ESTD.IN 1908

Registered under the Societies Act XXI of 1860 in 1917. WWW.TNAIONLINE.ORG

Incorporated in it : Student Nurses' Association, Health Visitors League and Midwives and Auxilliary Nurse-Midwives' Association Affiliated to : Commonwealth Nurses' Federation













P r e f a c e



After its establishment well over a hundred years ago in 1908, the Trained Nurses’ Association of India (TNAI) was registered under the Society Act XXI of 1860 in 1917 (Registration No. 199). It continues to be the only professional body of nurse practitioners in the country representing all categories of nursing personnel including Auxiliary Nurse Midwives, Lady Health Visitors and student nurses in India. TNAI has its Headquarters in New Delhi and branches in almost all the States and Union Territories of the country. Since its inception, the organisation has worked persistently towards upliftment of the nursing profession as well as standardisation of nursing education and nursing service resulting in improved quality of health services. It has been recognised by the Government of India at par with other service organisations since 1950.


As integral members of society, Nurses are entitled to same rights and privileges as are available to other sections of the country. The key role played by the nurses in general and in health care settings in particular has amply been recognised and appreciated all over the world. It is now well accepted that participation of nursing/ midwifery personnel is essential for effective implementation of national strategies.


The Policy and Position Statement adopted by TNAI endorses the nurses’ rights.


·       A right to equal remuneration for equal qualification and equal professional expertise as their counterparts, within and outside the profession.


·       The right to be included in planning and policy making at all levels of the Health Care system within and outside country.


·       Right to access the resources and working conditions, necessary to provide quality care to the clients including in-service training, fair shift assignments, adequate staffing pattern, efficient and effective logistic support and appropriate infrastructure.


·       Right to practice in accordance with the nursing legislation of the country, the regulatory body and adopt the national ethical code of professional conduct.


·       The right to undertake independent nursing practice within the framework of the professional conduct.


·       The right to be accorded dignity and honour as nurses.


As the voice of the nurses, TNAI has prepared a Memorandum in consultation with the nurse leaders and experts representing the various sectors for submission to the VII Central Pay Commission. The Core committee for VII Central Pay Commission Revision and Recommendations constituted by TNAI’s Executive Committee consisted of the following members:





Prof. (Sr.) Gilbert, President, TNAI





Dr. (Mrs.) Bimla Kapoor

1st Vice President, TNAI


Ms. SurekhaSama                   

Hony. Treasurer, TNAI


Ms. Madhabi Das                        

President, West Bengal Branch, TNAI


Dr. Jasbir Kaur                            

President, Punjab State Branch, TNAI


Dr. (Mrs.) Josephine Little Flower  

Nursing Advisor to the Govt. of India


Mr. T. Dileep Kumar                             

President, Indian Nursing Council


Mrs. Rita Sapra                


President, Delhi Nursing Council                 



Military Nursing Services



Indian Railways Hospitals



ESIC Hospitals


Mrs. G.K. Khurana

Secretary General, Delhi Nurses Union


Mrs. Santosh Mehta

Principal, RAK College of Nursing


Mrs. Evelyn P Kannan

Dy. Secretary General, TNAI   


Col. (Retd.)Arun Bala

Asst. Secretary General, TNAI


Mrs. Sanghamitra Sawant

Asst. Secretary General,TNAI’s CIN/ECH


Mrs. Sheila Seda

Secretary General, TNAI


Co-opted Members



Mrs. Anita Malik                       

Hony Secretary, M&ANM



Mr. Kaliappan

Consultant Nursing, Nursing Division


Dr Latha Venkatesan

Principal, Apollo College Of Nsg, Chennai, TN


Ms Neerja Sood

Asst Professor, IGNOU


Mrs Anita Panwar

Joint Secretary, DNU, Public Health Branch


To start with, a meeting was held on 22 May 2014 to draw the opinions and inputs from various sectors viz. namely Central and State Govt. bodies, ESIC, Railways, Military, Private, Nurses’ Union, hospitals, schools, colleges and institutions. In this meeting, a Core Committee was constituted to take up the various components of the Memorandum. The said Core Committee had several rounds of meetings with members to elicit suggestions and views in the backdrop of their knowledge, vast experience and expertise as well as facts and data received from various sources. I would like to place on record my grateful thanks to all those who provided help in achieving this stupendous task.


We sincerely hope that this esteemed Commission would consider all these factors while fixing the pay scales and allowances of nursing personnel and they would be given their rightful due and proper status.


                                                                                      Prof. (Sr.) Gilbert

Chairperson, Core-Committee

7th Central Pay Commission)

                                                                                      & President TNAI



Wait of 10 long years and comes the Central Pay Commission inviting suggestion, proposal and recommendations from all employees (groups individual) working in Government establishments.


