After completing various courses in Maharashtra, about 25,000-30,000 nurses graduate each year, but the state is reeling under a shortage of nursing staff and forced to rely on Kerala nurses and skilled doctors to combat the Covid-19 war.

State health officials have not provided a response to many nursing ads, though nursing associations have told The Indian Express that hundreds of qualified nurses are waiting for a job in Maharashtra, but have no government intimation. Besides what appears to be a coordination gap between the unions and the government, many nurses are also reluctant to work due to Covid-19's apprehension, the belief that hospitals do not have sufficient personal protective equipment, low wages and lack of job security.

Data from the Maharashtra Nursing Council indicates that the State has 1.25 registered lakh nurses, including BSc, MSc, General Nursing and Midwifery (GNM), and Auxiliary Nursing and Midwifery (ANM). ANM forms the largest chunk of this reservoir. "When the Mahalaxmi Racecourse center was built there was zero reaction to advertising. Our guess is that these nurses are not willing to work in a COVID hospital, or pay is too small, or they want a permanent and not temporary job, "said Maharashtra Nursing Council registrar Rachel George.

The council reviews their list only once every five years. The number of nurses enrolled with it can also include those who have moved or left their nursing careers.

On 22 June, the state government called out for specialist doctors and ICU qualified nurses to Kerala for a second time. In response, the Government of Kerala has asked for the number of medical professionals needed by Maharashtra. A fortnight before the letter from the Maharashtra government, six nursing associations jointly wrote to Iqbal Chahal, chief of Brihanmumbai Municipal Corporation (BMC), saying that "instead of recruiting nurses from Kerala, letters of appointment and recruitment for vacant permanent posts should be given to the 1,800 nurses who have cleared the DMER examination process and are waiting to enter the job as soon as possible."

Swati Rane, from Jan Swasthya Abhiyan, said wages are small and all nursing workers are given the same flat salary despite the disparity in qualifications. "BSc nurses and nurses with GNM diplomas were handled equally and their salaries fixed at Rs 30,000. Nurses account for 60 percent of the healthcare power, but are not included in key pandemic decision-making bodies, "Rane said.

According to the United Nurse Association, which recently tied up three private hospitals based in Pune to provide nurses, there has been no response from a letter to the BMC offering nurses. The group has licensed 1,300 nurses, who are eager to operate. N Ramaswamy, IAS Recruitment Officer at Seven Hills Hospital, said he was in contact with associations but didn't have an encouraging number of potential recruits. The shortage of over one hundred ICU beds is equal to nursing staffing.

"We are thinking of selling some hospital beds to an organization much as we were doing with jumbo facilities," he said. During the onset of the pandemic, the shortage of nurses was first felt in private hospitals and has now spread to public hospitals. 200 Kerala nurses left their work in Mumbai in March and went south. Infection risk, low pay, lack of transportation and living facilities were driving factors.

Suman Tilekar, of the Maharashtra Nurses Federation, said that lack of trust in the health care system has also led to leave. "The number of nursing seats has declined over the years. Contractual employment is on sale to nurses. We want security, and protection at work. We worry we will be forced to leave after a pandemic. The government must enter into a dialogue.

Dr. Santosh Kumar, attached to Doctors Without Borders, who facilitated Kerala nurses' movement to Mumbai after the Maharashtra government first asked the Kerala government for assistance, said the shortage of nurses in Seven Hills and Thane's new 1,000-bedded COVID hospital was severe. "BMC is not paying on time and that's a big Kerala nurses issue," he said. Also, Thane Municipal Corporation is seeking nurses for its hospital.

Nationally, the Indian Nursing Council has launched a live monitoring system for nurses to update records of nurses employed in both public and private hospitals. George from the Maharashtra Nursing Council said there are no data currently available about nurses who are unemployed or who have stopped working.

Meanwhile, the BMC ordered the Dean of Seven Hills Hospital to pay pending salaries by Thursday for four nurses and 40 Kerala doctors. These nurses and doctors had entered a two-month BMC duty in June but 40 doctors chose to return home after a month because of a delay in salary and to join hospitals in Kerala. "There was a pause in paperwork. Everything that's worked out now will be added to their salaries today (Thursday),' Ramaswamy said.