There is an urgent need to reorganize the Nursing Services of our Armed Forces

(Army in particular) to address the real issues adversely affecting the Patient
Care in the army medical establishments. Presently, the focus is on, to how to
ensure Patient Care by lowering the Pay and Status of the Army Nurses. There are
numerous articles written on the subject mainly to discredit the Military Nursing
Service. Everyone tend to forget the contribution made by the Army Nurses to the
common cause of the National defence. The Nursing arm of the Army begins with the
arrival of British Nurses in 1881. Throughout its past 127 years of existence,
most of the time, this was the only organization in which women are permitted to
serve. The sacrifices made by the Army Nurses can be forgotten only by an
ungrateful Army. Instead of modernizing the Nursing Services along with the
changing times as done by the numerous other Nations including Pakistan, here the
concerted efforts are only to how pull them down. The article by Brig (Dr) C P
Joshi (Retd), 23 Oct 2008 on 'Status of MNS' is an example.

The members of Military Nursing Service (MNS) are of Commissioned rank appointed
by a notification in the Gazette of India as Officers of MNS forming part of
regular Army (Section 5 Military Nursing Service Ordinance 1943). As they are
Officers holding a Commissioned rank, they are Commissioned Officers ranking
equally with any other arm/service Officers of same titular rank [Defence Services
Regulations (Army) Para 733 (b)]. As other Officers are not addressed as Members
of EME or AMC, JAG etc. the increased tendency in the Army to refer the MNS
Officers as Members of MNS is inappropriate and misleading.

The sense of fairness of today's Officers has been seriously affected by the
propaganda campaign unleashed by the AMC Officers or Commissioned Members of AMC
(in their own language). The Members of AMC have convinced the entire Army and
including the supposed to be wise Generals of other arms/services that the MNS
Officers are an out cast and shall be lowered from the Commissioned Officers
Status. The proof is the Army Chiefs letter asking to lower the pay scales of MNS
Officers. The Army Chief through his letter dated 20 Jun 2008 asked the Cabinet
Secretary to lower the pay scales of MNS Officers to ensure patient care in armed
forces hospitals!

The army doctors like the army nurses, also does not under go the Services
Selection Board (SSB) interview to test their Officer Like Qualities (OLQs). The
doctors, dentists and nurses are given Commission not because of their OLQs, but
merely for their professional qualifications. Therefore the army Doctors supposed
fears of 'nurses pay adversely affecting the patient care in the long run' should
be correctly interpreted as their 'lack of leadership qualities adversely
affecting the management of the medical establishments'. Due to their inferiority
complexes, many of the doctors after wearing army officers uniform tries to become
more officer like than the true Officers and end up being an 'Army Nurse Basher'.
They have misplaced notions about officer like qualities. Such army doctors tries
to vent their frustrations originated out of their professional inabilities and
lack of leadership qualities by pulling down the Army Nurses. The survey conducted
by the WHO in 2008, ranked the Indian Army Nurses as the best Nurses in the world.

The USA became the first country in 1901, to constitute the Nursing Services as a
Corps of its Army and placed all the Nursing Personnel under it. Now the Army
Nurse Corps Officers (Nurses) are considered equally for even Command positions in
their Army Medical Service (US Army Nurses routinely Commands Military Medical
Establishments and Army Medical Commands). The logic is that, in a system when
neither (doctor/nurse) is tested for OLQs, any one who has the requisite
leadership abilities should be given the opportunity to Command. A Nurse can be a
better Commander than a Doctor, because Command is a test of Leadership. Any army
nurse is also equally qualified to perform in leadership positions like the
doctors in the army, but both are not tested for OLQs. In India the Command of
medical units is a sacred act performed only by the Doctors! Let it remain that
way, I don't think any army nurse will demand for such posts due to our caseist
mindedness.

In 1943, the Nursing Services of all the Imperial Forces (Armies of India,
Canadian, Australian, South African and including British etc.) had the same
status as 'auxiliary force of army'. After the war, all these Countries including
Pakistan have formed Army Nurse Corps out of their own Military Nursing Service.
The nursing personnel (Nursing Assistants/ Nursing Orderlies) previously part of
Army Medical Corps were then transferred to the Nurse Corps for proper management
by the professional Nurses. But in the Indian Army the Nursing Assistants are
still part of AMC. Many of them are being misused as 'sahayaks' at the AMC
Officers houses and Messes, whereas they are meant for assisting the Nurses in the
medical units. Almost every country has constituted Army Nurse Corps in their
Armies after the WW-II. However, the MNS still continues as an 'auxiliary force of
Indian Army'.

The Nurse to Doctor Ratio in Indian Army is 1:2 (3000 nurses and 6000 doctors).
The ideal ratio is 4:1 as recommended by the Indian Nursing Council and being
followed by Civil Hospitals. Such low ratio of Nurses is being justified by
showing the 20000 strong Nursing Assistant tradesmen of AMC, as available for
assisting the Nurses. This is theoretically true but practically exists only on
paper. The Army manages by making the Nurses to work for 72 hours a week as
against the 48 hours in Civil. The minimum hours of work to be performed by the
Army personnel in a week are also 48 hours.

The most of the Countries including Pakistan have Army Nurse Corps as part of
their Army. In USA the Army Nurse Corps Officers (Nurses) even commands Army
Hospitals and Medical Commands. Is the Patient Care in those Army's have been
adversely affected due to this? The answer is no. The Indian Army Nurses are the
best professionals in this field. The patient care in the Indian Army is better
than the Civil. However, the Army's discriminatory attitude to the MNS Officers is
going to adversely affect the patient care (if not already affected). It will
further erode in the coming years unless immediate corrective steps are taken. The
supposedly wise Generals will realize it only post retirement, when there is
nobody else to look after them, other than an Army Nurse. Every General like the
Deepak Kapoor should get an opportunity to point out to an Army Nurse while lying
on a Military Hospital bed, that she is an 'inferior class of Officer as being
from an auxiliary force'. He is assured of a good care from her.

The need of the hour is to strengthen the Nursing Services by allowing it to be

managed by the professional Nurses. Presently the Nursing Services in Army is
managed by the Doctors. We shall follow in the steps of other nations by
redesignating the Military Nursing Service as a Corps of regular Army. And then
transfer al the nursing personnel to the Nursing Corps for proper management of
nursing resources. This is the only way the Nursing Services and there by the
Patient Care can be improved in the Indian Army.

by Brig (Dr) C P Joshi (Retd)

23 Oct 2008