The arduous and painstaking job of preparation of a Memorandum for consideration of the VII Central Pay Commission was accepted by The Trained Nurses' Association of India (TNAI). Necessary support was sought from many sister organisations and the professional colleagues with stakes in Nursing. TNAI’s Executive Committee initiated this task by first constituting a Core Committee for planning and preparing the draft document after the resolution on VII Central Pay Commission was posted on the web. The contact was continuously maintained with the Nursing division in MOHFW, INC, Railways, ESIC, Military Nursing Services, Nurses Union and TNAI’s State branches; Nursing Directorates and various other resources rushed the required information. Relevant facts and figures were collected for compiling the Memorandum to be submitted to the Seventh Central Pay Commission.


We are grateful to Prof. (Sr) Gilbert, President TNAI, who heartily accepted the Chairpersonship of the Core Committee entrusted by the TNAI Council on her. We extend our sincere thanks to members of TNAI  Executive Committee and Council for their approval for formation of this Core Committee and giving their expert and valuable inputs on the pay structure prevailing in different States/UTs. We particularly thank Dr. Bimla Kapoor, Ist Vice President,TNAI, Ms. Surekha Sama, Hony. Treasurer, TNAI, Dr. Josephine Little Flower, Nursing Adviser to the Govt. of India, Mr T. Dileep Kumar, President, Indian Nursing Council.  Dr.(Mrs.) Jasbir Kaur, President, Punjab State Branch, Ms. Madhabi Das, President, West Bengal State Branch, Mrs. Rita Sapra, President, Delhi Nursing Council and Mrs. Santosh Mehta, Principal, RAK College of Nursing, New Delhi, Mr. Kaliappan, Consultant Nursing, MoHFW, GoI for sparing their valuable time and whole-hearted involvement at every step in preparation of Memorandum. Our heartfelt thanks are due to the Indian Nursing Council and all State Nursing Registration Councils for their cooperation. At Headquarters, the rigorous and hard ground work done by Mrs. Evelyn P. Kannan, Deputy Secretary General-cum-SNA Adviser and Col.(Retd) Arun Bala, Assistant Secretary General, TNAI  from the very beginning in compiling and writing the Memorandum  who worked day and night and were deeply engrossed in taking care of minor details deserves to be mentioned. We sincerely commend their commitment towards completion of the task in time bound manner. Dr. (Mrs.) Latha Venkatesan  provided valuable inputs on clinical specialist nurse and other  information. Mrs G. K .Khurana and Mrs. Anita Panwar helped in providing inputs from Nursing Service and Public Health Nursing.


All the Core-Committee members who put in their best under the vibrant leadership of Prof (Sr.) Gilbert deserve our sincere thanks for participating in the rounds of discussions and taking decisions during the meetings. All the Committee members rendered valuable inputs in their respective areas of expertise. We are also grateful to the Dr. Josephine Little Flower, Nursing Advisor, MoHFW, Government of India for giving us the opportunity to have consultation with our nurse colleagues and compile and present this Memorandum.


We express our heartfelt gratitude to all nursing colleagues and other friends who have been associated with this work. All the  TNAI Headquarters Staff deserve our thanks specially Mrs. Kanta Bhoral, Mr. Prashant Sharma and Miss Seema Sejwal who provided Administrative and clerical assistance and  Mr. H.K. Barthwal, the Consulting Editor TNAI for its editing.


The nurses throughout the country are hopeful and confident that the existing conditions of nurses and the suggestions and recommendations contained in this Memorandum would merit the attention of the Hon’ble Members of the 7th CPC and be accorded due consideration in the prospective salary structure of nursing personnel.






(Mrs) Sheila Seda

                                                              Secretary General TNAI

                                                          Nodal Officer Member, Core Committee

 (7th Central Pay Commission)































“Nurses: A force for change-A vital resource for health”


-International Council of Nurses


1.          Introduction


Nursing, as a profession, with its own identity, is the largest, the most diverse, and one of the most respected among the health care professions.The scope of Nursing services and educational amenities in India have expanded considerably, since Independence. The scope of nursing includes primarily working in hospitals and public health as service providers, as nurse educators in schools/colleges of nursing and as nurse administrators and nurse researchers in both areas.


The unique identity of Nursing should be reflected in all planning papers, documents and policy statement of Government and non-Govt. organisations with the view to strengthening development of nursing, otherwise, this sector of the health system will get neglected and status of nursing services will get further deteriorated.


Nurses are the largest and an important human resource. They have a primary and pivotal role in the delivery of comprehensive health care and medical services at all levels of the country’s health care system. Nurses as professional practitioners are responsible for providing  leadership to nursing services, coordinate all kinds of health services provided by other health professionals and people in a given healthcare setting, including round the clock in-patient services and attending to people in the community all the time, even at odd hours and in remote, risky and difficult areas. Hospitals and health establishments will come to a standstill, if the nursing services are withdrawn.


