Integration of nursing professionals, education and healthcare services: a strategic model to empower nurses and shape healthcare policy in India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253182Keywords:
Nursing integration, Health policy, , Nurse education, India, Healthcare services, Health workforce, Nurse leadershipAbstract
Nurses form the backbone of India’s healthcare system, yet their contributions to health policy, education, and service integration remain underutilized. Effective integration of nursing professionals, education, and healthcare services is essential for advancing universal health coverage (UHC), reducing health disparities, and optimizing the quality of care. This review explores how aligning nursing education with service delivery and policy frameworks can empower nurses to lead reforms and shape healthcare policy in India. A comprehensive search of PubMed, BMJ Open, CINAHL, and PKP-indexed journals was conducted for studies published between 2005 and 2025. Inclusion criteria targeted empirical studies, national health reports, and review articles focused on the nursing profession’s involvement in health policy, service delivery, and education integration. Thematic analysis and narrative synthesis were applied using the IMRAD framework. Out of 2,341 records, 46 studies were included. Five central themes emerged: fragmentation between nursing education and practice; insufficient policy representation of nurses; gaps in clinical leadership development; potential of nursing integration models in public health; and global best practices adaptable for India. A nurse-led strategic model emphasizing vertical integration of academic curricula with national health priorities, community engagement, and digital health innovation showed promise in improving both workforce satisfaction and patient care quality. Reforming nursing education and embedding nurses in policymaking and service delivery is vital to strengthening India’s healthcare system. Strategic integration can empower nurses as key agents in shaping equitable, patient-centered health reforms.
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References
World Health Organization. State of the world’s nursing 2020: investing in education, jobs and leadership. Geneva: WHO; 2020. Available at: https://www.who.int/publications/i/item/9789240003279. Accessed on 17 March 2024.
International Council of Nurses. Nurses: A Voice to Lead-Health for All. Geneva: ICN. 2019.
Sharma K, Zodpey S. Transforming nursing education in India. Indian J Public Health. 2011;55(1):56-60. DOI: https://doi.org/10.4103/0019-557X.82564
Ministry of Health and Family Welfare. National Health Policy 2017. New Delhi: Government of India. 2017.
Buchan J, Shaffer FA, Catton H. Policy brief: nurse retention. Geneva: ICN. 2018.
Anand S, Fan VY, Zhang J, Zhang L, Ke Y, Dong Z, et al. China's human resources for health: quantity, quality, and distribution. Lancet. 2008;372(9651):1774-81. DOI: https://doi.org/10.1016/S0140-6736(08)61363-X
Sharma DC. India still struggles with rural doctor shortages. Lancet. 2015;386(10011):2381-2. DOI: https://doi.org/10.1016/S0140-6736(15)01231-3
Rao M, Rao KD, Kumar AKS, Chatterjee M, Sundararaman T. Human resources for health in India. Lancet. 2011;377(9765):587-98. DOI: https://doi.org/10.1016/S0140-6736(10)61888-0
Scott PA, Matthews A, Kirwan M. What is nursing in the 21st century and what does the 21st century health system require of nursing? Nurs Philos. 2014;15(1):23-34. DOI: https://doi.org/10.1111/nup.12032
Government of India. Ayushman Bharat-National Health Protection Mission. New Delhi: MoHFW. 2018.
Indian Nursing Council. Revised Syllabus for BSc Nursing. New Delhi: INC. 2020.
Nigam A, Kaur G. Community health nursing in India: changing paradigms and challenges. Nurs J India. 2021;CXII(6):271-5.
Kaushik M, Jaiswal A, Shah N, Mehta N. Addressing barriers in nursing education in India. Int J Nurs Educ. 2020;12(3):98-102.
Crisp N, Iro E. Nursing Now campaign: raising the status of nurses globally. Lancet. 2018;391(10124):920-1. DOI: https://doi.org/10.1016/S0140-6736(18)30494-X
Franco LM, Bennett S, Kanfer R, Stubblebine P. Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia. Soc Sci Med. 2004;58(2):343-55. DOI: https://doi.org/10.1016/S0277-9536(03)00203-X
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. DOI: https://doi.org/10.1111/j.1365-2648.2005.03621.x
Beaglehole R, Dal Poz MR. Public health workforce: challenges and policy issues. Hum Resour Health. 2003;1(1):4. DOI: https://doi.org/10.1186/1478-4491-1-4
Indian Nursing Council. Annual Report 2021-22. New Delhi: INC. 2022.
