Educational Preparations in India

Nursing education consists of theoretical and practical training that helps in preparation of student
nurses as the health care professionals at primary, secondary and tertiary levels. The nursing students
are taught by nurse educators and other medical professionals who are qualified and experienced for the
said educational tasks. However, there are multiple entry levels into nursing; and bit confusing for the
public, even to other health professionals. In India, the earliest nursing schools offered diploma
programs. Universities then began to offer Bachelor degrees, followed by M. Phil. & Ph. D. (N).
Nursing courses in India
Medium of Examination
Course Entry level Duration Certificate
instruction Body
ANM 12th Pass (any stream) 2 Years Regional/English Board Diploma
th
GNM 12 Pass with aggregate of 40% 3 Years Regional/English Board Diploma
Basic B. Sc. (N) 12th Pass (science stream) 45% 4 Years English University Degree
PB B. Sc. (N) Those who completed GNM 2 - 3 Yrs English University Degree
M. Sc. (N) Completed B. Sc./ PB B. Sc. (N) 2 Years English University Master Degree
M. Phil nursing Those who completed M. Sc. (N) 1 – 2 Yrs English University M. Phil Degree
Ph. D. in nursing Completed M. Sc./ M. Phil (N) 3 – 4 Yrs English University Ph. D. Degree

Post Basic Diploma Programs: One year Post Basic Diploma programs are available to prepare registered
nurses to acquire in-depth knowledge and skills in specialized areas of nursing. It aims to prepare them
to function effectively and efficiently in their specific area of nursing. The course listed below -
No. Post Basic Diploma Programs No. Post Basic Diploma Programs
1 Cardiothoracic Nursing 7 Operation Room Nursing
2 Critical Care Nursing 8 Psychiatric Nursing
3 Emergency and Disaster Nursing 9 Renal Nursing
4 Neonatal Nursing 10 Orthopedic & Rehabilitation Nursing
5 Neurology Nursing 11 Burns Nursing
6 Oncology Nursing 12 Geriatric Nursing

Short Term Nursing Courses / Certificate Courses in India: Apart from Post Basic Diploma Programs,
there are various certificate courses available for registered nurses to work in specialized areas of
nursing. The duration of these certificate courses may ranges from 1 week to 6 months. For example –
 Certificate course in waste management (CWM)
 Certificate course in home nursing
 Certificate course in MCH care (CMCHC)
 Certificate course in primary nursing management (CPNM)
 Certificate course in management of burns
 Certificate course in medical nursing assistant (CMNA)
 Certificate program in nursing management
  Certificate course in urology nursing
 Certificate course in renal transplant nursing
 Acute pain management certificate course in nursing
 Certificate course in neonatal nursing
 Certificate course in geriatric nursing

Auxiliary Nurse Midwifery: course is designed to prepare the student nurses to develop knowledge and
skill especially on maternal and child health through integration of theory and practice that required
serving in village level and public health centers, so the student nurse can assume the position of
Registered Auxiliary Nurse Midwife (RANM). The course of study leading to auxiliary nurse midwifery is a
full time diploma program comprises of two completed academic years including internship.
General Nursing and Midwifery: Course is designed to prepare the student nurses to develop
knowledge, skills, competencies and standards that required to practice in ever changing health care
setting through integration of theory and practice, so the student nurse can assume the position of
registered nurse (RNRM) in clinical and public health setting. The course of study is a full time diploma
program comprises of three completed academic years including internship
Basic B. Sc. Nursing: Course is designed to prepare the student nurses to develop critical thinking skills,
competencies and standards that required to practice in ever changing health care setting through in
depth integration of theory, practice and research, so the graduate registered nurse (RNRM) can assume
the role as nurse clinician, ward supervisor, manager, nurse teacher and many more in different health
care system. The course of study leading to Basic B. Sc. Nursing is a full time degree program comprises
of four completed academic years including research work and internship.
Post Basic B. Sc. Nursing: Course is designed to prepare the registered nurses to enhance knowledge and
skill acquired during their diploma, through in depth integration of theory, practice and research, so
graduate registered nurse (additional qualification) can assume the roles as nurse clinician, ward
supervisor, manager, nurse teacher and many more in different health care system. In addition, it also
provides an opportunity as a bridge for higher education in nursing. The course is a full time degree
program comprises of two completed academic years including research work.
Masters of Science in nursing: Masters of Science in nursing provides an excellent opportunity for the
post graduate students to develop leadership qualities that aids to practice in first level positions
independently and efficiently as a nurse specialist, educator, administrator, and researcher in various
health sector. The course of study leading to masters of Science in nursing is a full time program (no part
time / no correspondence course) comprises of two completed academic years including research work.
M. Phil and Ph. D in Nursing: Now there are several universities offering M. Phil and Ph. D programs in India.
M. Phil is one-year program (fulltime), or two-year program (part time) for the candidates those who are
completed Masters of Science in nursing. Further, Ph. D is three-year program (fulltime) or four-year
(part time) for the candidates those who are completed Masters in nursing.

