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Table 2 Status of different policy reforms for facilitating nurse leadership based on a review of nursing sector in 5 states

From: Setting the agenda for nurse leadership in India: what is missing

Policy reforms proposed Status of the reform Effect of lack of action on nursing cadre and health system
Improving nurse patient ratio(Recommendation of the 1st National Health Policy 1982) All states have made attempts to recruit additional nurses into the public health system. However, significant levels of vacancies still exist Overburdened nurses provide poor quality nursing care
Appointment of promotional positions for public health nurses at sub-district level (Chadha Committee 1963) Major shortfall again in filling the first promotional supervisory position in four out of five states. A higher level supervisory position of Public Health Nurse (PHN) is missing in 3 and major shortfall in 2 states Limited promotional avenues leading to lack of motivation among nurses.
Lack of professional supervision of nurses’ work
Appointment of District Public Health Nurse Officer (DPHNO).
(This position was created in 1983)
Not a single post has been created in 3 states and major vacancies in 2 states Key district level leadership for nursing sector is missing
Promotional supervisory positions for clinical nurses (A recommendation from many committees starting from Bhore Committee 1946) Norms are not followed in creating the positions. High levels of vacancies of nursing matrons and nursing superintendents in all the states Non recognition and no utilization of nurses in healthcare administration
Low quality nursing care in hospitals
Training and skill up-gradation of in-service nurses (A recommendation from many committees starting from Bhore Committee 1946) Sporadic training opportunities are available. Training institutions for preparing public health nurses for supervisory positions are non-functional in all states Poor quality nursing care
Less opportunity for promotions
Better working conditions for nurses including better salary and career opportunities (A recommendation from many committees starting from Bhore Committee 1946) Grossly inadequate salary and career environment. Non-availability of proper equipment and supplies for nursing care Poor quality nursing care
Post-graduate training opportunity for in-service nurses (A recommendation from many committees starting from Bhore Committee 1946) No sponsored post graduate training for in-service nurses. 4 states did not have post graduate training institutions in government settings Not enough qualified nurses available for higher positions
Creating leadership position at the state level (High power committee on nursing 1987) 2 Positions are created in one of the states, but only one position is filled. A single position was available for nurses in the state directorate in 2 states, which was not filled up due to non-availability of qualified candidates. No senior level position for nurses at the state level Lack of direction for nursing sector in the state