Nursing Status, Common Challenges & Issues 

 

Words by Pushpa Koirala

Nursing stands as the cornerstone of healthcare, embodying both the art and science of compassionate care. American Nurses Association (2021) states that nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity” 

Nurses today need to be more educated and prepared to adapt to the rapidly changing technologies, emerging new diseases, changing demographics of world population and overall healthcare environment. Nurses require specialized knowledge and competencies to navigate the healthcare delivery system, such as leadership, research, integration of innovative technology and working in expanded roles and settings. Nursing education and practice needs to move towards a patient-centered philosophy, higher standards for safe, quality care, with a stronger emphasis on information technology, scientific research, evidence-based practice, and interprofessional collaboration.

As healthcare evolves, so must nurses. The ever-changing landscape demands specialized knowledge, technological prowess, and a patient-centered ethos from today’s nursing professionals.

Current Status & Scopes in Nursing

Nurses comprise the country’s largest health care professionals providing health care services in diverse setting and fields as a front line health care provider. The scope of the nursing profession is growing with each passing days. Their doors are open to a number of job options in diverse sectors, such as armed forces, schools, voluntary organizations, universities, health service, clinics, private and public hospitals and healthcare providers. Graduates find opportunity to work as children’s nurse, health visitor, high-intensity therapist, midwife, physician associate, mental health nurse, and adult nurse. They even have the option to work as academician, counselor, social worker and health service manager.

In Nepal nurses work as ANM (Auxiliary Nurse Midwife), Staff Nurse, Nursing Officer, Public Health Nurse, Nurse Midwife, School Health Nurse, Public Health Nurse, Chief Hospital Nursing Administrator, Community Nursing Administrator, Community Nursing Officer, Hospital Nursing Administrator, etc. in Hospital & Community Setting. Nursing graduates have great career opportunities in abroad like USA, UK, Australia and Canada. 

Number of Registered Nurses 

According to Nepal Nursing Council till 17th march 2024 total 82,471 nurses, 1507 were specialist nurse, 66 midwives nurse, 37420 Auxiliary Nurse Midwives, and 849 foreign nurses were registered. There is no factual data on the current number of nurses working in Nepal. As per the data available from The Kathmandu Post published in February 1 2023   approximately 22,000 have been serving in government health facilities and around 35,000 have been serving in private centers hospitals, nursing homes and clinics. And thousands have changed their profession due to a lack of opportunities and exploitation in the private sector. 

From the front lines to diverse sectors, nurses play a pivotal role in healthcare. Their scope encompasses a myriad of roles, from caregivers to counselors, shaping the well-being of individuals and communities.

Nursing Education in Nepal

In Nepal, Nursing Education was started in 1956 in Lalitpur, Nepal. There is PCL, Bachelor’s, Master’s and Ph.D. level Nursing programs offered by Tribhuvan University and other national Universities.  The duration of course in nursing at various levels are different. For example, ANM: 18 months, PCL Nursing: 3 years, Bachelor of Sciences in Nursing (BSN): 4 years, Post Basic Bachelor in Nursing Sciences (PBNS): 3 years, Master in Nursing (MN): 2 years, KU M.Sc. in Midwifery: 4 years. TU has Started PHD in nursing since 2012 with intake of two students per year.

Proficiency certificate level (PCL) in Nursing Program

In Nepal PCL nursing program was started from Institute of Medicine, Tribhuvan University in 1956 AD. The authority to produce other PCL nursing program was given to Council of Technical Education and Vocational Training (CTEVT) in 1999 AD. Since 2000 AD, several private PCL nursing campuses were established under CTEVT. Currently in Nepal various colleges offers PCL Nursing in affiliation with CTEVT. Lately Nepal is trying to phase out PCL level nursing in favor of B.Sc. Nursing. 

Bachelor in Nursing Program

Bachelor in Nursing Program Mahabuddha Nursing campus (presently Maharajgunj Nursing Campus) started post basic bachelor level program in 1978 AD (2035 BS). In 1977 (2033 BS) Bachelor of Nursing in midwifery was introduced, furthermore programs in community (1980), adult (1983) and pediatric (1984) nursing were gradually introduced.

