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Nurses and midwives

Context: The year 2020 has been designated as “International Year of the Nurse and the Midwife”. It is well acknowledged that nurses and midwives will be central to achieving universal health coverage in India.

Do You Know?

India’s nursing workforce is about two-thirds of its health workforce.

The ratio of 1.7 nurses per 1,000 population is 43% less than WHO norm; it needs 2.4 million nurses to meet the norm.

Issues

Heavy Dependence on Private Players: 91% of the nursing education institutions are private and weakly regulated.

Inadequate Faculty: The faculty positions vacant in nursing college and schools are around 86% and 80%, respectively.

Structural Issues with Training: There is a lack of job differentiation between diploma, graduate, and postgraduate nurses regarding their pay, parity, and promotion

Quality of Training:The current nursing education is outdated and fails to cater to the practice needs. The quality of training of nurses is also diminished by the uneven and weak regulation.

Lack of Specialty Courses: There are insufficient postgraduate courses to develop skills in specialties, and address critical faculty shortages both in terms of quality and quantity.

Regional Imbalance: Inequities in distribution of nursing education institutions. Around 62% of them are situated in southern India.

Lack of Comprehensive Policy Focus: 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.

Non-standardised practices: Nurses in India have no guidelines on the scope of their practice and have no prescribed standards of care. Mismatch of the role description and remuneration that befits the role sets the stage for the exploitation of nurses.

Accountability Issues: Nurses are out of the purview of the Consumer Protection Act. This is contrary to the practices in developed countries where nurses are legally liable for errors in their work.

Social Status: The disabling environment prevalent in the system has led to the low status of nurses in the hierarchy of health-care professionals. In fact, nursing has lost the appeal as a career option.

Way Ahead

Improvement on Quality: A common entrance exam, a national licence exit exam for entry into practice. Transparent accreditation, benchmarking, and ranking of nursing institutions too would improve the quality.

Database to know supply-demand:A live registry of nurses, positions, and opportunities should be a top priority to tackle the demand-supply gap in this sector.

Regular Monitoring: Periodic renewal of licence linked with continuing nursing education would significantly streamline and strengthen nursing education.

Legislative Amendments: 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.

Federal Cooperation: The jurisdictions of the Indian Nursing Council and the State nursing councils must be explained and coordinated so that they are in synergy.

Promoting Nursing as Career: Incentives to pursue advanced degrees to match their qualification, clear career paths, opportunity for leadership roles, and improvements in the status of nursing as a profession.

Public-private partnership between private nursing schools/colleges and public health facilities is another strategy to enhance nursing education.

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HEALTH / SOCIETY/ GOVERNANCE

Nurses and midwives

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