours a day, and in some cases, there is no complaint mechanism to redress issues of workplace harassment, including sexual harassment. Private hospital lobby groups are also blocking the implementation of India’s Supreme Court order that mandated nursing and midwifery staff in private hospitals to be at par with government hospitals.

In 2016, a health ministry directive to state governments stated that “the wages and working conditions of nurses are pathetic and certain steps need to be taken to raise the level of working conditions.” Advised governments to make private hospitals mandatory. State government hospitals earn salaries of less than 200 beds equivalent to nurses’ wages. In case of private hospitals with more than 100 beds, salaries of state government hospital nurses and minimum wage in 20 bedded hospitals 20,000, it added. The recommendations also state that nursing staff should have better working conditions, including paid leave, working hours, medical facilities, transportation and accommodation during night shifts.

“For many old nurses, this is their last chance to earn a decent income in their lifetime. There are nurses who have lost family members due to COVID. These people need to secure their future,” says Salina Shah , Principal, Government College of Nursing, Thiruvananthapuram.

A nurse in her late 40s, who has two years left to serve in a government hospital and does not want to be identified, said she was considering moving to the US, where a new opportunity has opened up. This is because the US specifically seeks to hire experienced nurses with at least 20 years of experience.

“The US is clearing out its visa backlog for health professionals like nurses, so people in their 50s are leaving too. These are the people who applied for work visas in 2008 and were not getting calls for immigration.”

The shortage of nurses is also affecting the quality of nursing schools, which are struggling to find teaching staff. “India has been able to boast of quality nurses as our curriculum is medically oriented and has equipped it to provide quality care to those associated with the profession. But we also need qualified teachers,” says Shah.

Kerala, Maharashtra and Tamil Nadu are the top three states in the production of nursing staff. But these states also face policy hurdles when it comes to new recruitments. In Kerala alone, 10,000 nurses graduate every year, but the state’s health services need to open up to ensure that these graduates find lucrative work options and don’t give up, says Shah.

policy making challenge

Although India officially promotes the export of its nursing professionals, it could be looking at a scenario where a shortage of healthcare providers could reduce the quality of care.

At the peak of the pandemic, the healthcare system in the national capital also collapsed due to shortage of hospital beds and healthcare workers. A report by the International Council of Nurses (ICN) released this year said that in low-income countries, low nurse-to-patient ratios and high nurse workloads are “associated with hospital mortality, hospital-acquired infections and medication Errors among patients”.

As India recovers from the COVID pandemic and shifts its focus to other ailments, many of its health professionals are suffering from exhaustion and burnout after facing immense challenges over the past two years. As ICN reports, a survey of 120 nurses in emergency departments found that most of them experienced moderate to severe levels of burnout, emotional exhaustion and depersonalization.

“Most of us enter this profession with a sense of public duty. I have given 33 years of my life to this profession and my state, but not everyone can, especially in the current working conditions,” Shah explains. Huh. The unanimous call of nurses across the country is that their profession should be respected and respected. entitled.

Experts say that the nursing and midwifery staff need a pay hike and the ball is in the government’s court. Meanwhile, private hospitals have seen a massive shortfall in terms of dropping out nurses to join government hospitals. Healthcare industry watchers say doing more to protect the rights of its workers and implementing wage reforms could change that equation overnight.

The current shortage in India comes at a time when the demand for nursing staff is at an all-time high in countries that are willing to pay at least ten times what a graduate nurse earns here. Quite simply, this is a great time to be an Indian nurse. Not only in India.