Thirty years ago, when a nurse midwife like Mother Virginia, a European nun in St. Martha's Hospital, Bangalore, who trained thousands of young nurses and doctors like me in the art of midwifery, caring and supporting mothers during the birth pain, walked around with an aura of unquestioned leadership, affectionate smile and understanding glance to those in agony, imparting confidence to all staff in solving many emerging crises, nobody could ever think that nurses like her need any paternalistic support to excel in profession. She had a cheerful interaction with millions of newborns who do not socially respond other than cry, assertiveness in ward discipline and medical ethics with an infectious enthusiasm and untiring stamina to work.

Nurses are traditionally seen as following the doctor's orders in everything. They always walk behind doctors during rounds, more so if it is a male, assist him in all procedures and always seek his approval before doing anything needed for patient care, though on many occasions they help him in taking correct decisions on patient management. Their contribution has not been adequately recognised for many decades. Legally, all responsibility is owned by the doctor. The nursing profession historically grew in the shadows of medical profession in spite of the legacy of Florence Nightingale.

Seldom is “nursing” seen as a separate profession on a par with the medical profession; equally important and distinct in its role. The block is mainly in the mindset of everybody, mainly doctors especially men. As part of the health sector reform, there is a growing awareness to give them their long pending due. A separate directorate for nursing administration is the proposition. Why?

Nursing care and nutrition are as important as curative medications and surgical procedures. Nurses are present day and night with the patient. It is a round-the-clock service. Nurses are required to work with all modalities of treatment, specialisation and schools of medicine. Thus, nursing needs to be given a distinct professional status to boost its image. It requires autonomy to manage its own cadre and resources and freedom to take decisions.

The sheer size of the nurses' cadre in the overall human resource capital in any State makes the practical sense that they be given responsibility to manage themselves with accountability. The National Rural Health Mission since 2005 has added 80,086 ANMs (Auxiliary Nurse and Midwife) and nurses and 9,856 general duty doctors and specialists, making the nurses' cadre strength 2,42,210 in the country which is more than seven times the doctors' strength of 33,714. It is sheer logic that any large workforce requires an administrative structure from the bottom up for better communication and line of control.

Another justification for a separate directorate is cadre complexity. Under the umbrella of nursing, there are three different and distinct cadres:

a. Public health nursing personnel — ANMs, LHVs, PHNs, DPHNOs.

b. Clinical personnel — staff nurses, specialised nurses, head nurses, departmental supervisors, matrons and nursing superintendents.

c. Teaching cadres — clinical instructors, tutors, lecturers, associate professors, professors.

A separate directorate can bring all nursing personnel — clinical, teaching and public health under one unit of administration. At present, nurses work under different directors for medical education, family welfare and health services with no coordination of professional activities or information-sharing or mutual support.

In some States like Chhattisgarh, even the Nursing Council, supposed to be an autonomous professional regulatory body, works under the Director of Health Services.

There is a large variety of educational courses in nursing such as the diploma, certificate, degree, postgraduate, M.Phil and PhD. This requires a highly professional, comprehensive management system of syllabus approval, quality intake, conduct of courses, examinations and certification process. The nursing structure at the top is weak since there are very few positions at the national, State or district level occupied by ‘nurses only'. Nursing has been neglected owing to the low level of leadership development and poor involvement in policies and decisions. Low involvement in decision-making has not fostered the growth of the profession. Having a separate directorate is not a utopian idea but has been successfully demonstrated by the West Bengal Nursing Service, which is unique and distinct and responsible for all aspects of nursing administration such as training, postings and transfer, appraisals and promotion and service information which is maintained well and readily available when needed.

Clubbing of nursing with the proposed national/regional institute of paramedical sciences will again go against the principle that nursing is a separate professional entity rather than one of the paramedical disciplines.

Nurses are overwhelmingly women. The professional image, status and involvement in policymaking are linked to the status of women in society at large. This great profession of women has to be uplifted to serve as an opportunity and role model for others to enter into this caring sector.

(The writer is a former Health & Nutrition Specialist for UNICEF and former Director, State Health Resource Centre, Chhattisgarh. He can be contacted at krantony53


The great medical education bazaarJune 23, 2013

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