History of the Tamil Nadu Nurses And Midiwives Council

The commencement of Military Nursing was the fore-runner for the formation of the Nursing Service in this State.

In 1664, the Governor's Council of Fort St. George wrote to the Agent of the East India Company in London that Englishmen dropped away for want of Christian Charity (Medical and Nursing Care) and he stressed the necessity of having a house (Hospital) in purpose for them, and people appointed to look after them.

At first Nursing Sisters were sent out for Military Hospitals. They worked with fellow soldiers for a time. The Military Hospitals worked under difficult circumstances for about two hundred years. The Madras Hospital continued to be a Joint Civil and Military institution.

A transfer was effected in 1753 to the present General Hospital premises. A medallion on the wall of the present General Hospital bears the inscription "Hospital founded 1753".

Consequent on the formation of a Nursing Service by FLORENCE NIGHTINGALE at the time of the Crimean War 1854, reforms were brought about in the Army Nursing Service. Though she did not visit India she observed the conditions in the Military Hospitals, she made great efforts to collect information about the functioning of the Hospitals in India. Her accurate knowledge of the conditions in the Hospitals was very remarkable. Based on the answers compiled from her "Circular of Enquiry", the Royal Sanitary Commission on the Health of the Army in India was appointed in 1859.

After a long delay, the Commission presented its report. Their work inevitably led reforms in Civil Hospitals and efforts were made to provide a health service for all the people of India, particularly for those in the Madras Presidency.

As a result, a Lying-in Hospital was built in 1797 with the help of subscription by Dr.John Underwood for the poor of Madras. It was in this Institution that in 1854 the Government sanctioned the opening of the first training school of Midwives. The accommodation for the patients was 150 beds (Women). The certificate granted to those who completed the training was a diploma in Midwifery training.

If a candidate failed to obtain the Diploma in Midwifery, she was granted a certificate in Sick Nursing. The training in sick nursing was then much below the required standard. Therefore, a Scheme for more efficient training was drawn up in 1871 and submitted to the Government for approval by the Inspector-General, Indian Medical Department. The Madras Government sanctioned the scheme for training of six nurses in the Government General Hospital and the Govt. of India sanctioned the recruitment of a Lady Superintendent and four trained Nurses from England for starting the School of Nursing. The school was started on 1st July 1871.

Schoo and college of nursing. MMC, Chennai.

As there were no Nurses but plenty of Midwives, the proposal of the Surgeon-General that all candidates for Midwifery training should first go to the General Hospital for training and after they had passed through, go to the Lying-in Hospital for Midwifery training. In the beginning, there were only 6 probationers who had very short periods of training ranging from three to six months. Later, six trained Nurses were appointed in addition to six probationers.

The first Lady Superintendent (Matron) Miss Martyn was appointed in 1874 and Miss Pier-point came with her in the capacity of a sister (Head Nurse). In 1877, Miss Martyn resigned and after that, there were frequent changes both in staff and methods.

In December, 1891, the subject of improvement of the Nursing Service was submitted to the Government. The number of trained Nurses were increased and two grades were introduced. The staff sanctioned was one Head Nurse or Matron, One Assistant Head Nurse, four Staff Nurses (First Grade) and six Second Grade Nurses and Six probationers in second grade.

In 1894, a further increase in the number of staff was permitted bringing the total number of trained staff nurses upto 18. Great difficulty was experienced in obtaining trained staff, able and willing to undertake the training of probationers. Between 1874 to 1894, 259 candidates entered the Hospital either as trained nurses or probationers and 244 left. For several years, it was found difficult to retain the services of the Nurses, after they had received their certificates. But with better living conditions and pay, the position gradually improved. Training schools were sanctioned in the District Headquarters Hospitals also.

Simultaneously, Christian Missionaries started Hospitals in various parts of the State. The first such Hospital is the Christina Rainy Hospital, Madras. It was started in 1894 by the Church of Scotland Mission. A few years later in 1923 a training school was established in this institution. The teaching was given mainly in the local vernacular (Lower Grade).

Christina Rainy Hospital

In 1895, the Catherine Booth Hospital was started at Nagercoil by the Salvation Army. In 1902, Dr. Ida Scudder founded the Christian Medical College Hospital at Vellore. In 1918, a training School for Nurses commenced in it.

