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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 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,
The history of nursing in India dates back to about 1500 2003) described the qualities of a nurse as “knowledge
B.C.E., in the scriptures of Hindu teaching of the Sam- of the manner in which drugs should be prepared or
hite period (2000 e 1100 B.C.E.), the Atharva Veda, Sus- compounded for administration, cleverness, devoted-
hruta (500 B.C.E.) and Charaka (300 B.C.E.), which were ness to the patient waited upon, and purity (both of the
the leading authorities of ayurveda (the science of life). mind and body)..” However, there is little information
The eight parts of the ayurveda cover the entire field of about female nurses in ancient and medieval India of
medical science, including nursing treatments. More the Asoka, Huns, and Mughals (Sakurikar, 2011).
details and descriptions about nursing appear in the In India, the modern field of medicine, including
old Indian records than in those of any other country in 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 working conditions, education, and services of the
established the Royal Hospital (Sakurikar, 2011). For nursing profession.
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 The Nursing Workforce in India
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, India, which comprises 28 states and 7 union territo-
many nursing schools were established in different ries, is one of the oldest civilizations in the world.
parts of India with the objective of standardizing India’s population is 1.22 billion with 628.8 million
nursing training (Gill, 2011). The Trained Nurses’ males and 591.4 million females. The crude birth rate is
Association of India (TNAI) came into existence in 1922 20.97 births per 1,000 people, and the crude death rate
and initially undertook the preparation of short is 7.48 deaths per 1,000 people. The life expectancy at
abstracts of nursing research studies done on Indian birth and the literacy rate for the country is 66.8 years
nursing problems, at the master’s or doctoral level and 61%, respectively. The current infant mortality rate
(Sakurikar, 2011). is 47.57 deaths per 1,000 live births. The number of
At the time of independence in 1947, only about physicians (as of 2010) possessing recognized medical
7,000 nurses practiced in the entire country with qualifications (under the MCI Act) is 816,629 (Central
a population of about 350 million (Sakurikar, 2011). The Bureau of Health Intelligence, 2011). Currently, the
hospitals were understaffed and nursing lacked country has 6,368 nursing schools (Indian Nursing
professional and social status. In 1943, the Bhore Council, 2011).
Committee emphasized the integration of curative and Nurses represent the largest share (38%) of the total
preventive medicine at all levels and recommended health workforce of India (Gill, 2011). In India, four
the remodeling of health services in India. As a result, types of health workers provide “nursing services”: the
the Indian Nursing Council (INC) was established in general nurse midwife (GNM), the “lady health visitor”
1947 to regulate the standards of nursing education. In (LHV), the auxiliary nurse-midwife (ANM), and the
the first and the second five-year plan periods (1951 e midwife. Other personnel who also contribute to the
1961), because of the pressure of the growing need for delivery of nursing services include “the Dais” (trained
trained nurses in the country, a rapid development in and untrained), nursing assistants, orderlies, ward
nursing education occurred. The most significant boys, and ayahs. Dais are female assistants in the
development was the extension of nursing and villages who do not have formal nursing training, but
midwifery to the rural areas. Only in the third five-year after informal training can perform noninstitutional/
plan (1961 e 1966) were the education of nurses and hospital deliveries in remote villages, and ayahs are
supervision in the public health field more closely female attendants in the villages helping dais and
examined. mothers in the rearing of newborns. The suggested
Considerable steps were taken between 1950 and ratio for nurses is one nurse per 5,000 people living in
1970 to reform nursing education (Sakurikar, 2011). lowlands (non-hilly) areas and one per 3,000 in hilly
International agencies like WHO, UNICEF, and USAID areas, such as the northeastern part of the country
as well as consultants (medical experts) played an (Park, 2011). Yet, the nurse-to-population ratio found in
active role in organizing and reforming nursing the country is suggestive of the shortage of nursing
education. Many buildings designated as schools of personnel needed to provide needed services. Accord-
nursing were constructed with funding received from ing to the WHO, the number of nurses per 10,000 pop-
agencies such as WHO, UNICEF, and USAID. Nurses ulation in India is 8, whereas it is 33 nurses per person
and doctors were given study grants to obtain for the world and 16 for low-income countries (WHO,
advanced education degrees outside India. The 2011). India ranks 75th among 133 developing coun-
College of Nursing at the Post-Graduate Institute of tries with regard to the number of nurses (Pharma
Medical Education and Research (PGIMER), Chandi- Tutor, 2011).
