Some recommendations relating to the NNMC Bill- My humble opinions

I have been fortunate to be employed as Staff Nurse at the ESIC Model Hospital in Noida and being a M.Sc. in Mental Health Nursing, I have carefully perused the NNMC Bill in a view to see whether any changes are required. While it is difficult to come up with extensive responses in a short duration for a bill which is complex and vast, I wish to thank the Ministry of Health and Family Welfare for keeping this bill draft in the public domain although the information is not being properly spread amongst many nurses. I have a request to make- Can the date for suggestions for the Act be extended since this will bring major reforms to the nursing profession?  

I have already submitted my own suggestions for modification of this proposed bill and wish to thank the Government for giving me the opportunity. The first thing that I would like to state is that the NNMC Bill should have its name changed to the National Nursing Commission Act of 2020. The logic behind this is that Midwifery is a nursing branch and there are many other branches including pediatric, mental health, community, etc. Some other suggestions at my end include adoption of the definition given by ICN (International Council of Nurses) and also promotion of national goals, issuing of guidelines for scope and standards of nursing practices in all settings, maintaining state and central registers, developing skill-based pathways and adopting the latest technological and scientific advancements.  

Some other suggestions that I wish to make  

  • The definition of nursing as given by ICN in 2002 ( states that nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.  
  • It is better to redefine Nursing Care Assistant as Personal Support Worker.  
  • The head office should be moved to Central India in order to make it more convenient for all States to be a part of the process and to make the Council more approachable.  
  • The experience of the Chairperson should be lowered to 15 years of experience in the nursing field.  
  • If no nurses are represented as members in the National Medical Bill, then why should members from the bill be a part of the NNMC Bill? Nursing should be made independent and composition of bill should have those with nursing backgrounds.  
  • One member should be appointed from ICNR (Indian Council of Nursing Research).  
  • Nursing Superintendent ESIC Model Hospital or member from ESIC Nursing Association to be considered for membership.  
  • Principal of Nizams Institute of Medical Sciences, College of Nursing, Punjagutta, Hyderabad to be considered for membership.  
  • There should be ample representation from organizations like SOMI, TNAI, IAPH, NRSI and any other nursing professional organizations.  
  • Ample representation from student nurse associations or meritorious students achieving excellence in the council.  
  • Members to be included from patients rights organizations along with non-medical persons also.  
  • Appointment of members via election procedures throughout country.  
  • Instead of age as criterion, skill should be considered along with professional achievements and contribution to the nursing profession.  
  • All minutes of meetings to be made live on digital channels and schedule of the year should be published on ongoing basis. All meetings to be posted and made accessible for each and every Indian citizen.  

Going a little more specific with my recommendations  

I believe that a few more specific recommendations should be made in respect of the proposed NNMC Bill. These are:  

  • Policies should be framed for nurse patient ratios.  
  • Policies should be farmed for clinical practice guidelines.  
  • Policies for clinical nursing research should be framed.  
  • Curriculum to be framed with global standards.  
  • Frame licensure examination syllabus.  
  • Inspect workplace conditions of nurses like schools, hospitals, etc. Regulations to be framed as per national health goals.  
  • Scope of nursing to be framed as per qualification and designation and report to be submitted to concerned government departments.  
  • Central register to be maintained including tracking movement of nurses in and out of India.  
  • Universal registration number should be made for nurses and nurses can be shifted anywhere throughout India (Single Licensure System India-wide).  
  • Same educational standards should be maintained countrywide.  
  • Evidence-based policy development for nursing welfare.  
  • New courses to be framed and curriculum to be developed including mental health nursing, renal nursing, clinical nurse specialist course, cardiac nursing and advanced nurse practitioner programs.  
  • Leadership programs to be developed for nursing and continuing nursing education with credit hours for nurses through online platforms.  
  • Collaborate with global organizations like UNICEF, WHO and UN for developing leadership courses and offering scholarship facilities for clinical nurses and students for promoting nursing research in India.  

I also believe that some autonomous boards should be established in the country for the betterment of the nursing profession. These should include the Indian Council of Nursing Research, Indian Nursing Leadership Development Board, Nursing Quality Assurance Board, National Nursing Library and Interdisciplinary Nursing Board. Skill-based appointments to be the norm instead of experience-based.  

I also believe that there should be a system for rating and assessing hospitals as to whether they are nurse-friendly or not including Magnet accreditation of hospitals ( Something on the lines of the Magnet Recognition Program is highly recommended for transforming global healthcare, enhancing professional image for nurses and boosting confidence amongst society in this profession. Ethics boards should develop appreciation systems along with penalties. Recognition should be there for the best nurse in each hospital and best student nurse in every school/college of nursing along with outstanding professionals in different nursing fields. Nursing members should have eligibility for initiating school/college of nursing. NNMC Bill should take the power of assigning clinical setup areas for students nationwide and identify the best hospitals for training students. Fix qualifications for opening nursing colleges since only those from  nursing background should ideally open the same.  

While homeopathic and Ayurvedic personnel can open their own colleges and educational institutions, nursing professionals still cannot. The nursing council should retain this power and work for developing professionals in the nursing field instead of catering to medical professionals. NNMC Bill should have power for rating hospitals and giving placement to students. Institutes of national nursing importance should be established in the manner of IIM for building the proper image of the profession. A single point of registration throughout India will help in smoother migration of nurses and it should be integrated with the online search database and Aadhar Card. Details like the qualifications, workplace and others should be maintained in the database with all requisite fees. This will help nurses in developing their portfolios.  

NNMC Bill can propose a portal where all Indian nurses can readily register. Every nurse should have an identity card with NNMC Registration number so that students and patients may identify any malpractices and get this reported to the Commission. National Licensure examinations will be compulsory for all nurses passing out through UG and PG courses such as NCLEX. National Nursing and Midwifery Entrance Examination should be conducted for all nursing colleges including autonomous colleges in order to ensure that students may choose the best nursing colleges in the country. Regulations should be made for clinical nursing experience covering both postgraduates and graduates. For instance, 2 years of UG experience is equal to 1 year of PG experience. Dual experience of nursing and equivalency of experience should be taken into account. These are some of my humble suggestions for the betterment of the nursing field which the NNMC Bill has the potential to accomplish if it becomes a law. I sincerely hope that all these inputs and suggestions are closely examined and recommendations implemented for the benefit of nurses.


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