In August 2024, Wayanad, Kerala was grappling with a major calamity, landslides that had taken scores of lives. And, a collapsed bridge across the flooded Chaliyar river had left several people isolated and stranded. In these times of ex treme need, A Sabeena, a nurse from Tamil Nadu, became a life line for them. Using a zip line, she courageously crossed the river multiple times over five days, to deliver critical medical aid. She treated snake bites, in juries, and fevers, offering care and comfort until rescue teams could reach the victims. She was later awarded for her bravery and dedication by the CM of Tamil Nadu.
Many would remember Reshma Mohandas, a nurse at Kottayam Medical College in Kerala. During the early days of the pandemic, she contracted COVID-19 while caring for an elderly couple battling the virus. After recovering and complet ing the mandatory post-recov ery quarantine, Reshma made a swift return to the frontline. Her comeback also coincided with the recovery of the couple she had been treating. She is an in spiring example of the selfless ness and resilience of India’s nursing community during the pandemic.
In yet another example, four trainee nurses from Delhi’s For tis Escorts Heart Institute be came beacons of hope for an eld erly passenger who suffered a heart attack and collapsed while traveling by Rajdhani Express from Delhi to Kolkata. Recalling their Basic Life Support train ing, they immediately started CPR and restored the man’s pulse. They also alerted the train staff, who stopped the train at the next station where a medical team provided further emergency care and trans ported the man to a hospital.
These are but a few of the countless examples where nurses have played a vital role in community settings, often going above and beyond their routine duties and traditional setting to provide critical and life-saving care in diverse and challenging situations.
Promise and potential
They are also compelling cases in-point for expanding nurse practitioners’ scope of practice and establishing nurse-led healthcare models. Given India’s complex healthcare landscape, shaped by its vast and diverse population, rising patient loads, shortage of physicians, and the dual burden of infectious and chronic diseases, the need for a more effective healthcare model is greater than ever before. And, nurse-led care models could be the answer to making quality care more timely, equitable and inclusive.
In fact, global organisations like the International Nursing Council (ICN) also advocate for nurse-led services to strengthen health systems globally. In a re cent report, titled ‘Our Nurses, Our Future: The economic power of care’, it highlights the “impact of nursing and the economic power of care”. This report states, “While nurses have known all along about the cru cial importance of nursing to in dividuals, families and the soci eties they live in, in this report we have gathered the evidence to support what we instinctively knew: that funding nursing is never a cost – it is an investment in the peaceful, social, psycho logical and economic stability of societies everywhere.”
Fortuitously we are seeing a transformation in the role of nurses and the emergence of several nurse-led healthcare models across public and private healthcare settings in India.
Elaborating on the current scenario in India, Punita Sharma, Director – Nursing & Midwifery, Jhpiego India high lights how nursing leadership is undergoing a significant trans formation, especially in the post pandemic era. She says, “The COVID-19 pandemic catalysed significant changes in nursing leadership across India. Post pandemic, nursing leadership has expanded beyond clinical oversight to include crisis man agement, staff well-being advo cacy, and strategic decision making in health systems. Leaders are now more involved in shaping public health re sponses and driving innovation.”
Moving beyond clinical su pervision, it also encompasses responsibilities such as manag ing crises, advocating for staff well-being, and participating in strategic decision-making within health systems. Nurse leaders are increasingly contributing to public health planning and inno vation. She adds that in the In dian context, digital transforma tion has played a pivotal role in reshaping nursing care delivery and education, promoting com petency development through a hybrid, phygital learning model.
There are many real-life ex amples to support this point of view, pre-and-post pandemic. To cite a few examples:
1) Chettinad Hospital and Re search Institute in TamilNadu instituted surgical nurse-led clinics (SNLCs) to provide coor dinated care to surgical patients. Trained surgical nurses in these clinics oversee preoperative evaluations, patient education, post-opera tive monitoring, and discharge planning, to improve quality of care. The endeavour has seen high patient satisfaction rates and improved surgical out comes, including reduced infec tion rates and better recovery times.
