New Delhi: The proposal of Ministry of Health and Family Welfare to repeal the existing Indian Nursing Council (INC) Act 1947 and replace it with the National Nursing and Midwifery Commission BiIl (NNMC) Bill 2020 which when passed will become the Act, has been largely welcomed by the para medical professionals.  The bills is currently in the public domain for feedback.

However most of the professionals from nursing and midwifery say that the new bill will be of relevance only if it addresses the core issues faced by the entire sector rather than focus only on one or two aspects like education.

According to Mrs Shanta Dhamale a retired matron who spend nearly four and a half decades as a senior nurse in various hospitals, the old act was over 70 years old and the profession along with the sector has gone through a sea of change, however the professionals have remained just a second fiddle to the medical professionals. 

"There have been so much evolution in the profession the new act should cover it all along with concerns of  service standards and salary aspects and not only focus on education aspect which was the main focus of the old act," she said adding that the working conditions were not very good for nurses and related staff and if left to the hospital managements, they will never agree to a level playing field.  

Some others in the profession say that the bill is very vague on the scope of practice, as it does not provide a vision for if and how nurses and midwives may be considered professionals as contributors to the healthcare system in the country as such. "There was a wide demand for licensing of midwives like in western countries enabling them to practice independently, however any such thing is missing from the bill," said one senior nurse who specializes in assisting obstetricians.

The bill in its current form seeks to standardize entry and exit into the profession by conducting common tests called National Nursing and Midwifery Entrance Test and the National Exit Test. It is directed towards professionalizing the nursing services by defining the different nursing cadres and standardizing their nomenclature and scope of work according to the International Standard Classification of Occupations (ISCO).

In the old INC act there were provisions for an elected representative from each state council, the newly proposed national nursing and midwifery commission has limited state representation from six zones, as per the zonal distribution of state and union territories.  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 nursing and midwifery advisory council is the only body under the bill that is represented from all the states. However, the members of the advisory council are not elected by the nursing and midwifery professionals. Instead, they are nominated by the Centre and state governments. Further, as the name suggests, the council is an advisory body with no decision-making power.

The bill proposes that the the Centre will nominate most of the members of the regulatory bodies to be constituted under the Bill. Assisted by a seven-member search-cum-selection committee, also nominated by the Centre, it will have the power to select the chairperson, secretary and members of the national nursing and midwifery commission, and the president and full-time members of the four autonomous boards. There is no representation of members elected by the nursing fraternity something that will be totally against the interests of the fraternity.

The bill also disappoints in terms of the practice aspect as it dwells less into standardizing and regulating the nursing and midwifery professions and more to regulate their education.