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The retarded development of nursing and nursing profession seems to be mainly due to the fact
that no serious thought has been given to this discipline by the government over the years.
Timely action on the various reports submitted to the government would have prepared nurses
to take care of all areas of health care delivery and would have also avoided multiplication of
other categories like occupational therapists, physiotherapists, social worker , health educator
etc. All these are doing nursing duties.

Working conditions of nursing personnel
1. Employment
Uniformity in employment procedures to be made.
Recruitment rules are made for all categories of nursing posts. The qualifications and experience
required or these be made thought the country.
There should not be a bond for nursing students as some of the states do not give them
employment during the stipulated period. Keeping in view of the shortage of nurses in hospitals
and community health field states should create posts and appointment these nurses in the
appropriate positions.

2. Job description
Job description of all categories of nursing personnel is prepared by the central
government to provide guidelines.
3. Working hours
The weekly working hours should be reduced to 4o hrs per week. Straight shift should be
implemented in all states. extra working hours to be compensated either by leave or by extra
emoluments depending on the state policy .nurses to be given weekly day off and all the gazetted
holidays as per the government rules.

4. Work load/ working facilities
Nursing norms for patient care and community care to be adopted as recommended by
the committee.
Hospitals to develop central sterile supply departments, central linen services, and central
drug supply system. Group D employees are responsible for housekeeping department.
Policies for breakage and losses to be developed and nurses not are made responsible for
breakage and losses.
5. Pay and allowances
Uniformity of pay scales of all categories of nursing personnel is not feasible. However special
allowance for nursing personnel, ie; uniform allowance, washing, mess allowance etc should be
uniform throughout the country.

6. Promotional opportunities
For promotion to the post of ward sister, post basic Bsc Nursing is made an essential
qualification. The principle of possessing higher qualification than the category to be supervised,
should apply fro all levels and categories of nursing personnel in the rural and urban areas. The
committee recommends that along with education and experience, there is a need to increase the
number of posts in the supervisory cadre, and for making provision of guidance and supervision
during evening and night shifts in the hospital.
Each nurse must have 3 promotions during the service period.
Promotion is based on merit cum seniority.
Promotion to the senior most administrative teaching posts is made only by open selection.
In cases of stagnation, selection grade and running scales to be given.

7. Career development
-provision of deputation for higher studies after 5 yrs of regular services be made by all states.
The policy of giving deputation to 5 -10 % of each category be worked out by each state. Every
nursing personnel must have an opportunity to attend at least one refresher course every 2 years.

8. Accommodation
As far as possible, the nursing staff should be considered for priority allotment of
accommodation near to work place. Hospitals should not build nurse's hostel for trained nurses.
Apartment type of accommodation is built where married/unmarried nurses can be allowed to
live. Housing colonies for hospital s must be considered in long run.

9. Transport
During odd hours, calamities etc arrangements for transport must be made for safety and security
of nursing personnel.

10. Special incentives
Scheme of special incentives in terms of awards, special increment for meritorious work for
nurses working in each state/district/PHC to be worked out.

11. Occupational hazards
Medical facilities as provided by the central govt. by extended by the state govt to nursing
personnel till such times medical services are provided free to all the nursing personnel. Risk
allowance to be paid to nursing personnel working in the rural $ urban area.

12. Other welfare services
Hospitals should provide welfare measures like crche facilities for children of working staff,
children education allowance, as granted to other employees, be paid to nursing personnel.

Additional Facilities For Nurses Working In The Rural Areas
Family accommodation at sub centre is a must for safety and security of ANM's /LHV.
Women attendant, selected from the village must accompany the ANM for visits to other
The district public health nurse is provided with a vehicle for field supervision.
Fixed travel allowance with provision of enhancement from time to time.
Rural allowance as granted to other employees is paid to nursing personnel.