garh, was established in 1964. The College of Nursing There are 576,810 registered ANMs, 1,128,116 regis-
at The All-India Institute of Medical Sciences, New tered GNMs, and 52,490 registered LHVs (Central
Delhi, was established in 1969. By the end of the Bureau of Health Intelligence, 2011). In addition,
fourth five-year plan (1969 e 1974), the government of although these individuals are registered with the
India and the Indian Nursing Council proposed Indian Nursing Council, it does not necessarily mean
various measures to integrate psychiatric nursing in that they are practicing in India, or practicing at all, as
the basic nursing curricula throughout the country. By some may have migrated to other nations. In addition,
1975, some states also tried to establish similar state- the distribution of nurses in India is not equal in the
level institutions. Along with the development of ratio of nurses to citizens across the 28 states. For
national medical institutions/colleges, colleges of instance, the Kerala state with lower mortality rates
nursing were also established. In 1989, a prominent reported a higher availability of nurses in comparison
governmental committee for the nursing profession with the states experiencing high mortality rates, such
established guidelines and directions regarding the as Uttar Pradesh, Bihar, and Jharkhand (Indian Nursing
 Nurs Outlook 61 (2013) 129e136 131

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

force could be lost to wealthier states, such as Middle

Table 2 e Number of Institutions Providing
Nursing Education and Nursing Workforce in India Eastern countries, through “circular migration”
(2012) (Hawkes et al., 2009). Circular migration is a form of
Institutions/Courses Number migration by which the immigrants move to other
countries for a few months and then return to the
ANM-course Nursing school 1310 native country. After the 1980s there was a shift to
GNM-course Nursing school 2493
mass migration of nurses from India, most of them
B.Sc. Nursing Colleges 1506
Institution for Post-Basic B.Sc. course 615
belonging to the state of Kerala, which is in the
M.Sc. Nursing Colleges 444 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-
The National Rural Health Mission (NRHM), ment hubs in the country: Kochi, Bangalore, and Delhi.
launched in 2005, is a centrally funded plan, and These recruitment centers facilitate migration of
provides technical and financial support to address the nurses to other countries like the U.S., the United
shortage of human resources in healthcare services. As Kingdom, Ireland, Singapore, New Zealand, Australia,
an immediate measure of the NRHM, states were fun- and the Gulf nations (Khadria, 2007). As long as striking
ded by the central government to hire a second nurse- global disparities in nursing income persist, it will be
midwife for the distant health sub-centers in the difficult to stem the hemorrhage of nurses emigrating
different states of the country, three nurses for the in pursuit of better pay (Hawkes et al, 2009). Most of the
primary health centers, and nine nurses in the 30-bed private hospitals in India offer an initial pay of INR 2500
Community Health Centers (CHCs). This led to the to INR 3000 per month, whereas an Indian nurse can
appointment of an additional 26,993 nurses and 46,990 earn as much as INR 40,000 per month as a starting
ANMs. Unfortunately few states were unable to make salary after migrating to one of the Gulf countries
use of the opportunity due to the limited number of (Surya, 2001; Percot, 2006). Some of the salary other
ANMs or nurses available to be recruited (Ministry of countries pay to these nurses finds its way back to the
Health and Family Welfare, 2011). Indian economy as these nurses send money back to
The NRHM plans to set up 132 ANM and 137 GNM their families. A multicenter survey of 448 practicing
schools at a cost of Indian Rupees (INR) 660 crores nurses reported that 63% of India’s nurses intend to
(USD 125.66 million) and INR 1370 crores (USD 260.85 emigrate, citing dissatisfaction with working condi-
million), respectively, which has been approved by tions and unhappiness with prevalent social attitudes
the central government. Plans for upgrading and toward nurses as motivating factors (Thomas, 2006).
