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Nurs Outlook 61 (2013) 129e136

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Situational analysis of nursing education and work force

in India
Rajnarayan R. Tiwari, MDa,*, Kavya Sharma, PGDHHMb, Sanjay P. Zodpey, MD, PhDc
a
Scientist D, National Institute of Occupational Health, Ahmedabad, Gujarat, India
b
Manager-Academic Programs and Adjunct Lecturer, Public Health Foundation of India, New Delhi, India
c
Director, Public Health Education, Public Health Foundation of India, New Delhi, India

article info abstract

Article history: Nursing care has been mentioned in the Indian culture from the times of the
Received 11 January 2012 Vedas. However, according to World Health Organization, the nursing workforce
Revised 28 June 2012 in India is still insufficient to meet the needs of the country. The purpose of this
Accepted 29 July 2012 article is to examine the status of nursing education and the nursing workforce
in India and the challenges faced by the profession. Data supporting the state-
ments made in the article were obtained from the Nursing Council of India, the
Keywords: Ministry of Health and Family Welfare, the Government of India Web sites,
Nursing printed journals and communication with experts in the field. In India, there is
Education a need to train approximately a million nurses to meet the current shortfall of
Workforce health workers in the country. The nursing "brain drain" suggests that it may be
India one of the factors responsible for this shortfall. Further, nursing education faces
Migration challenges, such as streamlining nursing education, enriching the curriculum,
strengthening faculty development and increasing the use of innovative
teaching and learning techniques.
Cite this article: Tiwari, R. R., Sharma, K., & Zodpey, S. P. (2013, JUNE). Situational analysis of nursing
education and work force in India. Nursing Outlook, 61(3), 129-136. http://dx.doi.org/10.1016/
j.outlook.2012.07.012.

History of the Nursing Profession in India
The history of nursing in India dates back to about 1500
B.C.E., in the scriptures of Hindu teaching of the Sam-
hite period (2000 e 1100 B.C.E.), the Atharva Veda, Sus-
hruta (500 B.C.E.) and Charaka (300 B.C.E.), which were
the leading authorities of ayurveda (the science of life).
The eight parts of the ayurveda cover the entire field of
medical science, including nursing treatments. More
details and descriptions about nursing appear in the
old Indian records than in those of any other country in
the world. Sushruta defined the ideal relations of doctor,
nurse, patient, and medicine as the four feet upon
which a cure must rest. The Charaka Samhita (Loon,
2003) described the qualities of a nurse as “knowledge
of the manner in which drugs should be prepared or
compounded for administration, cleverness, devoted-
ness to the patient waited upon, and purity (both of the
mind and body)..” However, there is little information
about female nurses in ancient and medieval India of
the Asoka, Huns, and Mughals (Sakurikar, 2011).
In India, the modern field of medicine, including
nursing, was introduced by the Portuguese in the 17th

* Corresponding author: Dr. Rajnarayan R. Tiwari, Scientist D, National Institute of Occupational Health, Meghani Nagar, Ahmedabad-
380016, Gujarat, India.
E-mail address: rajtiwari2810@yahoo.co.in (R.R. Tiwari).
0029-6554/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.outlook.2012.07.012
130 Nurs Outlook 61 (2013) 129e136
Century when Albuquerque conquered Goa and
established the Royal Hospital (Sakurikar, 2011). For
many years nursing training was provided only to
Europeans and Anglo-Indians. The Jamsetjee Jee-
jeebhoy (JJ) Hospital was the first to train nurses in
Western India. The first Indian woman to come
forward for nursing training was Bai Kashibai Ganpat
in 1891 from Bombay. Between the years 1920 and 1939,
many nursing schools were established in different
parts of India with the objective of standardizing
nursing training (Gill, 2011). The Trained Nurses’
Association of India (TNAI) came into existence in 1922
and initially undertook the preparation of short
abstracts of nursing research studies done on Indian
nursing problems, at the master’s or doctoral level
(Sakurikar, 2011).
