This document summarizes the recommendations of the High Power Committee on Nursing in India. Key recommendations include: 1. Establishing uniform qualifications, recruitment rules, job descriptions, and pay scales for nursing personnel across India. 2. Improving working conditions for nurses, such as reducing weekly working hours to 40, providing weekly days off, and compensating nurses for extra work hours. 3. Upgrading nursing education by establishing degree programs and increasing opportunities for continuing education and specialization. 4. Developing a national nursing policy and improving the organizational structure and status of nursing to give nurses more involvement in decision-making. The recommendations aim to professionalize nursing, standardize its regulation, and improve

1. HIGH POWER COMMITTEE
ON NURSING IN INDIA

2. INTRODUCTION
• The retarded development of nursing and nursing profession seems
to be mainly due to the fact that no serious thought has been given to
this discipline by the government over the years.
• Timely action on the various reports submitted to the
government would have prepared nurses to take care of all areas of
health care delivery and would have also avoided multiplication of
other categories like occupational therapists, physiotherapists, social
worker , health educator etc.

3. RECOMMENDATIONS OF HIGH POWER COMMITTEE ON
NURSING AND NURSING PROFESSION
Working conditions of nursing personnel
1. Employment
• Uniformity in employment procedures to be made.
• Recruitment rules are made for all categories of nursing posts. The qualifications and experience
required or these be made thought the country.
• There should not be a bond for nursing students as some of the states do not give them
employment during the stipulated period. Keeping in view of the shortage of nurses in hospitals
and community health field states should create posts and appointment these nurses in the
appropriate positions.
2. Job description
• Job description of all categories of nursing personnel is prepared by the central government to
provide guidelines.
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4. 3. Working hours
• The weekly working hours should be reduced to 4o hrs per week. Straight shift
should be implemented in all states. extra working hours to be
compensated either by leave or by extra emoluments depending on the state
policy .nurses to be given weekly day off and all the gazetted holidays as per the
government rules.
4.Work load/ working facilities
• Nursing norms for patient care and community care to be adopted as
recommended by the committee.
• Hospitals to develop central sterile supply departments, central linen services,
and central drug supply system. Group D employees are responsible for
housekeeping department.
• Policies for breakage and losses to be developed and nurses not are made
responsible for breakage and losses.

5. 5. Pay and allowances
• Uniformity of pay scales of all categories of nursing personnel is not feasible.
However special allowance for nursing personnel, ie; uniform allowance, washing,
mess allowance etc should be uniform throughout the country.
6. Promotional opportunities
• For promotion to the post of ward sister, Post basic Bsc Nursing is made an essential
qualification. The principle of possessing higher qualification than the category to be
supervised, should apply fro all levels and categories of nursing personnel in the
rural and urban areas.
• The committee recommends that along with education and experience, there is a
need to increase the number of posts in the supervisory cadre, and for making
provision of guidance and supervision during evening and night shifts in the hospital.
• Each nurse must have 3 promotions during the service period.
• Promotion is based on merit cum seniority.
• Promotion to the senior most administrative teaching posts is made only by open
selection.
• In cases of stagnation, selection grade and running scales to be given.

6. 7. Career development
• provision of deputation for higher studies after 5 yrs of regular services
be made by all states. The policy of giving deputation to 5 -10 % of each
category be worked out by each state. Every nursing personnel must
have an opportunity to attend at least one refresher course every 2
years.
8. Accommodation
• As far as possible, the nursing staff should be considered for priority
allotment of accommodation near to work place. Hospitals should not
build nurse's hostel for trained nurses. Apartment type of
accommodation is built where married/unmarried nurses can be
allowed to live. Housing colonies for hospital s must be considered in
long run.
9. Transport
• During odd hours, calamities etc arrangements for transport must be
made for safety and security of nursing personnel.

7. 10. Special incentives
• Scheme of special incentives in terms of awards, special increment for
meritorious work for nurses working in each state/district/PHC to be
worked out.
11. Occupational hazards
• Medical facilities as provided by the central govt. by extended by the state
govt to nursing personnel till such times medical services are provided free
to all the nursing personnel. Risk allowance to be paid to nursing personnel
working in the rural $ urban area.
12. Other welfare services
• Hospitals should provide welfare measures like crèche facilities for children
of working staff, children education allowance, as granted to other
employees, be paid to nursing personnel.

8. Additional Facilities For Nurses Working In The Rural Areas
• Family accommodation at sub centre is a must for safety and security of ANM's
/LHV.
• Women attendant, selected from the village must accompany the ANM for visits
to other villages.
• The district public health nurse is provided with a vehicle for field supervision.
• Fixed travel allowance with provision of enhancement from time to time.
• Rural allowance as granted to other employees is paid to nursing personnel.

