The draft Nursing and Midwifery Commission BiIl is concerned only about educational institutions. It looks to replace the Indian Nurses Council with a government-appointed body

Representative Image (Photo Courtesy: Social Media)
Representative Image (Photo Courtesy: Social Media)

The Ministry of Health and Family Welfare has decided to repeal the existing Indian Nursing Council Act and replace it with the National Nursing and Midwifery Commission BiIl, 2020. The draft of the Bill, which has been circulated, aims to replace the largely autonomous Indian Nursing Council with a government-appointed body. Comments and recommendations for the Bill must reach the ministry before December 6.

As the Indian Nursing Council Act was passed in 1947, many in the profession were hoping that a new Bill would address the changes in the profession. The draft Bill, however, is mostly concerned about nursing colleges and teaching institutes.

“It’s been more than 70 years since the Indian Nursing Council Act was passed, so a lot changes have happened. In that way the Draft Nursing Bill is welcome because in 1947, the nursing education in this country was in a primitive stage and this is a much-needed revision in terms of education,” said Professor Roy K George, president of the Trained Nurses Association of India.

One of the main drawbacks of the Indian Nursing Council Act was that it covered only the educational aspect of nursing. There were no norms for service and patient care. There are no fixed details of the nurse to patient ratio, staffing norms and salaries. The new draft Bill does not address these concerns either.

Those in the profession have been advocating the inclusion of the working condition of nurses. “The draft Bill has nothing on that front and that is a major drawback. Both nurses and the public have issues on the service side of the profession. They have not touched it because this would upset the current status quo. Hospital administrations and hospital owners have a larger say in the matter than the nurses and the patients, who suffer due to lack of quality care,” pointed out George.

“This Bill is mostly concerned about nursing colleges and teaching institutes. One welcome step on the education front is that the government is planning a national entry and exit step. The current problem is that the entry in different states is of different standards, so the quality of nurses also differs. The same is the case with exit exams. In certain states, the quality of education is much below standards. If the exit examination has a skill test, we are assured that anyone who has registered themselves as a nurse will have a minimum standard set by the commission,” asserted George.

The draft Bill has included the term midwifery, which is a step above the current Act, which only includes the ‘nursing’ term. “That’s all that is there. Currently, even though nurses have been trained to handle deliveries, doctors have taken over. We do not require doctors for all deliveries. A midwife should be able to practice independently, but this draft Bill does not address that. Why should we have to work under doctors as we can practice independently,” remarked Professor Mithali Adhikari, president of the Society of Midwifery India. The society had demanded licensing of midwives, similar to other countries.

One of the main concerns of this draft Bill is the abolishment of the Indian Nurses Council, which is a largely autonomous body under the Ministry of Health and Family welfare. The members are selected through a democratic process. In the Indian Nursing Council, there were elections and representation from across the country.

This draft Bill states that the members of the new nursing commission will be appointed by the government. “This will affect the inclusive nature of the current decision-making processes and move towards becoming a government missionary. Whatever policies or changes the government wants will be agreed to by the commission irrespective of what the people in the profession think. There was a lot of freedom given by the earlier Act, but now merit of new Council will depend on the merit of the government. This will affect the lives of many,” pointed out George.

This Bill aims to dilute the professional control of nurses and increase the bureaucratic control of the profession, noted George. In the new commission, according to the draft Bill, there will be representation from the Central government institutions. “But what about the large number of nurses working in the private sector or those in remote areas of the country, who stand no chance of being represented in the new council because there is no such provisions made. The current representative nature of the council is lost in the new Bill. People sitting in Delhi are no authority on the issues faced by nurses in other parts of the country,” observed George.

In the draft Bill, the country is divided into six zones and representatives from various states will be appointed to the council only in rotation, which means there would be no equal representation of states. The current council has equal representation from all states. Now, the president of the new Commission will be a full-time officer appointed by the government. Earlier, it was a person elected by the members of the Indian Nursing Council.

The current Indian Nursing Act was weakened by certain judgements of certain High Courts and the Supreme Court. “The powers of the Indian Nursing Council were restricted in the last five years because the 1947 Act had many loopholes. All of that is being taken care of in the new draft Bill. It states that the new council will have powers to recognise, conduct inspections and withdraw recognition to nursing institutes. But, this draft bill makes a provision for appointing an external and private agency to conduct inspections. This was not possible until now. This will lead to exploitation and dilution of standards,” highlighted George.

With this draft Bill, the power of controlling those in the profession will become centralised. “When there is absolute power, power will corrupt absolutely. The government is taking away the democratic nature the institution. Every good provision in the existing nursing act is being side-lined,” underscored George.