Why is India facing an acute shortage of nurses?

India has been making great strides in the field of medicine.

Technology, healthcare infrastructure and facilities for doctors are getting better.

However, amidst this progress, a major crisis is unfolding at hospitals – a shortage of nursing staff.

With an already existing poor nurse-to-patient ratio in Indian hospitals, the crisis is about to get even worse.

Medical experts and doctors are warning that more and more nurses are leaving India.

Dr Girdhar Gyani, director general of the Association of Healthcare Providers (India), said India has over 3.3 million registered nurses.

However, this number is inadequate for India’s population of 1.3 billion.

But why are nurses choosing to leave India? Let’s take a closer look:

A crisis at home

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India produces 2 lakh nurses every year.

However, 40 to 50 per cent of these nurses opt to move to foreign countries shortly after gaining practical experience.

The numbers have surged notably since several European countries and the US eased their eligibility criteria to require just one year of nursing experience as compared to three years previously.

This change allows nurses with little experience to work abroad.

“The US and several European countries have an acute shortage of nurses, and they have reduced their eligibility requirements…This has been a boon for many,” Shoby Joseph, president of the Kerala-based United Nurses Association (UNA), considered the largest association of nursing professionals in India told Livemint.

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Private hospitals in India too are grappling with a severe shortage of nurses.

Kerala is experiencing a deficit of 25 per cent, while Maharashtra’s shortfall stands at approximately 40 per cent, as per a Livemint report.

“With 1.96 nurses per 1,000 population, India falls short of the World Health Organisation (WHO) recommended rate of three nurses per 1,000 population,” Dr Gyani told PTI.
“We have to realise that this is a big health crisis,” said Joseph. “A crisis created not because we don’t have enough nurses, but because we are doing a bad job retaining them.”

Better pay outside India

Experts say a higher salary is a big factor.

Dr Satish Joshi, former president of the Indore Medical Association and Consultant Pathologist said, “Many nurses are choosing to quit as they are looking for a better future abroad. They can earn far more abroad – sometimes up to even four times higher.”

He explained that nurses who have finished their courses usually earn between Rs 15,000 and Rs 25,000 per month at privately owned hospitals.

The pay in smaller institutions is far less.

Nurses who work more than 8 hours a day with one day off “can expect a salary of about Rs 30,000 to 40,000 after 3 to 4 years of nursing experience,” Dr Joshi added.

“They have fixed times to come at the hospitals, but sometimes when work pressure is high, they work extra-hours, we pay them over-time, but that does not make a major difference,” he added.

But why is this so?

“Hospitals are manpower-heavy. So, when the manpower cost increases substantially, the viability of the business becomes almost nil. Naturally, healthcare costs need to rise, which will become a socio-political problem,” MI Sahadulla, the founder of Kerala-based KIMS Hospital, explained to Livemint.

Harsha Elizabeth Michael, a 26-year-old nurse trained in Kerala relocated to the UK couple of years ago.

She told The Times of India, “If I work for five years in India, my salary would reach a maximum of Rs 40,000. However, in the UK, I can earn around Rs 4 lakh a month after five years of experience.”

Better facilities abroad

Dr Joshi also pointed out that nurses who head abroad have the chance to receive better training and learn from a much larger network of professionals.

This is something which “we are missing,” he added.

Harsha told TOI that she chose to work in UK for because of the myriad benefits.

“Imagine after five years, I will be a permanent citizen of the country and I will be eligible for all other benefits like free education for children, free medical treatment, etc. I can also save a lot of money which I can send to my parents,” she said.

“Unlike the 12-hour shifts for five days a week in India, the UK offers a 37.5-hour work week, spread across three days,” Harsha explained.

“Moreover, if one chooses to undertake advanced courses, the hospital covers the expenses,” she added.

She also said she can earn extra income by working “double shifts.”

‘Need for more skilled nurses’

Dr Joshi said to cope with staff shortages, small hospitals are preferring to recruit nurses who pursue shorter nursing courses (general nursing management of usually three years and six months), over those who hold a BSc degree (of four-and-a-half years).

“The shortage is not only affecting patient care quality but also placing an immense burden on the existing healthcare workforce,” Joshi said.

While it is the need of the hour to focus on increasing number of nurses, it is equally important to invest in upskilling the existing workforce, Dr Gyani said.

“While the shortage of nurses and their mass emigration to foreign countries is a cause for worry, there is a need to train them at home, especially amid the advent of health tech and other technologies,” Dr Shuchin Bajaj, director of the Ujala Cygnus Group of Hospitals, told PTI.
The public’s attitude towards doctors and nurses is another reason that many are heading abroad.

“Medical staff and nurses face abuse and wrath of patients’ relatives,” Dr Joshi said. “Sometimes even a slight delay by the staff can result in harassment.”

Harsha told The Times of India that healthcare professionals are respected in the UK – which is not the case India.

Gyani told PTI that the nursing community is looking for help from the government.

“The challenges are more persistent in Tier-2 and 3 cities, where there is a lack of a trained healthcare force despite the establishment of state-of-the-art hospitals or health facilities. Apart from that, the nursing community also looks forward to greater support from the government," Dr Gyani told PTI.

“By arming our nurses with advanced training and specialised knowledge, we don’t just fill staffing gaps, we unlock a cascade of benefits: better patient care, reduced healthcare costs and happier and motivated nurses,” he said.

With input from agencies