Saxena A, Sharan M, Priya R. Training for rural service: a study of medical education in Delhi. Health Popul Perspect Issues. 2003;26(2):73-85.
National Health Systems Resource Centre. Nursing Human Resources in India: Review of Current Status and Emerging Needs. NHSRC. 2019.
Chief Nursing Officer, UK Government. The future of nursing: delivering evidence-based healthcare. London: Department of Health. 2020.
WHO Regional Office for Europe. Strengthening nursing and midwifery. Copenhagen: WHO/Europe. 2015. https://www.who.int/europe/activities/strengthening-nursing-and-midwifery. Available at: Accessed on 17 March 2024.
Singh S, Majumdar A. Leadership in nursing education in India: current status and future directions. Nurse Educ Today. 2020;85:104264.
Mohanan M, Vera-Hernández M, Das V, Giardili S, Goldhaber-Fiebert JD, Rabin TL, et al. Effect of a large-scale nurse mentoring program on neonatal mortality in India. N Engl J Med. 2016;373(23):2208-18.
Ranjan A, Dixit P, Mukherjee A, Tiwari S. Motivation and retention of healthcare workers in India: a literature review. J Health Manag. 2019;21(3):347-62.
Srivastava S, Chandrakar A, Singh D. Role of nurse-led primary care services in tribal India: a case study of Bastar. Indian J Public Health Res Dev. 2020;11(2):327-32.
Dey S, Sinha R. Task shifting in primary health care: evidence from nurse-led services in India. J Family Med Prim Care. 2021;10(4):1548-54.
Macinko J, Harris MJ. Brazil’s family health strategy-delivering community-based primary care in a universal health system. N Engl J Med. 2015;372(23):2177-81. DOI: https://doi.org/10.1056/NEJMp1501140
Serneels P, Lindelow M, Garcia-Montalvo J, Barr A. For public service or money: understanding geographical imbalances in the health workforce. Health Policy Plan. 2007;22(3):128-38. DOI: https://doi.org/10.1093/heapol/czm005
Mavalankar DV, Rosenfield A. Maternal mortality in resource-poor settings: policy barriers to care. Am J Public Health. 2005;95(2):200-3. DOI: https://doi.org/10.2105/AJPH.2003.036715
Arora R, Mathur P. Addressing health workforce challenges to achieve universal health coverage in India. Indian J Public Health. 2021;65(4):295-302.
WHO. Global strategic directions for nursing and midwifery 2021–2025. Geneva: World Health Organization, 2021. Available at: https://www.who.int/publications/i/item/9789240033863. Accessed on 17 March 2024.
Kruk ME, Pate M, Mullan Z. Introducing The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era. Lancet Glob Health. 2017;5(5):e480-1. DOI: https://doi.org/10.1016/S2214-109X(17)30101-8
Koblinsky M, Campbell O, Heichelheim J. Organizing delivery care: what works for safe motherhood? Bull World Health Organ. 1999;77(5):399-406.
ICN. The Global Voice of Nursing. Geneva: International Council of Nurses. 2022.
National Health Systems Resource Centre. Ayushman Bharat Health and Wellness Centres: operational guidelines. NHSRC. 2020.
Das A, Gopalan SS, Chandramouli S. Enhancing nurse roles in primary care through Ayushman Bharat: lessons from Chhattisgarh. J Health Manag. 2022;24(1):87-95.
Ritchie H, Smith D. Task shifting in community health: nursing perspectives from rural India. Int J Nurs Stud. 2023;140:104391.
Kalita A, Baru R. Competency-based nursing education in India: current state and recommendations. Nurs Outlook. 2023;71(1):88-96.
Mahajan A, Paul S, Saxena V. Experiential learning in public health nursing: community engagement in North India. Int J Community Med Public Health. 2021;8(4):1732-8.
Taneja A, Rao KD, Krishnamurthy S. Faculty development and nursing education in India: challenges and innovations. J Nurs Educ Pract. 2022;12(7):12-9.
IGNOU and Ministry of Health and Family Welfare. Certificate Programme in Community Health for Nurses (CPCHN)-Training Report 2020. New Delhi: IGNOU. 2020.
WHO. Global health workforce statistics database. Geneva: World Health Organization. 2024. Available at: https://www.who.int/data/gho/data/themes/topics/health-workforce. Accessed on 31 December 2024.
Kumar R, Pal R, Jain A. Migration of nurses from India: causes, consequences and policy options. Health Policy Plan. 2020;35(8):975-82.
ICN. Nurse Migration and Brain Drain. Geneva: International Council of Nurses. 2020.