India needs robust nursing education to build healthy cities

lorence Nightingale, well known as “The lady with a lamp”, was the founder of Modern Nursing. She was born in England in the 19th century and died at the beginning of the 20th century. Despite lacking infrastructure and unhygienic practice in hospitals, she established a system for patient care. Her perseverance towards excellent patient care laid down the profession in a respectable and high-status style of health care.
In 1871, the first nursing school was started in Government General Hospital, Madras, with four students with a six-month diploma midwives program. While Nursing Council Act came into existence in 1948 to constitute a council of nurses who would safeguard the quality of nursing education in the country. There are seven levels of nursing education in India today.
1. Auxiliary Nursing and Midwifery (ANM) or Multi-Purpose Health Worker- Female (MPHW-F)
2. General Nursing and Midwifery (GNM)
3. Basic Bachelor of Nursing (B.Sc. Nursing)
4. Post Basic Bachelor of Nursing (P.B.B.Sc. Nursing)
5. Masters in Nursing (M.Sc. Nursing)
6. Masters of Philosophy in Nursing (M.Phil)
7. Doctorate in Philosophy in Nursing (PhD)
Nursing education emphasises restoring and maintaining health and preventing disease and helps develop a deep pride in the nursing profession among students to enable further professional growth.
A nurse plays an essential role in hospitals as well as society. Where a doctor is the brain of the hospital and a nurse is the heart of the hospital. Nurses advocate for health promotion, educate patients and the public on preventing illness and injury, providing care, assisting in the cure, participating in rehabilitation, and providing support. No other health care professional has such a broad and far-reaching role.
Nurses help families learn to become healthy by helping them understand the range of emotional, physical, mental and cultural experiences they encounter during health and illness. Nurses are considered as the saviour not only for patients but also for their families. Families are made comfortable to share their grief and pain encountered by illness. In addition, nurses provide emotional support and mental care for a speedy recovery.
Nurses do more than care for individuals. They have always been at the forefront of change in health care and public health.
Nurses played a critical role during the COVID-19 pandemic. They continued to be at the front line of patient care in hospitals and actively involved with evaluation and monitoring in the community. Nurses ensured that all patients acquire personalised, high-quality services irrespective of their infectious condition. They also engaged in planning for anticipated COVID-19–related outbreaks, which increase the demand for nursing and healthcare services. However, COVID-19 has affected the life and health of more than one million people across the world. This overwhelms many countries’ healthcare systems and, of course, affects healthcare providers such as nurses fighting on the frontlines to safeguard the lives of everyone concerned. Exploring the issues that nurses had face during their battle will help support them and develop protocols and plans to improve their preparedness. An integrative review by S Karger suggested that the major issues faced by nurses in this situation were the critical shortage of nurses, beds, and medical supplies, including personal protective equipment and, psychological changes and fears of infection among nursing staff.
Our country faces an acute shortage of nursing staff with an estimated deficit of about twenty lakh. The deficit in the public sector alone is considered to be 1,40,000 staff nurses. The Nurse-population ratio and Nurse-doctor ratio is also abysmally low in India compared to developed countries of Europe and other western countries.
Thus, to develop trained nurses, there are two main routes in our country. The majority of nurses undergo a three-year diploma training in Schools of Nursing to become General Nurse Midwife. A minority undertake a four-year training in a College of Nursing (affiliated to a University) to obtain a B.Sc degree from a Registered Nursing College recognised by Indian Nursing Council and State Nursing Councils. Apart from this, many universities are also offering courses other than these, ie., M.Sc in Nursing, PhD and M.Phill in Nursing.
While staff nurses are recruited from the GNM cadre in most public sector healthcare facilities, the B.Sc graduates work for a short duration in such sectors to gain experience. They are primarily interested in migrating to developed countries to get attractive salaries and perks and responsible positions. Thus, they have a bright career therein. This shows that the higher academic qualifications in Nursing are valued as a potential route of acquiring better-paid jobs and higher status, as their roles and responsibilities differ from the GNM cadre.

Nursing Education Overview

Auxiliary Nurse Midwifery Course: It is a two-year duration course with the eligibility of 10+2 (from the Arts or Science stream). Students have to secure at least 40-50 per cent marks in the qualifying examination. The minimum age requirement is 17 years. Only female students can apply for this course. The main aim of the course is to teach students to help the whole community of people in providing healthcare. This course has its importance because of the need for people to know the health profession. In case of a shortage of highly qualified Nurses, the candidates who have passed ANM are preferred as a stop-gap arrangement.
General Nursing and Midwifery: It is a three-year diploma course designed for aspirants who want to pursue a career in clinical nursing. The programme teaches candidates how to care for sick individuals or those who have been injured to help them attain full recovery. In addition, GNM courses are designed to prepare the students for the clinical approach of handling patients.
Internship: The internship is an integral part of Nursing education, which provides practical exposure to students from the hospital or any other healthcare organisation which should have full-fledged facilities to treat patients suffering from different diseases. During the attachment, they also get an opportunity to research. Further, they will also gain experience as to how they can professionally handle different situations and adjust to the requirements at the ground level. Administration and Ward Management, including health economics, are the other areas that would help manage health-related affairs in their future career.
Candle Light Ceremony: The name candle lighting was used because of the historical association with Florence Nightingale, known as the “Lady With A Lamp”. The lighted lamp, the flame, came to symbolise a nurse’s dedication to caring for patient’s needs.
During the ceremony, the students who have excelled in various areas during their academic period are awarded and appreciated. This event would give students little time to break from their busy schedules, recommit themselves to nursing careers, and establish social and supportive relationships with other students. The Candle Lighting Ceremony is considered one of the most emotionally moving and memorable moments for Nursing students.
It is also a get together of faculty and students and an opportunity to share their experience and achievements during their academic period.
The ceremony begins with the nursing students appearing on stage one by one holding candles, an action inspired by Florence Nightingale. She would tend to her patients at night, holding a kerosene lamp during the Crimean War. The students participating in the function wear traditional white nursing uniforms and caps, garments that give them a unique identity. Considering the scarcity of trained nurses in different healthcare organisations and with the recommendations of the Health & Welfare Department of Government of Gujarat, the Institute initiated the GNM (General Nursing & Midwifery Course) with the recognition of the Indian Nursing Council and Gujarat Nursing Council in the year 2004. The course was inaugurated by the then Minister of Health & Family Welfare, Jai Narayan Vyas, in 2004. Further, to give upward mobility to GNM students in their nursing career, we started Post-Basic B.Sc. students in the year 2008 followed by Auxiliary Nursing Midwifery Course in 2009.
The admission of the students to the above courses is given as per the norms laid down by Gujarat Nursing Council on a merit basis. It is a matter of pleasure that almost all passed out nursing students are working in different healthcare organisations in India and abroad. With an advanced syllabus and the support of experienced and qualified faculty, they share their knowledge on various topics as per the syllabus. The Academy is having all the required infrastructure, including a well-established Library and Laboratory. Further, we are also sending them to major Government and Private hospitals during the internship period, enabling them to have practical experience in nursing-related matters and procedures.