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INTRODUCTION The retarded development of nursing and nursing profession seems to be mainly due to the fact that 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. RECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND NURSING PROFESSION 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.
In cases of stagnation. The policy of giving deputation to 5 -10 % of each category be worked out by each state. ie. 8. the nursing staff should be considered for priority allotment of accommodation near to work place. 6. calamities etc arrangements for transport must be made for safety and security of nursing personnel. • • • • Each nurse must have 3 promotions during the service period. The committee recommends that along with education and experience. However special allowance for nursing personnel. Hospitals should not build nurse's hostel for trained nurses. Promotion is based on merit cum seniority. mess allowance etc should be uniform throughout the country. Promotional opportunities For promotion to the post of ward sister. 10. selection grade and running scales to be given. Promotion to the senior most administrative teaching posts is made only by open selection. The principle of possessing higher qualification than the category to be supervised. Accommodation As far as possible. . post basic Bsc Nursing is made an essential qualification. 7. Special incentives Scheme of special incentives in terms of awards. there is a need to increase the number of posts in the supervisory cadre.5. and for making provision of guidance and supervision during evening and night shifts in the hospital. Transport During odd hours. special increment for meritorious work for nurses working in each state/district/PHC to be worked out. Housing colonies for hospital s must be considered in long run. Pay and allowances Uniformity of pay scales of all categories of nursing personnel is not feasible. Apartment type of accommodation is built where married/unmarried nurses can be allowed to live. Every nursing personnel must have an opportunity to attend at least one refresher course every 2 years. washing. uniform allowance. should apply fro all levels and categories of nursing personnel in the rural and urban areas. 9. Career development provision of deputation for higher studies after 5 yrs of regular services be made by all states.
All school of nursing attached to medical college hospitals is upgraded to degree level in a phased manner. • • • • . admission to vocational /auxiliary nursing should be with 10 yrs of schooling . be paid to nursing personnel. Fixed travel allowance with provision of enhancement from time to time. The district public health nurse is provided with a vehicle for field supervision. 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. Master in nursing programme to be increased and strengthened. Women attendant. The committee recommends that. The duration of course should be 4 yrs at the university level.The duration of course should be 2 yrs in health related vocational stream.11. children education allowance. Admission to professional nursing should be with 12 yrs of schooling with science. 12. NURSING EDUCATION Nursing education to be fitted into national stream of education to bring about uniformity. Occupational hazards Medical facilities as provided by the central govt. Risk allowance to be paid to nursing personnel working in the rural $ urban area. recognition and standards of nursing education. Post certificate BSc Nursing degree to be continued to give opportunities to the existing diploma nurses to continue higher education. selected from the village must accompany the ANM for visits to other villages. All ANM schools and school of nursing attached to district hospitals be affiliated with senior secondary boards. • There should be 2 levels of nursing personnel . as granted to other employees. by extended by the state govt to nursing personnel till such times medical services are provided free to all the nursing personnel. Rural allowance as granted to other employees is paid to nursing personnel. Other welfare services Hospitals should provide welfare measures like crèche facilities for children of working staff.professional nurse (degree level) and auxiliary nurse (vocational nurse).
