The National Nursing And Midwifery Commission Act, 2023 : Transforming Regulation, Education, And Practice

Aananya Atri

Introduction

Nurses and midwives are the core of health service delivery and are foundational to universal health coverage (UHC), patient safety, and resilient primary health care systems. In India, the Indian Nursing Council (INC) 1947 framework had chronic concerns pertaining to uneven training quality, fragmented regulation, and workforce distribution. These concerns accelerated the need to modernise governance beyond the Indian Nursing Council (INC), 1947. Therefore, the enactment of the National Nursing and Midwifery Commission (NNMC) law in 2023 by the Indian Parliament took place and led to the replacement of the Indian Nursing Council Act, 1947. The NNMC establishes a new national–state regulatory architecture for nursing and midwifery education, licensure, ethics, and institutional oversight. Replacing the INC Act was deemed necessary to recover from the outdated legislative framework, which involved a lack of practice norms, the marginal role of midwives, and a lack of global mobility

Background

The Indian Nursing Council Act, 1947 focused on establishing a uniform standard of training for nurses, midwives, and health visitors, and the central council was empowered to recognise qualifications, inspect institutions, and maintain registers. Progressively, the scale and complexity of nursing education mushroomed; additionally, wide variations in institutional capacity, faculty availability, clinical exposure, and state-level oversight were observed, and broader health workforce governance and labour markets in India also witnessed challenges. As per the NSSO, the active health workers’ density of doctors and nurses/midwives is estimated to be 6.1 and 10.6, respectively. The numbers further dropped to 5.0 and 6.0, respectively, after accounting for adequate qualifications. The estimates were well below the WHO threshold of 44.5 doctors, nurses, and midwives per 10,000 population.

In the Lok Sabha, NNMC reform was introduced on 24 July 2023 and passed by the Lok Sabha on 28 July 2023 and the Rajya Sabha on 8 August 2023; with the succeeding assent, it resulted in the establishment of the National Nursing and Midwifery Commission Act, 2023. The law includes criteria for phased commencement through notifications; for example, select provisions were notified to take effect on 29 February 2024.

Functions and Key Provisions of the NNMC Framework

The Act establishes the National Nursing and Midwifery Commission as a body corporate, and its headquarters are in New Delhi. It consists of a chairperson who meets specified experience criteria and a multi-member composition, including ex officio representation and other members nominated through prescribed processes, with fixed tenure provisions for the members and chairperson. The central functions of the Act include framing policies and standards related to nursing and midwifery education and training, regulating institutions and professionals, ensuring competence for registration and licensure, setting norms for faculty and clinical facilities, and managing online and live registers. The Act further aims to embrace innovation and collaboration in the areas of technology, digital learning, hybrid education, and research with industry and other institutions in nursing education. Along with that, it seeks to facilitate global mobility and employability of Indian nurses by inviting foreign experts and specialists to participate in the national commission meetings.

Source:https://niramaya.upsmfac.org/UPSMF_NNMC.html

A distinctive feature is the creation of three autonomous boards under the NNMC:

(i) the Nursing and Midwifery Undergraduate and Postgraduate Education Board – This is placed as a separate autonomous education board dedicated to creating education standards with a competency-based curriculum, but the previous INC Act of 1947 followed a council committee model.

(ii) the Nursing and Midwifery Assessment and Rating Board – This defines procedures to assess and rate institutions, grant consent to open new institutions or increase seats, and conduct inspections with or without prior notice. However, the previous structure merely focused on inspection and withdrawal of recognition and did not establish a formal rating mechanism.

(iii) the Nursing and Midwifery Ethics and Registration Board – This board deals with the maintenance of the National Register, approval or rejection of applications for registration, regulation of professional conduct, and promotion of ethics. Whereas the previous INC relied on state register information and emphasised inspection rather than dedicated ethics and grievance boards.

Source:https://niramaya.upsmfac.org/UPSMF_NNMC.html

The Act recognises the significance of the states and therefore also mandates State Nursing and Midwifery Commissions, requires maintenance of State Registers and a National Register, and introduces a Nursing and Midwifery Advisory Council to facilitate centre–state coordination and policy advice.

Implementation: What Changes Are Considered in Practice?

Implementation involved transitioning from the INC-era model to a commission-and-boards structure that separates standard-setting by education boards, institutional oversight by the assessment and rating board, and ethics and registration by the ethics/registration board. The Act’s provisions on permission for new institutions, criteria for approvals, assessment and ratings, and public disclosure are intended to strengthen transparency and accountability in nursing education markets. The policy was opposed by the nursing group and was significant but remained underdeveloped.

