The story so far: The stormy Monsoon session of the Parliament saw a barrage of Bills being passed by both Houses without debate. One among these is a key health Bill – the National Nursing and Midwifery Commission Bill (NNMC), 2023, passed in the Lok Sabha on July 28 amid protests from the Opposition which had been demanding Prime Minister Narendra Modi’s presence in the House to debate the Manipur crisis.
Two health Bills – the National Nursing and Midwifery Commission Bill, 2023 and the National Dental Commission Bill, 2023 were tabled on July 24 in the Lok Sabha. On July 28, they were passed within minutes of being taken up for consideration, sans debate. Both Bills were then passed by Rajya Sabha on August 8 without debate as the Opposition had walked out.
The National Nursing and Midwifery Commission Bill, 2023 had been facing protests in Kerala and Maharashtra as it gives the Centre and the States more power over nursing education and employment.
What does the Nursing and Midwifery law do?
The key features of the law are establishment of the National Nursing and Midwifery Commission, autonomous boards, State Nursing and Midwifery Commission and Nursing and Midwifery Advisory Council to replace the Indian Nursing Council.
National Nursing and Midwifery Commission
Repealing the Indian Nursing Council Act, 1947, this law establishes a National Nursing and Midwifery Commission replacing the India Nursing Council. This Commission will be a Delhi-based governing body with a Chairperson, sixteen ex-officio members and twelve members, empowered to:
- Frame policies and regulate standards for midwifery and nursing education and training. This includes setting standards for faculty, assessment, instructional methods, admission in institutes, examination, research, tuition fee for various categories and professional education.
- Regulate institutions, research, and professionals involved in midwifery and nursing
- Provide a mechanism to ensure competence of midwives and nurses for enrolling in a national register via an exam in the final year of undergraduate studies. This will help grant licences to practice as a midwife or nurse.
- Integrate soft skills and elective courses in nursing and midwifery curriculum, and collaborate with industry partners for research and innovation.
- Assess requirements for nursing and midwifery in healthcare fields including career opportunities for professionals and associates.
- Ensure the polices for providing care by nurses and midwives follow professional ethics and code of conduct.
- Co-ordinate and frame guidelines for functioning of the National Commission, the autonomous boards, Advisory Council and State Commissions including co-ordinations between the Boards; ensure compliance of the Act; and exercise appellate jurisdiction for the decisions of the autonomous boards.
The Chairman, Secretary and members of the National Commission can hold office for a maximum term of four years. Members cannot be older than sixty-five years of age.
Autonomous Boards
This law empowers the Centre to set up three autonomous boards – (i) Nursing and Midwifery Undergraduate and Postgraduate Education Board (ii) Nursing and Midwifery Assessment and Rating Board and (iii) Nursing and Midwifery Ethics and Registration Board under the supervision of the National Commission.
(i) Nursing and Midwifery Undergraduate and Postgraduate Education Board
This Board sets the standards for nursing and midwifery education and examination at undergraduate and postgraduate level, by developing a competent curriculum to provide healthcare, teach and conduct research.
The Board also decides on the required undergraduate and postgraduate qualifications in nursing and midwifery institutions, standards to set up such institutions, norms for infrastructure, faculty, quality of education, and training of faculty members,, norms for mandatory annual disclosures by faculty and the institution, and regulates scope of practice of registered professionals in the field including their prescribing authority.
(ii) Nursing and Midwifery Assessment and Rating Board
This Board decides on the procedure to assess and rate nursing and midwifery institutions for complying with Board regulations. It also grants permission to set up new institutions, conduct inspections, empanel independent rating agencies to assess such institutions and publish the results in the public domain. The Board is empowered to issue warnings, impose monetary penalties or reduce/stop admissions to such institutions.
(iii) Nursing and Midwifery Ethics and Registration Board
This Board maintains the National Register for all registered nursing and midwifery professionals and has the power to approve or reject applications for registration. It can also regulate professional conduct and promote nursing and midwifery ethics. It also co-ordinates interaction with the State Commissions, receives complaints, addresses grievances and exercises appellate jurisdiction for actions taken by any State Commission.
State Nursing and Midwifery Commission
Under this law, every State must constitute a State Nursing and Midwifery Commission within one year of this law’s enactment.
The State Commission is tasked with the following:
- To enforce professional conduct, code of ethics to be followed by nursing and midwifery professionals and take disciplinary action.
- To ensure standards of education, courses, curriculum, facilities, staff qualifications, quality of instructions, assessment, examination, training, research and compliance with directives of the National Commission.
- To maintain State registers for registered professionals, issue certification for practitioners of nursing and midwifery, conduct counselling for admission to nursing and midwifery associates, and conduct skill-based examination to ensure competence of professionals before enrolment in the State Register.
Nursing and Midwifery Advisory Council
This law also allows the Centre to constitute a Nursing and Midwifery Advisory Council, which acts as a primary platform for States and Union Territories to voice their concerns to the National Commission. Their inputs help the Commission decide on policies, education, services, training and research pertaining to nursing and midwifery.
This Council also advises the National Commission on maintaining standards of nursing and midwifery education, services, training and research. It also advises on ways to enhance equitable access to nursing and midwifery for all citizens.
How is the new law different from the Indian Nursing Council Act, 1947?
With the formation of the National Commission for Nursing and Midwifery, the Central government has more power as most of the members are employees of the Union Health and Defence Ministry. The Indian Nursing Council comprised of one registered nurse from each State, two members elected from nursing education institutes, a member elected by the Medical Council of India, one elected member from Central Council of the Indian Medical Association, one from Council of the Trained Nurses Association of India and four midwives from the four zonal groups states are bifurcated into, the Chief Principal Matron, Medical Directorate, Chief Administrative Medical Office of each state, four members nominated by the Central Government, three members elected by Parliament -- two from Lok Sabha and one from Rajya Sabha.
In contrast, all members in the National and State Commission are nominated by the Centre or State governments -- mainly employees of either government. The scope for electing members to the body has been scrapped.
The Council was a stand-alone body which oversaw recognising qualifications awarded by registered nursing institutions in states, negotiating recognition of qualifications of foreign universities in the same field, inspect registered nursing and midwifery institutions, seek information regarding the courses offered by these institutions, withdraw the recognition awarded by it and maintain a national/ state register of nurses and midwives.
The Council also had the power to frame regulations for: managing its property, elections for members, functions of the members including the President of the Council, standard curricula for nurses and midwives, conditions for admission to courses and standards of examination.
However, under the National Nursing and Midwifery Commission Act there are provisions for establishing autonomous boards and advisory council for policy-making and ensuring compliance of the provisions of the law, thus bifurcating supervisory powers. These bodies also ensure a standardised admission process to ensure consistency in nursing education which is equitable to all. Functions such as registration, setting of standards for curricula, examinations, admissions are handled by the National and State Commissions.
Opposition from States
The law, which has been in the making since 2020, has met with severe opposition from nursing unions in Kerala and Maharashtra. As per reports, in Kerala, which has the highest number of nurses in India, the Kerala Government Nurses Association (KGNA) held protests against the Bill, claiming that it replaced the nursing unions’ autonomy.
They also pointed out that representation from each State has been replaced with zone-wise membership in the Commission, which means several States may not have a representative during a two-year term. The body also condemned the mandatory third-year exam for registration of nurses in the State Council, claiming that students from financially poor conditions will be at a disadvantage.
