Role of nursing in the economic power of care

Since Florence Nightingale first proved the significance of nursing in healthcare and how good nursing practices can drastically transform health care outcomes, the demand for nurses all over the world have grown exponentially. The nursing workforce in India (registered nurses and midwives) stood at a whopping 3.2 million as of 2020 and has only grown from there.

Popular for their dedication, care, compassion and resilience, the nurse’s role in India has expanded over the decades to go beyond traditional bedside care. From initial assessment and innovative care models to supervision, research and evaluation, nurses today are orchestrating every stage of the patient experience, improving efficiency and outcomes along the way. Significant increase in the number of nursing colleges and specialised training courses are further fuelling their ambitions.

However, the current landscape presents numerous constraints. Nurses today can choose from only a select range of opportunities which neither utilizes their upgraded skills nor meets their financial aspirations, let alone opening doors for desirable promotions. Other challenges includes a low pay scale, limited career progression, unsatisfactory working conditions, infrastructure issues, low social status in the healthcare hierarchy, and mistreatment by colleagues as well as patients. A consequence of this is heavy brain drain from India into countries where nurses enjoy a more respectable position and are actively involved in decision-making.

The Indian Nursing Council (INC) is pivotal in shaping nursing policies and education standards across the country. In the recent years, the council has adopted a slew of measures for improving the skills and status of nurses. Few of them include revisions in the syllabus, endorsing innovate education models, introducing minimum wages for nurses in private hospitals, and collaborating with International Council of Nurses (ICN). Recognising the capability of a nursing practitioner in dispensing a wide spectrum of curative services, the ministry of health and family welfare is further exploring their introduction as a new cadre. Considering the industry’s need for aggressive policy changes and comprehensive reforms to improve nurse-patient ratio and enhance job satisfaction, these measures seem inadequate.

In contrast, advance economies like the United States, Canada and Australia have well-established pathways for nurses to pursue specializations and advanced practice roles. Stricter regulations on nurse-patient ratios further prevents burnouts while a better pay structure and clear growth prospects ensure a motivated and more productive workforce.

To make matters worse, the involvement of our nurses in policy making is insignificant. Their authority to take decisions and make recommendations have shown weak progress as compared to the West, where nurses are assertive and deeply involved in policy making.

Like in most cases, educating our nurses is the best way to empower them. To build a resilient nursing workforce and a healthier India, we must invest in prioritising nursing education and enhancing their core competencies. Policy-level reforms to educate, improve work conditions, create better work opportunities and strengthen care quality are imperative. Emphasis must be laid on providing specialised and role-based training to our nurses, preparing them to handle health care challenges with agility and confidence. Other than these, we must also encourage our nurses to freely express their opinions and be assertive while navigating a difficult situation. They must, by utilising their skills and expertise, have the autonomy to make their own decisions and influence patient care outcome.

Another crucial transformation I aspire to witness is the active engagement of our nurses in the formulation of policies. Nurses, being at the frontline of patient care, witness health care challenges firsthand. Armed with this deep understanding, they are capable of serving as changemakers, and implementing innovative solutions to transform health care delivery. The future of health care, therefore, hinges on integrating nurses’ expertise into policymaking.

As a nursing leader, I strongly advocate establishment of a mentor-mentee programme to empower newcomers and help them to smoothly transition into their new roles. Other than providing guidance and support, such mentorship can also improve work satisfaction and lower employee attrition. To ensure inclusion, we must also look at opportunities to explore and absorb talent from smaller towns and cities of India. A hybrid work model can be instrumental in enabling these nurses to work from their native places, contributing to a favourable work environment and improved nurse to patient ratio.

To err is human. But what we make of those errors set us apart. Nurses should report their errors without fear of punishment or judgement and suggest preventive actions. This, other than preventing further errors, ushers a wave of empowerment and contributes to a positive work culture.

Nurses are the economic engine of the health care system. Wearing many hats, all at once, they deeply impact the health care spending, efficiency, and ultimately, population health outcomes. Leveraging the intellect and expertise of their nurses, hospitals can optimise the line of treatment, thus helping patients to shorten their hospital stay and minimise readmission. Well-trained nurses can also educate patients on healthy habits and disease management, potentially reducing the need for expensive interventions and hospitalisations later. Additionally, by delivering primary care services and telehealth consultations, nurses can play a significant role in keeping people healthier and lessening the overall strain on the health care system.

Overall, a strong nursing workforce, by contributing to a more cost-effective, efficient, and patient-centred health care system, is a pillar for nation-building.

This article is authored by Dr Annu Kaushik, director of nursing, Cloudnine Group of Hospitals, Haryana.