Uplifting nurses and caregivers in India

Sameer Joshi, Associate Vice President, Marketing (B2B), Godrej Interio, gives an insight on the current work environment and work pattern of the nurses in India, the challenges faced and how they can be overcome

Healthcare is one of the largest sectors in this country in terms of both revenues as well as employment. Nurses and caregivers are the single largest health professional group and they practice in nearly every setting of the healthcare system, including hospitals, long-term care, home health, ambulatory care, diagnostic and treatment facilities and clinics.
Nursing is a calling of care, which offers a pool of challenges. Despite urbanisation and globalisation in the country, the healthcare system in the country continues to face challenging changes.

To meet this changing demand, the well-motivated and well-prepared workforce is required. We can achieve this by meeting the requirement of nurses and taking care of their challenges which can lead to empowered and encouraged nurses who can continue to excel to do best without any barriers.

India has a shortage of an estimated 600,000 doctors and two million nurses. With this above objective in mind, we at Godrej Interio tried to understand the current work environment and work pattern of the nurses in India. The work culture in the Indian is immeasurably diverse. The Indian healthcare system is undergoing a transformative change. In adjusting with a change system and responsibilities, challenges faced by them needs to be addressed on a priority basis.

Challenges

The job tasks of nurses consist of pushing heavy trolleys, patient beds, lifting the patient to make them sit upright or give lateral position, moving patients from one surface to other, bending while delivering patient care such as bed making and feeding or infusing IV fluids, transferring the patient from bed to wheelchair and vice versa, delivering personal hygiene, etc.

All these tasks are strenuous and involve a lot of physical effort on the part of the nurses.

Stressed and pressed for time

Long working hours, overtime and work overload contribute to their physical and psychological wellbeing. According to our initial study, 88 per cent of nurses work for 8-10 hours a day along with doing overtime at least twice or thrice a month (35 per cent do over time more than three times a month).

Skewed patient to nurse ratio

The Godrej Interio’s Workspace and Ergonomics Research Cell study ‘Elevating experiences, Enriching lives’ reveals that 53 per cent of the nurses in departments like medicine and surgery (especially general wards) are observed to have staff-patient ratios of more than six patients per nurse.

As per Indian Nursing Council (INC) norms, the nurse-patient ratio should be 1:3 for general wards in medical colleges and 1:5 for district hospitals, one in each clinic room of the OPD and 1:1 in ICU, ICCU and other critical care areas.

Infrequent breaks

28 per cent take breaks after four hours of continuous work while 26 per cent take no breaks in a workday (eight or more hours of work).

Posture stress

Nursing as a profession requires the nurses to provide their services in a standing posture.
However, 74 per cent of the nurses stand for more than four to six hours a day at a stretch while delivering the services which could cause stress on their lower limbs.

Mechanical help

Transferring a patient from one surface to another is one of the major and important job responsibilities of the nursing staff. In view of this, we tried to understand which transfer techniques are being used by the nurses and whether those are safe for patients as well as the staff.

We found that some of the large private hospitals do have mechanical lifters, however, it was observed that the staff was either not trained to use the same or was hesitant to use the same sighting time-consuming process. This too can have a direct impact on the health of the back of the nursing staff. Nurses during the study highlighted the following issues:

• 44 per cent of the nurses lift the patient alone with the help of gait belt
• 58 per cent lift the patient alone without the help of gait belt
• 43 per cent reposition the patient in the bed alone
• 57 per cent shift the patient from one bed to another with the help of one person
• 74 per cent reported that they don’t use mechanical lifters while transferring a patient from one surface to other

Hospital space design involves factoring in many different facets of work, including physical elements (e.g., medical equipment design, workspace, workstation and physical environment) and psychosocial elements (e.g., job content, workload, autonomy and participation). All these elements impact the nursing staff’s stress and efficiency.

The design of the hospital spaces and infrastructure plays a major role in the job satisfaction of the nurses. Designers need to capitalise on design thinking methods to ensure a technologically advanced; ergonomically fit and design led healthcare setup that centres around the patient and their caregivers. These spaces must be designed according to the job hours and tasks of nurses. The design must ensure that they have space to relax, recover, and rejuvenate themselves. Reducing the stress and fatigue of the nursing staff and providing ergonomically supportive spaces should be given importance while designing the hospital infrastructure.

Various steps can be taken while designing these spaces like furniture adjustability, obstacle-free placement of medical equipment and furniture in the room, light in the room, ventilation in and around, and maintaining optional acoustics levels. All these are important for patient recovery and staff efficiency. Considering the long hours spent on the job, workspaces must be optimally designed to support ergonomics, efficiency, access, comfort, and productivity.

Overall, there should be a clear distinction between the staff areas and the patient-facing zones to allow mental relief to the workers. The materials, furnishings, colours, and style could be different to provide diversion and visual interest. The participation of nurses in the design or redesign of their workspaces is crucial to make them feel involved. It can act as a motivator and enabler of high-quality performance. Besides being a key work design criterion, participation is also an important characteristic of any big change.