Job choices of nurses trained in private and government

institutions in Tamil Nadu, India.

Elsa Mary, Sathish Kumar, V R Muraleedharan and Umakant Dash. Dept. of Humanities and Social Sciences, Indian Institute of Technology (Madras). India.

http://resyst.lshtm.ac.uk@RESYSTresearch

Introduction• Nursing personnel form a vital component of a country’s

health system.

• In the past decade, the number of nursing training institutions (with BSc degree in nursing) have increased in Tamil Nadu:

• TN; Production of Nurses on the increase (in private institutions in particular); But in terms of “absorption” (employment) in public and private delivery system, there is an acute shortage. Leading to migration (within and outside India). Shortage about 40 -50Koverall in TN (2012).

2006 2011 2012 2015Private 40 135 151 169Public 2 4 4 4

ObjectivesKnowledge gaps What are the Implications of expansion of private training

institutions? Are the public/private nursing students likely to have

distinct job preferences?

Research objectives Compare and contrast the characteristics of privately and

publicly trained nursing students Compare and contrast their work intentions Analyze the factors associated with these work intentions

Study design

Public Private MissionNumber of institutions

N= 4 N= 145 N= 16

Number of institutions surveyed

N=2 N= 12 N= 3

Number of students surveyed

N= 93 N= 527 N= 138

• Stratified random survey of nursing training institutions in Tamil Nadu

• All final year (BSc) nursing students interviewed

Data

• Self-administered questionnaire:• Main socio-demographic characteristics• Job intentions

• Total sample: N=758 final year nursing students

• Data entry in Epi data ; analysis in SPSS

Socio-demographic characteristics of nursing

students.Gender Social background

Public

Mission

Private

0% 20%

40%

60%

80%

100%

74%

77%

55%

1%

9%

28%

Sc/St Lower casteUpper caste

Public

Mission

Private

0% 50% 100%

90%

97%

95%

Male Female

Socio-demographic characteristics of nursing

students - Continued

48%

33%18%

Public

56%38%

6%Mission

village small towncity

38%

41%

21%

Private

Job intentions of privately and publicly trained nurses

Intentions to work in the public

sectorIntentions to work

in Tamil Nadu

Tamil nadu Rest of India020406080

100120

96.4%

3.6%

72%

28%

78.2%

21.8%

Public Mission Private

work in public

work in private

work in mission

0

20

40

60

80

100

63.6%32.7%

63.6%

24.2%12.1%

63.4% 35.4%

public mission private

Factors associated with intentions to work in the public sector

  OR 95%CI P-valueType of InstitutionPublic 1    Private 1.38 0.80 – 2.38 0.23Mission 1.84 0.45 – 1.55 0.58SexMale 1    Female 0.97 0.45 – 2.08 0.95Social ClassUpper caste 1    Lower caste 2.76 1.50 - 5.07 <0.01Sc/St 2.52 1.43- 3.54 <0.01Language in high SchoolEnglish 1    Mother tongue 1.92 1.30-2.8 <0.01Can earn more in private sectorAgree 1    Disagree 1.78 1.24- 2.56 <0.01

Factors associated with intentions to work in Tamil Nadu

  OR 95%CI P-valueType of InstitutionPublic 1    Private 0.94 0.56 -1.55 0.8Mission 0.77 0.43 -1.37 0.38SexMale 1    Female 4.38 1.99-9.65 <0.01Social ClassUpper caste 1    Lower caste 2.63 1.48 -4.67 <0.01Sc/St 2.38 1.51 -3.76 <0.01Language in high SchoolEnglish 1    Mother tongue 1.68 1.15 - 2.46 <0.01Rank first while considering a jobGood salary 1    Secure Job 1.24 0.84-1.83 0.26Help others 1.66 1.10- 2.48 0.01

Discussion• Irrespective of the type of training institution,

nursing students would like to take up a public sector job and socially backward students (lower castes/SC-STs) job security: culturally strong preference to

Government Jobs.

• Female Nurses show less preference to migrate outside TN state; (reasons: family concerns); Male nurses and those with preference for higher salary, prefer to migrate outside TN and country.

DiscussionsPolicy Implications:

Given 1. High preference for Govt jobs; 2. Low absorption of nurses (despite acute shortage), and 3. High migration outside the country, the policy question is: Should Government allow further expansion of private nursing Institutions in TN?

Future research: Actual job choices and associated factors, to be carried out with follow up of cohort (under progress); This might throw light on the actual career options for nurses available for addressing the above policy question.

Thank you