Anita A Deodhar, President, TNAI, gives an overview on the future of nursing in India and recommends several measures to improve the current scenario in nursing
In ancient India, the medical care was provided only by doctors and physicians. Though Sushruta, the father of medicine had mentioned about nursing while describing few essential qualities of nurses, there has been no mention about female nurses in India till the Mughal period. Nursing in India started and developed only after invasion by the British. The first nursing training school was sanctioned by the British government during 1854 in Madras in the lying-in hospitals. Initially, a two-years’ course for nurses training was started at St Mary’s hospital at Tantaran in Punjab. The recommendations of Bhor Committee (1943-46) acted as the foundation for development of nursing services in India. In post-independence period, various committees were formed to study the position/ situation of nursing profession in the country. Various changes were brought from time to time in education and service system as well as in the rules and regulations.
Trained Nurses of India (TNAI) was formed in the year 1908 and the Indian Nursing Council (INC) was established in the year 1947, which thereafter upgraded the basic educational qualification requirement for candidates desiring to undergo nursing education. In the past, nursing profession was considered to be an occupation for Hindu widows and/or deserted women as a self-supporting measure. Women from the Christian community undertaking the nursing profession were more in number than the women from other communities, since, as a profession, nursing did not have a proper status in the eyes of society.
After establishment of the INC, most of the states in India established their State Nursing Councils (SNC). The SNCs were responsible for maintaining the standard and uniformity in nursing education. Main function of SNCs was to conduct examinations and the registration of qualified nurses to permit them to practice. Those days courses in Auxiliary Nurse Midwife (ANM), (one year and six months) and General Nursing and Midwifery (GNM) (three years and six months) were mainly conducted. BSc and MSc Nursing courses were introduced subsequently and very few colleges were conducting these programmes. Now many universities are even facilitating M Phil and Ph.D programmes successfully and the achievers of these qualifications are holding the highest positions in nursing all over India. Periodic revision of all these programmes is
being done from time to time, to improve the educational standard.
It was noticed that there is great disparity between the available and required number of nurses as per the population and the set INC norms in the nurse/ patient ratio. Shortage of nursing personnel, between 1980-1990s, might have been due to migration of trained nurses to overseas countries, especially in the Gulf countries for higher salary and perks. Nursing profession, being entirely job-oriented, there is great demand for qualified nurses all over the India. Since many corporate hospitals are being established and any more avenues like medical tourism, home nursing, industrial nursing etc. are available to better qualified and efficient nursing personnel. Number of men entering this female dominated profession have been increasing in the last few years. It is a clear indication of increased demand for nurses.
Standard of education and code of ethics is regulated by the INC and SNC. The colleges and universities do play an important role in maintaining quality and standard of education. TNAI, along with other associations in specialised nursing fields and unions, provide collective professional identity to contribute to development of nursing profession. They play a major role in collective advocacy and safeguard welfare of nurses. Legal provisions and government control over the nursing practice ensures good and conducive working environment. All these combined efforts from different institutions would play an effective role in establishing professional status and autonomy in nursing.
However, in reality, nursing and midwifery profession is not honoured as an autonomous body in spite of the fact that they are fully developed, qualitatively and quantitatively. The services rendered by them to ailing patients do not receive proper recognition from other health professionals in the medical field and even by the society at large. They are not accepted as leaders or administrators in their own fields without assigning any justifiable reason for such lack of recognition for the nursing profession.
In the years to come, many changes are expected even in the National Health Policy regarding funding, education, specialisation, creation of a permanent nursing cadre, better salary structure etc. With respect to women’s empowerment the nurses are already empowered and they only need freedom to use their powers. There is a great need for the society to recognise the rights and responsibilities of nurses and midwives and therefore they should insist for having only qualified nurses whereever they get admitted for medical treatment.
It is necessary that managements of government and public sector hospitals should think on the lines of administrators of corporate hospitals and improve working and image of health services, including efficient patient care rendered in the public hospitals. One way of improving health services in the public sector is to maintain the INC prescribed nurse:patient ratio (1:3), at least to some extent in certain departments to give better service. If that is adopted by government hospitals, it would help the government-managed hospitals to gain public confidence.
Adoption of NABH accreditation shall certainly improve the quality of nursing care, which will be more patient-oriented even in public sector and government hospitals. Proper and controlled use of information technology is playing wonderful role in raising their performance standard.
In future, the concept of a ‘nursing practitioner’ and research in nursing, need to be encouraged more along with evidence-based nursing practice.
All these changes shall definitely give appropriate respect and position to nurses in the society, but would also bring financial stability to this noble profession of nursing.
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