The highly anticipated National Nursing and Midwifery Commission (NNMC) Bill 2023, initially introduced in 2020, is on the cusp of being passed during the upcoming monsoon session of the Indian Parliament, scheduled to commence on 20th July 2023. After an extended period of waiting, the National Nursing and Midwifery Commission Bill is now on the brink of receiving the parliamentary endorsement necessary to become law.
The current government has shown unwavering dedication to standardizing medical and healthcare practices in India, striving to align them with international benchmarks. This transformative endeavor began with the establishment of the National Medical Commission and the subsequent introduction of various bills and amendments aimed at reforming the healthcare landscape.
Parliamentary affairs often involve a multitude of divergent interests among the members, which can lead to delays in the passage of vital bills. Similar challenges were faced by the National Medical Commission Bill, which took time to pass after its initial introduction in 2017. The National Nursing and Midwifery Commission Bill (NNMC Bill) has encountered similar hurdles on its journey to enactment.
Government’s Remarkable Healthcare Reforms in the Last 5 Years
Despite these obstacles, the government has introduced and successfully passed a series of bills and amendments within the healthcare domain over the past three years. These commendable efforts include the following:
- The National Commission for Allied and Healthcare Professions Bill, 2020
- The Epidemic Diseases (Amendment) Bill, 2020
- The Assisted Reproductive Technology (Regulation) Bill, 2020
- The Medical Termination of Pregnancy (Amendment) Bill, 2020
- The Institute of Teaching and Research in Ayurveda Bill, 2020
- The National Medical Commission Bill, 2019
- The Dentists (Amendment) Bill, 2019
- The National Commission for Homoeopathy Bill, 2019
- The National Commission for Indian System of Medicine Bill, 2019
- These initiatives underscore the government’s unwavering dedication to improving the healthcare landscape in India.
The Imperative Need for a Nursing and Midwifery Commission
The current Indian Nursing Council falls short of effectively managing the complex nursing ecosystem. The establishment of a comprehensive framework, similar to the National Medical Commission, is essential to accommodate the diverse stakeholders and distinct entities involved in nursing education and practice.
Inadequacy of the Existing Nursing Council Act
The existing Indian Nursing Council Act lacks provisions regarding the scope of practice for emerging nursing branches, such as Nurse Practitioners and Doctors of Nursing Practice. To successfully implement pilot programs like the Doctor of Nursing Practice, robust oversight, an educational framework, an internationally standardized curriculum, and a clearly defined scope of practice are imperative.
Establishment of the Commission
The draft bill presents a well-defined framework for establishing the National Nursing and Midwifery Commission as a corporate body. This demonstrates a strong commitment to providing the commission with the necessary autonomy and resources to effectively fulfill its mandate. However, further clarification regarding funding and operational mechanisms is essential to ensure the commission’s long-term sustainability. The draft bill of 2020 encompasses the following provisions:
Composition and Expertise
The proposed commission’s composition includes a diverse range of members with expertise in nursing and midwifery, government officials, and representatives from renowned institutions. This composition aims to ensure a comprehensive representation of stakeholders and professionals from the field. It is crucial to ensure that the selection process remains transparent, impartial, and based on merit to uphold the integrity and credibility of the commission.
Powers and Functions
The draft bill assigns a broad range of powers and functions to the National Nursing and Midwifery Commission. These include formulating policies, setting standards, regulating institutions, promoting professional ethics, and coordinating healthcare requirements. While commendable, it is essential to strike a balance between the commission’s authority and the autonomy of individual nursing and midwifery institutions, fostering flexibility and encouraging innovation.
Governance and Accountability
The proposed draft bill outlines the appointment and removal processes for commission members, along with the establishment of a search cum selection committee. These measures aim to ensure transparency and accountability. However, provisions for periodic performance evaluations and mechanisms to address complaints or grievances are necessary to maintain the commission’s integrity and effectiveness.
Implementation and Stakeholder Engagement
Successful implementation of the commission’s policies and regulations necessitates active collaboration and engagement with various stakeholders, including nursing and midwifery professionals, institutions, and state governments. The draft bill should emphasize inclusive decision-making processes, regular consultations, and feedback mechanisms to ensure the effectiveness and relevance of the commission’s initiatives.