Operationally, states were expected to establish or align State Nursing and Midwifery Commissions, maintain live state registers, and integrate with the National Register to enable licensure, mobility, and better workforce planning. The phased commencement mechanism—where different provisions can begin on different dates—implies that implementation will unfold in stages and will require rules, regulations, staffing, and digital infrastructure to be fully functional.

Impact of the Nursing and Midwifery Commission Act, 2023

India faces persistent health workforce constraints, including shortages, skewed distribution across states and rural–urban areas, and gaps between “registered” and “active” health workers. The Act is enacted, which is not equal to being fully operational everywhere; only some provisions are formally enforced through a Gazette notification that appointed 29 February 2024 for provisions tied to composition or appointments, the selection process, some aspects linked to state commissions, and transition matters. These are initial but crucial milestones that will provide a strong pillar to constitute and transform the commission.

As far as state progress is concerned, the Indian Nursing Council (INC) still publishes and maintains a list of State Nursing Councils across India, which clearly indicates that state-level regulatory bodies are still operating in the older council form in the system.

The major state-level progress signal comes from the gradual expansion of unified digital registration workflows. Even though the NNMC Act states national and state registers, the currently live nationwide registration platform that is visible to the public and active is the INC Nurses Registration & Tracking System (NRTS). This matters because NRTS provides integrated registration services and personalised State Nursing Council portals. It is still active and presents a live register with state integration and uniform workflows.

The Andhra Pradesh Nursing Council public notice marked a move toward mandatory NRTS usage. Although this indicates progress in digital registry integration, which indirectly supports the Act’s intent around registers, it is not the same as a formal State NNMC Commission being constituted in the state. Uttar Pradesh launched Mission Nirmaya on 8 October 2022 to transform the nursing, midwifery, and paramedical ecosystem through better and improved education quality and workforce development. This mission functions as an early state-level model to operationalise NNMC principles.

At the same time, international evidence highlights nursing as the largest occupational group in health systems and stresses the importance of education capacity, remuneration, regulation, and leadership for retention and equitable deployment.

Implementation Challenges

First, institutional transition is complex: shifting regulatory authority, staff, records, and ongoing recognition processes from the INC framework to the new commission and boards can create interim uncertainty for students, institutions, and employers. Any misalignment between national rules and state execution may delay the establishment of state commissions and slow down licensing, inspections, and grievance redressal.

Second, capacity constraints could limit impact. Evidence from India’s broader health workforce landscape shows that merely increasing training capacity does not automatically convert into recruitment and retention in public facilities; vacancies can persist due to recruitment delays, incentives, and HR management issues.

Third, building stakeholder trust is a challenge: reports of opposition by nursing groups raise concerns about representation, accountability, and perceived centralisation, which—if left unaddressed—could reduce compliance and cooperation during the roll-out.

Fourth, INC continues issuing numerous regulatory notices and warnings pertaining to a fake NNMC website; such scenarios indicate that the ecosystem is still in a transition phase, where the previous regulator, INC, is still actively working in many operational areas.

Way Forward

A phased, transparent transition plan is essential. The Central Government and NNMC should publish timelines for rules, regulations, board staffing, and migration of registers, while ensuring continuity of recognition and registration services during the handover. In parallel, investing in digital registries, unique identifiers, and interoperable state–national databases can strengthen licensure integrity and workforce planning, aligning with global calls to improve health workforce data and governance.

To address quality and equity, the Assessment and Rating Board should adopt risk-based inspections and publicly available ratings, while the Education Board should increase the adoption of competency-based curricula, faculty development, and minimum clinical exposure standards. Finally, retention and deployment require labour-market reforms beyond regulation: states can adopt proactive recruitment systems, transparent postings, career progression pathways, and rural incentives—approaches already highlighted as necessary for closing HRH gaps in public facilities.

Conclusion

The National Nursing and Midwifery Commission Act, 2023 embodies a major regulatory reform deliberated to modernise nursing and midwifery governance in India by replacing the 1947 INC framework with a commission supported by specialised autonomous boards and coordinated state commissions. However, during the ongoing transition period, its legal authority and functions remain intact until the NNMC is enforced nationwide. Effective implementation of the model can enhance transparency in education quality, strengthen ethics and licensure, and improve workforce data for planning.

However, real-world gains will depend on managing the transition, building institutional capacity at national and state levels, and addressing workforce retention and distribution challenges that regulation alone cannot solve. Collaborative governance with states and nursing stakeholders, combined with investments in quality assurance and decent work, offers the best pathway to translate the law’s objective into safer care and stronger health systems.

About The Contributor

Aananya Atri, MA and UGC-NET in Political Science. Research and Editorial Intern at IMPRI. She is passionate about public policy, research and academic writing.