Absence of governance structure in nursing, untrained personnel working as nurses, untrained personnel working as Nurses, lay people under the garb of “nurses”.  Lack of co-ordination between states and the centre on matters related to nursing and skill levels of nurses to match the trends in health care delivery remains the major issues. Measures to absorb the existing nurses to close the issue of nursing shortages, creation of newer nursing cadres to absorb and utilize the potentials of higher qualified nurses with B.Sc. nursing, M.Sc. nursing and Ph.D. nursing.  Regulating the nursing service through nursing practice acts, standardization of nursing care through quality assurance and nursing accreditation, restructuring of nursing education from scientific based to competency based education with instructional reforms  are steps taken and professional development of  nurses.The mandatory continuing nursing education linked with renewal of their licenses at prescribed intervals are the suggested measures to be taken forward.



It is disappointing to learn that Sixth Central Pay Commission’s in para 3.6.15 of its Report included the age old and century driven nursing profession under the recently developed category of para-medical cadres.  However, the Gazette of India-Extraordinary (Part-II-Sec 3(i)-Page No.46), relating to 6th CPC,Nursing refers to the nursing profession and para-medical cadres as separate cadres.In actual practice, nursing profession has not been given its due recognition by the policy makers as a distinct profession.  Such an attitude towards Nursing has done considerable harm and lowered the image and status of the profession.  The Nurses across the country with the great hope and anxiety are eagerly looking forward to the 7th Central Pay Commission(CPC) to set right this perception and take a conscionable and just position regarding a separate identityto the nursing profession and give due recognition for the professional status of nurses, who are responsible and committed to holistic patient care in all health settingsdespite continuous exposure to risk and health hazards.



1.1Nursing scenario in India

All the  nurses in the service hold a diploma and some hold a Bachelor’s degree in nursing and midwifery. Specialist nurses in clinical practice are few and far between. Nurses and midwives do not have much opportunity for continuing education, as no such system exists in most hospitals.  In the interest of patient care, the National Health Policy (NHP) emphasizes the need for an improvement in the Nurse- Doctor/Nurse-Patient ratios.  It also emphasizes on improving the skill level of nurses and increasing the ratio of degree-holding nurses versus diploma holding nurses.  It further recognizes the need for establishing advance courses for developing super-specialty nurses for tertiary care institutions.


Many States in India face a shortage of nurses and midwives.  Most of the states have no system of re-registration of nurses.  About 13-28 lakh nurses and 6.18 lakhs ANMs have been registered with the various State Nursing Councils.  However, only 40 percent of registered nurses in India are in service, the said figure includes all the nurses who have been trained since 1947. (Source: Address by Shri T. Dileep Kumar, President, INC published in The Nursing Journal of India, Jan.-Feb., 2013 Vol.CIV No,1)


In India, there are approximately 21-24 lakh registered nurses and out of which only 8.496 lakh nurses are in active service.  Every year 52864 ANMs,  1,18,914 GNMs, 4085  Post Diploma candidates, 84,275  B.Sc (N), 10788 M.Sc.(N), 24120 P.B.B.Sc.The number of MPhil. (Nursing) and Ph.D. (N) candidates being enrolled in various Universities across the country is also increasing. 


Table-1Nurse  to Population/Patient Ratio in India



Nurse to Doctor

Nurses and Midwives/population

nurses midwives/patient







One human resource feature common to India and China is the low ratio of nurses to doctors. India has approximately one nurse and one nurse-midwife per allopathic doctor, while in most countries nurses and midwives outnumber doctors. Nurses have been found to be more amenable to government employment and work in rural areas. In addition they cost the government less in terms of both salary and training (Rao et al 2011). It is imperative for the Central and State governments to look into strengthening the nurses and also their training in the health system and giving them a greater degree of responsibility than traditionally assigned.


1.2 Nursing staffing and patient care

High nursing workload has significant implication. Research shows that a heavy nursing workload adversely affects patient safety.  Further more, it negatively affects nursing job satisfaction and, as a result, contributes to high turnover?and perpetuates the nursing shortage. In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses’ workload: nurses are expected to perform non-professional tasks such as delivering and retrieving food trays; housekeeping; transporting patients; and ordering, coordinating, maintaining hospital consumable and non-consumable logistic or performing ancillary services.


Overworked and underpaid nursing staff member are demotivated and dissatisfied and have impact on patient safety issues; patient care suffers andlack of time can lead to poor patient nurse communication. Quality of care also suffers.Understaffing and the consequent additional workload on nurses  have been shown to:

·        Stress and burnout among nursing personnel

·        Violations or work-around by nurses

·        Have a significant impact on nosocomial infections

·        Reduce time nurses have to help other nurses.

·        Difficulty in training or supervision of new nurses.

2. Ministry of Health and Family Welfare, Govt. of India

Nursing Structure at Ministry of Health and Family Welfare

Secretary Health


Addl. Secretary Health


Joint Secretary