The Overlooked Role of Nurses

Nursing care remains one of the most undervalued yet essential pillars of the healthcare system. Globally, nurses are expected to be the first point of patient contact—taking detailed histories, listening to symptoms, and guiding early interventions, often non-pharmacological, before escalating care to physicians. This model enhances patient safety and prevents premature use of medications. In Kashmir’s hospitals, however, including leading government medical colleges, this critical role is underplayed. Doctors are left overburdened, while patients lose out on the benefits of holistic care.
Where Kashmir Stands: Ratios and Realities
The disparity between Kashmir's healthcare staffing and global standards is stark. The World Health Organization (WHO) recommends a nurse-to-population ratio of at least 3 per 1,000 individuals. However, India's national average is approximately 1.96 nurses per 1,000 people, and Jammu & Kashmir fares even worse.
In institutions like SMHS Hospital in Srinagar, a single nurse may be responsible for up to 30 patients during a day shift, and two nurses often manage 60 patients overnight. In Intensive Care Units (ICUs), where one-to-one care is critical, two nurses sometimes oversee as many as 16 critically ill patients during the night shift.
Nationally, the health workforce density—which includes doctors, nurses, and midwives—is approximately 20.6 per 10,000 population, significantly below the WHO's recommended threshold of 44.5 per 10,000.
This severe shortage not only places immense pressure on healthcare providers but also compromises patient safety and the quality of care.

Medical Dimension

A key clinical consequence of the nursing shortage is that patients often bypass early nursing assessment and directly approach doctors, who may respond with high-dose medications or aggressive interventions. Without initial evaluation and guidance from nurses, patients are more likely to receive strong drugs unnecessarily, contributing to antimicrobial resistance, side effects, and higher treatment costs.
In contrast, if nurses were fully empowered as frontline caregivers, they could play a pivotal role in patient care. First, they could take detailed patient histories and carefully assess symptoms, ensuring that the physician has accurate and comprehensive information before making treatment decisions. Second, they could provide early guidance on lifestyle, diet, and mild interventions, helping patients manage conditions without immediately resorting to high-dose medications. Third, nurses could escalate cases to medical treatment only when necessary, which would often reduce the reliance on strong drugs, improve patient safety, and help prevent issues such as drug resistance.
This early intervention model is not only safer for patients but also helps preserve the effectiveness of medications and reduces the burden on physicians.

Social Dimensions of the Crisis

The shortage of nurses is not merely a health system issue but has deep social consequences:
Equity: Rural and remote districts like Kupwara and Gurez are hit hardest, as private healthcare options are scarce, further deepening regional health inequalities.
Gender: Nursing is a predominantly female profession. Underinvestment in the sector weakens health delivery and limits formal employment opportunities for women in a region already struggling with one of the highest female unemployment rates in India.
Migration: Many trained nurses leave for metropolitan cities or the Gulf, creating a local brain drain where publicly subsidized human capital benefits other economies instead of Kashmir.

Economic Implications

The nursing crisis has direct and indirect economic costs

Out-of-Pocket (OOP) Spending: Patients unable to receive adequate care in government hospitals often turn to the private sector, pushing up household OOP spending. In India, OOP already accounts for nearly 48% of total health expenditure, one of the highest in the world.
Productivity Loss: Poor quality of care leads to longer recovery times, medical errors, and avoidable complications—reducing working days and labor productivity.
Efficiency: Nurses are more cost-effective to train and deploy than doctors. Global evidence shows that strengthening the nursing workforce improves survival rates, reduces unnecessary prescriptions, and makes healthcare delivery more efficient.

Policy and SDG Linkages

The absence of adequate nursing care undermines broader policy and development goals. Without strengthening this workforce, J&K cannot realistically achieve SDG 3 (Good Health and Well-Being) or India’s commitments to Universal Health Coverage (UHC).
The WHO emphasizes that investment in the health workforce is not a cost but a growth strategy: every $1 invested yields an estimated $9–10 in returns through improved productivity and reduced premature mortality. For Kashmir, where both health and employment indicators are fragile, investing in nursing would yield a double dividend—better health outcomes and more jobs, especially for women.

The Way Forward

Strengthening healthcare in Kashmir requires a renewed focus on nursing care. Beyond their traditional supportive role, nurses should be equipped with continuous training to keep pace with modern health needs and empowered to serve as the frontline of patient interaction. By taking detailed histories, guiding early lifestyle-based interventions, and escalating treatment only when necessary, nurses can ensure safer, more patient-friendly, and cost-effective healthcare delivery. Recognizing them as professionals with an independent and indispensable role—rather than simply as assistants to doctors—will go a long way in building a more resilient and equitable health system in the region.

Conclusion

If policymakers are serious about reforming the health sector, nursing can no longer remain an afterthought. Recognizing nurses as the backbone of healthcare delivery is not only crucial for patient safety and clinical effectiveness but also for achieving equity, efficiency, and sustainable growth in Kashmir’s health sector.

Email:-------------------------------- sameersofi013@gmail.com