Post Diploma Courses in Nursing

Nurses have more recruitment opportunities when they do Post Graduate Diploma and certificate
courses in nursing after Bachelor Degree or M.Sc Nursing. Various government and Private medical
institution and Hospitals offer Post Graduate diploma and certificate courses. If nurses need to work in
specialized department in Hospital sector, the following courses give more value for career development
and abroad opportunities.
 Post Diploma in Cardio Thoracic Nursing : is designed to train registered nurses to provide advance
quality care to patients with Cardio Thoracic disorders and their families. The program will equip
the nurses with specialized knowledge and skills required for the treatment of cardiovascular
problems with surgery, medication, and lifestyle recommendations and management of a cardio-
thoracic unit.
 Post Diploma in Neuro Science nursing: prepares registered nurses with specialized knowledge,
skills and attitude in providing advanced quality care to patients with neurological disorders.
Students undertaking this course have the opportunity to apply theory to practice during clinical
placements in the areas of Neuro Intensive Care, Neuro-medicine and Neurosurgery.
 Post Basic Diploma in Operation Room Nursing : This course is designed to provide care and
support to patients before, during and after surgery.
 Post Basic Diploma in Critical Care Nursing : This program aims to develop and apply advanced
nursing care knowledge and skills for providing comprehensive nursing care to critically ill
patients in intensive care settings. It covers various specialties of Surgery, Medicine, Cardiac,
Renal, Neurosciences, Hematology, Obstetrics, Accident & Emergency, Neonatal and Paediatrics.
 Post Basic Diploma in Gerontological Nursing: is designed to strengthen and develop the
knowledge, skills and attitudes of nurses caring for the older adult.
 Post Basic Diploma in Orthopedic and Rehabilitation Nursing: This program equips nurses to care
for patients experiencing musculoskeletal problems. The course is designed to train nurses to
assess, diagnose, treat and care for patients with musculoskeletal problems following trauma,
tumors, chronic degenerative illness and other associated illnesses.
  Post Basic Diploma in Oncology Nursing : This course is designed to provide competent care to
patients with cancer in a safe and effective care environment. Advanced theoretical knowledge,
critical thinking and specialist skills required of an oncology nurse are met by this course.
 Post Basic Diploma in Neonatal Nursing : provides nurses with the skills and knowledge to practice
safely and competently in a variety of neonatal nursing settings, with sick and convalescing
infants.
 Post Basic Diploma in Psychiatric/Mental Health Nursing : is designed to prepare nurses with
specialized knowledge and skills in curative, preventive and promotive aspects of Psychiatric and
mental health care.
 Post Basic Diploma in Emergency and Disaster Nursing : This program is designed to equip nurses
to be competent in life-saving interventions, problem solving, and technical skills in Emergency
settings ranging from wound management and trauma response to disaster preparedness.

 Post Basic Diploma in Renal Nursing: is designed to equip nurses with the theory and skills
necessary to provide evidence based quality care to patients with renal disorders.

 Post Basic Diploma in Burn Nursing : This program equips nurses to gain knowledge of advanced
technologies and practices in burn care and provide comprehensive and holistic care to patients
with burn injuries in emergent, acute and in recovery phases.

Career Prospects / Career Opportunities / Career Development / Continuing Education /

Professional Advancement Practice, Roles and Scope of Nursing Education or Practice
Today nursing is one of the most exciting and in-demand profession in India and worldwide. There is a
great deal of need for skilled and registered nurses in the health field. Talking only of India, we are far -
far away from reaching the adequate nurse - patient ratio. Hence, there are numerous opportunities
available in the private as well as govt. sectors who offer jobs to qualified nurses immediately after
completion of nursing courses.
From large hospitals in central locations to community centers in rural areas, nurses are in demand. The
career opportunities in nursing are projected only in terms of total number of nurses needed  to increase
the size whereas in reality, nurses are in demand within the nursing with a wide variety of specialties and
work settings. There are many specializations, and the job requirements depend on the field, education,
location and employer. Registered nurses have an opportunity to work in a variety of settings such as–
hospitals, assisted living facilities, prisons, nursing homes or physicians’ offices etc.
Career Prospects / opportunities for the professional nurses in India
Nursing is the field that evolving constantly, hence the greatest aspects of nursing is an ability to work in
many types of environments with many different roles and responsibility.
Career opportunities / prospects in Public Health Sector
No. Areas / Sectors Position / Designation / Role / Title
1 Sub-centers Auxiliary Nurse / LHV / Multipurpose Health worker (Female)
2 Primary Health centers Auxiliary Nurse / Nurse / Staff Nurse
3 Community Health centers Auxiliary Nurse / Staff Nurse / Public Health Nurse
4 Rural hospitals Auxiliary Nurse / Staff Nurse / Public Health Nurse
5 District hospitals
6 Specialist hospitals
7 Teaching hospitals Auxiliary Nurse / Staff Nurse / Nursing Sister / Ward in-charge / Ward Sister
Health insurance scheme / Head Nurse / Department Supervisor / Nursing Supervisor / Nursing
8 Sister Grade 1 & 2 / Matron / Nursing Superintendent Grade 1 & 2
hospitals (ESI; state/central)
9 Railway/defence hospitals
10 National health schemes Auxiliary Nurse/Staff Nurse/Nurse Supervisor/Community Health Officer
Govt. colleges / universities Clinical Instructor, Assistant Professor, Associate Professor, Professor, Vice-
11
principal, Principal, Dean / Director, Assistant Registrar, Registrar
13 Nursing councils Secretary, Joint Secretary, President, Director
14 Govt. offices Assistant Director of Nursing, Director of Nursing

Career opportunities / prospects in Private Health Sector

No. Areas / Sectors Position / Designation / Role / Title
Polyclinics, nursing homes,
1 Nurse Assistant / Nurse
dispensaries
Auxiliary Nurse / Staff Nurse / Nursing Sister / Ward in-charge / Ward Sister /
2 Private hospitals
Head Nurse / Department Supervisor / Nursing Supervisor / Nursing Sister
Grade 1 & 2 / Matron / Nursing Superintendent Grade 1 & 2.
3 Private specialist hospitals Critical Care Nurse, Trauma Nurse, Holistic Nurse, Medical-surgical Nurse,
Peri-operative Nurse, Psychiatric Nurse, Radiology Nurse, Oncology Nurse,
Nurse Midwife, Acute Care Nurse, Plastic Surgery Nurse, Telemetry Nurse,
4 Private teaching hospitals ICU Nurse, OT Nurse, Forensic Nurse, Infection Control Nurse, Infusion
Nurse, Ambulatory Care Nurse, etc.
Clinical Instructor, Assistant Professor, Associate Professor, Professor, Vice-
5 Educational institutes
principal, Principal, Dean / Director
6 Factories / industries Industrial Nurse, Occupational Health Nurse, Disaster Management Nurse,
Rehabilitation Nurse, Home Care Nurse, Family Health Nurse, Hospice Nurse,
Home care / Private Disaster Management Nurse, School Health Nurse, Long Term Care Nurse,
7
Practice / Community Public Health Nurse, Prison Nurse, Telephone Triage Nurse, Travel Nurse,
Aerospace Nurse, etc.
Old age homes &
8 Hospice Nurse, Long Term Care Nurse,
orphanages
Career development in nursing consists of formal academic instruction in a defined program of higher
education, licensure, professional continuing education, certification, and advanced practice academic
degrees at the master's and doctoral levels. Requirement for continuing education brings with it an
obligation of the profession to provide the necessary educational programs. The commitment of nurses
extends to work in speciality areas.

