We are celebrating International Nurses Day today. The theme for this year is “A Force for Change: improving health systems resilience”.
Nurses' dedication and hard work established nursing profession as an indispensable part of health sector. As public health professionals, nurses provide care not only in the hospitals but in communities and families as well. Although the profession has gained a respectable status in Nepali society, hard work of nurses is not accorded a high value in terms of financial inecentives to this profession.
There are around 30,000 nurses in the country, and 5000 fresh gradutes are added every year. As hospitals prefer to recruit experienced and more qualified nurses, most fresh graduates do not get jobs and instead have to stay at home. Many of them volunteer in hospitals to gain experience, which could help them get job later. Some who can afford go abroad for further studies, and very few get job in private medical colleges and hospitals.
Developed countries fill nursing vacancies by enticing nurses from developing countries like Nepal that cannot compete with better pay, professional development and better life prospects offered by the former. Hence the new generation are attracted to the nursing profession only to migrate and settle in foreign countries. One study showed that 55.22% of nurses were not satisfied with their job in Nepal.
The story does not end here. For lack of opportunities in Nepal, a proportion of Nepali nurses are compelled to migrate to Malaysia and Gulf countries. What is worse is that most of them do not get jobs in hospitals or nursing homes there. Instead, they work as home care nurses and are treated as housemaids and domestic workers. One nurse who returned from Dubai described to me the lowly conditions they have to live in and emotional, psychological pressures and sexual assaults they face at the hands of their employers.
Low pay is a major issue in Nepal's nursing profession. Few nurses are paid Rs 6-14 thousand per month. With Bachelor's in Nursing (BN) degree, the pay could rise up to 20,000 rupees. To get a nursing education usually involves paying 300,000 for PCL and 1200,000 rupees or more for Bsc. Nursing. Currently, there are two groups: BSc and BN graduates. And since it’s BN that has been accepted all these years, BSc graduates are normally pushed aside when it comes to employment opportunities.
Practical aspect is core to nursing training. However, most nursing colleges fail on this except except for a few teaching hospitals in the country. This started the trend of volunteering for certain months in hospitals. I have met a lot of new nurses providing free service to hospitals for a long time. In one way, they are learning practical skills and whether they are paid or not does not seem much of an issue because they gain the practical skills they did not get in their colleges Very few get at most 2-3 thousand per month as renumeration. But personally I feel that this pay is too low as per their education and training, and work without pay amounts to exploitation.
Demand of nurses is another issue in the country. The nurse to patient ratio should be according to work load and nurses' specialization. This ratio is very low in Nepal. In Nepal, usually 20-30 occupant unit is covered by only 1-2 nurses in most hospitals. Usually, they also have to carry out non-nursing jobs which are time consuming and distract them from their work. There is a need to revise required posts and vacancies in hospitals according to health care demand in the country, growth of population and increasing clinical activities. This is lacking in Nepal.
Long working shifts and constantly changing schedules make nursing job difficult to manage with families, especially those with young children. Another serious problem for nurses in Nepal is work overload due to high number of patients and paperwork. On top of this, their work rarely get appreciated by their senior colleagues. An environment should be created where nurses get opportunity to continue their education alongside their career.
Nursing profession is great and ideal profession. To serve the ill people and help relieve their pain is not easy. It requires hard work and dedication. The state and other concerned authorities in the medical field should take measures to genuinely appreciate the work of the nurses by taking initiatives to ensure their dignity, provide them adequate financial remuneration and enforce acceptable working hours.
(Maharjan is Nursing Director, Grande International Hospital)