What would make you shift directions in a career that you really wanted?

For Rajesh, who became a nurse because he's passionate about caretaking, it was the low pay and poor work culture in India.

And now he's preparing to go to Germany and is even learning German.

He isn't alone. Every year, thousands of Indian nurses leave the country to go abroad.

And that's happening at a time when India needs more nurses. Healthcare is expanding and the country is aging.

So why are young nurses like Rajesh leaving, and what can India do to get them to stay?

To learn more and to hear from experts, tune into the latest episode of The Signal Brief.

The Core produces The Signal Brief. Follow us wherever you get your favourite podcasts.

NOTE: A machine transcribed this episode. A human has looked at this text but there might still be errors. Please refer to the audio above, if you need to clarify something. If you want to give us feedback, please write to us at feedback@thecore.in.

TRANSCRIPT:

Kudrat (Host): Rajesh, 25, decided to become a nurse because he felt a pull toward caring for people.

In 2023, he graduated with a BSc in Nursing; after that, he worked at two hospitals in Bengaluru.

But reality shook him hard.

Rajesh: So it's quite different. So we used to have a lot of expectations during college that we are always ready. We are full, full with energy. And of course, if we get a chance to show our energy, to show our creativity, as a young nurse, of course we have more ideas and more learning when we are interested in nursing. But in India, I think that we don't get so much exposure.

So here the job scope is limited. It is... Well, nursing in... It's only the independent profession. But in India, it is, they have not made it independent. They don't allow it. We need to be dependent. So mostly they tell us to follow the orders. And it has been limited, so we don't get to explore much. That's why I'm not very satisfied with the Indian work culture as a nurse, and which is why, which is also a reason I would like to move abroad.

Kudrat (Host): Specifically, Rajesh wants to move to Germany.

To that end, he's even learning German.

The pay in Germany is better, though that’s not the only reason.

Rajesh: The main reason I want to go there is because of the work culture. So they focus highly on work-life balance. People who have gone there as a nurse or as any profession, they are very happy, and they get a lot of time. They get a lot of time to spend with their family, and they get a very good lifestyle.

Kudrat (Host): Rajesh isn't alone. Each year, thousands of Indian nurses go abroad for work.

India is the world’s second-largest source of nurses, after the Philippines.

And that’s happening at a time when India actually needs more nurses.

Our population is ageing. Healthcare is expanding.

So why are young nurses looking for their futures elsewhere?

And is it possible to build a solid career in India?

Kudrat (Host): My name is Kudrat Wadhwa and you’re listening to The Signal Brief.

You’re listening to our Friday episode, where we tell stories about how Indians live, work and spend.

In today’s episode: why nursing could be a smart career bet and what India needs to do to make it one.

Kudrat (Host): Today, many in India consider nursing a backup. People generally aim for an MBBS seat—more money, more status in being a doctor. If that doesn’t work out, nursing is what you take instead.

But Rajesh intentionally picked the course. He wanted to be closer to patients.

Rajesh: Well, when we become doctor also, we will not get to spend that much time with the patient. So we have a lot of patient and we cannot just connect with the patient.

So when we are nurse, we get to spend more time with the patient. So we are like all the time. It's not like we can be with the patient twenty-four hours, but we are there when they need and mostly during medication administration and then also when the patient has some emergency, patient wants to speak something. So we are always there. We are... Like, we spend more time than doctors.

Kudrat (Host): He found that pull towards caretaking when he spent time with his grandmother.

Rajesh: So in my family, my grandma used to be there, and she used to be sick. Mostly she has, it's, respiratory problems, a condition called COPD. And when I was with her, she was like, you know, there are other family members in the family, and it's not always possible to speak with her.

So mostly I used to be at the home and do nothing related to household work. I didn't do much, so I had always much time, and I want to spend with her. So when I used to be with her, she used to be different. She used to be very happy.

So when I'm with the patient, I am, I have a very good feeling. So it started with my grandma, and now when I entered into the hospitals during my training as well. So I just want to be with patient. That's one word, one line answer could it be. So it made me happy to be with the patient and to help them.

Kudrat (Host): After studying Physics, Chemistry and Biology in Grade 11 and 12, Rajesh applied for a four-year nursing course at a reputed college in Bengaluru.

For a BSc, that science background is required.

A diploma is three years, and you don’t need the same subjects. Most hospitals take both though some prefer the degree.

The degree is four years and that’s what Rajesh did.

Kudrat (Host): He told me that he paid a yearly fee of two lakh rupees per year–that was in 2019, when he started the course.

He studied different kinds of nursing: child nursing, paediatric nursing, mental health nursing, medical-surgical nursing. The college had tie-ups with hospitals in Bengaluru, which meant that for each subject, he went to a hospital that treated patients.

