With rapid advancement in medical science, demands within the nursing profession has also become more complex. First and foremost hygiene has come to be emphasized much more. Nowadays, more forms of treatment and sophisticated equipment are available to treat patients. In this scenario, how do nurses cope with the demands of their profession?

In India, the Malayalee Christians were the first to take to nursing. Nowadays young Muslim and Hindu girls have been opting for nursing, but more out of the practical reason of eking out a livelihood. What are the constraints and tribulations in nursing?

The main aim of nursing is to provide support to doctors and other medical specialists in OPD and wards in a hospital or during surgery in the operation theatre. Without nurses, doctors would never have been able to manage the swelling numbers of patients. Nurses are also needed in polyclinics and nursing homes. They can even assist medical officers in rural health clinics or in Government health programs.

Definition of nursing
“A nurse’s job deals with care of the diseased person–one who is bed–ridden and who cannot be looked after by a family member”, states A H Dandawane, Principal of the School of Nursing at Pune’s Ruby Hall Clinic. A nurse must therefore not only know how to clean the patient’s mouth and wash his body when the patient can’t, but also be able to assist the doctor in providing comprehensive care to the patient. “Although the range of her activities is quite wide, the nurse is not authorized to prescribe drugs like a doctor. The Government has given the license to prescribe drugs only to doctors”, states Dandawane.

“If you look at the nurse’s job objectively, it is not routine work. Especially not in the Intensive Care Unit”, asserts Khatri who is the sister–in–charge of the ICU at Ruby Hall Clinic, Pune. “The one hour time after the patient is admitted into the ICU is the golden hour”, she avers.

Travails of the job
Proficiency in Anatomy and Physiology is not enough, good communication skills and the ability to handle people from diverse backgrounds is also important in this profession. Sometimes, the patient’s relatives may be very difficult or ask too many questions. “If the nurse does not answer, they often convey the impression she does not know anything”, laments Sister Khatri.

The job can be very demanding and exacting as the nurses have to work continuously for 12 hours and at times walk almost 50 km each day around the hospital!

Refresher courses on topical problems, video shows or lectures by doctors are arranged once a week in hospitals for nurses. The objective of these exercises is to keep them abreast of the latest.

In early stages some nurses may find it difficult to adjust to the timings of the night shift, admits Khatri who is in–charge of on–site training program at the ward. “During training itself we are taught to keep aside all personal problems”, explains sister Khatri.

It is easier to lose a job in private hospitals than in Government hospitals where trade unions are very assertive. In the event of a nurse found to have neglected her duties three warnings are issued to her before disciplinary action is finally taken.

The future
If one is asked about the future of nursing as a profession, the answer is unanimous: “The nursing profession is saturated”. In the scenario of less–demand–more–supply, many nurses have to accept jobs which offer low pay scales. A nurse joins the hospital regimen as staff nurse. Promotions can take as much as a decade of continuous service to move up the rung to a nursing superintendent.

The lot of nurses working in Government hospitals is definitely better than those in private hospitals. The former get better pay scales and their emoluments are reviewed at regular intervals. In private hospitals, pay scales of nurses move up at a slower pace.

Even if Government appraisals are adopted by private hospitals, a mere one–third of the monetary relief is granted. Changing jobs from private to Government hospitals is also difficult. “If a nurse works for 15 years in a private hospital and decides to take up a job in Government hospital, no recognition is given to his/her service”, says Dandawane. Due to the difference in wages, a lot of nurses have been shifting to corporation hospitals and Government hospitals. It is for this reason alone most male nurses prefer taking up jobs in the Middle East. Some may even opt to work as private nurses which is a more paying job.

Look out for private nurses
“A lot of enquiries for special nurses come from hospitals in the US and the Middle East”, says Ms Sheikh, who runs Zareen Nursing Bureau in Pune since the last 20 years and has doctors, leading business houses and famous personalities for regular clientele. According to Sheikh, nursing is a lucrative profession and the demand for nurses will increase as families grow smaller and more people go out to work.

Private nurses Ms. Sheikh insists should be paid around Rs 300 for 12 hours plus traveling allowance if the location is not easily accessible by public transport. Job opportunities are many since when a patient is admitted to hospital private nurses can give the attention a ward sister is not able to provide, explains Sheikh. Mostly, demands vary according to religion and food habits. But some are unique, she recalls. Sometimes, the client asks for a nurse who is beautiful, others don’t want a dark nurse, while others prefer an ‘Up–to–date’ nurse. “Sometimes the nurse may not be patient due to some personal problem, or bad behavior on the part of the patient’s relatives makes the nurse give up the assignment. Adjustments should be made from both sides”, asserts Sheikh. Sheikh agrees some bureaus conduct nefarious activities under the guise of supplying nurses.

A looking glass
In spite of inconsistencies, the outlook of nursing is changing totally. As Sheikh puts it, the demand for nurses is increasing. But, the picture as a whole shows that economics of demand and supply is definitely not on the upswing. Then why are new nursing schools being set up? Mr. Dandawane of Ruby Hall Clinic’s School of Nursing which was started in August 1991 agrees.

Ruby Hall Clinic’s School of Nursing follows a standard three–year curriculum. The course costs a fee of Rs 12,000 per year and admits only 20 students per batch per year. The women's college provides hostel accommodation and subsidized food. “As they come from far away places, in the beginning some cry, but by the year end they are completely adjusted”, reveals Dandawane. “All successful candidates must register with the Bombay Nurses Council which is recognized by the Indian Nurses Council, New Delhi and International Nurses Council, Switzerland”, he informs.

There are a lot of colleges offering general courses in Nursing. Undergraduates can also opt for four year B.Sc. (Nursing) degree. Practical training in hospitals and outside is an essential feature of all nursing courses. Some hospitals pay a stipend of Rs 175 to Rs 250 per month to students.

There is also a shorter Auxiliary Nursing Course (ANC) dealing with the basics of Gynecology and how to conduct a delivery. Though this course is being scrapped, some institutes still offer it. The ANC is open to only female students.