May 12 is celebrated globally as International Nurses Day  and recalls the pioneering contribution of Florence Nightingale (1820 – 1910),  who is considered to be  the founder of modern nursing. While nurses have always been the foundation of healthcare and hospitals world over, their role has not been adequately understood or acknowledged – till the current Covid crisis.

In India, the health infrastructure is deemed to be below the recommended global standards. While the WHO (World Health Organization)  norm is one nurse for 300  citizens, or 1:  300, the Indian ratio is 1: 670.

In a report submitted to the government by the Finance Commission earlier this year,  it was reported that India had nearly three million trained nurses with Kerala scoring the best ratio 1 : 111 (111 people for every trained nurse), while in the case of Jharkhand it is 1 : 4019.

The current covid-driven shortage of nurses and healthcare providers both in hospitals  and at home is distressing and the reports/visuals of over-worked nursing staff coping valiantly is illustrative.

India's current Covid caseload will call for the induction of more nurses into the existing HR pool and public-health experts have encouraged the government (both centre and states) to see how best to train final year nursing students and bring them into the work force.

According to official figures (2019), India  has 2 .13 million registered nurses and midwives (RN and RM), as also   885, 383 auxiliary nurse midwives (ANM) and 56, 644 lady health visitors (LHV). In addition, the country has about 8500 nursing institutions that train over 300,000 nursing personnel annually. There is a concentration of these institutions in certain states and, for example, Kerala relative to its population has a much higher footprint than other states.  Furthermore, nurses from this part of India find employment options in foreign destinations and are valued for their professionalism and commitment  to their calling.

The Indian  military has a dedicated nursing service – the MNS (Military Nursing Service)  and while their numbers are modest in comparison to their civilian counterparts,  the retired MNS officers represent a valuable gene pool in the current national public health crisis.

SAM spoke to one of the retired MNS officers,   Lt. Col  Mercy Kutty, about  the contribution of the nursing fraternity and some policy options that could be considered:

Q.  What is the significance of 12 May being International Nurses Day to Military Nursing Service(MNS) officers of the Indian Armed Forces?

A. The 12th of May being celebrated the world over as the International Nurses Day is not just one with inspirational significance; but also one that reminds us as to how the foundation of modern nursing was laid. As is well-known, it commemorates the birth of 'the lady with the lamp', ' the angel of Crimea' among other names referring to Florence Nightingale who was born in 1820 in Florence, Italy and who grew up to become a statistician, nurse and a social reformer. 

During the Crimean War, she was sent to a military hospital where she found that poor care was being administered to the wounded by overworked medical staff. Later, her observations in her report 'Notes on matters affecting the health and efficiency and hospital administration of the British army' led to the establishment of a Royal Commission to look into measures to improve the health of the army. Florence's Polar area diagram popularly known as the 'Nightingale Rose Diagram' showed how the death rates decreased due to improvement in sanitization conditions. Her work enabled statisticians to visualize that a large number of military fatalities were not due to battle but mainly due to preventable diseases. Further, she was also known to have vastly improved the sanitary conditions of the hospitals among other patient care improvements. Her work also led to major sanitary reforms in India and rest of the world.

Thus one can only imagine how much Florence Nightingale's work would have influenced the current practices in military hospitals, and that this day – her birthday -  acts as a reminder, to all those changes brought about by the ‘lady with the lamp’.

Q.  What measures in your opinion can be instituted by higher authorities to win the war against the COVID-19 pandemic?

A.  From my experience as a military nurse,  I can suggest the following:

(a)  Authorities must  continue to enforce social distancing and other preventive practices such as use of masks and hand sanitizers.

(b)  Take adequate measures to maintain the supply of vaccines for India’s  1.3 billion (130 crores)  population.

(c) Support research to tackle new variants. 

(d) Have working supply-chain backup plans ready in case of a catastrophic spread. 

(e) Promote positive news and awareness and tackle the menace of fake news.

(f) Promote adequate rest, nutrition and additional remuneration/incentives  to nurses, doctors  and other healthcare staff who are in the frontline.

Q. What can the retired community of MNS (military nursing service)  do to help the country at this point of time, particularly in training final year students in nursing colleges so that they can become part of the workforce in the fight against the pandemic? And is there anything specific to Kerala in this regard that you would like to share a few thoughts.

A. At this point, 90% of retired nursing officers are above the age of  60 and may  not be able to do much, since their mental and physical health restricts them from taking active part in the fight against this pandemic. However they may be asked to volunteer for training ‘task forces’ state or  district-wise  to better tackle covid 19. Their experience can greatly reduce training time which will be  a bonus when there is a dire shortage of nursing staff during the current pandemic surge across the country.

Given their vast experience, many prematurely retired nursing officers who are working as principals of nursing colleges or working as nursing superintendents in hospitals are in a better position to help lead teams of frontline warriors.

Final year students can be sent for frontline duties, however, not for handing complex procedures involving ventilators and such-like. Adequate guidance and vaccination of the  nursing students must be mandated.

Many of the retired  MNS (nursing) officers are members of  military veteran groups across the country. They are professionally qualified, organized and disciplined. This is an  HR asset that could be inducted to help in training and spreading awareness in their respective states.

There are forums in social platforms such as whatsapp where veterans who are willing to help can easily be reached. I am part of a 260 member retired MNS officers group myself.

Q. What is your message to the international nursing community at large in the present pandemic times?

A.  Two quotations come to mind: 

"Save one life, you're a hero. Save 100 lives, you're a nurse." (Anonymous ). And second - "How very little can be done under the spirit of fear." ( Florence Nightingale).

With that, my message to the international nursing community would be to press on with dedication during these dire times without fear. Our blessings and prayers are with them.   Eventually, we will beat the virus and win.