A Sector That Needs to be Nursed Back to Health

Context: While 2020 is being celebrated as “International Year of the Nurse and the Midwife”, nursing education in India suffers poor quality of training, inequitable distribution, and non-standardised practices.

Challenges in the Nursing Education Sector:

• Numerical deficiencies: India’s nursing workforce is about two-thirds of its health workforce.
  • India’s ratio of 1.7 nurses per 1,000 population is 43% less than the World Health Organisation norm; Need 2.4 million nurses to meet the norm.
  • The faculty positions vacant in nursing college (86%) and schools (80%).
  • Structural challenges:
  • Regional disparity: Around 62% of nursing education institutions are situated in southern India.
  • Lack of job differentiation: Between diploma, graduate, and postgraduate nurses regarding their pay, parity, and promotion, leading to low demand and underutilisation.
  • Migration of talent and qualified nurses: to other countries in search of better prospects.
  • Informalisation of nursing work: Small private hospitals offer courses of three to six months for non-clinical ancillary nursing roles and are paying very little.
  • Regulatory deficiencies: 91% of the nursing education institutions are private and weakly regulated.
    • The Indian Nursing Act: Primarily revolves around nursing education and does not provide any policy guidance about the roles and responsibilities of nurses.
    • The Consumer Protection Act: Holds only the doctor and the hospital liable for medico-legal issues; nurses are out of the purview of the Act (unlike in developed countries).
    • The Indian Nursing Council: The induction requirements vary widely, and so does the functioning of regulatory bodies in the States.
• Skill gap:
  • Education and re-training are not linked to the roles and their career progression.
  • Multiple entry points to the nursing courses and lack of integration of the diploma and degree courses diminish the quality of training.

Way forward:

• A common entrance exam: with a national licence exit exam for entry into practice, and periodic renewal of licence linked with continuing nursing education.
• Transparent accreditation: benchmarking, and ranking of nursing institutions too would improve the quality.
• Amend The Indian Nursing Council Act of 1947: to explicitly state clear norms for service and patient care, fix the nurse to patient ratio, staffing norms and salaries.
• Containing the skill exodus :
  • Providing incentives: to pursue advanced degrees to match their qualification career paths, opportunity for leadership roles, and improvements in the status of nursing as a profession.
  • Tracking and tackling the demand-supply gap: in the sector by creating a live registry of nurses, positions, and opportunities.
• Public-private partnership: between private nursing schools/colleges and public health facilities.
  • 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.

Conclusion: The National Nursing and Midwifery Commission Bill currently under consideration should be passed at earliest along with other recommended measures to address the deficiencies in nursing education.