“Nursing specialty – As a clinical cadre”

Speaker           : Dr.Prakasamma

Date                : May 03 2016

Time                : 1500-1700 hours

Venue              : PHRN Office, Hauz Khaz, New Delhi.

A seminar was organized by a group of active nurses called FINA on topic “Nurse Specialty as a clinical cadre” at Public Health Resource Network (PHRN) office, Hauz Khaz, New Delhi. The group consists of post graduate nurse representatives from the all specialties working in the public institutions, nursing association leaders and public health experts from Public Health Foundation of India (PHFI).

Discussions

Do the nursing academicians should have some clinical experiences or not?

A group of PG nurses from the clinical arena suggested that nursing teaching requires a on hand skills expertise to train the students hence they recommended  to enforce a minimum clinical experiences for nursing academicians and new initiative to  enroll working clinical eligible nurses to academic department. Few nurses suggested that it’s an individual choice to decide their work so we should not make compulsion but they also agreed with a suggestion of minimum clinical experience as eligibility criteria for recruitment of nursing teachers.

Nursing specialty as a cadre for clinical nurses

The speaker narrated that in 1970’s she had gained the excellent skills of treating the pulmonary care to patients and used to teach care aspects to MD students in one of the tertiary hospitals of Hyderabad. With aim to provide independent care she completed the Masters of Science in cardio thoracic specialty but there was no opportunity. After a repeated demand authorities deputed her as a lecturer at nursing college but her aim to care the pulmonary disease patients was not accomplished. She was involved in the research work and was one of the authors in two scientific papers. Then she started to build a career as public health experts and completed her PhD from Jawaharlal Nehru University, New Delhi. She was a one of the members in many of the expert committee and programmes of government of India and Andrapradesh. With this narration she raised following questions to the participants;

1. What is that stopping us to not to have a clinical specialist cadre?
2. Why MSc, B Sc and GNM nurses with experiences and core competencies are not demanding for acknowledgement of their skills?
3. Why there are many curriculum and courses without proper posts at public and private sector?
4. Why there are no clinical cadres for nurses?

Responses:

1.  One of the specialty nurses from the tertiary hospitals along with her colleagues has consulted their CNO and other higher authorities regarding the non-utilization of their skills in the clinical area. Even after their repeated appeals, nothing was done within the institute so they approached the authority at the central level. As a response, all these signatories had received memos for consulting the higher authority and raising their voices against hospital authority.
2. AIIMS PG clinical nurses had represented the issue of clinical specialty to their director along with the existing non-official or internal posts like Nurse Informatics, Trauma Nurse Cordinators, Infection control nurse and other. Authority had agreed to consider these existing internal or non-official posts as a specialty and as a next cadre but did not agree demand of acknowledging the skills and competencies of others.
3. Another PG clinical nurse has initiated to start the community care and health education in the ophthalmic department but it was rejected by the higher authority.
4. There were many anecdotal of not considering the educational qualifications and their previous experience before allotting the postings. There were many discussions with senior nurses and authority but nothing much was done.
5.  Many of them agreed that senior nurses within the system are not ready to accept the young nurses’ skills and competencies.
6. Dr.Joe, shared the West Benagal module of dual system of care. There is exchange between the clinical nursing and nursing academics as per their qualification and eligibility. He also mentioned that this module is followed in the CMC Vellore.
7. Speaker said that there are two main barriers, first is within the nursing fraternity from the seniors and second is external that is from the doctors/physicians/authority. Senior nurses have sense of inadequacy and loss of their post due to emergence of the young nurses’ clinical expertise. Doctors/physicians have issue of hierarchy, professional dominance, gender and class.
8. Senior nurses need to be involved in this type of discussions and confirm that because of clinical specialty, there will not be any problem to their promotion but instead there will be more chance. Development of professionalism among the clinical nurses and highlighting the same in the institution may develop confidence among the nurses and acknowledgement by the physicians.
9. House has an agreement that clinical specialist should be based on clinical experiences and educational qualification. There should be special allowances and initiatives to upgrade nurses as clinical specialist nurse.

The forum agreed that there is a need to recognize the skills of nurses who have served for long time in specific area and those who have educational qualifications.

What are the strategies to create the clinical cadre?

1. Speaker suggested two major strategies, first one is initiation of clinical specialty association and active participation of clinical nurses among association and another is promoting professionalism within the nursing fraternity.
2. One of the participants enlisted the list of the clinical specialty associations existing in India. Majority of then allow their membership to specialty PG nurses.
3. Professionalism: clinical nurses gathering to be initiated to discuss the cases, experiences and issues at all the levels (department, institutions, state and national).
4. Dr.Joe, suggested writing a letter to all the existing specialty association to open the membership to the clinical nurses working in the area of concern.

Other major issues which were part of the discussion

1.  Dr.Joe : FINA is a not registered body so who will do the advocacy with the stakeholder?Response: There are more than 150+ nursing associations existing so this body has remained unregistered but represent as FINA (Federation of Nursing Association)- Registering thoughts. It will be discussed further with other associations and will come to a conclusion at the earliest.
2. Administrative structure at the central level and its functions were discussed. After the 6 decades of independence still we have only advisory body in ministry.
3. Speaker flagged in the thought of calling medical and paramedical as patient care professionals and para- patient care.

Resolutions

1. Write a letter to the existing specialty nursing association to open the membership for the clinical nurses working in respected area.
2. All the participants will try to initiate the clinical discussion at their units, institutions and other levels.
3. Disseminating these discussions and sensitizing the need for clinical skills acknowledgement among their colleagues.
4. To organize this type of classes and forming a team for advocacy with stake holders.
5. To organize the meeting with the stakeholder in possible state or districts.