At the time of independence in 1947, only about
7,000 nurses practiced in the entire country with
a population of about 350 million (Sakurikar, 2011). The
hospitals were understaffed and nursing lacked
professional and social status. In 1943, the Bhore
Committee emphasized the integration of curative and
preventive medicine at all levels and recommended
the remodeling of health services in India. As a result,
the Indian Nursing Council (INC) was established in
1947 to regulate the standards of nursing education. In
the first and the second five-year plan periods (1951 e
1961), because of the pressure of the growing need for
trained nurses in the country, a rapid development in
nursing education occurred. The most significant
development was the extension of nursing and
midwifery to the rural areas. Only in the third five-year
plan (1961 e 1966) were the education of nurses and
supervision in the public health field more closely
examined.
Considerable steps were taken between 1950 and
1970 to reform nursing education (Sakurikar, 2011).
International agencies like WHO, UNICEF, and USAID
as well as consultants (medical experts) played an
active role in organizing and reforming nursing
education. Many buildings designated as schools of
nursing were constructed with funding received from
agencies such as WHO, UNICEF, and USAID. Nurses
and doctors were given study grants to obtain
advanced education degrees outside India. The
College of Nursing at the Post-Graduate Institute of
Medical Education and Research (PGIMER), Chandi-
garh, was established in 1964. The College of Nursing
at The All-India Institute of Medical Sciences, New
Delhi, was established in 1969. By the end of the
fourth five-year plan (1969 e 1974), the government of
India and the Indian Nursing Council proposed
various measures to integrate psychiatric nursing in
the basic nursing curricula throughout the country. By
1975, some states also tried to establish similar state-
level institutions. Along with the development of
national medical institutions/colleges, colleges of
nursing were also established. In 1989, a prominent
governmental committee for the nursing profession
established guidelines and directions regarding the
working conditions, education, and services of the
nursing profession.
The Nursing Workforce in India
India, which comprises 28 states and 7 union territo-
ries, is one of the oldest civilizations in the world.
India’s population is 1.22 billion with 628.8 million
males and 591.4 million females. The crude birth rate is
20.97 births per 1,000 people, and the crude death rate
is 7.48 deaths per 1,000 people. The life expectancy at
birth and the literacy rate for the country is 66.8 years
and 61%, respectively. The current infant mortality rate
is 47.57 deaths per 1,000 live births. The number of
physicians (as of 2010) possessing recognized medical
qualifications (under the MCI Act) is 816,629 (Central
Bureau of Health Intelligence, 2011). Currently, the
country has 6,368 nursing schools (Indian Nursing
Council, 2011).
Nurses represent the largest share (38%) of the total
health workforce of India (Gill, 2011). In India, four
types of health workers provide “nursing services”: the
general nurse midwife (GNM), the “lady health visitor”
(LHV), the auxiliary nurse-midwife (ANM), and the
midwife. Other personnel who also contribute to the
delivery of nursing services include “the Dais” (trained
and untrained), nursing assistants, orderlies, ward
boys, and ayahs. Dais are female assistants in the
villages who do not have formal nursing training, but
after informal training can perform noninstitutional/
hospital deliveries in remote villages, and ayahs are
female attendants in the villages helping dais and
mothers in the rearing of newborns. The suggested
ratio for nurses is one nurse per 5,000 people living in
lowlands (non-hilly) areas and one per 3,000 in hilly
areas, such as the northeastern part of the country
(Park, 2011). Yet, the nurse-to-population ratio found in
the country is suggestive of the shortage of nursing
personnel needed to provide needed services. Accord-
ing to the WHO, the number of nurses per 10,000 pop-
ulation in India is 8, whereas it is 33 nurses per person
for the world and 16 for low-income countries (WHO,
2011). India ranks 75th among 133 developing coun-
tries with regard to the number of nurses (Pharma
Tutor, 2011).