After several years of experience, the nurse is eligible to pursue higher / certification course in her
specialty of choice (continuing education). This can often mean more opportunities in the nursing
profession, including leadership or management; and usually means an increase in pay. After working in
a particular specialty for several years they are often chosen as leaders among their peers and are often
promoted into management positions. They can work directly with patients or indirectly by collaborating
with the interdisciplinary team or any other team involved in healthcare.

Nurses work in many different areas of healthcare and the roles often vary within each environment. All
of them can basically be differentiated by either direct or indirect patient care areas.
 Direct Patient Care: the nurse works directly "at bedside" in collaboration with a interdisciplinary
team and his/her primary role is to work "hands-on" with the patients.
 Indirect Patient Care: the nurse works in collaboration with the ‘’bedside Nurse’’ and
‘’interdisciplinary team’’ to support the care of patients. Nurses may not be as "hands-on" as a
direct patient care, and may work in more management or administrative capacities.

Career Opportunities or Prospects of Nurses at Hospital Setting

For nurses with big career aspirations, an advanced nursing practice is a rewarding pathway. These
nursing careers require graduate-level degrees that bridge the gap between theory, practice, and
research performing high-level duties. Further, advanced practice career may hold highly coveted
specialty positions in specialized health care settings. However, there are varieties of areas where nurses
can specialize in and want to be qualified in one or several specialties over the course of their career.
Here are some of the examples of nursing specialty fields / career where registered nurses (RN) can work
at specialized hospital setting / area –

 Clinical Nurse Specialist: is a certified nurse who demonstrates an advanced level of knowledge
and clinical skills in nursing care. They usually focus on education, research, and consulting.

 Nurse Anesthetist: a certified nurse anesthetist who Works in a variety of settings such as:
Hospitals, Outpatient surgery centers, Pain management centers, public Health centers etc.
 Critical Care Nurse: work in hospitals in the critical care or intensive care units. They work with
patients who have pulmonary, respiratory or cardiac failure etc.
 Emergency Room or Trauma Nurse: treats patients with life-threatening conditions such as
accidents, strokes and heart attacks. They work in hospital emergency rooms or as flight nurses on
medical helicopters.
 Holistic Nurse: treat a patient’s mental and spiritual health in addition to their physical health.
They provide care in massage, acupuncture, bio-feedback and aroma therapy.
 Infusion Nurses: administer medications, blood and other fluids into patients’ veins.
 Medical-surgical Nurses: provide basic medical care to a wide variety of patients in both in-
patient and out-patient settings.
 Perianesthesia Nurse: provide pre & post operative care to patients who receive anesthesia.
 Peri-operative Nurse: This RN position assists surgeons by handing surgical instruments, control
bleeding and suturing incisions.
 Psychiatric Nurse: These nurses treat patients with personality and mood disorders.
 Radiologic Nurse: provides care to patients who are undergoing diagnostic radiation
procedures such as ultrasounds and magnetic resonance imaging (MRI).
 Rehabilitation Nurse: care for patients with temporary and permanent disabilities.
 Transplant Nurse: cares for both organ transplant recipients and donors.
 Infection control nurse: is a nurse that specializes in preventing spread of infectious agents,
such as viruses and bacteria.
 Oncology Nurse: care for people of all ages who are diagnosed with cancer.
  Burn Care Nurse: treats and monitors burn wounds, and plays a critical role in the assessment
of emotional and psychological trauma that so often accompanies a burn injury. It calls for a wide
range of clinical skills including triage, pain management, critical care and trauma recovery.
 Acute Care Nurse Practitioner (ACNP) : An acute care nurse practitioner (ACNP) is an advanced-
practice registered nurse who specializes in the care of acutely ill or injured patients. They work
primarily in hospitals and urgent care centers. They diagnose medical problems and order
treatments and medications to help patients recover from sudden illness/injury or exacerbated
chronic conditions.

 Plastic Surgery Nurse: collaborate with surgeons and support staff to help patients achieve
their desired results. These nurses monitor patients during and after procedures, educating them
about what to expect before, during, and after surgery.

 Telemetry Nurse: Sometimes called progressive care nurses, these professionals work in the
telemetry unit of a hospital, where patients are often in critical condition and are in need of
 constant care and observation. In addition to typical nursing duties, telemetry nurses are trained to
monitor patients’ vital signs with electrocardiograms and other technical equipment. This is a great
nursing specialty if you’re passionate about technology and can interpret data.

