Shortage of 4.3 million nurses in India: Experts

New Delhi: Set against the context of the ongoing pandemic and the probable fear of advent of yet another wave across the globe, 'Think Change Forum' (TCF), a think tank dedicated to finding answers and solutions on critical issues in the post Covid era today organized a dialogue among nursing and midwifery experts from across the country to analyse issues plaguing the nursing sector.

The discussion themed 'Is India's Nursing Infrastructure Ready for Another Wave' saw participants representing nursing bodies, institutions and academia, international NGO's and nursing practitioners.

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Based on the deliberations, Think Change Forum has released a '5-Point Recommendations' for immediately strengthening the state of Nurses & Midwives in India. These include:

1. Urgent adaptation of the WHO norms as outlined in the Strategic Direction of Nursing & Midwifery (SDNM) 2021-2025 recently passed at the World Health Assembly 2021 and focuses on investment in nursing education, creation of positions and leadership.

2. Filling of sanctioned positions of nursing leadership at central and state levels immediately and set up additional nursing positions at the directorates of various states of India

3. Fast track passing of the National Nursing & Midwifery Commission Bill (NMMC) bill by Government of India and repeal the India Nursing Council Act 1947

4. Implement a Live Register replacing the Nurses Registration & Tracking System (NRTS)

5. Increase investments into nursing and midwifery quality education as due to a scanty number of Government institutions access to courses is limited

India has over 3 million registered nurses & midwives who are responsible for the country's 1.3 billion population, which is grossly inadequate. This is less than the WHO norm of 3 nurses per 1000 population. India needs to add more than 4.3 million nurses by 2024 to meet the prescribed WHO norms. The optimum Nurse Patient ratio recommended by the Government of India and the Indian Nursing Council (INC) has not been implemented and as a result one nurse is looking after 20 to 30 patients, which putting patient well-being to a huge risk, making the task of doctors difficult and frustrating, and adversely impacting the credibility of the India's healthcare system.

As roles and challenges faced by nursing professionals have multiplied over years, a major impediment to their growth and development is the lack of involvement of nursing professionals in decision-making and policy framing. There is a crisis of leadership in India's nursing cadres, which needs to be addressed immediately. Non-nursing professionals, who lack practical, day to day experience of the ground-realities are grossly ill-equipped to take decisions on behalf of practicing nurses.

The panel discussion underscored the need for an urgent review of current organizational and management structures for nursing positions at the Nursing Directorates in India and strengthen nursing management capacities. A special Nurses Human Resources Management System, a technology-based platform for maintaining live nurse and midwives' register, a need-based assessment of the number of nursing institutions as per the population of the state are some of the other recommendations which need urgent attention of the policy makers.

Speaking during the discussion, Dr. T. Dileep Kumar, President, Indian Nursing Council, highlighted the nursing leadership and impact of policy by nurses and said, "There is an urgent need to fill in the nursing cadre and positions to achieve an inclusive structure and adequate representation of nurses in policy making. Currently there are either few or no fully functional directorates across centre or sates. While much progress has been made to recognize, strengthen and support nurses and midwives, much remains to be done to ensure their growth."

Prof (Dr.) Roy K George, National President The Nursing Association of India (TNAI) speaking on the growing attrition of nurses from India said, "India is a global supplier of nurses despite their shortage within the country. The nursing and midwifery profession is witnessing a large-scale brain drain from the country due to poor salary, working conditions and absence of a proper career pathway,and out-dated systems of professional governance. Despite forming a large part of the healthcare force, nurses and midwives continue to be short-staffed across the nation leading to poor nurse-patient ratio, increased workload, long working hours, double shifts which eventually leads to poor quality of treatment. If this trend continues, India's healthcare infrastructure will be crippled and most of hospitals in the country will have to close down in the next five years because of their acute shortage".

Dr. Bulbul Sood, Senior Strategic Advisor, Jhpiego highlighted, "Nurses and midwives play a vital role in providing health services and often they are the first and only point of care in their communities. Therefore, it becomes imperative that we enable them with the right support and build awareness, recognition and representation for the nursing and midwifery cadre in our country. The #NurseMidwife4Change program of INC will help prioritise investments to further strengthen this cadre so that they are able to perform their roles optimally".

Prof.(Dr.) Smriti Mani, OSD Nursing Directorate, West Bengal "West Bengal currently is the only state in India today where there are about 19 Nursing Officers dedicatedly looking after administration of nursing education, practice, career path and working conditions. As a result, the workforce has increased from 3000 nurses in 1957 to 66983 in 2021. We strongly advocate creation of separate nursing directorates led by nursing leaders across India'.

Panel Moderator, Mr. Ratan Jalan, Managing Director Medium Healthcare Consulting and Former CEO of Apollo Health & Lifestyle, elaborated, "Being at the forefront, nurses played a pivotal role in providing care during the pandemic. Unfortunately, the challenges about them - be it the inadequate supply, poor compensation or lack of recognition got even more evident. My idea for this webinar was to address some of the challenges and reflect on the solutions".

Dr Saleena Shah - Principal Govt. College of Nursing Thrivananthapuram (Ex. Registrar, Nurses & Midwives Council, Kerala) emphasized, 'We need emphasize the need of investment into the nursing infrastructure and the integration of equal weightage for education as for other medical professions.

Prof. Reena Menon - Principal St John's College of Nursing, 'Nursing students have to be taught by faculty who have clinical expertise, for which Integration of service & Education is the key . We also need to be able to impart clinical & leadership skills and help the cadre become assertive and smart.'

Prof. Dr.S.Ani Grace Kalaimathi -Registrar, Nurses and Midwives Council, Tamil Nadu, "We need to bring out the leaders who are already there and highlight to the youngsters what has been done so far so as they are motivated'.

A recorded version of the panel discussion can be accessed at the YouTube channel of the Forum:

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