CHAPTER V. levels under different settings leading to different types. levels of responsibility to perform specifi~

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1 CHAPTER V NURSING EDUCATION & TRAINING FACILITIES Nu~sing education in India is imparted at various levels under different settings leading to different types These prog~ammes of education are designed for preparing personnel for entry at different posts with different functions. levels of responsibility to perform specifi~ The various courses offered under the programme of nursing education are General Nursing, Midwifery, Auxiliary-Nurses/Midwife, Health Supervisor (LHV) and the B.Se., M.Sc. and M.Phil. degrees in nursing. The three years' diploma course in general nursing is the basic preparatory course. This course followed by six months' training in midwifery is the qualification for entry into the system of patient care i.e., a hospital, as a staff nurse. In community health services, the one and a half years' course of ANM is ~he qualification for entry. Education at degree level aims at preparing nurses tor leadership in effective planning and administration of programmes in nursing services, in the teaching of nursing, care of patien ts, and in community services. The goal of the post certificate courses is to give competent professional skill in particular type of nursing care required for specific purposes.

2 I. Development QL Various Courses under Programme of Nursing Education The practice of nursing services, began in India- with the institution in its present hospitals form, during British regime to nurse their sick military personnel, and it later extended to other element~ of population in late nineties. The training. of norses ~ill that time, was an integral activity of the hospital staff. The formal recognised training course for General Nurses, however, came into being only in the year 90. Training for he~lth visitors was introduced in 98 in the wake of the Child Welfare Movement, which required home visiting as an essential tool for the success of the movement. In 942, the cadre of auxiliary nursing service was introduced by the then government to ameliorate the shortage of nurses in the wake of World War II, while specific post certificate diploma courses were introduced in the early 940s for specific purposes. The first college of nursing was opened in 946 in Delhi to prepare the nurses to hold responsible administrative positions and to overcome the shortage of teachers in training schools for nurses. A brief discussion on the development of nursing education for each of its programmes follows in the succeeding paragraphs separately for each one of them. 2

3 General Nursing The initiation of formal trainin9 for nursing in India dates back to the late nineteenth century. In Delhi, the first school was opened in 874, in Bombay in 877, in Guntur in Andhra Pradesh in 899, in Madras in 98 and Calcutta in 924. At first each hospital worked quite independently and the form of training tended to follow the course with which the nursing superintendents were themselves familiar. So in some hospitals, the courses for only eighteen months and in some others for two while in yet others it extended to two and a halt or lasted years, three years. Students usually received courses leading upto an examination, after which a hospital certificate was given. No particular standard of education was required for admission, it was often taken to be enough if one could read and write. The first attempt to organise a systematic training of nursing -: h nurses and their public examination was made by the Mission Hospitals in North India in 907 and, as a result, the "North India United Board bf Examiners for Mission Hospitals" was formulated. Intially the scheme was adopted only in Lucknow. Ban~ras and Patna. Later many government hospitals joined the Board in order to share the advantages of public examination and a recognised certificate, upon which its designation was altered to the 'North. A. Wilkinson: A brief History of-nur~ing in India and Pakistan, 958. (pp.35-45) 3

4 India United Board of Examiner$ for Mission and Other Hospitals'. Eventually, the South India and Mid-India Boards of Nurse Examiners also came into being by 90. As these institutions came into being in an ad hoc manner, after independence, a systematic effort was made to bring together all aspects of supervision education and practic. of nursing in India in the form of the Indian Nursing Council in 947. There is some parallel between Medical Council of India and Indian Nurs~ng Council, though, unlike the former, the INC is not a statutory body. In this way, a full-fledged nursing course of three years' duration became a formal and recognised method of training in General Nursing by 90. This marked the beginning of a well organised formal training in nursing, based on prescribed syllabi, etc. The Certificate of general nursing is awarded after completion of three years' training; and for becoming a general nurse midwife, the qualified general nurse has to undergo six months training in midwifery. Usually, more than 90% of the general nurses take this training. As many as 207 training schools were opened by the year 946. This number rose to 239 in 95. The latest number of recognised t~~ining schools in the year 990 is 448 for general nurses. The number annually qualifying which was only ~6 in the year 95 has increased almost ninefold by the year 990 to 032. As regards further study, these qualified gener~l nurses are eligible for un- 4