Bachelor of Nursing (BNS)

In 2013 AD a big change was made in Bachelor in nursing program with the addition of basic science courses, English and computer. The duration of course was made three years from two years. There are numerous nursing colleges, offering either BNS or B Sc. Nursing or both under TU, BPKIHS, PU, KU, PAHS or NAMS either as constituent campus or affiliated campuses.

B.Sc. Nursing Program

B.Sc. Nursing program was started in BPKIHS, Dharan in 1996 AD (2053 BS) at first. Gradually this program was started by different universities and institutions. The course duration is 4 years.

Master in Nursing, Master of Science Nursing and Midwifery

Master of Nursing Program was first started in Maharajgunj Nursing Campus in 1995 AD. Different universities and colleges offer Master in Nursing (MN), Master of Science (MSc) Nursing and Midwifery course in Nepal. 

Ph.D. in Nursing

Ph.D. in Nursing was started in 2012 in Nepal. 

 

Common Challenges facing nursing profession

Nursing Shortage

Nursing shortage is a serious challenge in the healthcare industry. Nursing shortages have a high impact on working environments, patient outcomes, and the long-term health of nurses, leading to longer shifts and higher nurse-to-patient ratios. This shortage increases stress, fatigue, and the risk of injury to nurses. It can also reduce patient care. In the State of the World’s Nursing report, the global nursing workforce was estimated at 27.9 million nurses; nine out of ten nurses worldwide are female. The global shortage of nurses was estimated at 5.9 million nurses. Nearly all (89%) of these shortages were concentrated in low- and lower middle-income countries. In Nepal currently 45000 nurses are working in various health facilities. Among 55 countries Nepal is included in World Health Organization red list facing a severe shortage of healthcare workers. More than one third of the 115,900 nurses registered have sought documents to practice overseas. About half of the Nepal’s migrant nurses went to the United States, followed by Australia and Dubai. Just over 500 have already migrated to Britain.

New Health Education System Policy

Nepal’s health education system is now governed by the National Medical Education Act-2075 and Regulations-2077. National Medical Education Act-2075 and Regulations-2077 led to collapse of a total of 72 PCL nursing colleges and 24 graduate-level colleges. These colleges have lost billions of investment in teaching institutions. This loss of financial resources, jobs, and supply of health workers for the economy is a very serious issue that needs to be addressed. Lately a House committee sent a directive to the government to allow nursing colleges without their own hospitals to resume their academic programmes, however, this has landed controversy. Nepal has been facing about 56,050 health professional shortages, according to an MEC survey. There are about 10,139 health service providers, and the demand for such health service providers has yet to reach a desired level.

Workplace violence

Workplace violence is one of the global health concerns. Although nurses are the backbone of the health care provision, they are facing violence in healthcare settings which has negative impacts on nurses as well as organizational achievement. One hospital based study found that out of 402 nurses 94.5% face verbal abuse, physical violence is faced by 17.6%, and sexual harassment by 4%. Among the perpetrators, 40.5% of workplace violence was done by patients’ relatives, 29.1%by patients, 24.2% by staff, and 6.1% by management.

Workload

Nurses who work in hospitals must deal with various challenges, including long working hours, high nurse patient ratio, etc. As a result, nurses are unable to rest and are overworked. A heavy workload can lead to decreased nurse performance and poor communication between patients and nurses, which can impact the patient’s condition and the quality of nursing services. Furthermore, a heavy workload might cause imbalance between work and life, reducing nurses’ quality of life. Again, increased nurses’ workload can lead to physical, mental, and emotional exhaustion. 

Navigating the challenges of nursing: From workforce shortages to workplace violence, nurses face multifaceted obstacles. Yet, their dedication to care remains unwavering, calling for systemic support and recognition.

