(Disclaimer: Some names have been changed to protect privacy; they are fictional)

“We save lives every day, yet struggle to sustain our own. The irony of nursing in India is that those who care for the nation’s health are often unable to afford proper healthcare for themselves.” – An ICU Nurse, Chennai General Hospital

In the soft glow of a flickering lamp, Deepa’s fingers trace over the columns of her budget notebook. It’s nearly midnight, four hours since her 12-hour shift ended at one of Bangalore’s busiest private hospitals. Seven years of nursing experience and a hard-earned critical care certification rest on her shoulders, yet her salary barely stretches to cover rent and basic necessities for her family.

Tonight, Deepa makes the same difficult choice she makes every month: her daughter’s education fund receives the extra five hundred rupees that could have gone toward the advanced cardiac care course that might finally earn her a promotion. As she closes the notebook, the weight of deferred dreams settles in alongside her exhaustion.

“Sometimes I wonder if my patients know that I can’t afford the very medications I administer to them,” she confides, her voice barely above a whisper. “Last month, when my daughter had fever, I had to borrow money from three colleagues to pay for her treatment.”

Deepa is not alone. Across India’s vast healthcare landscape, hundreds of thousands of nurses share similar stories of financial struggle despite performing work that is literally life-saving.

Beyond the White Uniform: The Human Cost of Inequality

At St. Mary’s Hospital in Kerala, Nurse Supervisor Joseph Thomas arrives an hour early for his shift, as he has for fifteen years. At 47, the lines on his face tell a story of dedication-and growing disillusionment.

“When I chose nursing, I knew I wouldn’t become wealthy,” he explains, organizing medication trays with practiced efficiency. “But I never imagined that after specializing in psychiatric nursing and managing a ward of thirty patients, I would still struggle to pay for my son’s college entrance exam fees.”

Joseph represents the experienced backbone/face of India’s nursing workforce now facing extinction as younger nurses increasingly seek opportunities abroad or leave the profession entirely. Recent research by Kurian and Nair (2022) suggests gender dynamics contribute significantly to the undervaluation of nursing, with over 80% of India’s nurses being women.

The reality of nursing in India often contrasts sharply with the public image. During morning rounds, Meera, a third-year nurse at a government hospital in Hyderabad, checks vitals with gentle precision. Her patients see confidence and compassion. What remains invisible is her second job teaching evening classes at a nursing school, the payday loans that keep her afloat between delayed salary payments, and the fact that she hasn’t had a salary increase in four years despite inflation pushing up living costs.

“We’re called ‘sister’ by everyone-doctors, patients, even hospital administrators,” Meera says. “But that respect doesn’t translate to our bank accounts.”

The Numbers Behind the Struggle

The statistics paint a sobering picture of nursing in India today:

Many entry-level nurses in private hospitals earn between ₹8,000-15,000 monthly (approximately $100-$180), which falls below minimum wage requirements in several states, according to nursing union reports and data from the Ministry of Labour and Employment.

A survey conducted by a Professional Nurses Association of India in 2023 revealed that approximately 60% of nurses report taking personal loans to cover essential expenses-from children’s education to medical emergencies.

The wage disparity between doctors and nurses in India averages around 10:1, significantly higher than the 3:1 ratio common in many developed healthcare systems, as documented by comparative studies from the World Health Organization.

Reports from the Indian Nursing Council and independent research indicate that thousands of nurses leave India annually for positions abroad, primarily citing inadequate compensation as their motivation.

During the COVID-19 pandemic, when nurses were celebrated as “frontline s/heroes,” many faced salary delays, contract terminations, and frozen wages even as they worked in hazardous conditions. The psychological impact of this disconnect between public praise and institutional devaluation continues to reverberate through the profession.

When Caregivers Can’t Afford Care

In a small apartment in Mumbai, off-duty nurses Lakshmi and Sunita share more than just living space to save on rent-they share medications. Both have developed hypertension, likely stress-induced from years of overwork, but neither can afford monthly prescriptions on their salaries.

“We split the pills,” Lakshmi explains matter-of-factly. “I take them Monday, Wednesday, Friday, and Sunita takes them the other days. It’s not ideal, but what choice do we have?”

The physical and psychological toll of financial precarity among healthcare workers has far-reaching consequences. Research by Thomas, Patel, and Murthy (2022) found significant correlations between financial stress and symptoms of burnout, compassion fatigue, and depression among Indian nursing professionals.

These personal struggles extend beyond individual nurses to affect patient care. Studies suggest connections between fair nursing compensation and better patient outcomes, including reduced hospital-acquired infections and lower mortality rates. When nurses work double shifts or multiple jobs to make ends meet, fatigue inevitably impacts vigilance and decision-making.

A System at Risk

The consequences of nursing wage inequality threaten to undermine India’s entire healthcare infrastructure. High turnover rates-with some private hospitals seeing 40% of their nursing staff leave annually-create a perpetual experience vacuum. Training costs mount as facilities constantly orient new graduates, many of whom leave within two years, either for overseas positions or other professions entirely.