9. NURSING EDUCATION
• Nursing education to be fitted into national stream of education to bring about uniformity,
recognition and standards of nursing education. The committee recommends that;
• There should be 2 levels of nursing personnel - professional nurse (degree level) and auxiliary nurse
(vocational nurse).
• Admission to professional nursing should be with 12 yrs of schooling with science. The duration of
course should be 4 yrs at the university level. admission to vocational/auxiliary nursing should be
with 10 yrs of schooling .The duration of course should be 2 yrs in health related vocational stream.
• All school of nursing attached to medical college hospitals is upgraded to degree level in a phased
manner.
• All ANM schools and school of nursing attached to district hospitals be affiliated with senior
secondary boards.
• Post certificate BSc Nursing degree to be continued to give opportunities to the existing diploma
nurses to continue higher education.
• Master in nursing programme to be increased and strengthened.
• Doctoral programmes in nursing have to be started in selected universities.
• Central assistance be provided for all levels of nursing education institutions in terms of budget(
capital and recurring)
• Up gradation of degree level institutions be made in a phased manner as suggested in report.

10. • Each school should have separate budget till such time is phased to degree/vocational programme. The principal
of the school be the drawing and the disbursing officer.
• Nursing personnel should have a complete say in matters of selection of students. Selection is based completely
on merit. Aptitude test is introduced for selection of candidates.
• All schools to have adequate budget for libraries and teaching equipments.
• All schools to have independent teaching block called as School Of Nursing with adequate class room facilities,
library room, common room etc as per the requirements of INC.
• Adequate accommodations are provided to students. A maximum of 3 students to share a room. Rooms to be
furnished with light, study table , chair etc. Adequate dining room, toilets and bathrooms facilities to be
provided in each hostel as per norms recommended.
• Students should learn under supervision in the wards. Tutors/clinical instructors must go to the ward with
students. Students should not be used for the service of the hospital.
• Community nursing experience should be as per INC requirements. Necessary transport and accommodation at
PHC be made available for safety, security and meaningful learning of students.
• INC requirements for staffing the schools and meeting the minimum requirements are followed by all schools as
these are statutory requirements.
• Specialty courses at post-graduate level be developed at certain special centres of excellence eg; AIIMS.
• Institutes like National Institute of Health and Family welfare, RAK College of Nursing and several others may
develop courses on nursing administration for senior nursing leading to doctorate level.
• Provision for higher training abroad and exchange programmes is made.

11. Continuing Education And Staff Development
• Definite policies of deputing 5-10% of staff for higher studies are
made by each state. Provision for training reserve is made in each
institution.
• Deputation for higher study is made compulsory after 5 yrs.
• Each nursing personnel must attend 1 or 2 refresher course every
year.
• Necessary budgetary provision be made,
• A National Institute for Nursing Education Research and Training
needs to be established like NCERT, for development of educational
technology, preparation of textbooks, media, / manuals for nursing.

12. NURSING SERVICES: HOSPITALS/INSTITUTIONS
(URBAN AREAS)
• Definite nursing policies regarding nursing practice be available in each institution .These policies
include:
a) Qualification/recruitment rules
b) Job description/job specifications
c) Organisational chart of the institutions
d) Nursing care standards for different categories of patients.
• Staffing of the hospitals should be as per norms recommended.
• District hospitals /non teaching hospitals may appoint professional teaching nurses in the ratio of
1; 3 as soon as nurses start qualifying from these institutions.
• Students not to be counted for staffing in the hospitals
• Adequate supplies and equipment's, drugs etc be made available for practice of nursing. The
committee strongly recommends that minimum standards of basic equipment needed for each
patient be studied , norms laid down and provided to enable nurses to perform some of the
basic nursing functions .
• Also there should be a separate budget head for nursing equipment and supplies in each
hospitals/ PHC. The NS and PHN should be a member of the purchase and condemnation
committee.

13. • Nurses to be relieved from non -nursing duties.
• Duty station for nurses is provided in each ward.
• Necessary facilities like central sterile supplies, linen, drugs are considered
for all major hospitals to improve patient care. Also nurses should not be
made to pay for breakage and losses. All hospitals should have some
systems for regular assessment of losses.
• Provision of part time jobs for married nurses to be considered. (min 16-
20hrs/week)
• Re-entry by married nurses at the age of 35 or above may also be
considered and such nurse be given induction courses for updating their
knowledge and skills before employment.
• Nurses in senior positions like ward sisters, Asst. nursing superintendents,
Deputy NS; N.S must have courses in management and administration
before promotions.
• Nurses working in speciality areas must have courses in specialities.
Promotion opportunities for clinical specialities like administrative posts
are considered for improving quality nursing services.

14. • The committee recommends that Gazetted ranks be allowed for
nurses working as ward sister and above (minimum class II gazetted).
Similarly the post of Health Supervisor (female) is allowed gazetted
rank and district public health nurse be given the status equal to
district medical/ health officers.