5 dertaking the Post Certificate Diploma Course/for Post Basic degree course in nursing after two years of experience. The required qualification for admission to the course is 0+2; i.e., Senior School Certificate, but in states lik. Punjab, Nagaland, Tripura, U.P., Mizoram, J&K and Manipur, only 0th standard basic qualificatidn is required for admission to General Nursing Course. Growth of educational facilities for general nurses in terms of number of institutions, intake (number under training) and the outturn during is shown in the Table 5. below at quinquennial intervals. NuMber 0 Institutions IMparting Trainino. Number of Student!t. under~oing Training and Outturn of 6ener"aINursing Year Number of Institutions Number of St~dents undergoing Training Outurn " N.A. 7,859,433 7,995 9,099 20,873 23,496 26,03* 28,788*,236,94 2,85 5,456 5,779 5,506 For the year 990 * Estimated Source: Indian Nursing Council. 5

6 State~ise distribution of training facilities of general nurses alongwith the number qualifying for the years 97, 98 and 99 are shown in Table 5.2. A ~Yr~QrY p~ry~~l of the tab8 that ~3 PQr E~nt of the total schools imparting training in general nursing are located in 6 states, namely, Andhra Pradesh (74S. Kerala (6), Maharashtra (46), Karnataka (30), and West Bengal (28). In line with the concentration of training schools in these states, 46% of the total Dutturn also come from the states of Kerala, Maharashtra and West Bengal and 2% come from the states of Tamil Nadu, Punjab and Bihar. In this way, 67% of the total outturn of general nurses is from the these six states. But the number qualifying per institution varies significantly over these states. The number q~alifying per institution varies from 29 in Kerala to 44 in Maharashtra and Orissa. These are respectively 36 in West Bengal, 34 in Tamil Nadu, 3 in Bihar and 30 in Punjab. The number is the least in the case of Assam and Himachal Pradesh being 2 and 2- respectively. 6

7 Table ~.2 Statewise Number of Trainino. Institutions for Benral Nurs.. and the Number annually qualifying and 99 States 98 99(x) No.of No.of No.of No.of No.of No.of Instts. Candi-.Instts. Candi- Instts. Candidat.e's dates dates qua.l i- quali- qualifying fying tying ~- - Andhra Pradesh 9 3:$ Assac\ 20 ll~ Bihar Gujarat Haryana Himachal Pradesh Jammu & Ka-shmir 8. Karnata"-a 5 4: Kerala M~dhya Pradesh Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar Prade$h West Bengal Other States & Union Territories ~ All India For the year 972 (x) For the year 990 Source: INC 7

8 Midwifery The first training school for midwives was sanctioned in 854 in the Lying Hospital at Madras. The certificate granted to those who completed the course was a diploma in midwifery and for those who failed the reward was a certificate in sick nursing. Since the standard of training und~r this certificate was very low, the then government decided that all candidates for midwifery should first get the training in general nursing and then QO for midwifery. This practice -is continuing till today. A six months' course in midwifery is preceded by a three years course in general nursing to become a general-nurse-midwife. The facilities for training in the midwifery course are generally available in almost all the institutions meant for training the ~enera I n-urses. ANtIs/HW ie.l. The initiation of ANMs course has a history which dates back to 942, when the British Government had started the Auxilliary Nursing Service in order to ameliorate the short- 2 ages of nursing personnel in the wake of war. It was designed as an intensive short term course of six months after which an examination was held and on qualifying this examination, the trained young women were posted in Military Hospitals in India and overseas to serve the Indian Defence 2. Indian Nursing Year Book,

9 Forces in the capacity of assistant nurses. But the recruitment to the services was stopped in 945 itself and the demobilization started thereafter auxiliaries were trained till then and of them, the number in services was On demobilization, they were granted certain concessions to enable them to complete the general nur~ing in shorter period but these concessions were later withdrawn in 955 as the decision for starting fulfledged course of ANM of two years was taken in 950 itself in the second meeting of the Indian Nursing Council. This course was intended to replace the various courses for the junior grade certificate and the course in midwifery for candidates other than nurses. This course of two years duration was later replaced by Revised ANN Course in 977 in accordance with the requirements of the Multipurpose Health Workers Scheme specifically relevant to the rural Health care needs of the people at the subcentre level. The duration of the course was also shortened to 8 months. The Revised ANM Course initially termed as MPHW (N&F) but later it came to termed as Revised ANN in order to facilitate their registration with Nursing Councils. Presently, ANN course is being run in as many as 494 schools with different titles as MPHW (F), FHW, ANN. For ANMs Course, the requisite qualification is 0th standard' but in the states of Gujarat, M.P., Sikkim, Nagaland and Andaman and Nicobar Island only 8th standard is insisted upon. In most of these States where the admission 9