Non-hospital Career Opportunities of Registered Nurses

A variety of non-hospital nursing career opportunities are also available for registered nurse who doesn’t
want to work in the fast-paced hospital environment. Typically, these jobs require at least a few months
or years of hands-on training in specialized nursing area. Nurses in an alternative environment may
travel, provide in-home care, treat the patients as outpatient basis, or works in an office setting are
known as Advanced Nurse Practitioners.
The Nurse Practitioner provides health care to clients usually in an outpatient, ambulatory, or
community based setting. They treat clients with complex problems and provide more holistic approach
attending to symptoms of non-pathologic conditions, comfort and comprehensiveness of care. Nurse
Practitioner has legal authority to implement patient management by ordering diagnostic tests and
treatments and prescribing medications. Examples of Nurse Practitioner are –
 Adult nurse practitioner (ANP): provide primary, ambulatory care to adults with a non-
emergent acute or chronic illness and in some settings tertiary care. The role includes; case
management, consultation, leadership, education, research, and health policy development.
 Family Nurse Practitioner (FNP) : provides primary ambulatory care for families, usually in
collaboration with a family care physician. The FNP meets the families’ health care needs, manages
some illness by providing direct care, and guides or counsels the family as needed.
 Geriatric Nurse Practitioner (GNP):- are trained in the specialized needs of ageing adults usually
65 & above. They provide healthcare delivering services such as examinations, diagnoses, and
prescriptions, and they evaluate well-being and devise care plans specifically for these individuals.
These professionals deliver primary healthcare services, while working closely with geriatric
physicians. 
 Psychiatric Nurse Practitioner: A psychiatric NP, formally known as a Psychiatric-Mental Health
Nurse Practitioner (PMHNP) is an advanced nursing role that requires a Masters or Doctorate
degree to prepare a Registered Nurse to practice as a provider, independent practitioner, or liaison
in the field of psychiatric and mental health. PMHNP can work as generalists in the field or further
specialize in as geriatric, forensic, psychotherapy, or child and adolescent APPNs.
 Pediatric Nurse Practitioner (PNP): provides specialty care for children in hospital ambulatory
care, emergency care and physician’s offices.
 Nurse Midwife / Women’s Health Nurse Practitioner (WHNP) : provides ambulatory care to
women seeking obstetrical and gynecological health care. Nurse-midwives provide primary care
to childbearing women in a variety of inpatient and outpatient settings including hospitals,
homes and birth centers. They provide care that is informed by core beliefs in patient
autonomy and the importance of supporting physiologic processes, including birth.
 Clinical Nurse Educator: are devoted to teaching nurses who work in healthcare facilities the
skills and knowledge needed to provide the best possible care to their patients.
 Hospice Nurse: provide care for terminally ill patients outside of hospitals.
 Ambulatory Care Nurse: treats patients outside of the hospital setting, either in a physician’s
offices or clinics.
 Long-term Care Nurse: provide services to patients with chronic physical or mental disorders.
 Home Health Care Nurse: provides home care for patients who are recovering from accidents,
surgery and childbirth.
 Occupational Health Nurse: These nurses specialize in providing treatment for job-related
injuries and illnesses. They also help employers detect potential health hazards.
 Family health nurse: is responsible towards maximizing the health and wellbeing of all
individuals within in a family system.
 School Health Nurse: perform a critical role within the school health program by addressing the
major health problems experienced by children. This role includes providing preventive and
screening services, health education and assistance with decision-making about health, and
immunization against preventable diseases.
 Public Health Nurse: work within communities and focus on different areas to improve the
overall health of the people within that community. They look for areas of concern within the
community and assess and plans ways through which the concerns can be resolved or minimized.
 Certified Nurse Midwife (CNM): is responsible for prenatal care, management of labor and delivery,
postpartum care of the mother and the infant, family planning, pap smears and treatment for
vaginal infections. CNM practices with a health care agency that provides medical consultation,
collaborative management and referral.
 Travel Nurse: work for independent staffing agencies. They are assigned to different care areas
on a temporary basis. They Move to different states or overseas for nursing care.
  Forensic Nurse: works with crime victims to gather medical evidence and provide expert
testimony that can be used in court. Forensic nursing is a unique specialty that blends the worlds
of nursing, science, and the legal system.
 Prison Nurse: tasked with providing individualized, direct nursing care for prisoners in
correctional facilities, these nurses evaluate and treat patients routinely and conduct necessary
emergency procedures as necessary.
 Nurse Advocate: works on behalf of patients to maintain quality of care and protect patients'
rights. They intervene when there is a care concern, and following the proper channels, work to
resolve any patient care issues. Realistically, every nurse is an advocate
 Telephone Triage Nurse: (tele-health nursing / tele-pathology) is a nursing specialty designed to
help patients who are unable to reach the hospital. The nurse work in telephone triage must help
patients purely by speaking to them on the phone with regard to the aspects of health and illness.

Role and Responsibilities (functions) of Professional Nurse

Nursing as a profession can offer a meaningful career, filled with many opportunities, challenges, and
rewards that has got a huge demand in India and abroad. The nursing professionals can choose from a
variety of exciting career opportunities depending on their educational background, interests, and
desired level of practice. Changes in the health care system have prompted an expansion and extension
of nurse’s roles in wide variety settings. However, for nurses with big career aspirations, an Advanced
Nursing Practice is a rewarding pathway. Advanced nurses may hold highly coveted specialty positions,
transforming in to extended roles & expanded roles in their specialized areas.

Extended Role: is a responsibility assumed by the registered nurses beyond their traditional functions,
which has the scope of nursing outside the hospitals. Expanded Role: is one in which
a nurse assumes expanded or increased responsibilities within the field of practice, and in most of the
cases they practice with greater autonomy.  It denotes that the nurse functions in specialized area with
an advanced knowledge and skill.

Expanded Role of Registered Nurse / Professional Nurse

 Nurse as a Clinical Specialist: may specialize in specific disease/area of nursing instead of a vague
working pattern. They may be specialized in diabetes mellitus, cancer or cardiac problems or in a
specific field such as pediatrics or gerontology.
 Nurse as an Advanced Nurse Practitioner: a certified nurse with an advanced education provides
a health care to client usually in an out-patient ambulatory care or community based settings.
 They can be an adult nurse practitioner, family nurse practitioner, pediatrics nurse practitioner,
acute care nurse practitioner, gerontology nurse practitioner.
 Nurse as a Researcher:  is specialized in investigate nursing problems to improve nursing care and
to refine and expand nursing knowledge. Researcher involves action taken to implement studies
to determine the actual effect of nursing care to further the scientific base of nursing, can include
all nurses, nurse scientist, graduates and students.
 Nurse as an Administrator: Manager’s position usually requires at least bachelor degree in nursing,
and director and nurse executive positions generally requires a master degree. Chief nursing
executive and vice-resident positions in large health care organization often need preparation at
the doctorate level.
 Nurse as an Educator / Teacher: responsible for educating the patients and families, community,
other health care team member, students, business and government. She/he serves as teacher
for next generation of nurse and staff development department of health care agencies and
client education department.
 Nurse as a Counselor: nurses can help patients and their families to cope with this crisis through
the sensitive use of counseling skills. In doing so, they will also become more aware of their own
beliefs and feelings surrounding the subject.
 Nurse as an Advocate: is a nurse who works on behalf of patients to maintain quality of care and
protect patients' rights. They intervene when there is a care concern, and following the proper
channels, work to resolve any patient care issues. Realistically, every nurse is an advocate.
 Nurse as a Caregiver: provides hands-on care to patients in a variety of settings. This includes
physical needs, which can range from total care (doing everything for someone) to helping a
patient with illness prevention.
 Nurse as an Anesthetist: a certified nurse anesthetist is a registered nurse who has received
advanced training in an accredited program in anesthesiology. Nurse anesthetist provides surgical
anesthesia under the guidance and supervision of an anesthesiologist.
Extended Role of Registered Nurse / Professional Nurse

