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Vol. XXVIII No. 18, January 1-15, 2019

Not the happiest of nursing scenes

by T. Rajagopalan

Florence Nightingale, the Lady of the Lamp, gave respectability to nursing and left her footprints on the sands of time. It was she who made nursing a valuable part of medicine. Every patient, after being under the surgeon’s scalpel, is cared for on his or her road to recovery by nurses. What a noble profession!

In this age of fast diminishing social values and ethical standards, let us take a look at our nursing scene. Chennai, that was Madras, is home to a variety of ‘nursing schools’ where this segment of paramedical staff is trained. These function with the avowed objective of equipping the trainees with a range of professional skills to ameliorate the pain of the patients.

Over 20 nursing schools and 40 colleges in the city and outskirts offer 3-year diploma and 4-year degree courses in Nursing. In Tamil Nadu, the 16 government medical colleges and over 200 nursing colleges affiliated to Dr. MGR Medical University offer about 8000 seats every year. Some hospitals, including Apollo, MIOT and Madras Medical Mission, have their own nursing schools. M.Sc. (Nursing) courses are also available in institutions like Dr. MGR Medical University. These run for two years and the graduates work not only in hospitals but in research settings as well. The P.G. degree holders are eligible to become Nursing Superintendents and Deans of Nursing Colleges. In addition, Ph.D. programmes are offered in a few institutions. In Tamil Nadu, about ten institutions are recognised as nodal centres for doctorate programmes. With all this, we still find a shortage of nurses everywhere.

While the majority of nurses in hospitals turn out to be good, a few get a poor rating from the patients and their attendants. The latter complain about the lack of language and communication skills on the part of nurses – this apart from professional ability to do tasks like administering an injection with care.

Undoubtedly, nurses are saddled with a lot of work, but it is in small matters, like speaking kind words and bolstering the confidence of patients, that real competence stands out. This is especially so when juvenile patients and the elderly are in the wards. This situation is allowed to drift from casual neglect to serious disrepair in some places.

Both doctors and nurses must infuse in patients a faith in recovery. This aspect of healthcare deserves more attention, since medicines alone are not enough. In the current scenario, patients are often made to accept their lot with a spirit of stoic acquiescence.

Interestingly enough, the ‘Nightingale Pledge’ enjoins on the practitioners “to render nursing services with due respect for the dignity and rights of the people… with no distinction of caste, creed, or race.” The alleviation of suffering forms an important part of the code of nursing ethics.

The unifying symbol for nurses globally is the ‘White Heart Symbol of Nursing’ launched in 1999 on the occasion of the 100th anniversary of the International Council of Nurses. It stresses “the caring, knowledge and humanity that infuse the work and spirit of nursing.”

Often, not without reason, criticism comes from the medical field about the low ratio of nurses to patients. This is certainly a worrying aspect of healthcare in society. Ideally, this ratio must be 1:5 (for five beds, one nurse) and 1:3 (for three beds, one nurse) for teaching and non-teaching hospitals. Thus, in the case of a 100-bed teaching hospital, there must be 20 nurses (teaching hospitals are those attached to a medical college). The deviation from the norms is quite glaring because of the in-built loopholes in rules.

Another aspect which deserves attention is that with the number of kidney patients on the rise, the training of nurses for home dialysis is very poor. Technically called CAPD, or Continuous Ambulatory Peritoneal Dialysis, this area calls for greater funding for training of nurses. The rapidly expanding spheres of elderly care, newborn care, palliative care etc. need to occupy a significant place in the scheme of things.

Many doctors refer to the declining standards in nursing schools. A surgeon with ripe experience who has set up his own clinic in Chennai says, “I have to take classes every day” referring to medical procedures to be adopted by nursing assistants. The attrition rate here does not alarm him much, since the nurses get a good grounding and also liberal pay and perks.

The students who opt for nursing courses hail mostly from the lower middle class strata in the southern States, especially Kerala. Here, traditional families send their children who complete the Plus-two or Higher Secondary course to nursing schools with the fond hope that after a few years they will earn enough for their marriage. (The dowry system is still entrenched in Kerala.) After getting the certificate ‘Registered Nurse, Registered Midwife (or RNRM)’, the products from nursing schools get jobs as Nursing Assistants in hospitals. Several of the schools are Church-sponsored and quite a large number of qualified nurses go abroad, where they are much in demand.

For the accreditation of corporate hospitals, the requirement demands qualified nurses for all cadres. This explains the hurried way in which several hospitals shift the wards, turning them into classrooms for offering theory instruction. The practical side is taken care of in the wards where the patients struggle to survive. I am reminded of the lines “Things are seldom what they seem/skim milk masquerades as cream.” Ingenious indeed are the efforts taken by the corporate hospitals to impress visiting inspecting teams.

You find patients from other parts of India and even foreign countries coming in droves to some of the City’s hospitals of repute. The foreign patients find the treatment here quite good and also cost-effective. The packages offered to them include not only the hospital charges but convalescence in nearby tourist resorts. This is medical tourism with a vengeance! But how about the average patient?

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