10 requirement is 8th class pass, the duration of the course is two years. Not only this, in Kerala and Tripura it ~s two years course even after Senior Secondary Certificate. In Nagaland the course is of two and a half years duration with 8th class pass as basic qualification for admission. Maharashtra is.the case wherein for Senior Secondary Cartificate is the requisite qualification for ANMs course in one institution and the course is of one year duration. Growth of trai9ing facilities at this level in terms of number of training centres and the number qualifying each year is shown in Table 5.3 for period at quinquennial intervals. Statewise distribution of training facilities in terms of number of training centres and the number of auxiliary nurses midwives qualifying in the years 97, 98 and ~99 are presented in Table 5.4. Table 5.3 Nuaber of Insti tu'tions I.parting Training~ Number of Students undergoing Training and Outturn of Au)CillalCL Nurse "id"ivrs,9~-8. Year Number of Institutions Number of Students undergoing Training Outturn ,332 9,939,002 9,43 8,252 2,597 N.A ,083 3,70 5,036 5,506 For the year 990 Source: Indian Nursing Council. 20

11 Table 5.4 Statewise Number of Traini~ Institutions A.N.H./H.W ~ and the Numbner of. ANMs annually qualifying, 97, 98 and 99 States 98 99(x) No.of No.of No.of No.of No.of No.of Instts. Candi- In!:.tts. Candi- Instts. Candidates dates dates quali- quali- qualifying fying fying 2 3 ij Andhra Pradesh '">... Assam Bihar Gujar-at : Haryana Himachal Pradesh Jammu &. Kashmir 8. Karnataka Kerala Madhya Pradesh II.Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar Pradesh West Bengal Other States & N.A !:' 220 Union Territories 9. All India For- the year 972 ( x ) For- the year 990 Source. INC. j;~"\, 'J \t\~ $- ) a ~._# 2

12 It will be noted from the above table that the maximum number of (44 out of 494) -schools are located in Andhra Pradesh accounting for 29% of the total. Next state that follows is the Uttar Pradesh with 48 training centres. But interestingly the number qualifying from Andhra Pradesh was only 257 as against the outurn of 237 from Uttar Pradesh in the year 990. Health Visitors The need to train health visitors was felt in the of the Child Welfare Movement which had its beginning wake so~etime before 98. It was realised that if the preventive work was to be made really effective, it had to be followed up systematically by home visiting 3 and as such the first Health School was opened in Delhi in 92. At first the length of the course was 9 months but this proved much too short a period and so it was lengthened to 8 months. Another health school was opened in Calcutta, financed by ~he Indian Red Cross Society. Madras Maternity and Child Welfare Society opened a health"school in Madras in 933 and one more was opened in- Nagpur. Thus at the time of independence, the country had 4 health schools. In fact, the kind of training programme, which was patterneq before independence. continued only upto the year 977. After that with the introduction of the MPW scheme, 3. Ibid., 0~ p.2. 22

13 all LHVs have been made as Health Supervisor~ with shortterm orientation training imparted in Rural Health & Family I.<Je I fare Train ing Centres OtHFVJTC, Prev ious I y known as RFPTC). Now LHVs' course is of six months' duration and is mainly imparted to ANMs on the basis of seniority. Only two institutions respectively in Assam and H.P. do admit matriculates for this course. The personnel after training are posted as health supervisors. As such, it now exists only as a promoti~nal course and the admissions take place to commensurate with posts created. Table 5.5 below gives the information of training facilities and the number qualifying during at quinquennial intervals. Table ~.5 Number of Institutions Imp~rting Trainina Number of Students Underaoing Training and Outturn of Health Visitors Year Numb~r of Institution.s Number of Students undergoing TI~aining Outturn N.A ly , , , ~ , ~206 Source: (i) Indian Nursing Council - upto the year 976 (ii) Ministry of Health & F/W adjusted:- 98, 986 & 99 Estimated. 23

