Jemimal Christopher, a senior nursing superintendent was recently awarded by the Govt of Karnataka for her exceptional contributions to the healthcare system.
Nurses play an integral role in the healthcare. While the profession is rewarding, it is certainly not in as much demand as medicine. The unaddressed challenges such as lack of social recognition, poor pay, non-conducive work environment and lack of autonomy are forcing many nursing students to move abroad in search of better opportunities.
Nurses like other healthcare professionals such as doctors are physically and emotionally exhausted. Increasing workload, mandatory overtime service and poor wages are leading causes many to give up the idea of pursuing the profession.
As per reports, India currently has 1.96 nurses per thousand population. According to the Indian Nursing Council records, the country has nearly 3.3 million registered nurses. The greatest irony is that India happens to be one of the biggest exporters of nurses but it falls short of them at home.
As per reports, research has shown a relationship between nurse staffing ratios and patient safety. Increased workload and stress can put nurses in situations that are more likely to lead to medical errors.
In times when the shortage of nurses is becoming a global concern and the concept of travel nurses is gaining momentum, there are nurses in the country who have given more than 25 years to the profession and the fire to provide relentless service is still burning in them.
The Health site spoke to the winner of the Florence Nightingale Award, Jemimal Christopher, a senior nursing superintendent in a Bengaluru hospital.
She was awarded in recognition of her exceptional contributions to the nursing profession and the healthcare system. The award was presented by the Chief Minister Of Karnataka Siddaramaiahduring a ceremony held at Vidhana Soudha.
The Florence Nightingale Award is a prestigious award that is given to nurses based in Karnataka state who have made a significant contribution to the nursing profession. This award is named after Florence Nightingale, who is known as the founder of modern nursing.
About the winner
Christopher’s career began in 1979 as a staff nurse at the Christian Mission Hospital in Madurai, and she later moved to the Christian Medical College and Hospital in Vellore in 1982, where she specialized in Neurology ICU. Throughout the years, Jemimal held various positions, including OT charge in different hospitals from 1989 to 1996. In 1997, she relocated to Bengaluru, joining a hospital as an OT supervisor, where she gained extensive experience assisting in open heart surgeries, renal transplants, and vascular surgeries. Between 2001 and 2010, she worked as a Deputy Nursing Superintendent in Mysore. Currently, she works as a senior nursing superintendent at SPARSH Hospital.
An ordinary day at nursing
The Health site spoke to Christopher to understand nursing as a profession and to gain insight into the challenges that lie at its heart.
Christopher took us through an ordinary day at a hospital that includes routine jobs such as ensuring patient safety, administrative roles and patient satisfaction at its very core.
According to her, nurses need to not only look after the individual needs of the patients but also the management of the system of care.
She said: “We are the first line of contact for all patients. We have to be with them all the time. Our availability at all times is essential.”
Talking about the average working hours for nurses, Christopher said in a lighter vein: “There is a fixed time to begin duty but there is no set time to exit. Typically, a working day might mean 8 hours but most of the time, it gets extended.”
“Nursing was always meant to be a service to people”
Talking about the brain drain of Indian nurses to foreign countries and a lack of desirability towards the profession, Christopher said: “Nursing is a service that requires selfless dedication and commitment. It was always meant to be like that. The question is do youngsters have that kind of dedication these days or not? For a nurse, patient recovery and satisfaction must be the reward they must be seeking. I have been a nurse for so long but the fire in me to do more is still burning. I chose this profession because I wanted to. I don’t have any regrets. I am proud to be a nurse. I wear that badge with honour.”
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Understanding the ground reality, Christopher believes that nurses seeking work opportunities outside the country are doing it for better pay, which according to her is a personal choice, much like any other professionals from different fields might do.
Only a few working hospitals attached to nursing colleges
While counting a few challenges in nursing, Christopher explained that not many nursing colleges have working hospitals attached to them. This, according to her, leads to young nurses lacking in technical experience.
She said: “Nursing students much like medical students have the necessary qualifications. However, they don’t have much practical experience. Hence, many of them have to learn things as they start to work in a hospital. Since much of their training happens at the workplace and it being an impactful job where stakes are high all the time, they might receive some scolding here and there from senior nurses or doctors. What they might be assuming as a struggle or challenge, is just a journey to make them more equipped and better at handling stressful situations. As I said before, nursing requires resilience.”
No personal rivalry
Talking about the existing notion of friction between medicine and nursing, Christopher said: “Whether it is medicine or nursing, the end goal is to heal the patient. Our roles are indispensable. While our duties run parallel to each, at some points our roles intersect. We are with the patient around the clock. We become their primary caretakers in a hospital. As a result, the consultants have the authority to trust us with responsibilities related to medication administration. Sometimes, we might make errors just like other people would do. Sometimes you have to hear an earful from the doctor if things do not go in the desired direction. However, as you mature, you will realize that the scolding or frustration shown towards a nurse is not personal but towards the situation. The response is professional and will fade away once we are out of the situation.”
Christopher said that nurses are the link between doctors and patients. Being in a sandwiched position, they have to make sure to execute the duties assigned to them and at the same time, ensure patient satisfaction which lies at the core of nursing.
She said: “A heartfelt apology and learning from mistakes is the best way forward.”
Where our autonomy lies
Autonomy is defined as the authority to use professional knowledge and judgment to make decisions and take action. In nursing, it means authority, freedom and discretion of the nurses to make judgements about patient care. Regardless of advanced knowledge and experience, studies are showing that nurses are bound to find themselves in a position where they are unable to make independent decisions.
Christopher responded to the statement and said: “Nurses do make autonomous decisions all the time, sometimes without realizing it. However, it is important to note that our autonomy doesn’t lie in diagnosis and prescribing medicine. We might be super specialized and might understand the situation at par with a doctor but we don’t have the authority to make that call. After so much experience, I do understand what might be happening with a patient. But I know where the boundary of my work ends. When it comes to autonomy in nursing, we have several roles where we can exercise our independence.”
Explaining the autonomous call, a nurse can make, Christopher said that she can perform CPR (Cardiopulmonary resuscitation) on an unconscious patient, can dress all bleeding wounds, prescribe simple tests like blood glucose levels, monitor blood pressure, and page the medical team if the situation requires. All this can be done without consulting the medical team.
She further explained: “As you become a specialized nurse, you get to work in more complex and sensitive spaces like in an ICU. As a result, your autonomy also expands. You can change the positions of the critically ill patient, perform suction (when the patient is unable to effectively move secretions from the respiratory tract) on ventilated patients, identify subtle changes in their situation and keep the medical team updated.”
Christopher also explained that due to their proximity to the patient, nurses can also gain additional knowledge from the patients and their family members.
She said: “While doctors visit patients for a limited time, it is natural for some details to get lost in the quick translation. We as the caretakers are spending much more time with them and their relatives. Hence, we can fill in the gaps by providing additional or missed information that could aid in quicker diagnosis like for instance, a medication that the patient might be on but forgot to tell the doctor.”
There is a hierarchy if you look closer
Christopher dismissed the notion that there are no growth options in nursing. According to her, nursing is like any other profession where one can progress. However, the idea is to keep upgrading oneself and upskilling. She said consistency and getting better at what you do is a tested way to get recognized by the management.
She said: “I started as an ordinary nurse. I worked hard and kept learning new things. I then worked as a shift in charge, became better at management, then rose to the position of a supervisor and currently, I am a senior nursing superintendent. My hard work, persistence and learning did get recognized. Yours will be too. You can always stand out in the job you do.”
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