How health ministry's draft guidelines may improve nurses' work conditions

In line with the World health Organisation’s (WHO’s) global strategy on “Human Resources for Health: Workforce 2030”, the Ministry of Health and Family Welfare (MoHFW) issued draft guidelines earlier this month to improve the working conditions of all categories of nurses in all healthcare institutions across India. The WHO’s global strategy calls for a safe and healthy work environment for nurses in order to ensure quality nursing care.

The MoHFW draft guidelines are open for comments from the public and other stakeholders on the ministry's website till August 31.

What do the draft guidelines say?

The proposals include provisions of basic amenities like separate washrooms and changing rooms for the nursing staff, annual health check-ups, necessary immunisation, adequate infrastructure, personal protective equipment and well-equipped work stations within the healthcare establishments.  

In line with the provisions of the Maternity Benefit (Amendment) Act, 2017, the guidelines provide for paid maternity leave and other authorised leave and allowances along with a creche facility for the newborns. These also recommend that all healthcare establishments may, as far as possible, provide accommodation to their nursing staff within or near their premises. 

In addition to this, the guidelines call for capping a work day at eight hours and not exceeding 40 hours a week, among other measures. Taking care of mental and emotional exhaustion of the people involved in nursing, the draft guidelines recommend promoting flexible working hours and shift duties, and practising routine transfer or rotation of nurses from high-demand settings to low-demand settings. 

Recognising that the nursing profession requires extreme care and diligence, the draft guidelines call upon the healthcare establishments to provide induction training to the newly recruited nurses and identify designated resting rooms for nurses working for a prolonged duration.

To sternly deal with issues of harassment of the nursing staff, the healthcare establishments will have to establish internal complaints committees in accordance with the provisions of the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013.

Why were the new guidelines needed?

WHO had designated 2020 as the “International Year of the Nurse and the Midwife” in recognition of their role during the pandemic and their central role in achieving universal health coverage.

India’s nursing workforce is about half of its active health workforce, which was estimated at 3.04 million in 2017-18 by the National Sample Survey Office (NSSO). Still, the sector is dogged by structural challenges like weak regulation, gap in education and training, and the actual services rendered by them. This leads to poor quality of training, inequitable distribution of workload, inequitable pay and non-standardised practices in health institutions.

The draft guidelines are an important move to address some of these issues. India reportedly still needs an additional 2.4 million nurses to meet the WHO norm of four nurses for every 1,000 patients, and since most of the nursing education institutions are private and weakly regulated, the quality of training of nurses is diminished leading to severe gaps in the provision of care services. 

What to expect? 

Speaking over the phone to Business Standard, Shalini (she uses only her first name), a nurse at a private hospital in Delhi, expressed “hope” that these new guidelines would change things for the better. She spoke of how the medical units “lack even basic amenities like water supply, disinfectants and dressing rooms”. She added that flouting of norms regarding workload and minimum wages is rampant in the sector, which is marred by severe staff shortage leading to erratic work hours, thus causing intense emotional and mental exhaustion. 

With these new draft guidelines being put out, she hopes that the medical institutions will take note and the harsh work conditions that hundreds of thousands like her face might ease in the future.