14 Specialised Courses There are 8S many as 5 specialised courses of short term duration to prepare the personnel for specific jobs like teaching, administration, research and specific like C~ncer, Physiotheraphy, Opthalmology, Ortheopaedic,. Coronary and Psychatric etc. A brief resume of some of these courses, as these have developed, has been attempted below. A shortage of teachers in nursing schools was relalisecl in the 930s. For many years, the teaching of nursing students was assigned to the nursing superintendents and sisters who already had much more than a full time job and therefore their teaching CQuid not be as thorough as it ought to have been. In view of this, a Sister Tutor Course was started for the civilian nurses by the Government which was of full one academic year duration in 943~ in the premises of the School of Health Admini6trat~on in Delhi. The School of Health Administration was opened in 943 to meet the urgent needs of. staff in the Military Hospitals. Public Health Nursing had its beginning ~n the late 940s. The training of nurses based on public health teaching was started inthe College of Nursing, Delhi, NurSing Schools of the Christian Medical College at Ludhiana and Vellore. In 95, a one year post graduate course in public health was introduced in other schools. 24

15 During these 40 years of planning not much significant changes are observed in the faci\ities tor teaching at the post certificate level. Presently, there are only 6 institutions which impart training in general tutor course, 9 inst-i tutions which impart Ward Administr.ation Course and only 4 have a facility for Nursing Admini$tration. The training in these courses also varies in duration from institution to -institution. It appears these courses are mainly institution based without much of standardisation. The training at the post certif~cate levels is imparted generally in the institutions havingtrainiog facilities for general nursing except for some courses like psychiatric nur?ing and cancer nursing. The training for psychiatric and cancer nursing is provided in the hospitals specifically meant to treat such cases only e.g. Cancer Centre and Nursing Home, Calcutta and the National Institute' of Mental Health & Neuro Sciences, Bangalore. The Mental Hospital, Dharwad, Karnataka also provides six months' tr-aining in psychiatric nursing for men. Table 5.6 provides the existing facilities available at the certificate courses in nursing. Table 5.7 below provides the information on number of students qualifying various post diploma certificate courses during ~5

16 Table ~.6. Details of Post Certificate Courses in Nursing SI. Name of the No. Course Duration No.of Requi$ite Institution, Qualification Objectives Ward Admn. ( i ) 3 months (Certificate) ( i) 6 months 2. Gen. Tutor's Certi- 9 months ficate Course "7..>. Midwifery Tutor's 9 months Certificate Course 4. Nursing Admn. 9 months Certificate 5. Nursing Tutor & 9 months Admn. (Combined) 6. Orthopadeic Nursing ( i ) 6 months Certificate CDurse ( i i) months (iii) 3 months 7. Operation Theatre ( i) 6 months Trg. Certificate Course ( i i) 2 years 8. Community Health & 6 months FP Certificate Course 9. Ophthalmic Nursing ( i ) 6 months Certificate Course (ii) - do - 0.Paediatric Nursing ( i ) 3 months ( ii) 0 months - Psychiatric Nursing 0 months 2. Orientation Programme i months month in Psychiatric Nursing 3. Continuing Edu. Prog. one month 4. PH Nursing Certificate (i)0 month ( i i) - do 5. Cancer Nursing ()6 months 6. PH Nursing Course tor LHVs 6 months 9 6 j~ Jl "'i.l do - :2 JL Jl () - (ii) 5 GN with 2 yrs. A Preexpo as Staff requisite Nurse jor - do - ad'/ance courses in Teaching & Admn. GN with 3 yrs expo as Staff Nurse do - -,do do GN " " GN " GN GN with yr. expo GN " " For men only GN College of Nursing AFMC GN GN w:.th "< ~, years expo GN -NA Only Deptl.Candidate below 45 yrs. of age. Source: MID H & F/W, DGHS, CBHI New Delhi (985). "Paramedical Training in India 985ij 26

17 Nu.ber 0 Students Qualifying various Post-diplola Certificite Courses during 95-9 HUlLber of students qualifying in the course ot Year ~ard Nursing Sister lfidl4i ferv.ph Psychiatric Public Padiatric Total Eister Ad~n. lutor- Tutor Nursing Nursing Health Nursing a 0 9~ ' '. '6 iio 2 67 HI B 6 ( J "' S < A'::. ~ -" b ( 3(! 7( ~ ( i'?9ii i9 6 i i t Relates to the year 990 Source : INC It will be observed from the above table that except for the courses on Public Health Nursing the popularity of traditional courses like ward sisters, sister tutor and - nursing administration have declined over these periods. The courses of midwifery and public health courses have almost discontinued. The number of students coming out in psychiatric and padiatric nursing is too small. It is due of the fact that facilities at the B.Sc. level are becoming more popular and gaining st ength these days which tend to 27 iii

