These are the areas where paucity of staff can adversely affect the observation and monitoring of patients, delay the treatment and directly affect the chances of recovery.
However, it is not uncommon to see one resident and one nurse made to manage 5 to 6 or even more ICU patients, including one or two on ventilator. Patients may be lucky if nothing happens. But, if one or two develop complications requiring intensive monitoring and vigorous resuscitation, which may often happen, they may not be in luck any more.
Critically sick patients, especially the babies deteriorate very fast-in minutes, and if the doctor and nurse being busy with another patient are not available in those few minutes, the consequences cannot be anything but disastrous. Similarly, shortage of staff in diagnostic services is bound to delay the investigations and treatment as a consequence. Although sophisticated/high accuracy equipment is available, human errors caused by an overworked technician can lead to false reporting. Non availability of housekeeping staff has many a time, lead to fall of bed ridden patients from bed while trying to get up on their own to go to toilet or passing of urine or stool in bed. They or the nurses take care of the personal hygiene needs of the patients by sponging, mouth wash, and change of clothes.
All these activities may get affected, if there is shortage of staff. Non availability of adequate strength of security staff may lead to uncontrolled public traffic, infections and noise pollution in the wards. This may be the single most important cause of thefts, assaults, rape, molestation or theft of babies in the hospital. In view of the above, norms have been laid down by various authorities like McGibony, Todd Wheeler, for authorization of manpower of various categories in various departments of hospital. Bureau of Indian standards have also published staffing norms for hospitals of some categories. However, these are not legally binding in entirety in all the hospitals.
Rules for registration of hospitals/nursing homes available in some states such as Delhi have specified the minimum manpower requirements in some categories of staff. Many hospitals are not following any fixed set of norms. Their own estimate of requirement tempered by the financial constraints is generally the guiding principles. As a result, a large percentage of hospitals are lacking in manpower in the critical care areas where chances of survival may depend largely on this vital resource.
“Deficiency of doctors, nurses amounts to deficiency in service” as stated by the Delhi State Consumer Disputes Redressal Commission, in Wing Cdr K K Chaudhry Vs Govt, of India “If any harm visits a patient because of deficiency of doctors, nurses, the hospital is liable to compensate the same to the aggrieved patient’s relative.”
Resident doctors play a crucial role in the patient care. They are employed on contractual basis for six to twelve months, subject to extension and are required to work in shifts. Depending upon the hospital, they may be required to do six 8 hourly shifts, four 12 hourly shifts or two 24 hour shifts in a week.
Doctors attending to the patients, especially in the intensive/acute care wards are required to work with full alertness and concentration to provide the patients their best chance of recovery and survival. A shift longer than eight busy hours is likely to compromise their energy, alertness and concentration and is, therefore, not desirable. A 12 hour shift may be workable if the work load is light such as during night shift. A continuous duty of more than 12 hours should not be allowed. Though the residents are not, as a rule, allowed to work in more than one hospital at a time, it has been seen that many of them take up jobs at other hospitals also on the quite, to make some extra bucks. Doing double shifts daily, it is doubtful whether they will be doing justice to their job at either place.
The hospitals should never allow residents to violate the rules or the conditions of employment contract and should keep a watch over their performance.