In exercise of the powers conferred by sub section 1 of Section 16 of Indian Nursing Council Act

REGD. No. D. L.-33004/99 The Gazette of India CG-DL-E-25012025-260469 EXTRAORDINARY PART III—Section 4 PUBLISHED BY AUTHORITY No. 50] NEW DELHI, FRIDAY, JANUARY 17, 2025/PAUSHA 27, 1946 462 GI/2025 INDIAN NURSING COUNCIL NOTIFICATION New Delhi, the 26th December, 2024 INDIAN NURSING COUNCIL {NURSE PRACTITIONER IN ANESTHESIA (NPA) – POSTGRADUATE RESIDENCY PROGRAM} REGULATIONS, 2024 F.No. 11-1/2024-INC (IX):—In exercise of the powers conferred by sub-section (1) of Section 16 of Indian Nursing Council Act, 1947 (XLVIII of 1947), as amended from time to time, the Indian Nursing Council hereby makes the following regulations, namely:— 1. SHORT TITLE AND COMMENCEMENT i. These Regulations may be called the Indian Nursing Council {Nurse Practitioner in Anesthesia (NPA) - Postgraduate Residency Program} Regulations, 2024. ii. These shall come into force on the date of notification of the same in the Official Gazette of India. 2. DEFINITIONS In these Regulations, unless the context otherwise requires, i. 'the Act' means the Indian Nursing Council Act, 1947 (XLVIII of 1947) as amended from time to time; ii. 'the Council' means the Indian Nursing Council constituted under the Act; iii. 'SNRC' means the State Nurse and Midwives Registration Council, by whichever name constituted, by the respective State Governments; iv. 'RN & RM' means a Registered Nurse and Registered Midwife (RN & RM) and denotes a nurse who has completed successfully, recognised Bachelor of Nursing (B.Sc. Nursing) or Diploma in General Nursing and Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered Nurse and Registered Midwife; v. 'Nurses Registration & Tracking System (NRTS)' means a system developed by the Council and software developed in association with National Informatics Centre (NIC), Government of India, and hosted by NIC for the purpose of maintenance and operation of the Indian Nurses Register. It has standardised forms for collection of the data of Registered Nurse and Registered Midwife (RN & RM)/Registered Auxiliary Nurse Midwife (RANM)/Registered Lady Health Visitor (RLHV) upon Aadhar based biometric authentication; vi. 'NUID' is the Nurses Unique Identification Number given to the registrants in the NRTS system; vii. 'General Nursing and Midwifery (GNM)' means Diploma in General Nursing and Midwifery qualification recognized by the Council under Section 10 of the Act and included in Part-I of the Schedule of the Act. NURSE PRACTITIONER IN ANESTHESIA (NPA) - POSTGRADUATE RESIDENCY PROGRAM I. Introduction and Background In India, reshaping health systems in all dimensions of health has been recognized as an important need in the National Health Policy, 2017. It emphasizes human resource development in the areas of education and training alongside regulation and legislation. It is highly significant that the healthcare professionals require advanced educational and clinical training in healthcare settings for specialized services. The Government of India recognizes significant expansion in all healthcare settings both in public and private sectors. There is a felt need to have specialist nurses and nurse practitioners with advanced preparation to support healthcare services in our country. Nurse Practitioners will be able to meet this demand provided they are well trained and empowered to practice in the area of need. With establishment of new cadres at the Center and State level, master level prepared Nurse Practitioners will be able to provide cost effective, competent, safe and quality driven specialized nursing care to patients in a variety of relevant settings in India. Nurse Practitioner in critical care/acute care, oncology, emergency care, neuro-care, cardiovascular care, anesthesia and other specialties can be prepared to function in all levels of relevant settings. Rigorous educational training will enable them to assess and participate in managing patients undergoing various procedures and surgeries both for prevention of complications and promotion of health. A curricular structure/framework is proposed by the Council towards preparation of Nurse Practitioner in Anesthesia (NPA) at master's level. The special feature of this program is that it is a clinical residency program emphasizing a strong clinical component with 15% theoretical instruction and 85% practicum. Competency based training is the major approach and NP education is based on competencies adapted from National Organization of Nurse Practitioner Faculties (NONPF) competencies (2022), International Council of Nurses (ICN, 2021), American Association of Colleges of Nursing (2021), American Association of Nurse Anesthesiology (AANA, 2023). Every course is based on the achievement of competencies. The provision of adequate surgical cover is a prerequisite to accomplishing local and global health goals {Lancet Commission on Global Surgery (LCoGS), 2019}. A large section of people seeking surgical care cannot afford the financial burden of medical treatment. About 66% of patients in low- and lower-middle-income countries do not have access to primary surgical care. Safe anesthetic care is essential to ensure safe outcomes of surgery. Five billion people across the world have no access to safe anesthetic care. Law T.J. et al. (2019) spell out various issues and barriers in the path to achieve safe and accessible anesthesia care. The LCoGS suggests an average minimum threshold of 5000 surgical procedures per 100,000 population by 2030. Sufficient trained anesthesia care providers are needed to cater for such large surgical volumes, and the workforce gap must be filled up by well-trained non-physician anesthesia care providers (NPAPs). Narrowing the gap becomes the priority according to the Sustainable Development Goals, 2030, that focuses on Global Health Equity. The Nurse Practitioner in Anesthesia (NPA) Program is the way forward to close down the gap. The NPA Program is intended to train registered B.Sc. Nurses at the master's level to provide peri-anesthesia care to patients and to carry out critical care procedures in various anesthesia relevant settings. NPA focuses on assessing patients and their medical fitness for anesthesia and surgery, preventing, and treating acute complications if any and stabilizing them during the peri-anesthesia period. These NPAs are required to practice in the operating rooms, pre-anesthesia clinics, post-anesthesia recovery rooms, ICUs, outpatient and in patient surgery units, emergency rooms, labor and delivery rooms, endoscopy suites, radiological centers, psychiatric units, including Community Health Centers (CHCs). The program consists of various courses of study that are based on strong scientific foundations including evidenced based practice and management of complex health systems. These are built upon theoretical and practice competencies of B.Sc. Nursing. On completion of the program and registration with the respective SNRC, they are permitted to practice all competencies listed in the logbook of the Council syllabus. They will be able to provide general, regional and local anesthesia with supervision by anesthesiologists. They will also be able to administer drugs relevant to the scope of anesthesia care, order diagnostic tests, procedures, medical equipment, and therapies as per institutional protocols/standing orders. They will be permitted to manage post-operative patients in the Post Anesthesia Care Unit (PACU) and discharge them based on specific criteria. The NPAs when exercising this authority