transforming 25 nursing schools that are attached to Another field study of nurses in Delhi indicated that
medical colleges into nursing colleges have been the most common impetus for emigration was better
announced. State Nursing Councils and state nursing income prospects overseas (Khadria, 2004).
units have been provided with INR 10 million (179,000
USD) each to improve their faculty capacities. This
funding supports faculty development programs to Nursing Education in India
train 300 faculty members to teach in these schools
in various states. Nursing Councils have also revised
guidelines or standards for establishing nursing Since independence, nursing education has grown
schools and colleges, thus enabling many more to rapidly with the increase in infrastructure and
start up immediately (Ministry of Health and Family workers. Nursing today demands a high level of
Welfare, 2011). There is an assessed need to train knowledge and skill, and basic nursing education
more than 0.9 million nurses to meet the shortfall programs strive to provide learning experiences that
of nurses in the country (International news and will equip the student to perform at a professional
views, 2011). level. These education programs still suffer from some
In India, the current student capacity in existing challenges, such as lack of faculties and infrastructure,
functioning diploma nursing schools, B.Sc. (Nursing) and nonuniform syllabi.
Colleges and M.Sc. (Nursing) Colleges is 88,202; The Indian Nursing Council is an autonomous body
68,858; and 8,000 students, respectively. The under the government of India. The Ministry of Health
Government of India plans to set up 269 new ANM & Family Welfare, which was constituted by the central
and GNM schools, which will result in an additional government under section 3(1) of the Indian Nursing
22,000 nurses being trained annually at diploma Council Act, 1947, of Parliament, governs all nursing
levels as ANMs and GNMs (International News and services and education in India. The council monitors
Views, 2011). the uniform standards of nursing education for nurse
However, these numbers do not necessarily reflect midwife, ANMs, and LHVs, and it prescribes the
the actual availability of new nurse graduates to prac- syllabus and regulations for nursing programs. The
tice in India. The discussions about the "brain drain" council also accredits the programs and monitors them
in India suggest that up to one-fifth of the nursing labor regularly.
 Nurs Outlook 61 (2013) 129e136 133

Several basic and additional qualifications exist areas of medicine and nursing. These programs are
for postgraduate-diploma or postgraduate-certificate designed for cardiovascular and thoracic nursing,
programs, such as public health nursing, and oncology nursing, critical-care nursing, neurology
pediatric nursing offered by institutions and nursing, nephro-urology nursing, orthopedic nursing,
universities. gastroenterology nursing, obstetric and gynecological
nursing, pediatric (child health) nursing, psychiatric
(mental health) nursing and community health (public
Nursing Schools
health) nursing. The usual duration of these courses is
one year and pursued as an additional qualification by
Health school-based nursing training is the dominant
nursing graduates that have the experience of clinical
form of nursing education in India. Most of these
nursing. Currently 615 institutions in India offer such
schools are attached to hospitals. These schools
post-basic diploma programs monitored by the SNC
usually provide training in ANM and GNM services,
and TNCI.
which are diploma programs. The students who have
Both government and private institutions provide B.
10 years of general schooling are eligible to take an
Sc. programs in nursing. The total amount of fees to be
ANM course, whereas those who have passed 12 years
paid in private institutions is comparatively more than
of schooling with a science stream (having subjects
in the government institutions. The course fee, stipu-
such as biology, chemistry, and physics in the 12th year
lated by the Indian Nursing Council, for B.Sc. nursing is
of schooling) are eligible for GNM courses. The average
INR 50,000 (USD 1,000). For any one-year specialty or
student age in the GNM program is 17 years. Admission
diploma course like critical-care nursing, oncology
to these programs is based on merit scored in the
nursing, cardiothoracic nursing, and disaster nursing
respective grades, i.e., 10th or 12th standard. The total
etc., the fee is INR 25,000. However, the total actual
duration of the ANM course is 2 years, and that of the
course fee for B.Sc. nursing can vary from INR 60,000 to
GNM program is three-and-a-half years. Thus the GNM
200,000 per year, depending on the institution
course is a more detailed one with more hands-on
(Education and Career in India, 2011).
experience and practical work. Those who success-
fully complete these courses are registered with the
respective SNCs.
