HIGH POWER COMMITTEE ON NURSING AND NURSING

PROFESSION

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. All
these are doing nursing duties.
High power committee on nursing and nursing profession was set up by the Government of
India in July 1987, under the chairmanship of Dr. Jyothi former Vice Chancellor of SNDT
Women University, Mrs. Rajkumari Sood, Nursing Advisor to Union Government as the
member-secretary and CPB Kurup, Principal, Government College of Nursing, Bangalore and
the President. TNAI is also one among the prominent members of this committee. Later on the
committee was headed by Smt. Sarojini Varadappan, former Chairman of Central Social Welfare
Board.

SAROJINI VARADAPAN COMMITTEE REPORT (1989)

The terms of reference of the committee are:
 To look into the existing working conditions of nurses with particular reference to the
status of the nursing care services both in the rural and urban areas.
 To study and recommend the staffing norms necessary for providing adequate nursing
personnel to give the best possible care , both in the hospitals and community .
 To look into the training of all categories and levels of nursing, midwifery personnel to
meet the nursing manpower needs at all levels of health services and education.
 To study and clarify the role of nursing personnel in the health care delivery system
including their interaction with other members of the health team at every level of health
service management.
 To examine the need for organized nursing services at the national, state, district and
local levels with particular reference to the need for planning service with the overall
health care system of the country at the respective levels.
 To look into all other aspects, the committee will hold consultations with the state
governments.

RECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND

NURSING PROFESSION
1. Employment
 Uniformity in employment procedures to be made.
 Recruitment rules are made for all categories of nursing posts. The qualifications and
experience required for this be made throughout 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 for 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.
3. Working hours
 The weekly working hours should be reduced to 40 hours 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. Pay and allowances
Uniformity of pay scales of all categories of nursing personnel is not feasible. However,
special allowance for nursing personnel, i.e.; 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 B.Sc. Nursing is made an
essential qualification.
 The principle of possessing higher qualification than the category to be supervised,
should apply for 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.
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.
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.
13. 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.
 Allowance as granted to other employees is paid to nursing personnel.

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
1. 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
years of schooling with science. The duration of course should be 4 years at the university
level. admission to vocational /auxiliary nursing should be with 10 years of schooling .The
duration of course should be 2 years in health related vocational stream.
2. All school of nursing attached to medical college hospitals is upgraded to degree level in
a phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated with
senior secondary boards.
4. Post certificate B.Sc. Nursing degree to be continued to give opportunities to the existing
diploma nurses to continue higher education.
5. Master in nursing program to be increased and strengthened.
6. Doctoral programs in nursing have to be started in selected universities.
7. Central assistance be provided for all levels of nursing education institutions in terms of
budget (capital and recurring).
8. Upgradation of degree level institutions be made in a phased manner as suggested in
report.
9. Each school should have separate budget till such time is phased to degree/vocational
program. The principal of the school be the drawing and the disbursing officer.
10. 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.
11. All schools to have adequate budget for libraries and teaching equipment.
12. 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.
13. 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.
14. 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.
15. 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.
16. INC requirements for staffing the schools and meeting the minimum requirements are
followed by all schools as these are statutory requirements.
 17. Specialty courses at post-graduate level be developed at certain special centers of
excellence eg. AIIMS.
18. 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.
19. Provision for higher training abroad and exchange programmes is made.
 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.
NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)
1. Definite nursing policies regarding nursing practice be available in each institution.
These policies include:
 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, 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.
 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. (minimum 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 specialty areas must have courses in specialties. Promotion
opportunities for clinical specialties like administrative posts are considered for improving
quality nursing services.
 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.
2. Community nursing services
 Appointment of ANM/LHV to be recommended.
- 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.
 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

NORMS RECOMMENDED FOR NURSING SERVICE AND EDUCATION HOSPITAL

SETTING.
1. Nursing Supdt. -1: 200 beds (hospitals with 200 or more beds).
2. Deputy Nsg. Supdt. - 1: 300 beds (wherever beds are over 200)
3. Assistant Nsg . Supdt - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave reserve
5. Staff nurse for wards -1:3 (or 1:9 for each shift) 30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients (1 bed : 5 out patients) 30% leave reserve
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
8.For specialized depts. such as operation theatre, labour room etc. - 1: 25 30% leave reserve.

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

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 organizational structure recommended for centre, state and district level is as
follows:
1. Each ADG level nurse to deal with continuing education /research component for
specialized areas.
2. Selection to these posts is made on merit and not by seniority alone.
3. Nurses appointed these posts must have courses in administration, management and
fiscal management.
4. Railway board, state insurance (labor minister), post $ telegraph union, territories
(Delhi), municipal corporations etc to create such posts for control, co-ordination and
development of nursing personnel.
NB: 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.

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, 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, 2004 with the following
terms of reference :
a) The Committee shall examine the State medical infrastructure available within the
State.
b) The Committee while examining the State medical infrastructure facilities, may invite
written representation/memorandum from any individual, organization, association and
local body.
c) The Committee may examine any other aspects of the State health care system as may
be considered necessary in the light of the judgment of Honble Court.
d) While giving its report, the Committee shall suggest the measures to be taken by the
Government.
Recommendations on preventive and primary health care:
i. The epidemiological surveillance system should be geared up with the support of the
field staff as well as the Panchayat Raj Institutions.
ii. Primary health care, public health programs, nutrition schemes, and school health
programs should be coordinated with a view to reducing incidence of diseases.
iii. Steps should be initiated to ensure the effective functioning of rural hospitals by
placement of Specialists, particularly Anesthetists and Radiologists.
iv. Simple labor cases without complication should be tackled in BPHCs and rural
hospitals for which necessary infrastructure is to be organized.
v. Special hands-on training programs need to be organized in a nodal institution for
newly recruited medical officers for at least one month. Management/administrative
training programs also need to be organized for the Superintendents of secondary level
hospitals.
vi. Refresher training programs on public health should be organized regularly for CMOH,
Dy. CMOH, ACMOH and Program Officers.
vii. Specialty and super specialty facilities outside the Kolkata metropolitan area should be
organized on a regional basis, most importantly in the area of Neurosurgery and
Trauma Centre, Dialysis units, Cardiology, Cardiac Surgery, Casualty and ICCU,
preferably on public private partnership.
 viii. Regular periodic visits of senior level health administrators to the field units for the
purpose of implementation, monitoring, supervision and evaluation should be insisted
upon.
ix. The present nurse-bed ratio (1:5) which was laid down in 1957 should be reviewed in
the light of developments since and a more realistic ratio arrived at.
x. Adequate supply of modern Tissue Culture Anti- rabies Vaccine (ARV) is to be
ensured at the earliest in the interest of a better health care delivery system.
xi. The fact remains that almost 50% of deliveries still take place in home situations.
Recognizing this fact it is necessary that facilities for ante-natal checkups and home
delivery should be augmented in terms of expertise and infrastructure.
JOURNAL REFERENCE

CONCLUSION
It was observed that nurses are not involved in making policies that govern their status and
practice. They are invariably excluded from the government 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.

BIBLIOGRAPHY
K. Deepak, C. Sarath, B.P. M ithun. A comprehensive textbook on Nursing Management.
Bangalore. EMMESS medical publishers. 2013
Basavanthappa. B.T. Nursing Administration. 2nd ed. Jaypee publication: p 401-3, 683-8
Patricia Kelly. Leadership and Management in Nursing. Delmar publication: p-49-50
High power committee on nursing in India. http://nursingplanet.com