Remembering Florence
The reality of nursing today is far removed from the image of kindness we have in our mind, writes GS Sethi

Florence Nightingale (12 May 1820 – 13 August 1910) was a celebrated English nurse. She was born at the Villa La Columbaia in Florence. She was named after the city of her birth. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed “The Lady with the Lamp” after her habit of making rounds at night. She walked miles every night among sick soldiers with a lamp for light. The grateful soldiers would kiss the shadow of Florence as she passed by.

When the Indian Mutiny broke out in 1857 Nightingale offered to leave for India immediately if there was anything she could do. Her services were not required but she became interested in the sanitary condition of the army and people there. From her work, a Sanitary Department was established in the Indian government. She became familiar with many facets of Indian life and demanded that there should be improvements in health and sanitation there. She did not visit India. She wrote papers on the causes of famine, the need of irrigation and the poverty of the people of India.

International Nurses Day
International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale’s birth. This day is also celebrated to signify the diversity of nursing roles and their contribution to health and wellbeing of the people and communities. Another purpose of its celebration is people get involved in promoting nursing profession as an attractive, rewarding and modern opportunity. The International Council of Nurses commemorates this important day each year with the production and distribution of the International Nurses’ Day (IND) Kit. The IND Kit 2012 contains educational and public information materials, for use by nurses everywhere. The IND theme for 2012 is: Closing The Gap: From Evidence to Action. The themes for the last few years have been – ‘Closing The Gap: Increasing Access and Equity’ (2011); ‘Delivering Quality, Serving Communities: Nurses Leading Chronic Care’ (2010); ‘Delivering Quality, Saving Communities: Nurses Leading Care Innovations’ (2009); ‘Delivering Quality, Serving Communities: Nurses Leading Primary Health Care’ (2008).

President Pratibha Devisingh Patil presented National Florence Nightingale Nurses Awards 2012 to 36 meritorious nursing personnel on the occasion of International Nurses Day. This year for the first time the Florence Nightingale Awards were given posthumously to two nurses, namely Late Vineetha PK and Late Remya Rajappan from Kerala, who sacrificed their lives to save patients under their care during the AMRI hospital fire incident on December 9, 2011, in Kolkata. Acknowledging the great contribution of nursing to health care, the President said that nurses are the frontline providers of medical assistance and information.

Nurses’ Diversified Role
There is a whole range of duties that nurses are called upon to discharge. They develop a plan of care in collaboration with physicians, therapists, the patient and the patient’s family, and other team members in observing, assessing, recording symptoms, responses and progress of patient’s condition. They work in all kinds of conditions including insufficient resources and labor force scarcity, guided by their duty to see that their patients receive the best healthcare. Nurses require a special set of skills to provide safe, quality nursing care, and this includes interpersonal skills like communication and leadership. Awareness about safety on the part of health workers is important, as WHO estimates that there are 1.3 million deaths of healthcare workers worldwide due to rampant use of the un-sterilised, reused needles. The UN agency linked 33 per cent of new hepatitis B injections and 2 million new cases of hepatitis C each year due to unsafe injections and needle stick injuries. Nearly 5 per cent of new HIV cases come from needle stick injuries. Though there is no official data documenting the number of deaths in India due to needle stick injuries, the number is believed to be high.

Importance of nursing profession in healthcare has been beautifully summed up as: “Let my care, remove your pain and bring smiles”. Nightingale believed very strongly that good nurses were the product of moral rectitude, maturity and a deep understanding of the character traits needed to care for sick and vulnerable people.

Ground reality
“Quality healthcare provisions and their easy accessibility are very important in a country like India with a population of over a billion. Care is most needed for patients with life-threatening diseases like cancer,” said Dr EV Ramana, Health Secretary on the occasion of 3rd National Nursing Conclave 2012 organised in Bangalore by Apollo Group of Hospitals. Roadblocks in quality healthcare, medical errors, nursing education, need for nurses to take care of themselves and importance of communication to provide care to others were mooted by way of debates, panel discussions and paper presentations during the conclave. All this is fine. But often ground realities don’t match with eloquent speeches.

As per a recent media report nurses in Kerala’s leading private hospitals brought work to a standstill demanding adequate compensation for their hard work. While the starting salary of a nurse should be around Rs 8,000 per month as per the Minimum Wages Act 2009, most of them get as low as Rs 3,000 and some may get Rs 5,000 after a year. Kerala is known for migration abroad of its people and a significant portion (15 per cent) is that of women, a majority of them being nurses. The nurses in Middle East start with a salary of Rs 50,000 upwards and those in US, UK and Australia as high as Rs 1.50 lakh upwards. In Coimbatore, International Nurses Day saw nurses complaining about meagre salaries, long working hours and pathetic work environment. Though a prolonged strike by nurses at the PSG Hospital earlier forced the spotlight on the grievances of the work force, nursing continues to be a thankless job with diminishing returns in Coimbatore. Many nurses and nursing students complain that their salaries are not enough to pay off the interest on their student loans. A nurse with a prominent city hospital said the interest on her loan alone comes to Rs 8,000, while her salary is a mere Rs 6,000.

A PIL filed by Indian Professional Nurses’ Association (IPNA) has submitted that the nurses are “literally treated as bonded labourers and are asked to make payment to get back their certificates”. The Supreme Court has sought response of the Centre and state governments for framing guidelines for hospitals, particularly private ones, to prevent them from retaining original certificates at the time of their employment.

This is one end of the story. The other end is that, perhaps in realisation of nurses’ contributions in healthcare, hospitals like Columbia Asia, Rajiv Gandhi Cancer Institute (RGCI), Fortis, Artemis and Raheja are trying to give their nurses a makeover through grooming courses in an effort to do away with their quintessential image of being stern and snappy. This includes teaching etiquettes, empathy and style like right shade of lipstick to use, how to tie hair, how to talk to and address patients and how to look graceful and cordial like knowing the patients by their names and not by bed numbers etc. Furthermore, they are taught to smile while talking to patients, to be polite, to talk in a language understood by everyone around and not in their native language.

Let’s hope the spirit of Florence Nightingale prevails.

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