2) Similarly, in several parts of Tamil Nadu and Kerala, community-based nurse-led clinics provide a wide range of essential primary healthcare services, including management of common illnesses, maternal and child healthcare, and care for chronic conditions. Reportedly, these clinics are safe and cost-effective, improving healthcare access and patient satisfaction in under served areas.
3) Nurse-led teleconsulta tion strategies proved invalu able in managing patients with chronic conditions like cardio vascular diseases during the COVID-19 pandemic. In Pun jab, for instance, nurses were trained to provide remote con sultations, triage patients, and refer them to physicians when necessary. This ensured conti nuity of care during lock downs.
4) Another significant devel opment in nurse-led care in India is the emergence of the Nurse Practitioner in Midwifery (NPM) cadre and the establishment of Midwife-Led Care Units (MLCUs). This government initiative aims to create a spe cialised group of midwives trained to international stan dards to provide high-quality, re spectful care to pregnant women and newborns. In sev eral states, NPMs in MLCUs have shown promising results in increasing normal deliveries and improving the quality of mater nal care.
Thus, when nurses serve as the first-line managers of patient care, traditional healthcare mod els get redefined. These evolved models demonstrate how nurses can not only support care but lead it.
Developing next-gen nurse leaders
However, to fully harness this potential in India, a formal struc ture that can support and em power nurses to take on ex panded roles which will help bridge critical gaps in health care. Nurse leaders must be trained and authorised to diagnose common illnesses, pre scribe medications, manage chronic diseases, and deliver maternal and child healthcare. These expanded roles will help bridge critical gaps in healthcare access, especially in under served regions.
There are several aspects to be considered while developing the next generation of leaders. In the earlier mentioned report, the International Coun cil of Nurses gives a call to action for global policymakers and healthcare leaders: It states:
◆ Empower nurses: Support comprehensive policies that al low nurses to practice to the full extent of their education and training. Encourage further de velopment of leadership roles and participation in policy devel opment.
◆ Invest in education and workforce development: In crease funding for nursing edu cation and create more opportu nities for career advancement within the nursing profession.
◆ Enhance working condi tions: Implement measures to improve the work environment for nurses, including adequate staffing levels, access to re sources, safe work environments and support for mental health and well-being.
◆Acknowledge and compen sate fairly: Ensure that nurses receive competitive wages that reflect their skills, responsibili ties and the critical nature of their work. Source: ICN report – Our Nurses, Our Future: The economic power of care increasing normal deliveries and improving the quality of mater nal care. ment of Midwife-Led Care Units (MLCUs). This government initiative aims to create a spe cialised group of midwives trained to international stan dards to provide high-quality, respectful care to pregnant women and newborns. In sev eral states, NPMs in MLCUs have shown promising results in Thus, when nurses serve as the first-line managers of patient care, traditional healthcare mod els get redefined. These evolved models demonstrate how nurses can not only support care but lead it. Developing next-gen nurse leaders However, to fully harness this potential in India, a formal struc ture that can support and em power nurses to take on ex panded roles which will help bridge critical gaps in health care. Nurse leaders must be trained and authorised to diag
◆Promote nursing’s role in society: Highlight the contribu tions of nurses to health and well-being through public awareness campaigns and inclu sion in decision-making processes.
The ICN report also cau tions, “Nursing is the corner stone of healthcare systems worldwide, but the economic value that it adds to healthcare and societies at large remains unacknowledged. Investment in nursing is often viewed as a drain on resources rather than a catalyst for economic stability and growth. This viewpoint di minishes the quality of health care and ignores the significant positive economic impacts that can be generated through pru dent investments in nursing.” The report emphasises that nurses are not just essential to healthcare delivery but also key drivers of economic growth, poverty reduction, gender equal ity, and improved health systems.
Growth opportunities galore…..but challenges also exist
Luckily, India is witnessing a re newed focus on nursing leader ship and skilling initiatives to strengthen the healthcare work force, especially in managing non-communicable diseases (NCDs) and advancing nursing education.
