Regulatory bodies Challenges in hospital setting Challenges in academic settings Overcoming these challenges

1. Issues and Challenges in
Nursing Profession
Prof. (Dr.) Smriti Arora
Amity College of Nursing
Amity University Haryana
smritiamit@msn.com

2. • International Nurses Day theme of this year (2020) is
“Nurses A Voice to Lead- Nursing the World to Health”.
• WHO has also designated year 2020 as
“International Year of the Nurse and Midwife”.

3. Objectives
• Regulatory bodies
• Challenges in hospital setting
• Challenges in academic settings
• Overcoming these challenges

4. Regulatory bodies
• MoHFW
• INC
• State Registration councils
• TNAI
• NABH- National Accreditation Board for Hospitals & Healthcare Providers; a
constituent board of Quality Council of India, set up to establish and
operate accreditation programme for healthcare organizations. Formed in
2005
• UGC , NAAC

5. INC
• Dr. T. Dileep Kumar
• President, president.inc@gov.in
• Dr. Asha Sharma
• Vice President, vp.inc@gov.in
• Lt Col (Dr) Sarvjeet Kaur
• Secretary, Email: secy.inc@gov.in
• Mrs. K. S. Bharati
• Joint Secretary, Email: js.inc@gov.in

6. Functions
• Inspections
• Guidelines- start CON, SON
• Prepare curriculum- Ph.D. , MSc, BSc, DGNM, ANM and other
diploma courses
• Guidelines for Admissions and Examination
• Eligibility criteria for faculty selection

7. Challenges in hospital settings
Limited
resources,
underpaid
KSA
Long working
hours
Demanding
patients
Gender issues
80-20
Demotivated for
CE
Apathy
towards
research
Ethical
Dilemmas

8. Challenges in hospital settings
• No separate cadre for nursing professionals
• Even with specialized education they work in general wards.
• Posting is not there based on qualification.

9. Challenges in hospital settings
• Working conditions
• Inadequate staffing - The nurse-patient ratios are usually not met at the
hospitals. Often the nurses are made to do long shifts without breaks.
• SIU norms not followed
• Too much documentation
• Nurses are prone to experience burnout and fatigue
• Nurses face ethical dilemmas with restricted resources
• Decline in quality care to patients

10. Workplace hazards
Nurses face a number of workplace hazards such as
• exposure to bloodborne pathogens,
• injuries,
• hand washing-related dermatitis and cold and flu germs
• Needle stick injuries

11. 80-20 rule
• 80 per cent of posts will be reserved for female candidates, while 20
percent will be for male candidates in all categories.
• AIIMS- The minutes of meeting stated that the CIB discussed the issue
of appropriateness and requirement of female nursing staffs in
a number of departments/specialized wards vis-à-vis patient comfort
and care.

12. Incorporating Evidence Based Practice in Nursing

13. Challenges in hospital settings
• Disparity in salaries – There is disparity in salaries at state and centre level, rural and urban level, and
private and government sector. The decision for minimum wages for nurses is still pending. Appointing
nurses for contractual period by the govt and private hospitals is another thing which puts the nurse at
unease and produces uncertainty in her mind about her growth , hence she cannot work with her full
potential to deliver quality care.
• Criteria of Promotion : There is no certain laid out criteria for promotion in government as well as
private sector. Sometimes even talented nurses don’t get their due promotion and incentives due to
some internal politics and corruption. Unfortunately nurses keep low hope of promotion in clinical or
teaching setting and flee to greener pastures.
• Lack of performance based incentives

14. Challenges in hospital settings
Violence in the workplace
• Nurses are subjected to violence at workplace by caregivers, relatives and other
healthcare employees.
• Incidences of bullying, harassment and abuse are increasing day by day.
• Employers, victims, nursing leaders and the political system need to work on united
approaches to layout plan for such circumstances.
• The mean age and work experience of the nurses were 33.5 ± 7.5 and 10.85 ± 10.1
years, respectively. The highest prevalence of verbal, physical, sexist, and racist violence
was from:
• patient's relative (42.3%, 95% CI [30.7, 54.7]),
• patients (12.6%, 95% CI [5.9, 25.0]), and
• healthcare workers (5.1%, 95% CI [2.4, 10.4])
Milad Azami Workplace Violence Against Iranian Nurses: A Systematic Review and Meta-
Analysis. Violence Vict 2018 Dec;33(6):1148-1175. doi: 10.1891/0886-6708.33.6.1148

15. Challenges in hospital settings
The most frequent challenges were
• staff absenteeism
• too many responsibilities
• lack of recognition
• The national policy and strategy should address areas that
could enable nurses to maintain a balance between
household and professional responsibilities; and also
encourage the enrolment of female nurses in the profession.
Wais Mohammad Qarani et al. Challenges On-The-Way of Nursing Administration at Public
Hospitals in Kabul, Afghanistan. J Nurse Manag.2018 May;26(4):420-424. doi:
10.1111/jonm.12558. Epub 2017 Oct 25
•.

