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Recently, the idea of nurses practising independently has been gaining momentum in Indian health policy circles as well, and the Ministry of Health and Family Welfare (MoHFW) is contemplating the introduction of nurse practitioners (NPs) in primary healthcare. We briefly assess the policy environment for the role of NPs in India. We argue for the need to conceptualise health stewardship anew, keeping the nursing profession in mind, within the currently doctor-centred health system in India. We argue that, in the current policy environment, conditions for independent nursing practice or for the introduction of a robust NP in primary healthcare do not yet exist. Introduction Nurses constitute a major proportion of the health workforce, and some of the innovations in health Enhancing the autonomy of Indian nurses MEENA PUTTURAJ, PRASHANTH NS Authors: Meena Putturaj (corresponding author–meenaputturaj@gmail. com), Research Officer, Institute of Public Health, 250, 2 C Main, 2 C Cross, Girinagar I Phase, Bangalore 560 085, INDIA; Prashanth NS (prashanthns@ iphindia.org), Faculty, Institute of Public Health, 250, 2 C Main, 2 C Cross, Girinagar I Phase, Bangalore 560085, INDIA. To cite: Putturaj M, Prashanth NS. Enhancing the autonomy of Indian nurses. Indian J Med Ethics. 2017 Oct-Dec:2(4)NS:275-81. DOI: 10.20529/ IJME.2017.058 Published online on May 30, 2017. Manuscript Editor: Vijayaprasad Gopichandran ©Indian Journal of Medical Ethics 2017 workforce management across the globe have focused on task shifting to non-physician health workers, such as nurses, to decentralise and transform the health system. Apart from playing their traditional roles, nurses in a few countries are performing extended roles with titles such as advanced practice nurse, nurse practitioners (NPs), clinical nurse specialists and nurse anaesthetists. Nurses practise independently in several high-income countries, such as the USA, Australia, Canada, Ireland, the UK, Finland and the Netherlands, and even in some middle- and low- income countries, such as Thailand and Nigeria. In some of the provinces of these countries, the nurses need to have collaborative practice agreements with the physicians to practise independently. There is evidence across the globe to show that NPs are increasingly being used as the point of first contact and that patients are as, or more, satisfied with NPs than doctors (1,2). The cost of health service is also lower with NPs. Several studies have found that there is no difference between the clinical outcomes with NPs and general practitioners (1,2). In recent times, the concept of independent practice by nurses has gained significant momentum within India’s health policy circles as well. The Ministry of Health and Family Welfare (MoHFW) is contemplating the introduction of NPs in primary healthcare and is already in consultation with the Indian Nursing Council (INC –the national regulatory body for nurses and nursing education) and other stakeholders to take the move forward. The aim of this article is to examine the issues involved in independent nurse practice and its relevance in India.