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abstract
Article history:
Received 11 January 2012
Revised 28 June 2012
Accepted 29 July 2012
Nursing care has been mentioned in the Indian culture from the times of the
Vedas. However, according to World Health Organization, the nursing workforce
in India is still insufficient to meet the needs of the country. The purpose of this
article is to examine the status of nursing education and the nursing workforce
in India and the challenges faced by the profession. Data supporting the statements made in the article were obtained from the Nursing Council of India, the
Ministry of Health and Family Welfare, the Government of India Web sites,
printed journals and communication with experts in the field. In India, there is
a need to train approximately a million nurses to meet the current shortfall of
health workers in the country. The nursing "brain drain" suggests that it may be
one of the factors responsible for this shortfall. Further, nursing education faces
challenges, such as streamlining nursing education, enriching the curriculum,
strengthening faculty development and increasing the use of innovative
teaching and learning techniques.
Keywords:
Nursing
Education
Workforce
India
Migration
Cite this article: Tiwari, R. R., Sharma, K., & Zodpey, S. P. (2013, JUNE). Situational analysis of nursing
education and work force in India. Nursing Outlook, 61(3), 129-136. http://dx.doi.org/10.1016/
j.outlook.2012.07.012.
* Corresponding author: Dr. Rajnarayan R. Tiwari, Scientist D, National Institute of Occupational Health, Meghani Nagar, Ahmedabad380016, Gujarat, India.
E-mail address: rajtiwari2810@yahoo.co.in (R.R. Tiwari).
0029-6554/$ - see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.outlook.2012.07.012
130
131
Eligibility Criteria
th
Completion of 10
grade
Completion of 102
grades with
aggregate of 40%
Completion of 102
grades with
aggregate of 45%
in PCBE
Training Duration
1 years
3 years
Examination
Usually work at
Nursing Examination
Board
Nursing Examination
Board
4 years
University
Completion of 102
grade GNM
2 years
University
Distance education
Completion of 102
grades GNM 2
years experience
3 years
University
M.Sc.
2 years
University
University
3e5 years
1 year
University
Board or University
M.Phil.
PhD
Post Basic Specialty
Diploma Courses
M.Sc./M.Phil.
R.N and R.M. with
one years of
clinical experience
Medical college,
hospitals, and super
specialty hospitals
Medical college,
hospitals, and
super-specialty
hospitals
Medical college,
hospitals, and superspecialty hospitals
Medical college,
hospitals, and
super-specialty
hospitals
Medical college,
hospitals, and
super-specialty
hospitals
132
1310
2493
1506
615
444
Nursing Schools
Health school-based nursing training is the dominant
form of nursing education in India. Most of these
schools are attached to hospitals. These schools
usually provide training in ANM and GNM services,
which are diploma programs. The students who have
10 years of general schooling are eligible to take an
ANM course, whereas those who have passed 12 years
of schooling with a science stream (having subjects
such as biology, chemistry, and physics in the 12th year
of schooling) are eligible for GNM courses. The average
student age in the GNM program is 17 years. Admission
to these programs is based on merit scored in the
respective grades, i.e., 10th or 12th standard. The total
duration of the ANM course is 2 years, and that of the
GNM program is three-and-a-half years. Thus the GNM
course is a more detailed one with more hands-on
experience and practical work. Those who successfully complete these courses are registered with the
respective SNCs.
133
University Degrees
The university degrees are housed in institutions of
higher education. These colleges of nursing within
universities award bachelors, masters, and doctorate
degrees in nursing. The graduates with B.Sc. Degrees in
nursing can engage in both clinical nursing and clinical
teaching. The eligibility criteria for graduate nursing
courses are 12 years of schooling with a science stream.
