Context: Nursing education in India suffers poor quality of training, inequitable distribution, and non-standardised practices.
- The year 2020 has been designated as “International Year of the Nurse and the Midwife”.
- Nurses and midwives will be central to achieving universal health coverage in India.
What are the structural challenges affecting nursing sector in India?
- Low number of nurses: India’s nursing workforce is about two-thirds of its health workforce. Its ratio of 1.7 nurses per 1,000 population is 43% less than the World Health Organisation norm. it needs 2.4 million nurses to meet the norm.
- Inequal Distribution: Though the number of nursing education institutions has been increasing steadily, there are vast inequities in their distribution. Around 62% of them are situated in southern India.
- Vacancies: The faculty positions vacant in nursing college and schools are around 86% and 80%, respectively.
- Higher qualifications of postgraduate nurses are not recognised: There is a lack of job differentiation between diploma, graduate, and postgraduate nurses regarding their pay, parity, and promotion. Consequently, higher qualifications of postgraduate nurses are underutilised, leading to low demand for postgraduate courses.
- Outdated and fails to cater to the practice needs: The education, including re-training, is not linked to the roles and their career progression in the nursing practice. There are insufficient postgraduate courses to develop skills in specialties, and address critical faculty shortages both in terms of quality and quantity.
- Lack quality training: Multiple entry points to the nursing courses and lack of integration of the diploma and degree courses diminish the quality of training.
- Largely unregulated: The Indian Nursing Act primarily revolves around nursing education and does not provide any policy guidance about the roles and responsibilities of nurses in various cadres. Nurses in India have no guidelines on the scope of their practice and have no prescribed standards of care.
- Lack of accountability for nurses: The Consumer Protection Act which protects the rights and safety of patients as consumers, holds only the doctor and the hospital liable for medico-legal issues; nurses are out of the purview of the Act. This is contrary to the practices in developed countries where nurses are legally liable for errors in their work
What is the way forward?
- A common entrance exam, a national license exit exam for entry into practice, and periodic renewal of license linked with continuing nursing education would significantly streamline and strengthen nursing education.
- Transparent accreditation, benchmarking, and ranking of nursing institutions too would improve the quality.
- The Indian Nursing Council Act of 1947 must be amended to explicitly state clear norms for service and patient care, fix the nurse to patient ratio, staffing norms, and salaries.
- The exodus of qualified nurses must be contained by Incentivising to pursue advanced degrees to match their qualifications, clear career paths, the opportunity for leadership roles, and improvements in the status of nursing as a profession.
- A live registry of nurses, positions, and opportunities should be a top priority to tackle the demand-supply gap in this sector.
- The National Institution for Transforming India (NITI) Aayog has recently formulated a framework for public-private partnership in medical education that could be referred to develop a model agreement for nursing education.
The disabling environment prevalent in the system has led to the low status of nurses in the hierarchy of health-care professionals. The National Nursing and Midwifery Commission Bill currently under consideration should hopefully address some of the issues highlighted.