West Bengal Nursing Report

Assessment of Nursing Management Capacity in

West Bengal

National Institute of Health and Family Welfarein collaboration with Indian Institute of Management, Ahmedabad

with support from SIDA

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AHMEDABAD

Department of Management Sciences

National Institute of Health and Family WelfareMunirka, New Delhi-110 067

In collaboration with IIM, AhemdabadWith support from SIDA

NIHFWProf. Deoki Nandan

IIM, AhmedabadProf. Dileep Mavalankar

Research Investigators

Prof. Rajni BaggaDr. Renu Shahrawat

Mrs. Bharati Sharma

Principal Investigators

PREFACE

Since Nurses and Midwives are the back bone for the delivery of quality Maternal and Child Health care services, their major contributions to health care development and to achieve the Millennium Development Goals is extremely crucial. India is committed to Millennium Development Goal 5, to improve maternal health by reducing Maternal Mortality Rate ¾ by 2015. But managing effective nursing care for maternal and child health in the health care institutions and at the community level, necessarily needs appropriate organizational and management structure at the state level. Various Committees and reports have pointed to the need for strengthening the nursing management capacity at the State Directorate level but there is a gap in policy formation documents and its actual translation.

The nursing management capacity, in the country, is quite weak. This gets reflected, in lack of active participation by human resources in nursing in any of the policy decision making processes. Issues and concerns being sidelined though no doubt, nursing constitutes one of the largest health workforces in the country.

It is important to identify the best practices of different states in order to develop a mechanism for its sharing and replication in other states. To address this issue, an exploratory study was undertaken in three selected states of India i.e., Uttar Pradesh, West Bengal and Tamil Nadu with an aim to review the management of nursing and midwifery issues at the State Directorate, Teaching Institutions, Health Care Institutions and other Nursing Professional Bodies; and identify variations, bottlenecks and gaps, if any, in the Nursing Management Capacity at the state level. The study was a joint effort of the National Institute of Health and Family Welfare, New Delhi and the Indian Institute of Management, Ahmedabad.

The study, in its findings, comes out with recommendations to have a separate nursing division at the state Directorate and preferably to be headed by a nursing professional on the post of 'Director Nursing' or its equivalent. The senior most nursing post must have total autonomy in decision making and to a member of all policy making bodies dealing with health and family welfare issues.

The immense human potential among nursing professionals needs to be converted into reality by creating an enabling work environment for them in terms of providing more power in decision making, and sound Human Resource policies. This requires a complete image changeover, keeping in line with the ever emerging importance of nursing profession, accorded universally. The contribution of the nursing to the overall health of the nation demands more visibility. Today the nurses need to be the equal partners in the betterment of health care delivery system.

Deoki NandanDirector, NIHFW

Assessment of Nursing Management Capacity in West Bengal

ACKNOWLEDGEMENT

The pleasurable part of writing the research report is the opportunity to offer our profound gratitude to many individuals. It would not have been possible to complete this research work without the support and inspiration of these people.

We are delighted to submit this study as a part of SIDA project Developing Inter-Institutional Collaboration between Institutions in India and Sweden for Improving Midwifery and EmOC Services in India improve maternal health. We sincerely thank with gratitude to Prof. Deoki Nandan, Director, NIHFW and Prof. Dileep Mavalankar, IIM-A for providing expert guidance from inception to completion of this study. Their constant support and inspiration has been extremely valuable for the study.

Our special appreciation and thanks for the West Bengal State officials and the nursing professionals at the State Directorate, nursing schools, hospitals, training institutions, professional bodies, etc for extending active support to facilitate the research team in data collection. We are particularly grateful to each of the interviewees who provided their valuable time and shared the relevant information to make this study meaningful.

The study could be successfully carried out due to the active support and involvement of research team members and faculty members from NIHFW and IIM-A and particularly put on record the sincere efforts of Mr. Ramesh Gandotra, Mr. G.S. Karol and Mrs. Reeta Dhingra during the process of data collection and analysis.

We particularly like to express our special appreciation for the sincere/hardwork put in by Ms Deepti T.V. for tirelessly working on the computer to put in shape all the figures and tables and typing the documents and without her hard work and patience the report could not have been compiled. We are very grateful for the technical support provided by Mr. Ravi Tewari for putting the report in its present shape.

Last but not the least we appreciate the efforts of the accounts and administrative sections of the NIHFW who actively supported for timely logistic arrangements.

Finally we are grateful to all those who supported in this study directly or indirectly and whose names are not reflected but without their support completion of the study was not possible.

In the end we sincerely hope that the study would meet the expectations of those involved in this profession and desirable changes are made in our approach and attitudes towards nursing. Together, definitely we will contribute in reducing maternal deaths and morbidities by improving management capacities of nursing/midwifery professionals.

Research Team from NIHFW and IIM-Ahmedabad


CONTENTS


Sl. No. Topic Page No.

Acknowledgement

Abbreviations

List of Tables

List of Figures

List of Annexures

Chapter - I Introduction 1-5 Management of Nursing and Midwifery Services 3

Chapter - II Objectives & Methodology 9-13 I Objectives 9 II Methodology 9 III Study Area 9 IV Study Population 9 V Tools for Data Collection 10 Secondary data 12 Data Management and Analysis 13 Limitations of the Study 13

Chapter - III Descriptive Analysis of Nursing Management Capac ity in West Bengal

17-44

17 State Profile 17 I Nursing Issues at the State Health Directorate 20

I.1 Organizational structure 20 I.2 Management processes 25

Job Profile of DD Nursing 25 Job Profile of Assistant Di rector and Deputy Assistant

Director (Nursing) 26

I.2.i Selection and Recruitment 27 I.2.ii Pre-service Training 27 I.2.iii In-service Training and Education 28 I.2.iv Promotion and Career Planning 28 I.2.v Performance Appraisal 29 I.2.vi Transfer Policy 29 I.2.vii Job Responsibilities 29 I.2.viii New Initiatives taken by the Directorate 29

II Nursing Issues at the Health Care Services especially Hospitals

30

II.1 Organizational Structure 30 II.2 Managerial Issues 31

III Nursing Issues at the Educational and Training Institutions especially the Nursing Schools and Nursing College and IHFW

33

III.A GNM Schools 33 III.A.1 Organizational Structure 33 III.A.2 Managerial Issues 33 III.B. Nursing Colleges 35

III.B.1 Organizational Structure 35 III.B.2 Managerial issues 36 III.C. Institute of Health & Family Welfare, West Bengal 37

iiiiiiv

III.C.1 Organization Structure 37 III.C.2 Training Activities 38

IV Nursing Issues with the Professional Bodies especially Nursing Council and Nursing Associations

39

IV.A West Bengal Nursing Council 39IV.A.1 Organizational Structure 39IV.A.2 Managerial Issues 42

V Nursing Issues as dealt by the local different Institution 43 V.1 All India Institute of Public Health and Hygiene 43

V.2. Trained Nursing Association of India, (TNAI) West Bengal branch

44

Chapter - IV Interpretation and Conclusions drawn from the analysis of WB data

47-49

I Interpretation and conclusion drawn from the Directorates of West Bengal

47

II Interpretation and conclusion drawn from the Health Care Services especially hospitals of West Bengal

48

III Interpretation and conclusion drawn from the Nursing Educational Institutions of West Bengal

49

IV Interpretation and conclusion drawn from the Professional Bodies especially Nursing Council and Nursing of West Bengal

49

Chapter – V SWOT Analysis onfNursing Issues in West Bengal 53-57 1. SWOT Analysis for the Directorate of West Bengal 53 2. SWOT Analysis of the Nursing Services in Health Care

Facilities of West Bengal 54

3. SWOT Analysis of the Education and Training of Nurses in West Bengal

55

4. SWOT Analysis of the Professional Bodies (State Nursing Council and TNAI) in West Bengal

56

Genesis of the SWOT Carried Out 57 Chapter – VI Recommendations 61-63 References 64 Annexures 67-103


List of Tables

Sl. No

Table Page No.

1. Categories of key informants for the state of West Bengal 12

2. Socio-demographic & Health Indicators of West Bengal and India 17

3. NFHS-3 MCH Indicators of West Bengal and India 18

4. Health Infrastructure of West Bengal 18

5. Health Institution in the State of West Bengal 19

6. Staff Strength of Nursing Personnel, State Health Directorate 23

7. Details of Memorandum

28

8. Staff Strength of Nursing Personnel, Nursing Colleges 36

9. Nurses, PHN, ANM and LHV registered with the West Bengal Nursing Council, 2005

40

10. Population served per Doctor and per Nurse West Bengal , 1981-2005

41


List of Figures

ii

Sl. No.

Figures Page No.

1. Organizational Chart of State Health Directorate

21

2. Detailed Structure of Nursing Division State Health Directorate

22

3. Organizational Chart of Nursing Staff at Health Care Services

30

4. Organizational Chart of Nursing Staff at Education and Training Institutions

33

5. Organizational Chart of Nursing Colleges

35

6. Organizational Chart of State Institute of Health & Family Welfare

37


List of Annexures

iii

Sl No.

Annexure Page No.

1. List of Officials Interviewed

67-68

2. Recruitment Rules

69-70

3. Duties and Responsibilities

71

4. Nursing Training Schools with addresses

72-73

5. Details of posts surrendered

74

6. Calcutta Gazetted Extra-ordinary, October 24, 1979

75

7. Memorandum: Rationalization of the cadre of Nursing services

76-77

8. Performance Report

78-80

9. Transfer Policy

81

10. Job Responsibility

82-98

11. Bengal Nursing Act – 1934 99

12. Curriculum of Diploma in Nursing Education and Administration

100-103


List of Abbreviations

Sl. No Abbreviations Full Form

1. A.D.H.S. Assistant Director Health Services

2. ACR Annual Confidential Report

3. AIIH&PH All India Institute of Hygiene and Public Health

4. ANM Auxiliary Nurse Midwife

5. ANMTC Auxiliary Nurse Midwife Training Centre

6. B.P.H.N. Block Public Health Nurse

7. BPL Below Poverty Line

8. CBR Crude Birth Rate

9. CDR Crude Death Rate

10. CMHO Chief Medical & Health Officer

11. CMO Chief Medical Officer

12. CMS Chief Medical Superintendent

13. CNE Continued Nursing Education

14. D.A.H.S. Deputy Assistant Director Health Services

15. D.D.H.S. Deputy Director Health Services

16. D.D.O. Drawing &Disbursing Officer

17. D.G. Director General

18. D.P.H.N.O. District Public Health Nursing Officer

19. Dir.(H.S.) Director (Health Services)

20. Dir.(MC) Director (Medical Care)

21. DNEA (CH) Diploma in Nursing Education and Administration (Community Health)

22. Dy. Dir. Deputy Director

23. G.B. General Body

24. GNM General Nurse and Midwives

25. GOI Government of India

26. H.A. Health Assistant

27. H.S. Health Supervisor

28. HRM Human Resource Management

29. I.E.C. Information Education & Communication

30. ICDS Integrated Child Development Scheme

31. IHFW Institute of Health and Family Welfare

32. IIHMR Indian Institute of Health Management & Research

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33. IMNCI Integrated Management of Neonatal & Childhood Illness

34. IMR Infant Mortality Rate

35. INC Indian Nursing Council

36. J.D. Joint Director

37. KGMU King George Medical University

38. LHV Lady Health Visitor

39. M.S. Medical Superintendent

40. MMR Maternal Mortality Ratio

41. MTP Medical Termination of Pregnancy

42. MVA Manual Vacuum Aspersion

43. NGOs Non-Government Organizations

44. NRHM National Rural Health Mission

45. O.T.S. Operation Theatre Supervisor

46. P.H.N. Public Health Nurse

47. P.N.O. Principal-cum-Nursing Officer

48. P.P.C. Post Partum Centre

49. PP Unit Post Partum Unit

50. R.A. Research Assistant

51. R.O. Research Officer

52. RCH Reproductive Child Health

53. RHFWTC Regional Health & Family Welfare Training Centre

54. SIHFW State Institute of Health & Family Welfare

55. SWOT Strength, Weakness, Opportunity and Threatness

56. TNAI Trained Nurses Association of India

57. U.P Uttar Pradesh

58. UPHSDP Uttar Pradesh Health System Development Project

59. W.B West Bengal

60. W.B.G.S West Bengal Govt. Services

61. W.B.H.S West Bengal Health Services

62. W.B.N.S West Bengal Nursing Services

63. WHA World Health Assembly

64. WHO World Health organization

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Chapter I

INTRODUCTION

INTRODUCTION

Nursing services in ancient medicine were practices in India since the times of King Ashoka. Florence Nightingale laid down the foundation of nursing education and services in the eighteen century in England. At about the same time British rulers in India organized health services first for their army and then gradually they extended to civilians where nursing played a major role. By the end of British rule it was thought to have a more organized health care system including nursing and midwifery education.

Professionalization of nursing in India began in 1905 when nine European nurse superintendents formed an organization which then got expanded and the Trained Nurse Association of India (TNAI) was established in 1909. Through sustained efforts from the TNAI, the Indian Nursing Council Act was passed in 1947 and the first college of nursing affiliated to the University of Delhi was established which was a concrete step towards professionalization of nursing in India. The TNAI established three sub-associations or leagues within TNAI; Health Visitors' League (1922), Midwives and Auxiliary Nurse-Midwives Association (1925) and Student Nurses Association (1929).

Since independence, India has progressed rapidly on various socio-economic indices, but the improvement in maternal health indicators have been slow. The maternal mortality rate is high at 307 per 100,000 live births (RGI, 2003) and more than 50 per cent deliveries occur at home without skilled assistance. The various committees and commissions appointed by government, international agencies support that there is a need to develop a strong nursing and midwifery services in the rural areas where there is a paucity of skilled manpower. WHO has also emphasized that “Nursing and midwifery services are vital for attaining health including maternal health as they form the backbone of maternal health care”. They are representing over 50% of the health profession.

As early as in 1948, World Health Assembly (WHA) identified the need to strengthen the roles of nurses and midwives. After half a century later in 2001, the member states in WHA again re-affirmed that nurses and midwives play a crucial and cost effective role in reducing excess mortality, morbidity and disability in promoting healthy lifestyles.

Nursing profession in India developed as 'midwifery' constituting of antenatal, natal and postnatal care. Nurses were treated as General Nurses and were rotated in all departments equally (including midwifery). Since the health demands were high and with limited nurses available especially in the rural area, the Auxiliary Nurse Midwives (ANMs) were introduced at the community level to cater to the growing MCH needs. The increase in their services ranged from MCH to additional responsibilities of immunization, family planning and other National Health Programmes, and this diluted the very important midwifery component. Resultantly the midwifery education, which was encouraged in pre-independence era, lost its importance after independence.

As far as nursing is considered, great imbalances in the manpower situation can be noticed. In comparison to the developed countries, the nurse population ratio in India is far from satisfactory. In 2004, the ratio was 1:2250 in India and 1:100-150 in Europe. The ratio in African countries, Sri Lanka and Thailand is 1:1400, 1:1100 and 1:850, respectively. Many states in India face a shortage of nurses and midwives (Dilip Kumar, 2005). In the Western countries, there are, on an average, 2 to 3 nurses to a doctor,


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while in India the nurse patient ratio however varies from 1:5 to 1:60 or 1:100 in different institutions. It strongly indicates that how our nursing care services are not developed adequately.

Two of the major goals of MDGs relate to reduction of maternal and child mortality. Majority of these services are delivered by the nursing personnel at the community level. But the goals cannot be achieved without strengthening the capacities of the nurses and midwives and presently their potential in terms of delivery of these services remains underutilized.

Acknowledging the contributions made by nurses to society, the late Prime Minister Indira Gandhi during a programme at the All India Institute of Medical Sciences, New Delhi, observed that, "A nurse is not merely an aid and assistant to a doctor, she has an independent part to play in many areas where a doctor need not necessarily be present. In the Western world, a nurse anaesthetist is properly trained, takes on important duties in minor surgical procedures and also takes care of newborns, among others. The nurse is in her own right a key member of the medical team”.

Different committees since 1946 emphasized the importance of nurse in health care delivery system. The Health Survey and Development Committee (Bhore Committee, 1946), was the most progressive in terms of its broad perspective and long-term vision for health in the country. It is relevant to mention here that the Committee had aimed at a target of one nurse to a 500 population. Most of the recommendations of the Bhore Committee are relevant even today. However, majority of the recommendations have not been taken up for implementation and even those that were initiated have been discontinued.

The Shetty Committee (1954) was setup on the recommendation of Central Committee of Health to review the then prevailing training and service conditions for nurses. The committee recommended that hospital nursing service staff and public health nursing service staff should be combined into a single cadre. The Mudaliar Committee (1961), recommended streamlining of nursing personnel to three grades of nurses: basic nurse with four years of training (including six months midwifery and six months Public Health Nursing). The Kartar Singh Committee (1972) had the greatest impact in terms of quality and longterm changes. This committee recommended the introduction of Multi Purpose Workers under Health and Family Planning Programme. The Shrivastav Committee (1975) further consolidated the recommendations of the Kartar Singh Committee. The Bajaj Committee (1986) strongly recommended that the health related vocational courses should be for ANMs.

In 1983, the National Health Policy was officially adopted by the Parliament. 'Health for all' principles and strategies were incorporated for strengthening and expansion of three-tier primary health care infrastructure - the subcentre, PHC and CHC. However, there was no qualitative difference in the job of any of the public health nursing personnel. Emphasis was given on orientation training to nursing personnel for implementing the new strategies.

The working and living conditions of nursing personnel have a direct bearing on the status of nursing services. The quality of nursing care depends on the number and quality of nursing manpower. It is also related to working conditions, equipment and supplies in the work place. The quality of nursing service also depends on the opportunities available for enhancement of professional education and incentives for


2

promotions, etc. Taking a serious note of this, a High Power Committee on Nursing was appointed by the Government of India, Ministry of Health and Family Welfare in July 1987 to review the role, functions, status and preparation of nursing personnel; nursing services and other issues related to the development of the profession and to make suitable recommendations to the government. The committee observed that nurses are generally not involved in making policies that govern their status and practice. The committee made several recommendations related to working conditions, nursing education, continuing education and staff development, norms for nursing services and education. Structural changes at administrative level, job descriptions for all nursing positions, working hours not more than 40 hours a week, opportunity for higher education after 5 years of service, accommodation and transportation facility for safety and security of nursing personnel, nurses to be relieved from the non nursing duties etc.

The National Health Policy, 2002 quotes “The ratio of nursing personnel in the country vis-à-vis doctor/bed is very low according to professionally accepted norms. There is also an acute shortage of nurses trained in super-speciality disciplines for deployment in tertiary care facilities The policy while emphasizing the need for an improvement in the ratio of nurses vis-à-vis doctor/bed lays focuses on improving the skill -level of nurses, and on increasing the ratio of degree holding nurses vis-à-vis diploma-holding nurses. It recognizes need for the central government to subsidize the setting up, and the running of, training facilities for nurses on a decentralized basis. Also, the policy recognizes the need for establishing training courses for super-speciality nurses required for tertiary care institutions.

It has been projected that the country requires about 2,00,000 nursing personnel to provide comprehensive care under the National Rural Health Mission (NRHM) project. In order to meet the shortfall in providing quality patient care, the centre has advised the state governments to enhance the capacity of the Auxiliary Nurse Midwives (ANMs) and GNMs by setting up additional nurse training institutions.

With the objective of improving the standard of nursing education and nursing practice, it has been decided to promote evidence-based practice and nursing research and improve the working conditions of nurses.

Management of Nursing and Midwifery Services

Existing situation of nursing and midwifery in India regarding nursing services, nursing education, nursing management, evidence-based nursing research and regulation are reviewed in a paper by Dilip Kumar (2005). While focusing on the management of nursing and midwifery services, the paper quotes “Nurses and midwives are not well accepted or recognized as leaders or administrators. Nursing management skills, leadership, lobbying and negotiating skills are poor. There is inadequate number of nurse and midwife leaders at the national and state levels for nursing practice, research, education, management, planning and policy development. Although the nurse is a member of the health team, she/he is never asked to represent the profession in planning and policy formulation for nursing services, education, etc. The nursing chief only looks after the nursing personnel and has no authority to make decisions on pay scales, number of posts, staff development or new interventions”. In response to the demand of the Delhi Nurses' Union, the Government of India has sanctioned 5 nursing posts at the national level. It quotes the major nursing issues that need to be addressed as:

.


3

²Insufficient contribution of nurses and midwives to health care development due to few positions for nurses and midwives at the state and national levels; inadequate nursing leadership and strategic management; inappropriate nurse to population/patient ratio;

²Poor quality of nursing and midwifery care due to inadequate number of nursing positions as per the recommended staffing norms; migration issues; insufficient number of nurses with Bachelors' and Masters' degree and in clinical specialties;

²Limited competency of nurses and midwives due to unclear roles and responsibilities of nurses and midwives; ineffective clinical preparation and supervision during training;

²Inadequate standards and guidelines for nursing practice and also ineffective regulation of nursing and midwifery practice;

²Inadequate infrastructure for nursing and midwifery practice;²Inadequate motivation to provide effective care;²Poor quality of nursing education to produce qualified graduates for service due to

inadequate national nursing and midwifery education plan and development; limited involvement of nurses and midwives at the policy level; shortage of qualified nurse educators; inadequate infrastructure for nursing education; and

²Limited role and authority of the INC in nursing development due to limited roles prescribed in the Indian Nursing Council Act, 1947; inconsistency in the Indian Nursing Council and State Nursing Council Acts; insufficient information systems in nursing and midwifery services; and shortage of staff at the INC and State Nursing Councils.

While addressing to the future of nursing and midwifery in India, the paper suggests that the Millennium Development Goals to be achieve. Nurses and midwives in India have to play a major role to improve the health and quality-of-life of the people.

For meeting the challenges, the paper recommends for involvement of nurses in health and nursing policy formulation bodies and to empower the nursing workforce to develop leadership and management skills.

