Who Cares? Socio economic conditions of Nurses in Mumbai, a book by Aarti Prasad, published by M/s Himalaya Publishing House Pvt.ltd. comes at a time when many a young students completing their higher secondary education are making a decision to choose a career. In the last couple of years the enrollment rate has dropped as students seek professional courses which will ensure them a secure future, baring a few mostly from Kerala still seek admission to the course in Nursing to make a career as it ensures 100% employment at all times.

Aarti Prasad‘s book is a outcome of her doctoral work “Economic Conditions of Nurses in Mumbai: A situational analysis” from the department of Economics, University of Mumbai. She is an Associate Professor in South Indian Welfare Society‘s College, Mumbai, Who is actively involved in teaching post graduate and undergraduate. Her writing reflects her experience as a journalist who had covered number of issues namely health issues, migration of Indian nurses, problems of Nurses in Mumbai brings out the sensitivity with which she bring out the socio economic conditions of the nurses in Mumbai. Her question “Who cares?” is very vital as this group of individual /professional who work long hours selflessly helping the sick to recovery at time are economical unstable, living in poor conditions.

The Information brought out in this book by her is based on data collected through interviews questioning the very essence of satisfaction that working individuals seek through fair remuneration; occupational health and safety, grievance redressal, support system at work which encourages and motivated individuals psychologically and gives the physical strength to carry on knowing their family too are benefiting and are comfortable.

The foreword for the book provided by Dr. Vibhuti Patel highlights the key issues of the book and adds depth and invokes interest of the reader. The preface clearly highlights the issue of the increasing shortage of nurses in relation to the numbers required to attend to the sick in various health care setting around the world. How jobs abroad are becoming lucrative to the nurses as a result there’s drain taking place in the developing countries increasing shortage of nurses, causing constraint in achieving the health millennium development goal. She has also highlighted how inadequate resource allocation and cost cutting measure have had detrimental effect on the heath system, adversely affecting the morale and desire to stay in the profession.

She has included a list of abbreviations that appear in the contents of the book allowing clarity to the readers. List of content and tables have been well arranged to enable readers a quick reference.

The first chapter brings out the historical genesis of health and its development since the last two decades from the eye of an economist. In a world driven with economical growth, the questioning of what is true development when its citizen lack health facility in term of manpower to provide it is well questioned. She quotes according to Haq Mahbub UI(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 development in a society ensure quality of life to the individuals living in it as health is the intrinsic need of all individual and they need the ability to procure it for themselves and their family.

She goes on to bring out the importance of Health workers in the health system. Since the health workers become the core of the system and the major work force in the delivery of care is ensured by the capable and efficient nurses who become the back bone of the health system. This is evident by the care provided and the recovery of the patient and reducing hospital stay. They are the largest group of workers providing direct care to patients using scientific knowledge and training to skillfully provide care with a humane touch. She states this can be enhanced by education and training of the health worker, supporting and protecting them; readers need to remember the populations under study are largely from the untrained group and private setting.

She also brings out the gendered health care economy. Where by the nurse naturally due to her biologically endowed ability to nurture is fitting to care for the sick. She also in her writing highlights the “call” to this profession which lays weight to it as a vocation ingrained with quality of altruism and sacrifice, and the influential role played by Florence Nightingale. She also brings out the effected of the patriarchal system on health. Issues in nursing have been brought to light how the shortage of health workforce, has precipitated in deteriorating the health system. The scenario in the health system is aggravated by the low Public expenditure for health service in low income countries which is on an average below one per cent of the Gross National Product. She bring out the plight of the public health services which have to cope with scarcity of trained health care workers with decades of cost cutting leaving them scarcely equipped to provided care and frustrated at work.

For any student nurse studying the ‘History of Nursing in India’ there is adequate content to read in the forth coming content sub- titled “development of nursing and nursing education in India” which highlights the trends in nursing. Emergence and proliferation of nursing in India, gives the available registered nursing personnel per one lakh population as per the end of calendar year of 2008in table no1.1, also highlights the number of institutions offering nursing courses recognized by the INC. She also aptly brings out the issues related to employment of untrained individual posted as nurses in private nursing home and its effect on remuneration of qualified nursing personnel. The table depicting growth of nurses in India from 1991 to 2010 has increased from 40 to 92 per lakh population but in term of requirement it’s inadequate given the population of India. She also depicts in her table state wise number of registered nurses in India.

In Chapter two “Present Study” brings out the provision of health infrastructure in public and private sectors in Mumbai occurring through mainly the MCGM and the Government run institutions. Since the study was mainly under taken in H ward (east) and H ward (west) of Greater Mumbai by her to understand the socio economic profile and the working condition of nurses. The objectives have been clearly defined to guide the flow of content for the study from understanding the issue to coming up with strategies for change /improvement of their work situation which has a bearing on their service. This chapter also indicated the methodology and the contribution this study makes to the nursing literature, and the difficulties faced in the process of the study by the investigator in procuring permission and information.

