‘NEET bringing MBBS rejects into nursing courses, exam should only be for medical colleges’

Founded in 1908, St. Stephen’s Hospital College of Nursing at Delhi’s Tis Hazari is among the oldest and the most prominent nursing training institutes in the country offering post-basic BSc Nursing course for GNM diploma holders and MSc nursing programmes. Feba Geevarghese, principal of the Christian-minority institute, speaks about new employment trends in nursing, changing profile of aspirants and the adverse impact of NEET on students and colleges. Edited excerpts:

What has St. Stephen’s College’s journey been like since its establishment?

The college is attached to St. Stephen’s Hospital, which has always placed great emphasis on training and educating doctors, nurses, and allied staff. The nursing institute was started as a part of the hospital in 1908 by Alice Wilkinson, a pioneer in nursing education. She was one of the co-authors of the Indian Nursing Council’s (INC) constitution and the founder of the Trained Nurses Association India (TNAI). The institute started with what was then called a B-grade diploma in nursing, which was upgraded to the A-grade diploma, now called General Nursing and Midwifery (GNM), in 1952. It also got the nursing ‘school’ label along the way.

In 2008, with the introduction of BSc Nursing (Hons) programme, the institute was elevated to a college affiliated to the Guru Gobind Singh Indraprastha (IP) University. We have since added a post-basic BSc Nursing course for GNM diploma holders and an MSc in nursing. We have been ranked A grade by the joint assessment committee of IP University, Delhi government and the state fee regulating committee (SFRC). We are ranked first in North India in the Indian Institutional Ranking Framework, an independent ranking body, and second across the country.

How has the institute helped shape nursing education and profession in the country in the last century?

We stand as a strong pillar of nursing training. Even as other colleges and schools came up, we remain rooted in the education, ethics and values that we impart. Our aim is to provide a good foundation. Those who graduate from here are successful everywhere, be it here or abroad, including in leadership roles.

What changes have been brought in nursing curricula and pedagogy in the recent years?

We follow the curriculum designed by the INC [Indian Nursing Council], the body formulating the standards. As and when revisions are made, we adapt to them. They keep in mind national healthcare policies, emerging trends and issues in the healthcare industry. Many of our nurses move abroad. They need additional skills and training according to international standards. The curriculum is built such that it responds to the social trends and realities and we try to align with the changing scenario.

Also read ‘Don’t know how NMC permitted’: New medical colleges started without faculty or equipment, say students

What are some of the key changes brought to the curriculum lately?

The new BSc Nursing (Hons) curriculum, introduced by INC in 2021, is a competency and skill-based one, where students not only go through classroom and laboratory instructions but are also exposed to simulations and skill labs. In some of the modules, such as basic life support (BLS), CPR for children and obstetrics and gynecology simulations, students are able to learn the latest developments. While these were part of the syllabus even earlier, now they constitute mandatory modules. Now, each student has to have these skill sets. They are more competent and able to provide care to patients while studying. This was expected abroad as well, and, hence, more recognition has come for Indian students.

It's a good syllabus, even though it's semester-based and we are always running short of time.

Apart from the shortage of time, what other challenges do you face in incorporating the modifications?

We are still in the fifth semester of the inaugural batch undergoing curricular changes. While the demand for equipment and simulators has increased, we already had most of them in our labs. We are increasing the number of equipment and getting rid of old ones. We have also sent students to skill labs outside. Of course, it’s expensive to get the equipment matching the curricular requirements.

Did it cause any substantial fee hike?

Since we already have most of the equipment, and in any case there's wear and tear every year, there has been no additional burden on students. Plus, we have a wonderful tertiary hospital, where students find good support and clinical exposure besides the hands-on lab training that they get in the college.

Students get public health training at our centre in Sunder Nagri, which provides health services to residents of the locality. The centre is entirely funded by our hospital.

Do you get any support from your alumni?

We have a large number of alumni working in government, teaching and leadership positions in the country as well as abroad. We keep in touch with them and they often visit the institute, especially for their transcript formalities.

But we have not received any monetary help from them, though it will be nice to. And I am sure they will be happy to give it.

Is there anything unique that the college offers to its students that sets it apart from nursing institutes?

As we are a postgraduate institute, students can pursue one course after another here. We are able to help them in career advancement. Many of them get absorbed into the hospital, where they are offered very good salaries. The institute takes care of our people very well. They like to stay here, unless they get government jobs or opportunities abroad. Many get inducted as faculty, too. In fact, I am an alumnus of the institute myself, having done my GNM here.

Do you have any plans to introduce PhD courses?

A doctorate [programme] is in the pipeline but there are only a handful of PhDs available at IP University’s nursing colleges to work as research guides.

Also read NMC chief’s mantra for regulating medical colleges: ‘Friendly handshake, less policing’

What new employment trends are you witnessing in the nursing sector?

Earlier, the graduates would start working immediately after their training. Now, they wait and prepare for government exams, undergoing rigorous training for them. The migration to foreign countries continues. In fact, it has risen after Covid. The graduates look for better opportunities, reputation and image abroad. Many of the outside placement agencies request databases of our students. Earlier, students would only learn English to crack IELTS [International English Language Testing System]. Now, German and Japanese language training has also picked up, thanks to the opportunities in countries like Germany and Japan.

Why the heightened aspirations for government jobs?

There are better opportunities and salary packages in the government sector. Over the last few years, many new AIIMS [All India Institutes of Medical Sciences] have opened up. There are many vacancies in railways and other organisations. Many nursing posts are lying vacant in the public sector and government salaries have gone up.

And what about salaries in the private sector?

