IN the third century BC, King Asoka set some strict guidelines for hospitals.  Only male nurses could work as women were not allowed to enter the profession because they were not ‘pure’ enough for the role.  Male nurses received training to be skilled in many aspects such as cooking, bathing, caring for patients, massage, physical therapy and bed making skills.

In India, nursing is a profession largely chosen by women. However, male nurses are becoming more common. According to statistics, Kerala and Rajasthan churn out the largest numbers at present.  The space occupied by male nurses is still limited to those spaces that require the least interaction with patients such as the ICU. However, people still do not accept male nurses especially in obstetrics/gynaecology departments.

Why nursing?
In November 2009, a national daily reported that 267 nursing schools are expected to open in the next two years to reduce the shortage of five lakh nurses in India, according to the government.  The Health Ministry hopes 22,000 new nurses will enter the profession annually.  The numbers show India lacks 1 lakh auxiliary nurse midwives and 4 lakh general nurse midwives. “With healthcare growing on a regular basis, there is huge gap in the number of nurses available, nursing is an ideal profession for people with a passion,” stated Dr. Dinesh Batra, CEO, Primus Super Speciality Hospital, New Delhi.

A nursing career 
Your duties and responsibilities as a nurse would have a broad range.  You would have to dispense medication, keep complete records of each patient’s progress, set up and operate medical equipment along with administration and routine duties. As you gain seniority, you would need to manage people functioning in areas like the psychiatric, paediatric and intensive care units.

Nurses are professionals you will find in all areas of a hospital from surgery to maternity to emergency to rehabilitative care.  Hospitals are the largest area in which nurses generally function.  Public health nursing/community health nursing is another option. You could be employed in government, private clinics and health departments functioning in both urban and rural areas, to provide basic medical services to a specified population.  Embassies, reputed companies and schools have openings for qualified nurses.

Part of your job as a nurse would include health education to individuals, families and other groups.  Also, you would need to instruct on nutrition, child care as well as disease prevention. Nursing is multi-faceted. You can become an educator, researcher or practitioner.  In each, you have another set of choices available like geriatrics, women, children and accident survivor care.

An insider’s viewpoint 
A nursing career is not easy, it is a mentally and physically demanding field.  “You can never be jobless, always keep a positive attitude and your human values intact,” advises Saravjeet Kaur, Director, Nursing, Pan Max.  Nurses are exposed to health risks such as infectious diseases while caring for their patients.  Waste management in terms of disposal of syringes, wearing gloves and masks need to be followed strictly.  “Nurses are the first to receive public backlash when patients die in the hospital and emotions of relatives runs high,” warns Batra.  Long hours of work are part of the parcel, you need to be service oriented, willing to work extra hours and put in night shifts.  In order to excel as a nurse, develop loads of patience, courage and a smile that comes automatically.

Options for studying nursing 
A student has various options available to enter the nursing profession. You can pursue a diploma, graduate or postgraduate course in nursing.  You can also opt for midwifery courses though some nursing courses include this as part of the programme (see Table 1 and 2 for institutions in India and in the US).

Auxiliary programme
ANM is Auxiliary Nurse Midwife/Health worker course, eligibility is having completed Class 10 and the duration is for 18 months.  You would be provided with training of health-related issues usually related to people living in rural areas, the focus is largely on children, mothers and old people.

General nursing programme
A large majority of Indian students opt for this option in terms of study.  Popularly known as GNM, the General Nursing & Midwifery programme is for 3  years, eligibility is again 10+2 with Biology, Physics and Chemistry as subjects.  This course prepares general nurses, you would function as a part of the health team in first-level positions in hospitals and other places requiring your special skills.

Bachelor programme
You can opt for a BSc in Nursing. In order to be eligible, you need to have completed 10+2 in Science with Biology, Physics and Chemistry as subjects.  The duration of the course depends on the institute but is typically for 4 years.  As a student, you would receive training in theory as well as practical aspects of nursing.  The course will provide you with basic knowledge about nursing, first-aid and midwifery as well.

