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Nursing in India: Education, employment and migration

A Nurse Practitioner (NP) is a registered nurse with advanced academic and clinical experience, which enables him or her to diagnose and manage the most common illnesses, including chronic ones, either independently or as part of a health care team. NPs largely focus on health maintenance, disease prevention, counselling and patient education in a wide variety of settings.

Role of nurse practitioners:

  1. Counsel and educate patients and families
  2. Conduct physical examinations and obtain medical histories
  3. Prescribe drugs for acute and chronic illnesses
  4. Order, perform and interpret lab tests, x-rays, ECGs and other diagnostic studies
  5. Diagnose, treat and manage acute illnesses
  6. Diagnose, treat and manage chronic illnesses
  7. Provide preventive care, including screening and immunizations
  8. Provide care coordination
  9. Make referrals
  10. Perform simple procedures

As per Indian Nursing Council (INC) records, there are around 8,85,383 Auxiliary Nurse Midwives (ANM), 21,29,820 Registered Nurses and Registered Midwives (RN&RM) and 56,644 Lady Health Visitors (LHV) in the Country. The Nurse patient ratio in the Country at present is 1.7 nurses per 1000 population which is less than the WHO recommendation of 2.5 nurses per 1,000 population. However, the nurse-patient ratio varies from State to State, District to District and Institution to Institution. The problem is more of skewed distribution, with a dense concentration of workforce in some areas and lesser concentration in other areas. 

Some of the measures taken by the government to improve the situation for better healthcare services in the country are: 

  1. There are around 8500 Nursing Institutions in the country producing about 3 lakh nursing personnel annually
  2. In order to increase the number of nursing seats:-
  • The requirement of land to construct buildings for School/College of Nursing and Hostel has been relaxed 
  • The requirement of a 100 bedded parent hospital has been relaxed for hilly and tribal areas
  • The student-teacher ratio for M.Sc.(N) programme has been relaxed from 1:5 to 1:10
  • Student patient ratio for Nursing Institutions has been relaxed from 1:5 to 1:3
  • Admission for Nursing has been allowed for married candidates.
  • A maximum number of 100 seats for Nursing College will be given to those having parent hospitals with 300 beds without insisting on a Medical College.
  • Distance from school to hospital has been relaxed from 15 km to 30 Km. However, for hilly and tribal areas the maximum distance is 50 Km
  • Eligibility Criteria to admission i.e. (Marks) for Diploma and Degree has been relaxed by 5% 
  • Relaxation for opening M.Sc. (N) programme. Super speciality Hospital can start M.Sc. (N) without having an undergraduate programme 

3. The Nurse Practitioner in Critical Care Nursing (NPCC) has been developed which prepares registered B.Sc. Nurses for advanced practice roles as clinical experts, managers, educators and consultants leading to an M.Sc. degree in Nursing

Nursing education

There is a range of nurse categories in India. Entry-level eligibility for nursing education is a pass in the Senior Secondary School Leaving Certificate Examination or equivalent 12-year schooling, preferably with physics, chemistry, and biology as chosen subjects, and a minimum age of 17 years. Postsecondary programs include both a 4-year Bachelor of Science in Nursing degree (B.Sc.(N)) and a 3-year General Nursing and Midwifery (GNM) diploma, the latter being the minimum requirement for an entry-level job of a staff nurse. Auxiliary Nurse Midwife (ANM), and Health Visitor (HV) and Health Supervisor (HS) are assisting nurses at a lower level of expertise.

Amongst higher-level courses in nursing that have been started in the country in more recent times are Master of Philosophy (M.Phil.) in Nursing—1 year for full time and 2 years duration for part-time; a Diploma course in Nursing Education and Administration—of 10-month duration; PhD in Nursing; Clinical Specialization in Master of Nursing; Clinical Specialization in Community Health Nursing, etc.

The National Health Policy recognises the need to improve regulation and quality management of nursing education. Other measures suggested are – establishing cadres like Nurse Practitioners and Public Health Nurses to increase their availability in most needed areas. Developing specialized nursing training courses and curriculum (critical care, cardiothoracic vascular care, neurological care, trauma care, palliative care and care of terminally ill), establishing a nursing school in every large district or cluster of districts of about 20 to 30 lakh population and establishing Centers of Excellence for Nursing and Allied Health Sciences in each State. States which have adequate nursing institutions have the flexibility to explore a gradual shift to three-year nurses even at the sub-centre level to support the implementation of the comprehensive primary health care agenda.

Employment and migration

Each state or a group of states has its own organization for the registration of nurses called the State Nursing Council. After the successful completion of training, a nurse must register her name with the state’s Nursing Council to be eligible for employment as a registered nurse. Data says that India does not have enough professional nurses to meet its own domestic health services needs. At the same time, the practice of international recruitment of Indian nurses in the model of a “business process outsourcing” of comprehensive training-cum-recruitment-cum-placement for popular destinations like the United Kingdom and the United States through an agency system has acquired growing intensity in India. Indian hospitals have engaged in “business process outsourcing” (BPO) to take advantage of this phenomenon. They recruit and train Indian nurses and prepare them to take the foreign nurse examinations. This has further widened the gap between domestic demand and supply. 

Conclusion

India is facing a serious risk of selective depletion of the most qualified nurses in the country. It is critically important that the data on nurse production, employment, retention, and migration be tracked and analyzed. Most of the time migration takes place because qualified nurses are not able to find the appropriate job they are looking for. There are some online networking and job search platforms for medical professionals like doctors and nurses which help them explore the available opportunities and act as a bridge between them and hospitals or telemedicine platforms. For example, Bengaluru-based MedPiper Technologies, Inc matches verified Doctors and nurses with hospitals and telemedicine platforms. The platform helps pre-verified and peer-authenticated professionals and practitioners track job alerts, industry updates, research trends among others. The platform uses blockchain technology to enable the verification of profile credentials by peers, educators and employers, and match those verified profiles to job requirements.

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