It may be concluded that since the nurses and midwives are the backbone for the delivery of effective quality care of MCH services, their major contributions to health care development and to achieve the Millennium Development Goals is extremely crucial. The available research information as presented above does provide strong indication for inherent potential of nursing professionals. Though the various Committees and reports, (National Health Policy; High Power Committee on Nursing; Macro-economics and Health) have very articulately listed the main recommendations for strengthening the nursing management capacity but there is gap in policy formation documents and its actual translation. And this requires a strong support at the policy level to ensure policy implementation of the key recommendations of earlier reports. It is important to identify the best practices of different states in order to develop a mechanism for its sharing and replication in other states. Nurses and midwives need to focus to empower themselves and to strengthen their competencies.

Organizing effective nursing care for maternal and child health in the health care institutions and at the community level, necessarily needs good management and administrative practices. Based on the above facts, the present study was proposed in selected two states of India i.e. UP and West Bengal. The present study undertakes to


4

describe, besides the current nursing organizational/administrative structure, the key nursing management issues at the State Directorate, Teaching Institutions, health care institutions and other nursing professional bodies. The study is aimed to identify the bottlenecks and gaps in the nursing management capacity and delivery of services at all the levels.


5

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CHAPTER II

OBJECTIVES AND METHODOLOGY

I. Objectives

The main objectives of the study were:

1. To review the current nursing and midwifery organizational/administrative structure and highlight issues in West Bengal and identify best practices, if any;

2. To review the management of nursing and midwifery issues at the State Directorate, teaching institutions, health care institutions and other nursing professional bodies and identify any constraints;

3. To obtain a perspective and the ideas to strengthen nursing and midwifery management capacities to address maternal health issues appropriately; and

4. To draft the recommendations to strengthen nursing and midwifery management capacities.

II. Methodology

The study on “Assessment of Nursing Management Capacity in Selected States was carried out in the states of Uttar Pradesh, West Bengal and Tamilnadu. The rationale for choosing these three states was to identify the nursing management capacity of the states with the relatively better MCH indicators in comparison to the one with weak indicators. Uniformity was maintained in methodology and objectives for all the three states studied. The present report focuses on the detailed and comprehensive analysis of the data obtained from the state of West Bengal.

The study is exploratory in nature. Both primary and secondary data were collected to obtain qualitative as well as quantitative information.

III. Study Area

The study was carried out in the state of West Bengal. The relevant information was collected, from the officials of the state from the following organizations:

1. State Health Directorate. 2. Health care services, especially hospitals.3. Educational and training institutions (especially the nursing schools and nursing

college, and Institute of Health and Family Welfare (IHFW).4. The State Nursing Council.5. Professional bodies such as nursing associations and other related institutions.

IV. Study Population

Interviews were conducted with the following and information collected:

1. Additional Chief Secretary and other Senior Administrators from the State Health Directorate.

2. Nursing officials of the Directorate.3. Commissioner, Health and Family Welfare4. Mission Director5. Matrons of Civil Hospitals6. Head of State Nursing Council7. President, West Bengal Branch of Trained Nurses Association of India8. Faculty, All India Institute of Hygiene and Public Health


9

9. Principals and other faculty members of the nursing schools and colleges.

Tools for Data Collection

Primary data were collected by conducting indepth interviews by using semi-structured interview schedules with key respondents. Using a checklist, a detailed review of secondary data in the form of reports and documents were carried out.

Indepth interviews were carried out from the 24 key informants in West Bengal. The list of the officials interviewed is attached at Annexure 1.

Table 1 Categories of Key Informants in West Bengal

Sl. No Designation Address 1. Commissioner Family Welfare Govt. of WB,

Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700091, West Bengal

2. Additional Chief Secretary Health & Family Welfare, Govt. of WB, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700091, West Bengal

3. Director Director Health Services, Govt. of WB, Swasthya Bhawan, Sector-V, Bidhan Nagar Kolkata-700091, West Bengal

4. Project Director and Mission Director

Govt. of West Bengal, Swasthya Bhawan, Wing-B, 3rd Floor, Sector -V, Salt Lake City, Kolkata-91, West Bengal

5. E.O. Secretary Directorate of Medical Education Health and Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

6. Director Institute of Health & Family Welfare, Special Secretary (MES) Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

7. Dy Director Health Services (Nursing)

Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

8. Assistant Director (Nursing) Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

9. Assistant Director Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

10. Registrar West Bengal Nursing Council, 8, Lyons Range, Calcutta-700 001, West Bengal


10

11. President West Bengal Branch of TNAI

12. Professor All India Institute of Hygiene and Public Health, Chittranjan Avenue, Kolkata

13. Professor All India Institute of Hygiene and Public Health, Chittranjan Avenue, Kolkata

14. Lecturer College of Nursing, Medical College Hospital, 88 College Street, Kolkata-700073, West Bengal

15. Nursing Superintendent Medical College Hospital 88 College Street, Kolkata - 700 073, West Bengal

16. Principal College of Nursing, Medical College Hospital, 88 College Street, Kolkatta-700073, West Bengal

17. Sister Incharge & Incharge ANM School

Medical College Hospital, 88 College Street, Kolkata - 700 073, West Bengal

18. Sister Tutor Medical College Hospital 88, College Street, Kolkata - 700 013, West Bengal

19. Principal West Bengal Government Nursing College, Kolkata, West Bengal

20. M.D Peerless Hospital & B.K. Roy Research Centre 360, Panchasayar, Kolkata - 700 004

21. Assistant Nursing Superintendent

Peerless Hospital & B.K. Roy Research Centre, 360, Panchasayar, Kolkata - 700 004

22. Principal Nursing College, Peerless Hospital & B.K. Roy Research Centre, 360, Panchasayar, Kolkata - 700 004

23. Nursing Superintendent M R Bangur Hospital, Kolkata

24. Dy. Nursing Superintendent M R Bangur Hospital, Kolkata

The data and information, as presented in this report, in the form of figures and tables was further validated by getting them appraised from the key informants.


11

The In-depth interviews focused on the following key variables:

Organizational Structure and Functioning

Health Directorates (education, clinical and public health services) State Nursing Councils Hospitals

HR policy for nursing

? Service and conduct rules for nursing professionals ? Selection and recruitment ? Placement and transfer ? Performance appraisal system ? Job profile ? Nursing cadre ? Career planning/Career graph ? Perceptions/observations/experience for

transfer/placement

Training and education (pre-service, induction and in-service)

? Continued Nursing Education (CNE) ? Methodology for induction training for nursing

personnel ? Content areas for induction training for nursing

personnel ? Methodology for promotional training for nursing

personnel ? Procedures for training and development

The indepth interviews also collected feedback on the following:

²Policy guidelines to health and related activities in the context of nursing services;²Administrative set-up and functioning of nursing personnel and their roles,

responsibilities and job description of nursing functionaries;²Involvement in decision making;²Perception and views on communication patterns in the Directorate; and²Perception and views on coordination with other related units in the Directorate.

VI. Secondary Data

Following secondary data were collected:

a. Organizational structure for the nursing administration and management positions, number of staff, their nature of posting, qualification and experience related to nursing etc.

b. Policies and practices related to human resources such as:i Job description of different cadres of nursing personnel at state/district levels.ii Recruitment transfer rules.iii Performance appraisal systems.iv Total nurses in clinical settings and community health settings, and vacancies.v In-service and pre-service training of nurses and ANMs.

c. Monitoring systems of nursing practice.d. Annual and other reports.


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VII. ata Management and Analysis

Detailed notes were taken of each indepth interview. Information was analyzed manually. The responses were categorized into themes against the pre-decided categories and triangulated across interviews with secondary data collected.

VIII. Limitations of the Study

The observations should be viewed in the light of the fact that this was a descriptive study based on the interviews of key informants, and primary data were not collected through a sample survey. The study results derive from the opinions from the personal experiences of the key informants and the researchers' interpretations from the interviews and secondary data sources.


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CHAPTER III

DESCRIPTIVE ANALYSIS OF NURSING MANAGEMENT

CAPACITY

Descriptive Analysisof Nursing Management Capacity in West Bengal

State Profile

West Bengal was created as a constituent state of the Indian union on 15 August 1947 as the result of partition of the undivided British Indian province of Bengal into West Bengal. West Bengal covers the bottleneck of India in the east, stretching from Himalayas in the north to the Bay of Bengal in the south. It is bounded on the north by Sikkim and Bhutan, on the east by Assam and Bangladesh. On the south by the Bay of Bengal and on the west by Orissa, Bihar and Nepal. It has therefore, three international frontiers-to the north, east and west.

The state of West Bengal has an area of 88,752 sq. km. and a population of 80.18 million. There are 19 districts, 341 blocks and 40782 villages. The state has population density of 903 per sq. km. (as against the national average of 312). The decadal growth rate of the state is 17.77% (against 21.54% for the country) and the population of the state is growing at a slower rate than the national rate.

The Total Fertility Rate of the state is 2.1. The Infant Mortality Rate at 38 and Maternal Mortality Ratio at 194 (SRS 2001-03) are lower than the national average. The sex ratio in the state is 934 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows:

Table 2: Socio-demographic & Health Indicators of West Bengal & India

S. No. Item West Bengal India 1 Total population (Census 2001) (in million) 80.18 1028.61 2 Decadal Growth (Census 2001) (%) 17.77 21.54 3 Crude Birth Rate (SRS 2007) 18.4 23.5 4 Crude Death Rate (SRS 2007) 6.2 7.5 5 Total Fertility Rate (SRS 2006) 2.1 2.9 6 Infant Mortality Rate (SRS 2007) 38 57 7 Maternal Mortality Ratio (SRS 2001 - 2003) 194 301 8 Sex Ratio (Census 2001) 934 933 9 Population below Poverty line (%) 27.02 26.10 10 Female Literacy Rate (Census 2001) (%) 59.6 53.7

Source: www.mohfw.nic.in/NRHM/State.

Better MCH indicators in WB are reflective of good MCH/ Midwifery services in the state.


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Table 3 NFHS-3 MCH Indicators of West Bengal and India

Key Indicators NHFS –3 (2005 -06)

India WB Maternal and Child Health Mothers who had at least 3 antenatal care visits for their last birth (%)

50.7 62.4

Mothers who consumed IFA for 90 days or more when they were pregnant with her last child (%)

22.3 24.3

Births assisted by a doctor/nurse /LHV/ANM /other health personnel (%)

48.3 45.7

Institutional births (%) 40.7 43.1 Mothers who rece ived postnatal care from doctor / nurse/LHV/ANM/other health personnel within 2 days of delivery for their last birth (%)

36.4 37.8

Anaemia among Children and Adults

Pregnant women aged 15-49 who are anaemic (%) 57.9 62.6

Table 4 Health Infrastructure of West Bengal

Sl No

Particulars Required In position,%

Shortfall,%

1. Sub-centre 12101 10356 (85.6)

1745 (14.4)

2. Primary Health Centre 1993 922 (46.3)

1071 (53.7)

3. Community Health Centre

498 346 (69.5)

152 (30.5)

4. Multipurpose worker (Female)/ANM at Sub Centres & PHCs

11278 9900 (87.8)

1378 (12.2)

5. Health Worker (Male) MPW(M) at Sub Centres

10356 5178 (50)

5178 (50)

6. Health Assistant (Female)/LHV at PHCs

922 1227 (133)

-

7. Health Assistant (Male) at PHCs

922 550 (59.7)

372 (40.3)

8. Doctor at PHCs 922 811 (88)

-

9. Obstetricians & Gynaecologists at CHCs

346 346 (100)

0

10. Physicians at CHCs 346 0 (0)

346 (100)

11. Paediatricians at CHCs 346 278 (80.3)

68 (19.7)

12. Total specialists at CHCs

1384 624 (45.1)

760 (54.9)

13. Nurse/Midwife 3344 858 (25.7)

2486 (74.3)

(Source: RHS Bulletin, March 2007, M/O Health & F.W., GOI)


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Table 5 Health Institution in the State of West Bengal

S.No Health Institution Number

1. Medical Colleges 9

2. District Hospitals 16

3. Ayurvedic Hospitals 4*

4. CHCs 386

5. PHCs 922

6. SCs 10356

7. GNM Nursing Schools 39** ( 26 Govt. & 13 Private)

8. A.N.M Schools 63** (42 Govt. & 21 PPP)

9. Nursing Colleges (B.Sc Nursing) 11** ( 4 Govt. & 7 Private)

10. Nursing Colleges (M.Sc Nursing) 2** (1 Govt. & 1 Private)

11. Promotees Training School (Health Supervisor Training)

2***

Source:www.mohfw.nic.in/NRHM/State, RHS Bulletin, March 2007, M/O Health & F.W., GOI), U P Nursing Council Report, *upeducation.net/educationprofile/colleges/nursing and **West Bengal Nursing Report Government of West Bengal, Directorate of Health Services Swasthya Bhawan Nursing Branch, Kolkata- 91.

*Health on the March 2005-06, State Bureau of Health Intelligence, ** Deputy Director of Health Services (Nursing), Directorate of Health Services, Government of West Bengal, Swasthya Bhawan, Kolkata, and ***TNAI Kolkata Branch.

The Table 5 shows the number of Health institutions meant for service delivery, education and training of the nursing in the state. West Bengal has proportionately more institutes of higher learning, which shows the enhanced capacity in building nursing human power for delivering nursing education and quality of services. This definitely puts WB in a more advantageous position for carrying out the training for nurse practitioners in the state.

As an initiative taken by the Government of West Bengal in 2005, three new nursing colleges were started by way of upgrading the three existing nursing training schools and the process of capacity building is going on. The statement showing the details of posts created are given in the above Table 8.

The state is taking initiatives for enhancing the nursing capacities at all levels. There is more focus in the state on nursing higher education; where in new colleges of nursing are being opened.


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The present chapter describes the management structures and the management processes especially human resource issues of nursing in the following institutions/organizations:

I. Nursing Issues at the State Health Directorate.

II. Nursing Issues at the Health Care Services especially Hospitals.III. Nursing Issues at the Educational and Training Institutions (especially the Nursing

Schools and Nursing College and IHFW).IV. Nursing Issues with the Professional Bodies especially Nursing Council and Nursing

Associations.

V. Nursing Issues as Dealt by the Local Different Institutions.

The detailed analytical description of the data collected was presented under the following management issues broadly management strategies and human resource issues:

I. Nursing Issues at the State Health Directorate

I.1 Organizational Structure

At secretariat level, the State has a post of Joint Secretary, which looks after the nursing and family welfare in the state. At the Directorate level, West Bengal has a separate nursing branch, which comes under the Director, Health Services. The organizational structure is presented in Figures 1 and 2.

The Deputy Director (DD), Nursing is the Executive Officer and Head of the Nursing Branch in the Directorate of West Bengal. This post came into force from 1975. In some other states the equivalent post is State Nursing Superintendent (SNS). This post is assisted by 2 Assistant Directors and 12 Deputy Assistant Directors. All these nursing administrators have nursing background as their qualification. The Nursing Division also has 21 administrative support staff. The Director (Accounts) and Director (Health Services), who also happen to be in charge of Central Medical Stores Department, manage all the financial and logistics matters related to nursing branch. Commissioner, National Rural Health Mission (NRHM) deals with nursing matters pertaining to NRHM, especially recruitment of the contractual staff nurses/(Auxiliary Nurse Midwives) ANMs under Reproductive Child Health-II (RCH-II)/NRHM. It is important to add that since all the postings and transfers are under the control of DD Nursing, the nursing personnel do get appropriate support and these results in least harassment of any kind.

DD (Nursing) plays a role in the transfer and placement of nurses in the hospitals. This involvement of DD (Nursing) coupled with the accessibility of the other senior nursing functionaries minimize any harassment of nurses in their postings and transfers.


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Figure 1: Organisational chart of State Health Directorate, West Bengal

Additional

Chief

Special

Secretary Director

Medical

Deputy Director

Health Services (Nursing)

Director

Health Services Director

Ayurvedic Director

Homoepathy

Assistant Director

Health Services (Nursing 2)

Deputy

Assistant Director (12)

Nursing

Education and

Research

Community

Health Service

Nursing

Service

Admn.

Principal

Nursing Officer/

Principal

Vice Principal/

Senior Sister Tutor

Nursing

Superintendent

Dy. Nursing

Superintendent

District

Public Health

Female Health

Supervisor

(Urban Community Health

Services)

Ward Sister

(Rural)

Sr. Public Health Nurse/

Public Health Nurse

Health Assistant (F)

Sister Tutor

Staff Nurse

Sr. PHN/PHN

Source: Nursing Division, Government of West Bengal, Directorate of Health Services, Swasthya Bhawan Nursing Branch, Kolkatta-91.


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Figure 2: Detailed Structure of Nursing Division State Health Directorate

Deputy Director of Health Services (Nursing) W.B.G.S -

(1)

Assistant Director of Health Services (Nursing)

(2)

W.B.N.S.

(1)

W.B.G.S.

(1)

Nursing Education

& Research Nursing Service

Administration

Community Health

Service

Principal Nursing

Officer (16)

Sr. Sister Tutor (17)

Gr.I (i) b

Sister Tutor/ PHN

Tutor

A.N.M.

Student

(520)

Health

Supervisor

Student (In-

service)

Ex-cadre

G.N.M.

Student

(870)

Nursing Superintendent

(95)

Dy. Nursing

Superintendent

(27)

Ward Sister/Sister-in-

charge

(572)

Gr.I (ii)

Staff Nurse Gr.

II/ A.N.M.

Gr.III (14789)

District Public Health

Nursing Officer

W.B.G.S.

Rural Comm. Urban Comm.

Service

B.P.H.N. Gr.I (ii)

(340)

P.H.N. Block

H.S. (F)

(1883)

H.A. (F) (10356)

P.H. N. at I.C. D.S.

Sr. P.H.N. at

P.S.M.

P.H.N. at P.P.

Unit

P.H.N. at

I.C.D.S Centre

P.H.N. at D.F.W

Centre

Ex-cadre

Deputy Assistant Director of Health Services

Source: Nursing Division, Government of West Bengal, Directorate of Health Services, Swasthya Bhawan Nursing Branch, Kolkata-91.


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All posts under West Bengal General Service (WBGS) are selection posts and those under West Bengal Nursing Service (WBNS) are promotional posts. The posts of Deputy Director of Health Services (D.D.H.S) (Nursing), Assistant Director of Health Services (A.D.H.S) (Nursing), Principal Nursing Officer and District Public Health Nursing Officer come under West Bengal General. Service, rest all the nursing service posts belong to West Bengal Nursing Services. The details of these posts are shown in the Figure 2 and Table 6.

The Nursing branch in WB is well equipped in terms of sufficient human resources as well as physical infrastructure and other resources like computer, telecom facility and furniture. All the proposals related to nursing are initiated from the nursing section by the DD (Nursing) and submitted to Director of Health Services and Secretariat as the case may be. The final authority for sanctioning the post is the Principal Secretary, Family Welfare (FW).

thThe total sanctioned posts are 29,550 as per Nursing Report 30 August, 2007 and out of which 27,568 were in position and 1,992 were vacant. It may be concluded from the Table 6 that out of the total sanctioned posts of Nursing Superintendents (95), only 63 posts are in position, and out of the 336 sanctioned posts for Deputy Nursing Superintendent, only 77 are in position.

Table 6 Staff strength of Nursing personnel, State Health DirectorateS.No.

Designation with Grade Pay Scale

(Rs) Sanctioned Strength

In position

(%)

Vacancy (%)

1. D.D.H.S (Nursing), W.B.G.S. 12000-375-18000 1 1 NIL 2. A.D.H.S. (Nursing), W.B.G.S. 10000-325- 15525 1 1 NIL 3. A.D.H.S. (Nursing), W.B.N.S. 1 1 NIL 4. D.A.D.H.S. (Nursing), Gr.-I(i)a 8000-275-13500 12 7

(58.3) 5 (41.7)

5. Nursing Superintendent, Gr. -I(i)a

95 63 (66.3)

32 (33.7)

6. Gr. I (i)b (i) Deputy Nursing Superintendent (ii) Sr. Sister Tutor

5000- 175- 5700-200-6500-225-8525-250-11275

336 77 (22.9)

259 (77.1)

7. Gr.I (ii) Ward Sister Sister Tutor Senior P.H.N

4500-150-5250-175-7000-200-8800-225-9700

1128 1101 (97.6)

27 (2.4)

8. Staff Nurse Gr-II P.H.N. Gr.II A.N.M. Gr-III

3800-100-4100-125-4725-150-6375-175-7775

15239 14746 (96.8)

493 (3.2)

9. Health Supervisor (F) 2346 1829 (78.0)

517 (22.0)

10. Health Assistant (F) 3350-90-3800-100-4700-125-6325

10356 9705 (93.7)

653 (6.3)

11. District Public Health Nursing Officer (W.B.G.S.)

8000-275-13500 19 17 (89.5)

2 (10.5)

12. Principal Nursing Officer (W.B.G.S.)

16 13 (81.3)

3 (18.7)

13. Principal Singur, (W.B.G.S.) P.H.N.O Nurse Tutor Health Education Officer

1 3 1 1

1 2 (67.0) 1 (100) Nil

Nil 1 (33.0) Nil 1 (100)

14. Health School (W.B.N.S.) Vice Principal Sr. Tutor P.H.N. -(ii)

5000- 175- 5700-200-6500-225-8525-250-11275

1 2 1

Nil 2 (100) 1 (100)

1 (100) Nil Nil

Grand Total 29550 27568 (93.3)

1992 (6.7)

Source: Government of West Bengal, Directorate of Health Services, Swasthya Bhawan Nursing Branch, Kolkata- 91


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The Nursing Wing has well laid out objectives as stated in its annual report for the year 2007-08. The objectives are as follows:

1. Planning of nursing manpower by suggesting the number, recruitment policy, job responsibility, promotion and transfer etc.