Excited, Rajesh entered the workforce in December 2023.

His starting salary as a fresher in a private hospital was about Rs 18,000 a month. In bigger branded chains—places like Apollo, Manipal, Fortis—he told me that freshers can start around Rs 25,000 CTC, and within five years you might get to Rs 30,000 or Rs 35,000.

Government hospitals pay more. State-level jobs can start around Rs 50,000. Places like AIIMS can start at Rs 80,000 and go to a lakh or more. But those jobs are extremely difficult to get.

No matter. Rajesh was still keen on the work.

But, the experience left much to be desired.

Rajesh: So I did not have a very good experience, but of course I learned a lot. And I also met nurses during my work who were very enthusiastic. Mm-hmm ... were creative, but they were not given a chance. They were not allowed to show their creativity. They were not allowed to show their capability. So they were, they were in a limit. They were kept in a limit. I'd say, they were not given much exposure, but they always wanted to be.

Kudrat (Host): He remembers how hospitals expected nurses to follow the orders of doctors and not question them even if they were wrong. What’s more, they made them do administrative tasks like taking food orders from patients’ families.

Rajesh: I experienced in Bangalore myself that they would wanted us to go and take the orders for food orders from the patient and their family. And in-- I mean, in, in the, the, in emergency of course we could do that, but they made it as our job description. It was not mentioned during the job interview, but once we went there, they made it like a daily habit. So they, they did not want to hire another staff for that.

Kudrat (Host): Rajesh’s experience mirrors that of many in India.

Col Binu: In our country, nursing will always continue to be the noblest and most ethical profession, like globally. But the hygiene part is not very well managed, especially in the private world. They're not compensated appropriately. The career pathways are very inadequate. Yeah. They do not find the right positions as they grow, as they gain the experience. Society still has a stigma for nursing. If somebody has to marry and there's a choice between a doctor, an engineer, a nurse, and an advocate, nurse would be the last one of the choices, if I may say. So there is a social stigma. The stature what nursing has in advanced countries outside India, we do not enjoy that stature.

Kudrat (Host): That was Colonel Binu Sharma. She dropped out of her stats degree in 1977, and joined the military as a nurse.

She spent roughly the first half of her career in the armed forces, from 1977 into the early 2000s. After that she moved into corporate healthcare. She was group chief nursing officer at Max Healthcare. Then she headed nursing across 14 hospitals at Columbia Asia.

Today she is CEO of the Infusion Nursing Society of India, a professional body.

She told me that when she started, the people who entered nursing were those who were socially-minded, with a seva-bhava. Today, almost 50 years later, little has changed.

Col Binu: Compensation is less, demands are high, and you've got more responsibility, more accountability, and more demands on yourself. Nurse is supposed to be a superwoman, a superhero.

Kudrat (Host): So, like Rajesh, many choose to go abroad.

Stan is a nurse living in the US. He immigrated there in 2014. He hadn’t studied Nursing in India, he had a BA degree.

But, once he arrived in the States, his uncle advised him to pursue nursing.

At first, Stan says that he felt ashamed telling his friends in India about his career choice.

Stan: Like, my friends in India were like, "Hey, what are you studying?" Like, you went to the US nursing. They're all like, "Nursing?" Like, we're... That's, you know, the picture of it shows up is, is, you know, a lady with that white hat and a white dress, and they're like, "You're one of them? What do you wear?" But in the beginning it's a little bit weird, but later on once you get used to how things work in a different country, and then the money and the stability versus other jobs, nurses are looked up to in the US, you know?

Kudrat (Host): During COVID he was a travel nurse: three-month contracts, living in an RV with his wife.

He now works as a nurse manager near Chicago. His wife teaches nursing. He told me that the work is steady, the pay is decent, and you can even pick up extra shifts through apps designed specifically for that.

Stan: There's so much to do that you-- even if you're bored and tired, you can switch jobs versus other opportunities you have to work from home or you gotta go to an office. But I'm happy. I, I mean, pay-wise, you decide where you wanna work or how much you wanna make. Your hourly, sometimes your salary, so it's as much as you wanna work, you can. In nursing, there's nonstop work. Literally, there are apps available where you can register and you can pick up, like right now, I can look at the clock and say, "You know what? I wanna go work right now." And I can pick up a shift in thirty minutes.

Kudrat (Host): At the same time, Stan too faces some of the similar struggles that Rajesh talked of.

Stan: It's similar because, you know, healthcare, health, health in general is universal, and doctors are trained a certain way. And when a doctor studies all that stuff, I work with a lot of doctors, Indian doctors, every ethnic, you know, background, they're pretty similar.

They have a little bit ego and then sometimes nurses, as much as we are trained and educated on all these topics and we are studying a lot, we may not be right because the doctors think at a different level compared to a nurse. And sometimes do our egos get hurt? Yeah.

