Nursing a dream

Nursing has always been considered a noble and dignified profession. But more and more nurses are looking for opportunities abroad. Will the exodus lead to a shortage in India? VASANTHA SURYA finds out.

PERFORMED SOUTH Indian-style, the modern-day rite of passage known as graduation often turns out to be a surprising 'avial'. Customs and costumes are mixed and matched, the "Indian" and the "Western" alternately overlaying and backgrounding each other. Graduation is an affirmation of a new identity, in a society where a sense of belonging is becoming problematic and older labels of one's native place, community, language, and caste/class are coming unstruck.

At the Andhra Mahila Sabha Nursing School's "Lamp-lighting and Graduation ceremony" held recently the 'avial' had a great deal in it. This being their special day, the nurses did not present the standard picture of the "women in white" and were colourfully clad. The school's second batch of 18 nursing graduates came swishing through a "passage" of fresh green asoka-leaves entwined with white paper flowers.

Ms. Josephine, the principal of the Nursing School, declared that she disliked the stereotype of a nurse as austere and self- sacrificing , who can't enjoy life, and who must wear white always. "People confuse nurses with nuns, which they certainly are not. They lead family lives, marry and have children. When there is so much stress in their working environment, dealing with illness and other human problems, why shouldn't they have some colour in their lives?" she says, with understandable passion.

Many nurses are from the backward and scheduled castes. Usually they are from the lower middle-class, income-wise. It costs a lakh of rupees for the three-year diploma course in Nursing and Midwifery. Most parents make an investment in their daughters' future, and look forward to them achieving economic independence and above all, job security. Most of those passing through the school will be snapped up by private clinics, nursing homes and hospitals right here in Tamil Nadu.

"What brings you to nursing?" I ask some 17-year-old first-year students. "The uniform!" breathed Gnanadeepam, whose older sister is a working nurse. "Wherever we go, people look at us with respect...Children are afraid we'll give them an 'oosi'!"

All of them answer that the lack of medical facilities in their villages pushed them towards the profession. "There is so much that a trained nurse can do," says Gunasundari. The nearest clinic is ten kilometres away from her village of Pudupet, and it was when she saw a neighbour die of a snake-bite that she began to think about the importance of learning first aid and nursing skills. Gnanadeepam agrees: "As a child I saw the way nurses handled a badly injured accident case. I made up my mind that I would become one myself, and my parents encouraged me." While Suneeta expects to go back to Thiruvannamalai after graduation, Gnanadeepam says she looks forward to working abroad.

Walking through the training ward of the Andhra Mahila Sabha School of Nursing, I catch sight of two strangely inert patients lying on cots...A second look, and I see that they are life-size dolls. "For students to practise on," explains Josephine. "But it isn't dummies that we use for our practicals, it's mostly real patients."

"Real patients?"

"We have so many patients requiring nursing attention that our students get plenty of hands-on experience. In most countries, nurses are trained mostly on dummies," says Josephine. "Patients there will not allow an untrained nurse to handle them, and the institution has always the fear of being sued. That's why there is such a demand for Indian nurses abroad."

Josephine is ambitious for her students, and wants the School to offer a B.Sc in Nursing. "It's a way to get academic recognition, and the profession gains in prestige, although it doesn't make much difference to their pay. The institution for which they work benefits more than they do as individuals. Since major medical decisions are always made by doctors, and it is implementation that is in the nurse's hands, it is experience that really improves your skills."

None of the graduates from the AMS School of Nursing is a man. S. V. Ponnuraj, a male nurse and Registrar of the Nursing Council of Tamil Nadu, says that there are 160 nursing schools and colleges in the State, offering diplomas and degrees, and training courses for nursing assistants and MPHWs. He says the ratio in the profession is one man to ten women in this State. It is only now that men are taking up the profession. In 1958, the State Government stopped recruiting men, and the promotion prospects of those already working also deteriorated. This "reverse discrimination" was fought in court, and now men are also eligible for recruitment.

There aren't many takers, however. One nurse confirms that the main reason for the social prestige of the profession being low is that it has been confined to women. There's an unspoken perception of it being 'women's work', and it indicates the value placed on care-giving, which is regarded as 'menial' labour. She says, resentfully: "It's my experience that male nurses don't take responsibility for actual patient care, or nursing training. They prefer to get into administrative posts, stores, purchase, and that sort of thing. That way they can dominate!"

"But do women really have a more tender touch, making them better nurses?"

Mr. Ponnuraj, a male nurse himself, says mildly: "It's true that women nurses are often dominated, and not just by men but also by women in the medical team. But male nurses can work as well as women, and it's a misconception that they don't have a tender touch. Men are preferred while handling patients for surgery and psychiatry, venereal disease and orthopaedics....Generally speaking, nursing is a job in which there is more accountability than power."

According to Mr. Ponnuraj, the recommended ratios, like one nurse for three patients in a general ward, are not being maintained, and it's not because qualified and registered nurses are not available, but because they are not being employed. Instead, in many places, there are people wearing the uniform, but have not been trained properly.

Why is nurses' morale and efficiency so often low? The demand for nurses within the country does not translate into high salaries. Generally, in private hospitals, they start at Rs. 2,500 or Rs. 3,000 per month, with a prospect of up to Rs. 6,000 after 15 years of service. The job security, in-service training opportunities, and eight-hour shifts characteristic of government service are not available in most private institutions. In striking contrast, the 500 nurses who pass out of government-run nursing schools - all absorbed in government hospitals - receive a basic pay of Rs. 5,000. These nurses also have better chances to go abroad for higher studies and employment.

Many nurses find that they are stagnating after some time. "The work is the same, year after year, and the status also does not greatly improve," says Ponnuraj. "In government hospitals, there is little difference between nurses belonging to different branches of the service." Nurses in private hospitals, trained in the super-specialities like cardiology, neurology, intensive care, nephrology, neo-natal medicine, and hospice (care of the terminally ill) are paid about four or five hundred rupees more. Both morale and discipline suffer, and it's commonplace for patients to encounter surly and sloppy nurses , even in the most expensive private hospitals.

"It is high time that we regard nurses as important and equal members of health care teams," says Dr. Jayalakshmi Rajagopal, a UK-based specialist in pain-management. "In India we need to have an integrated approach to the training, recruitment, and employment of nurses, and a better implementation of policies. The failure to do this in the UK has resulted in acute shortages,with a fallout on the quality of the health care system."

No wonder many young nurses try to go abroad. In the Middle East, Indian nurses are very much part of the health care picture. The current U.K. Government is looking abroad for the government-run National Health Service's nursing service needs. Indian and Filipino nurses are being recruited through British agencies.

Being reasonably proficient in English, Indian nurses are at an advantage. Jayalakshmi thinks this recruitment gives our nurses the opportunity to develop professionally, and to bring back this new experience to be integrated into our current system, both in the training and the practice of nursing.

However, she cautions: "We have to consider whether the exodus of nurses is causing a shortage here. And, once they are abroad, are Indian nurses really receiving additional training, or are they just being used as a cost-effective alternative? Will their pay be on par with that of local nurses, and will they enjoy the same employment rights?" Nursing accommodation has become a thing of the past, and housing in big cities in the UK is very expensive.

The loneliness and isolation suffered by Indian nurses in the UK also bothers her.

Finally, Jayalakshmi hastens to add: "Of course we should not discourage nurses from seeking employment abroad, but they need to make an informed decision. After all, this is one of the very basic rights of any human being."

Send this article to Friends by E-Mail

Section  : Features
Previous : Science made interesting
Next     : Where disability is no bar