Salient Features of the National Nursing and Midwifery Commission Act, 2023

Salient Features of the National Nursing and Midwifery Commission Act, 2023

On August 12, 2023, the National Nursing and Midwifery¹ Commission Act, 2023 ("NNMC"), was given the assent of the President. The NNMC brings significant legislative reform in the sector by repealing the existing Indian Nursing Council Act, 1947, with a modern structure. The NNMC’s commissions and boards strive to regulate and enhance the standards of education and services for nurses and midwifery, strengthen professional conduct, and assure accountability and transparency.

The salient features of the NNMC are as follows:

1. The National Nursing and Midwifery Commission: Under the NNMC, the Central Government shall establish a National Nursing and Midwifery Commission ("National Commission") consisting of 29 members, including the Chairperson, sixteen ex-officio members and twelve members as follows, namely: (a) Chairperson; (b) one representative of the Department of Health and Family Welfare, Ministry of Health and Family Welfare; (c) one representative of the Ministry of Defence, Military Nursing Services, General of Armed Forces Medical Services (d) one representative of the Directorate General of Health Services (e) one person representing the National Medical Commission; (f) President of each of the Autonomous Boards; (g) three persons, not below the rank of Chief Nursing Officer or Nursing Superintendent of any of the hospitals or Dean or Principal of College of Nursing; (h) one person from each of the six zones; (i) six nursing members of eminence, one from each of the six zones (j) four nursing and midwifery members of eminence, (k) one person representing charitable institutions engaged in education or services in the field of nursing and midwifery (l) a person of eminence to be appointed by the Central Government. The head office of the National Commission will be in Delhi and shall have meetings once every quarter.

The National Commission’s functions include, inter alia:

• to frame policies and regulate standards for the governance of nursing and midwifery education and training;

• to regulate nursing and midwifery institutions, research, professionals and associates;

• to identify and regulate any other category of nursing and midwifery profession;

• to provide basic standards of education, physical and instructional facilities, assessment, examination, training, research, continuing professional education and maximum tuition fee payable in respect of various categories;

• to provide standards for nursing and midwifery faculty and clinical facility in teaching institutions;

• to provide for a uniform mechanism for admission into the nursing and midwifery institutions at various levels.

• to provide for a mechanism, either through final year undergraduate exam, to ensure adequate competence of the nursing and midwifery professionals for enrolment in the National or State Register, and for granting licence to practice as a nursing and midwifery professional;

• to collaborate with industry and other institutions for use of cutting-edge technology and hybrid education to drive innovation and research in the field of nursing and midwifery;

• to integrate soft skills and elective courses in the curriculum and to take measures to enhance skills and competency of registered professional for facilitating global mobility;

• to assess the nursing and midwifery requirements in healthcare, including human resources for various healthcare settings, provide mechanisms for career development pathways for all nursing and midwifery related cadres including appropriate lateral entry;

• to ensure policies and codes to ensure observance of professional ethics and to promote ethical conduct during the provision of care by nursing and midwifery professionals, including nursing associates and midwifery associates;

• to promote, co-ordinate and frame guidelines and lay down policies for the proper functioning of the National Commission, the Autonomous Boards, the Advisory Council and the State Commissions;

• to ensure coordination among the Autonomous Boards;

• The National Commission will hold a meeting at least once a year, with the National Medical Commission, Pharmacy Council of India, National Commission for Indian System of Medicine, National Commission for Homoeopathy and National Commission for Allied and Healthcare Professions, or the corresponding National Regulator for regulating the professions.

The National Commission will employ these responsibilities to assure consistency in nursing education and development and to focus on preserving the competence of nursing and midwifery practitioners to provide high-quality healthcare services. Further, The National Commission intends to invite foreign professionals and industry experts to their meetings to facilitate Indian nurses’ global mobility and employability. This international collaboration will help Indian nurses enhance their skills and expertise. The National Commission will partner with industry and other organisations to promote synergy and excellence in the field.

2. Autonomous Boards: The Central Government will establish the following Autonomous Boards ("Autonomous Boards") under the overall supervision of the National Commission:

(a) the Nursing and Midwifery Undergraduate and Postgraduate Education Board; (“Education Board”)

(b) the Nursing and Midwifery Assessment and Rating Board; and

(c) the Nursing and Midwifery Ethics and Registration Board (“Ethics Board”).

3. Advisory Committees of Experts ("Advisory Committee"): Every Autonomous Board, other than the Nursing and Midwifery Ethics and Registration Board, will be assisted by an Advisory Committee consisting of experts constituted by the National Commission. The Nursing and Midwifery Ethics and Registration Board will be assisted by ethics committees of experts constituted by the National Commission. The Advisory Committee will advise and assist the National Commission on nursing and midwifery education, services, training, and research.

4. State Nursing and Midwifery Commissions: Every State Government shall constitute a State Nursing and Midwifery Commission ("State Commission"), where no such State Commission exists. It will have ten members. Members will include officials from the state’s health department, nursing and midwifery colleges, and nursing and midwifery professions.

5. Permission for establishment of a new nursing or midwifery institution: To establish a new nursing and midwifery institution, begin a postgraduate course, or increase the number of seats in an institution, the Nursing and Midwifery Assessment and Rating Board must be consulted in the manner specified by the NNMC.

The criteria in accordance to the NNMC that will be taken into consideration while approving or disapproving a proposal shall be the following:

(a) adequacy of financial resources;

(b) if adequate academic faculty and other required facilities are available to ensure the efficient operation of the nursing and midwifery institution or will be available within the timeframe specified in the proposal;

(c) whether adequate hospital facilities have been provided or will be provided within the timeframe specified in the proposal; and

(d) such other factors that the regulations may specify. However, the criteria for institutions established in regions designated by regulations may be reduced subject to the prior approval of the Central Government.

6. The National and State Registrar: The Nursing and Midwifery Ethics and Registration Board will maintain an online and live Indian Nurses and Midwives’ Register with information and qualifications about midwifery and nursing professionals and associates. The Ethics Board shall ensure dynamic and electronic synchronisation of the National and State Registers in such a manner that changes in any of the registers are automatically reflected in the other register. Further, the National Registrar will be a public document made available to the public as a digitally accessible portal. An individual must be on the National or State Register to practice midwifery or nursing as a qualified professional. Any contravention to this provision may result in up to one year in prison, a fine of up to five lakh rupees, or both.

7. Recognition of nursing and midwifery qualifications: All nursing and midwifery qualifications granted by any University or institution must be listed and maintained by the Education Board and these qualifications will be recognised under the NNMC. If any University or institution desires to conduct a course that is not on the Education Board’s list, it may apply to the Education Board for recognition of the said course. Further, the National Commission may withdraw recognition granted to an institution or University if the courses and examinations to be taken, or the proficiency required from candidates at any examination held, do not conform to the standards specified by the Education Board; or if the standards and norms for infrastructure, faculty, and quality of education in the institution are not adhered to by any University or institution, and corrective action is not taken.

The NNMC promulgates an emphasis on developing soft skills among registered professionals and specialised courses and certification programmes for nursing and midwifery. This initiative intends to improve nursing and midwifery professionals’ knowledge in various domains. Furthermore, it will promote cutting-edge technology and innovation in nursing education, and it fosters transparency and accountability among nursing education regulators.

The passage of the National Nursing and Midwifery Commission Bill 2023 represents a significant step towards raising nursing education and practice standards, encouraging innovation, and improving collaboration across the healthcare sector. It will create a system that improves access, enhances professional standards and the quality of education for nurses and midwives. It is a significant milestone to developing a highly skilled and competent nursing workforce to provide excellent healthcare services to the nation.

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