Introduction

Recognizing the significance of Continuous Nursing Education (CNE) in promoting the professional and personal development of nurses, the Indian Nursing Council (INC) has underscored its importance in the code of ethics for nurses in India. In line with this, the Council has developed guidelines for implementing CNE across the country. Although the iNC formulated these guidelines  in 2005, they did not come into effect then. However, some State Nursing Registration Councils (SNRCs) have implemented CNE guidelines independently.

However, with the upcoming introduction of the Unique Nurse Identification (NUID) system by the Council, it is imperative to ensure uniform implementation of the CNE guidelines in all states. Indian Nursing Council (Continuing Nursing Education) Regulations, 2019, aims to provide clear direction and encouragement to professional nurses, enabling them to recognize, appreciate, create, and make the most of CNE opportunities. By actively engaging in CNE, nurses can enhance their personal and professional development while strengthening their competencies in line with professional standards.

CNE Requirement

According to the Indian Nursing Council's regulations, all Registered Nurses (RNs) and Registered Midwives (RMs) must participate in a professional CNE program and earn 30 CNE credits or 150 CNE hours every five years. The minimum requirement is 30 hours per year, with a maximum of 60 hours per year. This CNE requirement is mandatory for renewing nurses' registration and licence. 

Certain categories of nurses, such as Rural Auxiliary Nurse Midwives (RANM), Rural Health Visitors (RLHV), Public Health Nurses, and Nurses holding positions of Mid-Level Health Providers (MLHP) or Community Health Officers, must participate in government-mandated training programs and earn the same CNE credits or hours for renewal of their registration and licence.

Accreditation for Continuing Nursing Education (CNE) encompasses the following academic endeavours:

i. Participation in events like conferences, workshops, seminars, symposia, etc.

ii. Attendance in hands-on clinical skill update workshops, including individual experiences such as BCLS or ACLS.

iii. Serving as a speaker or presenting a poster at conferences, workshops, seminars, symposia, etc.

iv. Engaging in CNE or scientific sessions during official meetings organised by professional associations or organisations.

v. Taking on the role of Chairperson or Moderator for scientific sessions or plenary sessions at State, National, or International events.

vi. Holding positions as an Organizing Secretary or Chairperson for State, National, or International conferences, workshops, seminars, symposia, or scientific committees.

vii. Publishing articles, case reports, book reviews, etc., as an author or co-author in indexed State, National, or International journals as an author or co-author.

viii. Contributing as an author or co-author to textbooks.

ix. Writing chapters for books.

x. Collaborating on the revision of books produced by professional organisations or associations.

xi. Serving as the Chief Editor of an indexed journal (excluding ex-officio roles).

xii. Acting as an Executive or Contributory editor for an indexed journal.

xiii. Delivering lectures via videoconferencing (related to scientific and research topics, e.g., PhD consortium) or teleconferencing.

xiv. Completing online CNE modules/courses.

xv. Pursuing higher education, such as Doctoral, Postgraduate, Post Basic B.Sc., Post Basic Diploma, or NP Programs recognised by the Council, with a duration of one year or more.

xvi. Undertaking short-term training courses lasting 3-6 months.

Table 1: Guidelines for awarding credits and hours 

Discussion

Attendance at live CNE events

Much like their counterparts in dentistry and medical, the Indian Nursing Council understands the significance of the live events. It recognises their vital role in Continuing Education. These Continuing Nursing Education (CNE) events are fundamental in helping nurses stay current in the ever-changing healthcare landscape. They provide a platform for nurses to participate in discussions, gain insights from experienced speakers, and share information with colleagues. These events are carefully designed to focus on various nursing specialities, encompassing various topics from practical nursing skills to medical advancements and efficient administrative approaches.

The significance of attending live CNE events is undeniable; however, it's crucial to weigh their practicality and accessibility. Nurses across India often grapple with intricate schedules due to demanding shifts and the challenges of geographical constraints.

Notably, the World Health Organization (WHO) recommends a nurse-to-population ratio of approximately 2.5 per 1,000 population for developing countries. India has made commendable progress, with a ratio of around 1.7 nurses per 1,000 population. However, this ratio fluctuates considerably across the nation. Similarly, to the distribution pattern observed among dentists, nurses also tend to cluster in urban areas, with nearly 64% practising in these settings, leaving a mere 36% to address the healthcare needs of rural communities.

Thus, it is imperative to strike a harmonious balance between fulfilling mandatory CNE requirements and respecting the demanding clinical schedules that nurses, already stretched thin due to the scarcity of nursing professionals, adhere to. Collaborative endeavours are indispensable to curating CNE programs that are accessible and pertinent, tailored to the distinctive roles and obligations nurses hold in various healthcare dimensions.

Table 2: Clinical time spent in earning CNE credits through live events

The estimated travel time of 6.24 hours is calculated by taking into account the average travel time of both rural and urban nurses. This calculation considers a minimum daily travel time of 12 hours for rural and 3 hours for urban nurses. The distribution of nurses between urban and rural areas is approximately 64:36.

Gaining 1 Continuing Nursing Education (CNE) credit necessitates 5 hours of study. The complete duration for obtaining 1 CNE credit is 12.24 hours, encompassing 6.24 hours of commuting and 1 hour of social interaction. Consequently, to achieve the yearly minimum requirement of 6 CNE credits, a cumulative time of 73.44 hours is calculated by multiplying 12.24 hours by 6 CNE credits. To meet this 6 CNE credit obligation for 3.34 million nurses in India, approximately 245.28 million clinical hours would be essential each year.

The way forward for CNE in India

If CNEs in India could be conducted solely online, the yearly burden on nurses would be reduced to 30 hours per year, meaning that 43.3 clinical hours would remain available for clinical practice (Table 2) per nurse. If all nurses are considered, online CNE frees up 43.33 x 3.34 million = 145.08 million clinical hours annually for India only.

Table 3: Time saved per nurse by 100% adoption of online CNE

References

1. https://www.staffnews.in/2020/11/indian-nursing-council-continuing-nursing-education-regulations-2019-amendment.html
2. https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00575-2
3. https://www.staffnews.in/2020/11/indian-nursing-council-continuing-nursing-education-regulations-2019-amendment.html