Nursing education to be fitted into national stream of education to bring about uniformity,
recognition and standards of nursing education. The committee recommends that;
1. There should be 2 levels of nursing personnel - professional nurse (degree level) and
auxiliary nurse (vocational nurse). Admission to professional nursing should be with 12
yrs of schooling with science. The duration of course should be 4 yrs at the university
level. admission to vocational /auxiliary nursing should be with 10 yrs of schooling .The
duration of course should be 2 yrs in health related vocational stream.
2. All school of nursing attached to medical college hospitals is upgraded to degree level in
a phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated with
senior secondary boards.
4. Post certificate BSc Nursing degree to be continued to give opportunities to the existing
diploma nurses to continue higher education.
5. Master in nursing programme to be increased and strengthened.
6. Doctoral programmes in nursing have to be started in selected universities.
7. Central assistance be provided for all levels of nursing education institutions in terms of
budget( capital and recurring)
8. Up gradation of degree level institutions be made in a phased manner as suggested in
9. Each school should have separate budget till such time is phased to degree/vocational
programme. The principal of the school be the drawing and the disbursing officer.
10. Nursing personnel should have a complete say in matters of selection of students.
Selection is based completely on merit. Aptitude test is introduced for selection of
11. All schools to have adequate budget for libraries and teaching equipments.
12. All schools to have independent teaching block called as School Of Nursing with
adequate class room facilities, library room, common room etc as per the requirements of
13. Adequate accommodations are provided to students. A maximum of 3 students to share a
room. Rooms to be furnished with light, study table , chair etc. Adequate dining room,
toilets and bathrooms facilities to be provided in each hostel as per norms recommended.
14. Students should learn under supervision in the wards. Tutors/clinical instructors must go
to the ward with students. Students should not be used for the service of the hospital.
15. Community nursing experience should be as per INC requirements. Necessary transport
and accommodation at PHC be made available for safety, security and meaningful
learning of students.
16. INC requirements for staffing the schools and meeting the minimum requirements are
followed by all schools as these are statutory requirements.
17. Speciality courses at post-graduate level be developed at certain special centres of
excellence eg; AIIMS.
18. Institutes like National Institute of Health and Family welfare, RAK College of Nursing
and several others may develop courses on nursing administration for senior nursing
leading to doctorate level.
19. Provision for higher training abroad and exchange programmes is made.
Continuing Education And Staff Development
Definite policies of deputing 5-10% of staff for higher studies are made by each state.
Provision for training reserve is made in each institution.
Deputation for higher study is made compulsory after 5 yrs.
Each nursing personnel must attend 1 or 2 refresher course every year.
Necessary budgetary provision be made,
A National Institute for Nursing Education Research and Training needs to be established
like NCERT, for development of educational technology, preparation of textbooks,
media, / manuals for nursing.
1. Definite nursing policies regarding nursing practice be available in each institution
.These policies include:
a) Qualification/recruitment rules
b) Job description/job specifications
c) Organisational chart of the institutions
d) Nursing care standards for different categories of patients.
1. Staffing of the hospitals should be as per norms recommended.
2. District hospitals /non teaching hospitals may appoint professional teaching nurses in the
ratio of 1; 3 as soon as nurses start qualifying from these institutions.
3. Students not to be counted for staffing in the hospitals
4. Adequate supplies and equipments, drugs etc be made available for practice of nursing.
The committee strongly recommends that minimum standards of basic equipment
needed for each patient be studied , norms laid down and provided to enable nurses to
perform some of the basic nursing functions . Also there should be a separate budget
head for nursing equipment and supplies in each hospitals/ PHC. The NS and PHN
should be a member of the purchase and condemnation committee.
5. Nurses to be relieved from non -nursing duties.
6. Duty station for nurses is provided in each ward.
7. Necessary facilities like central sterile supplies, linen, drugs are considered for all major
hospitals to improve patient care. Also nurses should not be made to pay for breakage
and losses. All hospitals should have some systems for regular assessment of losses.
8. Provision of part time jobs for married nurses to be considered. (min 16-20hrs/week)
9. Re-entry by married nurses at the age of 35 or above may also be considered and such
nurse be given induction courses for updating their knowledge and skills before
10. Nurses in senior positions like ward sisters, Asst. nursing superintendents, Deputy NS;
N.S must have courses in management and administration before promotions.
11. Nurses working in speciality areas must have courses in specialities. Promotion
opportunities for clinical specialities like administrative posts are considered for
improving quality nursing services.
The committee recommends that Gazetted ranks be allowed for nurses working as ward sister
and above (minimum class II gazetted). Similarly the post of Health Supervisor (female) is
allowed gazetted rank and district public health nurse be given the status equal to district
medical/ health officers.

Community nursing services
Appointment of ANM/LHV to be recommended.
ANM/LHV promoted to supervisory posts must undergo courses in administration and
Specific standing orders are made available for each ANM/LHV to function effectively in
the field.
Adequate provision of supplies, drugs etc are made.
Recording system be simplified.
Posts of public health nurses and above are given gazetted status.
Norms recommended for nursing service and education hospital setting.
1. Nursing Supdt -1: 200 beds (hospitals with 200 or more beds).
2. Dy. Nsg. Supdt. - 1: 300 beds ( wherever beds are over 200)
3. Asst. Nsg . Supdt - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients) 30% leave
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
For specialised depts such as operation theatre, labour room etc- 1: 25 30% leave reserve.
Community nursing services
1 ANM for 2500 population ( 2 per sub centre)
1 ANM for 1500 population for hilly areas
1 health supervisor for 7500 population( for supervision of 3 ANM's)
1 public health nurse for 1 PHC ( 30000 population to supervise 4 Health Supervisors )
1 Public Health Nursing Officer for 100000 population ( community health centre)
2 district public health nursing for each district.
Teaching staff for schools/colleges of Nsg as per INC
1 Nurse Teacher to 10 students for post graduate programmes.

