Nurse’s Role in Health Care

Delivery in IndiaMr. B. D. Kulkarni

Department of Community Health Nursing

Mile Stones in Nursing Profession in India• 1857 - Took interest in health of Army in India.• 1859 - Royal Commission was appointed.• 1868 - Sanitary department was established.• 1888 - 10 British Nurses arrived in India to look

after British Army in India.• 1905 - Missionary Nurses arrived as a member of Missionary Medical Association.This was the very start of formal nursing services

in India.

• Gradually, the increasing need of adequate professionally qualified nurses lead to

• 1911 - South India Examination Board.• 1912 - North India Examination Board.• 1934 - Mid India Examination Board.• Mission Hospital Nursing leaders laid a

foundation of systematic Nursing Education in India.

• However, this was not regulated for registration.

• State wise Councils started developing from 1935 onwards.

• 1947 – Parliament passed the Indian Nursing Council Act.

• Indian Nursing Council upgraded the educational requirements, which permitted matriculate candidates to seek admission to the Schools of Nursing.

• The Government of India approved the recommendations of Sir Bhore Committee and started two Colleges of Nursing in 1946 & 1947 at Delhi and Vellore respectively.

• With the efforts of Professor S. Radhakrishnan (the then Chairman of University Education Commission) Nursing Education in the country was integrated into the system of higher education.

• Over the decades, there has been an improvement in Nursing Education in India.

Courses offered and approved by Indian Nursing Council:

• Revised Auxiliary Nurse Midwife.• Revised General Nursing and Midwifery.• Basic B.Sc. Nursing.• Post Basic B.Sc. Nursing. (Regular)• Post Basic B.Sc. Nursing. (Distance Learning)• M.Sc. Nursing.• M.Phil in Nursing.• Ph.D. In Nursing

Role of a Nurse in Health Care Delivery System in India –

• It varies with professional qualification of the Nurse.

• Before discussing the role of the nurse, it is important to understand two things-– The Governments' Health Care Delivery

Set up’ in India.– Institution providing health care to the

community.

• Sub Center • Primary Health Centre • Community Health Centre • District Hospital

• Medical College Hospital

• Super speciality Hospital

• Maximum health services are provided by the Government.

• The other institutions providing health care to the community are ––Municipal Corporations.–Mission Hospitals.–Charitable Institutions.–Private Hospitals.–General Physicians.

• The role and functions of nurse depend on her position in the institution, providing health care.

• For recruitment of nurse on specific position, her professional qualification is given due importance.

• Like other countries, in Indian scenario also nurses are performing various functions, that means their role is multidimensional.

• Role of a nurse is associated with her hierarchy position in the organization.

At Sub Center level:• Caters health needs of about 3000 – 5000

population• Currently one ANM and a Male Health

Worker is appointed.• The ANM concentrates on MCH services• The male Health Worker concentrates on

Environmental sanitation and allied health services.

• Role is of direct health care provider.• ANM is the backbone of health services in

India.

At Primary Health Care Centre

• The GNM &/or ANM with 6 months additional training function at this level.

• Roles of nurse include-–Direct care provider–Supervision & guidance to ANM

working at sub-centre level.

At Community Health Centre• Nurses with GNM and B.Sc. Qualification• Nurses with specialized diploma in PHN,

Pediatric Nursing, etc.• Roles of Nurse include-

– Direct health care provider– Supervision and guidance– Resource person

At District Level• Qualifications are GNM, B.Sc.• Specialized Diploma in PHN, Pediatrics etc.• The District Health agency acts as a

referral unit and certainly the role of Nurse is much advanced.– Direct Health Care Provider– Manager– Supervision and guidance– Educator and Resource person– Leader

At Medical College Level

• In addition to above mentioned roles the nurse is involved in–Planning and evaluation of health

services.–Apart from rendering the care at

this level, the nurse plays an important role in health care administration.

At Super-specialty level

• They are established by Govt. in Metro cities.

• They render highly sophisticated and specialized care.

• The nurse’s key role as case managers, nurse specialists and advance clinical nurse

At State Level• The nurses hold higher positions like State

Nursing Superintendent, and Additional Director of Nursing Services.

• The nurse’s role include –– Liaison between the Grass root level nurses

and their higher authorities– Leaders, Organizers, Policy makers,

Educators, administrators, Decision Makers, Collective Bargainers, Evaluators, etc.

In Indian Health Care Delivery System, Nurse’s Extensive & Intensive Role

• Direct care provider, • Sensitive observer, • Change agent, • Educator, • Advocate, • Concerned advisor, • Manager, organizer, • Director and coordinator,• Controller, evaluator,• Collaborator, leader • Researcher

• The nurse influences the health decisions at local, state and national level,

• Participates in development of health program and

• Lays down policy related nursing service, practice, education, administration and research.

Nurse’s Status• Professionally, the nursing profession –

– Lacks autonomy.– Considered secondary to medical profession.– Yet to reach the full fledged professional

status due to lack of professionalism among nurses.

– Shows a ray of hope in terms of Independent nurse practitioners.

– Strives for Legal status as independent nurse practitioner or consultant or clinician.

Economic Status• Majority are employed on salary basis.• Earnings are less in comparison with other

professionals as well as their counterparts in other developed countries.

• Collective bargaining has improved the economic conditions but still there is scope for further improvement.

• Working conditions need to be improved and working hours of nurses in the clinical area need restructuring.

Social Status• Lower due to cultural dominance and male

dominance in general in the society of which they are part.

• Basically trained to earn the livelihood rather than enjoy economic, social freedom.

• Less support from family and society.• In recent years there is increasing social

recognition and improved status with increased awareness of nature of nursing.

In nutshell• Nurses are nevertheless backbone of

health care delivery system in any country.• Everyone accepts that the entire health

care delivery system would collapse in the absent of nurses.

• We need to accept that We have a long way to trade to achieve professional autonomy that caters to improved social status, working conditions and earnings, educational diversification and opportunities.