Students should learn under supervision in the wards. Selection is based completely on merit. INC requirements for staffing the schools and meeting the minimum requirements are followed by all schools as these are statutory requirements. Central assistance be provided for all levels of nursing education institutions in terms of budget( capital and recurring) Up gradation of degree level institutions be made in a phased manner as suggested in report. Adequate dining room.• • • • • • • • Doctoral programmes in nursing have to be started in selected universities. • • • • • • • • • • • . A maximum of 3 students to share a room. Continuing Education And Staff Development Definite policies of deputing 5-10% of staff for higher studies are made by each state. Necessary transport and accommodation at PHC be made available for safety. common room etc as per the requirements of INC. chair etc. Nursing personnel should have a complete say in matters of selection of students. Each school should have separate budget till such time is phased to degree/vocational programme. All schools to have adequate budget for libraries and teaching equipments. Community nursing experience should be as per INC requirements. study table . Students should not be used for the service of the hospital. AIIMS. Tutors/clinical instructors must go to the ward with students. Institutes like National Institute of Health and Family welfare. security and meaningful learning of students. Necessary budgetary provision be made. library room. All schools to have independent teaching block called as School Of Nursing with adequate class room facilities. Speciality courses at post-graduate level be developed at certain special centres of excellence eg. Each nursing personnel must attend 1 or 2 refresher course every year. Provision for higher training abroad and exchange programmes is made. Adequate accommodations are provided to students. toilets and bathrooms facilities to be provided in each hostel as per norms recommended. Rooms to be furnished with light. Provision for training reserve is made in each institution. Aptitude test is introduced for selection of candidates. Deputation for higher study is made compulsory after 5 yrs. RAK College of Nursing and several others may develop courses on nursing administration for senior nursing leading to doctorate level. The principal of the school be the drawing and the disbursing officer.
media.• A National Institute for Nursing Education Research and Training needs to be established like NCERT. Provision of part time jobs for married nurses to be considered. . The committee strongly recommends that minimum standards of basic equipment needed for each patient be studied . Also nurses should not be made to pay for breakage and losses. District hospitals /non teaching hospitals may appoint professional teaching nurses in the ratio of 1. Promotion opportunities for clinical specialities like administrative posts are considered for improving quality nursing services. Nurses to be relieved from non -nursing duties. Nurses working in speciality areas must have courses in specialities. N. drugs etc be made available for practice of nursing.S must have courses in management and administration before promotions. nursing superintendents. (min 16-20hrs/week) 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 employment. The NS and PHN should be a member of the purchase and condemnation committee. drugs are considered for all major hospitals to improve patient care. Nurses in senior positions like ward sisters. 3 as soon as nurses start qualifying from these institutions. Staffing of the hospitals should be as per norms recommended. Also there should be a separate budget head for nursing equipment and supplies in each hospitals/ PHC. NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS) Definite nursing policies regarding nursing practice be available in each institution . for development of educational technology.These policies include: a) b) c) d) Qualification/recruitment rules Job description/job specifications Organisational chart of the institutions Nursing care standards for different categories of patients. Duty station for nurses is provided in each ward. linen. All hospitals should have some systems for regular assessment of losses. 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. norms laid down and provided to enable nurses to perform some of the basic nursing functions . Deputy NS. Students not to be counted for staffing in the hospitals Adequate supplies and equipments. Necessary facilities like central sterile supplies. preparation of textbooks. The committee recommends that Gazetted ranks be allowed for nurses working as ward sister and above (minimum class II gazetted). Asst. / manuals for nursing.
Dy. Nsg.1: 100 patients ( 1 bed : 5 out patients) 30% leave reserve For ICU -1:1(or 1:3 for each shift) 30% leave reserve For specialised depts such as operation theatre. labour room etc. Supdt .Community nursing services Appointment of ANM/LHV to be recommended. Nsg .1: 300 beds ( wherever beds are over 200) Asst. Norms recommended for nursing service and education hospital setting. Recording system be simplified. 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.1: 100 Ward sister/ward supervisor . . . Nursing Supdt -1: 200 beds (hospitals with 200 or more beds). drugs etc are made. Teaching staff for schools/colleges of Nsg as per INC 1 Nurse Teacher to 10 students for post graduate programmes. Adequate provision of supplies. Supdt. Posts of public health nurses and above are given gazetted status.1:25 beds 30% leave reserve Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve For nurses OPD and emergency etc .1: 25 30% leave reserve. Specific standing orders are made available for each ANM/LHV to function effectively in the field. • • • • • • ANM/LHV promoted to supervisory posts must undergo courses in administration and management.
