NEWS  The year 2020 has been designated as “International Year of the Nurse and the Midwife”.

PRESENT STATUS OF INDIA’S NURSING SYSTEM

• Nurses and midwives are central to achieving universal health coverage in India. 
• 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 i.e. it needs 2.4 million nurses to meet the norm. 

CHALLENGES TO NURSING SYSTEM

The sector is dogged by structural challenges that lead to poor quality of training, inequitable distribution, and non-standardised practices.

Uneven regulation- 

• The Indian Nursing Council regulates nursing education through prescription, inspection, examination, and certification. However, the induction requirements  and the functioning of regulatory bodies vary widely in the States.
• 91% of the nursing education institutions are private and weakly regulated. 
• Hence, the quality of training of nurses is diminished by the uneven and weak regulation.

Outdated Education- 

• The current nursing education is outdated and fails to cater to the practice needs.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.
• Thus, these factors have led to gaps in skills and competencies.

Faulty admission process- 

• Multiple entry points to the nursing courses and lack of integration of the diploma and degree courses diminish the quality of training. 
• Inequities in 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.
• Further, the faculty positions vacant in nursing college and schools are around 86% and 80%, respectively.

Gaps in education, services– 

• Most nurses working in the public and private health sector are diploma holders due to lack of job differentiation between diploma, graduate, and postgraduate nurses regarding their pay, parity, and promotion. 
• As a result, higher qualifications of postgraduate nurses are underutilised, leading to low demand for postgraduate courses. 
• Further, those with advanced degrees seek employment in education institutions or migrate abroad where their qualifications are recognised. This has led to an acute dearth of qualified nurses in the country.
• Compounding the problem, small private institutions with less than 50 beds recruit candidates without formal nursing education, instead they are offered courses of three to six months for non-clinical ancillary nursing roles and are paid very little.

Weak Regulation- 

• 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. Thus, endangering patient safety.
• 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, while 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.

WAY FORWARD

• A common entrance exam, a national licence exit exam for entry into practice, and periodic renewal of licence 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 governance of nursing education and practice must be clarified and made current. 
• 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 jurisdictions of the Indian Nursing Council and the State nursing councils must be explained and coordinated so that they are synergistic.
• Incentives to pursue advanced degrees to match their qualification will help in improving the status of nursing as a profession.
• A live registry of nurses, positions, and opportunities should be maintained to tackle the demand-supply gap in this sector.
• Public-private partnership between private nursing schools/colleges and public health facilities is another strategy to enhance nursing education.

GOVERNMENT INITIATIVES

• 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 Government has also announced supporting such projects through a Viability Gap Funding mechanism.

WHAT ELSE IS BEING DONE?

The National Nursing and Midwifery Commission Bill, 2020 is currently under consideration and will hopefully address some of the issues highlighted in the nursing system.

Reference:

1. https://www.thehindu.com/opinion/lead/a-sector-that-needs-to-be-nursed-back-to-health/article33322153.ece