Table 2 Status of different policy reforms for facilitating nurse leadership based on a review of nursing sector in 5 states
From: Setting the agenda for nurse leadership in India: what is missing
Policy reforms proposed | Status of the reform | Effect of lack of action on nursing cadre and health system |
|---|---|---|
Improving nurse patient ratio(Recommendation of the 1st National Health Policy 1982) | All states have made attempts to recruit additional nurses into the public health system. However, significant levels of vacancies still exist | Overburdened nurses provide poor quality nursing care |
Appointment of promotional positions for public health nurses at sub-district level (Chadha Committee 1963) | Major shortfall again in filling the first promotional supervisory position in four out of five states. A higher level supervisory position of Public Health Nurse (PHN) is missing in 3 and major shortfall in 2 states | Limited promotional avenues leading to lack of motivation among nurses. Lack of professional supervision of nurses’ work |
Appointment of District Public Health Nurse Officer (DPHNO). (This position was created in 1983) | Not a single post has been created in 3 states and major vacancies in 2 states | Key district level leadership for nursing sector is missing |
Promotional supervisory positions for clinical nurses (A recommendation from many committees starting from Bhore Committee 1946) | Norms are not followed in creating the positions. High levels of vacancies of nursing matrons and nursing superintendents in all the states | Non recognition and no utilization of nurses in healthcare administration Low quality nursing care in hospitals |
Training and skill up-gradation of in-service nurses (A recommendation from many committees starting from Bhore Committee 1946) | Sporadic training opportunities are available. Training institutions for preparing public health nurses for supervisory positions are non-functional in all states | Poor quality nursing care Less opportunity for promotions |
Better working conditions for nurses including better salary and career opportunities (A recommendation from many committees starting from Bhore Committee 1946) | Grossly inadequate salary and career environment. Non-availability of proper equipment and supplies for nursing care | Poor quality nursing care |
Post-graduate training opportunity for in-service nurses (A recommendation from many committees starting from Bhore Committee 1946) | No sponsored post graduate training for in-service nurses. 4 states did not have post graduate training institutions in government settings | Not enough qualified nurses available for higher positions |
Creating leadership position at the state level (High power committee on nursing 1987) | 2 Positions are created in one of the states, but only one position is filled. A single position was available for nurses in the state directorate in 2 states, which was not filled up due to non-availability of qualified candidates. No senior level position for nurses at the state level | Lack of direction for nursing sector in the state |