By Dr. T Dileep Kumar and Dr. Bulbul Sood,
As we celebrate World Patient Safety Day on September 17 with a vision of “a world in which no one is harmed in health care, and every patient receives safe and respectful care, every time, everywhere”, the importance of delivering safe healthcare through skilled doctors, nurses and midwives, in the backdrop of the pandemic has never been stronger.
World Patient Safety Day 2021 is dedicated to “Safe maternal and newborn care” recognizing the significant burden of avoidable harm women and newborns are exposed to due to unsafe care, particularly around the time of childbirth. It raises the importance of nurses and midwives, advocates of patient safety, in delivering safe and respectful maternal care.
WHO recognizes ‘positive childbirth experiences’ as an important part of maternal healthcare. During birth, mothers are often subjected to procedures without consent and without clear communication of their usage or need. Methods of augmenting labour with uterotonics used can have devastating effects, both physically and mentally, on mothers to negatively impact their childbirth experience while raising questions over patient safety.
As per the Guidelines on Midwifery Services in India, 2018 report, India witnesses the death of nearly 32,000 pregnant women each year during pregnancy, childbirth and the postnatal period. UNICEF states that while India accounts for nearly one-fifth of the world’s annual childbirths, every minute one of those babies dies. However, these mass-scale avoidable deaths can be corrected through experienced midwives to provide professional care to mothers and newborns in a friendly and respectful environment.
Nurses and Midwives role in maternal & newborn healthcare delivery
There currently exists a large deficit in the number of nurses and midwives in India’s healthcare systems to deliver safe care. Nursing forms 47% of the health workforce in the country. However, India’s nurse to population ratio (an indicator of patient safety) of 1.7 nurses per 1,000 of the population falls short of the WHO recommended 3 nurses per 1000 population. This ratio also varies unevenly from state to state guided by socio-economic metrics.
A nurse’s role is closely linked to patient safety as they account for almost 80% of all care episodes worldwide. India in 2018, took an important step to establish the National Reference Simulation Lab to drive better patient safety by introducing simulation-based training/education (SBT is directly linked to patient safety) into the nursing curriculum. However, that alone is not enough.
A study mentions that maintaining an optimal nurse-patient ratio and preventing burnout, is crucial to patient safety. It also adds that placing a large number of patients at the disposal of a single nurse can highly compromise patient care. It is for these reasons India’s paucity of nurses and midwives needs to be plugged as nurses are the frontlines of healthcare, especially in the villages and remote areas where there is an even greater absence of doctors and specialists.
Challenges to nursing and midwifery growth in India
The recently released State of the World’s Nursing Report 2020 and State of the World’s Midwifery 2021 highlight that investment in nursing and midwifery will not only contribute to achieving health-related SDG targets but also to education, gender and economic growth globally. Leadership, education and job creation are three top priorities for India to focus on as per these reports.
At the service level, nurses and midwives in India face issues of compensation disparity, workplace violence, short-staffing, long working hours and lack of career progression. It calls for creating a positive environment, pay parity and recruitment and retention policies for positive growth of the professions.
Nursing education in the country also needs to be reviewed as it is affected by increasing privatization, stagnant number of government colleges and low enrollment. While nursing education has seen quantification, quality remains a concern. These can be corrected by ensuring the provision of quality education in institutions with parent hospitals and state-wise need-based assessment of the number of nursing institutions as per the population of the state.
At the root of the challenges faced by nurses and midwives lie their lack of representation in key leadership bodies and the absence of a nursing organisation at the State level to supervise and monitor. Enabling more nurses in administrative and leadership roles, creating a Directorate of Nursing, and immediate filling of nursing leadership at central and state levels can rectify this glaring shortfall.
Nurses and midwives form the cornerstone of healthcare delivery in India. However, the system needs to enhance their strength optimally by providing them an adequate supply of equipment, an essential component of safety, and supportive supervision to deliver patient safety. By enabling nurses and midwives in our systems, we can create an ecosystem of reduced healthcare errors. We cannot wait for another crushing pandemic to accelerate these crucial actions. We need to do it now to save lives while ensuring patient safety.
(The authors – Dr. T Dileep Kumar is President, Indian Nursing Council and Dr. Bulbul Sood is Senior Strategic Advisor, Jhpiego. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)