1 School Health Nurse 11 Occupational Health Nurse

2 Home Care Nurse 12 Family Health Nurse
3 Hospice Nurse 13 Public Health Nurse
4 Rehabilitation Nurse 14 Travel Nurse
5 Military Nurse 15 Forensic Nurse
6 Tele-Nurse / Telephone Triage Nurse 16 Prison Nurse
7 Nurse Entrepreneur 17 Ambulatory Care Nurse
8 Home Health Care Nurse 18 Space Nurse
 9 Nurse Navigator 19 Nurse Consultant
10 Women’s Health Nurse Practitioner (WHNP) 20 Nurse Midwifery Practioner
The duties of Registered Nurses vary based on the area of specialization. They play a key role in
promoting the wellness by performing a wide range of services. A Registered Nurse mainly focuses on
caring for and educating the patients and their family members about early recovery and ways of
prevention of diseases. Hence, nurses assess patients’ health problems and needs, develop and execute
nursing care plans, and uphold medical records. Following are the general role and responsibilities of
professional nurses -
1. Nursing Care Role / Nurse Practitioner Role
 Patient services like admission & discharge procedure, direct nursing care and skilled
interventions / advanced nursing care or practice, etc.
 Managing emergency nursing care like shock, post operative complications, cardiac arrest, etc.
Setting the emergency unit with necessary equipments in working conditions.
2. Nurse Administrator Role
 Management of ward / unit: : planning & implementation of ward policies, organizing the routine
works, nursing rounds, records and reports, internal audit, etc.
 Management of physical conditions of the ward / unit : ensure cleanliness of surfaces, infection
control measures, lighting and ventilation, adequate temperature, humidity control, protection
of patients and staff from mechanical, thermal, electric, and chemical injuries etc.
 Management of drugs / medicines: maintenance of drug supplies, emergency drugs/medicines and
its records, policies of accountability of drugs etc.
 Maintenance of supplies and equipments: maintenance of stock registers, periodical stock
verification, audit of supplies & equipments (inventory), making indents, taking necessary
measures for prevention of misuse, theft or damage, etc.
 Management of personnel: orientation of new staff, supervision, teaching, guiding floor nurses in
nursing care, delegate responsibility with authority and accountability, maintenance of
confidential reports of the staff, etc.
 Maintenance of records and reports / information processing: 24 hrs report, daily census,
incidental report, confidential report to be processed to higher authority from time to time.
Maintain necessary records and registers required for the ward / unit.
3. Nurse Supervisor Role
 Assign duties to the sub-ordinates, and delegate responsibility with authority.
 Supervise the staff functions day to day and record immediately in supervisor’s diary.
  Supervise the safety and comforts of the patients
 Supervise the records, registers, articles, equipments, rubber goods, materials and also physical
conditions of the ward / unit.
 Prepare confidential report of every staff after supervision.
 prepare for nursing audit for quality assurance of nursing care
4. Teaching Role / Nurse Educator Role
 Health education to the patient and their family with regard to health and illness, preventive
measures, diet, exercise, hygiene, etc.
 Organization of orientation / induction program for the new staff
 Organize formal or informal ward teachings like nursing rounds, bedside clinics, demonstrations,
incidental teachings, individual/group conference, etc. for the staff and students
 Conducting ICE and encouraging nursing staff to attend CNE viz., seminar, conference, workshop
etc. to keep up-to-date knowledge of trends and issues in nursing profession.
 Training & development, and performance appraisal of nursing staff
 Plan for clinical experience of nursing students
 Guiding & assisting in clinical activities of nursing students
5. Nurse Researcher Role
 Registered nurse as a researcher investigates nursing problems of the patients by her rich
experiences, by making observation, recording the data, and comparing with other cases /
patients, or comparing with existing literature in order to improve nursing care and to refine and
expand nursing knowledge.
 By designing and implementing scientific studies, they look for ways to improve health, health care
services and health care outcomes.
 Research nurses will often perform a great deal of research, both by studying previous findings and
observing patients. They may be required to examine medical journals, for instance, as well as
observe, study, and care for patients suffering from a particular disease.
 The Nurse researchers improves clinical expertise and personal knowledge, helps to implement
changes to provide excellence in nursing care, and helps to locate additional resources.

6. Nurse Communicator Role

 As a communicator, the nurse has to communicate effectively with the patient and family
members as well as other members of the healthcare team.
  The professional nurse makes upward communication with the higher authorities for ongoing day
to day activities or problems using formal or informal communication technique.
 The professional nurse makes downward communication to the sub-ordinates using formal or
informal communication technique in order to pass on instructions, directives, orders,
information etc.
 Nurse as a communicator maintains the relationship with other departments of the health agency
like CCSD, OPD, OT, ICU, diet department, blood bank, radiological wing, labs, etc.
 Nurse as a communicator maintains the good IPR with patients, family members, colleagues, sub-
ordinates and other members of health care agency.
7. Nurse Collaborator Role

 Collaborative care is a healthcare aims to improve patient outcomes through inter-professional

cooperation. Nurses as a collaborative health care team, encourages patients, families and
healthcare providers to be active participants in the treatment process which in turn promotes
improved quality outcomes, improvements in patient experience, patient safety, and effective
use of resources.
8. Leadership role of a Nurse

 Nurses are considered leaders in providing patient care, as leadership is a key part of effective

nursing care. Nurses are the frontline of healthcare delivery, thus, they are pivotal to providing
safe, high-quality care, and assuring positive patient outcomes .