2. Planning, organizing nursing educational programmes including continuing education/in service education for nursing personnel.

3. Communication with various units of health services - Directorate and related departments, Non-governmental Organizations (NGOs) for betterment as per rule etc.

4. Receiving, processing and disseminating the information related to nursing service and nursing education.

5. Evaluating nursing services, education and administration.6. Conducting nursing research work.

WB appears to have a better evolved nursing branch in the Directorate headed by DD (Nursing) who is ably assisted by 2 Assistant Directors and 12 Deputy Assistant Directors.


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I.2 Management Processes

West Bengal has a well-defined nursing cadre. There are 30,000 registered nurses in the state, both General Nurse and Midwife (GNM) and Auxiliary Nurse Midwife (ANM). The state does not have an overall written Human Resource (HR) policy. Though there are guidelines for transfer/posting and job responsibilities of each cadre of nursing personnel, but the Deputy Director (Nursing) and other senior officers felt a strong need to have a formal HR policy document.

The Nursing Division in the West Bengal Directorate was perceived to be proactive. This is shown in the measures being taken to create 3,900 more new posts of staff nurses in the West Bengal Nursing services. This is aimed to further facilitate and strengthen the maternal health care services in the state. Thirteen hundred personnel will be added each year over a span of 3 years, over and above filling up the regular vacancies of the nurses. This will greatly improve the nurse bed ratio from current 1:5 to 1:4. As per the information provided by Additional Chief Secretary, Health and Family Welfare, the state is also taking the initiative to train, on pilot basis, few of the nursing personnel, say about 100, as nurse practitioners. The aim is to post them at Community Health Center (CHC)/ Primary Health Center (PHC) level to facilitate service delivery related to Maternal Child Health (MCH) services and to also compensate for the services of Medical Officers as there is a dearth of them in the rural areas.

Earlier there used to be delay in filling the vacant posts due to the requirement of finance department's/cabinet approval, but now the process is streamlined and these posts can be filled on ad hoc basis. And the contractual staff under NRHM can be appointed without such formalities.

Job Profile of DD Nursing

Deputy Director (Nursing) is taking a very active part in all matters related to formation of policy for betterment of nursing services in the state. As reported by the senior functionaries, efforts are going on to upgrade the present post of DD (Nursing) to that of Joint Director (Nursing) and this will definitely give a further boost to this position.

² DD (Nursing) acts as the Advisor to the government regarding all nursing matters.²She is the Chief Executive Officer to implement all the plans and programmes

related to development of nursing in the state.²She has got the decision-making powers for staffing, recruitment, promotion and

transfer of nursing personnel of both the faculty of teaching institutions and as well those in the service delivery side.

²The DDHS (Nursing) takes care of Establishment of Gr.I(i)a and Gr.I(i)b Nursing Officers.

²She is actively involved in decision-making for educational activities both for pre-service and in-service education in the state.

²She first processes any new nursing proposal, in the nursing section before forwarding it to higher authorities.

²DD (Nursing) is the member of the task force for decision-making related to budget.

²All the establishment jobs of all the nursing personnel are first processed in the nursing section.

²She carries out decision-making for selections of students for GNM and ANM schools.


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Job Profile of Assistant Director and Deputy Assistant Director (Nursing)

The two Assistant Directors and 12 Deputy Assistant Directors have a clear job profile though their functioning is quite interrelated. The Deputy Director prepares the work profile of Assistant Directors and Deputy Assistant Directors.

²Assistant Director Health Services (ADHS) (Nursing) looks after the Establishment of Gr.I(i)b and I(i)a Nursing Officers including their transfers and promotions.

²The various posts of Deputy Assistant Director Health Services (DADHS) (Nursing) look after various aspects of nursing service as well as training that includes taking care of establishment of various levels of nursing cadre starting from Gr.I(ii) Nursing Officers down to Health Assistant (H.A.) Female (F) and Health Supervisor (H.S) (F). These posts also look after the Establishment of various nursing schools and nursing colleges. They also look into all matters relating to Nursing Training [GNM, A.N.M and H.S (F)].The details of job responsibilities are shown at Annexure 10.

²The Assistant Directors and Deputy Assistant Directors do visit the field from time to time and definitely once a month. They visit the district hospitals and also interact with the district Public Health Nurses (PHNs).

With well defined job profile for the DD (Nursing) and all other nursing officers, the branch is very proactive in taking keen initiatives to enhance nursing capacity building to further facilitate and strengthen the maternal health care services in the state.


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I.2.i. Selection and Recruitment

The posts for nursing personnel in the Directorate are selection posts rather than promotion posts. The selection to the Directorate is through Public Service Commission and the procedural details of some of the nursing positions are given in Annexure 2. The promotional scales are given after 8 to 10 years of service.

I.2.ii. Pre-Service Training

In the state, there are 2 colleges of Master of Science (MSc.) Nursing (1 in government and another in private), 39 GNM Nursing Schools (26 Government and 13 Private), 63 ANM training Schools (42 Government and 21 with Public Private Partnership). But in spite of having a good infrastructure for nursing education, no institution is conducting the PhD programme. All the teaching institutions are governed by the guidelines of Nursing Council of India. The list of these schools and type of courses run in the state are given in Annexure 4.

To further strengthen the nursing education in the state, in 2005, 3 nursing colleges were opened. For filling up the teaching posts in these new colleges, the State Finance Department bargained for relinquishing a number of posts of Nursing Superintendents, Deputy Nursing Superintendents and Sister Tutors in order to fill up the faculty posts (of the 107 Nursing Superintendents, one post was abolished from the TB hospital and 11 other posts were surrendered, in addition, 27 posts of Deputy Nursing Superintendents and 49 posts of Sister Tutors were also surrendered to create the posts of faculty i.e. at the level of Lecturers, Professors etc.). But as admitted by senior officials, this has not been a fruitful exercise. Since it resulted in no Deputy Nursing Superintendent at some hospitals, the absence of this senior nursing position resulted in non-compliance of orders at the junior level. Moreover various key decisions were delayed. As a result the State Directorate is putting up the proposal for creation of more senior nursing positions at the hospitals. The details are given in Annexure 5.

During 2007-08, 850 nursing students were selected for GNM course, 110 students for condensed B.Sc (Hons.), 520 students for ANM course. There has been a recent increase in number of ANM training schools (5-6 new schools are being opened in which one is proposed under government and rest all under Public Private Partnership (PPP).

Director (Medical Education) heads the pre-service training and education matters for nursing. The notification of Calcutta Gazette Extraordinary, October 24, 1979 discusses the details for the admission of nursing students in West Bengal. As per this notification, certain rules were laid to regulate the admission of students to the State Nursing Schools in West Bengal (Annexure 6). As per the Calcutta Gazette Extraordinary order, the educational qualifications for GNM and ANM course are Higher Secondary (10 plus 2) Examination/equivalent public examination and School Final Examination/Madhyamik Examination/equivalent public examination respectively. For the selection process, a Board constituted by the Director of Health Services, looks after the admission to the GNM training schools. For admission to Auxiliary Nursing Midwifery Course, Principal Nursing Officer/Nursing Superintendent and Senior Sister Tutor are members of selection board.


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I.2.iii. In-Service Training and Education

State does not have an overall training policy but in-service training guidelines exist. There is no formal induction training for any cadre of nurses. In fact except for ANMs, the staff nurses rarely get a chance of any type of training after graduating from the nursing school or college throughout their careers. In West Bengal, the staff nurses are posted at the district level hospitals at the beginning of their careers. Later they are promoted to the higher level facilities such as the Intensive Care Units and this requires specialized nursing skills. After serving at district level for several years, they are required to perform both administrative/managerial and clinical roles. However, in the absence of any in-service training, for upgradation of their skills, there exist wide gaps in their performance. A need for having separate cell for Continued Nursing Education (CNE) was raised by all so that all types of in-service training are systematized.

I.2.iv. Promotion and Career Planning

In-spite of a relatively large branch of nursing in the health directorate, the state has several issues related to promotion and career development, which need to be streamlined. There is no time bound promotion for the nursing staff. The laid out guidelines for the promotion of the staff were written way back in 1957 in which the ANM and Sevikas were also under the preview of nursing cadre. However as per memorandum from Deputy Secretary to Government of West Bengal, dated 1987 on modification of cadre division, their recruitment to the Grade-III cadre was stopped. The memorandum also shows the ratio to be followed for the promotion of nursing, which is 3% for Group-A, 7% for Group-B and 90% for Group-C posts of the total nursing posts. The details of the memorandum are given below:

Table 7 Details of Memorandum

Sl. No

Category Percentage of total Nursing Posts

1. Grade-I (i)Nursing Superintendents, Dy A.D.H.S (Nursing) , Dy Nursing Supdts. Matron, Senior Sister Tutor

3

2. Grade-I (ii) Sisters, Sister-Tutor Instructor, Assistant Matrons, Senior Public Health Nurse

7

3. Grade-II Staff Nurse, Public Health Nurse 90 4. Grade-III ANM outside the cadre strength

Grade-IV Sevikas - outside the cadre strength Dying Cadre

Nil

Source: Memo, Health/CA (N)/220/IN-52/86 dated 13.11.87, Modification of cadre divisions in West Bengal Nursing Services.

In West Bengal, the nursing personnel get service benefits upon getting higher educational qualifications as reflected in the notification for the promotion of nursing dated 1979. As per this notification, ANM after passing the condensed course in GNM gets promotion from Grade III to II and otherwise others in Grade III get it on seniority basis. Similarly for promotion from Grade II to Grade I (ii), the GNM qualified nurse upon completing the condensed B.Sc (Nursing) gets promotion to the higher post. Whereas others, in Grade II get the promotion on seniority basis. Promotion from Grade I (ii) to Grade I (i) will be filled up by promotion from Grade.1 (ii) on seniority basis. The notification is placed at Annexure 7.


28

Since in WB the promotions are mainly on the basis of achieving higher/additional qualifications, but the ones who do not get the chance to do so end up getting stagnated and frustrated. And this is more in case of nurses who get recruited as staff nurses. This indeed is a matter of deep concern as the career growth of a large human power is stagnated. Immediate measures need to be taken to address this issue while the state is planning to further increase the work force.

I.2.v. Performance Appraisal

The performance appraisal is done through Annual Confidential Reports (ACRs). ACR report was earlier written in form no. 290 for the staff, but now it is modified in 2007.There are separate ACR forms for Group A officers and non-Group A officials. A copy of the ACR format is given in Annexure 8.

But the current ACR format does not have any mention for independent research undertaken or publications prepared. This does not seem to send the positive message for the importance of any research or academic work as no credits are awarded for the academic pursuits but these are important for the growth of knowledge generation within the profession.

I.2.vi. Transfer Policy

The state has a transfer policy for nursing and as per the guidelines provided in the notification in the Annexure 9, the posting and transfer of Gr. I (i) a to Gr. II of nursing staffs are classified under two zones. In the notification, West Bengal is divided into two zones i.e south zone and north zone. For transfers of Gr. II, Gr. I (i) nurses, zone A includes all districts of South Bengal, whereas zone B includes all districts of North Bengal. According to this policy, the initial posting of all the Gr. II and I (ii) nursing personnel is to be at PHC/Block PHC/ Rural hospitals for at least 5 years. After 5 years they can seek transfer from Zone A to Zone B or vice-versa. The other details are given in the Annexure 9.

I.2.vii. Job Responsibilities

Directorate of Health Services have documented the job responsibilities of nursing staff, (the details of each category is attached in Annexure 10), in which the clear-cut responsibilities are drawn for different categories. This translates in to clarity of job profile and the functioning.

I.2.viii. New Initiatives Taken by the Directorate

²One of the very important measures being proposed for the career development of nursing is to have independent nurse practitioners. In the near future the state plans to recruit 100 nursing practitioners. It will create opportunities for GNM to be trained as nurse practitioners. The proposal is to develop these nurse practitioners as an alternative for absence of medical officers in Primary Health Centres. This project will be undertaken on a pilot basis first. There was a pilot project by the Australian Agency under which 6-7 nurses were given one and a half years of training in midwifery. These midwives were placed in Community Health


29

Centres. Their performance was found to be very good, but the state could not create a technical and administrative post of a midwife, which has financial and structural implications. This project has led to a dialogue for developing an independent cadre for nurse practitioners. However the project could not take off because the Finance Department did not approve the pay scale of Rs. 8000 for these Nurse Practitioners. But the proposal is still under consideration.

²The Nursing Cell is developing a new proposal for creating the post of District Nursing officer (DNO). For 18 Districts in WB, 18 posts of DNO are proposed to be created and these posts will come under DD (Nursing). The proposal is being processed by the Finance Department.

II. Nursing Issues at the Health Care Services especially HospitalsII.1. Organizational Structure

CMHO (Chief Medical Health Officer) is responsible for all the hospitals in the district. Medical Superintendent (MS) of the hospital comes under CMHO. The organizational chart of the nursing staff is given below:

Figure 3: Organizational Chart of Nursing Staff at Health Care Services,West Bengal

Chief Medical Health Officer

Deputy Nursing Superintendent

Gr.1 (ii) Sister

Gr.II Staff Nurse

Medical Superintendent

Nursing Superintendent

Ward Sister


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For community level nursing services the DPHNO under the overall in-charge of CMHO and DD (Nursing), looks after the affairs of PHNs, health supervisors and ANMs. The details of the organizational structure are given in Figure 2.

II. 2. Managerial Issues

Medical Superintendent looks after the administrative, financial and other HR issues particularly supervisory and training of the hospital personnel including nurses. Nursing Superintendent is not involved in selection, recruitment and transfer of nursing staff at the hospital. Nursing Superintendent represents institute in nursing related matters. The Nursing Superintendent is involved in the placement of the nursing staff within the hospital. There is no separate nursing budget. Nursing Superintendent is responsible for ward management and service delivery. The leave record, duty hours etc. are looked after by the NS. Group D staff does not come under NS. The State Directorate looks after them.

Issues related with transfers and placements: As reported by one of the senior nurse administrators of the hospitals, Deputy Director Nursing (DD Nsg.) has power for transfer of nurses to other hospitals and CMOH has powers for transfer within the district. DD (Nursing) also contributes to decision related to the posting of Nursing Superintendent and Deputy Nursing Superintendent.

The Directorate looks after issues related with career development. There are opportunities for nursing personnel being sent for specialized training like e.g. Emergency Nursing, Psychiatric Nursing, and Skilled Attendance at Birth (SAB). No training is conducted at the district hospital, but candidates from the district hospitals do get nominated for various trainings conducted in the state.

Though the state is increasing its nurse bed ratio from 1:5 to 1:4, but still it would not be sufficient to ease their workload, as this calculation does not take into account the requirement for special areas like ICU, labour room and post-operative wards etc. With opening of newer super-specialty units, this problem is going to become more acute in the future.

Private Hospital

Besides visiting the government health facility, the team also visited the one private hospital, The Peerless Hospital and B.K.Roy Research Centre that is a multidisciplinary super-speciality hospital. The ISO certified Peerless Hospital and B.K.Roy Research Centre opened "School of Nursing' in 1994. In 2006, in addition with the diploma course, the hospital started the Baccalaureate programme in Nursing with the due approval of Government of West Bengal, as well as West Bengal University of Health Sciences. The Indian Nursing Council and West Bengal Nursing Council approved the institute to start the Post Basic B.Sc. Nursing Course. The college runs Post Basic Nursing Course under W.B.H.H.S. The total numbers of seats are 30 and duration is 2 years.

The nursing candidates are coming from government setup also. In a way this private institution does play an important role in capacity building of the state nursing force. But their potential is not fully utilized, as a proposal, from the Government of West Bengal, to start ANM training at this hospital could not materialize due to lack of financial agreement. There was input from the Principal of the Nursing College of this


31

hospital to the Medical Health Science University for the revision of curriculum for the degree course. But their inputs are not taken for the revision of curriculum for the school.

Support System

1. In the Kolkata city, accommodation and security were some of the issues of concern faced by the nursing human power working in the state capital. Though the hostel accommodation is available but the married girls have to stay in rented accommodation.

2. Since the nursing staff in WB is quite empowered and vocal, they hardly seem to face problems related with exploitation and gender discrimination. The easy approachability of the senior nursing officials in the Directorate, who are all women from the nursing background and the State Nursing Council being headed by a nurse Registrar, makes the whole scenario to be positive and supportive to the nursing profession in the state.

Community Nursing Services

To gain a better understanding of midwifery services, a mention is being made of nursing services at the community level. For delivery of MCH services in the community, there is the post of Health Assistant (Female) (equivalent post of ANM in other states), who are supervised by Health Supervisor (Female) (equivalent post of Lady Health Visiter in other states). The HA (F) after undergoing 6 months training can become HS (F). Both HA (F) and HS (F) are supervised by Public Health Nurses (PHNs) and senior PHNs (posted at block level). The DPHNO is the overall supervisor incharge of the nursing personnel in a district (the cadre is shown in Figure 1). The PHN posts are meant for both B.Sc/condensed B.Sc candidates as well as GNM candidates who have undergone one-year diploma course in Public Health Nursing. But for the senior PHNs post, B.Sc is a pre-requisite.

In WB, the nurses are facing the problem of increased workload. WB has a well-developed supervisory structure for community health services, as there are posts of PHNs and DPHNO to supervise the Health Supervisors (Female) and Health Assistants (Female).


32

III. Nursing Issues at the Education and Training Institutions especially the Nursing Schools Nursing Colleges and IHFW

III.A. GNM Schools

III.A.1. Organizational Structure

In the West Bengal, the nursing schools come under the Nursing Education and Research Wing. West Bengal has 25 government and 10 private GNM nursing schools approved by the West Bengal Nursing Council. However the research team visited two Government GNM schools, one in the Medical College Hospital, and the other one in Bangoor Hospital and also the private nursing school under the Peerless Hospital.

The organizational structure is presented in Figure 4. As per the Nursing Superintendent of the Calcutta Medical College and Hospital, who also happened to be the in charge of the GNM school, the Principal Nursing Officer (PNO) post is there for ANM training and not for GNM training. If both the schools exist at one place, then Principal is required otherwise NS is I/C of GNM school.

Figure 4: Organisational chart of Nursing Staff at Education and Training Institutions

Principal/

Principal Nursing

Officer

Vice Principal/ Sr.

Sister Tutor

Sister Tutor/ P.H.N.Tutor

Administrative /

Supportive Staff

Source:-Information provided by Hospital Nursing staff.

III.A.2. Managerial Issues

The managerial functions performed by the in-charge of the schools are administrative, supervisory, and coordinating and monitoring for educational activities like teaching and training, but are not involved in the selection and recruitment and also the transfers as these are taken at the Directorate level with the Secretary Health as the decision-making authority. The Medical Superintendent under


33

the hospitals decides all the financial and other logistics matters and the In-charge Nursing school does not have any financial power. There are no specific guidelines for involvement of nursing officials in the policy decision-making. But while framing any policies concerning teaching institutions, the nursing tutors are consulted and invited for discussions from time to time. They are not part of any task group. The in-charge of the nursing school coordinates the teaching and training activities within the hospital. PNO coordinates with other institutions e.g. All India Institute of Hygiene and Public Health for the training and study tours.

The Annual Confidential Report (ACR) of the staff of the GNM school is written by PNO. As per the state transfer/placement policy for nursing professionals, they should be transferred after every 3-4 years but it is not being implemented, but transfers are carried out only on request or under complaints.

There are guidelines for career planning procedures. GNM after doing Bsc. Nursing can become Ward Sister and after doing MSc., Sister Tutor can get the post of teaching. But the training/capacity building of nursing tutors is not systematized. Though there are some refresher courses and CNE and all these programmes are ad hoc. There is no systematic procedure for induction training for nursing personnel.

In WB, the schools face a problem with finding adequate number of cases for imparting hands on skill based midwifery training due to the cases being shared amongst undergraduate and postgraduate doctors and nurse trainees, but certain training institutions do explore for a formal tie up to send the students to the private hospitals to acquire the skill.

The Principal being the head of the institution has not been delegated any financial powers. They only do data to day coordination and supervisory work. For the selection of the students of the GNM schools, the Principal has no role to play.


34

III.B. Nursing Colleges

III.B.1. Organizational Structure

Principals, of the college is the overall in-charge of the management, administration and teaching/training activities. Principal is assisted by Professor-cum-Vice Principal, Readers, Senior lecturers, Clinical Instructors for the activities of the college

Figure 5: Organizational Chart of Nursing Colleges, West Bengal

Principal

Professor-cum-Vice

Principal

Readers

Senior Lecturers

Clinical Instructors

Administrative staff (including

Librarian)

Group D Staff

Source:-Information provided by Principal of the Nursing College.


35

Table 8: Staff strength of Nursing personnel, Nursing Colleges

Sl. No. Name of the Post Number of Posts Created in the Following Colleges of Nursing attached to:

Medical College and

Hospital

NRS Medical College and

Hospital

R.G Kaur Medical

College and Hospital

1. Principal, College of Nursing

1 1 1

2 Professor, College of Nursing

1 1 2

3 Reader, College of Nursing

1 1 7

4 Senior Lecturer, College of Nursing

5 5 8

5 Clinical Tutor, College of Nursing

14 14 21

6 Librarian, College of Nursing

1 1

7 U.D.C., College of Nursing

1 1

8 L.D.C., College of Nursing

1 1

Source: Memo, G.O. No. HF/O/MERT/685/2N-46/02 dated 29.06.05, Government of West Bengal, Department of Health and Family Welfare, MERT Branch, Salt Lake City, Kolkata-700 091.

III.B.2. Managerial Issues

The Principal as the overall administrative head of the college is actively involved in day-to-day functioning of the college related to teaching, and Principal is also the Drawing and Disbursing Officer for all the financial matters. But nursing personnel from Government colleges are not called at the State Health Directorate for policy decision-making. They are not members of any task force.

Appointing authority of the Principal is the Secretary, Health. Principal is accountable to Secretary and Director, Medical Education (ME). Director (ME) looks after the HR related issues of nursing colleges. The job responsibilities of the staff are given in Annexure 10.