Let’s look at a few of these en deavours from different parts of the country:
◆ AstraZeneca and AIIMS Jodhpur’s ‘Skill for Scale’ e learning programme: As traZeneca, in partnership with the India-Sweden Healthcare In novation Centre and AIIMS Jodhpur, launched ‘Skill For Scale’, in 2023. It is an e-skilling initiative to enhance the capabil ities of nurses in managing NCDs, with a special focus on di abetes in its first phase. Report edly, the initiative aims to upskill 5,000 nurses in 2025 and will later expand to include hyper tension, cardiovascular care, and oncology. It is certified by AIIMS Jodhpur and endorsed by the Directorate General of Health Services (DGHS) and the Indian Nursing Council. Upon completion, participants receive a certificate and Continuing Medical Education (CME) cred its via INC.
◆ Independent Faculty of Nursing at MUHS: The Maha rashtra University of Health Sci ences (MUHS) has established Nursing as an independent fac ulty. Dr Sreelekha Rajesh has been appointed the first Dean of the Nursing Faculty. Dr Rajesh, who also serves as Vice Princi pal at the GMF Tehmi Grant In stitute of Nursing Education (Ruby Hall Clinic, Pune), was recognised as the Best Nurse Educationist of 2023 by the Trained Nurses Association of India, Pune.
◆ Aster Guardians Global Nursing Award: Aster DM Healthcare’s Aster Guardians Global Nursing Award is a plat form that recognises and cele brates contributions of nurses across the world. In 2024, it re ceived 78,000 applications from 202 countries. The award recog nises nurses for their excep tional service in combat zones, disaster relief, and underserved communities.
Another interesting develop ment in India’s nursing landscape is the geographic di versification of career opportu nities. “India’s nursing talent is becoming a driving force in healthcare, not just in big cities but across smaller towns as well. We’re seeing a steady rise in nursing job opportunities in tier 2 locations – this signals a shift where talent is being nurtured and hired beyond metros. These cities are quietly becoming the new hubs of quality care, bring ing skilled healthcare closer to where people live,” observes Sashi Kumar, Head of Sales at Indeed India.
This decentralisation of nurs ing careers has dual benefits: it addresses the urban rural healthcare divide while creating employment opportu nities in smaller cities and towns. “Indian nurses are re spected globally for their clinical skills, cultural awareness, and ability to work across different healthcare systems,” adds Ku mar
Progressive policies are an imperative
Nevertheless, despite promis ing developments, several challenges persist in realising the full potential of nurse-led care models in India. These include limited awareness about expanded nursing roles, absence of clear career pathways, potential resistance from other healthcare professionals, and the need for supportive policies and regulations.
So, to nurture nursing leadership, governments and institutions must invest more in leadership development programmes, including online platforms and digital innova tions such as Learning Management Systems and app-based modular learning.
“Lots of hand holding is required at this stage from institutions as well as the Government of India,” notes Sharma. This includes creating clearer pathways to leadership positions and recognising lead ership potential beyond tradi tional roles. She opines that nursing leaders should not be identified based on only age, experience and education, but also by their competence and capability.
She also advises other nursing leaders to be more “assertive and advocate for evidence-based policies, repre sent frontline nursing educa tion reforms, healthcare per spectives in legislative processes, and help design reforms that prioritise student centered education and patient centered care and workforce sustainability,” in policy spheres.
Thus, investing in spe cialised training, fostering in terprofessional collaboration, ensuring adequate resources, and creating supportive regu latory frameworks are crucial steps toward empowering nursing leaders to transform healthcare delivery in India, recommend industry experts.
The way ahead
The economic and health ben efits of empowering nurses are clear and significant. As In dia navigates its complex healthcare challenges, how it nurtures its nursing leader ship will define and determine the future of healthcare in this country. By recognising nurses not just as care providers but as care leaders and economic contributors, India can build a more re silient, responsive, and patient-centered healthcare ecosystem.
References
https://www.icn.ch/sites/de fault/files/2024 05/ICN_IND2024_report_EN_A 4_6.1_0.pdf- https://www.tnaijournal nji.com/admin/public/up loads/78/13472_pdf.pdf
lakshmipriya.nair@expressindia.com
laxmipriyanair@gmail.com