Challenges in Nursing Education in India
University Degrees
Nursing education in India is not streamlined and
The university degrees are housed in institutions of therefore faces several challenges. A streamlined
higher education. These colleges of nursing within course consisting of a unified and comprehensive
universities award bachelor’s, master’s, and doctorate syllabus replacing different level courses, such as
degrees in nursing. The graduates with B.Sc. Degrees in ANM, GNM, and B.Sc. nursing, should be done.
nursing can engage in both clinical nursing and clinical Currently, in a few states, diploma-level courses are
teaching. The eligibility criteria for graduate nursing available whereas in the majority of other states the
courses are 12 years of schooling with a science stream. basic-level course is the degree in nursing. Many
This degree can also be acquired as an additional smaller states of the northeast and less-developed
qualification by GNMs either through regular courses regions lack the basic infrastructure needed to
from a recognized university or through distance- provide good (with respect to complete and updated)
learning processes from open universities, such as nursing education. The focus of the nursing at
Indira Gandhi National Open University New Delhi, a primary health center and district-level hospital is on
Yashwantrao Chavan Open University, and Annamalai maternal and child healthcare and optimal nutrition of
University Chennai, etc. In India, 1,506 institutions the patients, whereas along with epidemiological
offer a bachelor’s course of study, and 444 institutes transition, specialties like the noncommunicable
offer a master’s course of study (Table 2). The master’s disease, environmental, and occupational health
courses are offered in public health nursing, cardio- hazards areas have emerged. This change requires
vascular nursing, oncology nursing, and pediatric developing skills in these types of health hazards to
nursing, etc. The graduates pursuing those master’s tackle them effectively.
courses have a better opportunity of working in
specialty hospitals. Further if they wish to leave
a government job voluntarily, they have better oppor- Methods to Improve Nursing in India
tunities for employment in private super-specialty
hospitals.
Streamline Basic Nursing Education
University Diplomas
Until recently the basic qualification for practicing
Several universities and teaching hospitals also run clinical nursing was the ANM and GNM. However,
short-term specialty programs in different specialized recently some SNCs such as those in Maharashtra and
134 Nurs Outlook 61 (2013) 129e136

Kerala have started B.Sc. nursing courses or programs Enrich Curriculum

and established it as the basic qualification for prac-
ticing and teaching nursing. Though the transition Recently, the curriculum of nursing education has
from diploma courses to degree courses is slow, it has been enriched a great deal. Taking into account the
shown encouraging results, as there are many states development of specialties and super-specialties in the
accepting this change. However, this degree is offered field of medicine or health, several post-basic courses
only through schools of nursing attached to hospitals, in these specialties are offered by different institutions,
which are in turn affiliated with respective universi- such as medical colleges, nursing colleges, and other
ties. The disadvantage of this system is that the health institutions. This has provided an opportunity
nursing education programs for all levels run on an for practicing nurses to enrich their expertise and
apprenticeship basis. Thus the nursing student- qualification. However, there is a need for additional
learners are utilized to fill the workforce deficiencies specialties, such as geriatric nursing, occupational
rather than being free to engage their attention on health nursing, etc. Further, due to the changing role of
training and education. nurses with transition in disease patterns and national
For the first time, a decade ago a Working Group on priorities, periodical redesigning of curricula should
Nursing was constituted by the Ministry of Health to be conducted. For example, better immunization
assess the situation of nursing education in the and high-quality antibiotics have controlled many
country and to develop the nursing education and communicable diseases, whereas changing lifestyles
nursing infrastructure during the 10th National (e.g., smoking, obesity) have increased mortality and
Plan (2002e2007). Their recommendations included: morbidity related to diseases, such as cardiovascular
convert nursing schools that are currently offering diseases, cancer, and diabetes mellitus. Patients with
diploma courses into colleges of nursing offering B.Sc. non-communicable diseases, often middle- and old-
nursing courses; offer periodic continuing-education aged, typically require rehabilitative care over a long
programs to update nurses’ skills in general as well period of time, sometimes decades, as these diseases
as in specialty nursing; open postgraduate nursing are mainly chronic debilitating diseases. Thus, the
educational institutions offering the M.Sc. and post- curriculum of nursing should take this into account
basic nursing courses; offer clinical specialization and emphasize rehabilitative nursing in addition to
diplomas or certificates in geriatric nursing, occupa- curative nursing. In addition, post-basic courses may
tional nursing, pediatric nursing, etc.; create a cadre address some of these issues, as these are specific
of specialty practice as well as nurse educators; courses.