Select categories of female candidates can opt for a four-year BSc (Nursing) or a three year probationary nursing course conducted at various armed forces hospitals all over India. Candidates pursuing these courses would require to sign a bond to serve in the Military Nursing Services (MNS) for five and four years respectively. All candidates are given free ration, furnished accommodation, uniform allowance and monthly stipend during training. A BSc (Nursing) degree course is available at the Armed Forces Medical College in Pune.

The National Institute of Mental Health and Neurological Sciences (NIMHANS), based in Bangalore, offers specialisation in psychiatric nursing and neurosurgical nursing. Remember, to grow in the sector a higher the degree and participation in continuous programmes throughout is ideal for your career. “While working with the sick, always remember money and your own needs are secondary, the patient comes first,” said Anitha Sreedharan, Sister-in-charge, Primus.

Higher programmes
You can study further by opting for an MSc in Nursing, the duration is for 2 years.  Some continue to do an MPhil or PhD but it is still not a very common phenomenon in India.  Doing post basic speciality diploma courses is more common along with continuing programmes.

Getting a degree
Each state has its own organisation and registration norms, be aware and do the required research.  In India, the regulatory body for nursing is the Indian Nursing Council.  To be able to practice, you need to be registered with the Council by undergoing and passing courses decided by the council.  Keep this in mind before you choose your course and institution for study, the theoretical and practical aspects of nursing should have an equal balance, advises Kaur.

As part of training to be a nurse, you would spend time in all departments in the hospital.  This hands-on experience, helps you decide the kind of work you would like to do and what you would like to avoid when you become a registered nurse.  You can make informed decisions when opting for your area of expertise or specialisation based on hands-on experience.  “In OT and ICU, nurses should have the mental ability to correlate the whole body while the focus is on a part of the body, physical co-ordination and multi-tasking,” reveals Batra.

Pay packages in a nutshell
Going abroad and government jobs are most sought out options, especially by the younger generation of nurses.  Salaries are dependent on various factors, the level of nursing education you have pursued, area of expertise, work location and years of experience. Employment opportunities vary, ranging from hospitals, nursing homes, clinics, health departments, old age homes, orphanages, schools, railways, institutes, public sector medical department, research and also the services like the army, navy and air force.

Nurses employed in government hospitals get a monthly salary that is higher than a private hospital in India. “With the 6th Pay Commission revision, a nurse with no work experience would receive a starting salary of Rs. 32,000 plus free accommodation and medical benefits,” shares Kaur.  A nurse joining a private hospital can expect approximately Rs. 10,000 to Rs. 12,000 to begin with but as you prove your calibre, the growth in the private sector increases.

Salary packages abroad are substantially higher, sending a lot of our nurse force towards greener pastures.  In addition to salaries, nurses can expect packages to include health insurance, holiday pay, pension plans, annual vacation and other benefits.  In the US, nurses receive $2,000 to $10,000 as signing bonus.  Registered nurses with one year of experience get $17 per hour plus premium $2 per hour for evening shifts and $3 for night shifts in the US. However, before you sign a contract abroad ensure you are covered for malpractice and other legal issues.

Becoming a good nurse
As a nurse, you need to be patient, responsible and dedicated. Your job would require you to be alert and aware all the time, team spirit is a given along with genuine compassion and tactful behaviour.  You should be physically fit, you are usually on your feet for hours at a time.  Develop the ability to serve the needs of each patient equally, balancing is part of your job (See Box First Person).

A nurse, wanting to specialise as a paediatric nurse should focus on studying paediatrics in detail along with developmental changes that occur in various age groups from prenatal to adolescence.  “Nursing is one profession where learning never ends, it goes on constantly,” states Celin Mohan, Nursing-in-charge, at Primus.

