workers' rights

Why nurses go unheard in India – even when they strike

India has more than 16 lakh nurses. But their complaints seem to be ignored repeatedly.

The indefinite strike by nurses that began on September 2 was short lived. The strike was called off after just two days following a meeting between the All India Government Nurses' Federation and health ministry officials at which the nurses were assured that their demands will be sent to the finance ministry by September 12.

However, the Delhi government had already invoked the Essential Services Management Act on Friday classifying the strike as illegal. It detained more than 20,000 nurses. Even though ESMA was declared only at 1.30 pm, nursing association leaders were arrested at 10.30 am that day. Two association leaders were even sent to Tihar Jail. Media reports focused on state health services affected by the nurses’ strike but not on the nurses demands.

The All India Government Nursing Federation has presented their demands to the government many times before. Their basic demand is for a better entry-level pay-scale, which they say has been due for correction since the Fifth Pay Commission in 1996. The nurses contend that while doctors have been given a salary hike of more than 14% in the Seventh Pay Commission, nurses have continued to be ignored.

Substandard working conditions

Most of India’s nurses work in private hospitals, which are largely unregulated and do not follow the norm of having nurse-patient ratios of one to every four. Nurses work nine- to 14-hour days, often doing double shifts. Their starting salaries are between Rs 3,000 and Rs 15,000. Many nurses are required to sign contractual bonds with their employers withholding their educational certificates as guarantee.

In the public sector, nurses are paid better than in private hospitals. But even here, nurse patient ratio are a far cry from the 1:4 norm. Nurses get promotions based on their management abilities and the number of years of experience they have. However, higher authority positions are occupied by physicians, with a nurse being restricted to one promotion in the course of her career. Many retire as staff nurses due to a lack of the higher positions and few opportunities for continuing education. Daily duties are also difficult with most hospitals not providing proper spaces for nurses to change or rest.

A World Health Report of 2006 reveals that 70% of the doctors are male and 70% nurses are female. In India, more than 90% of the nurses are women. In the rigid healthcare hierarchy, nurses are not considered independent professionals but are dominated by physicians and hospital managements.

Most health authorities, physicians and politicians acknowledge that nurses are the backbone of both health system and hospital but when nurses demand autonomy and legal recognition or even basic facilities like changing rooms, toilets and conducive work environments, they go unheard.

Protesting nurses are often punished, as has been reported many times. In December 2009, staff nurses of the Batra Hospital in New Delhi went on strike demanding basic facilities and minimum basic salary of between Rs 10,000 and Rs 15,000. They succeeded in getting the salary hike but those nurses at the forefront were fired on disciplinary grounds. In the public sector, nurses protesting working conditions are sometimes sent to difficult locations or may be refused leave.

A new dimension to nurses’ exploitation by the state is through contractual systems and recruitment outsourcing. The National Rural Health Mission recruits nurses on contractual basis with salaries from Rs 5,000 to Rs 11,000 but without offering any other conveniences. Even if they work for the same hospital, nurses with the same qualification and job description are paid differently depending on whether they are permanent and contract workers. These differences are in the range of Rs 15,000 to Rs 30,000.

India had more than 16 lakh nurses, according to a survey in December 2008. But their complaints seem to be ignored repeatedly. First, the government only set up nursing institutions in 2002, even though these were proposed in all five-year plans and other policy documents. Even here, a majority of nursing colleges were run by the private sector.

Few of states like West Bengal, Gujarat and Odisha have created a nursing director post but these are occupied by doctors. In Karnataka, which also has a nursing director position occupied by a doctor, the state government is merging nursing and paramedical boards.

Nursing movements

In the late 1970s and early 1980s, there were strong agitations by government nurses, who formed associations and unions. They made basic demands regarding uniforms and residence facilities. These associations were concentrated in the northern region and included the Delhi Nurses Union, the Maharashtra Government Nurses Federation, the Rajakiya Nurses Sangh in Uttar Pradesh , the Nursing Research Society of India and the All India Government Nurses Federation. Many of these are still active.

As nursing services have been commercialised over the past two decades, thousands of nursing institutes emerged between 2002 and 2005, especially in the southern states. Many young nurses formed associations such as the Indian Professional Nurses Association, Delhi Private Nurses Association, and the United Nurses Association to demand better working conditions. In May 2015, there was attempt to unite all nursing associations of India.

It's a difficult task. After all, a physician-dominated health system with men in the majority will not allow the advancement of professionals groups that have more women. However, healthcare needs teamwork: each member has to contribute, coordinate and cooperate for better outcomes. Uniting nurses and improving their conditions is essential to build a healthy nation.

We welcome your comments at
Sponsored Content BY 

Why should inclusion matter to companies?

It's not just about goodwill - inclusivity is a good business decision.

To reach a 50-50 workplace scenario, policies on diversity need to be paired with a culture of inclusiveness. While diversity brings equal representation in meetings, board rooms, promotions and recruitment, inclusivity helps give voice to the people who might otherwise be marginalized or excluded. Inclusion at workplace can be seen in an environment that values diverse opinions, encourages collaboration and invites people to share their ideas and perspectives. As Verna Myers, a renowned diversity advocate, puts it “Diversity is being invited to the party, inclusion is being asked to dance.”

Creating a sense of belonging for everyone is essential for a company’s success. Let’s look at some of the real benefits of a diverse and inclusive workplace:

Better decision making

A whitepaper by Cloverpop, a decision making tool, established a direct link between inclusive decision making and better business performance. The research discovered that teams that followed an inclusive decision-making process made decisions 2X faster with half the meetings and delivered 60% better results. As per Harvard Business School Professor Francesca Gino, this report highlights how diversity and inclusion are practical tools to improve decision making in companies. According to her, changing the composition of decision making teams to include different perspectives can help individuals overcome biases that affect their decisions.

Higher job satisfaction

Employee satisfaction is connected to a workplace environment that values individual ideas and creates a sense of belonging for everyone. A research by Accenture identified 40 factors that influence advancement in the workplace. An empowering work environment where employees have the freedom to be creative, innovative and themselves at work, was identified as a key driver in improving employee advancement to senior levels.


A research by stated the in India, 62% of innovation is driven by employee perceptions of inclusion. The study included responses from 1,500 employees from Australia, China, Germany, India, Mexico and the United States and showed that employees who feel included are more likely to go above and beyond the call of duty, suggest new and innovative ways of getting work done.

Competitive Advantage

Shirley Engelmeier, author of ‘Inclusion: The New Competitive Business Advantage’, in her interview with Forbes, talks about the new global business normal. She points out that the rapidly changing customer base with different tastes and preferences need to feel represented by brands. An inclusive environment will future-proof the organisation to cater to the new global consumer language and give it a competitive edge.

An inclusive workplace ensures that no individual is disregarded because of their gender, race, disability, age or other social and cultural factors. Accenture has been a leading voice in advocating equal workplace. Having won several accolades including a perfect score on the Human Rights Campaign’s Corporate equality index, Accenture has demonstrated inclusive and diverse practices not only within its organisation but also in business relationships through their Supplier Inclusion and Diversity program.

In a video titled ‘She rises’, Accenture captures the importance of implementing diverse policies and creating an inclusive workplace culture.


To know more about inclusion and diversity, see here.

This article was produced by the Scroll marketing team on behalf of Accenture and not by the Scroll editorial team.