Literature Reviewed has been presented in chapter three which weaves a rich tapestry of socio economic profile of health sector. The background of women choosing the profession, their reason for choosing the nursing profession as predominantly being to serve humanity which emerged in most of the studies quoted, the need for ongoing training on the job to update knowledge and to develop skill to use newer technology so that they remain efficient nurses. Also bring out the recruitment policies, the chapter also review literature related to condition of work and employment, promotion and career advancement, it also indicates the lack of proper performance appraisal, and affiliation of nurses to association and union.

Literature also indicates location of choice for employment and reasons to work in one’s home town or move away. This chapter also brings to light the difficulties faced by the nurses at their place of work, related to shortage of staff , material and resulting workload, occupational health hazard due to caring for infected patients with contagious disease and the menace of getting infected with HIV/AIDS poses risk due to inadequate provision to protect themselves.

Literature review also brings out the impact of shift duty special night duty on the life and health of the nurse. Since the study was conducted in public and private hospital the investigator also review literature related to transfer related problems, ethics, demands, rights and strikes by nurses. Adequate weight age has been given to status of nursing as a profession. This also reflects will the individuals working as nurses recommend this profession to their children. The reviewed literature leaves adequate room to reflect for newer areas of research where data is inadequate.

Chapter four brings out the essence of the study findings, which are presented to help the reader to understand the socio economic profile of the participating subjects, providing a demographic background of the participants. She presents a quick glimpse of distribution of participants in the selected wards by the type of management i.e. Private, Municipal and those employed in private nursing homes, their age religious and language background which was interesting to note was Marathi followed by Malayalam and others which indicate large number of locals employed in this profession. She has interestingly brought forth the occupational background of the unmarried as well as the married participants of the study. The findings in her study bring out the training received by the participants where majority i.e.49% of the participants who did not receive training from recognized institution were employed in private sector this is a very important data for the authorities who spell out the policies and regulation for nursing education and employment. The study also highlights the experience, enrollment with professional bodies’ job hopping of nurses for varying reasons. The study throws light on the monthly family income as well as the savings of the respondents. The investigator has also brings out the reasons why respondents did not avail of loan even when they needed. The study also focuses on the reasons for joining the professional as well as the reasons and for regretting and for recommending as well as not recommending this profession to others.

Nurses and their working conditions are interestingly brought out in chapter five. Where the investigator has explored the working condition, the structure, disparity in the wages were few receive a sum of 3000/- or less to those receiving 15,001/- and above, poor wages are reflected mostly in private sector as compares to Municipal hospitals. She has also compared the wages with the years of experience of the participants working in the different sectors. Aarti’s study also bring out the gaps in social security of the participant whether it’s monetary or otherwise in terms of facilities like medical or maternity leave in smaller private institutions, she also highlights their job profile from meeting care needs of patients to administrative responsibilities. The study has brought out some of the glaring occupational hazards like hepatitis B/C, sexual harassment, violence; risk of contracting HIV etc. which is adequate research evidence for authorities to take stock of the situation and deal with them to make the work place more conducive for nurses.

This chapter brings clear evidence for the dwindling number of young student’s not finding this profession economically lucrative nor attracting them in getting jobs abroad as there are other fields providing more economical stability.

Chapter six summarizes the journey of the author in exploring and presenting the finding and wide range of recommendations to deal with issues/problems related to this profession so as to improve the working condition and retain qualified nurses and in attaining the status of nursing profession one which is noble among others and the backbone of the health system.

The book also includes the tool used for collecting data, bibliography of literature referred to by the author for more in depth reading if the reader or other researcher desires to use to further the research set out by Aarti Prasad.

The findings of the book can be used as ready reference by student’s nurses studying Hospital administration and management to familiarize them with the problems and issues encountered by nurses, history of nursing and trends in nursing education can help student’s studying Nursing education. The findings brought out by the study emphasizes the need for the authorities at the public and private sector as well as policies maker at the ministry of health to take corrective steps to ensure we have satisfied and efficient nurses if we want to have a healthy nation.

I appreciate the pain staking effort made by Aarti Prasad through her study of the socio economic status of nurses to bring relief and draw attention of authorities. It’s a book that every hospital, school /college of nursing should have in their library so that they may be sensitized to the problems and socio economic conditions; so that those who are cared for by nurse start to care about the nurses.

Dr. (Mrs.) Nancy Fernandes Pereira, Assit. Professor
Leelabai Thackersey College of Nursing, S.N.D.T. Women’s University, Mumbai