Strengthening the Health-care System: Need for Nursing Education Reforms

Dear Editor, As per the Ministry of Health and Family Welfare data, nursing workforce currently constitutes 47% of health-care workforce in our country with an estimated shortage of 2.4 million nurses. The nurse: population ratio stands at 2.06 nurses/1000 people against the World Health Organization norm of 3 nurses/1000 people.[1] A well-trained nursing workforce is one of the important building blocks of a strong health-care system, helping it to achieve the goal of Universal Health Coverage. To counter the nursing population shortage, the last two decades have witnessed exponential growth in nursing educational institutions in India (predominantly in the private sector), with over 50% educational institutions being located in the five southern states of India. Over 80% of the institutes are in private sector and are reported to have several issues that include lack of parent hospital for clinical training, poor staffing, lack of staff development programs, and nonadherence to norms prescribed by statutory bodies, resulting in poor quality of education and incompetent graduates.[2] The nursing education is currently regulated by the Indian Nursing Council and State Nursing Councils at central and state levels, respectively. However, the lack of empowerment and malpractices in regulation along with political interference in work of regulatory bodies have resulted in mushrooming of substandard nursing educational institutions, thereby producing incompetent graduates. On the other hand, the nursing service has always been very poorly regulated. The state nursing councils have their roles in only registration and licensing of graduating nurses. There is no regulation of standards in nursing practice and its scope for nurses with various levels of stringent educational preparation. The National Nursing and Midwifery Commission (NNMC) Act-2023 was recently passed in the parliament. As per the act, the NNMC will be constituted at state level shortly. The constitution of NNMC is a ray of hope to improve governance of nursing education in the country. Some of the important tasks for NNMC include: Improvement in regulation of nursing education and practice to improve the quality of education Relooking at levels of educational preparation with specific scope of practice and aligning nursing curricula of various nursing programs with National Health priorities. Further, NNMC may strive for bridging the gap between providing quality nursing education and practice. Exploring engagement of nursing educational institutions to collaborate with local governments for the implementation of important National Health Programs would add value to nursing education as well as health-care systems. In addition, the state and central governments need to invest more in nursing education to ensure quality education in this sector. In a significant move toward strengthening nursing workforce in the country, the Cabinet Committee on Economic Affairs has approved establishment of 157 new nursing colleges in colocation with the existing medical colleges established since 2014. As per the implementation plan, by 2025, all these institutions are envisaged to be functional. The continued attention and investment in nursing education by government will certainly boost quality nursing education that is affordable and equitable. This will also help address the challenge of nursing shortage that we face in the country. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.