There are 576,810 registered ANMs, 1,128,116 regis-
tered GNMs, and 52,490 registered LHVs (Central
Bureau of Health Intelligence, 2011). In addition,
although these individuals are registered with the
Indian Nursing Council, it does not necessarily mean
that they are practicing in India, or practicing at all, as
some may have migrated to other nations. In addition,
the distribution of nurses in India is not equal in the
ratio of nurses to citizens across the 28 states. For
instance, the Kerala state with lower mortality rates
reported a higher availability of nurses in comparison
with the states experiencing high mortality rates, such
as Uttar Pradesh, Bihar, and Jharkhand (Indian Nursing
 Nurs Outlook 61 (2013) 129e136 131

Council, 2012). More nurses prefer working in urban,
rather than rural, areas. However, the need for nursing
services is greater in the rural than in the urban areas,
because lower health status and higher mortality rates
are experienced by rural populations (Park, 2011).
In India healthcare is provided through government
and private hospitals. In each district the government
hospitals include primary health centers and sub-
centers at village levels and community health
centers at the district level. In urban areas healthcare
is provided through municipal corporation hospitals
and medical college hospitals. In addition, there are
private hospitals, which include general practitioners,
specialized clinics, poly-clinics, and super-specialty
hospitals offering advanced healthcare services (Park,
2011). The ANMs and LHVs work at primary health
center and sub-center levels whereas GNMs usually
work at community health centers and medical college
levels. The B.Sc. degree holders and postgraduate-
degree holders usually work at medical college levels
and are largely involved in teaching activities. Table 1
describes the different nursing education programs of
India that are registered with the Nursing Council of
India (Indian Nursing Council, 2012) and their usual
place of placement.
The number of nurses working in urban areas is
almost three times higher than nurses employed in the
rural areas (Gill, 2011). According to a Government of
India report of 2007, about 153,568 ANMs, 17,608 LHVs,
and 56,975 GNMs are working in rural India, which is
approximately 26.6%, 33.5%, and 5% of the available
workforce, respectively (Park, 2011).
Table 2 depicts the number of such institutions and
the registered nursing workforce within each. Nursing
schools are unevenly distributed among different
states of the country. For instance, Maharashtra, Pun-
jab, Odisha, Uttar Pradesh, and West Bengal account
for 58.4% of the total ANM course nursing schools.
Similarly, four southern states of Karnataka, Andhra
Pradesh, Kerala and Tamil Nadu accounts for 52.5% of
the total GNM course nursing schools and 56.9% of the
total B.Sc. nursing colleges in the country. These states
are more urbanized than elsewhere and have better
hospital infrastructures; therefore, they provide better
employment opportunities in comparison with
northern and northeastern states.

Table 1 e Nursing Programs in India

Nursing Program Eligibility Criteria Training Duration Examination Usually work at
th
Auxiliary Nurse Completion of 10 grade 1½ years Nursing Examination Primary health center
Midwife (ANM) Board and sub-center
General Nurse Completion of 10þ2 3½ years Nursing Examination Community health
Midwife (GNM) grades with Board centers and hospitals
aggregate of 40% at urban areas
B.Sc. (Basic) Completion of 10þ2 4 years University Medical college,
grades with hospitals, and super
aggregate of 45% specialty hospitals
in PCBE
B.Sc. (Post Basic)
Regular Completion of 10þ2 2 years University Medical college,
grade þGNM hospitals, and super
specialty hospitals
Distance education Completion of 10þ2 3 years University Medical college,
grades þ GNM þ 2 hospitals, and
years’ experience super-specialty
hospitals
M.Sc. B.Sc. Nursing / B.Sc. 2 years University Medical college,
Honors Nursing / hospitals, and super-
Post Basic B.Sc. specialty hospitals
Nursing with
minimum of 55%
aggregate marks.
One year of experience
after Basic B.Sc. or
Post-Basic B.Sc.
Nursing.
