Events & Issues
New
Delhi, 11 August 2017
Health Providers
NEED RECOGNITION
& REWARD
By Dr.S.Saraswathi
(Former Director,
ICSSR, New Delhi)
The month-long
strike by nurses in Kerala has exposed the miserable state of the nursing
profession described as “the finest of fine arts” by Florence Nightingale. Strike by nurses has now become an annual
event performed in some part of the country necessitating resort to Essential
Services Maintenance Act (ESMA). But law
and regulations pertaining to hospitals, medical care, labour, contract
law – all of which have a bearing on Nursing as an occupation and are
undergoing reforms – have not removed the genuine grievances of nurses in
India.
Nurses
have partially succeeded in achieving their demand for pay hike this time, but other
problems faced in this profession have not been removed. Nor is it possible to remove them by strikes in
view of certain common notions about personal service in India.
The
strike, called by the United Nurses Associaltion (UNA) and the Indian Nurses
Association (INA) was opposed in Kerala High Court by Health Care Providers
(India) on the ground that health services in the private sector would come to
a grinding halt. The State was indeed going through a period of fever epidemic creating tremendous pressure on hospitals.
The
Kerala High Court asked the State government to apply ESMA in public
interest to persuade the nurses to
withdraw the strike. The Court even went to the extent of passing
an interim order prohibiting the strike.
The WHO
has stated that “Nursing encompasses autonomous and collaborative care of
individuals of all ages, families, groups and communities, sick or well and in
all setting”. It also “includes
promotion of health, prevention of illness, and care of ill, disabled, and
dying people”.
Strike
by nurses can affect the entire healthcare system and the functioning of
hospitals and nursing homes. Besides
small services to patients, it would seriously
affect intensive care unit and surgical departments and laboratories and
bring their work to a standstill. They all depend on nurses to carry on their work. Private hospitals face even the prospect of
closure if nurses go on strike.
Nurses
are as important for doctors as for patients.
They provide the link between the two.
Nursing is no longer a simple “calling” as designated by Nightingale
over 150 years ago differentiated from a “profession”. Medical science has advanced so much taking
along many other auxiliary services that once remained moral
services. Professionalism marks every
segment of health providers and nursing involves good academic exercise in the
area and sound on the job training. It
combines necessary knowledge and skills required in the treatment of patients
at all stages.
Nursing
fulfils the main criteria required for recognition as a profession like well
developed academic course, scope for using
judgement in work, professional organisation, acknowledged
social worth, significant contribution
to human wellness, and special knowledge and skill. Different countries may emphasise different
factors, but nursing has definitely grown as a separate profession and has
earned recognition in the world of work.
What it
needs in India is social recognition, ending aloofness from the general public
like certain other uniform-wearing service personnel like the police. Studies
in some western countries reveal that there prevails an idea that low status
given to nursing generally is due to predominance of women workers in this sector. Gender bias
is active in India too. Male
dominance by number in medical practitioners stands as a sharp contrast to
female dominance in the number of nurses.
Strike
by nurses is known in all countries including those where working conditions are far better than in
India. In May this year, nurses voted in
favour of a nation-wide strike called by the Royal College of Nursing in the UK.
In June, all hospital work was paralysed and services were suspended in
Kenya.
France
is renowned for quality healthcare service, but the condition of nursing
professionals is wanting in many
respects. Towards the end of 2016, it
gave rise to an “unprecedented movement” across the country to raise the
quality of healthcare profession. A wave
of suicide of nurses was believed to be related to intense job stress. In several other European countries, low pay
has led to prolonged strike by nurses.
The
strike in India ended in the last week
of July with the Kerala government agreeing to implement the Supreme Court directive to fix
the minimum salary of nurses in the State as Rs. 20,000 per month in government
hospitals and to extend this to private hospitals with less than 50 beds. It
was decided to appoint a committee to fix salaries in hospitals with more than 50 beds.
Nurses constitute the largest group of professionals
in the healthcare system. In many countries, nursing is considered an independent profession but in India it depends on doctors and
hospitals heavily though nurses are indispensable for them. Even nurses in home
care services depend on organisers and placement agencies. Nurses have little bargaining strength to
fight for status and reward.
There
is no strong all-India labour union for
nurses in India. Established unions like CITU
take up common labour issues affecting large labour population, but not so much specific problems
of particular professionals.
According
to WHO estimates, the country needs 2.4
million nurses. Nurse-population ratio
in India is said to be lower than in
many developing countries in Asia. Low
professional and socio-economic status , gender issues, lack of political support, and unregulated private sector are said to be
the reasons for scarcity of nurses in
number and their low quality. Nurses
themselves largely come from poor families – a factor that easily leads to
exploitation in many ways. All these are compelling reasons for the society to take up their case earnestly.
In many
developing countries, information on human resources available in the health
sector is incomplete and unreliable to help workforce management and planning. According to WHO estimates, nurses account
for about 30.5 per cent of health workforce in India. In some States like UP, Bihar, and Haryana it
drops below 20 per cent.
Still,
large-scale migration of nurses to Middle East and European countries take
place not so much by pull factors, but by push factors like very low salaries and difficult working
conditions. Estimates suggest that
Indian nurses constituted the biggest group among those recruited from non-EU
countries into Britain’s National Health Service between 2009 and 2015. Those who have stayed behind are tempted to go
on strike to force improvement in working conditions. It is
common knowledge that nurses from Kerala are working all over the world and
have earned appreciation.
The
diverse kinds of work entrusted to nurses demand different types of abilities
and expertise. Western countries have
developed nursing degrees like Master’s
Degree in neuro-vascular problems, cardiac problems, burns, etc., and
also in nursing education and administration.
Similar advanced courses have
been started in India also from Auxiliary and Midwifery Course to Ph.D. Degree. To establish more nursing colleges and to make these courses popular, the profession of
nursing has to be made attractive for both boys and girls from all economic
strata.
In
brief, nurses and other health providers
need recognition and reward. It
will go a long way in directly improving
our health index.---INFA
(Copyright,
India News & Feature Alliance)
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