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INTRODUCTION The term status is slippery and difficult to define; however in this paper, “status” has been referred to an element of professional “honor” or recognition of nurses in society. The status of the nursing discipline is still viewed as lower-level subordinate, dirty and menial jobs in this country. It could be because of their projection as submissive females in subordination with physicians assisting them in caring and curing the patients without any autonomy. Although nurses are obtaining undergraduate and or postgraduate professional degrees to practice as a nurse in the country unfortunately, they are still socially socially viewed as servants in health-care delivery system. Nurses are continuously striving to achieve a higher status in this patricentric society, but still long journey is waiting a head to achieve honor and respect, which they deserve. Lack of social status, recognition, low pay, poor working conditions, lack of autonomy in practice, lack of recognition as a member of health-care team and exploitation has significantly contributed towards brain drain of nurses to the Western world. Nurses' shortage has been reported by the WHO worldwide and the latest Indian trends suggest shortage of more than two million nurses that give a nurse: Population ratio of 1.7:1000, which is 43% 40 years of this incident, scenario has not changed and every now and then, nurses are at the verge of violence by patients, attendants or relatives and co-workers. The nursing profession is a well-recognised and respected discipline in the Western world, where nurses are considered equivalent to doctors and other health care professionals in health-care team, and thus, they have significantly contributed in ensuring quality healthcare, however the situation is not the same in our country Figure 1.Figure 1: Reflection of nurses in India versus western worldExceptional job done by nurses during this COVID-19 pandemic is highly appreciated by many be it the general public, physicians or hospitals' management and government. However in our opinion, it is all temporary because if we look for working hours and facilities during quarantine, nurses again faced discrimination and better facilities were given to doctors.8 Nurses in India do not have voice and most of them are not assertive and lack confidence when it comes to talk about their rights as a RN and the one possible reason which we come across more often is that they feel ashamed to be called as a 'Nurse.' There are many nursing professionals who have opted nursing as a secondary choice after failure to reserve seat in the medical entrance and that is why have minimum acceptance for nursing and top of that stagnant carrier instead of higher qualifications make nurses unwilling to do much for their professional growth. Nurses who are working on a reputed position even do not want their children or relatives to be a nurse as this is still not accepted as a reputed profession such as doctors and engineers. Moreover, very few higher secondary school students are aware and interested to join nursing because this discipline lack in popularity and social recognition.9 Although nursing is a profession based on scientific knowledge and skills, it is still overpowered as a nurturing and caring job for which only women are considered best. These stereotypes are deep-rooted and cause hindrance in professional growth. Reputed institutes in the country like PGIMER and AIIMS do not enroll male students into B.Sc., nursing programme and recent amendment of 80:20 between females and males nurses for AIIMS recruitment in 2019 has become a matter of debate in every other nursing conference or meeting, but no one listens and this also give rise to myth that nursing is a profession that belongs to submissive females. Most of the countries, including India, are already facing serious shortage of nurses and this phenomenon may further expand the gap in demand and supply of this category of workforce and tomorrow world may not find the sufficient number of motivated, capable and competent nurses for the smooth running of their hospitals. Nursing profession in our country lacks dynamic leaders and there are very few unsung leaders who are meticulously putting efforts to represent ignored issues and problems of nurses. There are numerous factors which are contributing to poor status of nurses in our country as illustrated in Table 1.10,11,12Table 1: Barriers and challenges faced by nurses in IndiaSTRATEGIES TO IMPROVE STATUS OF NURSES IN INDIA Appropriate status or professional recognition for nurse is not a one-man job and that is why it requires efforts on all levels with the planning and implementation of short and long-term goals. With the advancement in the number of nursing institutes and availability of seats, infrastructure facilities and skill training have been compromised to a great extent that raised serious concern on quality in nursing education and sanctity nursing degrees. Nursing training and education must be sound and should be entirely outcome-oriented based on desired clinical competencies. Nursing regulatory bodies and the health ministry of India need to take the lead for bringing change in the existing system, whether it is curriculum, licensing for RNs, or cadre structure for nurses. Nurse practitioner course has been started in few of the institutes, but neither there is any law to protect their practices nor separate job or cadre available for their deployment, which ultimately will add on to nurses' disappointment. License issuing system for become a RN in India is an another major area of concern because in the current scenario it is given to everyone who so ever passes nursing diploma or degree from the Indian Nursing Council recognised institutes, which again enhance the number of incompetent and unskilled nurses. Licensing system should be improvised with the provision of stagnant exit or licensing examination like America's National Council Licensure Examination for RNs exam and standardized skill assessment before nurses are considered eligible for getting their license to practice as RN or advanced nurse practitioner. Negative attitude of medical colleagues and fear of wrath by them should not stop nurse leaders to raise their voice. Provision of inter-disciplinary education is the best approach to create awareness among the medical fraternity about scope of nursing practice, a team working culture so that they can work collaboratively, contributing much more in quality care and overall professional growth. Solving an alarming issue of gender discrimination is a prerequisite for professional advancement because people working in a profession should be a clear representation of all sections of society and diversity in the professional discipline and this will also have its impact on quality care and health outcomes. It would not be wrong to mention that somehow status comes with money and nurses who are being paid well for their work will be more satisfied and have better social recognition. Therefore, strict amendments and provisions on minimum wages need to be established and practiced by all health-care organisations. Resolving all these issues with the different but unique approaches are important to promote status and establish recognition of nurses in the country. Nurses need to work on broader horizon and should try to become an entrepreneur so that they can work in different areas with all their strengths to bring desired prestige and marked contribution in health-care outcomes. There are many areas where nurses need to focus their services and the first and foremost is 'nurse-led clinics' which is best for clients with chronic illnesses such as diabetes, hypertension and palliative care. Adjuvant nurse-led clinics along with physicians are successfully implemented in Western countries and we have enough data to support this but unable to implement because of endless reasons and we have tried to compile list of barriers and challenges in Table 1. Tele-nursing, home-based care, independent nurse practitioners, clinical nurse specialist and expanded role of nurses are another area which can be further explored and nurses' role can be expanded in these areas. Surprisingly, nurses are totally missing in policymaking and at top-level administrative roles; there is no presence of nurses, especially in health directorates of centre or states and they are also not seen in governing body or institute of bodies in autonomous institutes like all AIIMS, PGIMER, JIPMER, etc., In spite of being the largest group of health-care workers in these institutes, they are being seriously marginalised and their voice is left unheard. Therefore, nurses should reflect their strong presence in policymaking and at ministerial positions to reiterate themselves properly and bring expected honor and acknowledgement. Nurses with doctorate degrees can also give their remarkable contribution towards professional development by doing evidence-based research, developing new theories or modifying existing theories and putting emphasis on required changes at both public and policy level. All areas of nursing, including education, training, administration, and research, require changes and reforms to incorporate best standards of practice. Sense of self-accomplishment or confidence comes with up-to-date knowledge, competency, well-formulated policies, and laws for practice; only then desired status can be achieved as well Table 2.13,14,15,16Table 2: Strategies to improve nurses' status in IndiaCONCLUSION Nurses are the head honchos and lifeline of health-care organisations but still lack recognition. Concern on this has been expressed by many, but till date, no strong recommendations and visible implementation of laws and policies are seen. Nurses need to take leadership and proceed to participate more at higher levels to bring a change in the existing scenario. Adaptation of nurses as a nurse practitioner would not be easy, but it will definitely bring the pride and honor which every nurse desire for. Collaborative working model of nurses and doctors with mutual respect would reflect positively on the health outcomes of the country. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Sharma et al. (Wed,) studied this question.