16. Challenges in hospital settings
• Nurses migration…..increased staff turn over
• Caste based reservation system
• Poor pay and facilities, No respect or social status
• Increased workload, Lack of Recognition
• Occupational Stress and unfavourable working environment (bullying)
• Ineffective academic and professional growth
• availability of various incentives, job dissatisfaction, social or political unrest
and less social welfare
Sousan Valizadeh et al. Nurses’ Immigration: Causes and Problems .
International Journal of Medical Research & Health Sciences, 2016, 5, 9S:486-
491

17. Challenges in hospital settings
• Disconnect between clinical nurses and teachers
• Dual model ?

18. Challenges in academic settings
• Is nursing an independent discipline/profession or borrowed knowledge…
from psychology, medicine etc.
• Lacks own body of knowledge.. so need to develop own theories/knowledge
base
• Currently, the nursing regulations and standards are specified predominantly
in medical science terms, with little reference to unique nursing knowledge.
This is according to tradition and largely related to nursing’s early
subservience to medicine.
• The discipline-specific knowledge in standards and regulations sets forth the
service that society can expect from members of the profession, thus
clarifying the status of nursing for the public.

19. Challenges in academic settings
• Poor professional environment (teaching - learning)
• Considering the inadequate professional performance environment
and defective educational structure, designing and delivering lessons
with clear goals is essential.
• Using objective and measurable scales for evaluating educational
standards,
• the use of empowered instructors with high communicational skills is
useful for increasing students' motivation and interest toward clinical
education and solving existing challenges.
Madineh Jasemi et al Challenges in the Clinical Education of the Nursing Profession in Iran: A
Qualitative Study Nurse Educ Today. 2018 Aug;67:21-26. doi: 10.1016/j.nedt.2018.04.010. Epub
2018 Apr 21.

20. STRUCTURE
• Class rooms
• Space for
faculty
• Library with
reputed
journals
• Insufficient
well equipped
Labs
• Staff shortage
• Poor quality
of teachers
PROCESS
• Teaching learning
activities
• AV aids- LCD
projectors,
• Simulation
• Group
discussions
• Workshops
• Presentations
• Group research
projects
• Journal clubs
OUTCOME
• Poor quality
nurses will be
produced
• Increased risk
to patients

21. Challenges in academic settings
• Inadequate pay, Stagnation , Delayed or no promotion, withholding
allowances, Limited accommodation facilities
• pressure on faculty to pass students, increase in number of
admissions
• Inadequate clinical exposure to students
• Poor academic planning
• Mismatched theory and clinical exposure to students.
• Unethical activities – Plagiarism, academic dishonesty, non attending
masters, post Basic nursing, fake documentation

22. Managing challenges
• Personal and professional excellence
• honesty
• hardwork
• teamwork
• Professional ethics
• Good communication
• KASH

23. Managing Challenges
• Well groomed personality- Building a positive image in the society by
appropriately communicating with patients, caregivers and colleagues, improved
dressing sense, and being skilled in the competencies.
• Continuing Research- Sharing of evidence and best practice by getting involved
in research activities with full enthusiasm and motivation. Regularly participating
in conferences, workshops to update her knowledge and sharing the knowledge
with peers.

24. Managing challenges
Partnering with media
• Nursing needs to be advertised positively in media.
• It is not merely hand-holding and emotional experiences with patients but also
involves knowledge-based care that requires high levels of competency.
• Most of the non nursing people/disciplines are not even aware that Nursing is a
full time programme with well defined curriculum and council, Ph.D. in Nursing
is also available

25. Managing challenges
Career advancement
• Opportunities for Career advancement and personal development
should be offered under Continuing Nursing education programs for
better clinical skills, promotion, and competency based recognition.
• Employment process of Nurses in India should include an exit
interview to explore what went wrong during their tenure and why
nurses are leaving or repeatedly changing their jobs.

26. Managing challenges
Collective Bargaining
• between employers and nursing personnel to regulate salaries, working environment , benefits, and
other compensation needs to be practised. For that each and every nurse should be a member of a
reputed association like TNAI so that negotiations can be done.
• The nurses voice has yet not been heard due to the historical role of nurse as handmaiden (not an
independent role), limited role in decision making; largely physicians have all the say in decision
making related to patient care. Nurses should be very clear with their role, have confidence and
should not be insecure and should not have any sense of inferiority while carrying out their duties.

27. Managing challenges
Strong Nurses Network
• In these times of social media, nurses should develop strong network to connect
with each from all corners of country, to speak unanimously for their rights, to
spread awareness about their rights, needs and demands for growth of the
profession.

28. Managing challenges
Policy making- Advocacy, Lobbying
• Lobbying is the act of attempting to influence decisions made by officials in
the government, most often legislators or members of regulatory agencies.
• Lobbying is done by many different types of people and organized groups,
including individuals in the private sector, corporations, fellow legislators or
government officials, or advocacy groups (interest groups).
• Nurses need to serve in an active manner on board of advisory committees
and commissions boards where policy decisions are taken to bring
advancements in health care systems to improve quality of patient care as
well as in administration.
• Nurses must build new partnerships with other clinicians, business owners,
philanthropists and elected officials.

29. Developing leadership qualities
• Mentoring and nurturing novice nurses
• Senior Nursing professionals’ willingness to guide and support creates a loving
and non-judgmental environment facilitating nurses to learn and grow.
• Mentorship is indeed a great way to support nursing profession growth and
promote its glory.

30. Summary
• Maintaining moral and ethical standards
• Being honest and hardworking
• Collaboration
• Participating in policy making decisions
• Being updated
• Good communication skills
• Partnering with media

31. Thank You!