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In a welcome move, the Indian Nursing Council will allow non-science students to join BSc nursing. This will help meet the shortage of nurses worldwide

By Dr KK Aggarwal

The Indian Nursing Council (INC) recently framed draft rules permitting students from the arts and commerce streams to sign up for BSc nursing. Until now, the four-year degree course was only open to students from the science stream. Once the draft comes into effect, all students passing out of Class XII with a score of at least 45 percent would be eligible to appear for the entrance test. This would make them eligible to join the professional course in colleges across India.

However, there are many naysayers. Perhaps the biggest one is that nursing requires full knowledge of biology, physics and chemistry, while Auxiliary Nurse Midwifery (ANM) courses (diploma courses where science subjects are not required) are mainly for mother and childcare and usually not assigned for surgery and mainstream medical care. This move may lead to producing nurses with B grade knowledge, they say.

First, one should understand what a BSc nursing course entails. After a student from the science stream completes the basic BSc programme, he/she can go for advanced courses like MSc nursing, PG Diploma in Nursing, MPhil Nursing or a PhD programme. BSc nursing comprises eight semesters. These prepare a student to become a registered nurse qualified to practise in a variety of settings in public/government or private healthcare. It adopts a credits system and semester system as per UGC guidelines. The programme encompasses foundational, core and elective courses. The choice-based system is applicable to electives only and offered in the form of modules. The programme prepares nurses for generalist nursing practice. Knowledge of wellness, health promotion, illness, disease management and care of the dying is core to nursing practice.

In addition to a range of nursing skills, students get knowledge on nursing practice. This is achieved through learning in skill/simulated labs and a clinical environment. Simulation will be integrated throughout the curriculum to enable them to develop competencies before entry into the real world of nursing practice. Through this educational process, students assimilate and synthesise knowledge, cultivate critical thinking skills and develop care strategies.

Competencies that reflect practice standards of the INC address the areas of cultural diversity, communication technology, teamwork and collaboration, safety, quality, therapeutic interventions and evidence-based practice. They are prepared to provide safe and competent care to patients and influence patient outcomes.

The question that needs to be addressed is why is there a change in the criteria wherein even commerce and humanities students can join the course? There are some reasons for this.

  • Shortage of nurses: Currently, India has only 1.7 nurses available per 1,000 population. This is less than the WHO recommendation of 2.5 nurses per 1,000 population. In other words, India is short of 2.5 million nurses, a number that has now dwindled to 1.56 million. Without the prescribed number of nurses, it is not possible for hospitals to legally function.
  • Decline in student enrolments and poor educational facilities: It is a fact that admissions to nursing colleges have come down by nearly half across the country. In addition, half of nursing colleges in south India are in the process of shutting down. However, there is an increased demand for nurses in West Asia, Asia and Africa and it won’t be long before the gates for US and Europe open as well. This is because there is a shortage of nurses there as well.
  • Course without a science background: There are auxiliary nursing and midwifery diplomas not requiring a science background. While it is agreed that nursing is considered a professional course meant for science students, it is also true that ANM does not require a science background.
  • Nursing is all-encompassing: It is im­perative to understand that nursing is about both health and wellness. Health is a state of well-being that encompasses physical, psychological, social, economic and spiritual dimensions. It is every human being’s fundamental right. Our society consists of dynamic and interactive systems involving individuals, families, groups and communities. Cultural diversity, race, caste, creed, socio-economic levels, religion, lifestyles, changes in environment and political factors in­fluence it. Nurses are required to recognise and respect human differences and diversity of population and provide ethical care. This profession, therefore, utilises knowledge derived from arts, sciences (physical, biological and behavioural), humanities and human experience. It also incorporates clinical competence, critical thinking, communication, teaching, professionalism and caring. Nurses collaborate with other health disciplines to solve individual and community health problems. The profession facilitates evidence-based practice and compassionate caring among its practitioners in response to emerging issues in healthcare and new discoveries and technologies. Above all, nursing practice requires personal commitment to professional development and life-long learning. When arts students can practise nursing after doing ANM, there should be no problem with them undertaking a BSc nursing degree.

Let us first consider the new National Education Policy 2019 which talks about pluralistic healthcare education and delivery. The first year or two of the MBBS course will be designed as a common period for all science graduates, after which they can take up MBBS, BDS, Nursing or other specialisations. It indicates that common foundational courses based on medical pluralism will be followed by core courses focused on specific systems and electives that encourage bridging across systems. Graduates from other medical disciplines will also be allowed lateral entry into the MBBS course.

Given the pluralistic healthcare legacy of India, different health systems such as Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) will be mainstreamed and better access to AYUSH treatment will be provided through co-location in public facilities. The precedent set by the National Rural Health Mission, which leveraged the popularity of AYUSH and low cost of medicines by appointing AYUSH physicians at primary health centres/community health centres will be evaluated and adapted as necessary. As per the new policy, all students who opt for nursing, BDS, MBBS or AYUSH will have a common two years’ course and then they can decide which course they want to pursue.

Similarly, after Class 10, there should be a common course with basic knowledge of all subjects. After this, a student can decide which subject to choose. However, at this level, the knowledge provided should be very basic and not advanced. There should be common 10+2 studies and later, students can choose their course of choice. That would provide a holistic education.

—The writer is President, Confederation of Medical Associations of Asia and Oceania, and Heart Care Foundation of India

Lead pic: President Ram Nath Kovind at an International Nurses Day function in Rashtrapati Bhavan/Photo: UNI

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