 Nurse as a leader can influence patient and his/her relatives to follow the desired therapeutic
regimen. Nurses are capable of leading the patient’s complex environment.

 Nurse leaders can navigate the complex and ever changing health care system in solving
problems and making decisions related to issues of health care services.

 The nurse leader specialty oversees the integration of patient care, including development of
treatment plans, collecting and evaluating treatment results, and managing patients’ medical
teams. The nurse leader can also lead health promotion and disease prevention efforts.
9. Nurse Liaison Role

 Nurse liaison officer establish patients' eligibility for care, communicating with families, and
interacting with a wide range of staff members, from admissions coordinators to case managers to
physicians. They work in acute care, long-term acute care, hospice, and rehabilitation environments.
 Nurse liaisons Review patient’s medical records, and determine whether they should be admitted
for care. They explain the types of care and service their facility offers to patients and their families.

 A nurse liaison also works with the facility to schedule therapy sessions and doctor visits.
Coordinating with other staff members to ensure smooth patient discharge is also among a nurse
liaison's duties.
10. Nurse Advocate Role
 Nurse advocate works on behalf of patients to maintain quality of care and protect patients' rights.
As a patient advocate, the nurse's responsibility is to act on the patient's behalf, and support their
decisions.
 They intervene when there is a care concern, and following the proper channels, work to resolve
any patient care issues. Realistically, every nurse is an advocate.
11. Nurse Counselor Role / Nurse Consultant Role
 Help patients and their families to cope with the crisis through the sensitive use of counseling skills.

Types of counseling situations that the nursing professional may encounter are; genetic
counseling, prenatal counseling, mental health counseling, rehabilitation counseling, family
health counseling, substance abuse counseling, suicide counseling, etc.
12. Self Development Responsibilities of a Professional Nurse
 Self learning responsibilities for leadership roles and managerial skills i.e., utilize all the resources
that are around the nurses like daily rounds with the doctor, learning diagnostic findings,
rationales of new therapy, equipments, using departmental library, books, journals for better
understanding of principles and advanced practice of nursing etc.
 In-service Education: nurses with big career aspirations need to undergo in-service education for
advanced nursing practice and for competitive nursing care. While serving, a graduate nurse can
opt for post graduation program (M. Sc. Nursing) on the basis of deputation.
 Continuing Education: every professional nurse need to attend seminar, conference, workshop,
etc. to keep up-to-date knowledge and also for self career development. Every individual nurse
has an opportunity to undergo refresher courses, certificate course (1 week to 6 months), or post
basic diploma courses (1-2 yrs)
 Health camps/programs: every professional nurse need to attend or participate in health
programs/camps like; blood donation camps, diabetic clinic, under-five clinic, health checkup
 camp, communicable disease awareness program, and other health related programs for the
sake of contribution of nursing profession as well that aids in self learning and self development.

ANA standards for Nursing Practice

 Standard 1: The collection of data about health status of the patient is systematic and continuous.
The data are accessible, communicative and recorded.
 Standard 2: Nursing diagnosis is derived from health status data.
 Standard 3: The plan of nursing care includes goals derived from the nursing diagnoses.
 Standard 4: The plan of nursing care includes priorities and the prescribed nursing approaches or
measures to achieve the goals derived from the nursing diagnoses.
 Standard 5: Nursing actions provide for patient participation in health promotion, maintenance,
and restoration.
 Standard 6: Nursing actions assist the patient to maximize his health capabilities.
 Standard 7: The patient’s progress or lack of progress towards goal achievement is determined by
the patient and the nurse.
 Standard 8: The patient’s progress or lack of progress towards goal achievement directs re-
assessment, re-ordering of priorities, new goal setting, and a revision of plan of nursing care.

Skills of Professional Nurse / Registered Nurse

 Conceptual / cognitive skill

 Human relation skill

 Communication skill

 Technical skill

 Intervention skill

 Analytical skill

 Problem solving skill

 Decision making skill

EVIDENCE BASED PRACTICE IN NURSING

Evidence Based Practice (EBP) has developed over time to till date that integrate the best research
evidence, clinical expertise, the patient's individual values and circumstances, and the characteristics of
the practice in which the health professional works.

Before EBP, the health professionals relied on the advice of more experienced colleagues, often taken at
face value, their intuition, and on what they were taught as students.  Relying on older, more
knowledgeable colleagues as a sole information source can sometimes provide out dated, biased and
incorrect information.  This is not to say that clinical expertise is not important - it is in fact part of the
definition of EBP.  However, rather than relying on clinical experience alone for decision making, health
professionals need to use clinical experience together with other types of evidence-based information.

Definition: The EBP is defined as a ‘’conscientious, problem-solving approach to clinical practice that

incorporates the best evidence from well-designed studies, patient values and preferences, and a nurses’
expertise in making decisions about patient's care’’.
In simpler words, EBP is simply an integration of best possible research evidence with clinical expertise
and patient needs. It requires an integration of individual clinical applications with the best available
clinical evidence based on scientific literature / systematic research.

So, EBP is not only about applying the best research evidence to decision-making, but also using the
experience and skills of nurses, and taking into account the patient's situation and values (e.g. social
support, psychological support, financial situation). And, this process of integration is known as clinical
reasoning.  When we consider all of these four elements in a way that allows us to make decisions about
the patient care, then we are engaged in EBP.