M.Phil. M.Sc. 1 year (Full time) University Medical college,
2 years (Part time) hospitals, and
super-specialty
hospitals
PhD M.Sc./M.Phil. 3e5 years University
Post Basic Specialty R.N and R.M. with 1 year Board or University Medical college,
Diploma Courses one years of hospitals, and
clinical experience super-specialty
hospitals
132 Nurs Outlook 61 (2013) 129e136
Table 2 e Number of Institutions Providing
Nursing Education and Nursing Workforce in India
(2012)
Institutions/Courses Number
ANM-course Nursing school 1310
GNM-course Nursing school 2493
B.Sc. Nursing Colleges 1506
Institution for Post-Basic B.Sc. course 615
M.Sc. Nursing Colleges 444
The National Rural Health Mission (NRHM),
launched in 2005, is a centrally funded plan, and
provides technical and financial support to address the
shortage of human resources in healthcare services. As
an immediate measure of the NRHM, states were fun-
ded by the central government to hire a second nurse-
midwife for the distant health sub-centers in the
different states of the country, three nurses for the
primary health centers, and nine nurses in the 30-bed
Community Health Centers (CHCs). This led to the
appointment of an additional 26,993 nurses and 46,990
ANMs. Unfortunately few states were unable to make
use of the opportunity due to the limited number of
ANMs or nurses available to be recruited (Ministry of
Health and Family Welfare, 2011).
The NRHM plans to set up 132 ANM and 137 GNM
schools at a cost of Indian Rupees (INR) 660 crores
(USD 125.66 million) and INR 1370 crores (USD 260.85
million), respectively, which has been approved by
the central government. Plans for upgrading and
transforming 25 nursing schools that are attached to
medical colleges into nursing colleges have been
announced. State Nursing Councils and state nursing
units have been provided with INR 10 million (179,000
USD) each to improve their faculty capacities. This
funding supports faculty development programs to
train 300 faculty members to teach in these schools
in various states. Nursing Councils have also revised
guidelines or standards for establishing nursing
schools and colleges, thus enabling many more to
start up immediately (Ministry of Health and Family
Welfare, 2011). There is an assessed need to train
more than 0.9 million nurses to meet the shortfall
of nurses in the country (International news and
views, 2011).
In India, the current student capacity in existing
functioning diploma nursing schools, B.Sc. (Nursing)
Colleges and M.Sc. (Nursing) Colleges is 88,202;
68,858; and 8,000 students, respectively. The
Government of India plans to set up 269 new ANM
and GNM schools, which will result in an additional
22,000 nurses being trained annually at diploma
levels as ANMs and GNMs (International News and
Views, 2011).
However, these numbers do not necessarily reflect
the actual availability of new nurse graduates to prac-
tice in India. The discussions about the "brain drain"
in India suggest that up to one-fifth of the nursing labor
force could be lost to wealthier states, such as Middle
Eastern countries, through “circular migration”
(Hawkes et al., 2009). Circular migration is a form of
migration by which the immigrants move to other
countries for a few months and then return to the
native country. After the 1980s there was a shift to
mass migration of nurses from India, most of them
belonging to the state of Kerala, which is in the
southern part of the country (Nair and Percot, 2007)
because of the greater number of graduates from there
and fewer jobs opportunities. There are three recruit-
ment hubs in the country: Kochi, Bangalore, and Delhi.
These recruitment centers facilitate migration of
nurses to other countries like the U.S., the United
Kingdom, Ireland, Singapore, New Zealand, Australia,
and the Gulf nations (Khadria, 2007). As long as striking
global disparities in nursing income persist, it will be
difficult to stem the hemorrhage of nurses emigrating
in pursuit of better pay (Hawkes et al, 2009). Most of the
private hospitals in India offer an initial pay of INR 2500
to INR 3000 per month, whereas an Indian nurse can
earn as much as INR 40,000 per month as a starting
salary after migrating to one of the Gulf countries
(Surya, 2001; Percot, 2006). Some of the salary other
countries pay to these nurses finds its way back to the
Indian economy as these nurses send money back to
their families. A multicenter survey of 448 practicing
nurses reported that 63% of India’s nurses intend to
emigrate, citing dissatisfaction with working condi-
tions and unhappiness with prevalent social attitudes
toward nurses as motivating factors (Thomas, 2006).
Another field study of nurses in Delhi indicated that
the most common impetus for emigration was better
income prospects overseas (Khadria, 2004).
Nursing Education in India
Since independence, nursing education has grown
rapidly with the increase in infrastructure and
workers. Nursing today demands a high level of
knowledge and skill, and basic nursing education
programs strive to provide learning experiences that
will equip the student to perform at a professional
level. These education programs still suffer from some
challenges, such as lack of faculties and infrastructure,
and nonuniform syllabi.
