Can Mumbai Recuperate from the Reverse Migration of Nurses?

With the rapid rise of COVID-19 cases, 99.9 % of ICU beds are occupied in Mumbai hospitals. An even scarier issue is that there are not enough nurses in hospitals to handle these COVID facilities.

The survival story of COVID positive nurses in Mumbai hospitals is undoubtedly a tale of resilience. Majority of the nurses who work in Maharashtra is from Kerala. According to news reports, more than a thousand healthcare workers have been affected in the last three months. The rate of infections is higher in nurses and other frontline health workers.

Many nurses think that they are in a complicated circumstance. Some of them have already handed in their resignations. They claim that the drastic move is because hospital managements don't ensure their safety. Further, their families also urge them to return home.

Pandemic Impact Falling Disproportionately on Nurses?

Take the case of *Teena Mathew from Kottayam, who works at a leading private hospital in the city. She joined the hospital eight months ago. All seemed bright until the COVID-19 pandemic. "Working in the COVID ward was emotionally and physically daunting for us. It was draining the life from most of us. But what we didn't expect was the indifference from the part of the management. The moment, we were tested positive, we were sent into a BMC quarantine centre. The conditions at the centre were unhygienic and didn't even have essential pieces of equipment like a thermometer," explains the mother of a toddler.

"Our jobs have taught us to be flexible. But it isn't very comforting when your employer doesn't ensure your safety. We are being judged every time we bring up our issues. It is not like nurses don't have work ethics," adds *Christa Thampy, her colleague.

She notes that many have taken educational loans to pursue their dream. "A shift in a COVID ward is several hours of pure terror for nurses. There are no processes in place at hospitals. They don't provide institutional quarantine for nurses and have made us stay together in the same hostel, which led to the spread of infection," she explains.

Growing Chaos Inside Mumbai Hospitals

So, why is she still sticking to her job? The Malayali nurse adds that earlier a stint at a Mumbai hospital was a passport for an excellent job in the future. "But many have resigned or planning to quit due to lack of safety. Everybody is different. Some people can't handle sickness. A lot of things don't faze me, I have that kind of personality," she explains.

Sujanapal Achuthan, State General Secretary of United Nurses Association, points out that they are expecting 20-30 % of nurses from Kerala to come back to the state. "The flow of nursing skills from resource-poor states to other states will create a care crisis. It also proves that there is a huge demand for talent and skill. Many front line workers in metros like Mumbai didn't even have protective gear. It is proof of dysfunction at many corporate hospitals. The mortality rate is high in metros like Maharashtra. So, they think that it's better to be in small states like Kerala where there are not many cases," explains Achuthan.

The case is not so different at government hospitals too. Brihan Mumbai Municipal Corporation (BMC) gave a warning to nurses and ward boys who haven't come for work at its hospitals in the first week of June. The civic body informed them that if they don't show up to work, they will be issued show-cause notices from the next day. Would this pressure tactic help in improving the morale of frontline healthcare workers?

Experts point out that the government should come up with a clear policy regarding compensation of nurses. Many like Dr. Swati Rane add that hospitals cannot dole out different procedures for doctors and nurses.

Nurses have lost trust in the System

Dr. Rane, who is the Vice President of Clinical Nursing Research Society, points out that most of the corporate hospitals were not prepared for COVID-19. "It was a new norm, and they didn't know how fast the disease could spread. Most of the employees were stuck in different parts of the city due to the lockdown. There were also a lot of regulatory changes from MCGM, which created turmoil at private hospitals. It had a direct impact on nurses because they got infected and didn't have any SOPs. The nurses were also not directly handled by the Chief Nursing Officers. These young girls were thrown out of the hospital, as soon as they were detected COVID positive and sent to BMC quarantine centres. It was a cultural shock for many of them," she explains.

Rapid Policy Reform and Investment in Nurses

There was already a shortage of frontline healthcare workers in Mumbai. The reverse migration of nurses to their home states have aggravated the deficit. Dr. Rane points out that she gets calls from several hospital management, but they are not willing to pay for nurses.

"Today, a driver's salary and a fresh graduate nurse's salary is almost the same— roughly around Rs. 15,000 per month. If you throw peanuts at them, they won't care about their employers. Today nurses come from well-to-do families, and they get good opportunities abroad," she adds.

Dr. Hiren Ambegaonkar, CEO of SL Raheja hospital, has a different story to tell. He points out that his hospital has lost 12 nurses in the last two days because the Maharashtra government has hired them as contract employees for four months at its COVID centres. "The government is paying them Rs 50, 000 per month. None of the private hospitals will be able to do that. We pay our nurses with one year experience around Rs. 30,000. Hiring nurses who already work at COVID wards of private hospitals won't help anyone, because it won't lead to an increased capacity building," he adds. Dr. Ambegaonkar also adds that his hospital has built a separate quarantine centre for all employees, including ward boys, and the cost of treatment is borne by hospitals.

There are close to 28 million nurses around the globe who fulfils about 90 percent of primary healthcare, including frontline response to the COVID-19 pandemic. Therefore, securing their optimal participation and sustained well-being amid the many results of COVID-19 will enhance the potential for assessable and enhanced health outcomes.