A true crusader for the nurses and nursing education in India, Dr Manju Chhugani, Principal, Rufaida College of Nursing, Jamia Hamdard shares her views with Shahid Akhter, ENN

India produces the largest number of nurses, yet we have the highest child and infant mortality rates. Where lies the short circuit ?
True, India produces a large chunk of nurses and we prepare them for the whole world but unfortunately they are not adequate for our own needs. Today we have 0.75 nurses per thousand people. Ideally it should be 12.12 per thousand. In India, the demand for nurses outstrips supply. The developed world (US, Australia and New Zealand) entice our nurses with lucrative packages. We need to reconsider what nurses are offered in India. Nurse to doctor ratio in India is 1.5 : 1 and ideally it should be 3 nurses per doctor. UK has the best record of 5.54 nurses per doctor. Every year 45,000 doctors graduate from 362 medical colleges and comparatively the turnover of nurses is low. I contradict the other statement that India records the largest number of infant mortality. There is no  count ability for private hospitals and the definition parameter also differs. Mortality rate is high but certainly we are not at the bottom of the list. There is a flaw in accountability.

How do you rate the quality of nursing education in India ?
Nursing in India has been historically neglected. However, things are gradually
improving. Today we have 3.5 year diploma in midwifery, 4 years of B Sc nursing, 2 years of M Sc nursing and then PhD in nursing. There is also a bridge course. Nursing education and colleges continue to be governed by Indian Nursing Council and it is still managed by the 1947 ACT. Some of the nursing colleges are certainly exemplary while others are outright deplorable. They stand for namesake only and quality of education is equally poor. Unfortunately, such colleges are mushrooming.

Four years for nursing education is almost parallel to medical education ? Is there so much of education really required ?
40 percent of the entire syllabus, foundation science of nursing can be slashed down. Only the part they are going to apply should be taught. A good chunk of the syllabus is at par with medical education which is really not required. We need to do away with the exhaustive curriculum, theory based studies. Just as doctors take a Hippocratic Oath, nurses take a pledge to do their best for their patients. Often called the Florence Nightingale Pledge, the nursing oath is often administered at graduation ceremonies.

Nurses are not subservient to doctors, nor should they be stigmatised. Both are different professions with different roles

Nurses assume additional responsibility with negligible autonomy and authority.

Can you identify some of the roadblocks in nursing education?
The nursing profession is badly lacking in proper representation at key decision making forums. We have exhaustive, theory based curriculum.  Lack of clinical facilities and mushrooming of nursing colleges are few  of the major roadblocks.

Remedial measures that you may like to suggest ?

Competency based training with adequate clinical practice
There should be a check on the growth of mushrooming colleges that are diluting the quality of education.
Provision of family nurse to meet the growing needs of the growing
population. It should be a 1 ½ year course.
Introduction of PG courses as introduced in Vellore Medical College.
Introduction of skill labs
Licensing and re registration of licensing
Establishment of nursing directorate at the Centre and state
Virtual training and telemedicine
Strengthening the clinical capacity of the faculty
Establishment of nodal centers

How true is saying that nurses are heaven sent ?
Nursing binds human society  with a bond of care and affection. Nurses are the most valuable resource of National Health Services. Nursing is born out of great struggle and hardship. The lady with the lamp withstood tremendous amount of pressure and brought not only acceptance but also recognition to the noble profession. Nursing over the years have undergone metamorphosis. Now they are involved in research, projects, handling high tech equipments and using computers in patient care. In short- Nurses are heaven sent.

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