Kerala’s nursing workforce is overwhelmingly female, nearly 95 percent, yet the sector still lacks even basic women-centric policies. Beyond the PR praise and fleeting tributes, like the one offered to Lini Puthussery, who lost her life to Nipah in 2018, nurses continue to work in conditions far from dignified or safe.
Published Nov 25, 2025 | 9:00 AM ⚊ Updated Nov 25, 2025 | 9:00 AM
The private hospital association has secured a stay on implementing the 6-6-12 shift system for nurses.
Synopsis: Kerala’s plan to introduce a uniform 6-6-12 shift system in private hospitals has stalled after the Kerala Private Hospitals Association secured an interim stay from the High Court, raising fears among nurses of a return to long and unsafe work hours. Nurses’ unions say the reform is essential for their health, dignity, and safety, especially in a female-dominated workforce that still lacks basic women-focused policies and adequate staffing.
For 34-year-old Anu Sebastian from Kottayam, a nurse at a private hospital in Kochi, October brought a rare sense of relief. After years of battling metabolic issues, anxiety, and the crushing exhaustion of erratic shifts, she finally began to breathe easier.
The reason was simple: sleep. For the first time in years, she was getting enough of it.
That moment of calm followed the Kerala government’s order standardising nurses’ working hours in private hospitals, bringing them on a par with government institutions through a 6-6-12 shift system mandated by the Labour Department. For Anu and thousands like her, it felt like the beginning of a long-awaited correction.
But the relief did not last.
“We have suffered under inhuman shift patterns that wrecked our health, our minds, even our families. We thought one major battle was finally over. Now we are scared all over again. People praise us as angels, but when it comes to treating us as workers, we’re invisible,” Anu told South First.
The fear stems from the private hospital association securing a stay against the reform, a move many nurses see as an attempt to roll back their most basic rights.
According to representatives of UNA, Kerala’s nursing workforce is overwhelmingly female, nearly 95 percent, yet the sector still lacks even basic women-centric policies.
Provisions such as menstrual leave have never been formally discussed, they say.
Beyond the PR praise and fleeting tributes, like the one offered to Lini Puthussery, who lost her life to Nipah in 2018, nurses continue to work in conditions far from dignified or safe.
Nurses also continue to face frequent harassment from doctors, patients, and bystanders, making the work environment even more challenging.
Speaking to South First, UNA treasurer Divya ES said the previous two-shift system created multiple hardships.
“During the earlier shift pattern, even managing something as basic as changing pads during menstruation was difficult. Midnight travel after duty was unsafe. The 6-6-12 system was a long-awaited relief. It allows us to work with more focus and dignity,” she said.
Even with the new schedule, Divya explained that nurses often end up working seven to eight hours because the handover itself takes time.
The system also requires an adequate number of staff, one of the primary reasons private hospital associations are resisting it, she alleged.
Divya also pointed out what she called a contradiction in the hospitals’ stand.
“Hospitals increased service charges and doctors’ fees saying they needed funds to pay nurses. But we didn’t see any increment. We only came to know about the hikes when patients complained. Even basic tests are priced differently in each hospital. Patients are burdened financially in our name, but nurses haven’t had proper salary revisions for years,” she said.
Most private hospital wards, she added, expect two nurses to manage at least 16 patients. The 6-6-12 system has finally given them a chance to punch out by around 7.30 pm, reducing safety concerns.
“We can finally travel home without fear,” Divya said.
The 6-6-12 shift pattern is a duty schedule that splits the 24-hour cycle into two six-hour shifts during the day and a single 12-hour shift at night. In this system, staff members rotate between short day shifts and a longer night shift, ensuring round-the-clock coverage while reducing excessive workloads.
In the last week of October 2025, the Kerala government formally adopted this model for all employees working in private hospitals, including nurses. The Labour Department issued an order directing every private healthcare institution, regardless of bed strength, to follow the same shift structure used in government hospitals.
The directive also ensures that any duty beyond the allotted shift will be treated as overtime, with compensation permitted up to 208 hours a month.
Until now, such regulated shifts applied only to private hospitals with over 100 beds, where workers followed the six-hour day shift and 12-hour night shift pattern. With the latest order, the schedule becomes uniform across all private hospitals in the state.
This decision builds on earlier reforms.
A 2021 order, originally applicable to larger hospitals, has now been extended based on recommendations of the V Veerakumar Committee, constituted in 2012 after a statewide nurses’ strike. The committee, led by former Joint Labour Commissioner V Veerakumar, had proposed a comprehensive restructuring of duty hours and working conditions in the private healthcare sector.
Within days after the government ordered a uniform 6-6-12 shift system for all nurses in Kerala, the Kerala Private Hospitals Association (KPHA) moved the High Court and secured an interim stay on the directive.
Copy of the order
The order, obtained by South First and issued on 13 November, pauses the implementation and enforcement of the government’s shift mandate for a month. The Court observed that while the Veerakumar Committee’s recommendations were confined to nurses, the Labour Department’s October directive extended them to all categories of employees in private hospitals, a move the bench found unsustainable.
The Court also noted the association’s argument that the 6-6-12 shift pattern violates Section 6 of the Kerala Shops and Commercial Establishments Act, which caps daily working hours at eight.
With the stay in place, no coercive action can be taken against private hospitals for non-implementation of the shift system until the case is heard further.
The 6-6-12 shift system, hailed as a major relief for nurses in Kerala after years of agitation led by the United Nurses Association (UNA), has hit a roadblock after the Kerala Private Hospitals Association secured an interim stay from the High Court on 13 November.
Speaking to South First, UNA state general secretary Ajay Viswambharan said the stay came “within days of the government issuing the order,” adding that even the public prosecutor did not defend the government’s position in court.
“UNA has around seven lakh members worldwide and representation in more than 450 private hospitals in Kerala. For 15 years, we have fought for nurses’ rights, from minimum wages to shift reforms. Every gain came through continuous struggle,” Ajay said.
UNA founding member and national president Jasminsha warned that cancelling the 6-6-12 system would have serious consequences.
“Everyone, including the Kerala media, celebrated the implementation of the 6-6-12 shift. But no one reported the stay order. This misleads the public. When we announce a statewide strike, people may think nurses are protesting ‘despite getting so many benefits’,” he told.
He recalled how UNA forced Kerala’s first three-shift system in Thrissur in 2012, replacing the earlier two-shift model where nurses worked 12 to 14 hours at a stretch. “When shifts ended at midnight, most nurses had no transport and stayed back in hospitals, only to be called again for emergencies. Some ended up staying for days without going home,” he said.
He also noted that when Shibu Baby John was Labour Minister, a committee led by V Veerakumar held state-wide consultations and finally recommended the 6-6-12 system for nurses’ safety and wellbeing.
“But private hospital managements have hidden agendas. They approached the court because implementing 6-6-12 means they must hire adequate staff, which they see as a huge expense. They want minimal staff working like machines, while profits keep rising,” Ajay added.
Ajay also pointed out that nurses have long demanded the implementation of the Jagdish Prasad Committee recommendations, including timely revision of minimum wages.
“In 2018, minimum wages were fixed at ₹20,000. The validity is three to five years, but no revision happened. Governments only think about salary revision before elections. All we want is pay equal to government nurses, whose basic pay is around ₹39,000, even though the workload in private hospitals is much higher,” he added.
