The 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.
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.”
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.
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.
Hmani Chandna | The Print