“It is pertinent that you keep the identity of your patients and their personal information regarding their illness confidential, that is the toughest part to ensure as a student. You have to actively guard yourself from discussing your patients in any way with anyone else that can reveal their identity,” expressed Naghma Abidi, a student of nursing in the US.

New roads for nurses
Trauma nursing would be an upcoming field in India, it has already risen abroad.  It requires knowledge and skills in terms of critical care, emergency care, medical-surgical nursing, psychiatry and also obstetrics and pediatrics on occasion.  Travel Nursing jobs is also an area that can be explored.  It would provide you with the opportunity to work with different people in different cultures on a global platform.  You could decide where you want to work by finding a travel nursing company that can help you get placement as well.

Nursing profession summed up

‘1 is to 1’ or ‘1 is to 3’ is commonly heard as part of conversation between nurses and doctors.  Don’t be surprised, it is just the talk about the nurse to patient ratio, largely dependent on the seriousness of the patient.  Being aware of any change in sound of machines is part of the nurse’s world, largely depending on the kind of equipment attached to your patient.  Whether it is a two-year-old patient who has just undergone heart surgery in ICU or a fifty-year-old suffering from head injury after a hit-and-run accident, nurses remain professionally calm and collected.

It is part of their job to provide help to all patients and deal with crisis situations. Nurses are on their toes, ready for any eventuality that occurs along with the normal routine of work.  Awareness of diseases and treatment has increased in the public arena, expectation levels are high and nurses play a large part in effective delivery of healthcare. Enter nursing only if you can deliver genuine care to all and keep a smile on your face while fulfilling your duties!

Student Speak

Q. Why did you opt for nursing?

A. Nursing is my second career choice; I already have a Master’s degree in education. There were few job opportunities available there so I moved to nursing. A counsellor helped chart out my time-line, what courses needed to be completed as prerequisites to apply to the nursing programme. The beauty of the American system is that you can pursue the career of your interest at any age. I chose Oakland Community College.  It was the cheapest, rigorous programme available that prepares its nurses well.

Q. Tell us about your nursing programme.
A. It’s a 2- year intensive programme. After the first 15 weeks, we have a semester of 7.5 weeks. In the first year, we cover OB/GYN, medical surgical 1 and psyche rotation. In the second year, we have two med surgical rotations and paediatrics. Everyone covers their clinical simultaneous to the theory that they are taking. One day comprises of theory and two days of clinical experience, duration of 8 hours each. We cover 15 weeks worth of subject matter in 7.5 weeks with a test every two weeks.

Q. Can you give a sense of what studying nursing entails?
A.Once you are in, you need to breathe and live nursing. Within the first couple of weeks you clear your basic skills test of taking vital signs, ready to get hands on experience on the floor. I began with the older population. You are assigned to work in a hospital for two days for 8 hours. Very importantly, you learn to work as a team on the floor.

Expert Speak

Q. What is your advice to nursing students?
A. 
Nurses need to take care of their own health, many miss meals and don’t even stop to have a glass of water during their duty hours.  Don’t do that, you can provide the best to your patients when you are healthy and fit. When your patient goes home happily, this is your Diwali, this is your Christmas. 

Q. What should new nurses keep in mind?
A. 
You need to be open to learning everyday and be aware of legal issues, registration and certification. Just remember, if you can’t do right, don’t do anything wrong as part of your job either.  Give respect to all your patients and follow basic etiquette such as saying sorry and thank you.  Also, be part of the Trained Nurses Association of India.

Q. What is the nursing scenario today?
A. 
Practical knowledge is lacking in nurses today, it is important that the curriculum being offered gives nursing students the right blend of theory and practical training.

Q. Has the outlook towards nurses changed over the years?
A.
Patients have become more demanding, which has both positive and negative aspects. Nurses do not have to be submissive. But remember the rules of discipline and protocol, but your focal point is your patient and doctors can be wrong too. If you feel that the medication dose is wrong, say so and do not keep it to yourself. You have received training, so just follow your instincts.