Director (Medical Education) writes the ACR for Principal and the Principal for the rest of the functionaries of the Nursing College. Promotion is decided on the basis of ACR. There is no incentive for good performance, no transfer policy for the colleges and the transfers are being done amongst the nursing colleges itself. Currently 50% seats are on direct recruitment and 50% are through promotion. DD (HS) looks after promotion and other career related issues. There are job benefits for educational enhancement e.g. unless the candidate is M.Sc. they are not eligible to become Sr. Lecturer. Teachers are nominated for courses both within as well as outside state also they are being sent for Training of Trainers (TOT) training courses such as for intra-uterine device (IUD) insertion, Integrated Management of Neonatal and Childhood Illness (IMNCI) etc. Interestingly though there is provision for study leave, but as reported there is no systematic CNE for staff of nursing colleges.


36

For the cost of education, there is a huge margin in the fees structure of the government vs. private institutes like the course fees is Rs. 5000 in government M.Sc college whereas it is Rs. 1 lac per year in the private college. III.C. Institute of Health and Family Welfare, West Bengal

III.C.1.Organizational Structure:

The IHFW West Bengal has following staff strength:

Figure 6: Organizational Chart of Institute of Health and Family Welfare

Director

Administrative

Officer

Accounts In-charge

Accountant-cum-clerk

Group ‘D’ Staff

Source:-Information provided by IHFW Staff.

Since there is no regular Director at IHFW, the Special Secretary (Medical Education Services) in Directorate, is also having the additional charge of Director IHFW. There is no faculty in the institute. The IHFW West Bengal conducts the trainings with the help of guest faculty only. Though they have good infrastructure with a good library having sufficient number of books and journals and fully air conditioned faculty rooms, 2 lecture halls. A.V aids, computer unit, canteen, staff quarters and hostel facility but the activity part is visibly lacking.

The Principal is the overall administrative head of the college and also is the Drawing and Disbursing Officer for all the financial matters.


37

III.C.2.Training Activities

During the last eight years IHFW is involved in different types of training especially for the nursing personnel under RCH-I & II e.g.:

²Integrated Skills Training ²Specialized Skill Training²I.U.D²Training Skilled Attendance at Birth for Staff Nurse/GNM/ANM²Orientation Training on SAB and Basic Emergency Obstetric Care

But the above trainings are part of RCH/NRHM programme and are conducted nationwide, and there are no other capacity building attempts for the nursing by the IHFW. So in a way the huge infrastructure and resources are not being tapped to its full potential.

The Institute does not have any regular Director and also lacks adequate teaching staff. IHFW potential is not being tapped fully for in-service capacity building of nursing personnel though the Institute has adequate infrastructure. Only programme related training carried out here.


38

IV. Nursing Issues with the Professional Bodies Especially Nursing Council and Nursing Associations

IV.A. West Bengal Nursing Council

IV.A.1. Organizational Structure

At the Council, there are two committees: the General Purpose Committee and the Education and Evaluation Committee. The General Purpose Committee looks after the matters related to finance, fee fixation, any incident and all the other matters except examination. The other Education and Evaluation Committee looks after all the examination matters beside inspection, recognition, de-recognition etc. The general body of the council meets twice in a year. After each examination, there is a meeting of the examination body, which is held 5 to 6 times in a year. The General Purpose Committee meets 4 times in a year.

The registrar looks after all the management and administrative issues like conducting exams, finance, audit and budgets. Registrar is the Drawing and Disbursing officer. Apart from other administrative matters, he also looks after the registration of GNM and BSc. and MSc. nurses.

For pre-service education, the syllabus of Indian Nursing Council is followed, but the State Council does the monitoring of quality of education. At the Council the Director of Health Service, is the Ex-officio President. In total there are 13 ex-official members. At the Council the Registrar is Registrar-cum-Secretary. There is one post of Assistant Registrar which is currently vacant. In total they have 19 support staff. There are separate registers for the registration of BSc. and MSc. nurses, but joint register for ANMs and GNMs.

Under the West Bengal Nursing Council, there are 56 GNM and ANM schools, out of this 35 are government and rests are private. There are two government colleges for B.Sc. Nursing, 5 B.Sc. private Nursing colleges, one government M.Sc. Nursing and one private M.Sc. Nursing College.

The total number of Nurses, Public Health Nurses, Auxiliary Nurse-cum-Midwives, and Lady Health Visitors registered with the West Bengal Nursing Council in 2005 is given in Table 9.


39

Table 9: Nurses, Public Health Nurses, Auxiliary Nurse-cum-Midwives, and Lady Health Visitors registered with the West Bengal Nursing Council, 2005

Register

ed Categor

y

Number registered upto

31.12.2004 (Previous year)

Additional Number

registered during 2005

Number registered

upto 31.12.2005

Number deleted

upto 31.12.200

5

Number of active list

upto 31.12.2005

Male

Female Male

Male

Female Male

Male

Female

Nurse (Genera

l)

75 4778+23755

(a)=28533

3 1189 78 4788+24934 (a) =29722

7 1643 71 3203+24876 ( a)=28079

A N M 13 19447 407 13 19854 1 270 12 19584 Midwive

s 4794+23755(b)=2

8549 1176 4791+24934(b)

=29725 1805 3044+24

876 (b)=2792

0 L H V 276 276 80 196 P H N 231( c ) 2 233 6( c) 227 (C)

Source: West Bengal Nursing Council

P H N = Public Health Nurse

A N M = Auxiliary Nurse-cum-Midwives

L H V = Lady Health Visitors

(a) These Nurses are also entered in Midwives column.

(b) These Midwives are also entered in Nurses column.

(c) These Registered Nurses are also included in Nurses column.

FemaleFemale

Source: Health on the March 2005-06, State Bureau of Health Intelligence, Directorate of Health Services, Government of West Bengal, Swasthya Bhawan, Kolkata.

The total number of 28,000 Nurses (General) including midwives are registered with West Bengal Nursing Council. The number of ANMs registered is nearly about 20,000. It is very much visible from the Table 9 that approximately 50,000 nursing personnel are registered with West Bengal Nursing Council.

The Registrar with nursing background heads the WB Nursing Council and this is in accordance with the WB Nursing Act. DD (Nursing), is the Vice-president of the Nursing Council. The nursing personnel at decision-making level at the council promote issues related with capacity building of nurses.


40

Table 10: Population Served per Doctor and per NurseWest Bengal, 1981–2005

Sl. No Y e a r

Population Served

Per Doctor Per Nurse

1. 1981 2236 2613

2. 1982 2215 2434

3. 1983 2162 2277

4. 1984 2126 2206

5. 1985 2097 2175

6. 1986 2085 2086

7. 1987 2058 2001

8. 1988 2109 1899

9. 1989 2100 1878

10. 1990 2191 1948

11. 1991 2158 1871

12. 1992 2166 1870

13. 1993 2156 1868

14. 1994 2163 1848

15. 1995 2160 1818

16. 1996 2212 1850

17. 1997 2167 1905

18. 1998 2181 1894

19. 1999 2088 1648

20. 2000 2060 1771

21. 2001 2041 1751

22. 2002 2030 1725

23. 2003 1998 1718

24. 2004 1974 1702

25. 2005 1956 1662

26. 2006 1961 1646

Source: Health on the March 2005-06, State Bureau of Health Intelligence, Directorate of Health Services,

Government of West Bengal, Swasthya Bhawan, KolkataCalculation based on: (a) total number of registered Allopathic Medical Practitioners having recorded their address

in the State,(b) Nurses (all categories) registered with the West Bengal Nursing Council


41

The Table 10 indicates that in the last three decades or so, the ratio of doctors and nurses to population have shown progressive improvement. This may be due to WB state's efforts to improve the human power for health service delivery in the state.

As per the document “Health on the March 2005-06”, State Bureau of Health Intelligence, there are 48,637 doctors, 28,079 nurses and 20,007 ANMs/ LHVs registered in the state. By calculation this gives nurse doctor ratio as 1:0.98 (including ANM's) and 1: 1.7 (excluding ANMs).

IV.A.2. Managerial Issues (West Bengal Nursing Council)

The practice for renewal of registration after every 5 years was started 5 years back. The Registrar nursing council is sometimes called at State Health Directorate for issues related to pre-service and in-service nursing education and training, but is not a member of any task force.

The Registrar is involved in all the managerial and decision-making issues of her organization. For governing body meetings the Registrar acts as a Member Secretary.

The communication in the Nursing Council is both written and verbal and everything is communicated to DD (Nursing), as she is the Vice-president of Nursing Council. There is no performance appraisal in the Nursing Council but the need was felt for performance appraisal in the nursing service to be changed and the authority should be with the nursing personnel only.

Some of the issues raised by the Registrar

²President should also be a nursing person.²For training, Indian Nursing Council (INC) norms are followed. There is no specific

training policy at State. She felt that there is no systematic system of service training. It is mainly need-based and not on a regular basis.

²At the Nursing Council, they are not directly conducting any CNE but they are helping the other organizations in conduction of CNE.

²At Nursing Council, they are publishing the textbooks of GNM, ANM and Nursing.²Nursing Registration Body should be separate from the Examination Body

because there is already increased work load.²There should be a separate Joint Director for Nursing.²The pay scale of Registrar is not at par with the other States. It is the same for

both Registrar and Deputy Registrar. ²There should be renewal of registration for all the nurses.²During skill training of nursing students, there is difficulty in getting the

adequate number of delivery cases. ²For separate Midwife cadre there is no benefit of separate Midwife, GNM should

work as Midwife. ²Number of people with General Nursing and Midwifery skills are not up to the

mark and their number should be enhanced.²There is a need to increase the number of schools of nursing.

Two documents are available with the Nursing Council i.e. The Bengal Nurses Act, 1934 and The Calcutta Gazette Extraordinary was modified in October 24, 1979. The brief details are placed at Annexure 11 and 6.


42

V. Nursing Issues as Dealt by the Local Different Institutions

V.1. All India Institute of Hygiene and Public Health

The All India Institute of Hygiene and Public Health (AIIH&PH), Calcutta, was established in 1932 with the assistance of Rockefeller Foundation. AIIH&PH continues to be a leader in pursuit of its mandate for Human Resource Development in the field of public health. The institute with eleven academic departments has well qualified teaching faculty. Since 2004, the institute is running Diploma in Nursing Education and Administration (Community Health). This ten-month post certificate course for Community Health Nursing was initially established as Diploma in Public Health Nursing (DPHN) in 1953. Later with the permission of the Government of India, the institute revised and renamed it as Diploma in Public Health Nursing from 1975. Further from 2004 the course was revised and re-named as Diploma in Nursing Education and Administration (Community Health) [DNEA (CH)]. The course provides training of nurses at post basic level to take up positions as administrators, supervisors and teachers in the field of community health nursing field. Intensive training in all aspects of Community Health Nursing is provided so as to ensure that nursing personnel function effectively as important member of the health team. The course includes both theoretical and practical instruction with field work in rural and urban area.

The Admission requirements of the course are: Senior Nursing Certificate – 'A' grade from any of the schools of nursing recognized by the Indian Nursing Council or its equivalent in other countries and a Senior Midwifery Certificate – Essential for female nurse. Male nurses are required to have approved training in lieu of Midwifery.

General Education: Minimum Higher Secondary Passed or its equivalent qualification. Experience minimum of two years experience after completing nursing course/preference will be given to those with experience in Community Health Nursing.

The Curriculum of Diploma in Nursing Education and Administration (Community Health) [DNEA (CH)] Course is placed at Annexure 12.

Though this institute, with its infrastructure and resources, is an asset to the state for nursing capacity building but it also has some administrative and academic constraints and bottlenecks. And some of the issues raised by the senior faculty interviewed are as follows:

²The Institute is facing shortage of faculty in PHN Department. A well qualified nursing tutor is there but she has not yet been promoted to senior faculty position.

²Since the teaching norms of Nursing Council are not fulfilled, there is an apprehension that this may be derecognized in future.

²Though this course helps the candidate in future avenues and for taking up teaching cadre but presently the institute is getting fewer candidates from the State of West Bengal as the State has started sponsoring its candidates in other training centre at Shimbhol.

It is important for the State Directorate to consider to encash on the institutes capacity and to further strengthen it.


43

V.2 Trained Nurses Association of India, (TNAI) West Bengal Branch

The team interviewed present President of TNAI, WB Branch, Mrs Gaytri Bondopadhyay. The following issues and suggestions were received for enhancing the nursing profession as well as improving the enabling environment for nurses to function:

²The West Bengal, TNAI has 9,000 registered nurses as its members. ²The TNAI does not have a proper office and infrastructure for its functioning with

just one room in IMA building in Kolkata. For holding various meetings and workshops, they use the premises of different nursing schools.

²Directorate does not involve the TNAI on nursing related matters but whenever there is problem TNAI gives a representation to the government and it is taken care of.

²The attendance to the General Body meetings of the TNAI is very small as the district people are not able to come due to non availability of Travel Allowance (TA).

²TNAI conducts CNE and other training courses for the Nursing Teachers on Basic Nursing. Earlier they had conducted courses on Nursing Management for Block B.Sc. Nurses/Public Health Nurses.

²It was suggested that the nursing training to be replaced with practical and field based training from theoretical/classroom based training.

²An important observation that many of the reforms and initiatives for nursing are based on personal interests taken by senior officials. It all depends upon such people's personal attitudes and their own personalities. So in a way such initiatives are not in-built in the system but are all personality driven. For more sustainability of such reforms, policy decisions are required.

²The work culture, day by day is lacking in team spirit between doctors, technicians and nurses and role model. In the work situations are lacking.

²Even though the state has adequate number of qualified Nursing personnel, but the sanctioned posts in the government set up are short to meet the demand.

²There is a need for independent midwifery cadre after 1½ years training of B.Sc. Nursing. They could be appointed as independent nurse practitioners at the PHC level.

²Over the years the issue of turnover of nursing personnel is on the rise and this is due to lack of career growth and incentives.

²TNAI gets funds from the Central Government and Indian Nursing Council but these are not adequate for meeting the expenses for conducting various workshops.

²Gender issue: Since in WB, nursing work force is 100% female dominated, it is required for the nursing policies to be more gender sensitive.

²More training is required in developing the behavioural skills for developing the motivation level and improving positive attitude.


44

CHAPTER IV

INTERPRETATION AND CONCLUSION FROM THE

ANALYSIS OF WEST BENGAL DATA


Analysis of Key Indicators of West Bengal State

West Bengal with a population of 80 million consists of 19 districts. The WB Health and MCH indicators are better than the national indicators. For example the IMR and MMR in WB are better than all India figures at 38 vs.57 and 194 vs. 301 respectively. Other indicators like TFR, sex ratio and female literacy rate are also much better in the State of WB when compared with national figures as shown earlier in Table 3. These indicators by itself speak of a more enhanced overall health care delivery system particularly the nursing setup in WB. This has been reinforced in the earlier study, “Situational Analysis of Public Health Nursing Personnel in India: Based on National Review and Consultation in six States” wherein it states “ West Bengal is known as a progressive state in relation to nursing administration and public health nursing” (Prakasamma, M, 2005).

I. Interpretation and Conclusion Drawn from the Directorate of WB

The West Bengal State Health Directorate has 15 sanctioned posts of nursing personnel. The research team observed a very proactive Nursing Division in West Bengal Directorate. West Bengal had been a very progressive state during the British period. Bengal was one of the first states to have a nursing and midwifery act in 1936, many years before the Indian Nursing Council Act established in 1947.

Interaction with all senior officials in the Health Directorate of West Bengal indicated a very proactive and positive approach towards nursing management affairs and the active role played by the nursing functionaries of the Nursing Division, as indicated by the number of proposals in the pipeline such as increasing the number of nurses (3900 more posts have been created), and training GNM as nurse practitioners.

Management process and HR issues

Leadership and Role Behaviour: Though there is no post of Director Nursing and the final decision-making still rests with the health secretaries and other senior policy makers but the DD Nursing does play a very important role in decision making. There is a potential for leadership among the Nursing Division of the WB which was evident from the responsibilities and functions assigned to DD Nursing as indicated in her job profile. DDHS (Nursing) in WB is the Chief Executive Officer and Head of the Nursing Branch in the Health Directorate. All the proposals related to Nursing Branch are processed and initiated from nursing section and submitted to Director of Health Services and Secretariat as the case may be. She also takes a very active part in all matters related to formation of policy for betterment of nursing services.

Selection and Recruitment: Promotion to the Directorate in WB is through selection based on merit rather than seniority only. Administrative action has been taken in WB resulting in filling up of the vacant posts on ad hoc basis.

West Bengal has clear cut job responsibilities for different levels of nursing human power at the State level, leading to no ambiguity in job delivery.

WB is 100% female dominated nursing cadre.

Nursing Training and Education:

In WB, there is good number of nursing colleges as well as schools. The state has only


47

training guidelines but no training policy. A pro-active stance was observed at the WB State Health Directorate wherein the initiatives are being taken to create more teaching level posts e.g the 87 posts of Nursing Superintendent, Deputy Nursing Superintendent and Sister Tutors were relinquished and to be replaced with teaching faculty/instructors positions. This is aimed at strengthening the pre-service education in the state.

Career Planning and Promotional Avenues

In WB, as the promotions and career growth are linked to higher qualification and on merit, this clearly explains the presence of more number of nursing institutions of higher education here. But on the flip side, the state has not been able to plan career paths to senior positions leading to stagnation at the entry level which is the Staff Nurses. As a result many of them retire as Staff Nurses without any promotion. But presently the state is planning to further increase the work force.

The in-service training and particularly CNE is very ad hoc and not linked to placement opportunities. This requires establishing a separate cell for CNE.

Transfer/placement Policy:

The well laid down transfer policy guidelines which exist in WB are followed in principle as political interference is almost nonexistent. In the beginning of the career the transfers are intra-zonal but inter-zonal transfers are also possible after 5 years of service.

II. Interpretation and Conclusion Drawn from the Health Care Services especially hospitals of West Bengal

1. Shortage of nursing human power is noticed in the state as observed from disparity in the nurse bed ratio of both the states. Though the nurse bed ratio is 1: 4 in WB, but this ratio does not take in to account the nurses requirement for special area like I.C.U, OPD, post operative ward and labour room where the required nurse bed ratio varies from 1:1 to 1:3.

2. In WB, the decentralization of decision-making power with, Nursing Superintendent/Sr. Matron/Matron is lacking. The hospitals have no specific guidelines for involvement of nursing officials in the policy decision-making. During interaction, they mentioned how their role is merely confined to day to day supervision and monitoring. Even for small budgets, the financial powers are not delegated. As reported the senior nursing administrators at the hospital are involved in the decision-making related to nursing services at the hospital level only but no involvement at the Directorate level.

3. There is shortage of senior nursing positions at level of DNS and above, leading to weak administrative capacity at hospital level.

4. In WB, concerns for issues like security, provision of accommodation and transport were not raised, may be due to active involvement of senior nursing officials in the decision-making in such matters. DD (Nursing) and the State Nursing Council's Registrar, both are very sensitive to all these issues.

5. In WB, a well defined supervisory structure exists for the supervision of the field


48

staff in the form of posts of PHN or DPHNO.

III. Interpretation and Conclusion Drawn from the Nursing Educational Institutions of West Bengal

1. In WB, there is adequate emphasis on nursing higher education as seen from number of educational institutions providing B.Sc and M.Sc Nursing Degrees.

2. Though an acute shortage of teachers was noticed in the state, efforts are going on to address this issue. It is reported that in the coming years the demand for teachers will further increase with the need to open more nursing teaching institutions.

3. Due to the shortage of adequate number of cases, a difficulty was reported in imparting optimum hands on skill-based training for midwifery in GNM course. But certain institutions, in WB, are making efforts to tie up with the private hospitals for students to get the skill-based training.

4. IHFW, WB does not have regular full-time Director and lacks adequate teaching staff. The training activities also are adhoc in nature. Though IHFW is well positioned in the campus of Swasthya Bhawan and has required infrastructure with hostel facility etc., but the potential is highly underutilized.

5. In WB, the overall physical infrastructure, of the nursing schools visited, was adequate by way of good demonstration laboratories and well equipped libraries.

IV. Interpretation and Conclusion Drawn from the Professional Bodies especially Nursing Council and Nursing Association of West Bengal

1. In WB, since the Director, Health Services and DD Nursing at the Directorate are the ex-officio president and Vice-President respectively of the State Nursing Council, the nursing issues are more streamlined.

2. In WB, the Registrar is a nursing person. It is to be noted here that the Registrar is not a member of any task force, but gets invited sometimes at the Directorate for matters related to teaching and training.

3. It is important to highlight the effective coordination observed amongst the tripartite of DD (Nursing), Registrar (State Nursing Council) and the Principal of the Government Nursing Colleges. This gets translated in the nursing matters e.g the education and training and the ones related with the selection procedures being more streamlined and do not get delayed administratively. This has also facilitated the state's initiative to pilot the nurse practitioners programme.

4. The State Nursing Council in WB is very stringent in granting the permission for the opening of nursing education institutions in the private sector with a view to maintain the quality of teaching standards.

5. The state has explored the PPP initiative for conducting ANM training.


49

CHAPTER V

SWOT ANALYSIS OF NURSING ISSUES IN WEST

BENGAL

1.S

WO

T A

NA

LYSIS

FO

R T

HE D

IREC

TO

RAT

E O

F W

EST B

EN

GA

L

ST

REN

GT

HS

W

EA

KN

ESSES

1.

DD

nurs

ing is

support

ed b

y 14 s

enio

r nurs

e a

dm

inis

trato

rs t

o p

erf

orm

all t

he k

ey

funct

ions

in t

he D

irect

ora

te.

2.

Nurs

ing p

ost

s in

the D

irect

ora

te a

re s

ele

ctio

n a

s w

ell a

s pro

moti

on

post

s.

