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The changing face of Indian nursing

May 11, 2005 -- Lopamudra Maitra's piece posted on the expressindia web site today reports that, as nurses celebrate Florence Nightingale's birthday, Indian nursing schools are seeing more young women and more men taking an interest in the profession, as well as an increased demand for Indian nurses in English-speaking developed nations. The piece appears to be based mainly on conversations with local nursing school leaders and teachers, and it provides some interesting and important information about these trends. Unfortunately, it lacks any sense of the broader context of such migration, and it also presents some regressive stereotypes of nursing--the most egregious of which appear to come from a local dean of nursing.

The article is headlined "On Nurse's Day, profession sees more young faces, more demand abroad," and the sub-head is "Increasing opportunities, changing attitude and awareness also draws more boys to a service of care and patience." The piece leads off by paying tribute to Nightingale for the "dedicated service" in the Crimea in 1853 that earned her an "unrivalled" place in history. This reinforces the stereotype of Nightingale (and all nurses) as being mainly about self-sacrifice, a damaging distortion of the contributions of one of the 19th century's great health reformers and thinkers, though one that is almost too common to complain about. The piece goes on to report that because nursing is "becoming more professional," it is seeing an increase in awareness of its importance and an increase in interest from recent school graduates of both genders. Apparently, in recent times students had tended to be older women with few other options. Nursing school teachers and officials now point to improved training methods, facilities and technologies, as well as recent demand for Indian nurses abroad. Tapati Bhattacharjee, the "dean of nursing and principal" at a local college of nursing, notes that several of the school's young graduates will be joining hospitals abroad, especially in the U.K., the U.S., Ireland and Australia, where the pay and opportunities are better. The article contains no hint that anyone sees any issues with the devastating effect such migration may have on India's health system. In fact, as you might imagine, migration of a developing nation's most skilled nurses can be a big problem. Of course, some argue that such migration is a necessary trade-off for the remittances nurses may send back, and that some nurses return to their home nations with new skills, but readers of this piece learn none of that. The piece contains quotes from three nursing school representatives and one Mumbia-based foreign nurse placement agent, but none from any hospital nurse or from any of the new graduates who may be considering such a move.

Some of the quotes from nursing school officials are troubling. Meena Ganapati, "principal" of a local institute of nursing education, points to the discovery of the profession by males, noting that in a "batch" of 50 students, nearly 30 are "boys." This would seem to be an encouraging development, because greater gender balance will almost certainly be required if nursing is to gain the strength it needs to overcome the current crisis. However, the only potential benefit noted in the piece is Meena Ganapati's comment that the boys' interest is good because they "can serve at odd hours, do night shifts and stay in ambulance services. Family or other responsibilities often hold back a woman from working odd hours." We don't doubt any of that, but we note the implication that the answer to such gender-specific limits is not to look for ways to reduce them, but to recruit members of the other gender.

Still more curious are comments attributed to dean of nursing Tapati Bhattacharjee, who explains that a key reason Indian nurses are in demand abroad is that ‘‘[t]hey are considered more patient and kind compared to [the foreign nations'] own nurses and can spend eight long hours sitting close to a patient's bed. This kind of manual jobs [sic] -- like tending to a patient -- is comparatively less in demand among nurses of foreign countries. They want to focus more on administrative jobs.'' This presents a startling vision of developed nation nurses fleeing the bedside for "administrative" jobs because they are tired of the "manual" labor of sitting around being "patient and kind" for "eight long hours" at a stretch. Silly us--we thought the developed world nursing shortage was driven by rampant short-staffing and deeper nursing status factors that left highly skilled nurses feeling utterly burned out and scarcely able to meet their patients' most basic physiological needs. You know, like saving their lives. We thought nursing involved complex care that required years of college level training and experience to master, and that--even in the absence of a critical shortage--the typical registered nurse was too busy using his advanced physical and mental skills to help his patients return to health to spend a whole lot of time "sitting" at the bedside. There may be nursing jobs that involve sitting at a patient's bedside for long periods, but the suggestion that this is the typical developed world scenario is about as far from reality as it is possible to get. Of course, if anyone did subscribe to such a fantasy vision of modern nursing--like, say, a hospital administrator or consultant--it would make it much easier to justify denursifying a given care setting.

On the whole, this piece provides a mix of interesting, troubling and potentially encouraging information, but its lack of balance and perspective may mislead many readers as to the true nature of nursing and its current state worldwide.

See the article: "On Nurse's Day, profession sees more young faces, more demand abroad: Increasing opportunities, changing attitude and awareness also draws more boys to a service of care and patience" by Lopamudra Maitra which appeared on the expressindia web site on May 11, 2005.

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