Nurses administer medicine to a patient at Kanti Children’s Hospital in Kathmandu, Nepal.
KATHMANDU, NEPAL – Anu Banjara, 19, says she used to dream of becoming a qualified nurse because of employment opportunities in the field. She had heard from her friends who were nurses that she could start working soon after completing the required three-year certification course.
Banjara started preparing for the examination to enroll in a Proficiency Certificate Level nursing program after passing her School Leaving Certificate examination in June 2013 in Kathmandu, Nepal’s capital. A month later, she also passed her nursing course entrance examination.
In August, Banjara joined the Holy Vision Technical Campus, a private college near her house. The course costs 435,000 rupees ($4,350). But she is confident this investment will guarantee her a job after graduation.
“My dream to become a nurse will be fulfilled,” she says. “I will be self-dependent after three years of studies.”
Government health care policies have increased the number of hospitals and health care posts across Nepal, which has led to a demand for qualified nurses. These initiatives have elevated Nepalese society’s perception of nursing from a job for young women from disadvantaged backgrounds to a sought-after profession by young women nationwide. Universities and colleges are attempting to meet the demand for qualified nurses by offering nursing studies as a core vocational training course. Rigorous training has also opened job opportunities abroad to nurses, which has made female nurses popular brides for Nepalese men living overseas. The government aims to make the profession accessible to all students by requiring public and private institutes to grant scholarships and considering tuition caps.
In the 1990s, the government introduced policies to improve and to expand the coverage of health care services in the country, says Daya Laxmi Vaidya, president of the Nepal Nursing Council, the government body that formulates national policies on nursing, develops nursing curricula, controls registration of nursing colleges and issues all nursing certifications.
The government adopted the National Health Policy in 1991, Vaidya says. Then, it launched the Second Long-Term Health Plan for 1997 to 2017, which continues to guide the development of the health sector today.
These policies have been leading to the expansion of facilities in existing state hospitals, as well as the development of new private hospitals nationwide and smaller health care facilities and posts in rural areas, Vaidya says.
There are 132 government hospitals and 366 private hospitals in Nepal, says Ashish Adhikari, a consultant for the Department of Health Services, citing figures from the Ministry of Health and Population. As the number of hospitals increases, the demand for nursing staff continues to grow.
Nurses are eager to work at the well-known, well-equipped government hospitals in Nepal because they receive an attractive salary in a timely manner and transportation, says Dr. Bhojraj Adhikari, a medical doctor and associate professor at Bir Hospital in Kathmandu.
As the number of private hospitals increases in Nepal, even newly qualified nurses can get jobs, Ashish Adhikari says. This attracts young people to the profession.
Bindila Gautam, 22, who completed her Proficiency Certificate Level training two years ago, found a job at the private Anmol Hospital and Research Centre in northern Kathmandu three days after she got her final exam results, she says. After working there for a year, she got a job at the private Nepal Medical College in Jorpati, a city in the Kathmandu Valley.
“I got the opportunity to work at the hospital where I studied,” she says. “That was my dream.”
Her starting salary at Nepal Medical College was 14,000 rupees ($140) per month, she says. After three months, the hospital increased it to 16,000 rupees ($160).
In comparison, a primary school teacher in Nepal, who must also complete a three-year undergraduate course, earns 13,840 rupees ($138.40) a month.
“My sister and I are both nurses,” Gautam says. “We are providing for the family with our income.”
The rise in nursing jobs also increased respect for the profession in Nepalese society.
Before, people tended to perceive it as a last-resort career for young women who could not get employment elsewhere or were from disadvantaged backgrounds, including women who were widows, unmarried, abandoned by their families or from lower-income groups, Vaidya says. Parents were generally reluctant to let their daughters study nursing, as the profession required nighttime duties and care of men.
This began to change in 1973, when the late Princess Prekshya Rajya Laxmi Devi Shah took up nursing studies, which sparked interest among the general public, Vaidya says. Since then, it has developed into a respectable profession. But until a decade ago, the nursing profession did not command the respect it does today.
The perception of the nursing profession began to change after the new health care policies in the 1990s led to improvements in health care services in Nepal, Vaidya says. People started using health care facilities more and came to see nurses as professionals. The increase in hospitals also created more well-paid jobs for nurses. Media and increased interaction with other countries further showed Nepalese society that the health care profession was respected around the world.