Fig: Evidence Based Practice (Clinical Reasoning; a process of integration)

Process / Steps of EBP in Nursing

Ii is essential to clearly outline the theory of EBP and explain how that theory can be put to practice in
the day-to-day nursing care of patients.   The steps / process of EBP follow 5 ‘A’ Cycle that includes;
Asking, Acquiring, Appraising, Applying, and Auditing. And, again the cycle begins with an assessment for
better nursing care.

1. Asking: It is the process of making clinical question. It includes two things –

a. Assessment – is the collection of necessary information from the patient. Here, the nurse
has to use the PICOT Formatted questions to address the patients i.e., population (P),
issue of interest or intervention (I), comparison group (C), outcome (O), and time frame
(T). Asking questions in this format assists in generating a search that produces the most
relevant, quality information related to a topic.
b. Clinical question – is converting the collected data in to an answerable clinical question /
nursing diagnosis. Prioritize the nursing care for evidence.

2. Acquiring: It is the process of finding most relevant and best evidence to answer the clinical
question through personal clinical expertise in combination with statistically significant research
findings. To begin the search for evidence, use each keyword from the PICOT question that was
formed. Once results have been found on nursing care, the research can be rated to determine
the strongest level of evidence. However, there are seven levels of evidence, with a level I being
of the strongest quality, and level VII being a weakest quality of evidence. The levels are -
 Level I: Evidence from systematic reviews or meta-analysis of randomized control trials
 Level II: Evidence from well-designed randomized control trials
 Level III: Evidence from well-designed control trials that are not randomized
 Level IV: Evidence from case-control or cohort studies
 Level V: Evidence from systematic reviews of descriptive or qualitative studies
 Level VI: Evidence from a single descriptive or qualitative study
 Level VI: Evidence from expert opinions

3. Appraising: It is critical assessment of clinical evidence for validity, reliability, and applicability. To
begin the critical appraisal process, three questions need to be asked to determine the relevance
of evidence. And those questions are -
a. Are results of the study valid? This question measures the validity. In order to be valid, the
study results must be as close to the truth as possible.
 b. What are the results? This question measures the reliability. If it is an intervention study,
reliability consists of; whether an intervention worked out, how large the effect was, and
whether a nurse could repeat the same with similar results.
c. Will the results be applicable in nursing care? This question measures the applicability.
The study may be used in practice when caring for patients if the subjects are similar to
the patients being cared for, the benefit outweighs the harm, the study is feasible, and
the patient desires the treatment.

4. Applying: It is an integration of clinical evidence in decision making i.e., applying the clinical

evidence in nursing care by considering patient's preferences and values. The patient is
encouraged to practice autonomy and participate in the decision-making process. Therefore,
even if the study had successful outcomes, the patient may refuse to receive a treatment.
Assessment findings and patient history may reveal further contraindications to a certain
evidence-based treatment. Lastly, availability of healthcare resources may limit the
implementation of a treatment even if it is found to be effective in a study.

5. Auditing: It is an evaluation of previous four steps to find out the effect and efficiency, and seek
ways to improve one's ability to ask, acquire, appraise, and apply. In other words, it is an
evaluation process to know whether the treatment is effective in terms of patient outcomes.
 Futuristic Nursing / the Future of Nursing

The nursing industry is changing at a rapid rate. With shifting technology, and new challenges brought on
by federal legislation, the nursing industry is being forced to evolve to ensure that hospitals and other
organizations are able to continue to provide the best possible nursing care.
As a nursing professional, we ensure that patient care keeps pace with changes in the field. Part of that
responsibility requires staying abreast of nursing industry developments to make sure that we are up to
date with the latest and greatest in clinical practice.
As the largest segment of health care workforce, nurses are full partners and active with other health
professions to achieve significant improvements in nursing profession at the local, state, and inter-
national levels. Hence, it is important to tap into their future practices & roles, and to explore how
nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing
technology, and maintaining patient and family-focused care in the future. Following are the trends that
may change the future of nursing profession -
1. Increase in reliance on health care technology
 Clinical technologies are evolving at a rapid rate. Every year, new types of healthcare software
and devices improve the way nurses do their job. For example, in many hospitals point-of-care
handheld computers, electronic IV monitors and barcode medication administration systems
have replaced manual systems. Furthermore, in future, the health care personnel especially
nurses, may demonstrate complete reliance on bio-technology.
2. Rapid changes in nursing care modalities
 New treatment modalities in nursing and latest bio-technologies in the future may reduce the
sick time as well as hospital stay of the clients. These technologies may prolong the life span
causing higher life expectancy rates, and there might be gross reduction in the reduced
mortality due to fatal illness.
 The growth of telemedicine, tele-nursing, and tele-health may influence the changes in pattern
of nursing care.
3. Growing role of health informatics; trends in demographics & epidemiology
 The health care data (demographics & epidemiology) collected through information
technology has a significant impact on nursing practice in the community as well as hospitals.
Such health informatics helps the nurses to recognize health care needs of the society and
gives information for cost effective nursing services.
  Informatics’ growing role in the future may change the way that nurses record and
communicate patient information, how nursing care will be coordinated and the approaches
of evidence-based practices.
 In addition to it, the increased use of informatics may create positions for professionals who
want to focus entirely on the intersection of nursing and data. Some specific jobs titles will be
Nursing informatics specialist, Nursing informatics analyst, and Clinical informatics specialist.