I don’t think there’s much change on the private side. Of course, we pay good salaries. But there’s a disparity elsewhere as the hospitals need to sustain themselves. It’s different from government establishments.

The nursing profession has been dominated by aspirants from Kerala. Has there been any change in student composition?

Nursing has penetrated across the states. In the last decade, we have had candidates coming from Haryana, Uttar Pradesh, Delhi, Bihar, Gujarat and North Eastern states, who comprise around half of the student body. The remaining half are from Kerala, down from around 90%, say, 25 years ago.

Do you also find greater gender parity among nursing students?

The nursing institutes and teachers are still wary of having boys in the classroom. The nursing profession is still considered as meant for women. We do have male students in the post-basic BSc and PG courses – they make up 20% of the batch – but there’s no provision to admit them [in GNM and BSc]. In fact, 90% of nursing colleges have only girls. But the trend is changing.

There are some institutes, such as Rufaida College at Jamia Hamdard, which are allowing male students in all courses.

Why are you reluctant?

All our faculty members are women. There’s a mindset across the board that boys are difficult to handle – not that girls are any easier to. Even the patients, particularly obstetrics and gynaecology patients, [prefer female nursing staff]. Of course, boys should be given an opportunity.

Have you faced any difficulty with boys in PG and post-basic BSc courses?

No, but it could be because they are a little more mature.

What about the boys’ mindset? Are they more willing to take up nursing?

There has been increased demand from male candidates. More boys are looking at the profession. They are required in operation theatres, ICUs, psychiatry and geriatric care. If admitting male students becomes mandatory, we will have to do it.

Has the perception about nursing changed over the years? Is the profession considered more dignified?

Nursing students feel they are here to treat and cure patients, but when they join the course, they get a reality check. We are the backbone of the healthcare system. The dignity for the profession has to come from within. While the professional bodies are trying hard, the nurses’ work will itself bring dignity. It depends on how we carry ourselves.

Nowadays, many students join nursing for the sake of teaching. We tell them that unless you have bed-side nursing training – empathising with patients, knowing their names – you can’t be good teachers. Whether it’s teaching or administrative position, our primary image is that of a nurse. And we have to keep that flag flying.

Also read NFSU expands to 10 campuses in 15 years, but can it ease India's forensic science crisis?

Should there be more career progression opportunities available to nursing students?

A lot of aspirants get distracted by the courses where they are not required to attend the colleges. The institutes must follow the regulations and the curriculum for the training. There are so many new courses being run by colleges, which may not be that useful. The actual useful courses are only four – GNM, BSc, post-basic BSc and MSc. But we don’t give any suggestions to the council. We accept what they prescribe.

In recent years, INC has shut down many nursing schools and colleges for failing to meet the norms. Why were so many sub-standard institutes set up in the first place?

For minting money. The regulatory body got to know about them and they shut it down. It's a serious profession and a matter of life and death. One really needs to have good life skills. You can't just be running the courses without standards. At the end of the day, the society suffers.

Was there any oversight on part of the regulator in allowing them?

The institutes are allowed only after inspection. There must be something in the process that might have gone wrong. Or they might have fallen short after the initial approval.

Why does the country have a shortage of nursing staff according to World Health Organisation (WHO) standards, despite the large number of training institutes?

The migration and brain drain is the main reason. Nurses get better opportunities abroad after some training. The foreign countries largely rely on our nurses. We always end up with a shortage.

How can they be retained?

By providing a safe environment, better salaries and working hours, well being, less stressful environment and social status for nurses. Compliance with the regulations should be strict.

Has there been any impact of introducing the NEET [National Eligibility cum Entrance Test] for nursing admissions?

Students and colleges, even the government institutes, are having a really tough time with admissions. The Medical Counselling Committee (MCC) has included nursing among the courses for which one needs to qualify NEET. It was initially mandatory, but INC said that even university entrance exams can be considered for admission. Currently, there’s no uniformity.

We have observed that wherever the admissions are conducted through NEET, it’s the medical aspirants, for whom nursing is the last-resort option, that get in. They are not at all inclined to do nursing and are not happy with the profession. They don’t have the aptitude for nursing. After joining the course, they keep trying for medical education and end up leaving, even if they don’t clear NEET.

They keep missing the lectures and tests and get detained. They have anxiety and mental health issues. They feel shattered. Colleges, including government colleges, are left with vacant seats. And the actual nursing aspirants, who would have been admitted had it not been for NEET, are left wanting.

Also read NEET PG Admissions: MBBS graduates in Maharashtra may get relief from revised one-year bond service rule

NEET should only be for medical colleges. Before NEET, we used to have a good influx through the university entrance test and they would continue with nursing and even pursue higher education. We never had any drop-outs.

How does it impact the nursing services?

There are fewer nurses for patients, and those without the right attitude or aptitude for bedside care. Students should be allowed to choose their professions as per their aptitude. Entrance exams have to be designed as per the professional requirement.

Some friends of nursing students might get into MBBS. Seeing them working as doctors in the same hospital might add to the mental stress.

The students feel obligated to join coaching classes to clear NEET. It’s not fair to those who don’t have the money to do so. The question levels and types for the two courses have to be different. We can't club them all together.

What’s the solution for this issue?

The universities can have their own entrance tests. The central institutes are made to follow NEET, creating a lot of pressure on others to follow the suit. The same pattern is being followed everywhere.

How about a separate national-level entrance test for nursing?

A central level nursing exam can be piloted but other challenges involved in online counseling might creep in. The admission would get delayed.

Things were smoother when the varsities could do their own admissions. The classes would start on time. Now, with so many court cases, the instructions never begin on time, with classes starting as late as in January. These problems will keep accumulating, if the universities aren’t allowed their own tests.