Angels on Earth
"Indian Express" on awful conditions for nurses
October 14, 2012 -- Today the Indian Express (New Delhi) website ran a good story about a recent study by sociologist Sreelekha Nair (right) of the Centre for Women's Development Studies focusing on the troubling situation of India's nurses. The study reportedly found that nurses continue to confront appalling working conditions including understaffing, especially in the private sector; abuse from employers, colleagues, and patients' families; very low pay and workplace restrictions that seem to approach servitude; and widespread undervaluation, including low work and social status, even though, as the report itself notes, they save lives. The Indian Express story, headlined "Indian nurses still an exploited lot: Study," originated with the Thiruvananth-apuram press agency. The article quotes extensively from the study and relies on additional comment from the study author, as well as Indian Nursing Council member P. K. Thampi. The piece links the status of nursing to the fact that the profession remains predominantly female. The report notes briefly that some nurses do find opportunities and even "adventures" by taking their skills overseas, though it does not explore how that migration affects India. The piece might have sought more input from nurses themselves, particularly those working in the clinical setting, and it might have gotten some reaction to the study from government and hospital officials. But the article provides valuable information about the state of nursing in India today, and we thank those responsible.
The piece starts by noting the irony that although nurses are "hailed as 'angels on earth,'" the new study has revealed that the lives of Indian nurses are actually "rather 'miserable,'" especially in the private sector, where recent "strikes and agitations" have apparently failed to improve wages or working conditions. Of course, though the piece does not seem to recognize it, the "angel" image of nursing has a great deal to do with awful working conditions the piece describes. When nurses are "angels," we need not worry about whether they suffer or need the basic things that other human workers do. The article says that the study was conducted by Sreelekha Nair, Junior Fellow at the Centre for Women's Development Studies in New Delhi, and it apparently focused on nurses from the state of Kerala working in New Delhi hospitals. The piece does not discuss Sreelekha's professional background, but does say that she has written the book Moving with the Times--Gender, Status and Migration of Nurses in India. In fact, Sreelekha is a sociologist who focuses on women in the workplace, particularly nurses.
Much of the piece describes the poor treatment Indian nurses receive, not only from physicians and hospital management, but from "co-workers" and even patients' families. Sreelekha says that nurses' "superiors" and "even the relatives of the patients verbally and, like in some cases as reported in newspapers, physically harass them." Nurses are also reportedly subject to a "bond system" in which hospital management "confiscates" nursing certificates which "would prevent them from seeking better opportunities in India or abroad." Sreelekha says the study participants confirmed that his happens nationwide. The piece goes on to note that private sector nurses are actually "cheated in many other ways." Their salaries are very low, especially in relation to the fees they pay to attend school, and the study also found that "the actual amount paid to them is lower than what has been recorded in the payment register on which the nurses are compelled to put their signatures." Angels on earth! The report also notes that both private and public sector hospitals have very poor nurse-patient ratios, with public sector ones so overwhelmed that patients are admitted even if there are no beds for them.
The piece does consult one nurse, "Indian Nursing Council member P K Thampi," who not only confirms that nurses are "exploited" but also says that there is "virtually a slave-landlord relationship between nurses and managements." Thampi explains how low nursing salaries are but notes that most nurses still stick with their jobs "as they have no other option." The piece might have done more to get input from nurses, particularly those in the clinical setting. Workplace sociologists are not necessarily in a position to fully understand nursing. Some appear to be unaware that nurses do have at least theoretical autonomy, although the extent to which that is made real varies greatly. This article does not suggest that nurses report to physicians, but of course, it does suggest that many Indian nurses cannot even count on being treated lawfully, much less as autonomous health professionals. The piece might also have asked government officials and hospital executives to explain why nurses appear to be subject to such horrific conditions.
The report rightly links the poor treatment of nurses to how society perceives and values the profession. It notes that the fact that nursing remains a "women majority profession" "contributes to [nurses'] low status," as most of the study participants apparently stated. The article quotes the study to illustrate the gap between nurses' real value and how their society sees them:
Nurses share several stories of their saving the patients' lives. However, they feel that their contributions in patient care were not valued. It is true that the name of doctors who participated in important events, for example, the first heart surgery or such historical occasion, are known to everyone but the nurse who is part of that event is not mentioned even in records.
Great point--who kept that heart patient alive? The study also found that the mistreatment of nurses itself contributes to their low social status, along with the fact that their work "involve[s] caring for strangers and include[s] handling of body fluids." And the low status extends to nurses' personal lives. There are "stories of rejection and resistance by future in-laws just due to prejudices surrounding only this group of women workers." This reminds us of the reports that nurses in some nations are regarded as little more than prostitutes, which would naturally limit their social options.
Near the end, the report mentions that some nurses, especially from Kerala, migrate abroad for better jobs and that some plan this from the start of their careers, a trend that has been widely reported in the Indian media. The report even suggests that these nurses may "undertake a number of adventures." But the piece explores the subject no further, and so it does not get into the difficulties some migrating nurses face, nor the effects on the nations they have left behind, from the helpful impact of remittances to the less helpful loss of skilled nurses the nation of origin has trained, as discussed in detail in the work of Mireille Kingma (right). The new study does seem to have looked specifically at the situation of nurses who have migrated within India, from Kerala to New Delhi, although the article does not discuss it in any detail. In fact, nurse migration within nations is a common trend globally and an apparent research interest of Sreelekha herself, based on her book title.
On the whole, this report provides a distressing but valuable look at the difficulties nurses still face in many parts of the world, with a particular focus on the role of social undervaluation. We thank those responsible for the Indian Express article and the study on which it is based.
See the article "Indian nurses still an exploited lot: Study" posted October 14, 2012 on the Indian Express website.
Also see a related article "Kerala nurses struggle against bond trap" posted February 26, 2012 on ZeeNews.com.