“We invested three months training a brilliant young nurse in our neonatal intensive care unit,” says Dr. Ramesh, a pediatrician at a private hospital in Pune. “Within six months, she left for Dubai. I can’t blame her-she’ll earn in one month there what would take her a year to earn here. But our babies lose an exceptional caregiver.”

The international migration of Indian nurses represents a significant loss of national investment in healthcare education. Government and private nursing schools provide high-quality training at subsidized rates, yet many graduates quickly leave the country, effectively transferring these educational investments abroad.

Voices for Change

Despite these challenges, movements for change are gaining momentum across India. In Kerala, the United Nurses Association has successfully negotiated minimum wage standards for private hospital nurses. In Maharashtra, nursing unions have secured commitments for regular salary reviews and increment structures.

Shyama, a nursing leader with fifteen years of experience, now dedicates her evenings to organizing her colleagues. “For too long, we’ve been told that nursing is a ‘calling’ that should be done out of service, not for money,” she explains. “But dedication and fair compensation aren’t mutually exclusive. We can be both committed caregivers and professionals who deserve financial security.”

Individual facilities are also recognizing that fair compensation makes business sense. Artemis Hospital in Gurugram implemented a revised nursing salary structure with clear advancement pathways based on experience, education, and specialization. Their nursing turnover rate dropped by 60% in the following year, reducing recruitment and training costs significantly.

The Path Forward

Addressing wage inequality and contractual exploitation requires coordinated action across multiple fronts:

Regulatory Standards and Enforcement: The Indian Nursing Council and state bodies could establish binding minimum wage standards based on qualifications and experience. Labor legislation specifically addressing healthcare worker protections could limit exploitative contractual arrangements.

Public Sector Leadership: Government healthcare institutions must lead by example, implementing transparent pay scales with regular increments and comprehensive benefits packages that influence private sector practices.

Professional Empowerment: Supporting nursing unions and professional associations would strengthen nurses’ collective voice in wage negotiations. Professional certification pathways with clear links to compensation increases could create advancement opportunities that reward continued education.

Changing Perceptions: Media campaigns highlighting nursing expertise could help shift public understanding beyond outdated stereotypes. When communities recognize the technical knowledge and specialized skills nurses employ daily, support for fair compensation naturally follows.

Private Sector Accountability: Transparency requirements, such as mandated disclosure of nursing salary ranges in job postings, would create accountability and allow prospective employees to make informed choices.

A Matter of Justice and Care Quality

For Deepa, Joseph, Meera, and thousands like them, fair compensation represents not just financial security but recognition of their essential contribution to healthcare. It acknowledges that the hands that heal, comfort, and care deserve dignity themselves.

As India continues building toward universal healthcare coverage and improved health outcomes, addressing nursing compensation must become a priority-not as a peripheral workforce issue but as a central component of healthcare quality and sustainability.

In her small apartment, Deepa closes her budget book and sets her alarm. Tomorrow brings another 12-hour shift caring for others. She glances at a photo of her daughter in school uniform-the reason she perseveres despite the challenges.

“I became a nurse to make a difference,” she says, her exhaustion momentarily lifting as determination shines through. “I still believe in that purpose. I just hope that someday, my profession will be valued as much as I value it.”

The path toward more equitable healthcare begins with treating healthcare providers themselves with fairness and dignity. For India’s nurses, that recognition is long overdue.

References

Chandra, A., & Singh, R. (2023). Contractual employment patterns and their impact on healthcare worker wellbeing: A case study of nursing professionals in Indian hospitals. Indian Journal of Labour Economics, 66(2), 312-327.

Indian Nursing Council. (2023). Annual report on nursing workforce statistics. Ministry of Health and Family Welfare, Government of India.

Kurian, S., & Nair, P. (2022). Wage disparities across gender and professional boundaries in Indian healthcare: A comparative analysis of nursing and allied professions. Gender, Work & Organization, 29(4), 1125-1142.

Mathew, V., Kumar, A., & Das, S. (2024). Economic implications of nurse migration: Calculating the return on educational investment loss for the Indian healthcare system. International Journal of Health Economics and Management, 24(1), 45-61.

Ministry of Labour and Employment. (2023). Report on minimum wage implementation across healthcare sectors. Government of India.

Sharma, R., & Gupta, N. (2023). Correlation between nursing compensation structures and patient outcome metrics: Evidence from multi-center studies across six Indian states. Journal of Nursing Management, 31(3), 478-492.

Thomas, B., Patel, V., & Murthy, S. (2022). Psychological impacts of financial precarity among nursing professionals: A mixed-methods study from tertiary care institutions. International Journal of Nursing Studies, 129, 104235.

Trained Nurses Association of India. (2023). Survey report: Financial wellbeing of nursing professionals in India. TNAI Publications.

World Health Organization. (2023). Global health workforce statistics: Comparative analysis of nursing compensation structures. WHO Press.