The Indian Nursing Council is an autonomous body
under the government of India. The Ministry of Health
& Family Welfare, which was constituted by the central
government under section 3(1) of the Indian Nursing
Council Act, 1947, of Parliament, governs all nursing
services and education in India. The council monitors
the uniform standards of nursing education for nurse
midwife, ANMs, and LHVs, and it prescribes the
syllabus and regulations for nursing programs. The
council also accredits the programs and monitors them
regularly.
 Nurs Outlook 61 (2013) 129e136
Several basic and additional qualifications exist
for postgraduate-diploma or postgraduate-certificate
programs, such as public health nursing, and
pediatric nursing offered by institutions and
universities.
Nursing Schools
Health school-based nursing training is the dominant
form of nursing education in India. Most of these
schools are attached to hospitals. These schools
usually provide training in ANM and GNM services,
which are diploma programs. The students who have
10 years of general schooling are eligible to take an
ANM course, whereas those who have passed 12 years
of schooling with a science stream (having subjects
such as biology, chemistry, and physics in the 12th year
of schooling) are eligible for GNM courses. The average
student age in the GNM program is 17 years. Admission
to these programs is based on merit scored in the
respective grades, i.e., 10th or 12th standard. The total
duration of the ANM course is 2 years, and that of the
GNM program is three-and-a-half years. Thus the GNM
course is a more detailed one with more hands-on
experience and practical work. Those who success-
fully complete these courses are registered with the
respective SNCs.
University Degrees
The university degrees are housed in institutions of
higher education. These colleges of nursing within
universities award bachelor’s, master’s, and doctorate
degrees in nursing. The graduates with B.Sc. Degrees in
nursing can engage in both clinical nursing and clinical
teaching. The eligibility criteria for graduate nursing
courses are 12 years of schooling with a science stream.
This degree can also be acquired as an additional
qualification by GNMs either through regular courses
from a recognized university or through distance-
learning processes from open universities, such as
Indira Gandhi National Open University New Delhi,
Yashwantrao Chavan Open University, and Annamalai
University Chennai, etc. In India, 1,506 institutions
offer a bachelor’s course of study, and 444 institutes
offer a master’s course of study (Table 2). The master’s
courses are offered in public health nursing, cardio-
vascular nursing, oncology nursing, and pediatric
nursing, etc. The graduates pursuing those master’s
courses have a better opportunity of working in
specialty hospitals. Further if they wish to leave
a government job voluntarily, they have better oppor-
tunities for employment in private super-specialty
hospitals.
University Diplomas
Several universities and teaching hospitals also run
short-term specialty programs in different specialized
133
areas of medicine and nursing. These programs are
designed for cardiovascular and thoracic nursing,
oncology nursing, critical-care nursing, neurology
nursing, nephro-urology nursing, orthopedic nursing,
gastroenterology nursing, obstetric and gynecological
nursing, pediatric (child health) nursing, psychiatric
(mental health) nursing and community health (public
health) nursing. The usual duration of these courses is
one year and pursued as an additional qualification by
nursing graduates that have the experience of clinical
nursing. Currently 615 institutions in India offer such
post-basic diploma programs monitored by the SNC
and TNCI.
Both government and private institutions provide B.
Sc. programs in nursing. The total amount of fees to be
paid in private institutions is comparatively more than
in the government institutions. The course fee, stipu-
lated by the Indian Nursing Council, for B.Sc. nursing is
INR 50,000 (USD 1,000). For any one-year specialty or
diploma course like critical-care nursing, oncology
nursing, cardiothoracic nursing, and disaster nursing
etc., the fee is INR 25,000. However, the total actual
course fee for B.Sc. nursing can vary from INR 60,000 to
200,000 per year, depending on the institution
(Education and Career in India, 2011).
Challenges in Nursing Education in India
Nursing education in India is not streamlined and
therefore faces several challenges. A streamlined
course consisting of a unified and comprehensive
syllabus replacing different level courses, such as
ANM, GNM, and B.Sc. nursing, should be done.