4. Rapid changes in nursing manpower / employment status / supply of nurses and competition
 Rapid changes in the health care delivery and changing population demographics may affect
the supply and demand of nurses in future. There might an acute shortage of registered nurses
i.e., higher demand and lower supply of nurses.
 Nursing has a greater opportunity to grow and develop its vision through evidence based
practice, education and research; that made rapid changes in the present health care delivery
about supply and demand of registered nurses across the world.
 Manpower shortages or surpluses in health care professions (like doctors, pharmacists, lab
technicians, radiographers, and other allied health care workers) may have an impact over the
utilization of Registered Nurses or Advanced Nurse Practitioners.
 States across the globe may come up with an implementation of certain policies like; greater
access to federal loans and grants (scholarship) for the students who opt nursing profession,
strengthening the nursing institutes with more focus on speciality nursing course viz., family
care nursing, tele-nursing, forensic nursing, etc.
 Trends towards downsizing or the nursing shortage in future may increase or may continue the
use of non-licensed personnel (fake or mask nurses / any person working as a nurse) in many
healthcare arenas.
 Due to physician shortage, there will a need of more direct care providers. Hence, nurse
practitioners may increasingly earn a doctoral-level education to fill some of that void.
5. Advancement in nursing education (Nursing Specialization / continuing education)
 Increased number of Clinical Specialization courses like; Telemetry Nursing, Holistic Nursing,
Transplant Nursing, Plastic Surgery Nursing, Critical Care Neonatal Nursing, Critical Care
Pediatric Nursing, Acute care Gerontology Nursing, Progressive Adult Care Nursing, etc.
 Increased number of Nurse Practitioner courses like; Home Health Care Nursing, Tele- Nursing,
Forensic Nursing, Ambulatory Care Nursing, Family Health Nursing, Hospice Nursing, Travel
Nursing, Adult Nursing Practitioner, Acute Care Nursing Practitioner etc.
  As more institutes make a Bachelor of Science in nursing an entry-level requirement, the
healthcare field will see an increase in nurses earning their advanced degrees such as Master of
Science or Doctoral degrees in nursing to stay competitive in the job market.
6. New career opportunities for registered nurse
7. Health care has been increasingly shifting from inpatient to outpatient settings. Wellness is
what nurse’s work toward, and wellness begins in the community. Hence, there will be
increasing demand of nurses at community setting.
 While the number of patient-facing nursing roles will continue to grow, alternative nursing
positions  (nurse practitioners) will increase in popularity as well. These are the positions
outside of the hospital or clinic that nurses can pursue as their nursing career. For example -
Forensic Nurse, Nurse Legal Consultant, Tele-Nurse, Family Health Nurse, Travel Nurse, Nurse
Case Manager, Hospice Nurse, etc.
8. Working conditions
 There might be a gradual changes towards shorter and more convenient hours of duty, better
accommodations and higher salaries
9. Changing role and responsibilities of Registered Nurses
 Nurses may be more autonomous ‘nurse practitioners’ whose service focuses more on health
rather than illness / disease.
 In the new millennium, nurses will be doing more in the community but also will continue to
be even more integral to the provision of intensive care that will increasingly be the focus of
hospital care.
 Advanced nurse practitioners (RN with higher qualification) may cross medical threshold to
provide nursing service that usually provided by the physicians.
 Nurse therapists will provide numerous services to the clients and their families.
 Nurses may be strong and self assertive with a different title such as tele-triage nurse, space
nurse, forensic nurse, family nurse etc.
 Today, nurses are the most efficient leaders and change agents who have transformed the
health care system; ensuring nursing care as patient centered, effective, safe, and affordable.
In future, this success may lead to advanced research practice and collaboration approach of
nurse in health care delivery.
10. Increasing leadership opportunities
 Nurses have long been an integral part of the health care system, but in recent years, nursing
professionals have seen increased opportunities for leadership. The nurses are being called on
to meet the growing health care needs of patients and organizations. Some job titles that fall
into this category include clinical nurse leader, nurse manager, nurse executive and nurse
administrator etc. Hence, it may influence increase the number of leadership opportunity in
nursing profession.
 Due to advancement in nursing specialization as well Doctoral degrees, the nurses increasingly
move into administrative roles at major hospitals and other sectors of health systems.
11. Changing needs of consumers / consumer demands / patients’ bill of rights
 The nurse will be more accountable for patients care and has legal responsibilities for the
patient due to patients’ bill of rights and their health care demands
 In future, the clients may be more likely to combine conventional therapies with
complementary healing techniques (viz., therapeutic touch, reflexology, acupressure,
aromatherapy, nutritional therapy etc) that may influence on health care policies and bio-
technological changes. And it could be a challenging task for the entire nursing community and
sometimes could be a risk as an employment is concerned.
12. Nursing theory, practice and research
 Every aspect of nursing shall be integrated with nursing theory, practice and research that
results in EBP.
 Increased number of research studies and its findings i.e., TRIP database (turning research in
to practice) tend to strengthen the body of nursing science and to incorporate high quality
results for advanced nursing practice. These research needed to identify or develop effective
nursing practices for eliminating gaps and disparities in health care
13. Increasing emphasis on community health / population health
 In coming millennium, clients will be moved out of hospital rapidly or an early discharge of
clients will become more important. As those discharged clients surely need more assistance
at home level, the registered nurses like; rehabilitative nurses and hospice nurses play a vital
role in taking care of such discharged clients at community setting.
 Community / population health will be a broad care approach with various nursing care
strategies; they usually involve community wide initiatives, such as educating school children,
prevention of diseases, promotion of health, care of senior citizens etc. The registered nurses
 like; family care nurse, home care nurses, public health nurses, and school health nurses play a
vital role in taking care of such population at community setting.
 Nurses can bring great value to identify problems and connect patients with specific services
that are provided in communities by Nurse Collaborator.
14. Collaborative nursing care
 Collaborative nursing care aims to improve patient outcomes through inter-professional
cooperation. Nurses as a collaborative health care team, encourages patients, families and
healthcare providers to be active participants in the treatment process which in turn promotes
improved quality outcomes, improvements in patient experience, patient safety, and effective
use of resources.
 At the same time we need to explore whether more collaborative programs of care can be
developed effectively. So that we are not holding on to outmoded ideas of the profession but
can develop newer modes, such as advanced practice nursing, to work in interdisciplinary
collaboration. Collaborative rather than competitive strategies can strengthen quality of care
by better utilizing the expertise of each participant.

While there are no guarantees of what the future of nursing will look like, every nurse has a
responsibility to their patients and themselves to always be on the lookout for new ways to improve the
quality of care they provide. Nurses who embrace new clinical technology, focus on their professional
development and seek out opportunities to increase their knowledge will be in an excellent position in
the coming year.