3.

Good infr

ast

ruct

ure

and s

upport

faci

liti

es.

4.

Job p

rofi

le o

f D

D N

urs

ing v

ery

cle

ar.

5.

DD

Nurs

ing a

ctiv

ely

invo

lved in p

olicy

deci

sion-m

akin

g.

6.

Well

docu

mente

d s

ele

ctio

n a

nd r

ecr

uit

ment

crit

eri

a,

job

resp

onsi

bilit

ies

and t

ransf

er

policy

.

7.

Enabling a

nd s

upport

ive e

nvi

ronm

ent

for

nurs

ing in t

erm

s of

adequate

num

ber

of

hum

an r

eso

urc

es

alo

ng w

ith g

ood infr

ast

ruct

ure

and o

ther

support

; M

ore

invo

lvem

ent

in t

he p

olicy

deci

sion

-makin

g.

1.

No p

ost

of

Dir

ect

or

Nurs

ing.

2.

Senio

r m

ost

post

of

nurs

ing is

at

Deputy

Dir

ect

or

leve

l only

.

O

PPO

RT

UN

ITIE

S

T

HR

EAT

S

1.

NRH

M is

em

phasi

zing o

n q

uality

of

MCH

serv

ices,

and

requir

es

deve

lopin

g s

kill and c

om

pete

ncy

of

nurs

es

and m

idw

ives.

2.

Policy

reco

mm

endati

ons

docu

mente

d

(e.g

. G

OI

s H

igh P

ow

ere

d

Com

mit

tee o

n

Nurs

ing (

1989);

Macr

o E

conom

ics

report

, 2005;

and

vari

ous

reco

mm

endati

ons

at

the h

igh leve

l) a

nd t

hese

requir

e

init

iati

ves

and s

trong c

om

mit

ment

at

the H

igher

leve

l.

3.

Rela

tive

ly s

table

politi

cal

si

tuati

on a

nd a

lmost

non

-exis

tent

politi

cal

inte

rfere

nce

in v

ari

ous

adm

inis

trati

ve m

att

ers

.

4.

Bett

er

MCH

indic

ato

rs in c

om

pari

son t

o n

ati

onal and U

P s

tate

fig

ure

s.

5.

Wit

h h

igh f

em

ale

lit

era

cy in W

B,

there

is

gre

ate

r hum

an p

ow

er

pote

nti

al and p

olicy

makers

to e

nca

sh o

n t

his

.

1.

The e

merg

ing o

pport

unit

ies

from

the p

riva

te h

ealt

h c

are

sect

or

com

peti

ng w

ith t

he p

ublic

sect

or

for

pla

cem

ent

of

train

ed

nurs

ing h

um

an p

ow

er.


53

2.

SW

OT A

NA

LYSIS

OF T

HE N

UR

SIN

G S

ERV

ICES IN

HEA

LTH

CA

RE F

AC

ILIT

IES O

F W

EST B

EN

GA

L

ST

REN

GT

HS

W

EA

KN

ESSES

1.

W

ell e

stablish

ed p

ublic

healt

h s

etu

p.

2.

Init

iati

ves

bein

g t

aken f

or

incr

easi

ng t

he n

urs

ing p

ost

s.

3.

In

itia

tive

s bein

g t

aken f

or

recr

uit

ing independent

nurs

e p

ract

itio

ners

(o

n p

ilot

basi

s).

4.

Hig

her

educa

tion lin

ked t

o c

are

er

gro

wth

opport

unit

ies.

5.

Ad h

oc

appoin

tments

for

vaca

nt

post

s.

6.

The n

urs

ing p

ers

onnel get

an e

nvi

ronm

ent

of

easy

acc

ess

ibilit

y to

the

senio

r nurs

ing f

unct

ionari

es

at

the D

irect

ora

te leve

l w

hic

h h

elp

s in

m

itig

ati

ng a

ny

job h

ara

ssm

ent

rela

ted iss

ues.

1.

Senio

r le

vel nurs

ing p

ost

s va

cant.

2.

Nurs

ing Su

peri

nte

ndent

not

re

pre

sente

d in

any

policy

deci

sion-

makin

g.

3.

Senio

r nurs

e a

dm

inis

trato

rs o

f hosp

itals

have

lit

tle t

o c

ontr

ibute

in

train

ing a

nd H

R iss

ues

of

nurs

ing p

ers

onnel.

4.

Hum

an p

ow

er

short

age a

s per

the p

rese

nt

requir

em

ents

.

5.

Low

pay

scale

s.

6.

No p

roper

guid

elines

and p

rovi

sions

in p

lace

fo

r sk

ill

enhance

ment

and a

lso p

art

icula

rly

in s

uper

speci

alt

y a

reas.

7.

Fin

anci

al

pow

ers

not

dele

gate

d e

ven f

or

small b

udgets

.

O

PPO

RT

UN

ITIE

S

T

HR

EAT

S

1.

Centr

al G

ove

rnm

ent

keen o

n d

eve

lopin

g P

ublic P

riva

te P

art

ners

hip

m

odels

for

eff

ect

ive s

erv

ice d

elive

ry.

2.

Well d

raft

ed g

uid

elines

for

the r

equir

em

ent

of

hum

an r

eso

urc

es

esp

eci

ally

nurs

ing p

ers

onnel deve

loped b

y N

urs

ing C

ounci

l.

3.

NRH

M f

ocu

ses

on s

kill enhance

ment

esp

eci

ally

for

MCH

serv

ices.

1.

Due t

o lack

of

em

plo

yment

opport

unit

ies,

the w

ell q

ualifi

ed n

urs

e

hum

an p

ow

er

shif

ting t

o p

riva

te s

ect

or.


54

3.

C

OM

PA

RAT

IVE S

WO

T A

NA

LYSIS

OF T

HE E

DU

CAT

ION

AN

D T

RA

ININ

G O

F N

UR

SES IN

WEST B

EN

GA

L

ST

REN

GT

HS

W

EA

KN

ESSES

1.

More

nurs

ing c

olleges

(for

B.S

c and M

.Sc

Nurs

ing D

egre

es)

.

2.

Init

iati

ves

bein

g t

aken t

o o

pen f

ew

more

gove

rnm

ent

aid

ed

nurs

ing c

olleges.

3.

Well e

quip

ped a

nd g

ood infr

ast

ruct

ure

in s

chools

and c

olleges

of

nurs

ing.

4.

To s

trength

en t

he p

re-s

erv

ice e

duca

tion in t

he s

tate

, in

itia

tive

s

bein

g t

aken t

o c

reate

more

teach

ing leve

l post

s

(by

relinquis

hin

g t

he 8

7 p

ost

s of

Nurs

ing S

uperi

nte

ndent

s, D

eputy

N

urs

ing S

uperi

nte

ndent

s and S

iste

r Tuto

rs b

y re

pla

cing t

hese

w

ith t

each

ing p

ost

s.

5.

IHFW

has

good infr

ast

ruct

ure

and o

ther

reso

urc

es.

1.

Lack

of

ava

ilabilit

y of

adequate

no.

of

teach

ers

.

2.

In

-charg

e N

urs

ing s

chool do n

ot

have

any

financi

al pow

er.

3.

M

idw

ifery

com

ponent

of

6 m

onth

s is

less

in G

NM

cours

e.

4.

N

ot

enough o

pport

unit

ies

for

skill deve

lopm

ent

part

icula

rly

mid

wif

ery

skills

.

5.

IH

FW

does

not

have

regula

r fu

ll-t

ime D

irect

or.

6.

IH

FW

lack

s in

facu

lty

reso

urc

e.

7.

Init

iati

ves

for

in-s

erv

ice c

apaci

ty b

uildin

g o

f nurs

es

lack

ing.

8.

N

o t

rain

ing p

olicy

deve

loped.

O

PPO

RT

UN

ITIE

S

T

HR

EAT

S

1.

Univ

ers

ally

the d

em

and f

or

nurs

ing h

um

an p

ow

er

is

incr

easi

ng

requir

ing fo

r se

ttin

g u

p m

ore

num

ber

of

nurs

ing e

duca

tional

inst

ituti

ons.

2.

Well laid

out

guid

elines

for

nurs

ing e

duca

tion b

y IN

CI.

3.

N

HP-2

002 h

as

alr

eady

em

phasi

zed t

he n

eed f

or

the C

entr

al

Gove

rnm

ent

to s

ub

sidiz

e t

he s

ett

ing u

p,

and t

he r

unnin

g o

f,

train

ing f

aci

liti

es

for

nurs

es

on a

dece

ntr

alize

d b

asi

s.

4.

In-s

erv

ice t

rain

ing e

mphasi

zed u

nder

NRH

M.

5.

Netw

ork

ing w

ith S

IDA f

or

Adva

nce

d M

idw

ifery

Tra

inin

g w

ith a

n

aim

to s

trength

en n

urs

ing t

rain

ing.

6.

WB h

as

enca

shed t

he P

PP init

iati

ve f

or

AN

M t

rain

ing.


55

4.

SW

OT A

NA

LYSIS

OF T

HE P

RO

FESSIO

NA

L B

OD

IES (

STAT

E N

UR

SIN

G C

OU

NC

IL A

ND

TN

AI)

IN

WEST B

EN

GA

L

ST

REN

GT

HS

WEA

KN

ESSES

1.

D

D N

urs

ing

(D

irect

ora

te)

is t

he e

x-o

ffic

io V

ice-P

resi

dent

of

the S

tate

Nurs

ing C

ounci

l.

2.

The

Regis

trar

nurs

ing,

headin

g t

he C

ounci

l is

a n

urs

ing

pro

fess

ional.

3.

Renew

al of

regis

trati

on r

equir

ed a

fter

eve

ry 5

years

.

1.

Pro

fess

ional sk

ill-

base

d t

rain

ing a

cquir

ed,

by

nurs

ing p

ers

onnel,

is

not

reco

gniz

ed f

or

renew

al of

regis

trati

on.

OPPO

RT

UN

ITIE

S

TH

REAT

S

1.

As

per

the e

mphasi

s m

ade b

e N

ati

onal H

ealt

h P

olicy

, th

ere

is

a

need

fo

r th

e c

ounci

l to

est

ablish

tr

ain

ing c

ours

es

for

super

-sp

eci

ality

nurs

es

requir

ed f

or

tert

iary

care

inst

ituti

ons.

2.

M

ore

thru

st r

equir

ed t

o e

stablish

m

ore

degre

e c

olleges.

3.

N

ati

onal H

ealt

h P

olicy

has

ask

ed f

or

the m

inim

al st

atu

tory

norm

s fo

r th

e d

eplo

yment

of

nurs

es

in m

edic

al in

stit

uti

ons

under

the India

n N

urs

ing C

ounci

l Act

.


56

Genesis of the SWOT Carried Out

The SWOT analysis presented above lists the key strengths of the nursing in the WB state in terms of well established public health setup and available nursing manpower. This coupled with policy guidelines in terms of selection, recruitment, teaching, training and development, and other service matters. WB does present a model in terms of a separate nursing branch at the Directorate level, which comes under the Director, Health Services. The Deputy Director (DD) Nursing is the Executive Officer and Head of the Nursing Branch in the Directorate of West Bengal. This post is assisted by 2 Assistant Directors and 12 Deputy Assistant Directors. All these nursing administrators have nursing background as their qualifications. The Nursing Division also has 21 administrative support staff. It is important to add, that since all the postings and transfers are under the control of DD nursing, the nursing personnel do get appropriate support and this result in least harassment of any kind. DD Nursing having clear cut job profile is actively involved in policy decision-making. Enabling and supportive environment for nursing in terms of adequate number of human resources along with good infrastructure and other support at the Directorate shows in a very pro-active measures being taken for nursing.

For moving toward betterment of the nursing capacity building, it is important to pay attention to the opportunities existing in the present day. NRHM, the flag ship programme of Government of India, emphasizes on quality of MCH services, which require focusing on capacity building and skill enhancement of nurses. Of the various strategies/models available, Public Private Partnership models for effective service delivery have already started to show positive results.

Universally the demand for nursing human power is increasing with estimation that 3.5 lakh nurses would be required by 2015. This requires immediate attention to establish 225 new nursing colleges, 769 schools to be upgraded and 266 colleges to be strengthened, as quoted in the “Report of the National Commission on Macro Economics and Health” (2005).

We cannot ignore the emerging threats in terms of increasing shortage of well trained skilled nurses. There is concern of low quality of instruction and skill acquisition more particularly in private nursing institutes (Report of the National Commission on Macro Economics and Health, 2005). With the ever growing demand from private sector and other countries for skilled nurses, the government health system need to re-design the HR strategies for the career growth and retention of nursing manpower.

How the threats are minimized and resolved, require strategic attention to en-cash on the strengths and opportunities.


57

CHAPTER VI

RECOMMENDATIONS

RECOMMENDATIONS

After carrying out the analysis of nursing scenario in WB, and by identifying the constraints, the report attempts to draw the following recommendations:

At the foremost the nursing as such needs a complete image changeover keeping in line with the ever emerging importance of nursing profession accorded universally. From the image of being submissive and at the receiving end, they need to shift to play the more pro-active role. This requires a change in the mind set right from the top level of the planners up to the community and stakeholders. Their immense human potential needs to be converted in to reality by creating an enabling work environment for them in terms of providing more power in decision making, and sound HR policies. The contribution of the nursing to the overall health of the nation demands more visibility. Today the nurses need to be the equal partners in the process of health care delivery to achieve the United Nations' Millennium Development Goals.

The professional bodies need to apply more concern for protecting the rights of nursing personnel and this also needs more gender sensitivity among the policy planners. This also requires suitable laws, if needed, to be enacted.

²The State Directorate should have a separate Nursing Division and preferably to be headed by a nursing professional at the post of 'Director Nursing' or its equivalent. The senior most nursing post must have total autonomy in decision-making and to be member of all policy making bodies dealing with health and family welfare issues.

²The West Bengal Nursing Branch can act as a model for an adequately staffed Nursing Division.

²The structure of the Nursing Division to have the separate posts of Joint Directors/Additional Directors each for nursing services, nursing education and training and public health nursing/community nursing.

²The nursing personnel interviewed, all required the uniformity in the pay scale particularly in reference to the central scales.

²ACR and performance appraisal needs reform to give due recognition to the conduction and documentation of research carried out by nursing personnel. The criteria for work performance should be objectively linked to the job profile.

²For effective manpower planning and development for nursing, its extremely important to develop the human resource (HR) policy which will take into consideration future human resource planning for nurses. The HR policy also to focus on developing guidelines for training and development of the nurses keeping in view the demand generation.

²The career path should provide flexible opportunities i.e. the transfer from service delivery side to educational and vice versa. But the transfer and placement should be supported by the requisite skill development.

²The nursing transfer policy to emphasize that nurses with the specialized and


61

super-specialized training to be transferred to the other service delivery setups in their area of specialization.

²Higher educational qualifications should be linked to career growth. But seniority should not be completely ignored, and there can be a certain percentage for seniority-based promotions.

²Since the working and enabling work environment are the pre-requisite for the quality of nursing services, the nursing service rule must re-frame guidelines for issues like security, accommodation and transport.

²For the service delivery set up, the nurse bed ratio calculation should take into account the requirement for specialized areas, e.g for labour room, ICU and other super-specialty areas.

²The hospitals also need to have Nursing Division headed by senior nursing administrators with more leadership and management skills to make nursing workforce more pro-active.

²More decentralization with budgetary powers to senior nursing functionaries in the hospitals.

²The government needs to focus on creating more nursing educational institutions (both schools and colleges), by keeping in mind the demand and supply gap for nurses in the service as well as the education sector.

²The skills of the teaching faculty of the institutions should be strengthened, and the infrastructure and other resources to be provided to facilitate quality nursing education.

²With the emerging demand for super-specialization in the health sector, the need is to increase the number of super specialty skill-based courses.

²Along with developing the clinical skills of the nurses, it is extremely important to provide behavioural skill training especially in Leadership Skills, Assertive Skills, Communication Skills, Conflict Management and Negotiation Skills etc.

²Adequate opportunities for development of midwifery skills for hands on training need to be worked out.

²To address the need for providing quality health services, the feasibility of developing nurse practitioners and their placement needs to be worked out. West Bengal has already initiated the process.

²Moreover teaching posts also need to be created for adequate placement. This can be compensated by the creation of more nursing colleges i.e. both B.Sc and M.Sc.

²The post of Registrar of the State Nursing Councils should be occupied by a nursing professional only, to comply with the recommendations of the Nursing Act. The Executive heads of the Governing and other Bodies of the State Nursing Council should preferably be nursing professionals.


62

²Nursing being a woman dominated profession and to protect their rights, it is considered extremely significant for each state to setup Sexual Harassment Committees as per Supreme Court guidelines.

²It is suggested that the State Nursing Divisions should organize inter-state exchange visits of the key nursing functionaries (from administrative units, service delivery centres and the nursing faculty). This will help in sharing the best practices and experiences for nursing capacity building.


63

REFERENCES

1. A Report of Nursing Committee to Review Conditions, Emoluments etc., 1954, Shetty Committee, Ministry of Health and Family Welfare, Government of India, New Delhi.

2. A Report of the Group on Medical Education and Support Manpower, 1975, Shrivastava Committee, Health Series and Medical Education: A Programme for Immediate Action, Ministry of Health and Family Planning, Government of India, New Delhi.

3. History and Trends in India, 2001, TNAI, New Delhi.

4. National Health Policy, 2002, Ministry of Health and Family Welfare, Government of India, New Delhi.

5. Nursing for the Delivery of Essential Health Interventions. Financing and Delivery of Health Care Services in India, 2005, Dileep Kumar, National Commission on Macro Economics and Health, Background papers, Ministry of Health and Family Welfare, Government of India, New Delhi.

6. Report of Expert Committee on Health Manpower Planning, Production and Management, 1986, Bajaj, J.S. Committee, Ministry of Health and Family Welfare, Government of India, New Delhi.

7. Report of Historical Perspective of Nursing and Midwifery Training, Education and Practice in India, Draft, 2007. Mr. Anand Kulkarni and Ms Anita Deodhar, TNAI, IIM, Ahmedabad.

8. Report of the Committee on Multi-purpose Workers under Health and Family Planning Programme, 1972, Kartar Singh Committee, Ministry of Health and Family Planning, Government of India, New Delhi.

9. Report of the Health Survey and Development Committee, Vol.II, 1946. Bhore J. Committee: Manager of Publications, Delhi.

10. Report of the Health Survey and Planning Committee, 1961. Mudaliar Committee, Ministry of Health, Government of India, New Delhi.

11. Report on High Power Committee on Nursing and Nursing Profession, 1990, Ministry of Health and Family Welfare, Government of India, New Delhi.

12. Role of Regulatory Bodies in Nursing and Midwifery Training and Practices, IIM, Ahmedabad (Unpublished report).

13. Situational Analysis of Public Health Nursing Personnel in India, 2005, conducted by Academy for Nursing Studies, Hyderabad, Andhra Pradesh.

14. The Trained Nurses Association of India, Indian Nursing Year Book, 2000, New Delhi.


64

ANNEXURES

Annexure 1LIST OF OFFICIALS INTERVIEWED

Sl. No.

Name Designation Address

1. Dr. Kalyan Kumar Bagchi

Additional Chief Secretary

Health & Family Welfare, Govt. of WB, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700091, West Bengal

2. Dr. Sanchita Bakshi

Director Director Health Services, Govt. of WB, Swasthya Bhawan, Sector-V, Bidhan Nagar Kolkata-700091, West Bengal

3. Mr. Chandra Sinha

Project Director & Mission Director

Govt. of West Bengal, Swasthya Bhawan, Wing-B, 3rd Floor, Sector -V, Salt Lake City, Kolkata-91, West Bengal

4. Prof. Jayshree Mitra

E.O. Secretary Directorate of Medical Education Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

5. Prof. Soumendra Nath Banerjee

Director Institute of Health & Family Welfare, Special Secretary (MES) Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

6. Mrs Madhuri Das

Dy Director Health Services (Nursing)

Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata -700 091, West Bengal

7. Mrs. Santmana Kundu

Assistant Director (Nursing)

Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

8. Mrs. Dipti Dutta

Assistant Director Health & Family Welfare Department, Swasthya Bhawan, Sector-V, Bidhan Nagar, Kolkata-700 091, West Bengal

9. Smt. Pratima Chatterjee

Registrar West Bengal Nursing Council, 8, Lyons Range, Kolkata-700 001, West Bengal

10. Mrs. Gayatri Bandhopadhyay

President West Bengal Branch of TNAI

11. Dr. Madhumita Dubey

Professor All India Institute of Hygiene and Public Health Chittranjan Avenue, Kolkata

12. Mrs Bandna Dass Principal College of Nursing, Medical College Hospital, 88 College Street, Kolkata-700073, WB


67

13. Ms. Gauri Burman, Lecturer College of Nursing, Medical College Hospital, 88 College Street, Kolkata-700073, WB

14. Ms. Gopa Roy Principal College of Nursing, Medical College Hospital, 88 College Street, Kolkata-700073, West Bengal

15. Ms. Rinku Biswas, Nursing Superintendent

Medical College Hospital 88 College Street, Kolkata- 700 073, West Bengal

16. Ms. Bishnu Priya Principal College of Nursing, Medical College Hospital, 88 College Street, Kolkatta-700073, West Bengal

17. Ms. Sunita Bagchi,

Sister Incharge & Incharge ANM School,

Medical College Hospital, 88 College Street, Kolkata- 700 073, WB

18. Mrs. Mitali Adhikari Sister Tutor Medical College Hospital 88, College Street, Kolkata – 700

013, West Bengal

19. Mrs. Maha Sweta Bose

Principal West Bengal Government Nursing College, Kolkata, WB

20. Dr. S.K. Bose M.D. Peerless Hospital & B.K. Roy Research Centre 360, Panchasayar, Kolkata- 700 004, WB

21. Mrs. Binami Chakrabarthy

Assistant Nursing Superintendent

Peerless Hospital & B.K. Roy Research Centre, 360, Panchasayar, Kolkata- 700 004

22. Mrs. Sumitra Chakbrothy

Principal Nursing College, Peerless Hospital & B.K. Roy Research Centre, 360, Panchasayar, Kolkata- 700 004, WB

23. Mrs. Swapna Ghosh Nursing Superintendent

M R Bangur Hospital, Kolkata

24. Mrs. Ratna Kotal Dy. Nursing Superintendent

M R Bangur Hospital, Kolkata


68

Annexure 2

RECRUITMENT RULES

Recruitment rules for the selection of Deputy Director, Dy. Assistant Director, Assistant Director, Principal Nursing Officer and District Public Health Nursing Officer were advertised through different notifications. The details of each category are given below:-

Deputy Director of Health Services (Nursing)

Method of Recruitment:By selection (direct recruitment) through the Public Service Commission, West Bengal, Departmental candidates being eligible to apply; or By promotion of confirmed Assistant Director of Health Services (Nursing), West Bengal having at least five years of service as such.

