• There are 1,800 nursing vacancies in public health centres across Tamil Nadu; but in the last two years the state government has been unable to fill them up because of a shortage of qualified nurses.
• There are 118,000 nursing vacancies across United States hospitals, and the deficit could reach as high as 800,000 in the next decade.

The irony is that Tamil Nadu is running short of nurses because nursing graduates from the state -- and from across India -- are bound for greener pastures in the US.

In the last few years, nursing has become the easiest route to the US Green Card as American hospitals are frantically scouting for nurses from developing countries, especially India and the Philippines.

Every year, India produces more than 30,000 nursing graduates. Nursing school authorities say almost all of these nursing graduates are also training to take the CGFNS (Commission of Graduates of Foreign Nursing Schools), TOEFL (Test of English as Foreign Language), TWE (Test of Written English) and TSE (Test of Spoken English) examinations.

To be considered for nursing assignments, Indian nurses have to take the above mentioned four tests, and must have valid nursing licences from recognised institutes.

In the last one year, scores of American hospitals have put in requests with manpower consulting agencies and nursing schools across India for recruiting nurses.

A number of nursing colleges in India are also tying up with hospital groups in America for supplying nurses.

As a result, the quality of health services across Indian hospitals is suffering because of shortage of nurses.

"Every nursing graduate wants to go abroad. They do not want to serve the country. The rush of Indian nurses to countries like the US is putting our healthcare system in malady," says Annamma Mathew, a nursing superintendent who earlier worked with St John's Medical College, Bangalore.

Mathew, who now works in a private hospital in Coimbatore, says Tamil Nadu is one of the worst hit by the shortage of nurses.

"Last year the Tamil Nadu government advertised for some 1,500 nurses in the primary health centres. But the Health Department did not get enough applications," says Mathew.

"Indian nurses want to go abroad, especially to Europe, the Gulf and the US because the pay packets there are very good compared to the pitiable salaries that Indian hospitals offer to nurses," Mathew adds.

A nurse in an Indian hospital earns a starting salary of less than $2,000 a year. In the US, that figure is at least $36,000.

Vineeta Ramachandran, director of Kochi-based nursing recruitment agency Nurses Abroad, says the sad state of Indian hospitals and poor pay are the main reasons for the exodus of Indian nurses abroad.

"Added to this, the new Immigration Bill in the US would open throw open the gates to Indian nurses. I am getting 15 applications every day from nurses who want to go abroad," Ramachandran says.

Last month, Kansas Republican Senator Sam Brownback sponsored a proposal in the US Senate that aims to remove the limit on the numbers of nurses who can immigrate to America.

Moving the new provision in the Immigration Bill, Brownback said it was needed to help America cope with a growing nursing shortage.

Health experts in India say the new, relaxed US immigration provisions for nurses would have an impact on countries like India and the Philippines, which are already sending thousands of nurses to America every year.

Says Dr Paul Abraham, who heads a Bangalore-based non-governmental healthcare organisation called Centre for Health and Social Action: "The exodus of nurses from countries like India to the US will surely strain the health systems (in those countries)."

"In India, already many hospitals are reeling under severe shortage of nurses. Now I think every Indian nurse would try to go to the US if the new immigration rule comes into force," Dr Abraham says.

He says international standards prescribe the nurse-patient ratio per shift to be 1:5 in a general ward and 1:1 in the intensive care unit. "But in India, the nurse-patient ratio is pitiable. For instance, the J J Hospital in Mumbai has a 1:70 nurse-patient ratio. That is, one nurse is forced to take care of an average of 70 patients who visit the hospital daily," he says.

What is the way out?

"(There are) no short cuts," says Dr Abraham. "The government has to sanction more nursing colleges. And a condition has to be laid down that a nurse should work compulsorily five years in India before she goes abroad," he says.

Agrees Madhu Devan, member, Trained Nurses Association of India: "The pay scales of nurses in India also have to go up. The government should also increase the number of nursing institutes across the country."

Some states are waking up to the crisis. Kerala [Images] -- that has produced more nurses than any other state in India -- now has 85 nursing schools. In 1991, it had only 45. The Maharashtra Nursing Council has granted official recognition to 70 more nursing colleges in the last two years.

More and more young men are also opting for a nursing career because of the bright job prospects abroad.

Suju Mathew, son of a Kerala school teacher, opted for nursing studies. "I have joined for the three year nursing degree course in a Mangalore college. In my class, there are 10 boys and 30 girls," he says.

Does Suju like to work as a nurse? "Yes, but not in India," says the 19 year old. "I want to go to America. And nursing is the only solution."