Job stress

Job stress is another challenge faced by nurses today. There are multiple factors such as patient-care demands; professional issues, work environment, organization policies and procedures are associated with job stress in nursing. Personal- and family-related issues also play a vital role in causing stress for nurses. Work stress may contribute to absenteeism and turnover, both of which detract from the quality of care. A study in Nepal found that 95.6% of nurses have mild to moderate level of stress in Government Hospital and in Private hospital 79.1% faces mild to moderate and 20.9% faces severe level of job stress in Private hospital. 

Changing Schedule

Nurses’ shifts sometimes change from one week to the next, which can make it difficult to adjust to the schedule. For example, a nurse may work morning shift for one week and night shift the following week, sometimes there may be a daily variation in the work shift. Constantly changing schedules can interfere with sleep patterns, physical and other health related problems. So, it’s important to get as much rest as possible between shifts.

Physically Demanding Job

Nurses’ duties are often required to perform physically demanding duties such as helping to lift, reposition, transport patient, carry heavy objects and stand for long periods of time with few breaks. These types of jobs cause regular strain on body and can lead to injury.

Migration of Nurses

Nurses’ immigration is the major challenges today faced by the country. The decisions to migrate among Nepalese nurses are influenced by multiple factors. One nurse listed three problems nurses face: lack of respect, low wages and overwork. Indeed, nurses have to work for as little as Rs15, 000 a month in private hospitals in Nepal after spending millions on their degrees. These are all results of neglect of the nursing profession by the state. It is therefore hardly surprising that nurses are moving overseas to meet a global shortage of healthcare professionals. Health workers tend to go where the working conditions are best. One study revealed that the general factor provoking migration was bad nature of politician (98.6%) followed by political instability (90.5%) and non-availability of job (90.5%). The major working condition and social factors provoking migration were occupational security in other country (85.10%) and peer influence (91.9%) respectively. The reasons for migration as mentioned by respondents were education (59.50%) followed by better job opportunities (40.50%), better living standard (21.60%) and family and/or peer pressure (8.10%).

Underpay

Nepali nurses have made their reputation in the international markets but it is found that they are paid very low here in Nepal in spite of heavy workload and longer duty hour in most of the nongovernment health institutions. Moreover, the private nursing homes who are charging huge amounts to the patients are giving low salaries and less facility to nurses involved in their healthcare.

Workplace safety and security

Nurses face a number of workplace hazards in a hospital or clinical environment. As nurses come into direct contact with sick people, their risk of exposure to someone with an infectious illness is much higher than that of the general public. They are also risk for needle stick injury, hand washing related dermatitis, flu, cold and exposure to blood borne pathogens. Thus, this is one of the serious issues nursing professionals’ faces. 

Working Conditions

In hospital setting the nurses are facing challenges working in high nurse patient ratio, high turnover, too much nursing documentation, lack of recognition, disparity of salary, ethical dilemma with restricted resources makes them more prone to fatigue and burnout. These overall leads to decline in quality care to the patients.

Changing technology

The fast-developing technology plays an important role in changing nursing profession in Nepal. Technological advances in healthcare require nurses to learn new software, programs, and equipment frequently. Learning new systems can be challenging for nurses and healthcare workers who aren’t familiar with technology, especially when added to an already demanding job. Technology moves at a very fast pace, and new advances can have an immediate impact on the way nurse’s work, requiring nurses to continually learn and update new skills.

Conclusion

In the face of multifaceted challenges, nurses remain steadfast in their commitment to care. From the persistent shortage of nursing professionals to the ever-evolving landscape of healthcare technology, each obstacle underscores the vital need for collective action and support. Governments must prioritize the well-being of nurses by addressing systemic issues, ensuring workplace safety, and providing avenues for professional growth and resilience. As we confront the uncertainties of tomorrow, let us stand in solidarity with nurses, empowering them with the resources and recognition they deserve. Through collaboration, advocacy, and a renewed dedication to holistic care, we can fortify the foundation of nursing and usher in a brighter, healthier future for all.

Check Also

USA CDC on COVID-19 Vaccine-Related Deaths

Recent revelations from The Epoch Times shed light on a controversial issue surrounding COVID-19 vaccines …

Sahifa Theme License is not validated, Go to the theme options page to validate the license, You need a single license for each domain name.