Autonomous Boards for Nursing and Midwifery
Constitution of Autonomous Boards
The National Nursing and Midwifery Commission Bill proposes the establishment of autonomous boards to carry out specific functions under the supervision of the Commission. These boards include the Nursing and Midwifery UG Education Board, Nursing and Midwifery PG Education Board, Nursing and Midwifery Assessment and Rating Board, and Nursing and Midwifery Ethics and Registration Board. Each board will operate as an autonomous body with professionals from the nursing and midwifery field as its President and Members. The boards will function within the framework set by the Commission and the regulations prescribed.
Composition of Autonomous Boards
Each Autonomous Board will consist of a President, two whole-time Members, and four part-time Members. The President and two whole-time Members must possess outstanding ability, proven administrative capacity, integrity, and a postgraduate degree in any discipline of nursing and midwifery. They should also have a minimum of fifteen years of experience in the field, including at least seven years in leadership roles. The part-time Members will be chosen from the Members specified in the Act, and their selection will follow the prescribed manner. The composition of the boards aims to ensure expertise and comprehensive representation of stakeholders.
Term of Office and Conditions of Service
The President and two whole-time Members of each Autonomous Board will hold office for a term of up to four years without the possibility of extension or reappointment. The part-time Members will serve a term of two years. The provisions related to salary, allowances, and other terms and conditions of service for the President and Members of the Autonomous Boards will be prescribed by the regulations. The existing provisions for other terms and conditions of service and removal of the Chairperson and Members of the Commission will also apply to the President and Members of the Autonomous Boards.
Advisory Committees of Experts
To ensure the effective discharge of their functions, each Autonomous Board will have the authority to constitute advisory committees of experts as deemed necessary. These committees will provide valuable insights and recommendations to assist the boards in carrying out their responsibilities under the Act.
The staff of Autonomous Boards
The experts, consultants, professionals, officers, and other employees appointed under Section 8 of the Act will be made available to the Autonomous Boards as per the regulations specified by the Commission. The number and manner of their appointment will be determined to support the optimum functioning of the boards.
Meetings and Decision-Making of Autonomous Boards
Every Autonomous Board will convene meetings at least once a month, at a time and place determined by the board. The decisions of the boards will be made by a majority vote of the President and Members. In cases where a person is aggrieved by a decision of an Autonomous Board, they will have the option to appeal to the Commission within thirty days of the communication of such decision. The Commission will then review the appeal and provide an appropriate order within sixty days.
Powers and Functions of Autonomous Boards
Each Autonomous Board will have specific powers and functions assigned to them. For example, the Nursing and Midwifery UG Education Board will determine the minimum requirements and standards of nursing and midwifery education at the undergraduate level. It will develop a competency-based dynamic curriculum, prescribe qualifications, frame guidelines for nursing institutions, and regulate the scope of practice. Similar functions and responsibilities will be assigned to other Autonomous Boards based on their respective areas of focus.
Delegation of Powers and Governance
The President of each Autonomous Board will have administrative and financial powers delegated by the Commission to enable effective functioning. The President may further delegate powers to Members or officers of the board. This delegation of powers aims to ensure streamlined governance and decision-making processes within the boards.
State Nursing & Midwifery Commission
Within one year of the commencement of the National Nursing and Midwifery Commission Act, every State Government is mandated to establish a State Nursing and Midwifery Commission. This provision applies specifically to states that do not already have a State Commission in place through existing state legislation. The State Nursing and Midwifery Commission will be responsible for exercising the powers and fulfilling the duties prescribed under the Act. This provision ensures that each state has a dedicated regulatory body to oversee and govern the nursing and midwifery profession, promoting standardized practices and quality healthcare across the country.
Establishment of Central Register for Nursing and Midwifery Professionals
As per the National Nursing and Midwifery Commission Act, the Nursing and Midwifery Ethics and Registration Board is mandated to create and maintain a Central Register. This online database will contain essential details such as the names, addresses, and recognized qualifications of nursing professionals, midwifery professionals, nursing associates, midwifery associates, and other relevant information as specified by regulations. The Central Register aims to provide up-to-date and easily accessible records, enabling efficient monitoring, transparent regulation, and effective management of the nursing and midwifery workforce in India.
