Dr Kishore Kumar, Founder Chairman and Neonatologist, Cloudnine Group of Hospitals, Bengaluru shares his view on where the Indian healthcare sector stands in terms of training and empowering nurses
India’s healthcare sector is battling a major crisis — inadequate infrastructure, oxygen supplies and human resources. However, this is a reflection of multiple things – inadequate investment in public and preventive health over decades and also panic admissions leading to improper use of the available beds without their proper triage or distribution.
We all know equitable and efficient delivery of health services has a profound impact on population health and health workers, who are responsible for delivering health services and play a critical role in the functioning of the health system. Greater availability of health workers has been shown to be associated with both — increased service utilisation as well as health outcomes. Despite knowing all this, where are we in terms of training and empowering our healthcare workforce, especially the nurses?
Today, several low- and middle-income countries (LMICs) face an acute shortage of trained and well-performing health workforce, precisely because of a sustained under-investment in health and training of work force in these countries.
Why this shortage
There are several reasons. First of all, total numbers of annual new medical graduates (doctors) and nurses/midwives in comparison to the population size are significantly lower in India compared to those in the Organisation for Economic Cooperation and Development (OECD) countries, and also several countries in Asia such as China, Thailand and Sri Lanka.
India has currently a little over 500 medical colleges and 7,000 nursing institutes producing on average nine doctors and four nurses/midwives per 100,000 population annually. The same numbers are as high as 44 and 13 respectively in OECD countries. India, hence, needs to invest in opening new institutions for producing an increased number of health professionals. Moreover, there is discrepancy in the number of health professionals available in different parts of the country, with some states fairing much more poorly than others.
According to a recent study published in the British Medical Journal (BMJ), the Indian medical industry fares poorly on many critical parameters. As many as 54 per cent of health professionals in India — including doctors, nurses, paramedics and midwives — do not have proper qualifications while 20 per cent of adequately qualified doctors are not part of the current workforce and do not have access to training. On top of all these is the reservation system, lack of respect, violence against them and poor pay scales in India leading to “brain drain” to the west of many of our talented healthcare professionals.
What can we do better?
The healthcare environment is dynamic, with medical breakthroughs emerging every day. To stay ahead of the game, we must aim at strengthening of our nursing workforce by empowering them with more training and learning opportunities. By keeping them up-to- date with the latest trends as well as potential future healthcare developments, we will pave way for more healthcare leaders. Noone is better than a nurse to lead the nurses. Nevertheless, less than two per cent of our nurses are leaders. We need to encourage nursing leadership training which can revolutionise healthcare in a huge manner. The change of mindset, curriculum and training in various aspects including technology and safety of nurses – occupational, physical and mental – and prevention of sexual harassment/abuse will need to be focussed on with the changing scenario.
Work from home is the new beginning for many able nurses, as it does not just allow them to continue pursuing their passion from home, but also helps them to expand their service beyond clinical and bed-side roles. Alongside, it offers tremendous learning opportunities as the new role necessitates them to develop various new skills and accentuate their professional capabilities.
Availability of technology and the quickly growing acceptance of virtual work in many industries—along with the global pandemic highlighting the vital importance of healthcare positions— work-from-home nursing jobs are more prevalent than ever.
Some of the opportunities for them include to work as telephone triage nurses which is a brilliant opportunity for those who struggled to balance the risks and achieve a work-life equilibrium. This role is created in hospitals, especially to answer calls from patients, triage their symptoms and refer them to the appropriate level of care. These telephonic services relieve the burden on physician offices, urgent-care facilities and emergency departments, allowing them to conserve resources for higher acuity patients.
Another opportunity is to operate as health informatics specialists which is an exciting new branch of healthcare and aims at finding innovative intersections among technology, communication and healthcare systems in order to move the entire industry forward. Other infinite possibilities include using the clinical expertise at call centres.
Unfortunately, it took a pandemic to make this more apparent to the most, but nurses and nurse practitioners are well-positioned to push healthcare into a new era, starting with the transformative potential of this pandemic.
In the new normal, patients are needing support, guidance, home care, tele-consultations, home vaccinations; in fact, everything, at home, at the click of a button. Restrictive physical barriers to access care have ushered in the demand for remote nurses, nurse practitioners and other healthcare professionals to bridge this gap and connect patients to the care they need. Nursing is no exception.
By shifting demographics and upgrading to technology, we are creating leadership positions for nurses which is the need of the hour. Remote nursing is possible and gone are the days when the options for a bed-side nurse who wanted to grow in her career was limited.
Let’s not forget that nurses will continue to provide the bed-side care that is essential to treatment and recovery, but there are a wide variety of roles that nurses can play within the medical industry.