Because we are like, "I went to school. I studied anatomy. I know m- pharmacology. I know the medications." And the doctor's like, "I know, but I'm thinking at a different level." So that's gonna be there no matter what. The thing what I learned is, how to approach things. If you're the nurse at the hospital, the, don't argue with the doctor. You can recommend stuff and you can build a confidence, build a rapport with the doctor where he trusts you.

Kudrat (Host): Stan’s experience as a nurse in the US has been great.

But Colonel Binu told me that not everyone who immigrates abroad feels similarly.

Col Binu: When people get a job offer from outside, most of the time they're so excited, they do not do due diligence. Where exactly is the hospital?

What is the level of hospital? Is it a primary health clinic? Is it just a daycare center? Is it in remote area somewhere in the rural village of Europe or somewhere?

So they, they, they end up reaching a place which is not very advanced, which is not highly specialized, a multi or a super specialty hospital, which is a clinic in a suburb or area where they don't have anything to learn, where they do not have advanced technology, where they, they, they have no life. There's no entertainment. They have no life.

They're into forced isolation. So the homesickness, the lack of opportunities to grow professionally. Then they, they realize that, if they get stuck there for a longer time, they, they may not want to come back, et cetera. So they, they take a faster decision. I know people who come back within three months. I know people who came back within a year, less than a year, and they did not go back after that ever.

Kudrat (Host): So if leaving isn’t always the upgrade, what can staying look like?

I spoke to Prof Jasvir Kaur. She started as a clinical instructor–trauma, emergency, ICU–still on the ward, supervising students. Then senior tutor, lecturer, professor. She’s now the principal of a nursing college in Hoshiarpur, Punjab.

She says nurses need not be stuck in the ward. They can move into teaching, administration, research, specialties like paediatrics or oncology.

Still, her advice to young nurses is this:

Prof Jasvir: They should devote their at least five years of beginning. They should devote in the bedside nursing. In this way, they can come to what the-- basically what nursing profession is doing. If we are going to leadership, if we are going to research, if we are going to bedside, if we are going to teaching. Ultimately, we are going to serve the humans. So they should be very much sensitized to those.

Kudrat (Host): Colonel Binu talked of roles outside the hospital–home healthcare, infusion clinics, teaching, research, even nurses running hospitals as CEOs.

And unlike most careers, this particular one may be relatively safe from AI.

Col Binu: Because nursing is a, is a very humane touch job. You need a lot of compassion, you need empathy, you need to reassure the patient, you need to speak to the patient, you need to stand by the patient, holding hand of the patient. Despite AI, coming up to you with data analytics, predictive analysis, so on and so forth, you still need a nurse to analyze the data and take precise decisions. You may see a graph generated from AI.

A nurse, along with that graph, will see actually how is the patient's skin. Is the color shallow? Is the color gray? Is the patient breathing rapidly? Is the patient sweating? Lot many those things require a human intelligence, which will come from a nurse. So AI will complement the nursing profession, and nurses can be most reassured that nursing is a career of the future despite AI, and AI will become a specialized pathway.

Kudrat (Host): But here’s the catch. To actually grow into those roles, you have to keep investing in yourself—a specialty, a certification, a master’s.

Colonel Binu says a lot of young nurses don’t know those pathways exist.

And even when they do, the starting salary is so low that they don’t have the money to pay for the next course.

So maybe the problem isn't that nursing is a bad career in India.

It's that the path from a Rs 18,000-a-month first job to a specialised, well-paid, respected career isn't easy to see, or easy to afford.

And if India wants more nurses, that's the path that it may need to fix.

Rajesh is still learning German. He’s not waiting for that path to get clearer.

Colonel Binu says if India wants people like him to stay, several things have to move at once.

First, pay–especially in the private sector.

Then the job itself. A real say for nurses when care is being decided. A place to sit, eat, rest. Hostels that are liveable. Transport after a late shift.

Then the culture outside the hospital. Parents. Schools. Career counselling.

Col Binu: When career counseling is being done, nursing should be included as a good career, as an attractive career for people to choose. Healthcare burden is increasing. Hospitals are increasing. If you do not have nurses, who will run these hospitals? So that is my one suggestion to the education departments, to the schools, to parents to encourage their children for this, wonderful, noble, and a rising profession in our country.

Outro: That's all for today. You just heard The Signal Brief, your twice-a-week look at the stories shaping how Indians live, work and spend.

The Core produces The Signal Brief. Follow us wherever you get your favourite podcasts.

To check out the rest of our work, go to www.thecore.in.

If you have feedback, we'd love to hear from you. Write to us at feedback@thecore.in or you can write to me personally at kudrat@thecore.in.

Thank you for listening!