A further reorganization of Nursing Service in Hospitals was sanctioned in 1922 with a view to giving increased ration allowance, washing allowance, a small allowance to keep the quarters clean, free supply of crockery and furniture, employment of servants in the Nurses quarters and common mess run by nurses. Later it was identified that to establish a Legislation to monitor the training and practice of the Nurses and Midwives.

MADRAS NURSES & MIDWIVES ACT 1926 (MADRAS ACT III OF 1926):

Prior to 1926, Nurses and Midwives and Dhais were carrying on unlicensed practice of their profession in the presidency of Madras. Great need was felt to control their practice. A vital legislation for regulating the unlicenced practice of their profession by nurses, midwives and dhais was introduced in the Madras Legislative Assembly in 1926. It was passed as the Madras Nurses and Midwives act, 1926 (Madras Act III of 1926) and came into force on the 14th day of February, 1928.

The syllabus for the training of nurses was revised in 1927 by adopting the syllabus prescribed by the General Nursing Council for England and Wales, London in a modified form.

MADRAS NURSES AND MIDWIVES COUNCIL:

A Council called the Madras Nurses and Midwives Council was constituted in accordance with the provisions of the Act. This is the earliest piece of legislation on Nursing in the whole of South-East Asia.

The first meeting of the Council was held on 11th April, 1928 under the presidentship of Maj.Gen.F.H.G. Hutchinson, I.M.S., the Surgeon-General with the Government of Madras.
The second meeting of the Council held on 20-03-1929 gave recognition to nine hospitals as training institutions for nurses, four hospitals for midwives and 35 hospitals for dhais.

The first Register of Nurses, Midwives and Dhais was compiled and printed and published in 1930. A Registrar was also appointed to carry out the functions of the Council and to implement its decisions.

GOVERNMENT / CMAI BOARDS OF EXAMINATIONS:

At first, only nurses and midwives who underwent their training in recognized Government Training Schools and produced certificates of qualification from Government Boards of Examiners were admitted to the Registers of Nurses and Midwives maintained under the Act. Certificates issued by the Examining Board of the Christian Medical Association of India (South India Branch) were accepted for registration after the grant of recognition to the Mission Training Institutions under the management of that Association and the receipt of a satisfactory report on inspection of the examinations in nursing conducted by the Association in October, 1930. CMAI as Medical Missionaries Association was formed in the year 1905 and renamed as Christian Medical Association of India in the year 1926. The Mission Board was also required to have a nurse-member of the Council.

Besides the grant of recognitions to several institutions in the Madras Presidency (the composite states of Madras, Andhra Pradesh and Malabar) for training of nurses and midwives, the Council granted recognitions to a large number of institutions in India, outside the Madras Presidency and in foreign countries, as and when necessity arose for the grant of such recognition, to afford facility of registration under the Act.

The syllabus and curricula for the Courses in nursing and midwifery were approved by the Council and periodic changes and revisions were effected as deemed fit prior to the constitution of Indian Nursing Council before 1947.

IInd WORLD WAR AND COUNCIL:

During the emergency years of the Second World War from 1938 to 1943, the Council afforded all possible help for the success of the war efforts of the Government of India in the recruitment of student nurses, and others for the Auxiliary Nursing Service and fully trained nurses for the Indian Military Nursing Service (Temporary). Utmost care was taken to see that the standard of nursing was not lowered or affected in any way. After the termination of the war, the Council gave all possible concessions to the demobilized Nursing Orderlies of the Army, Navy and Air Force and also the Auxiliary Nursing Service personnel for further training in Nursing in approved civil training institutions. These concessions which were allowed to them for a period of about ten years, after their demobilization, were withdrawn in December, 1956.

RECIPROCITY:

The Council had entered into reciprocal arrangements for registration of nurses and midwives with the other State Nursing Councils in India on the condition that they fulfill all the requirements prescribed by this Council.

The Council had also established reciprocity of registration with the General Nursing Council for England and Wales, London, the Central Midwives Board, London, the General Nursing Council for Scotland, the Central Midwives Board for Scotland, An Board Altranois, Northern Ireland and the registration bodies of some foreign countries recognized by the international Council of Nurses, Geneva.