Currently, in a few states, diploma-level courses are
available whereas in the majority of other states the
basic-level course is the degree in nursing. Many
smaller states of the northeast and less-developed
regions lack the basic infrastructure needed to
provide good (with respect to complete and updated)
nursing education. The focus of the nursing at
a primary health center and district-level hospital is on
maternal and child healthcare and optimal nutrition of
the patients, whereas along with epidemiological
transition, specialties like the noncommunicable
disease, environmental, and occupational health
hazards areas have emerged. This change requires
developing skills in these types of health hazards to
tackle them effectively.
Methods to Improve Nursing in India
Streamline Basic Nursing Education
Until recently the basic qualification for practicing
clinical nursing was the ANM and GNM. However,
recently some SNCs such as those in Maharashtra and
134 Nurs Outlook 61 (2013) 129e136
Kerala have started B.Sc. nursing courses or programs
and established it as the basic qualification for prac-
ticing and teaching nursing. Though the transition
from diploma courses to degree courses is slow, it has
shown encouraging results, as there are many states
accepting this change. However, this degree is offered
only through schools of nursing attached to hospitals,
which are in turn affiliated with respective universi-
ties. The disadvantage of this system is that the
nursing education programs for all levels run on an
apprenticeship basis. Thus the nursing student-
learners are utilized to fill the workforce deficiencies
rather than being free to engage their attention on
training and education.
For the first time, a decade ago a Working Group on
Nursing was constituted by the Ministry of Health to
assess the situation of nursing education in the
country and to develop the nursing education and
nursing infrastructure during the 10th National
Plan (2002e2007). Their recommendations included:
convert nursing schools that are currently offering
diploma courses into colleges of nursing offering B.Sc.
nursing courses; offer periodic continuing-education
programs to update nurses’ skills in general as well
as in specialty nursing; open postgraduate nursing
educational institutions offering the M.Sc. and post-
basic nursing courses; offer clinical specialization
diplomas or certificates in geriatric nursing, occupa-
tional nursing, pediatric nursing, etc.; create a cadre
of specialty practice as well as nurse educators;
strengthen nursing educational institutions both in
terms of infrastructure development and increase the
number of seats for admissions; promote nursing
research; and improve the nurses’ working conditions.
A significant increase in funding was allocated to
support the implementation of the nursing elements
of the National Plan (Planning Commission, 2002).
Implementation of some of the recommendations
have started and are reflected in terms of increased
nursing workforce and improved nursing education.
For example, the number of registered nurses has
increased to 1.12 million in comparison with
0.7 million at the beginning of the 10th five-year plan.
Similarly there were only 654 nursing schools offering
diploma courses at the beginning of 10th five-year
plan, and currently in addition to 2,493 nursing
schools, there are 1,506 colleges also offering B.Sc.
nursing courses resulting in a threefold to fourfold
increase in nursing schools in the span of 1 decade.
However, challenges remain in spite of the progress
detailed above. Facilities for learning should be
strengthened in the training centers and the field
(community), and clinical teaching should be
improved. Infrastructure, teachings aids, and other
facilities are poor at many institutions and need to be
strengthened. Administrative control of the profession
and education should be with nurses. This control will
help in further strengthening the infrastructure and
other facilities, as they will better understand their
needs.
Enrich Curriculum
Recently, the curriculum of nursing education has
been enriched a great deal. Taking into account the
development of specialties and super-specialties in the
field of medicine or health, several post-basic courses
in these specialties are offered by different institutions,
such as medical colleges, nursing colleges, and other
health institutions. This has provided an opportunity
for practicing nurses to enrich their expertise and
qualification. However, there is a need for additional
specialties, such as geriatric nursing, occupational
health nursing, etc. Further, due to the changing role of
nurses with transition in disease patterns and national
priorities, periodical redesigning of curricula should
be conducted. For example, better immunization
and high-quality antibiotics have controlled many
communicable diseases, whereas changing lifestyles
(e.g., smoking, obesity) have increased mortality and
morbidity related to diseases, such as cardiovascular
diseases, cancer, and diabetes mellitus. Patients with
non-communicable diseases, often middle- and old-
aged, typically require rehabilitative care over a long
period of time, sometimes decades, as these diseases
are mainly chronic debilitating diseases. Thus, the
curriculum of nursing should take this into account
and emphasize rehabilitative nursing in addition to
curative nursing. In addition, post-basic courses may
address some of these issues, as these are specific
courses.