The establishment of the NRTS (Nursing and Midwifery Registration and Tracking System) and Healthcare Professional Registry marks the initial steps towards achieving this goal. These initiatives lay the foundation for the upcoming National Nursing and Midwifery Commission, which will further develop and enhance the necessary infrastructure to support the registration and tracking of healthcare professionals.
Similar to the National Exit Test (NExT) initiated by the National Medical Commission, the National Nursing and Midwifery Commission will also introduce the NExT test. This test will serve as a comprehensive examination for nursing and midwifery professionals, ensuring a standardized assessment of their knowledge and competencies. The NExT test aims to establish a uniform evaluation system, comparable to the medical field, to assess the proficiency and readiness of nursing and midwifery professionals. Through this test, the commission strives to enhance the quality of healthcare services by ensuring that professionals meet the required standards and qualifications.
ISCO Defined in the NNMC Bill Schedule
Incorporating the ISCO – International Standard Classification of Occupations, the NNMC Bill encompasses various professional categories related to nursing and midwifery. These categories include Nursing & Midwifery Services Managers, Nursing Professionals, Midwifery Professionals, Nurse Associates, Midwifery Associates, and Nursing Care Assistants. Each category is defined by specific roles and responsibilities within the healthcare system.
Nursing & Midwifery Services Managers, with the ISCO code 1342, are professionals who plan, direct, coordinate, and evaluate the provision of nursing and midwifery education, clinical care, and community health services. Their tasks include teaching and administration of nursing institutes, providing overall direction and management for healthcare services, supervising nursing personnel, and developing and implementing procedures and policies for nursing staff.
Nursing Professionals, represented by the ISCO code 2221, provide nursing education, treatment, support, and care services to individuals in need of nursing and midwifery care. They assume responsibility for planning and managing patient care, working autonomously or in teams with medical professionals and other healthcare workers. Their roles encompass applying preventive and curative measures in clinical and community settings.
Midwifery Professionals, identified by the ISCO code 2222, are responsible for planning, managing, providing, and evaluating midwifery care services throughout the pregnancy and childbirth process. They work to reduce health risks for women and newborn children, adhering to modern midwifery practices and standards. Midwifery Professionals may also engage in research and educational activities in clinical and community settings.
Nurse Associates, with the ISCO code 3221, provide basic nursing and personal care to individuals affected by aging, illness, injury, or other impairments. They offer health advice, monitor patient conditions, and implement care plans established by medical and nursing professionals. Nurse Associates work under the supervision of healthcare providers and contribute to the overall patient care process.
Midwifery Associates, represented by the ISCO code 3222, work in community settings and provide basic healthcare and advice during pregnancy and childbirth. They implement care plans established by medical and midwifery professionals, playing a crucial role in ensuring the well-being of pregnant women and their infants.
Nursing Care Assistants, denoted by the ISCO codes 5321/5322, offer direct personal care and assistance with daily living activities to patients and residents in various healthcare settings. They work closely with medical and nursing professionals, following established care plans and practices. Nursing Care Assistants provide essential support such as personal hygiene, feeding, mobility assistance, medication administration, and emotional support to patients and their families.
These categories, outlined in the NNMC Bill, reflect the diverse roles and responsibilities within the nursing and midwifery professions, promoting standardization and excellence in healthcare delivery.
Revised Approach to BSc Nursing Curriculum
The Indian Nursing Council’s transformative journey to revamp the BSc Nursing curriculum, aligning it with international standards, has received widespread acclaim. Esteemed institutions like the University of New Brunswick in Canada have taken notice, potentially paving the way for collaborations that integrate Indian nurses into the Canadian healthcare system. The establishment of the National Nursing and Midwifery Commission will further enhance the scope of practice for nurses and spearhead comprehensive reforms across multiple dimensions of the nursing profession.
As the monsoon session of Parliament approaches, there is renewed hope for the passage of the National Nursing and Midwifery Commission Bill. This landmark legislation has the potential to elevate the nursing profession, enhance the quality of education and practice, and integrate advanced nursing roles into the healthcare system. By establishing a dedicated commission, India can align its nursing and midwifery practices with international standards, creating a robust framework that benefits nurses, patients, and the healthcare sector as a whole.