18 ~- provide specialised and comprehensive training at the degree level. B,Sc,<Bursingl/P,B,Sc., ~ The scheme for the B.Sc. (Nursing) was prepared in 944 itself as a four years' course comprising theoretical teaching of a university standard, pra~tical nursing experiencein hospital wards and other departments, field work in public health and midwifery, with a view to prepare suitable personnel to hold responsible administrative positions and to overcome the. shortages of teachers in different training schools for nurses. The training is imparted in the colleg~s attached to the universities. The first college of Nursing was started in 946, which was later shifted in 956 in the building meant for this college only. During the same years the course of B.Sc. (N) was also started in the School of Nursing, Vellore. A total of 4 nurses qualif~ed the B.Sc. (N) course in 950 as its first batch. Since then, the number of nursing college~ imparting training at B.Sc. (N) level has increased to 2S~he year 985". The duration of the course, is four years and the requisite qualification for admission is 0+2 with_science subjects. But in one of the nursing colleges in Maharashtra under SNDT University it is three and a half years; while in PGr Chandigarh, the required qualification for entrance is 28

19 B.Sc. A short term course of t"o years' duration in order to enable the general nurses having ce.,rbi;~/"i to qualify themselves upto graduate level is also being run parallel in many colleges. This is known as Post Basic B.Sc. (N). Growth of nursing education at graduate level in of number of colleges and the number qualifying each terms year during at quinquennial inttnvals is shown in Table 5.8 below. Table 5..Jl Rnaber o.!. Colleges japartjog tx,llining ill. LSce {Il aw P,B,See (Kl aw ~ ~~ gnalifyjng during ~ gginan.ooial intervals ~ ~----- ~~qualifyjng Year ~ ~ Colleges B.Sc.(N)" P.B,Sc,(N) ~~ LNl P,B.Se. inl :32 ~ l:)9 650* For the year 989 * For the year 990 Source ; INC Statewise number of colleges imparting training B.Sc. (N) and P.B.Sc.(N) alongwith the nmnber qualified for the 29

20 year 985 is given in Table 5.9. Here again the southern states account for a major share both in terms of facilities and the outturn of graduates. The states needing special mention are Kerala, Karnataka and Maharashtra. Maharashtra alone brings out more than 20% of the graduates. Table 5.«Statewise Nu.ber o~ Colleges Imparting Training in B.Sc.(N/P.B.B.Sc.(N) and the nu.ldber o~ quali~yinq for the year ''85 States Number of colleges Number of students qualifyin.g B.Sc.(N) P.B.Sc.(N) B.Sc.(N) P.B.Sc.(N) ~ , Assam.J Bihar 4. Gujarat 5. Haryana 6. Himachal Pradesh 7. Jammu & Kashmir 8. Karnataka 9. Kerala lo.madhya Pradesh.Maharashtra 2. Orissa 3. Punjab 4. Rajasthan 5. Tamil Nadu 6. Uttar Pradesh 7. West Bengal 8. Other States & Union Territories. Andhra Pradesh 3 (2 ) () 3 ( 2 ) 2 () 3 ( ) 3 ( ) 3 9. All India 25 (8) 3 (5) _._ Figures within bracket indicate the number of unrecognised institutions. Source : INC. -" () 3 ( ) 2 ( ) ()...,.) () 57 6 N.A. N.A N.A

21 t.sc.(n) Facilities for education up to the level of M.Sc. (N) are available in 7 nursing colleges. A B.Sc.(N)/P.B.Sc. (N) can untertake this course. It is a two year$' duration course-with an intake capacity of 50 students im all the. ~. seven colleges. Total number of students under training during the 986 was 3 for this course. Erbwth 0 nursi~g education at po~t graduate level i.e., M.Sc. (N) in terms of number of colleges and the number qualifying each year during at quinquennial interval is shown in Table below. Table 5.0 Number of Colleges i.pa,rting training for H.Sc. (N) during at. quinquennial intervals No. of Colleges Number gualifying N.A. N.A. Sourc:e :- INC 3