Qualifications for Direct Recruitment:B.Sc (Hons.) in Nursing or Post-graduate degree in Nursing from a recognized university or institute; at least ten years of experience in Nursing Administration and/or teaching; knowledge of Bengali spoken and written.

Age: Not more than 45 years on the 1st day of January of the year of advertisement, relaxable, for otherwise well-qualified and experienced candidates and also for departmental candidates.

Qualifications and experience are relaxable for otherwise well-qualified candidates and for candidates having outstanding experience and training.

Assistant Director of Health Services (Nursing)

Method of recruitment:By selection (direct recruitment, through the Public Service Commission, West Bengal

orBy promotion from the posts of Nursing Superintendent of State Hospital, Vice-Principal, Health School, Principal, Regional Teacher, PH Nurse Training School.

Qualification:B.Sc (Nursing) degree from a recognized University or equivalent qualification; Five years experience in Nursing administration and teaching.

Age:For direct recruitment: not exceeding 45 years of age on the first day of January in the year of recruitment, relaxable in exceptional cases.Qualification for Promotion:10 years experience in Nursing administration in the Nursing service.

Deputy Asstt. Director of Health Services (Nursing)

Method of recruitment: By selection from Gr. I (i) posts of the West Bengal Nursing Services.


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Principal Nursing Officer

By selection (direct), by transfer of an officer from Grade (I) of West Bengal Nursing Services possessing item (i) of the qualification for direct recruitment to the post.

Qualification B.Sc (Hons.) Nursing or a degree of a recognized university

orGeneral Nursing, Midwifery Diploma/certificate inn Public Health Nursing, two-year experience, good power of expressions in Bengali-spoken and written. Two year experience in teaching any nursing training school and experience in community nursing for three years.

Age: 35 years and relaxation for government service

District Public Health Nurse Officer in the Distict Family Welfare Bureau

Method of Recruitment:By selection (Direct recruitment), departmental candidates being eligible to apply.

orBy promotion of an officer of Grade-I (i) of the West Bengal Nursing Service possessing all the essential qualifications for recruitment by selection direct recruitment (no relaxation shall be allowed in this regard).

Qualification:B.Sc (Hons.) degree in nursing of a recognized university/institution

orA degree of a recognized university in any discipline with general nursing midwifery diploma/certificate in public health nursing from a recognized institute.5 years experience in Community Nursing out of which 3 (three years) must be in rural community. Good power of expression in Bengali-spoken and written.

Age:stNot more than 40 years on the 1 January of the year of advertisement, relaxable

for persons already in government service.


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Annexure 3

DUTIES AND RESPONSIBILITIES

For General Nursing Midwives

Those who have been appointed for one year on contractual basis need to be present in the appointed place with the help of institutional deliveries and immunisation 5-6 times more than the existing. These are the salient features, duties and responsibilities of the GNM.

1. According to the rule those who are working during this period their main duty is to register the pregnant ladies, giving TT dosage, providing the iron tablets to pregnant ladies. Advice them for rest, weight checking and recognize any kind of complications, care and their management and also to help and coordinate with NGOs for executing the activities.

2. Taking care of the pregnant ladies during deliveries and normal delivery and support the doctors in all the activities in the labour room.

3. Look after the newly born babies, and give important advice to the mother about breast feeding and to advice the mothers to continually breast-feed their babies for 6 months and then give extra food for the baby.

4. Look after the pregnant ladies after deliveries and advice and diagnose any difficulties.

5. Identify any critical conditions in newly born babies and manage any difficulties caused thereof.

6. Provide full knowledge about family welfare methods to the ladies after the delivery.

7. Provide immunization services to the child and give knowledge about their proper nurture.

8. Provide assistance to MO official in PHC for running the programmes which are run by government from time to time.

9. Any other assignment given by higher officers.

If any discrepancy is found in the working during the contractual period, a warning is given. If the discrepancy in the work continues then the contract will be terminated.


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Annexure 4

NURSING TRAINING SCHOOL

Sl. No.

Name of the Training Institutions (G.N.M.)

Address

1. District Hospital, Balurghat, Dakshin Dinajpur

PO: Balurghat, District West Dinajpur, 733 101

2. B.S. M. College Hospital, Bankura PO and District Bankura, 722 101 3. Burdwan Medical College Hospital,

Burdwan PO and District Burdwanm, 713 101

4. National Medical College Hospital, Kolkata

Gorachand Road, Kolkata - 700 014

5. District Hospital, Darjeeling P.O. and District Darjeeling, 734 101 6. Howrah General Hospital, Howrah P.O. and District Howrah, 711 101 7. District Hospital, Jalpaiguri P.O. and District Jalpaiguri 735 101 8. J.N.M. Hospital, Kalyani, Nadia P.O.: Kalyani, District Nadia, 741 235 9. Sub-divisional Hospital, Kalimpong PO: Kalimpong,

District Darjeeling 734 301 10. L.D.V. Hospital, Kolkata Amherst Street, Kolkata 11. M.R.Bangur Hospital, Kolkata PO & Tollygunge, Kolkata - 700 033 12. District Hospital, Malda PO and District Malda 732 101 13. Midnapore Medical College

Hospital, Midnapore PO and Di strict West Midnapore 721 101

14. M.J.N. Hospital, Cooch-Behar PO and District Cooch-Behar 736 101 15. N.R.S. Medical College Hospital,

Kolkata Sealdah, Kolkata – 700 014

16. North Bengal M.C. Hospital, Sushrutanagar

PO: Susrutanagar, District Darjeeling

17. District Hospital, Purulia Ranchi Road, PO and District Purulia 723 101

18. R.G. Kar Medical College Hospital, Kolkata

Belgachia Raod, Kolkata- 700 004

19. District Hospital, Berhampore, Murshidabad

PO: Berhampore, District Murshidabad, 742 101

20. Sambhunath Pandit Hospital, Kolkata

11 Lala Lajpat Roy Sarani, Kolkata- 700 020

21. S.S.K.M. Hospital, Kolkata 244 AJC Bose Road, Kolkata -700 020 22. District Hospital, Chinsurah,

Hooghly PO: Chinsurah, Dist rict Hooghly 712 101

23. Sadar Hospital, Suri, Bhirbhum PO: Suri, District Birbhum 731 101 24. E.S.I. Hospital, Manicktala, Kolkata 55, Bagmari Road, PO: Manicktala,

Kolkata- 700 054 25. Saktinagar Hospital, District: Nadia PO: Saktinagar, District Nadia 741

102


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Non–Government Institutions(Conducting General Nursing-Midwifery Courses)

Sl. No.

Name of the Training Institutions Address

1. Mission of Mercy Hospital, Kolkata 125/A, Park Street, Kolkata -17 2. Burnpur (IISCO) Hospital, Dist:

Burdwan PO: Burnpur, Dist: Burdwan -713 325

3. Calcutta Nursing Training Institute, Kolkata

10 A, Shakjespeare Sarani, Kolkata-700 071

4. Calcutta Hospital & M.R Institute, Kolkata

7/2, Diamond Harbour Road, Kolkata-27

5. Islamia Hospital, Kolkata 73, Chittaranjan Avenue, Kolkata-12

6. Khristiya Seva Niketan, Sarenga, Bankura

PO: Sarenga, Dist: Bankura-722 150

7. Ramkrishna Mission Seva Pratisthan, Kolkata

99, Sarat Bose Road, Kolkata-700 024

8. Peerless Hospital & B.K. Roy Research institute

Panchasayar, Garia, Kolkata-700 094

9. Advanced Medical Research Institute, Kolkata

38/1A, Gariahat Road, Kolkata-700 029

Source: West Bengal Nursing Council.


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Annexure 5

DETAILS OF POSTS SURRENDERED

Sl. No.

Name of the posts

surrendered

Number of Posts

Scale of Pay

G.O.No. & Date vide which the Posts were Created

1. Nursing Superintendent

11 Rs. 8 000-13500

Health/GA(ng)/29/HNG19/9 M-341-92 Pt. II dt. 20.3.95

2. Deputy Nursing Superintendent

27 Rs. 5000 -11275

Health/GA(N)/220/IN-52/86 dt. 13.11.87

3. Sister Tutor 49 Rs. 4500 -9700

Medl/8328/IN-2/5 dt. 17.9.57 -(NRSMCH) & Medl/7358/IN -2/79 dt. 31.7.79 (Burdwan)

Source: Memo, G.O. No. HF/O/MERT/685/2N-46/02 dated 29.06.05, Government of West Bengal, Department of

Health and Family Welfare, MERT Branch, Salt Lake City, Kolkata-700 091.


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Annexure 6

CALCUTTA GAZETTE EXTRAORDINARY IN OCTOBER 24, 1979

This second document published by “The Calcutta Gazette Extraordinary, October 24, 1979. This notification includes certain rules which shall regulate the admission of students to the State Nurses Schools in West Bengal. The document is divided in five parts.

²Part I: In this part rules regarding “Short title and commencement” and Extension are given.

²Part II: Rules for admission are given in this part. The components include in this part are: Total number of seats, annual intake, number of students to be admitted within ceiling of seats, admission on zonal/block basis, right of admitting authority, quota of reservation, condition where reservation does not apply, admission on merit, eligibility of candidates (for GNM and for ANM), residential certificate, prescription of age of candidates, prescription of qualification of candidates, procedure of notification of vacancy and submission of application, bar to apply in more than one school course, method of selection of candidates, selection board for GNM course, selection board for ANM course, processing of applications and selection of candidates.

²Part III: The part contains the rules regarding the discipline i.e., rules and code of conduct written by West Bengal Nursing Council.

²Part IV: Rules regarding stipend, restoration of stipend, in case of withheld and discharges in case of names struck off are given.

²Part V: Miscellaneous rules include free available medical treatment, maintenance of prescribed uniform, execution of bond undertakings, condition of posting are given.


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Annexure 7

MEMORANDUM: RATIONALIZATION OF THE CADRE OF NURSING SERVICES DATED TH17 SEPTEMBER, 1957

In this document the rationalization of the cadre of nursing services is given. The following issues were discussed in it. The nursing cadre was divided into four categories:

Grade-I(i) Nursing Superintendent, Deputy Assistant Directors of Health Services, Deputy Nursing Superintendent.

(ii) Sister, Sister-Tutors, Instructors, Assistant Matrons, Matrons.The strength of personnel under this category will be 3% - for (i) and 7% -for (ii).

Grade-IIStaff Nurse (Junior & Senior Trained Nurses)- for 30% the strength of personnel under this category.

Grade-IIIAuxiliary Nurse-cum-Midwives-Assistant Nurses – for 60% the strength of personnel under this category.

Grade-IVSevikas for 10% the strength of personnel under this category.

The document also contains the following allowances.

Lodging – Rent free furnished quarter/house rent, boarding – free food not exceeding Rs.2.50, amenity allowance, uniform allowance, hazard or risk allowance, qualification pay, instructor allowance, age of first entry into service, age of superannuation, leave, pension and gratuity, medical facilities, discipline and conduct.


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Modification of Cadre-Division dated 13/11/87This modification was done on 13/11/87. In this memo nursing cadre include Gr. I (i), Gr. I (ii), Gr. II which as follows:

Grade-I (i)Nursing SuperintendentsDy A.D.H.S (Nursing) W.B. 3%Dy Nursing SupdtsMatronSenior Sister Tutor

Grade-I (ii)SistersSister-TutorInstructor 7%Assistant MatronsSenior Public Health Nurse

Grade-IIStaff NursePublic Health Nurse 90%

Grade-IIIANM-outside the cadre strength

Grade-IVSevaba- outside the cadre strengthBut ANM and Sevaks were put outside the nursing cadre.

stMethod of promotion to different grades of West Bengal dated 1 September, 1979

This memorandum had revised the promotion for Gr. III to Gr. II, Gr. II to Gr.I (ii) and Gr.I (ii) to Gr. I (i). The brief about the memorandum is given below:

Promotion from Grade III to IIANM pass the condensed course in GNM. Other in Grade III on seniority basis

Promotion from Grade II to Grade I (ii)Person who pass the condensed B.Sc (Nursing) immediately on their passing the said exam, Other in Grade II, on seniority basis.

Promotion from Grade I (ii) to Grade I (i) will be filled up by promotion from Grade I (ii) on seniority basis.


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Annexure 8

PERFORMANCE REPORT

Performance Report for “Group-B” and “Group-C” employee in terms of F.D.Memo No. 9135-F dated 10.9.2002

(To be filled in by the Reporting Officer)Performance Report for the period :: from ___________ to _______________

1. Name of the Employee :: 2.

Department/Office

::

3.

Designation/Post held

::

4.

Date of Birth and

Date of Entry into government

service

::

Part-IAppraisal of Attendance, Performance and Efficiency

A. Attendance Marks-25

1. Total No. of working days during the period under review

::

2.

No. of days the incumbent was on leave ::

3.

No. of days of late attendance and early departure during the period under review

::

4.

No. of days of unauthorized absence without leave

::

5.

No. of days deducted as leave due

to late attendance/early departure

::

6.

No. of days of effective attendance of the incumbent during the period under review (item 1 minus item 4 & 5)

::

7.

Percentage of late attendance or early departure as against the total no. of working days during the

period under review (item3/item1%)

::

8. Percentage of effective attendance as against the total no. of working days during the period of review (item6/item1%)

::


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B. Performance and Efficiency Marks-60

Grading with the corresponding marks: Excellent (6), Very Good (5), Good (4), Average (3), Below Average (0)(On the basis of record such as Case Book, Case Diary, Field Diary, etc. whichever applicable, marks will have to be given)

1. The extent to which the employee take his/her job seriously.

::

2.

The quality of maintenance of the Work diary/Case diary/Case Book/Note Book/Field diary etc.

::

3.

The quantum of disposal of allotted work promptly and completely

::

4.

The capacity of the employee to inspire public confidence

::

5.

The capacity of the employee to inspire public confidence

::

6.

Quality of disposal of work of this employees

::

7.

Knowledge of the employee regarding office procedure, Rules, Regulations and instructions in general and with reference to work of the post/office.

::

8.

Ability to apply relevant Rules and Regulations correctly.

::

9. Capacity of examining cases thoroughly ::

10. Capacity and resourcefullness of the employee in handling normal as well as unforeseen problems/situations and willingness to take new challenges

::

____________________________ Signature of the employee With Date

_____________________

Reporting

Officer

_____________________

Countersigning Officer

_____________________

Accepting Authority

Contd., ……………………. Part-II


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Part-II

Appraisal of Accountability and Integrity of Group “B” and Group-“C”

C. Accountability Marks-15Grading with the corresponding marks: Excellent (5), Very Good (4), Good (3), Average (2), Below Average (0)

1. Reliability in carrying out instructions

::

2.

Sense of responsibility, ability to judge urgency of a case and responsiveness to such urgency

::

3.

Behaviour with colleagues and members of public

::

C. Assessment of Integrity[If anything adverse has come to notice, please specify it also] ::

Marks Obtained

Part –I …………………………

::

Part-II ………………………….

::

Total ……………………

::

_____________________

Reporting Officer

_____________________

Countersigning Officer

_____________________

Accepting Authority


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Annexure 9TRANSFER POLICY

Guidelines for posting and transfer of Gr.II & I (ii) s Gr. I (i) a & Gr. I (b). West Bengal is divided into two zones for the transfer of Gr. II, Gr. I (i): Zone A-all districts

of South Bengal, Zone B-all District of North Bengal. All the Gr. IIs and Is (ii) nursing

personnel will be posted in PHC/Block PHC/ Rural for at least 5 years. After 5 years they

can transfer from Zone A to Zone B or vice-versa.²The Grade II & I (ii) nursing personnel will have the option to stay in Zone B for another

five years. Those nurses who seek transfer from Zone B to Zone A after having served in

Zone B for five years will be considered for transfer to Zone A (subject to availability of

vacancies).²After serving in the PHCs/BPHCs/Rural Hospitals, as in paras 2 & 3 above, the Grade II

& I(ii) nursing personnel will be transferred to the Sub-Divisional Hospitals/State General

Hospitals/District/Specialised Hospitals outside CMDA Area (subject to availability of

vacancies) and the Grade II & I (ii) nursing personnel will have to serve there for at least 10

years.²After completion of the tenure of service for at least 20 years in paras-2-4 above, the

Grade II & I(ii) nursing personnel may be considered for posting in the hospitals/non-

teaching institutions within the CMDA areas (subject to availability of vacancies).²However, in view of the special requirements of some critical units in the tertiary

hospitals and also to ensure a proper age-mix, these nurses who have shown good

performance for at least 10 years of any of the tiers mentioned between 2-4 and who had

topped (were amongst the first ten (the last degree examination of nursing may be

brought on to specialized units meant for critical care in these hospitals (subject to

availability of vacancies). The nursing staff once absorbed in a specialized unit will be

transferred only to specialized unit of the same nature. ²Grade I(i) b will be posted at all SG/SD/District and other tertiary hospitals after

considering the previous place of posting. But grade I(i) a can only be posted in 107

hospitals as mentioned in G.O.No. Health/GA(Ng.)/29/HNG?9M-341-92/Pt.II dated the

20th March 1995.²The Grade I(i) a post in the teaching hospital will be filled up only after considering

their educational qualifications and previous experience. ²When the nursing personnel has only four years of service left she may be given a

preferential choice of posting (subject to availability of vacancies) where she may

continue till she attain superannuation.²The last posting before retirement of the nurses should at least for a period of two

years, unless it is a case of promotion or on representation.²All the transfer and posting will be made in the public interest (subject to availability

of vacancies). Nevertheless, any nurse may be transferred by government at any time at

any place on administrative grounds. ²In the transfer order, 'Who will move first' be explicitly mentioned. ²As far as practicable, husband and wife who are employed under the government will

be posted near to each other to station (subject to availability of vacancies).²Sickness of self, husband and children, supported by medical certificate can be

considered.²Staff from physically handicapped category will receive special consideration.²Mutual transfers will be continues provided they fulfil the norms of mutual transfer.²First appointment should be outside the home district.

This order will take effect from 1 April 2002.


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Annexure 10

JOB RESPONSIBILITIES

Directorate of Health Services also prepared the job responsibilities of different categories mentioned below:

1. Deputy Assistant Director of Health Services Nursing-Administration2. Principal Nursing Officer/Sister Tutor-in-Charge of the Training School3. Nurse Teacher/Sister Tutor/Instructor/P.H.N. Tutor4. District Public Health Nursing Officer5. Staff Nurse6. Matron7. Ward Sister8. Nursing Superintendent9. Deputy Nursing Superintendent10. Health Assistant (F)11. Health Supervisor (F) 12. Block Public Health Nurse 13. Principal, Nursing College14. Senior Lecturer15. Clinical Instructor

1. Deputy Asstt. Director of Health Services Nursing-Administration

The Deputy Assistant Director of Health Services (Nursing) is responsible to undertake all administrative functions connected with the West Bengal Nursing Service on behalf of the D.D.H.S. (Nursing). Her function on extends overall the hospitals in the state upto Sub-Division level and P.H.C. level. Her functions are given below:

Helps the D.D.H.S. (Nursing) in all developmental plans for the nursing service and helps in submission of all project reports, budget reports and proposals to the government.

She assists the D.D.H.S. (Nursing) in General Administration and undertakes the responsibility of appointment, posting, transfer and confirmation of nurses in consultation with the A.D.H.S. (Nursing) and Community Health in respect of teachers and Public Health Nurses and ANMs.

Promotion according of selection grades to nurses.

Scrutiny and submission of pension claims and re-employment of nurses.

Granting of leave, maternity leave and change of surname of nurses.

Enquiring into disciplinary cases and other allegations and submission of reports.

Periodical supervisory tours of hospitals in West Bengal and submission of reports.

Helping in the preparation of annual and periodical reports and returns.


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Helping the D.D.H.S. (Nursing) with all legal procedures and court cases.

Acting as a Convenor-Secretary for the Nursing Advisory Committee and arranging meetings.

Conducting research studies and surveys in relation to nursing services and administration and taking necessary steps thereto.

Maintaining lison and co-ordination with the A.D.H.S. Education and Community Health.

Arranging for deputation of selected nurses for various courses in India and abroad.Assists in Office Administration.

Maintaining overall supervision and discipline and regular attendance among the office staff.

Scrutiny of all incoming letters and their placement and distribution to other nursing officers and taking actions over letters related to her sphere of work.

Maintaining working statement, leave account of all office staff.

Maintaining records and reports pertaining to office staff.


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Notification No. HNG/9E/MJ-I-2003/575 dated 1.08.06

S.No. Designation Allotted responsibilities 1. ADHS (N) Estt. of Gr. I(i) b and I(i)a Nursing Officers

including Transfer & Promotion. 2.

DADHS(N) Training of GNM/ANM ®, Promotees & Estt. of College of Nursing.