strengthen nursing educational institutions both in
terms of infrastructure development and increase the Strengthen Teaching Faculty in Nursing
number of seats for admissions; promote nursing
research; and improve the nurses’ working conditions. The crucial problem is lack of teaching staff, both in
A significant increase in funding was allocated to numbers and quality. In many instances, school
support the implementation of the nursing elements administrators hire retired nonteaching staff from the
of the National Plan (Planning Commission, 2002). health sector, such as retired nurses from government
Implementation of some of the recommendations medical colleges and hospitals. Currently in most of
have started and are reflected in terms of increased the nursing schools, the teachers are nursing gradu-
nursing workforce and improved nursing education. ates from B.Sc. programs. Teachers of nursing students
For example, the number of registered nurses has should be strengthened in teaching and clinical skills
increased to 1.12 million in comparison with and with further education such as master’s and
0.7 million at the beginning of the 10th five-year plan. doctoral degrees. The knowledge of faculty members
Similarly there were only 654 nursing schools offering about prevalent health conditions and their nursing
diploma courses at the beginning of 10th five-year care needs to be updated by attendance at conferences
plan, and currently in addition to 2,493 nursing and seminars. It is essential that nursing educators
schools, there are 1,506 colleges also offering B.Sc. identify and attempt to understand students’ precon-
nursing courses resulting in a threefold to fourfold ceptions related to upcoming clinical experiences to
increase in nursing schools in the span of 1 decade. develop strategies that are effective in preparing the
However, challenges remain in spite of the progress students for entry into new and unique settings.
detailed above. Facilities for learning should be Facilitating a positive transition for students’ support
strengthened in the training centers and the field efforts improves the image of and create favorable
(community), and clinical teaching should be attitudes toward community-health nursing practice
improved. Infrastructure, teachings aids, and other (Leh, 2011). Further helping students perceive coher-
facilities are poor at many institutions and need to be ence between theory and practice in nursing educa-
strengthened. Administrative control of the profession tion, developing students’ reflective skills, and
and education should be with nurses. This control will strengthening the theoretical components of the initial
help in further strengthening the infrastructure and nursing education program will be beneficial (Hatlevik,
other facilities, as they will better understand their 2011) for developing a well-prepared practicing as well
needs. as teaching nurse.
 Nurs Outlook 61 (2013) 129e136 135

Nursing Research facilities require emphasis to strengthen nursing

education in India.
Though the Trained Nurses Association of India (TNAI) Thus, on the basis of the information summarized
undertake several nursing research studies done on in this article, it is recommended that instead of having
Indian nursing problems, during pursuit of master’s or three separate level courses, such as ANM, GNM and
doctoral degrees more studies are needed on self- B.Sc. nursing, a unified, comprehensive and stream-
directed and student-centered learning approaches lined degree-level program should be developed and
for teaching, which are considered better than tradi- gradually more such graduate nursing personnel
tional ways of teaching. Such teaching methods should should be trained to reduce the demandesupply gap in
include problem-based learning, science-based the nursing workforce. These recommendations can
learning and competence-driven learning (Frenk et al, then be measured by statistics such as nurses per
2010). Nursing has been dependent on other disci- 10,000 people, the number of schools offering B.Sc.
plines, such as sociology and psychology, for knowl- nursing, and the number of B.Sc.-qualified nurses.
edge about teaching as well as learning research Implementation of these recommendations will
methods. To develop a knowledge base for nursing strengthen the nursing services and education in the
dboth evidence-based teaching and practicedmore country.
nursing research is needed by those who hold master’s
and doctoral degrees.
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