Nurse Practitioners in India; a way forward

A nurse practitioner (NP) is a registered nurse with advanced academic and clinical experience, which enables them to diagnose and manage most common and many chronic illnesses, either independently or as part of a health care team. Also there is a great need to establish a postgraduate program titled Nurse Practitioner in Critical Care to meet the challenges and demands of tertiary health care services in India which is reflected in the National Health Policy in order to provide quality care to critically ill patients and families.

Indian Nursing Council also believes that a variety of educational strategies can be used in the clinical settings to address the deficit of qualified critical care nursing faculty. It is hoped to facilitate developing policies towards licensure and create cadre positions for appropriate placement of these postgraduate critical care NPs in tertiary care centers.
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Not Enough Doctors

The doctor-population ratio in India is 1:1456 against the WHO recommendation of 1:1000. The supporting role of trained nursing staff to the practitioners when the latter examines and initiates a course of treatment for patients is very important.

India has shortage of an estimated 600,000 doctors and 2 million nurses, say scientists who found that lack of staff who are properly trained in administering antibiotics is preventing patients from accessing live-saving drugs. Even when antibiotics are available, patients are often unable to afford them. High out-of-pocket medical costs to the patient are compounded by limited government spending for health services, according to the report by the Center for Disease Dynamics, Economics & Policy (CDDEP) in the US.

Given that the Primary Healthcare Centres (PHCs) are the basic structural and functional unit of the public health services, it is important to ensure that India starts by addressing the shortage of doctors in that area. As per the 2018 government data, 10 Indian states face a shortage of doctors at the PHC level.
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Policies around the Nurse Practitioner Cadre

The National Health Policy (2017) recognizes redesigning the healthcare delivery system and establishing cadres like NPs and public health nurses to increase their availability in most needed areas.

The introduction of the NP role is a well thought solution to bridge the widening gap between the populations and demand for primary care physicians. The introduction of the NP role is a better way to meet these challenges. The union government is considering creating a cadre of NPs to address the shortage of doctors in rural areas.

The Indian Nursing Council (INC) implemented a NP in the critical care program with the approval of the MoHFW all over the country since 2017 to expand the role of registered nurses. INC has signed a memorandum of understanding (MoU) with the University of Houston College of Nursing in April 2018. In continuation of MoU, INC invited two faculties from the University of Houston to share and guide in the implementation of the nurse practitioner in critical care (NPCC) and a doctorate of nursing practice (DNP) programs in India.
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Challenges in the implementation of NP role in India



  • Lack of clearly defined policy.

  • Restrictive government legislation and regulations for nurse practitioner (NP) practices.

  • Insufficiently trained nursing faculty and clinical facility to train NPs.

  • Scarce in preparation of nurses in biomedical subjects at the undergraduate levels, such as anatomy, physiology, pathology, pathophysiology & pharmacology, etc.

  • Reluctant or refusal of other health care workers to work collaboratively with NPs.


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Section - 5

We have reimagined the ways how the process of new age policy making would be.

Over the last decade, the government has taken a more professional approach to policy making.There has been a movement away from policy advice by generalists to one informed by concepts of risk, management, and delivery of services.

Our approach to policy advisory incorporates the perspectives of ministers as well as civil servants, since policy is the responsibility of both parties, and a product of their joint efforts. Bureaucrats, members of standing committees, joint parliamentary committees and opinion leaders can be persuaded to take a more proactive and participatory role in the emerging grey areas in policy dialogues.
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Section -6

India remains a complex market. It is best to view India not as a single market, but as a series of interconnected regional markets where the regulatory and investment climate changes from one state to another.

Many states have created investment cells to attract business and have framed policies around them but the lack of coherence between the launch of new policy initiatives and policy stewardship leaves a lot to be desired. While most of the state civil servants acknowledge that they have to be innovative in their approach, there is a lack of clarity over what this means in practice. The ensuing implementation of reform policies is therefore likely to be heavily shaped by the culture. It has been the case that few states in India, receive the new policy ideas like Smart City Mission and Ayushman Bharat very attractive and scalable yet difficult to implement due to logistical and legacy issues.

To correct such perceptual anomalies and resistance, policy discussion needs to be tailored to the culture and existing economic opportunity present in the state.
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Section -7

Many companies have attained stepladder growth by identifying the winds of change in policies, which sometimes open up new business models. Those companies are also able set the agenda for future industry reforms through sustained dialogues.

Policy agenda might be construed as a specific policy ask, but this is not always the case. Moreover, a good policy agenda is accomplished only after several revisions, lengthy discussions, and healthy debate. Therefore, in the best interest of industry, leading companies deliberate, discuss and voice their concerns to the policy makers and parliamentarians.

Given the potential for a seismic shift in our nation’s political and regulatory landscape, we believe; these are times when close attention should be paid to regulatory developments. In times to come, when regulatory supervision is only going to increase, more proactive companies would continue to bear the fruit of favourable and accommodating rules.
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Section -8

The ripple effects of a tumultuous 2020 are likely to be even more enduring and impactful than the forces that initially triggered them. In the aftermath of Covid the government is determined to build the economy through incentives like PLI schemes to boost domestic manufacturing, amending FDI regulations, setting aside startup funds, accelerating digital transformation, building infrastructure and going ahead with its ambitious disinvestment and asset monetization plans.

All of this would entail administrations pulling regulatory and legislative levers to implement its priorities. We are here to help your business along with implications for how to respond to shifts. Numerous companies and hyper growth startups have been a beneficiary of our advocacies and interventions.
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Section - 9

We have reimagined the ways how the process of new age policy making would be.

Over the last decade, the government has taken a more professional approach to policy making.There has been a movement away from policy advice by generalists to one informed by concepts of risk, management, and delivery of services.

Our approach to policy advisory incorporates the perspectives of ministers as well as civil servants, since policy is the responsibility of both parties, and a product of their joint efforts. Bureaucrats, members of standing committees, joint parliamentary committees and opinion leaders can be persuaded to take a more proactive and participatory role in the emerging grey areas in policy dialogues.
bt_bb_section_top_section_coverage_image
bt_bb_section_bottom_section_coverage_image

Section -10

India remains a complex market. It is best to view India not as a single market, but as a series of interconnected regional markets where the regulatory and investment climate changes from one state to another.

Many states have created investment cells to attract business and have framed policies around them but the lack of coherence between the launch of new policy initiatives and policy stewardship leaves a lot to be desired. While most of the state civil servants acknowledge that they have to be innovative in their approach, there is a lack of clarity over what this means in practice. The ensuing implementation of reform policies is therefore likely to be heavily shaped by the culture. It has been the case that few states in India, receive the new policy ideas like Smart City Mission and Ayushman Bharat very attractive and scalable yet difficult to implement due to logistical and legacy issues.

To correct such perceptual anomalies and resistance, policy discussion needs to be tailored to the culture and existing economic opportunity present in the state.
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