“The guardian who used to hide the fact that their daughters and daughters-in-law were studying nursing now feel proud today,” Vaidya says.
Because of the respect the profession now commands, the number of students studying nursing has been increasing, Bhojraj Adhikari says.
There are 247 centers in the country where students study nursing at various levels, according to the Nepal Nursing Council. Of these, the government operates 25 centers, while the others are privately owned.
Nursing studies started in Nepal in 1956 but was limited to practical training, Vaidya says. In 1972, the Lalitpur Nursing Campus introduced an academic course that has become the standard for all nursing colleges and centers in Nepal.
The policies that the government introduced in the 1990s set specific criteria to regularize and to improve standards within the nursing profession, Vaidya says. These include exams for nurses before they can obtain their nursing licenses and regular inspections of nursing colleges to ensure the infrastructure and services meet the government requirements.
From the inception of nursing studies in 1956 to December 2013, more than 45,000 students have received their nursing certification, Vaidya says.
Shankar Kant Adhikari is the director of Kathmandu Nursing Campus, which has offered the Proficiency Certificate Level nursing program since 2007.
“At present, there is an increasing trend for nursing studies,” he says. “This year, 100 students applied for the 40 seats.”
Anyone who passes the School Leaving Certificate examination with a score higher than 45 percent can apply to enroll in the Proficiency Certificate Level nursing course at schools nationwide, Vaidya says. They also have to pass the entrance exam held by the nursing campuses. After completing the basic three-year nursing program, students can work in a hospital. The bachelor’s degree in nursing requires an additional two years of practical work.
In recent years, employment opportunities for Nepalese nurses abroad have emerged thanks to their rigorous training.
“In Nepal, both practical and theoretical studies take place simultaneously,” says Ishwori Devi Shrestha, former chief nursing officer for the Ministry of Health and Population and current registrar of the Nepal Nursing Council. “So, they become skilled in three years and have no difficulty to get jobs abroad.”
Shrestha names the U.S., U.K., Australia and Canada among the most lucrative destinations for Nepalese nurses. The wide scope for employment in foreign countries has led to the increasing interest in the nursing profession among Nepalese women, she says.
Because of the ease of getting a job abroad as a nurse, there is also a strong preference among Nepalese men living abroad to marry nurses, Shrestha says.
Deependra Bhandari, 28, won a visa through the U.S. Diversity Immigrant Visa Program and has been living in in the U.S. for three years. He returned to Nepal in 2013 to undergo a traditional arranged marriage. He searched for a nurse as his bride after seeing many Nepalese nurses working at hospitals in the U.S.
“There are demands for qualified nurses abroad,” Bhandari says. “Even if they do not get suitable jobs, they can initially work as caregivers. I know many men who have married nurses and are dependent on their incomes.”
In 2013, he married Ayushma Neupane, a nurse working at Shahid Gangalal National Heart Centre in Kathmandu. Neupane continues her job while making arrangements to move to California, the U.S. state where her husband lives, in March 2014. She plans to study for a bachelor’s degree in nursing once she gets there.
“I will be moving to California in a month with my husband,” Neupane says. “I will continue my studies along with work. I want a career in nursing.”
Although studying nursing has become more popular in recent years, it can still be too expensive for some students.
To increase the access of students from remote, rural and poor communities to nursing studies, the government has reserved 10 percent of all spots at government nursing colleges as full scholarships for eligible students, Shresthasays. Additionally, the government has made it mandatory that all private colleges must provide a full and half scholarship for at least two such students in every academic session.
Officials at the Ministry of Health and Population are also discussing measures to limit the fees for the Proficiency Certificate Level nursing course at private colleges to 400,000 rupees ($4,000), Shrestha says. Some private colleges currently charge up to 500,000 rupees ($5,000) for this course.
The fee for the full nursing course at government centers ranges from 150,000 rupees ($1,500) to 200,000 rupees ($2,000), Shrestha says.
But for Banjara, the price tag is worth it. She is confident that once she qualifies as a nurse, she will not struggle to find employment as her brother has struggled in a different field, she says.
“My 24-year-old brother has completed [a] master’s in management but is trying hard to get a job,” she says. “I do not have to be unemployed as my brother.”
GPJ translated this article from Nepali.
No sources in this article are related.
