Who cares about nurses?

Nancy Fernandes Pereira


Aarti Prasad. Who cares? Socio-economic conditions of nurses in Mumbai. Mumbai: Himalaya Publications, 253 p. Rs 458.00, ISBN-13-9789351429074

This book has come at a time when the enrolment rate in nursing courses has dropped as students seek professions which will guarantee a secure future. There are a few exceptions, generally from Kerala, who still seek admission to the course in nursing, as it ensures 100% employment at all times.

Aarti Prasad’s book is an outcome of her doctoral work, “Economic conditions of nurses in Mumbai: a situational analysis”. Her writing also reflects her experience as a journalist who has covered a range of issues, including health, the problems of nurses working in Mumbai, and the migration of Indian nurses. She brings out with sensitivity, the socioeconomic conditions of this group of professionals who put in long hours of work to help the sick recover, while themselves living in economically unstable and oppressive conditions.

The book is based on data collected through interviews on the nature of satisfaction that working individuals seek through fair remuneration; occupational health and safety; grievance redressal; and the familial support system that encourages and motivates individuals and gives them the strength to carry on.

The foreword by Dr V Patel, lends depth to the issues in the book. The preface dwells on the increasing shortage of nurses to attend to the sick in various healthcare settings around the world. The author points out how the inadequate allocations of resources and cost-cutting measures have harmed the healthcare system, by adversely affecting the morale of nurses and their desire to join the profession.

Chapter One describes – from an economist’s perspective – the historical genesis of healthcare and its development over the past two decades. The author asks what constitutes true development when citizens lack healthcare facilities, and quotes Mahbub ul Haq (1996): “The defining difference between the economic growth and the human development schools is that the first focuses exclusively on the expansion of only one choice – income – while the other embraces the enlargement of all human choices – whether economic, social, cultural or political.” This is true, as the development of a society ensures the quality of life of individuals, and healthcare is an intrinsic need of all individuals and must be provided for.

The author talks of the importance of healthcare workers who are the backbone of the system, using their scientific knowledge and skills, and rendering services with a human touch. Participants in the author’s study are largely untrained and work in the private setting.

Dr Prasad stresses that the nursing profession should be imbued with the qualities of altruism and sacrifice. Effects of patriarchy on healthcare are discussed. Speaking of the deterioration in the healthcare system, the author puts the blame on the inadequate health workforce and related issues, adding that the situation has been aggravated by low public expenditure on healthcare services in low-income countries. She draws attention to the plight of public health services, which are forced to manage with a few trained healthcare workers who are ill- equipped to provide care.

For nursing students, there is adequate material in the chapter titled “Development of nursing and nursing education in India” on the history of nursing in India. The author draws our attention to issues related to the employment of untrained individuals as nurses in private nursing homes and the effects of this on the remuneration of qualified nursing personnel.

Chapter Two discusses the healthcare infrastructure in the private and public sectors in Mumbai. The author focuses mainly on the H-Ward of Greater Mumbai when providing the socioeconomic profile and working conditions of nurses. This chapter also describes the methodology, the contribution of the book to nursing literature, and the difficulties faced by the investigator.

Chapter Three provides a review of literature and provides the socioeconomic profile of the healthcare sector. Most studies say that the main reason for choosing the nursing profession is to serve humanity. There is the need for continuous training on the job to update one’s knowledge and become fluent in the new technology. The author reviewed the literature related to work conditions, recruitment, employment, and promotion policies, and opportunities for career advancement – indicating that the performance of nurses is not appraised properly.

Chapter Four presents the essence of the findings. The demographic background of participants is shared to help us understand their socioeconomic profile. It is interesting to note that most of the participants employed in this profession are Maharashtrian locals. The author has explored the occupational backgrounds of the nurses’ families and the respondents’ savings. An important finding relates to the training received by the participants – 49% of them had not received training from a recognised institution and were employed in the private sector. The study highlights the experience, enrolment with professional bodies’, job-hopping of nurses for various reasons; it mentions the reasons for nurses joining the profession, as well as their regret at having joined it. Similarly, it explores why they would or would not recommend it for others.

Chapter Five looks at hte working conditions of nurses and the disparity in their wages. The author compares the wages of participants with those in other different sectors with the same years of experience. The gaps in social security are discussed. The study draws attention to certain occupational hazards, which provide more than enough research evidence for the need to ensure a safe working environment. The study presents evidence that an increasing number of students no longer find this profession lucrative. Further, they are not drawn by the prospect of seeking nursing jobs abroad, as jobs in other fields provide greater economical stability.

Chapter Six summarises the journey of the author as a researcher. Recommendations are provided which focus on dealing with issues related to this profession and ways to improve the working conditions so that qualified nurses are retained. The book includes the interview tool and a bibliography which is useful for those interested in further research.

This book can serve as a ready reference for nursing students, and those studying hospital administration and management. It will familiarise them with the problems and issues encountered by nurses, and give them a glimpse of the trends in their profession.

Prasad’s painstaking study of the socioeconomic status of nurses and her efforts to draw the authorities’ attention to their plight so as to bring them some relief are laudable. This is a book that all those connected with hospitals and nursing institutes should read. By bringing out the problems faced by nurses and their socioeconomic conditions, the book can sensitise people to care for those who care for them.