Daybreak - India's nursing brain drain: Why building more colleges won't stop the crisis

Episode Date: May 8, 2023

The pandemic worsened the nursing crisis in India. If 35 nurses were required for every 10,000 people, India only has 25. Exploitative work conditions and poor pay are making nurses migrate in huge numbers to other countries for better jobs. It is an exodus.The government on its part its trying to solve the crisis by building more nursing colleges. But this is akin to a doctor treating the symptom instead of the disease.Tune in to find out why.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing, and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get alert, as soon as we release our first video. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. We as a country are suffering from a serious crisis, an acute shortage of nurses. Let me give you a sense of just how bad it is. If India needed 35 nurses for every 10,000 of its people, It only has 25.

Why is this happening? I'll explain with the example of money. Money is a 51-year-old woman who works at a private nursing home in Rajasthan's Alwar, a city known for its beautiful forts and lakes. It has been 31 years since she joined the profession. She handles all critical care, labour and delivery cases. Money deals with almost 10 times as more patients than a typical nurse.

Very often, she also works 12-hour shifts. So now at this point, you can almost imagine the kind of life she leads. Now, try to guess how much she makes every month, with more than three decades worth of experience. 31,000 Indian rupees. That is less than $400. The average salary of a nurse in the United States is nearly $7,000 a month. Money is just one of many, of course. And this is just a symptom of a much deeper malaise. So nurses have been leaving India for better opportunities outside the country. In fact, after the Philippines, India is the second largest from where nurses are migrating. But wasn't the pandemic a big enough lesson for us?

It was. So the central government came up with a plan. It decided it would set up more than 150 nursing colleges across the country. But wait a second. Who is going to teach at these colleges? We are also running out of nursing educators. Take Money's case, for example. She considered getting into teaching,

but she realized that it pays even lesser than her nursing job. So she changed her mind. So, is starting more nursing colleges the solution to this problem? Welcome to Daybreak, a business podcast from the Ken. I'm a host, Nickda Sharma, and I Don't Chase the News Cycle. Instead, thrice a week on Mondays, Wednesdays and Fridays, I will come to you with one business story that is worth understanding and worth your time. Today is Monday, the 8th of May.

The Ken reporter, Vanita Bhatnagar, spoke to Jason Vargis, the managing director of LJ Medical Staffing. It is a firm that helps nurses find jobs abroad. He told her that the pandemic only made the shortage of nurses worse. He said that at least 23,000 nurses moved abroad in March alone. This was particularly seen from Kerala to the UK. So last month, the union government said that it was going to set up 157 new nursing colleges to increase the availability of qualified nurses. But this has been done before, and unfortunately, it did not work.

In 2000, there were just 30 nursing colleges offering a BSC degree in the country. By 2022, there were over 2,000 of them. But the nursing sector continues to struggle. Private hospitals, which cater to nearly three-fourth of the country's health care needs in India, suffer from the issue even more. Clearly, starting more nursing schools is not going to solve this problem. But why is that? Stay tuned to find out.

There are not enough teachers to teach in these nursing colleges. Vanita spoke to Dr. Judith Norona, a dean at Manipal College of Nursing. She told her that a little over five years ago, they were able to close a vacancy for a nursing professor within a span of three months. But now, it takes them more than a year to find a good qualified teacher. Most nursing institutions struggle to maintain even the stipulated 1-10 teacher-student ratio. Norona told us that because of this, colleges are forced to hire faculty on a part-time basis. The other option is to call clinical practice. practitioners as tutors, all because of the shortage of full-time faculty.

But why then don't these institutions make more effort to recruit more faculty? A professor at a nursing college said that there are two reasons for this. One, is hiring more faculty would mean more cost, and two, there are no consequences if they do not meet the set standards. The Indian Nursing Council or INC, the regulatory body for nurses and nursing education, mandates having a teacher-to-student ratio of 1 is to 10. But private nursing schools often only recruit four or five nursing faculty. And to match the INC mandate, they just bring in more people. They are referred to as ghost faculty.

This is what the professor told us literally. Inspections are a joke. Another dangerous outcome of this shortage is that these universities are resorting to hiring freshers as faculty, despite the fact that this is clearly against INC rules. Coming up next, we try to better understand this problem by looking at how an education and nursing actually works. Stay tuned. There are two ways to acquire an education and nursing. One, through degree colleges which would land you a BSE, MSC, MFIL, or a PEOPLE, or a PEOC,

PhD degree and the other via diploma schools. For degree colleges, students need to have studied science in class 12. But for diploma colleges, including general nursing and midwifery, which is also known as G&M and auxiliary nursing midwives, A&M, non-science students can also apply. So in the last couple of years, though, institutions offering diploma have grown by nine times. Now, this is a bit of a problem. You see, diploma colleges don't even have a basic entrance examination for enrollment, and they don't have enough staff to teach. Also, there have been concerns with the quality of nurses with G&M diplomas.

So in 2019, INC decided that it needed to standardize nursing education. It released a notice for phasing out the GNM program by 2020-2020 and upgrading nursing schools to colleges. Four years have passed since and there has been no action on this notification. Plus, these diploma colleges have no parent hospitals that they're attached to. This is a big setback because nurses in training do not have a way to gain continuous practical experience. This is why the quality of education obviously suffers. It reminds me of a few years ago when my mother was admitted to a private nursing home in West Bengal. Both her arms were covered with black and blue.

bruises by the end of her treatment because the nurses, who were trainees, could not insert an IV properly. They were young women from small towns. When I asked them about their recruitment, they told me that they had a class 12 degree and they came to the hospital which also ran a nursing school for six months of training, after which they were hired as nurses. As you can tell, it is a vicious cycle. So what can be done then? Stay tuned to find out. Here is a is what is going on. The issue has been diagnosed, but the treatment is not on the right track. How can you solve a crisis of nurses without involving them in it? Our healthcare system has always been doctor-driven, but it is not like that everywhere. For example, in West Bengal,

qualified and experienced nurses work in senior decision-making positions at hospitals. In Kerala, too, nursing is well-respected and senior positions have been created in nursing administration. Patricia Mary, a nursing superintendent at the MS. Ramaya Memorial Hospital in Bengaluru, suggested how hospitals could adopt innovative solutions such as remote patient monitoring systems. This would help nurses better utilize their time. Maybe they could even use that extra time to start teaching.

Also, existing colleges could tie up with private hospitals to develop a partnership so that nursing colleges can get skilled clinical practitioners. The solution is right in front of us, but it will obviously require a much more concerted and wholesome effort from the government. Just setting up nursing colleges is not going to solve the crisis. Daybreak is produced from the Newsroom of the Ken, India's first subscriber-focused business news platform.

What you're listening to is just a small sample of our subscriber-only offerings. A full subscription unlocks daily long-form. feature stories, newsletters, subscriber-only apps and podcast extras. Head to the ken.com and click on the red subscribe button on the top of the website. I am Snigda Sharma, your host, and today's episode was edited by my colleague Rajiv Sien.