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As India struggles with doctor shortage, govt gives a push to nurse-led clinics

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If changes come through, a nurse practitioner may be allowed to prescribe medicines, conduct invasive procedures under supervision of senior doctors.

New Delhi: Nursing professionals may soon be allowed to run autonomous clinics in India. At the behest of the government, the Indian Nursing Council, the regulatory body for nurses and their education, is preparing a draft bill to amend a 1947 act which will bring nurse practicing rights in the country up to global standards.

The programme may allow nurse practitioners (registered nurses educated to a master’s degree level) to prescribe medicines for primary care and conduct invasive procedures in the presence of senior doctors. It is also expected to institute a new examination process to issue nursing licences.

Once the draft bill is ready, it will be sent to the ministry of health and family welfare for approval and introduction in Parliament. The council is likely to send the draft in the next three months.

“Nurse practitioner programmes and licentiate examination for nurses are among the key initiatives under the National Health Policy 2017 of the government of India. The ministry of health & family welfare has entrusted the Indian Nursing Council with their implementation in a time-bound manner,” Rathish Nair, secretary of the council, told ThePrint.

With nurse-led clinics, the idea is to increase the scope for nurses to practice more autonomously and to develop and apply advanced practice. The move is in line with the government’s vision of raising a non-MBBS cadre in certain fields to combat the shortage of doctors, especially in rural areas.

Prescribe drugs, conduct invasive procedures

The government has already introduced an amendment in the National Medical Commission (NMC) Bill, a wide-ranging legislation for reform in medicine, to allow nurse practitioners to prescribe medicines.

The amendment has been cleared by the union cabinet.

Also read: Expired medicines, no doctors & equipment: What audit of India’s govt health scheme found

According to the bill, nurse practitioners may also be allowed to perform some invasive procedures under the supervision of senior doctors, and in certain circumstances.

“To fulfil the delivery of healthcare services in rural areas and share the workload of senior doctors, we have decided to allow nursing practitioners to prescribe and practise modern medicine,” Jayshree Mehta, president of the Medical Council of India, had told ThePrint.

“The nursing practitioners with specialisations such as tertiary nursing and ICU care, cardiac problems and pharmacy, as well as physician assistants and optometrists are eligible for the upgradation.”

Stricter licencing

To ensure quality healthcare, the nursing council plans to make the process of obtaining the licences stricter.

The planned amendment is likely to introduce a licentiate examination for registering nursing professionals.

At present, after completing academic programmes, one needs to register with the relevant state nursing registration council to get the licence to practice. However, under the licentiate examination, the government could make it mandatory for nurses to pass two examinations — theoretical and practical — to get the licence.

Also read: Crippled by shortage of doctors, government wants qualified nurses to prescribe drugs

What happens the world over 

In several countries, apart from playing their traditional roles, nurses also work under titles such as ‘advanced practice nurse’, ‘nurse practitioner’, and ‘clinical nurse specialist’ such as anaesthetists.

Nurses are allowed to practice independently in some middle- and low-income countries such as Thailand and Nigeria, as well as in high-income countries, such as the USA, Australia, Canada, Ireland, the UK, Finland and the Netherlands.

“I recently met an Indian nurse who is now settled in United States. She is a paediatric nurse practitioner who successfully runs her own clinic. She has two other nurse practitioners and two paediatric medical practitioners working at her clinic,” said Nair.

“The medical practitioners perform procedures and therapies which might be needed in case a patient requires further medical evaluation or intervention beyond the scope of practice of a nurse practitioner.”

While in some provinces of these countries, nurses need to have collaborative practice agreements with physicians to practise independently, the ministry expects discontent among the medical fraternity. The idea of alleviating the status of nurses in a doctor-driven healthcare system is likely to face some backlash.

But according to the Indian Journal of Medical Ethics, there is evidence across the globe to show that nurse practitioners are increasingly being used as the point of first contact and that patients are equally or even more satisfied with them than doctors.