Provision for regulation for private nursing bureaus and practice by unqualified nurses. nursing education. the positions up to the DADG level are proposed to be at the office of the Directorate General of Health Services. Provision of renewal of registration every 5 yrs. The positions below the level of DADG are to exist at the institutions governed by the central govt.e. (N). The salary scales and structure of the staff of colleges of nursing will be as per norms of INC and the UGC. I.. nursing service and community nursing should be under the control of nursing personnel at all the levels. Provision of independent practice of nursing by nurses. At every level adequate provision of budget should be made for development of nursing profession. Provision of maintaining of minimum standards of nursing practice Provision of regulation for nursing care standards in private nursing homes. Provision of approval of INC before opening a SON or CON.NURSING LEGISLATION • • • • • • • • • • • INC and state nursing council acts be amended to provide for control by INC on states nursing councils. Total nursing components. i. At centre. INC to set up a national examination system in about 10 yr time to regulate standards of nursing education.e. . ORGANISATION OF NURSING SERVICES 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. stateand district level. Provision for regulation of nursing education standards by timely inspections and follow up. • Ø 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. Provision of more nurse members. Ø Also.
and school health programmes should be coordinated with a view to reducing incidence of diseases. Nurses appointed these posts must have courses in administration. Eg. nutrition schemes. NATIONAL NURSING POLICY There is a need for national nursing policy within the framework of national health policy and national health planning. 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. municipal corporations etc to create such posts for control. public health programmes. Railway board. state and district level is as follows. NB: The principal. . organization. iii) Steps should be initiated to ensure the effective functioning of rural hospitals by placement of Specialists.The organisational structure recommended for centre. constituted a High Power Committee with Justice Chittatosh Mookerjee. Recommendations on preventive and primary health care. ii) Primary health care. Selection to these posts is made on merit and not by seniority alone. • • • • Each ADG level nurse to deal with continuing education /research component for specialised areas. the Committee shall suggest the measures to be taken by the Government. college of nursing will be equal to the rank of ADG (N) and will be eligible for promotion to the post of DDNS/ DNS. particularly Anaesthetists and Radiologists. may invite written representation/memorandum from any individual. state insurance (labour minister). as Chairman and five other members on 7th January. i) The epidemiological surveillance system should be geared up with the support of the field staff as well as the Panchayat Raj Institutions. High Power Committee by Government of West Bengal Government of West Bengal. post $ telegraph union. management and fiscal management. 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 salary and structure of college of nursing will be as per as norms of INC and UGC. territories (Delhi). co-ordination and development of nursing personnel. formerly Chief Justice of Bombay High Court.
v) Special hands-on training programmes need to be organised in a nodal institution for newly recruited medical officers for at least one month. vii) Speciality and super speciality facilities outside the Kolkata metropolitan area should be organised on a regional basis. preferably on public private partnership.iv) Simple labour cases without complication should be tackled in BPHCs and rural hospitals for which necessary infrastructure is to be organized. 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. ACMOH and Programme Officers. Recognising this fact it is necessary that facilities for ante-natal checkups and home delivery should be augmented in terms of expertise and infrastructure CONCLUSION It was observed that nurses are not involved in making policies that govern their status and practice. monitoring. Cardiology. It is possible that this situation is the direct result of lack of appropriate status accorded to the nursing staff. Dy. usually physicians without the benefit of professional input from by nurses. Management/administrative training programmes also need to be organised for the Superintendents of secondary level hospitals. Nearly 97% of nursing staff are in group "c "category and their status are too low . CMOH. supervision and evaluation should be insisted upon. Most of the decisions concerning nursing care and nurses are made by other people. They are invariably excluded from the govt bodies that decide decide these policies. most importantly in the area of Neurosurgery and Trauma Centre. Casualty and ICCU. 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. vi) Refresher training programmes on public health should be organized regularly for CMOH. xi) The fact remains that almost 50% of deliveries still take place in home situations. Dialysis units. viii) Regular periodic visits of senior level health administrators to the field units for the purpose of implementation. Cardiac Surgery.
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