Nursing is also a “profession” like doctors, engineers, or IT. Its origins as a distinct and secular profession can be traced to a school founded by legendary nurse, Florence Nightingale in England in 1860. This position as a profession was further cemented by “Nightingale Pledge,” (quite like Hippocratic Oath for physicians) developed in 1893. Further, the code of conduct for nursing professionals was also not unlike the physicians, i.e. of not only promoting health and preventing illness but in addition also caring for the patient who is experiencing varying degree of physical, psychological even spiritual suffering. Interestingly, before 1960, the focus of the nursing code was on nurses’ obedience to physicians, but since then till date, patient care has remained the corner stone of their activity. Thus, wholeness of character, which involves integrity, knowing the value of nursing profession and one’s own moral values, is central to the value system of this profession. Currently health care system is plagued with numerous constraints, politics, vested corporations, and even self-serving individuals/groups. Often nursing professional is pressurized to do something that conflicts their professional values, such as to deceive patients, falsify records, or simply face and/or accept verbal abuse from physicians, administrators, even patients. However, in light of these pressures, maintaining integrity and do what is right and ethical is the crux of modern nursing code.1

2. The occupational status of nursing professionals

At first, the nursing profession was forced into ancillary activity of physicians, as an appendage of physician’s work, directed towards administration of “broom and poultice” and characterized by passive sub-ordinance to physician in charge of the case. In Western society, in pre-modern age, the care of sick or infirm when not entrusted to servants was the duty of nuns, “Sisters”, and subsequently nursing professional (Sister!) took over this secular role. Over a course of time, the role of a nursing professional has evolved from a sub-ordinate to an independent stakeholder in health care delivery. The journey has taken them from the role of a drug dispenser to trained professional in cath lab, but at the same time, they still specialize in TLC (tender loving care). However, old mindsets still persist and there is certainly poor public perception of nursing profession, and as such, they are grossly undervalued as a professional. Further, even within the confines of health care system, they become easy targets for the location of guilt and blame for poor practice by a failing and dysfunctional system. Further, hard physical and emotional work environment coupled with inadequate financial rewards now makes the nursing profession as one of the most unattractive of all professions.2 As a result, few motivated and caring individuals are attracted into this profession. Consequently, the health care system, whether be it government or particularly private, is faced by a serious crunch of nursing professionals, and nursing has become one profession where there is a “steady hemorrhage of experienced nurses” from all health care facilities. Not only India but also countries around the world are facing critical nursing shortages, and globally, communities are challenged with growing health care needs but diminishing numbers of nursing professionals. It is projected that by the year 2020 the shortage of nursing professionals will be a staggering 20 percent below requirements.3

3. Threats and challenges to nursing profession

Currently, the nursing profession is faced with several challenges including low prestige, poor public perception, financial issues, heavy workload, stressful conditions, and lack of professional gratification coupled with shortage of nursing personnel and poor quality of training and education.

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  Obstacles to improving prestige of nursing profession. The most obvious factors responsible for this sorry state of affairs range from rigid hospital traditions and shackles of privilege and prestige, which even a balanced physician, administrator, or lay public can succumb to. In a hierarchical system of power within the practice environment, currently, the position of nursing professional is intermediate. Although they truly belong to the intellectual class, but being insecure of status and at risk of being pushed to the working class status, they are forced to display an excessively professional attitude, devoid of any emotional content, which paradoxically stunts both their professional and emotional growth. Thus, nursing remains a profession where extreme discipline remains almost like a religious order and its practitioners “starch the façade of their professionalism even more than they starch their uniform.”