15. Community nursing services
• Appointment of ANM/LHV to be recommended.
• ANM/LHV promoted to supervisory posts must undergo courses in
administration and management.
• Specific standing orders are made available for each ANM/LHV to
function effectively in the field.
• Adequate provision of supplies, drugs etc are made.
• Recording system be simplified.
• Posts of public health nurses and above are given gazetted status.

16. Norms recommended for nursing service and education hospital
setting.
• Nursing Supdt -1: 200 beds (hospitals with 200 or more beds).
• Dy. Nsg. Supdt. - 1: 300 beds ( wherever beds are over 200)
• Asst. Nsg . Supdt - 1: 100
• Ward sister/ward supervisor - 1:25 beds 30% leave reserve
• Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve
• For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out
patients) 30% leave reserve
• For ICU -1:1(or 1:3 for each shift) 30% leave reserve
For specialized depts. such as operation theatre, labour room etc- 1: 25
30% leave reserve.

17. • Community nursing services
• 1 ANM for 2500 population ( 2 per sub centre)
• 1 ANM for 1500 population for hilly areas
• 1 health supervisor for 7500 population( for supervision of 3 ANM's)
• 1 public health nurse for 1 PHC (30000 population to supervise 4
Health Supervisors )
• 1 Public Health Nursing Officer for 100000 population ( community
health centre)
• 2 district public health nursing for each district.
• Teaching staff for schools/colleges of Nsg as per INC
• 1 Nurse Teacher to 10 students for post graduate programmes.

18. NURSING LEGISLATION
• INC and state nursing council acts be amended to provide for control by INC on
states nursing councils.
• Provision of more nurse members.
• Provision for regulation of nursing education standards by timely inspections and
follow up.
• Provision of maintaining of minimum standards of nursing practice
• Provision of regulation for nursing care standards in private nursing homes.
• Provision for regulation for private nursing bureaus and practice by unqualified
nurses.
• Provision of approval of INC before opening a SON or CON.
• Provision of renewal of registration every 5 yrs.
• Provision of independent practice of nursing by nurses.
• INC to set up a national examination system in about 10 yr time to regulate
standards of nursing education.

19. • Also, the positions up to the DADG level are proposed to be at the
office of the Directorate General of Health Services. The positions
below the level of DADG are to exist at the institutions governed by
the central govt.
• The Principal, College Of Nursing will be equal to the rank of ADG
(N) and will be eligible for promotion to the post of DDG (N)/ Addl.
(N). The salary scales and structure of the staff of colleges of nursing
will be as per norms of INC and the UGC.

20. ORGANISATION OF NURSING SERVICES
• The position and status of nursing personnel working in the directorates need up gradation and
expansion of the nurse to enable the nurses to participate in policy making and decision making.
Total nursing components, i.e., nursing education, nursing service and community nursing should be
under the control of nursing personnel at all the levels. I.e. At centre, state and district level. At every
level adequate provision of budget should be made for development of nursing profession.
• The organisational structure recommended for centre, state and district level is as follows.
• Each ADG level nurse to deal with continuing education/research component for specialized areas.
• Selection to these posts is made on merit and not by seniority alone.
• Nurses appointed these posts must have courses in administration, management and fiscal
management.
• Railway board, state insurance (labour minister), post $ telegraph union, territories (Delhi), municipal
corporations etc to create such posts for control, co-ordination and development of nursing
personnel.
• The principal, college of nursing will be equal to the rank of ADG (N) and will be eligible for
promotion to the post of DDNS/ DNS. The salary and structure of college of nursing will be as per as
norms of INC and UGC.

21. NATIONAL NURSING POLICY
• There is a need for national nursing policy within the framework of national health
policy and national health planning.
• Eg. High Power Committee by Government of West Bengal
• Government of West Bengal, constituted a High Power Committee with Justice
Chittatosh Mookerjee, formerly Chief Justice of Bombay High Court, as Chairman and five
other members on 7th January, 2004with the following terms of reference :
• i) The Committee shall examine the State medical infrastructure available within the
State:
• ii) The Committee while examining the State medical infrastructure facilities, may invite
written representation/memorandum from any individual, organization, association and
local body:
• iii) The Committee may examine any other aspects of the State health care system as
may be considered necessary in the light of the judgement of Hon'ble Court:
• iv) While giving its report, the Committee shall suggest the measures to be taken by the
Government.

22. CONCLUSION
• It was observed that nurses are not involved in making policies that
govern their status and practice. They are invariably excluded from
the govt bodies that decide decide these policies.
• Most of the decisions concerning nursing care and nurses are made
by other people, usually physicians without the benefit of
professional input from by nurses.
• It is possible that this situation is the direct result of lack of
appropriate status accorded to the nursing staff. Nearly 97% of
nursing staff are in group "c "category and their status are too low.