3. DADHS(N) Estt. of PHN (Gr.II), Senior PHN (Gr.I(ii) DPHNO, Training Course of DCHNEA.

4. DADHS(N) Gradation List of Gr.II Nursing Personnel .

Notification No. HNG/9E/MJ-I-2003/409/1(3) dated 28.5.08

S.No. Designation Allotted responsibilities 1. DADHS(Ng) Estt. of the H.A.(F) cadre 2. DADHS (Ng) Estt. of Gr.II Staff Nurses (confirmation, surname

change) and workshop.

Memo No. HNG/3P-3-59/Pt.-II/74 dated 31.1.06

S.No. Designation Allotted responsibilities 1. D.D.H.S (Ng) Estt. of Gr.I(i)a & Gr.I(i)b Nursing Officers. 2. DADHS (Ng.) a) All matters relating to Nursing Training [G.N.M.,

A.N.M. & H.S. (F)] b) Estt. of P.N.O & Sister Tutors including confirmation

and Surname change. 3. DADHS (Ng.) a) Appointment & Transfer of Gr.II Nursing Personnel.

b) Recording of death & superannuation of Gr.II, Staff Nurse

c) Vacancy list of Gr.II, Staff Nurse. 4. DADHS (Ng.)

a) Estt. of Nursing Training Schools b) Statistics c) Dealing with Assembly matters.

5. DADHS (Ng.)

a) Estt. of H.A.(F) & H.S.(F) b) Appointment, Transfer, Gradation & Promotion,

Confirmation & Surname Change of H.A.(F) & H.S.(F) 6. DADHS (Ng.) a) Court case

b) Estt. of Gr.I(ii) Nursing Officers including Confirmation & Surname change.

c) Appointment of Gen. B.Sc. & Promotion of Cond. B.Sc., Transfer & Gradation list of Gr.I(ii)

d) Estt. of Gr.IV Nurse. 7. D.A.D.H.S. (Ng.) a) Estt. of Gr.II Staff Nurse including Confirmation &

Surname change b) All type of leave of Gr.II, S/Nurse

8. D.A.D.H.S. (Ng.) a) Estt. of D.P.H.N.O & P.H.N. including Confirmation & Surname change.

b) Appointment & Transfer of D.P.H.N.O & P.H.N. c) Gradation list of Gr.II Staff Nurse & Promotion d) Higher Studies.

9. D.A.D.H.S (Ng.)

a) Estt. of A.N.M (Gr.III) b) Appointment, Transfer, Confirmation & Surname

change of A.N.M. (Gr.III) c) Workshop & Pulse Polio Programme

10. A.O.(Ng.) Office Establishment


84

2. Principal Nursing Officer/Sister Tutor-in-Charge of the Training School

The job responsibilities include mainly teaching of nursing students, administration of school and health research and professional activities and staff education. The details are given below:

I. Duties in Respect of Student Nurses

She shall plan, implement and evaluate the curriculum.She shall assist and guide the student nurses through personal contact in developing right professional attitude. She shall prepare a total plan for the teaching programme, including orientation, at the beginning of each session. She shall plan for the students' clinical and community experiences in consultation with the other teachers.She shall plan and arrange for educational visits for the student nurses. She shall arrange for the clinical rotation for the student nurses in consultation with the Deputy Nursing Superintendent or Nursing Superintendent.She shall ensure that the student nurses fulfil the minimum requirements before appearing for the Council Examination. She shall prepare definite plans for evaluation of the student nurses. She shall be responsible for clinical supervision and evaluation of student nurses in the wards as well as in community nursing field. This will cover supervision of students in all the shifts in the hospital wards and community. She shall assist and guide the student nurses complete their records of practical experiences case books etc. She shall assist and guide the student nurses in their methods of study, use of reference books and the library. She shall ensure that daily roll call for student nurses is carried out at least one a day.

II. Duties in Respect of the Health, Recreation and Professional Activities of Student Nurses She shall ensure that the student nurses have regular health checkup.She shall be responsible for ensuring that the prompt care and treatment are arranged whenever necessary. She shall plan recreational and social functions for student nurses. She shall encourage and help the student nurses to participate in professional programmes. She shall make regular, periodical visits to the students' living room and ensure that they develop and maintain healthy personal habits.

III. Duties in Respect of Administration of the School of Nursing She shall be responsible for selection of student nurses.She shall be responsible for maintaining the Nurses' Library. She shall be responsible for keeping the training school well equipped and in taking inventories from time to time.She shall organize functions like prize distribution, sports, annual socials etc. for student nurses. She shall be fully responsible for maintaining the records and registers in respect of the Training School. She shall carry out any other duty that may be allotted to her by the Nursing or


85

Medical Superintendent in connection with the Training School.She shall ensure that the Nursing Administration of the Hospital are informed of the students class time tables in advance. She shall carry out correspondence with Nursing Council and Nursing Section in connection with Nursing Training as and when required.

IV. Duties in Respect of Staff EducationShe will initiate and plan for staff education programme in consultation with the Nursing Superintendent. She shall participate in the staff meetings convened in the institution.

V. Duties Towards the ProfessionShe shall maintain the professional ethics herself. She shall encourage her colleagues to maintain professional ethics and participate in professional activities. She shall try to keep her professional knowledge up-to-date and encourage her colleagues to do the same. She shall help to prepare materials whenever necessary for organizing publicity for nursing and stimulating interest of the community in nursing. She shall perform any other duty allotted to by the Nursing Superintendent or Medical Superintendent as and when situation is called for.

3. Nurse Teacher/ Sister Tutor/ Instructor/P.H.N. Tutor

She shall work under direct guidance and supervision of the Sister Tutor-in-charge of the Training School.She shall actively participate and help the Sister Tutor-in-Charge to carry out all the duties and responsibilities formulated for the Sister Tutor-in-Charge with respect to: implementation of curriculum for the student nurses, health sickness, recreation and professional activities of student nurses, administration of the School of Nursing, Staff Education Programme.

II. Duties in Respect to Clinical SupervisionShe shall be directly responsible for supervision and evaluation of student nurses in all the shifts in the hospital wards and community field. She shall schedule her students clinical practice in consultation with the Ward Sister/Staff Nurse-in-Charge.During her clinical supervision and evaluation in the wards, she shall take an account of the Nursing cadre rendered by individual student nurses in their day-to-day practice.She shall carry out roll call of student nurses at least once a day.III. Duties Towards the ProfessionShe shall maintain the professional ethics herself. She shall encourage her colleagues to maintain professional ethics and participate in professional activities.She shall try to keep her professional knowledge up-to-date and encourage her colleagues to do the same.She shall help to prepare materials whenever necessary for organizing publicity for Nursing and stimulating interest of the Community Nursing. She shall perform any other duty allotted to her by the Nursing Superintendent or Sister Tutor-in-charge as and when situation is called for.


86

4. District Public Health Nursing Officer

At District Family Welfare Bureau the main job functions are coordinate and supervised the total MCH programme, touring and administration at CMO level. This post is sanctioned at District F.W. Bureau under the F.W. programme. The creation of the post aims at achieving co-ordinate and supervision of total M.C.H. programme as a part of F.W. programme and also for proper guidance and supervision of the nursing personnel involved in the programme. Accordingly the working relationship and the job description of the said officer, which have been evolved by the Government of India in their letter No. P.11021/13/79-MCH dt. 8.5.1979 have been accepted by this government. The duties and functions of the officer will require her to tour frequently, the minimum being 15 days a month and she will require a transport. One of the pool cars belonging to the F.W. programme shall be arranged to be placed by the Chief Medical Officer of Health/District Family Welfare Officer of the district to her on those days.

Further more the officer concerned has been entrusted with various administrative works for which clerical and typing assistance will be required and the Chief Medical Officers of Health/District Family Welfare Officers shall provide assistance to enable her to discharge her duties and responsibilities smoothly.

5. Staff Nurse

The main responsibilities of this category are related to patient care, ward administration, teaching of student. Generally most of the responsibilities are covered under Ward administration. Responsibilities in respect of patient care.Direct bedside care to patient.Care of acutely and dangerously ill patients.Render pre-operative, post-operative intensive care to patient.Assist for diagnostic procedures for patients.Attend to the normal and special nutritional needs after the patients. Health teaching to patient care.Responsibilities in relation to ward administration.Nursing care plan for all patients with ward sister.Assign patients to student helping in mind the level of experience.Perform the nursing activities for admission, discharge and transfer of the patient.Checklist and help patient belonging in safe custody.Help the ward sister for supervising the work of class D staff.

6. Matron

In this category, responsibilities include patient care, ward management, nursing education. Most of the job responsibilities are related to ward management and patient care. She will be responsible for management and supervision of Nursing services of a department, a unit or floor with two or more wards. The units may be outpatient department, special clinics, operation theatres, special therapy units etc. or of a small hospital. Duties and responsibilities in relation to patient care and ward managementShe will be responsible to organize and plan for nursing care activities and guide ward sister for its implementation.Assist nursing superintendent/Deputy Nursing Superintendent to ensure staffing in her


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unit.To maintain safety and cleanliness of the unit/institution.To maintain equipment and supplies in her unit/institution. To maintain record and reports of the patients. To supervise and guide the ward sister in patient care and ward management. To act as Public Relation Officer and solve the problems faced by the ward sister, if any. To make regular round with Nursing Superintendent/Deputy Nursing Superintendent and with medical team or hospital committee and when required.To keep Nursing Superintendent/Deputy Nursing Superintendent informed of the needs and problems of her unit.To write open performance report/ACR of the ward sisters of her unit/department.Responsibilities in relation to Nursing EducationShe will be responsible to conduct guidance and counselling of the staff and students, to arrange and guide continuing education programme for staff nurses and ward sisters of her unit. MiscellaneousShe will arrange, conduct and attend departmental and intra-departmental meetings and conferences, she will act as laison officer between Nursing Department and the higher authorities of the hospital, she will carry out any duty delegated to her by Nursing Superintendent/Deputy Nursing Superintendent time to time.

7. Ward Sisters

The job responsibilities of this category include patient care, administrative functions, nursing education. The Ward Sister is the team leader and chief administrator of the unit. She is directly responsible to the nursing superintendent through the Matron if present, for the administration of the ward and the efficient patient care.

Duties and responsibilities in relation to patient care:She will be responsible for the overall planning of Nursing care of the patients in her unit, maintaining cleanliness and sanitation of the unit, rendering direct care to seriously ill patients as and when situation arises, taking over charge from the night nurse and make bed to bed rounds and assign nursing care, specially for the acutely ill, dangerously ill patients and postoperative cases, supervision dietary arrangement and proper serving of diet to the patients feeding of the helpless patients, seeing to the health teaching programme to the patients and their relatives is carried out.

Administrative duty and responsibility of the Ward Sister:She will be responsible for :Making the duty roster of the staff nurses and the students nurses.Checking the attendance of all nurses posted in her unit and report to Nursing Superintendent/Matron absenteeism for replacement.Maintaining stock of equipments, medicines, linen and making regular inventory of the stock of her unit. Indenting for supplies required for the running her unit and maintaining records or Registers of non-serviceable articles and making arrangement, for condemnation of all unserviceable articles of the unit. Ensuring prevention of waste, misuse and loss of article and medicines etc. of her unit. Reporting any case of indiscipline theft or loss to the nursing Superintendent/Matron.


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Overseeing the programme of orientation of the new staff students and making arrangement for continuous on the job training. Preparing performance report of the staff nurses, student nurses time to time and send it to the authority concern.Giving relevant information to the patient relative and friends regarding the patient's condition.Making arrangement for keeping patients belonging in safe custody as per laid down policy of the hospital. Supervising, guiding and directing to carry out treatment of the patients as prescribed by the physician/surgeon of the unit.Maintaining daily census of the unit in relation to patients and report about the critically ill cases to the Nursing Superintendent/Matron.Checking all the records, related to the patients diagnosis condition, treatment and diet for making herself aware of needs of the patients and supervise the patients care by the staff nurse. Co-ordinating patients scare with other departments.Performing any other duty allotted to her by the Nursing Superintendent/Deputy Nursing Superintendent/Matron in the interest of the public as and when necessary.

Responsibilities in Regard to Nursing EducationShe will be responsible for taking necessary step for proper implementation of practical part of the Nursing education programme, she will assist to organize health teaching programme for the patients and their relatives, she will organize ward teaching programme for the staff nurses and student nurses, she will help in medical and Nursing research as and when required.

8. Nursing Superintendent She works as the laison officer between institution and Directorate of Health Services, other Nursing Officer. The job responsibilities include placement of staff, their rotation, ACR, member of various committee of hospitals, issue of show cause notice, condemnation of articles, patient care and welfare of Nursing staff. The Nursing Superintendent is expected to work independently in connection with the Administration of Nursing Services of her Institution, in the most effective way.

Administrative Responsibilities:She shall formulate policies for placement of staff in different units, their rotation, job responsibilities and maintain a satisfactory schedule of patient care. She will maintain individual cumulative record of all nursing staff. The Nursing Superintendent shall forward the Annual Confidential Report/Open Performance Report of all Nursing Staff working under her to the Nursing Directorate and maintain a Gradation list of the Nurses of all categories in her Institution.The Nursing Superintendent shall be member of various Hospital Committees and participate in all development planning of the hospital. She shall be responsible to ensure insurance/of Show Cause Notices to all nurses remaining on unauthorized absent. She will hold periodical meeting with the hospital Administrator and the Nursing Staff to make the Nursing Administration effective. She will take initiative and participate actively in condemnation of articles of the Hospital. She will keep herself appraised of the Hospital condition and will be aware of any


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special patients of significant diagnosis and needing special care. She will attend of all disciplinary problems which Deputy Nursing Superintendent or other subordinate staff find it difficult to handle. She will enforce implementation of the hospital Rules, Regulations and Policies. Patient Care:She will make regular hospital rounds individually, with the hospital Superintendent, as well as with various hospital committees to ensure the quality of patient care. She will ensure regular supply of articles and equipments for proper nursing care to the patients and be vigilant about proper utilization of hospital properties. She will supervise the maintenance of various records and reports in the Wards.She will hold periodical staff meetings with Deputy Nursing Superintendent, Matron, Ward Sister, Sister Tutor. She will review the hospital census and daily reports of the hospital wards and report to the higher authority if needed. Welfare of the Nursing StaffShe will take an interest in staff development through orientation programme for new staff, in-service Education Programme, guidance and counselling. She should see to the comforts of the Nursing Staff and guide them as far as practicable. She will ensure periodical health checkup of all nursing personnel working under her, maintain health records and take action for sick nurses. She will supervise the running of Nurses' Hostel and the Nurses' Mess. She should submit proposals for expansion and construction of Nurses' Hostel, classroom etc. as and when necessary.She shall encourage recreational programme for nurses and actively participate in all recreational/social/professional activities. She will initiate new projects/study/research for professional growth and submit the proposal to Nursing Directorate. Nursing EducationShe will participate in student selection and recruitment which will be done by the Principal Nursing Officer/Sister Tutor-in-Charge, she will keep herself appraised of the teaching programme attached to her institute, she will plan and organize continuing Education Programme for her Nursing Staff with the help of Deputy Nursing Superintendents and Teachers of her Institution.

9. Deputy Nursing Superintendent

I. Duties in Relation to Nursing AdministrationThe Deputy Nursing Superintendent is second in Command in the Nursing administration of the hospital. She assists the Nursing Superintendent in all areas of nursing activity and deputation for her in her absence. The Dy. Nursing Superintendent will assist the Nursing Superintendent in her office work and deal with any matter that may be allotted to her by the Nursing Superintendent. Her hours of duty will be as allotted in the roster prepared by the Nursing Superintendent. She will be responsible while on duty for making relief arrangements in cases of sudden absence on the part of nurses. She will be responsible for the preparation of the duty lists of nurses subject to the approval of the Nursing Superintendent.She will make rounds in the hospital wards and department as allotted to her every day while she is on duty.


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She will deal with all problems met with during her rounds on the spot as far as possible. The matter she cannot settle herself, she will report to the Nursing Superintendent.On the day she is on evening duty, she will visit emergency wards, the seriously ill and post-operation patients in various wards and the sick nurses.She will report any case of breach of discipline or dereliction of duty on the part of any member of the nursing staff to the Nursing Superintendent in writing. She will convene and arrange for all staff meetings in consultations with the Nursing Superintendent. She will perform any other duty allotted to her from time to time by the Nursing Superintendent according to the needs of the hospital.

II. Duties in Respect of the Training School and Nurses' Education:She should be aware of the clinical experience roster and the Duty Roster of the students done by the Sister Tutor-in-Charge of the Training School.She will attend sister tutors' periodical meetings and take part in the committee proceedings.

III. Duties in Relation to Supervision of the Nurses' Hostel and Mess:She will be responsible for making rounds in the Nurses' Hostel every day and ensure neatness, cleanliness and hygiene there.She will supervise the work and cleanliness of the Nurses' Kitchen and Dining Room and check the quality and quantity of food served to nurses. She will supervise the serving of meals during her duty hours by being present in the Nurses' Dining Room. She will be responsible for the smooth running of the hostel, kitchen and dining room and see that there is adequate crockery, cutlery, and cooking utensils and furniture in the hostel. She will be responsible for keeping the inventory of all articles used in the hostel and make physical verification of stock at least once a year. She will arrange for repair and replacement of unserviceable articles and will be responsible of condemnation of Nurses' Hostel Articles.

IV. Duties in Relation to Nursing AdministrationThe Deputy Nursing Superintendent is second in Command in the Nursing administration of the hospital. She assists the Nursing Superintendent in all areas of nursing activity and deputation for her in her absence. The Dy. Nursing Superintendent will assist the Nursing Superintendent in her office work and deal with any matter that may be allotted to her by the Nursing Superintendent. Her hours of duty will be as allotted in the roster prepared by the Nursing Superintendent. She will be responsible while on duty for making relief arrangements in cases of sudden absence on the part of nurses. She will be responsible for the preparation of the duty lists of nurses subject to the approval of the Nursing Superintendent.She will make rounds in the hospital wards and department as allotted to her every day while she is on duty. She will deal with all problems met with during her rounds on the sport as far as possible. The matter she cannot settle herself, she will report to the Nursing Superintendent.On the day she is on evening duty, she will visit emergency wards, the seriously ill and post-operation patients in various wards and the sick nurses.She will report any case of breach of discipline or dereliction of duty on the part of any member of the nursing staff to the Nursing Superintendent in writing.


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She will convene and arrange for all staff meetings in consultations with the Nursing Superintendent. She will perform any other duty allotted to her from time to time by the Nursing Superintendent according to the needs of the hospital.

V. Duties in Respect of the Training School and Nurses' Education:She should be aware of the clinical experience roster and the Duty Roster of the students done by the Sister Tutor-in-Charge of the Training School.She will attend sister tutors' periodical meetings and take part in the committee proceedings.

VI. Duties in Relation to Supervision of the Nurses' Hostel and Mess:She will be responsible for making rounds in the Nurses' Hostel every day and ensure neatness, cleanliness and hygiene there.She will supervise the work and cleanliness of the Nurses' Kitchen and Dining Room and check the quality and quantity of food served to nurses. She will supervise the serving of meals during her duty hours by being present in the Nurses' Dining Room. She will be responsible for the smooth running of the hostel, kitchen and dining room and see that there is adequate crockery, cutlery, and cooking utensils and furniture in the hostel. She will be responsible for keeping the inventory of all articles used in the hostel and make physical verification of stock at least once in a year. She will arrange for repair and replacement of unserviceable articles and will be responsible of condemnation of Nurses' Hostel Articles.

10.Health Assistant (Female)

The main job functions include registration, care at home, care at clinic, care in the community and some miscellaneous. The Female Health Assistant will cover a population of 5000/3000. She should reside in the sub-centre area, location of the sub-centre itself being her headquarter. She will perform 16 days' field visit in a month i.e. 4 days per week, the Saturday being the weekly meeting/diary day and another day duly earmarked being the sub-centre clinic day. The following are the job functions:

I RegistrationShe will:Register pregnant women from 3 months onwards, married women in the reproductive period and children through systematic home-visits and at clinics.Maintain basic information regarding villages, houses, and population etc. with the help of her male counterpart. Maintain maternity record, register of antenatal cases, eligible couple register and children register uptodate.Category the eligible couples according to the number of children and age of mothers.

II Care at HomeProvide care to pregnant mothers especially the registered ones throughout the entire period of pregnancy.Give advice on nutrition to expectant and lactating mothers.Distribute Iron-Folic-Acid Tablets. To pregnant and lactating mothers and children as well as to the family planning adopters, and Vitamin A in oil to children upto 6 years of


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age.Immunise pregnant mother with Tetanus Toxoid and with others to the children as per immunization schedule. Conduct home deliveries whenever required in normal labour cases.Refer cases of abnormal pregnancy, difficult labour, at risk-babies cases with medical and Gynaecological problems and help them get institutional care properly.Provide post delivery visits for each delivery case and followup care to the patients recovered and discharged from hospital.Maintain close liaison with local trained dais and extend help when called for, supervise the deliveries conducted by the dais and forward the list of deliveries thus conducted recommending claims of payment to the concerned PHC as per rules. Promote cases of sterilization and I.U.D. through spread of small family norm to the eligible couples and arrange facilities of service to the willing acceptors. Distribute conventional contraceptive to the couples during home visit as well as through the Dais and Anganwadi Workers.Take active part in the special sterilization camps when held in PHC/other areas.Get herself trained in BCG technique by the local BCG technician meant for the purpose and cover the area with BCG vaccination with the help of the technician and male Health Assistant.Provide followup services to F.P. adopters, identify side-effects and minor complaints, if any, and refer those cases to the nearest PHC/hospital when required.Detect cases of 8 target diseases under EPI and any abnormal episode within the area and arrange containment measures promptly.Provide first aid and preliminary treatment of common ailments and refer cases beyond her competence to the nearest PHC/hospital.Arrange testing of urine for albumin and sugar, and blood for haemoglobin of pregnant women.Collect blood smears from at least suspected malaria cases and administer presumptive treatment. Identify cases that require help for Medical Termination of Pregnancy, provide information on the availability of services and refer them to the nearest approved institution.Educate the female folks regarding maintenance of health and nutrition of the pregnant and lactating mothers and children, importance of immunization, births and deaths registration, prompt reporting of any disease, use of safe drinking water and maintenance of personal hygiene and environmental sanitation and use of ORS in Gastrointestinal diseases. She will also motivate mother to accept the health facilities including the nutrition programmes provided by the SC and PHC/SHC.Enquire and record births and deaths occurring in her area and report them to the local Registrar.