“The cost of the health service is also lower with NPs. Several studies have found that there is no difference between the clinical outcomes with NPs and general practitioners,” the journal said.

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  1. Its a very good step.i have seen in hospitals 70% of work is done by nurses means they have the capability to work so they need this course to work independently like developed nations.

  2. Actually nurses they know well but the think is they can’t prescribe medication during emergency so they wait for doctors …some tym doctor don’t reach ok time so patient gets expired .in that situation nurses even can’t prescribe medication .. I think NP is the best option during emergency

  3. I am a bsc nurse ,still we are compel to follow Homeopathy practiced dr’s order in modern Alopathy hospital system.They practised in Dr Haniman placebo theoretical medicine and doing work in modern medicine allopathic hospital name of Dr. With out any practical knowledge .In the critical scenario how can they act like our team leader and very pathetic feel to carried out orders some time,as a nurse practitioner level of knowledge and skills are worth less .

  4. its nice step and it should be encouraged but one thing i should say here is that there are thousands of foreign medical graduates without licence ,give them licence and allow them to work indeoendently they know.much more and can do better if there is serious shortage of medicos …

  5. It’s a need of time…. Really nice thought by govt…. Hope it will be amended soon earlier… 👍👍👍👍

  6. This idea is a grest boon for health care system and this benefits the remote area people. But here one has to be very cautious of giving this NP only to a reslly qualifued nurse who is practically compenent and knowledgeable.As we see there are no good nurse training in some places in india some of them are half baked to get certificate they conduct ciurses and affiliates to university. This eill boost the nurses as well as the health sectors if givernment

    • It is certainly a good move to empower nurses to take on a bigger role in patient care.
      However, also bear in mind that “MBBS proved to be nothing” is a “grapes are sour” statement. Increasing the role of nurses does not diminish the role of doctors except in the minds of the ignorant. It is not for nothing that a longer training period is required for doctors because there is a lot more to medicine than what you seem to imagine unfortunately without a doctor’s training you might not realize that.

  7. I favour the idea of NP since she serves at the first point of contact for patients. Many decisions and actions can be taken in an emergency with the help of a qualified and experienced nurse. This move will definitely empower the medical practice. In order to implement these services in India, we can learn how other countries have applied it in their day to day practice. And I am very sure that many people will voluntarily provide guidance in this endeavour. Get going Nurses… to get India going!

  8. If the proposed suggestion comes to pass in a developing country like India we can expect a real decrease there will be a great d morbidity &mortality rates in the rural areas,& in the hamlets which are not connected to main roads.As it is quite evident that the nurses serving in PHC s were able to transport antenatal mothers in ambulances to the nearest secondary level or tertiary care when diagnosed in early stage of complications.Also incidences like bites & stings which needs immediate care can be handled by them if given a freedom of execution.Standing orders from the department of health & family welfare can prevent the the overlap between medical,& nursing practice.

  9. Nps is started in USA since1950′ even doctors of India following USA health policy,in USA xero mortality during cardiac arrest because all emergency in USA handle by nps they are loaded with all equipment and emergency drugs they reach on time and treat patint even iabp, ventilation intubation All don independently if any body wants me discuss about making policy in India I can tell how it can impliment and work

  10. The government is promoting schemes to empower non-medical personnel to take on medical roles at poorly staffed health facilities at the primary/secondary levels while there are gross man power deficits in nursing and allied health sciences. This will only enhance the increasing lop sided development of Medicine in favor of specialization and tertiary care. Medical profession needs to accept that sound multi competent medical practice at primary/secondary levels is an equally important part of Medicine. Medical education should be reoriented such that: (1) medical graduates have multi-competencies sufficient to address three fourths of the morbidity spectrum in Indian conditions and thus perform adequately at the PHSs and CHCs; and (2) sufficient number of specialists are also produced as experts in this neglected area of Medicine. Such a long term approach is needed even as short term measures may also be pursued.

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