Independent Practice as a Nursing Practitioner

Commentary
DOI: https://doi.org/10.54393/nrs.v3i02.61

SING & MIDWI

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Volume 3, Issue 2 (Jul-Dec 2023)

Independent Practice as a Nursing Practitioner in Pakistan: “Opportunities and

Amir Sultan1
¹Tasleem College of Nursing and Health Sciences, Swat, Pakistan
*nursingwithamir@gmail.com

ARTICLE INFO
How to Cite:
Sultan, A. (2023). Independent Practice as a Nursing Practitioner in Pakistan: “Opportunities and Misconceptions: Independent Practice as
a Nursing Practitioner . NURSEARCHER (Journal of Nursing & Midwifery Sciences), 3(02). https://doi.org/10.54393/nrs.v3i02.61

Pakistan is the fth most populous country in the world, third in Asia, and second among Muslim countries. According to
World Bank data, the poverty rate was 39.3% in 2020–21 and is expected to remain at that level in 2021–22 [1]. The health care
system of Pakistan includes public, private, and trust hospitals. The World Health Organization estimates that there are 7.8
doctors for every 10,000 people and 3.8 nurses and midwives for every 10,000 people [2]. The number of doctors and nurses is
below the required level, and many health professionals travel to developed countries in search of a better future and
professional development. In the past 5 years, the increasing number of nursing colleges in the country indicates
satisfaction for the healthcare industry to overcome the de ciencies. A nurse practitioner is a specialized program of
nursing practice that performs independent practice within certain limits [3]. Nursing practitioner (NP) practices were rst
authorized in 1960 due to a physician shortage, and in Pakistan, only Aga Khan University hospitals have begun a two-year
advanced practice nursing program. The concept of health and practices in developing countries were in uenced by the
United States, where 26 states have fully authorized nurse practitioners and 24 states require nurse practitioners to work
under the supervision of physicians. In order to task-share with physicians in the UK, mid-level practitioners (MLPs), such as
physician associates (PAs) and advanced nurse practitioners (ANPs) have been employed [4]. In a developing country like
Pakistan, the national assembly makes an amendment to the Pakistan Nursing Council Act, 1973, in Section 2(m) that
provides an opportunity for nursing practitioners to practice independently. On one side, the news has a feeling of motivation
and happiness among the nurses; instead of welcoming such a revolutionary act, unfortunately, the other health
professionals have seriously criticized this act and considered this amendment "legal cover for the quacks". A misconception
is created through social media that every nurse has given the status of (NP) “Nursing practitioner”, while the amendment is
very clear regarding the independent practice of nursing practitioners: they have a two-year degree in (MSN) Master of
Science in nursing specialized in nursing practitioner, with a valid license from (PN&MC) Pakistan Nursing and Midwifery
Council for independent practice. To provide care and practice in hospitals, nurses require a license from PN&MC, which
requires a minimum quali cation of a 4-year BSN (Bachelor of Science in Nursing) degree with one year of internship from a
tertiary care hospital or teaching hospital. During hiring in health departments, nurses have a 4-year degree and a 1-year
internship and are hired in 16 grades. They have the same quali cations as other health care professionals who have a 4-year
degree and a 1-year house job and are hired in 17 grades. In the majority of health universities, nursing and other health
degrees are completed under the umbrella of one administration and examination department, and each profession has its
own curriculum and goals, while they also perform their clinical in the same a liated hospitals, so how does this professional
discrimination occur that one profession is superior and the other is inferior? Since independence, the majority of the nurses
have been hired and retired in the same grade without promotion from government hospitals and face this professional
grading discrimination. In the clinical setting, nurses work and provide care to patient's shoulder-to-shoulder with other
professionals from entry to discharge; moreover, they travel and work in the Middle East and developed countries. So how

Nursearcher VOL. 3 Issue. 2 July-Dec 2023 Copyright © 2023. Nursearcher, Published by Lahore Medical Research CenterLLP
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 Independent Practice as a Nursing Practitioner
Commentary
DOI: https://doi.org/10.54393/nrs.v3i02.61

can a nurse care for and work in developed countries? It is very important to accept the existence and importance of each
profession and to use our advocacy and time for patient outcomes instead of wasting energy criticizing other professions. In
the last 10 years, a boom in the nursing profession has seemed to be a result of the importance of nursing at the international
and national levels, which has attracted the attention of students as well as their parents towards nursing. These efforts
came as a result of the active participation of nursing associations in all provinces and the sincere efforts and struggles of
the regulatory authorities, but still, many steps are incomplete and require immediate attention. In the future, nursing will be
among the top professionals who work overseas and become an asset to the country in their contribution to development.
The authorities should permit nurses practitioners to practice independently under the supervision of the Pakistan Nursing
Council and a special task force in a limited area while taking help from international organizations or nursing regulatory
bodies. Currently, the world is facing a shortage of not only nurses but all healthcare workers, which does not mean
restricting the nursing profession from moving forward but should increase the capacity of nursing production under the
theme of "no compromise on the quality of education and clinical practice." Pakistan has a good tendency to increase the
capacity of nursing professionals and can be a good contributor to the country's nances.
Authors Contribution
Conceptualization: AS
Writing-review and editing: AS
The author has read and agreed to the published version of the manuscript.
Conicts of Interest
The author declares no con ict of interest.
Source of Funding
The author received no nancial support for the research, authorship and/or publication of this article.
REFERENCES
[1] Business Standard. Poverty in Pakistan rises to over 5% in 2020, Estimates World Bank. 2021. Last Cited: [21st Dec
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in-2020-estimates-world-bank-121062200084_1.html.
[2] World health Organization. Country cooperation strategy for WHO and Pakistan 2011-2017. 2013. Last cited: [21st Dec
2023]. Available at: https://iris.who.int/bitstream/handle/10665/113228/CCS_Pakistan_2013_EN_14946.pdf?
sequence=1.
[3] Moola S, Bhaumik S, Nambiar D. Mid-level health providers for primary healthcare: a rapid evidence synthesis.
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[4] World Health Organization. Mid-level health workers for delivery of essential health services: A global systematic
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https://www.who.int/workforcealliance/knowledge/resources/mlp2013/en/.

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