Nursing is indeed a noble profession. But has nursing education in India been given the attention it deserves? With a burgeoning healthcare industry, both government and private, the demand for trained nurses and paramedical staff has been on the rise. However, experts in the industry have also been pointing to great inadequacies in the quality of nurses who graduate every year, skill levels and the lack of accountability in the nursing education system.
Today, there are 322 nursing colleges in Karnataka. No less than 34 of these colleges offer post-graduate courses. And 18 colleges even offer post-basic diploma in specialised care such as oncology, cardio-thoracic and trauma care. Compare this to the fact that in States such as Uttar Pradesh there are no PG courses on offer, and it is clear that nursing education has been skewed in its growth, and healthcare education in this sector has been largely unregulated.
In the past decade when a majority of these colleges have sprung up, the quality of education provided in these colleges has taken a nosedive. Fake colleges, that act in cahoots with touts who lure young students from rural areas with the promise of a job and overseas opportunities, too have brought disrepute to this burgeoning sector. While the demand for healthcare personnel continues to rise, the presence of these colleges which provide skeletal infrastructure and no clinical training have resulted in students being weary of this stream.
In recent years, the demand for nursing education too has seen a decline in the State. The president of the Indian Nursing Council T. Dileep Kumar, who spoke to The Hindu on a recent visit, attributes this to the fact that students are not able to afford the cost of education. Last year, students complained to the State Nursing Councils that banks were denying them education loans, and many banks also reduced the amount of education loans for nursing students. Mr. Kumar said that the INC is taking this up with banks in several States. On the issue of increasing fees charged by nursing colleges, particularly those run by successful private hospitals, he said that the State Councils were dealing with the issue.
Meanwhile, it may be recalled that in January 2010 the High Court of Karnataka issued notices to the Director of Medical Education, Karnataka Nursing Council, and Rajiv Gandhi Institute of Medical Sciences on the hike in fees, acting on a PIL on the issue. A petition filed by the association of Malayalee students in Karnataka claimed that the nursing colleges and allied health science institutions in the State have hiked the tuition fee for B.Sc Nursing and B.Pharma from Rs. 35,000 to Rs. 65,000. The hike violated the Karnataka Education Institution (Prohibition and Capitation Fee) Act, 1984, the petitioners had argued.
Caution required
On the issue of errant colleges that have duped students by running campus out of single rooms, and offering little in terms of training, Mr. Kumar said that students must be more cautious of what they sign up for. The State Nursing Councils and INC have active websites that enlist all the recognised nursing colleges. Students must verify with the website to begin with ( http://www.indiannursingcouncil.org).
The Karnataka State Nursing Council had also made it mandatory for all nursing schools to have their own website, giving details on the institutions. The details include physical facilities, photographs (hostels, buildings and labs, and their size), clinical facilities (hospitals — photos and government order), details of teaching faculty (name and address, phone number and photos of principal, tutors and lecturers) and details of Trust/Society. Details of the Council's recognition, fees and admission procedure are also mandatory. Cross-checking these criteria will enable students get a better picture of what the college offers, and empower them to make an informed choice.
The principal of a private nursing college says: “In this information age, students needn't be victims of their circumstances. If touts are promising them the heaven and earth at these colleges, all they need to do is get online and simply search for the institutes. All the reputed ones maintain their websites. Cross-verifying with the Nursing Council website is also a good idea.”
Mr. Kumar believes that there is a great need to increase the nurse-patient ratio in hospitals, both State-run and corporate. Globally too, the demand for allied medical staff is rising and the lack of trained paramedical staff is a big issue. The World Health Organisation is estimating a shortage of over four million healthcare personnel. “Students must realise that this is a great profession. And with healthcare expanding, the demand will only increase.”
He believes the fact that most trained nurses opt for overseas jobs is not an issue, for trends are bound to change, what with a booming corporate health sector. However, the corporate health sector today does not pay as much as government hospitals do. “Every year the demand for government nurses increases, and now with the National Rural Health Mission making some of these posts permanent and mandatory at Public Health Centres, and the Sixth Pay Commission increasing the salaries of government employees, students will find that the profession is a lucrative one.”
Even in the corporate health sector, where nurses are currently poorly paid, rising levels of attrition are slowly resulting in an increase in pay packets.
Quality issues
Veterans in the field of nursing education point to another issue that plagues this skill-intensive profession. The quality of nursing education provided today, many fear, is outdated and does not equip graduates with the required skills. A nursing teacher from a government nursing college in Mangalore, who did not wish to be named, complained that the nursing syllabus has not been revised for several decades now, thereby rendering courses irrelevant to the industry. Various technological advancements in health sciences have not been included. Further, she says, poor payscales in nursing colleges keep talented teachers away from the profession. Many nursing schools have been upgraded into colleges, but quality remains the same. While the 11th Five-Year Plan has allocated substantial funds for the profession and each nursing council has been allocated funds to the tune of Rs. 1 crore, little has been done.
Continuing Nursing Education
In a bid to improve the general quality of nurses and update them with the requirements of the healthcare industry, the Government of India had decided to institute Continuing Nursing Education. The INC president announced recently that nurses across the country will have to attend 30 hours of training or seminars every year in order to qualify for renewal of licences. So, licence renewal will move from being a mere attestation formality, currently mandatory once in five years, to a reflection of their skills. In foreign countries, nurses are required to take a qualifying examination once in five years.
“Since the logistics of that is difficult, we chose this system,” Mr. Kumar says. The council was moving towards making Continuing Nursing Education a part of their professional lives. The State nursing councils, which would receive Rs. 1 crore to hire staff members and purchase equipment to implement the plan, would oversee these matters. Mr. Kumar pointed out that in the 11th Five-ear Plan period, each State would be granted Rs. 20 crore to establish centres of excellence.
