Nursing a grudge: Overworked, overlooked

Amaninder Pal 

Tribune News Service

Fatehgarh Sahib, May 3

In the orthopaedics ward of the 100-bed Civil Hospital at Fatehgarh Sahib, Gurdev Singh (64) of Bassi Pathana, who fractured his left arm four days back, waits for a staff nurse to adjust his plaster and administer him a painkiller.

In another part of the hospital sits Rakha Ram (65). After spending 22 days, he is back again. He’s not sure about his ailment, he says, as he waits for a staff nurse to remove a minor snag in a nebulizer he is using to inhale from a bronchodilator.

On the second floor, septuagenarian Jarnail Singh lies on a bed, gazing intently at a near-empty glucose bottle. Having lost all his energy to a disease which he identifies as “lowering of blood”, the wait here too is for a nurse to change the bottle.

Meanwhile, the only ward attendant available at the time has just finished the morning round of administering injections to patients, while assisting a staff nurse. Now he is required to change dressings. He keeps looking at the watch, hoping for a staff nurse to appear. He knows none will.

One scene continues to play at this three-floor largest state-run health centre in the district: one or two staff nurses hopping from one ward to another. The hospital has just 17 staff nurses on its rolls against the sanctioned strength of 48.

“Can you imagine that from this lot of 17 nurses, we have to depute nurses everyday in wards, labour room, operation theatre, Emergency, blood bank, dialysis unit and de-addiction cell. Again, the duty in wards and Emergency runs in shifts,” says a senior staff nurse, requesting anonymity.

“A doctor,” she reasons, “takes a few seconds to prescribe glucose or injection. But it takes five to seven minutes to administer these. On an average, 40-50 patients remain admitted in the wards. Even if one goes by conservative estimates, it takes a nurse three to four hours just to administer injections and glucose, leave alone procedures like regular monitoring of blood pressure, temperature or managing emergency conditions  in wards.”

A gynaecologist is candid: “It’s common to see the same nurse assisting in the labour room, administering injections in the indoor wards and attending to patients in the Emergency, all in a single day.”

Deputing staff nurses on night shift creates another problem for the hospital management. For instance, a staff nurse handles the dialysis unit during the day and wards during the night. But whenever she is deputed for night duty in the ward, a nursing student of a nearby college has to manage the sensitive dialysis unit. As per norms, there is no holiday for staff nurses. Each nurse has to work 21 days a month, which on an average includes five to eight night duties, depending on the staff strength in the hospital. For instance, at the Fatehgarh Sahib hospital, staff nurses have to remain present for seven to eight nights a month.

Right priorities? 

Putting all its resources to recruit doctors, the state government is yet to wake up to address the acute shortage of nurses. At the Fatehgarh Sahib hospital, 25 per cent (eight out of 32) posts for doctors are vacant. However, in case of nurses, just 35 per cent of the posts are filled.

The gap is glaring even in Punjab as a whole. Of the about 4,000 posts of doctors, only 10 per cent slots are vacant. However, around 30 per cent of the 4,216 posts are lying vacant, while 369 nurses are working on a contract basis.

Paramjit Kaur Hundal, who heads the staff nurses’ association, says, “It was in 2002 that the government recruited staff nurses in Punjab. Over 300 nurses working on a contract basis for years were given permanent postings in 2013. There is hardly any recruitment.” 

However, in case of doctors, the state government has offered permanent jobs to around 1,000 in less than six years. Since 2009, jobs for doctors are being advertised every year. Besides, a special provision has been floated whereby a specialist doctor can join duty just by appearing in walk-in interviews held every month.

“Nurses have to remain available for patients round the clock. But the government’s sole focus is to recruit as many doctors. Patients are not being attended to properly at indoor facilities due to an acute shortage of nursing staff. Not only should sanctioned posts be filled, but the government should increase the number of posts across the state both in hospitals and medical colleges,” says Hundal. 

Swaranjit Singh, president of the Punjab Paramedical and Health Employees Front, says the “fact is that it is not the job of a nurse to monitor blood pressure, perform surgical dressings or manage patients in medical emergency. 

“All this is meant to be done by resident house surgeons. But house surgeons are missing from hospitals because they are offered woefully low salaries.”