As hospitals embark on an expansion spree, perhaps the biggest hurdle that lies ahead of them is recruiting nurses to man the beds.
India has a shortfall of 1.37 million nurses if we wish to meet the World Health Organisation (WHO) recommendations; and globally there is a need for 13 million nursing professionals.
While there is no recent estimation of the shortfall of nurses in the government sector, the 22 All India Institution of Medical Sciences (AIIMS) alone have 1500 vacancies at each of them adding up to 33,000 vacancies for nursing staff. On top of this, there is demand from the private sector.
Speaking to Business Standard, Suresh K Sharma, Principal at College of Nursing, AIIMS, Jodhpur, said that there is no recent estimation of the shortfall in government sector for nurses, but with growing hospital beds, there is a significant shortfall of nursing manpower now.
Private hospitals, which employ around 50 percent of nurses and midwives, are expanding bed-count post-pandemic. According to an ICICI Securities report in May, Fortis Healthcare will add 1300 beds in the next four years, Krishna Institute of Medical Sciences (KIMS) plans to add about 700 new beds over three years, Apollo Hospitals will boost its bed-count by 2000 beds in three years. Manipal Hospitals is eyeing 3600 beds in the next three years.
Two nurses are required to attend to six beds (working in a single shift), says Ranjan Pandey, Fortis HR Head. “Hospitals work in two shifts, and then we have to also consider days off and leaves. So, the demand for nurses is going to surge tremendously in the coming days. Moreover, we have to grapple with a high level of attrition of around 30-40 percent already,” Pandey explains.
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Dilip Jose, MD and CEO of Manipal Hospitals says that they have already taken more than three salary corrections in the last two years in an attempt to retain the nursing talent. “We already pay better than the industry standards,” Jose adds.
Not only is there a demand-supply gap in nursing, the bigger problem seems to be losing Indian nurses to other countries. Usha Banerjee, Chief Nursing Officer, Apollo Hospitals points out that nurses are typically attracted to large institutions like Apollo where they train well, learn to document, but more than 80-90 percent of young nurses want to leave the country in 2 years of practicing in India. India ranks second after the Philippines with respect to the number of nurses working abroad, says the FICCI-KPMG report on Strengthening Healthcare Workforce in India.
“Overseas they get paid around Rs 2-4 lakh a month, compared to Rs 35000-45000 a month in a good private institution in the country,” she says. Pandey says that corporate hospitals pay a starting salary of Rs 25,000 and above, while the government pays more than Rs 40,000 for a nurse of similar skillset.
Smaller hospitals and nursing-homes pay meager salaries of Rs 5000-6000 a month, alleges Suraj Gupta, president of the All India Registered Nurses Federation. “Most of the small nursing-homes do not go for registered nurses, they opt for quacks that they try to train,” Gupta says.
AIIMS nurses get paid well – Sharma says that at the entry level the gross salaries are in the level of Rs 70,000 or so, and a chief nursing officer with 12-15 years of experience gets around Rs 2.5 lakh or so a month. Sharma feels that there is a general lack of awareness of the high-paying nature of the job, and men usually stay away from this profession. It is estimated that only 10 percent of India’s nurses are men.
Large corporate hospitals have resorted to wellness programmes like mental wellness, food and accommodation provisions, and opportunities to train and up-skill, in order to retain their nursing talent.
Smaller hospitals and nursing homes have a bigger challenge in recruiting and more often than not they resort to hiring quacks, Sharma says.
In a 2016 study conducted by Sharma and Silvia Parihar in 53 nursing homes in Punjab where 218 participants were interviewed; 50.9 percent of the subjects had not obtained any nursing qualification or training. Out of them, 60.3 percent were having lesser than higher secondary education, and 9.9 percent were academic graduates, while 29.7 percent had paramedical training.
“Out of all the nurses working in these private healthcare facilities, 18.7 percent of them were not registered with the State Nursing Council and only 10.1 percent were having nursing association membership because of the unawareness. Moreover, nurses and nurse quacks were enjoying nearly equal amounts of pay wages, allowances and fringe benefits,” the study had noted.
The Centre has announced 157 new nursing colleges in co-location with the existing medical colleges established since 2014 for investment of Rs 1570 crore that would add around 15700 nursing graduates every year. Sharma feels that government intervention is key to solving the trouble of India's missing nurses.