III Care at Clinic:Arrange and perform MCH clinics at sub-centres once a week with the help of the concerned male Health Assistant.Conduct Urine examinations and estimate haemoglobin of the pregnant mothers.Conduct IUD insertion of the willing mothers at SC.Conduct feeding programme at SC, if it is there.Take help of the Vol. Female attendant attached to her SC.Conduct other activities of the SC including immunization, proplylaxis, MCH, Health and Nutrition education, and preliminary treatment of common ailments.Impart continuing education to the Anganwadi Workers under ICDS project and help and supervise the activities of the said workers.


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Assess growth and development of the infants and take suitable action as called for.

IV Care in the Community:Identify women leaders and help the HS(F) and SWO in conducting training of those leaders.Setup depot holders for Nirodh distribution and help HS(F) in training them in this.Participate in Mahila Mandal Meetings and educate women in family welfare.Utilise satisfied customers, village leaders, CHGs, Trained Dais, AWWs for promoting family welfare programme.Attend Anganwadi and MCC (Sishukalyani Centre) Centres, arrange immunization of the mothers and children, health care of the mothers and children and help AWWs in the implementation of the Supplementary Nutrition Programme under ICDS.Collect monthly monitoring report from the AWWs and submit those after compilation to the PHN/LHV or HS(F).

V Miscellaneous:Remain in charge of the SC and maintain cleanliness of the same.Attend weekly meeting and submit performance report in conjoin with that of the HA(M).Involve local Dais in F.W. programme and IUD campaign.Help HS (F) in training the indigenous Dais.Take help of local panchayat in maintaining SC building.Co-ordinate her activities with HA (M) at all steps.Take help of her HS (F) and allow her supervision and monitoring, when required. Help HS (F) in conducting School Health Programme.Participate in the organization of Eye Operation Camps, Eye Health Care Camps, Sterilisation and Laparoscopy Camps, and discharge nursing skill to the patients admitted/operated in the institutions.Detect the physically handicapped from the field and refer those to the nearest health institution.Prepare and maintain all registers, records, maps and charts in her sub-centre and submit the prescribed periodical reports to the HS (F) in time. Maintain field diary for her own performance and exhibit the same for inspection to the HS (F) when called for. Perform any other job as may be assigned to her from time to time by the BMOH or any other officer authorized by him.

11.Health Supervisor (F)

She helps the Health Assistant to carry out the functions mentioned in HA (F). She also assists the BMOH/MO in the different activities at PHCs SC level. The female health Supervisor will cover a population of about 20000/30000 in which there will be 6 Health Assistants to be supervised by her. It has therefore, been rationally contemplated that each such Health Supervisors (F) headquarter will be well-located at each SHC. The Supervisor will perform field supervisory visit in her area of operation in a monthly cycle of 16 days and 4 days office work. The job-functions are as follows:She will:Supervise and guide the Health Assistants (F) in the delivery of the total health care to the community.Strengthen the knowledge and skill of the Health Assistants (F) in different areas by training and retaining them during concurrent supervision and on weekly meeting day.


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Help the Health Assistants (F) in improving the skill of maintaining optimum public relation and favorable rapport building, as well as in breaking down the resistance against any health programme.Help and guide the Health Assistants (F) in planning and organizing their day-to-day activities during the course of supervision.Promote team work amongst the Health Assistants (F) and Health Assistants (M), and help establish proper coordinaton amongst themselves as well as with CHGs, Dais, AWWs, Computers and other voluntary organizations.Visit each Health Assistants (F) once a week in the field as per fixed programme or supervision.Arrange group meetings with local leaders and involve them in spreading message of various health programmes.Scrutinise maintenance of records of Health Assistants (F) to guide them in proper way. Attend and organize weekly staff meetings at PHC/SHC as the case may be and assess the progress of work of his Health Assistants (F) on receipt of individual reports and submit the compiled report with comments to the BPHN/PHN/BMOH/MO in the meeting.Assist BMOH/MO in organisisng different Health programmes in the area and in the control of outbreaks of epidemic diseases.Assist in mass camps and campaigns held on Health programmes in the area from time to time e.g. sterilization camps, immunisation camps, IUD drive, eye camps.Supervise the AWWs/Sishukalyanies in these Centers as well as in the SCs and coordinate with the supervisors of the ICDS and MCC programmes at her level.Indent, procure and supply medicines, vaccines and other materials to Health Assistants (F) of her jurisdiction.Prepare, maintain and utilize prescribed records, reports and store-accounts.Collect, consolidate and submit periodical reports to PHN/BPHN and analyse with proper monitoring for improvement of the deficiencies in performance of any Health Assistants (F) and coordinate with the concerned male Health Supervisor in this.Lay supervisory visit to the SCs on their clinic days and help in conducting clinic and feeding programme.Attend to cases referred by Health Assistants (F) and refer such to those beyond her competence to the nearest PHC/Hospital.Conduct and supervise immuisation programme and help Health Assistants (F)and the local Dais in conducting deliveries along with their supervision.Guide Health Assistants (F) in establishing women depot holders for C.Cs.

12.Block Public Health Nurse

The function of BPHN is to ensure proper coverage of MCHs and immunization services in the community with the help of female component. The job functions include supervision, coordination, health education, conducting training programmes and monitoring. The function of Block Public Health Nurse is to ensure proper coverage of MCH and immunization services in the community within the Block area assigned to her. She shall supervise, on behalf of B.M.O.H. the activities of the entire female component e.g. Health Assistants (F)s. and the PHNs within the Block and shall remain directly responsible to B.M.O.H. for proper implementation of the M.P.H. Scheme, specially the health care for the mothers and children with which she is primarily concerned. She will perform duties of field supervision in a monthly cycle of 12 days outside 8 kms. of place of posting and in a monthly cycle of 4 days a month within 8 K. Ms. of the


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place of posting as per advance programme duly chalked out and approved by the B.M.O.H. She shall maintain daily diary of her work and exhibit the same to the BMOH or any of her higher authority when asked for. In addition there will be 4 days cycle in a month of office work. The following are the details of the job function of the BPHN:She will:Supervise and arrange effective implementation of MCH, FP & EPI services.Participate in and B.S.I in the control and prevention of communicable diseases.Coordinate activities with male counterpart, compile the performances with those of male component and analyse the total performance of the Block.Coordinate and obtain help of the volunatary organizations, panchayats, Mahila Mandals etc. for proper implementation of the health programmes. Arrange breaking down resistance felt by any health staff while implementing particular health programme related to the health of the mother and children.Supervise the delivery services conducted by the Health Assistants (F) and Dais at home.Arrange health education activities by way of group meetings, in collaboration of SWO/BSI.Participate in any special health drives e.g., FP camps, IUD camps, immunization campaign, Eye operation camps. Eye health care camps ICDS, sanitation programme, exhibitions, baby show, fair and festivals, nutrition programme etc.Keep constant vigilance over the activities of the HA (F), HS (F), and PHN under her so as to achieve the targets laid down for the Block so far as these relate to mother and children by way of proper monitoring and education to the staff concerned.Supervise S.C clinics within the Block area and arrange effective I.U.D. campaign threat.Supervise and participate in the training programmes organized by BMOH e.g. for AWWs, Sishukalyanies, MP Training of HA and H.S. CHG Training, Training of Dais. Visit AWs and Sishukalyani Centres as well as the sub-centres to supervise the implementation of the feeding programme and immunisation programme.Visit S.Cs., and S.H.Cs. to supervise feeding programme if any.Attend I.C.D.S. monitoring meeting at Block level and submit MMR after compilation of those received from the Health Assistants (F) and coordinate with the C.D.P.O. and the Supervisors under I.C.D.S.Attend weekly/monthly meeting, assist BMOH/MO in its conduction in collaboration with SWOS/BSI, collect performance report from the female component, compare and compile with those of the B.S.I. and submit the same to B.M.H.O. with the help of B.S.I. computer. She will analyse the performance of the Health Assistants (F) and HS (F) and take steps necessary for improvement and correction of any such required.Perform any other duty as may be assigned to her from time to time by the higher authorities for the sake of public service.

13.Principal, Nursing College

Overall administration of the CollegePlanning for the development of the College.Formulation of Policies of the College.Working as the Drawing and Disbursing Officer of the College and Dealing with all related financial matters.


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(a) Staff Payment

(b) Other bills regarding: College Office and related matters Teaching materials

College Library Other related matters in connection with teaching.

(c)

Bills re:

Remuneration to teaching and non teaching staff of other institutions where the students go for their science classes etc.

Maintaining laison with Health Secretariat, Health Directorate, Office of the NDHS (N), Finance Department and the West Bengal Nursing Council and following up and pursuing of different proposals. Maintaining laison with Calcutta University-particularly with the Secretary, Under-Graduate Councils, Controllers' Department Registrars'Department and the Inspector of Colleges.Maintaining laison with other institutional authorities where the College of Nursing students have their classes on Science (viz. University College of Medicine, I.P.G.M.E.R., S.S.K.M. Hospital.Contacting outside lectures for teaching of behavioural science and making necessary arrangements. Maintenance of close contact and cooperation with SSKM Hospital authorities particularly in connection with regard to the development of the clinical practice field of the students. Working as a member of Board of Studies in Nursing and Undergraduate Council of Medicine of the Calcutta University.Working as a member of the West Bengal Nursing Council and participating in all the educational activities of the Council wherever necessary.Organization and supervision and conduction of the overall college programme. Supervision and evaluation of faculty and staff.Overall supervision of the evaluation programme of students' performance in clinical situations and classes.Giving guidance to faculty.Counselling and guidance to students as and when necessary.Taking classes for the students. Arranging for the Community Nursing experience for the students including field visits and visits to different institutions. Maintenance of records, reports and statistics and stock of the college. Giving guidance to students of Masters in Nursing who come for field experience to this college from College of Nursing, Delhi.Working as a Examiner and Moderator for Delhi University and Calcutta University.Working regarding students admission in the college and related matters.

14. Senior Lecturers

Planning and organizing the courses of study of B.Sc. (Hons.) Nursing both Generic and Condensed in consultation with the Reader and the Principal.Conducting classes both theory and practical.Supervising and guiding the students in classes and clinical fields. Carrying out assignments for such field work as may be necessary for the courses taught in the college e.g. selection and arrangement of clinical fields in hospital and in community.


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Planning and conducting examination both theory and practical.Evaluating answer scripts of students for examination conducted by the College, University and other Universities.Checking assignments, paper and lesson plan submitted by the students. Planning and organizing ongoing assessment of the students (Evaluation of the students performance).Assisting the Principal in the management of the hostel and the mess attached to the College. Arranging and participating in N.S.S. Programme, sports and games and other extracurricular activities as well as ceremonial functions of the college. Planning and arranging health programme for the students of the college. Participating in students' counselling programme.Holding meeting with the guardian of the students as and when required. Assisting the Principal with regards to selection and admission of the students. Assisting the Principal in purchasing the teaching material/equipments, books etc. and maintaining the stock.Participating in the departmental and interdepartmental meetings. Attending professional meeting and conference and participating in Seminars and Workshops held at State and national level. Maintaining records and reports related to student teaching programme, health programme and N.S.S. Programmes.Conducting conference with clinical instructors.Helping the Principal as and when necessary.

15. Clinical Instructor

Planning and organizing clinical experiences of the students in consultation with the Head of the Division.Supervising and guiding the students during their clinical experiences in the clinical fields i.e. hospital, community and class practices according to the needs and requirement as prescribed in the course under study.Checking of practical assignments i.e. nursing care plan, care-study, medication sheets, lesson plan for health talk, case book etc. submitted by the students. Attending case presentation, demonstration of procedure and return demonstration, observation reports. Maintaining records and reports related to students clinical experience.Evaluation of the students performance whom she supervised.Participating in the students' counselling programme. Participating in the departmental and intra-department meetings. Attending professional meeting and conference and participating in seminars and workshops held at state and national levels.Participating in the conduction of competitive examination for condensed BSc. (Hons.) Nursing Programme.Planning and arranging health service programme for the students of the college in consultation with concerned lecturer.Arranging and participating in N.S.S. programme, sports and games and other extra curricular activities of the students as well as ceremonial functions of the college.Meeting with the concerned lecturer regarding students' progress and performance in the clinical field for necessary improvement.Participating in the conduction of Calcutta University Examination both theory and practical.


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Annexure 11

BENGAL NURSES ACT, 1934

The Bengal Nurses Act, 1934 published in the Kolkata Gazette sanctioned by the Governor-General for the registration of Nurses, Midwives and Health Visitors in Bengal and to secure their better training. Following are the enumerated Sections:²Local extent and commencement of the Act.²Definition, subject or context of the Act.²Establishment and incorporation of the Council.²Appointment of Members and Ex-officio for the Council.²Appointment of the Members in default of election.²Publication of names of the members.²Leave of Absence to Members.²Cessation of Membership.²Filling of Casual Vacancies.²Terms of Office Members.²Meeting of the Council and construction of committees.²Payment of fees and traveling expenses of member.²Appointment of Registrar.²Maintenance of registers of registered nurses, midwives, public health nurse and

health visitors etc.²Maintenance of the registers by the Registrar.²Removal of names from registers on notice of death.²Removal of fraudulent and incorrect entries in registers.²Persons entitled to be registered.²Admission to register of persons trained in other States of India.²Refusal of registration removal and re-entry of names.²Appeal from order under Section 20 (Refusal of registration removal and re-entry

of names).² Registration under this Act to qualify for registration under the Bengal Medical Act,

1914 (Bengal Act-IV of 1914).²Institutions for training of nurses, midwives and health visitors to be recognized by

the Council²Appeal against refusal to recognize training institution²Prohibition of issue of certificate and entry of names by unrecognized institutions²Supervising Board.²Disabilities of unregistered person.²Penalty for dishonest use of certificate procuring registration by false means, and

falsification of register or certificate.²Penalty for unlawful assumption of title registered nurses, registered midwife or

registered health visitors.²Disposal of fees.²Publication and use of annual list of registered and health visitors.


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Annexure 12

CURRICULUM OF DIPLOMA IN NURSING EDUCATION AND ADMINISTRATION [DNEA (CH)] COURSE

BY ALL INDIA INSTITUTE OF HYGIENE AND PUBLIC HEALTH

Introduction:

This ten month post certificate course for Community Health Nursing, was initially established as Diploma in Public Health Nursing (DPHN) in 1953. Then with permission of the government of India-institute revised and renamed as Diploma in Nursing Education & Administration (Community Health) [DNEA (CH)]. The course provides training to nurses at post basic level to take up positions as administrators, supervisors and teachers in community health nursing field. Intensive training in all aspects of Community Health Nursing given so as to ensure that nursing personnel function effectively as important member of the health team. The course includes theoretical and practical instruction in advanced Community Health Nursing, participation in family care programme, methods of supervision, administration and teaching and field work in rural and urban area. There is an examination at the end of the course.

Philosophy:

The All India Institute of Hygiene and Public Health, Kolkata believes- that the DNEA (CH) course with its higher knowledge and skills in the principles and practice of community health nursing, teaching and administration, along with the reinforcement of knowledge in scientific nursing, offered to register General Nurse-Midwives will enable them to practice at top and middle management levels in the community field.

General Objectives of the course:

To prepare community health service providers of a higher competency and supervisors, administrators and teachers for undertaking higher responsibility in the field of community health through an educational programme offered at post basic level to General Nurse-Midwives.

Specific Objectives of the course:

On completion of the course the students should be able to ? Develop understanding and attitudes in relation to the total concept of

community health and community health nursing so that an effective nursing service can be organized and provided to individuals, families and community for the promotion of health, prevention of disease, care of the sick, prevention of disability and deterioration of health as well as rehabilitation where indicated.

? Develop a holistic concept of the health care delivery system in the country. ? Acquire a broader understanding of changing patterns of health services, their

organisation and administration as well as the role of community health nurses in such programmes.

? Realise the importance of team approach and the maintenance of good relationship with members (within and outside the agency) working in community.


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? Gain further knowledge and skills, based on fundamental nursing principles in providing qualitative and quantitative nursing service and health guidance in homes, clinics, schools or any other community health programme.

? Develop knowledge and skill in supervision and guidance to nursing and auxiliary nursing personnel especially Multipurpose Health Workers (Female) and increase their awareness of the qualities required for effective and successful leadership.

? Gain knowledge of the nursing education programmes at different levels. ? Understand the principles and methods of teaching and develop skills in

teaching and organizing learning experience in public health for nursing and auxiliary nursing students as well as medical and other disciplines.

? Acquire the knowledge and develop skills in carrying out research and studies aimed at improving nursing service.

? Reinforce the awareness of professional development for personal growth and service upliftment.

General Information: The DNEA (CH) course commences every year and continues for a period of ten months. Medium of instruction and examination is English.Fees-Fees as per government rules are required to be paid by every candidate. Stipend-government of India stipend of Rs. 800/- per month is offered to non-sponsored candidates.

Admission requirements:

Senior Nursing Certificate – 'A' grade from any of the Schools of Nursing recognized by the Indian Nursing Council or its equivalent in other countries and a Senior Midwifery.Certificate – Essential for female nurse. Male nurses are required to have approved training in lieu of Midwifery.General Education – Minimum Higher Secondary Passed or its equivalent qualification. Experience – Minimum of two years experience after completing nursing course-preference will be given to those with experience in Community Health Nursing.

Course Design:

The course comprises of 14 subjects, which are based on the syllabus, prescribed by INC. Various methods are used to teach these subjects such as lecture-cum-discussion. Demonstrations and return demonstration, practical and laboratory methods, seminar, selfstudy, case study, assignment, guided hospital ward experience in Obstetrical Nursing, Paediatric Nursing and Psychiatric Nursing and community field experience in Urban and rural community, supervised practice teaching etc. Excellent ongoing rural and urban community service fields are available for proper training facility, well-equipped classroom with modern teaching aids e.g. overhead projector/VCR etc.

The detail hours allotted and method of teaching and the course contents of each subject offered is given in the following:


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Division of Time (Working days 5 days per week)

Total no. of weeks 43 weeks Counseling and Orientation 1 week Instructional hours including Practical 35 week (Practical in Hospital-6 weeks and in Urban and Rural Field-1 week)

Preparatory leave 1 week Examination and result declaration (Midterm and Final

4 weeks

Vacation 2 weeks

35 weeks [(18 weeks * 5 days * 8 hours (classes, practice teaching & visits) + 6 weeks {(6 hours * 5 days-hospital practical hours) – (3 hours * 5 days-classes)}+ 11 weeks * 5 days * 7 hours (field)]

Breakup of Instructional Hours- 575Sl. No.

Instructions Hours

1. Comprehensive Health 50 hrs 2. Community Health Nursing 150 hrs. 3. Nursing E ducation – I 30 hrs. 4. Nursing Education – II 30 hrs. 5. Nursing Administration 50 hrs. 6. Community Health Nursing Administration 30 hrs. 7. Epidemiology and Control of

Communicable Diseases 30 hrs.

8. Obstetric Nursing 25 hrs. 9. Paediatric Nursing 25 hrs. 10. Psychiatric Nursing 25 hrs. 11. Nutrition and Diet in Health and Diseases 30 hrs. 12. Social Sciences 40 hrs. 13. Applied Biology and Microbiology 30 hrs. 14. Physics and Chemistry 30 hrs.

Total – 575 hrs.175 hrs.

Library hoursPractical in Hospital (6 hours per day * 5 daysfor 6 weeks = 180 hrs.) &Community Field experience (7 hours per day * 5 daysfor 11 weeks = 385 hrs.)


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Practice Teaching and visit in different Institutions

Sl. No.

Teaching Hrs.

1 Supervised practice teaching 3 hrs. 2 Practice teaching 12 hrs. 3 Visit (in different institutions) 45 hrs.

Field practice:

Students are placed for a period of 5-6 weeks each in Urban health Centre, Chetla and Rural Health Unit and Training Centre, Singur, which are two field practice attached to the Institute.The Public Health Nursing Supervisor of each Rural and Urban Health Centre organized intensive field programme for the students in consultation with Officer-in-Charge of Administration of respective centres, faculty of the Public Health Nursing department of the Institute. The programme is drawn up and carried out in closed cooperation with medical officers, social workers, public health nurses, health visitors and midwives and other member of the staff of the respective centres. The sister tutor attached to the Public Health Nursing deptt. in consultation with the PHN supervisor coordinates the day to day programme both in rural fields. The nursing staff of each centre acts as field instructors and local supervisors of students.

Practical in Hospital Ward:

Students are placed in Maternity Ward, Paediatric Ward in Medical College Hospital, Kolkata and Psychiatric Ward in Gobra Mental Hospital, Kolkata for a period of two weeks each.

Field Visits in Different Institutions:

Observations-cum-participatory field visits are arranged with various medical institutions of the state of West Bengal and private and voluntary institutions, Chest clinic, V.D. Clinic (MCH); Children's Hospital; Infectious Diseases Hospital; Cancer Hospital; Skin and Leprosy Clinics (School of Tropical Medicine); School of Nursing, both government and private; Family Health and Welfare Training Centres; Institutions for Physically and Mentally Handicapped; ICDS Schools and industries including creche.

Primary Health Centres, Sub-centres, H.C. Memorial Health School and Community Development Blocks belonging to W.B. State are also included in the list and these places are visited during the field work in the rural areas.


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Documents

West Bengal Nursing Report