Strengthen Teaching Faculty in Nursing
The crucial problem is lack of teaching staff, both in
numbers and quality. In many instances, school
administrators hire retired nonteaching staff from the
health sector, such as retired nurses from government
medical colleges and hospitals. Currently in most of
the nursing schools, the teachers are nursing gradu-
ates from B.Sc. programs. Teachers of nursing students
should be strengthened in teaching and clinical skills
and with further education such as master’s and
doctoral degrees. The knowledge of faculty members
about prevalent health conditions and their nursing
care needs to be updated by attendance at conferences
and seminars. It is essential that nursing educators
identify and attempt to understand students’ precon-
ceptions related to upcoming clinical experiences to
develop strategies that are effective in preparing the
students for entry into new and unique settings.
Facilitating a positive transition for students’ support
efforts improves the image of and create favorable
attitudes toward community-health nursing practice
(Leh, 2011). Further helping students perceive coher-
ence between theory and practice in nursing educa-
tion, developing students’ reflective skills, and
strengthening the theoretical components of the initial
nursing education program will be beneficial (Hatlevik,
2011) for developing a well-prepared practicing as well
as teaching nurse.
 Nurs Outlook 61 (2013) 129e136
Nursing Research
Though the Trained Nurses Association of India (TNAI)
undertake several nursing research studies done on
Indian nursing problems, during pursuit of master’s or
doctoral degrees more studies are needed on self-
directed and student-centered learning approaches
for teaching, which are considered better than tradi-
tional ways of teaching. Such teaching methods should
include problem-based learning, science-based
learning and competence-driven learning (Frenk et al,
2010). Nursing has been dependent on other disci-
plines, such as sociology and psychology, for knowl-
edge about teaching as well as learning research
methods. To develop a knowledge base for nursing
dboth evidence-based teaching and practicedmore
nursing research is needed by those who hold master’s
and doctoral degrees.
In-Service Training
“In-service training” means that while the nurses are
employed in different settings, regular continuing
medical education programs should be conducted
to update knowledge and skills. A well-planned
in-service training program needs to be integrated
into the basic programs in the planning phase to
institutionalize new knowledge and skills. Mecha-
nisms have to be established to ensure that the
training centers providing the basic education are
aware of the changes and are involved in the
designing and planning of the in-service training
course. Varieties of innovative training methods have
been used to impart training to in-service learners.
“Open Universities” have adopted an integrated
multimedia approach that includes self-instructional
material supplemented by face-to-face counseling,
practical contact sessions, hands-on training, audio-
video programs, teleconferencing, telecasts, broad-
casts and interactive radio counseling for training of
in-service nurses. Such in-service training programs
may include training about newer investigative tech-
niques and newer treatment modalities, etc. Other
innovative methods include virtual learning (Wood
& McPhee, 2011), satellite-training and distance-
learning programs. In addition, using a trans-
formational leadership style provides staff educators
with a strong framework for ensuring nurse leader-
ship competency (Wojciechowski et al, 2011; Tinson
et al, 2011).
Tremendous efforts have been undertaken to
strengthen nursing education in India, such as
increased number of graduate and post-graduate
courses/institutions along with increased enrollment
in such courses over a period of time. And those in
practice are better prepared; yet the country still faces
a shortage of nurses. There is an inadequate number
of nursing workers (only 8 nurses per 10,000 people).
Uniform course syllabi and improved faculties and
135
facilities require emphasis to strengthen nursing
education in India.
Thus, on the basis of the information summarized
in this article, it is recommended that instead of having
three separate level courses, such as ANM, GNM and
B.Sc. nursing, a unified, comprehensive and stream-
lined degree-level program should be developed and
gradually more such graduate nursing personnel
should be trained to reduce the demandesupply gap in
the nursing workforce. These recommendations can
then be measured by statistics such as nurses per
10,000 people, the number of schools offering B.Sc.
nursing, and the number of B.Sc.-qualified nurses.
Implementation of these recommendations will
strengthen the nursing services and education in the
country.
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