Indian Nursing Council ACT 1947:

On repeated representations made to the Government of India by this Council and other State Nursing Councils and other bodies, the Indian Nursing Council Act was passed by the Centre in 1947 and the Indian Nursing Council was constituted.

This Council took up the function of maintaining a uniform standard of nursing education in India by prescribing common syllabus for General Nursing and Midwifery/B.Sc.(N) Courses and Rules and Regulations and admission criteria. Further INC is empowered by this Act to recognize the qualification conferred by the examining bodies ie., Universities/Boards of all the State within India.

In 1957, the syllabus for the Auxiliary Nurse-Midwives Course prescribed by the Indian Nursing Council in place of the Course in Midwifery and it was accepted for introduction in suitable training schools in this State. Subsequently midwifery training was merged with general nursing programme.

DEGREE COURSES IN NURSING / POST GRADUATECOURSES/ SPECILIZATION:

Within the last two decades, the Council gave its approval for and recognition to the syllabus for the degree course in [B.Sc.(N)] Nursing. First to the College of Nursing attached to the Christian Medical College, Vellore and later in the College of Nursing of the Government General Hospital, Madras. Through its efforts, post-graduate courses in Nursing', 'Nursing Tutor Course', 'Hospital Administration', 'Ward Management', etc. beside M.Sc.(N) were introduced. Great impetus has been given to the speedy advancement of Nursing education in this State.

REGISTRATION CERTIFICATES

Early in 1962, this Council adopted the uniform format of Registration Certificates to register Nurses, Midwives, Auxiliary Nurse-Midwives and Health Visitors as prescribed. The rules and by-laws made under the Act were amended suitably.

REGISTRATION

All nursing qualification were brought under following category (ie., Nurse, Midwife, HV, ANM). The Registers were divided into two sections and each section into five parts 'A' to 'E'.

SECTIONS:
Section I - Nurses and Midwives qualified in their own State.
Section II - Nurses and Midwives qualified and registered in other States registering in our State.

PARTS:
Part A General Trained Nurses (Women)
Part B General Trained Nurses (Men).
Part C Midwives
Part D Health Visitors
Part E Auxiliary Nurse-Midwives.

Nurses, Midwives, Auxiliary Nurse-Midwives or Health Visitors who have undergone training in the concerned State in the Indian Union should apply to concern State Nursing Council for registration as nurses, midwives, Auxiliary Nurse-midwives or Health Visitors to obtain their primary registration. Thereafter if they wish to practice other state within Indian Union, they may apply for secondary registration which is given on fulfillment of all prescribed conditions for other state candidates who has completed nursing in the other state and of its being in full force and effect, by any State Nursing Council within India where the candidates wish to practice nursing. Candidates are not eligible to do secondary registration without primary registration.

FOR SAFE PRACTICE:

It is relevant to mention here that the rules framed under the Act have provided for taking of disciplinary actions by the Council for offences, including breach of any by-law, professional incompetence, negligence or contravention of methods ordinarily inculcated in the Course of training of nurses, etc. The Council as per the Act has taken action against registered persons who were found guilty under these rules and punished them by removing their names from its registers either permanently or temporarily or refusing to register applicants for registration as provided under the Act. Action was also taken against un-recognised or unauthorized institutions issuing certificates of qualification for nursing and midwifery etc.

CONCLUSION:

As stated earlier in this brief history, the Council has been striving, from its inception, for the advancement of nursing generally in India and particularly in Tamil Nadu and championing the cause of the nursing profession.

Aiming excellence in Nursing education with conscious commitment with legal sanction to practice altruism to make our mother land the ONE in the world to alleviate suffering and healing the sick with holistic care round the globe with dignity.

The Council is monitoring the standard of nursing education as prescribed by INC which is imparted through the INC and TNC recognized institutions in Tamil nadu for the purpose of registering the recognized qualification conferred by the recognized examining bodies subsequently to maintain the professional practice in the legal manner in Tamil Nadu and also to render selfless health service to the Society.

The Council will meet yearly twice as per the Act and pass the resolution accordingly take decisions.

As and when required amendment are sent to the Government for approval.

CURRENT INVOLVEMENT