Faced with a crippling shortage of healthcare specialists, the Ministry of Health is planning to introduce nurse practitioners (NPs) in select disciplines such as oncology, neurology and critical care.
The Indian Nursing Council has finalised the curriculum for a two-year postgraduate residency programme for NPs, with the ministry inviting feedback from all stakeholders, including professionals and the general public.
However, a legal amendment would be needed in the Indian Nursing Council Act 1947 before the NPs can actually perform the role envisaged for them, which is a combination of nursing and basic diagnosis and treatment.
“Nurse practitioners in critical care/ acute care, oncology, emergency care, neurology, cardiovascular care, and anaesthesia, can be prepared to function in tertiary care settings. Rigorous educational preparation will enable them to diagnose and treat patients with critical illnesses as well as preventive… care relevant to such illnesses and patients’ responses to illness,” stated a document circulated by the Ministry of Health for feedback.
Sources said the ministry would wait for feedback from stakeholders before finalising the curriculum. “But it is important to understand that the current laws governing the profession do not provide for NPs to practice independently. Those amendments will have to be made before the first batch of NPs are ready to join the workforce,” said sources.
To start NP programmes, hospitals should be recognised as parent tertiary care centres with a minimum requirement of 500 beds and above each, with medical, surgical and cardiothoracic ICUs — each should have a minimum of 10 beds in each ICU and a total of 40-50 ICU beds.
NPs have been functioning in the US since 1960s, UK since 1980s, Australia since 1990s and Netherlands since 2010. In these countries, they are essentially nurses registered for advanced practice, who can take medical decisions or perform specified procedures. The American Association of Nurse Practitioners describes NPs as “clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management”.
The introduction of nurse practitioners in the public health system has been a recurring theme in most stock-taking exercises in India.
The disciplines have been chosen keeping in mind India’s changing disease profile and the limited availability of trained specialists. For instance, there are less than 2,000 oncologists in the country for an estimated 1 crore cancer patients.
Neurology is yet another under-serviced area. While the Indian Council of Medical Research’s data show that an estimated 1.6 million people suffer a stroke every year, there are only an estimated 1,200 neurologists available.
Cardiovascular diseases are said to account for about 30 per cent of all deaths in India. But according to the Cardiological Society of India, the country has less than “4,000 cardiologists and 1,200 cardiac surgeons for a population of 1.2 billion”.