Health Ministry to enhance autonomy for nurses in midwifery to address shortage of doctors at delivery points

PSM News /

Dec, 2015

The Union Health Ministry will soon enhance clinical autonomy for Nurse Practitioner in Midwifery (NPM) as an independent practitioner for addressing the longstanding issue of shortage of doctors, especially at delivery points. 
According to sources, a consultation on enhancement of autonomy for Nurse Practitioner in Midwifery in India was organized on July 31, 2015 which was attended by officials of ministry of health and family welfare and office-bearers of Indian Nursing Council. The meeting was also attended by Gujarat State Nursing Council, representatives of state governments of Odisha, West Bengal, Gujarat, Andhra Pradesh and Maharashtra, academia, representatives of professional associations like Trained Nurses Association of India (TNAI), development partners, physicians and trainers of Nurse Practitioner in Midwifery (NPM) course from West Bengal and Gujarat and practicing NPMs. 
After detailed deliberations, it was recommended that the NPM assessment report provides evidence about the effectiveness of NPM as an independent practitioner; so states may consider the option of replacing doctors or addressing the shortage of doctors through deployment of NPMs especially at delivery points. 
It further recommended that there is a need to have a well-defined career progression pathway and posts in place before initiating the NPM course in a state; and the level of posting (place of posting) of the NPMs whether primary, secondary or tertiary needs to be defined right from the beginning. 

Career progression for Nurse Practitioners (NP) should be designed such that their initial postings are only clinical or teaching (with strong clinical component). As their career progresses, their role can include a proportion of administrative and other duties. Competency based career progression for NPMs must be mandated. Promotion to the next level may be based upon assessment of competencies as the sole criterion. NPMs posted in tertiary hospitals may assume a different role of supervision and management. These NPMs may be positioned as labour room managers, master trainers, skill lab trainers or clinical supervisors for nursing students, the meeting further recommended. 

The meeting further recommended that the job description of a NPM should have an optimal mix of both clinical and administrative roles and NPMs may be posted both in rural as well as urban areas;   a robust job description and central guideline for every level of posting should be developed for NPMs and this should be uniform and standardized across the country; and continuing professional development (CPD) should be mandatory for the NPM graduates. 

The states planning to implement NPM course should make provision of having a licensure examination before certification of the NPM graduates may be considered by states to ensure the quality of passing out NPMs.  NPMs should be authorized to conduct all 7 BEmOC signal functions. For greater uptake of the NPM course and attracting more of private candidates; the scope of linking the private hospitals deploying NPMs to accreditation schemes or health insurance companies may also be considered. The Ministry has now invited suggestions and recommendations from the stakeholders on the recommendations of the committee.