This degree can also be acquired as an additional
qualification by GNMs either through regular courses
from a recognized university or through distancelearning processes from open universities, such as
Indira Gandhi National Open University New Delhi,
Yashwantrao Chavan Open University, and Annamalai
University Chennai, etc. In India, 1,506 institutions
offer a bachelors course of study, and 444 institutes
offer a masters course of study (Table 2). The masters
courses are offered in public health nursing, cardiovascular nursing, oncology nursing, and pediatric
nursing, etc. The graduates pursuing those masters
courses have a better opportunity of working in
specialty hospitals. Further if they wish to leave
a government job voluntarily, they have better opportunities for employment in private super-specialty
hospitals.
University Diplomas
Several universities and teaching hospitals also run
short-term specialty programs in different specialized
134
Enrich Curriculum
Recently, the curriculum of nursing education has
been enriched a great deal. Taking into account the
development of specialties and super-specialties in the
field of medicine or health, several post-basic courses
in these specialties are offered by different institutions,
such as medical colleges, nursing colleges, and other
health institutions. This has provided an opportunity
for practicing nurses to enrich their expertise and
qualification. However, there is a need for additional
specialties, such as geriatric nursing, occupational
health nursing, etc. Further, due to the changing role of
nurses with transition in disease patterns and national
priorities, periodical redesigning of curricula should
be conducted. For example, better immunization
and high-quality antibiotics have controlled many
communicable diseases, whereas changing lifestyles
(e.g., smoking, obesity) have increased mortality and
morbidity related to diseases, such as cardiovascular
diseases, cancer, and diabetes mellitus. Patients with
non-communicable diseases, often middle- and oldaged, typically require rehabilitative care over a long
period of time, sometimes decades, as these diseases
are mainly chronic debilitating diseases. Thus, the
curriculum of nursing should take this into account
and emphasize rehabilitative nursing in addition to
curative nursing. In addition, post-basic courses may
address some of these issues, as these are specific
courses.
Nursing Research
Though the Trained Nurses Association of India (TNAI)
undertake several nursing research studies done on
Indian nursing problems, during pursuit of masters or
doctoral degrees more studies are needed on selfdirected and student-centered learning approaches
for teaching, which are considered better than traditional ways of teaching. Such teaching methods should
include problem-based learning, science-based
learning and competence-driven learning (Frenk et al,
2010). Nursing has been dependent on other disciplines, such as sociology and psychology, for knowledge about teaching as well as learning research
methods. To develop a knowledge base for nursing
dboth evidence-based teaching and practicedmore
nursing research is needed by those who hold masters
and doctoral degrees.
135
references
In-Service Training
In-service training means that while the nurses are
employed in different settings, regular continuing
medical education programs should be conducted
to update knowledge and skills. A well-planned
in-service training program needs to be integrated
into the basic programs in the planning phase to
institutionalize new knowledge and skills. Mechanisms have to be established to ensure that the
training centers providing the basic education are
aware of the changes and are involved in the
designing and planning of the in-service training
course. Varieties of innovative training methods have
been used to impart training to in-service learners.
Open Universities have adopted an integrated
multimedia approach that includes self-instructional
material supplemented by face-to-face counseling,
practical contact sessions, hands-on training, audiovideo programs, teleconferencing, telecasts, broadcasts and interactive radio counseling for training of
in-service nurses. Such in-service training programs
may include training about newer investigative techniques and newer treatment modalities, etc. Other
innovative methods include virtual learning (Wood
& McPhee, 2011), satellite-training and distancelearning programs. In addition, using a transformational leadership style provides staff educators
with a strong framework for ensuring nurse leadership competency (Wojciechowski et al, 2011; Tinson
et al, 2011).
Tremendous efforts have been undertaken to
strengthen nursing education in India, such as
increased number of graduate and post-graduate
courses/institutions along with increased enrollment
in such courses over a period of time. And those in
practice are better prepared; yet the country still faces
a shortage of nurses. There is an inadequate number
of nursing workers (only 8 nurses per 10,000 people).
Uniform course syllabi and improved faculties and
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