Injustice Anywhere Is Injustice Everywhere: The Professional Neglect of Nursing
NV Paulose, Chairman, Global TV +91 98441 82044
Nursing is not servitude. It is a licensed, skilled, and intellectually demanding profession. A nurse is a healthcare professional just as a doctor is. Both are trained. Both are accountable. Both carry responsibility for patient lives. Yet the professional position of nurses differs sharply between advanced countries and India.
In advanced countries such as the United States, the United Kingdom, Canada, and Australia, nursing is treated as an independent profession. Registered Nurses hold licenses granted by regulatory bodies. They are legally accountable for clinical decisions within their scope of practice. In many systems, Advanced Practice Nurses and Nurse Practitioners can diagnose conditions, prescribe medications, and manage patient care independently. Their salaries reflect their responsibility, education, and contribution to healthcare delivery. Nursing is seen as a respected career choice, not a secondary option.
Hospitals in these countries do not frame nurses as assistants to doctors. They function as collaborative partners in patient care. Multidisciplinary teams rely on nursing assessments, monitoring, and clinical judgment. Compensation structures are transparent. Pay scales are structured according to qualification, experience, and specialization. Intensive care nurses, emergency nurses, and specialized practitioners earn significantly higher wages because their skills are recognized as critical assets, not routine labor.
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In contrast, in India, nursing is often positioned administratively as a supportive workforce rather than as a parallel professional pillar. While nursing education in India can be rigorous and technically sound, institutional culture frequently limits autonomy. Decision making authority remains concentrated with doctors. Nursing is commonly perceived as subordinate rather than collaborative.
The financial structure reflects this mindset. Indian hospitals bill patients separately for nursing care, sometimes at substantial daily rates, especially in intensive care units. However, nurses are typically paid fixed salaries that bear little direct relationship to the professional charges collected under the category of nursing services. Unlike consultants, nurses do not receive proportional shares of professional billing. This disconnect creates a contradiction: nursing care is priced as a professional service, yet compensated as operational staff cost.
Social perception also differs. In advanced countries, families openly encourage nursing as a prestigious and stable career. The profession offers upward mobility, research opportunities, leadership roles, and policy influence. In India, medicine is celebrated as a pinnacle achievement, while nursing is often treated as an alternative rather than an equal professional pathway. This cultural narrative influences both public respect and institutional compensation patterns.
The result is visible. Many highly trained Indian nurses migrate to countries where their profession is valued in authority, autonomy, and earnings. The same nurse who is underpaid and underrecognized in India often thrives professionally abroad. This contrast does not reflect a difference in competence. It reflects a difference in systemic valuation.
Nursing is not a charitable act. It is not auxiliary service. It is a regulated healthcare profession that demands knowledge, judgment, resilience, and responsibility. When hospitals charge professional fees for nursing care but fail to align compensation with that professional identity, it creates a structural imbalance.
If India seeks to strengthen its healthcare system to global standards, nursing must be positioned and compensated as a true profession. Respect cannot remain symbolic. It must be reflected in authority, autonomy, and fair financial recognition.