1. INC and state nursing council acts be amended to provide for control by INC on states
nursing councils.
2. Provision of more nurse members.
3. Provision for regulation of nursing education standards by timely inspections and follow
4. Provision of maintaining of minimum standards of nursing practice
5. Provision of regulation for nursing care standards in private nursing homes.
6. Provision for regulation for private nursing bureaus and practice by unqualified nurses.
7. Provision of approval of INC before opening a SON or CON.
8. Provision of renewal of registration every 5 yrs.
9. Provision of independent practice of nursing by nurses.
10. INC to set up a national examination system in about 10 yr time to regulate standards of
nursing education.
Also, the positions up to the DADG level are proposed to be at the office of the Directorate
General of Health Services. The positions below the level of DADG are to exist at the
institutions governed by the central govt.
The Principal, College Of Nursing will be equal to the rank of ADG (N) and will be eligible
for promotion to the post of DDG (N)/ Addl. (N). The salary scales and structure of the staff of
colleges of nursing will be as per norms of INC and the UGC.

The position and status of nursing personnel working in the directorates need up gradation and
expansion of the nurse to enable the nurses to participate in policy making and decision making.
Total nursing components, i.e., nursing education, nursing service and community nursing
should be under the control of nursing personnel at all the levels. I.e. At centre, stateand district
level. At every level adequate provision of budget should be made for development of nursing
The organisational structure recommended for centre, state and district level is as follows.
1. Each ADG level nurse to deal with continuing education /research component for
specialised areas.
2. Selection to these posts is made on merit and not by seniority alone.
3. Nurses appointed these posts must have courses in administration, management and fiscal
4. Railway board, state insurance (labour minister), post $ telegraph union, territories
(Delhi), municipal corporations etc to create such posts for control, co-ordination and
development of nursing personnel.
NB: The principal, college of nursing will be equal to the rank of ADG (N) and will be eligible
for promotion to the post of DDNS/ DNS. The salary and structure of college of nursing will be
as per as norms of INC and UGC.

There is a need for national nursing policy within the framework of national health policy and
national health planning.
Eg. High Power Committee by Government of West Bengal
Government of West Bengal, constituted a High Power Committee with Justice Chittatosh
Mookerjee, formerly Chief Justice of Bombay High Court, as Chairman and five other members
on 7th January, 2004with the following terms of reference :
i) The Committee shall examine the State medical infrastructure available within the State:
ii) The Committee while examining the State medical infrastructure facilities, may invite written
representation/memorandum from any individual, organization, association and local body:
iii) The Committee may examine any other aspects of the State health care system as may be
considered necessary in the light of the judgement of Hon'ble Court:
iv) While giving its report, the Committee shall suggest the measures to be taken by the
Recommendations on preventive and primary health care.
i) The epidemiological surveillance system should be geared up with the support of the field staff
as well as the Panchayat Raj Institutions.
ii) Primary health care, public health programmes, nutrition schemes, and school health
programmes should be coordinated with a view to reducing incidence of diseases.
iii) Steps should be initiated to ensure the effective functioning of rural hospitals by placement of
Specialists, particularly Anaesthetists and Radiologists.
iv) Simple labour cases without complication should be tackled in BPHCs and rural hospitals for
which necessary infrastructure is to be organized.
v) Special hands-on training programmes need to be organised in a nodal institution for newly
recruited medical officers for at least one month. Management/administrative training
programmes also need to be organised for the Superintendents of secondary level hospitals.
vi) Refresher training programmes on public health should be organized regularly for CMOH,
Dy. CMOH, ACMOH and Programme Officers.
vii) Speciality and super speciality facilities outside the Kolkata metropolitan area should be
organised on a regional basis, most importantly in the area of Neurosurgery and Trauma Centre,
Dialysis units, Cardiology, Cardiac Surgery, Casualty and ICCU, preferably on public private
viii) Regular periodic visits of senior level health administrators to the field units for the purpose
of implementation, monitoring, supervision and evaluation should be insisted upon.
ix) The present nurse-bed ratio (1:5) which was laid down in 1957 should be reviewed in the
light of developments since and a more realistic ratio arrived at.
x) Adequate supply of modern Tissue Culture Anti-rabic Vaccine (ARV) is to be ensured at the
earliest in the interest of a better health care delivery system.
xi) The fact remains that almost 50% of deliveries still take place in home situations.
Recognising this fact it is necessary that facilities for ante-natal checkups and home delivery
should be augmented in terms of expertise and infrastructure

It was observed that nurses are not involved in making policies that govern their status and
practice. They are invariably excluded from the govt bodies that decide decide these policies.
Most of the decisions concerning nursing care and nurses are made by other people, usually
physicians without the benefit of professional input from by nurses. It is possible that this
situation is the direct result of lack of appropriate status accorded to the nursing staff. Nearly
97% of nursing staff are in group "c "category and their status are too low.