Feature Workforce Planning

Why is India short of nurses and what can we do about it?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f4024 (Published 25 June 2013) Cite this as: BMJ 2013;346:f4024

Re: Why is India short of nurses and what can we do about it?

Dr Bhaumik’s article highlights another aspect and fallout of the absence of a potent regulatory body for the private health care sector in India. He correctly draws much needed attention to the effect not only on nurses’ remuneration and working conditions but also the lack of professional and societal respect for them.

However, it is noteworthy that this lack of regulation in the private health sector in India also affects hundreds of fresh MBBS, BDS, BAMS and BHMS graduates every year who are neither able to get selected for the limited number of vacancies in government sector or for post graduate courses nor do they have the financial resources to set up a private practice. The vast majority end up facing the same plight as that of nurses being given much lower salaries than the government sector, made to work 12 hour shifts with no job security. The only difference from the nurses would be in terms of societal respect which they do command and a slightly higher remuneration due to a higher qualification. But that also prevents them from divulging their poor pay structures and exploitative working conditions in the mushrooming small hospitals and nursing homes in the private sector which dot entire cities and towns in India.

This state of affairs in the health care sector is paradoxical with a huge need and demand for health professionals on one hand and non-remunerative, exploitative working environment in the unregulated private sector for both nurses as well as fresh medical graduates on the other hand.

So, what can be a pragmatic solution to this critical issue for better utilization, working conditions and career pathways of both nurses and young physicians leading to better quality and availability of health care services in India?

The solution would be to develop and implement a nurse centric but physician guided health care model similar to “nurse practitioners” in the United States by both the central and state governments. The Government of India has already initiated steps towards a non physician health care provider cadre for rural areas by proposing a three year rural health professional course. This course should give preference for admission to registered nurses who would then qualify and get trained to work as “nurse practitioners” who would then automatically get a higher remuneration as well as societal respect. These nurse practitioners would have to work in a facility under the supervision and guidance of a physician in the initial years to ensure quality and also to seek technical advice. These nurse practitioners could provide adequate numbers to fill the gap of medical doctors in multiple rural and urban health centres across the country. The fresh medical graduates could be given contractual positions for three years as medical officers for supervision and guidance to these nurse practitioners in the government. The government would need to make a provision for a thirty percent higher salary for working in rural areas for contractual positions of both doctors and nurses to make it attractive for young doctors and nurses to go to rural areas. In conclusion, this nurse centric model with guidance from young medical graduates with incentives for rural postings can address the issues of lack of health manpower both in terms of quality, quantity and availability.

E mail: bidyutk.sarkar@gmail.com

Competing interests: No competing interests

26 June 2013
WT Research Scholar
University College London
Dept of Epidemiology and Public Health,UCL,1-19,Torrington Place, London WC 1E 6BT, U.K