22 For statewise distribution of nursing colleges and the outturn therefrom, the information is obtained from Indian Nursing Council and pertains to the year 985. There were 4 recognised and 3 unrecognised colleges imparting training in nursing at MSc (N) level. Of the recognised colleges, one each was located in the states of Maharashtra, Tamil Nadu and UTs of Chandigarh and Delhi and the unrecognised ones are located om~ each in the states of Andhra Pradesh, Haharashtra and Kerala. But 'of the total outturn (58), Haharashtra and Delhi had a major share with 20 students graduates from each, 0 from Andhra Pradesh and four each from the states of Kerala and Punjab. II.Linkages b~tween Hursing Posts ~ Nursjng Educatjon The different programmes of nursing education at different levels intend to prepare personnel for entry at varying levels of responsibility for specific function. Table 5. below provides the different modes of entry to the various posts specified as functionary under different settings. The opportunities' for inter cadre movement, however, depend upon the number of posts available for different ~unctionaries and the number of candidates directly available. The post of health supervisor is essentially the promotional cadre filled from the ANMs on the basis of seniority after short term orientation. The process of movement with modes of entry through additional educational preparation may be seen in Table

23 Table 5., Se~~ing,~ype of Func~ionary and ~hr ~es of en~ry ~o ~he specified func~ionary Setting. Community ~ Qi functionar-y. ANM Mode Qi Entr-y Through training of one and a half years' duration. 2. HA/(F) Health Supervisor. ANM with 5 year experience and with 6 months Promotional Cour-sea Public Health Nurse. B. Sc. (N) 2.GNs through PB.B.Sc.(N) 3. GN with Post Certificate Cour-se of 0-2 months for the PHN Diploma 2. Hospital. Staff Nurse 2. Ward Sister- GNM GNM with Specialised Post Certificate Diploma B. Sc. (N) 3. Nur-sing tr-aining Schools Faculty P B. B Sc. ( N ) B. Sc. (N) P B. B Sc. ( N ) M. Sc. (N) 33

24 III. Salient Points Qi the Programme of Nursing Education Som~ Issues The present structure of nursing education and its growth over the past four decades alongwith their interlinkages among different levels/courses present certain salient features which give rise to inconsistent situation in the area of nursing education not only in quantitative terms or in terms of cadre structure, development, prospects, etc., but also. with regard to the overall manpower spectrum of the nursing education. Some of the sa ient features are The most training institutions for general nurses are hospitals and not the training institutions where the patient care is the predominant activity and.therein all students admitted are used for this purpose. Training therefore becomes a secondary activity. The faculty for training is also picked up t~om the faculty of the doctors/nurses on duty in the hospital whose teaching method are more confined to their experience in the wards; and less imbibed with basic knowledge required for the profession. Besides, the nursing education at Senior Secondary Certificate stage is also imparted in Tamil Nad~ as part of the programme on '/ocat.ionalising higher secondary education. To provide opportunities for 34

25 ~ertical mobility, 0 percent seats are reserved for the put--~u~n. of this course in B.Sc. (N) second year. This course is, however, not recognised for employment as equivalent to the general nurses or ANM either in hospital settings or community. Such students can however go for higher education as GN or BA/B.Sc. On the other hand, an ANM with a training of one and a half years duration, if not absorbed in the department due to any reason, is left with no options of either higher education/training in the same profession where experience is a pre-requisit. or in the. stream of general education. The degree level institutions are under dual control. Academically these are under university and administratively under Ministry of Health. With this status these institutions do not enjoy autonomy like other institutions of higher learning. After 0+2, ge~eral nurse and midwife is awarded with only diploma/certificate after three and a halfyears' training, whereas in genera educatic-n stream the student is awarded with degree after three years of college education. Again within the nursing education itself, a 0+2 candidate admitted in nursing college with four years of traioinggets a degree. Thus with the same entry qualification, the awards 35

26 at three types of institutions e.g. training hospital: nursing education in college~ and general education stream vary. Not only this, the career development prospects in each of these cases also vary sharply. A hospital based trained cert~ficate/diploma holder nurse would require another four years' time to earn a degree: with only one line option before her, whereas a general educaticn stream graduate can earn a post graduate in only two years_time with lots of avenues before her. The nursing education, therefore, being placed at a fairly disadvantageous position is never able to attract good promising students. It usuall.y happens to be a choice of III divisioners; and those hailing from lower middle class families because of the stipend~ary attractions. The High Power Cpmmittee on Nursing & Nursing Pro- 4 fession has observed that "although ~nough candidates are available for joining the nursing course still it is not the first preference of the majority of candidates. The provision of stipend attracts many needy candidates who may not be actually interested in the nursing profession". As revealed from the discussion in the Report of the High Power Committee on Nursing and Nursing Profes- 4. Report of the High Power Committee on Nursing and Nursing ProfeSSion,

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