VALUING NURSING CAN TRANSFORM HEALTH CARE
In the critically-acclaimed comedy, Meet the Parents, the hero essayed by Ben Stiller is an object of ridicule in the eyes of his prospective father-in-law played by a taciturn Robert de Niro on account of Stiller being a male nurse. The word nurse is spoken of with disbelief and contempt, as it is not seen as a job for men. This attitude is evident in India where the ratio of male to female nurses is 20:80.
At a time when health workers are being lauded, we need to look at why it is seen as such an unattractive profession. The reason men stay away from nursing, apart from the social opprobrium, is that it is so poorly paid. Salaries for nurses range from ~13,000 to ~35,000. The private sector is niggardly about revising salaries for nurses, the average yearly increase is around 2%.
That nursing does not attract enough people is seen from the poor ratio of 1.7 nurses and auxiliary medical staff to 1,000 people in India, 43% less than prescribed by the World Health Organization (WHO). This includes nurses, midwives, health visitors and auxiliary nurse midwives. Ironically, WHO has declared 2020 as dedicated to the nurse and midwife. The nurse-patient ratio in India is 1:20 against the international norm of 1:4.
A lesson to learn from the coronavirus disease (Covid-19) crisis is that the working conditions and remuneration for nurses should be drastically revised. They work long hours and get little by way of perks and pay.
Some time ago, while in hospital after a surgery, I got talking one night to one of the many nurses in the private hospital I was in. She was from the north of Kerala — of the 2 million registered nurses in India, according to the Indian Nursing Council, 1.8 million are from Kerala. She told me she felt a sense of safety that night as she was in a room with a woman. She told me of how nurses are harassed by male patients and even their attendants when they do their nightly rounds. Most of all, she spoke of the culture of silence in which the authorities did not want to offend patients for fear of loss of profits. The nurses live on small salaries, in largely vegetarian hostels provided by the hospital, and their only form of relaxation was to visit a relative and, hopefully, she told me, eat non-vegetarian food.
During the Covid-19 crisis, there were reports of how they were given lesser accommodation in far-off places as part of their self-isolation and made to take crowded transport to their places of work, defeating the very concept of isolation. Many nurses work in these trying circumstances to gain enough experience to get an infinitely better paying job abroad. As European societies age, more opportunities have opened up for health caregivers from India, something Kerala has had the foresight to anticipate. The state has opened several nursing courses dedicated entirely to geriatric care.
With substantial unemployment, this should be a career option for more men and women. But it isn’t. Men don’t consider it a job which can bring in enough money and it is also seen as a demeaning job not suited to men.
The virus has highlighted the shortsightedness of these issues. The presence of male nurses in hospitals will make the environment safer for women, and may even improve salary structures. The trying circumstances under which nurses work was brought home when the final words of a nurse who died from the nipah virus in Kerala were made public. She looked after patients and in the process became infected. “I don’t think I can meet you again, sorry”, she said from isolation to her husband and child. Today, nurses on the frontline of the fight against Covid-19 have tested positive. Hopefully, all of them will recover. But this is the right time to look at the profession with a view to making it more attractive, safe, respected and gender-neutral.