Strengthening Nurses’ Influence in Health Policy Decision-Making in India: A Nursing Perspective

Abstract

Nurses constitute the backbone of India’s healthcare workforce, delivering care at the community, primary, secondary, and tertiary levels. Despite their critical contributions, their representation in health policy decision-making remains limited, and their voices are often underutilized in shaping national health priorities. This review article critically examines the role of nurses in health policy decision-making in India, barriers to their involvement, and strategies to strengthen their influence from a nursing perspective.The primary aim of this review is to analyze available evidence on nurses’ participation in health policy-making and to propose approaches that empower them to become influential stakeholders in shaping the healthcare agenda. The methodology employed was a narrative literature review of peer-reviewed articles, reports, and government documents published between 2005 and 2025, sourced through PubMed, Scopus, CINAHL, and Google Scholar. The inclusion criteria involved studies focusing on nursing leadership, health policy engagement, advocacy, and healthcare governance in India and comparable low- and middle-income countries.The results revealed that although nurses constitute more than 60% of the healthcare workforce in India, their participation in policymaking is minimal. Key barriers include hierarchical structures dominated by physicians and bureaucrats, lack of policy education in nursing curricula, inadequate mentorship, gender-related challenges, and limited exposure to advocacy platforms. Successful case examples from global contexts highlight how structured leadership training, nursing councils, policy fellowships, and academic–policy partnerships can enhance nurses’ roles in decision-making. The discussion emphasizes the urgent need for systemic reforms to ensure equitable representation of nurses in policymaking. Integrating health policy education into nursing programs, strengthening the role of nursing associations, encouraging nurse-led research, and promoting mentorship opportunities are essential. Furthermore, creating reserved policy positions for nurse leaders at state and national health bodies would ensure inclusivity and diversity in decision-making processes. Strengthening nurses’ influence in health policy decision-making in India requires a multipronged approach involving education, leadership development, advocacy, and institutional reforms. By empowering nurses as policy advocates, India can advance towards a more equitable and responsive healthcare system aligned with universal health coverage goals.