Advanced Practice Nursing in India

Snapshot

APN Role Exists in Country Today:
No

Title:
Nurse Practitioner (in development)

Contact:
Indian Nursing Council

Role

With 72% of the Indian population residing in rural areas and 75% of medical providers residing in urban areas, India is currently experiencing significant shortages of physicians, particularly in rural areas (Penn Nursing Science, 2013).  In addition, the overall country has a shortage of nurses and physicians, so much so that is it estimated that there is only one physician for every 1700 people (Kumar, 2013).  While the normal standards for nurse to physician ratios often reflect between a 2.0 to 3.0 nurses per physician, India has an alarmingly low nurse to physician ratio estimated around 1.22 nurses per physican (Munjanja, Kibuka, & Dovlo, 2005).  With alarmingly low health care professionals in the country, there is significant need for advancement of those few who have the education as a nurse may well be the exclusive healthcare professional in a rural area.

Recently the region of West Benghal started training Advanced Practice Nurses, identified as Nurse Practitioners (Kumar, 2013).  While this role has just begun, India has found significant resistance to developing an advanced nursing role primarily based on strong pressures by medical organizations to not increase the scope of practice of nurses.  This is primarily related to the country’s health system that has traditionally held very limited roles for nursing and maintained physicians as sole individuals to provide advanced healthcare (Penn Nursing Science, 2013).

Meanwhile, in the region of Kerala, some have reported that graduate level Nurse Practitioner courses are already offered from the Kerala Institute of Medical Sciences (shahinshahul, ClinicalResearchSociety.org, 2012, May 28).  While such programs are offered through various independent schools throughout the country, there is yet a standard identified for a Nurse Practitioner or specific advanced practice role.

Education and Certification

Education standards in India vary from diploma programs for general nursing, bachelor programs consistent with international standards, and masters and PhD programs in nursing (CurrentNursing.com, 2013).  While these programs do offer education allowing individuals to learn advanced practice nursing concepts, the current healthcare structure in the country does not provide ample opportunities for nursing advancement at the bachelor level, let alone at the masters and PhD levels, leading to many individuals leaving their areas and country to pursue more adventitious employment (Baumann & Blythe, 2008; Penn Nursing Science, 2013).  While many of the individuals who practice nursing in India are not bachelor educated, according to Nochols, Davis and Richardson (2009), India has begun to phase out their non-bachelor programs.

Midwifery is a standard of general nursing practice in India.  Regulation varies according to state and in the country no nurse is allowed to have permission to practice in more than one state at a time.  In some states, it is illegal for males to perform midwifery and obstetrics care and as it is a part of general education, there is a greater shortage of nurses in those regions (Nichols, Davis, & Richardson, 2009).

Individuals interested in attaining permission to practice in India require permission by the Equivalency Council at selected charities for a limited duration (Indian Nursing Council, 2013).  Such provisional permission to practice in India is granted for diploma, bachelor, and master prepared nurses and granted permissions.

While an individual of foreign education may have a master degree in nursing, the provisional permissions currently in India allow them to work in the administration, but no part of the application requires specific education on patient care, indicating an individual can likely not practice at any Advanced Nursing level without exclusive permission by the nursing council (as has been granted to Penn State in the region they are attempting to initiate Nurse Practitioner education) (Indian Nursing Council, 2013).

Specialties

Not applicable at this time.

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References:

Baumann, A. & Blythe, J. (2008). Globalization of higher education in nursing.  The Online Journal of Issues in Nursing, 13(2), manuscript 4.  doi: 10.3912/OJIN.Vol13No02Man04

CurrentNursing.com (2013).  Nursing Education In India.  Retrieved October 2, 2013 from: http://currentnursing.com/nursing_education/nursing_education_in_india.html

Kumar (2013, September 23).  India has just one doctor for every 1700 people.  The New Indian Express.  Retrieved from: http://newindianexpress.com/magazine/India-has-just-one-doctor-for-every-1700-people/2013/09/22/article1792010.ece

Indian Nursing Council (2013).  Home.  Retrieved October 2, 2013 from: http://www.indiannursingcouncil.org/

Munjanja, O.K., Kibuka, S., & Dovlo, D. (2005).  Issue Paper 7: The Nursing Workforce In Sub-Saharan Africa.  International Council of Nurses.  Retrieved from: www.ghdonline.org/

Nichols, B.L., Davis, C.R., & Richardson, D.R. (2011).  Appendix J: International models of nursing.  The Future of Nursing: Leading Change, Advancing Health.  Institute of Medicine.  Retrieved from: http://www.nap.edu/catalog/12956.html

Penn Nursing Science (2013).  Utilizing APNs to Solve Provider Shortage in Rural India.  Retrieved October 2, 2013 from: http://www.nursing.upenn.edu/gha/Pages/UtilizingAPNstoSolveProviderShortageinRuralIndia.aspx

[Updated 2013, October 30]

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