Not all recent high school graduates standing at crossroads lean toward the obvious scholastic choices such as degree courses in Arts and Commerce, and not all aspire to become doctors.

But those who seek a field of study in medicine that allows them to provide humanitarian services to society have the option of pursuing a Bachelor of Science in Nursing.

Nursing education started under the Ministry of Health in 1956. The faculty was recognised as part of the university programme when it came under the Tribhuvan University’s Institute of Medicine in 1972.

Since then, nursing has been taught on various university campuses, affiliated colleges, and government and private health education institutions. Around 50 colleges affiliated with various universities and institutes, including Tribhuvan University, Kathmandu University, Pokhara University, Purbanchal University, Council of Technical Education and Vocational Training and BP Koirala Institute of Health Sciences (BPKIHS), offer nursing education to students from Staff Nurse to Doctorate level degrees.

A major driving factor for those pursuing this particular field of study is the easy availability of jobs in foreign markets, as it also increases access to residency statuses.

Following the recession in 2008-09 and protests from nursing unions, these processes became significantly more complex, resulting in a sharp dip in the import of foreign nurses.

However, a recent bilateral agreement between Nepal and the United Kingdom on health partnership on August 22 has opened the door for Nepali nurses to work in the island nation.

As per the agreement, potential candidates must have completed Staff Nurse, Bachelor’s Degree in Nursing—Bachelor of Science in Nursing (BSc) or Bachelor of Nursing (BN)—or Master’s in Nursing from a recognised institution. They must also hold an active professional licence from the Nepal Nursing Council and have at least two years of experience in a registered hospital in Nepal. Nepali nurses will receive the same rights, privileges, protection and dignity as health professionals from the UK, as per the agreement.

Although this has opened up an avenue for Nepali nurses, the question arises whether Nepal’s fragile healthcare system can cope with the out-migration of skilled healthcare workers.

Nepal faced an acute shortage of healthcare staff when the Covid-19 pandemic hit the Nepali shores. The media reported extensively on how health workers were stretched thin. With other countries demanding skilled healthcare workers, the Nepali healthcare sector could potentially face a shortage of skilled human resources in the future.

According to the Nepal Nursing Council, 72,550 nurses, 36,825 auxiliary nurse midwives, 847 foreign nurses, 645 specialists, and 31 midwives had been registered in Nepal as of August 16 this year.

Despite students pursuing nursing, the dearth of nursing staff has increased the nurse-patient ratio in government and private hospitals alike.

Prof Goma Devi Niraula, director at the Nursing and Social Security Division under the Ministry of Health and Population, says that the division or the ministry has not officially formed any policy regarding sending nurses to another country but suggests that Nepali students must opt for nursing not only for job prospects but also for one’s aspirations to serve society.

Niraula said that when such a policy is formed, the recruitment process should prioritise nursing graduates who have completed their courses and are searching for jobs.

“When the framework for the recruitment process is prepared, it should at least refrain from hiring nurses who are already in the system and are working at various hospitals,” said Niraula. “We have hundreds of graduates who are jobless or nurses working at various private health institutions and are paid a meagre salary. Those students or nurses should be prioritised.”

The government should also focus on formulating a retention policy for nurses who are already working in the system, said Niraula.

“The government has invested in further training of the nurses who are already working, and when such skilled workforce leaves their jobs, it is a loss both for the healthcare sector and the government,” Niraula said. “The stakeholders must develop a retention policy apart from the regular salaries including residency, transportation, allowance, and timely promotion.”

Furthermore, increased hiring of nurses for health institutions in Nepal should be made a priority to minimise the nurse-patient ratio gap.

“Although nurses at government hospitals receive salaries starting from Rs32,000, which moves up as per the position and the grade, the frustration regarding the work pressure among nurses is growing due to the disparity in nurse-patient ratio,” said Niraula. “We should also focus on decreasing that, and the best way to do it is to hire more nursing graduates and enrol them into the system.”

Associate Professor at the Karnali Academy of Health Sciences Sharmila Shrestha points out that the nurse-patient ratio can be reduced if the concerned stakeholders meet certain requirements.

“First of all, the government should hire nurses in various government hospitals facing staff shortages, and it should also work towards filling the vacant nursing positions,” said Shrestha. “Introduction of various retention policies can also help encourage our nursing staff to stay in the country and provide their service.”

Shrestha, who also works as chief nurse at Nepal-Bharat Maitri Hospital, said that apart from scholarships provided by the educational institutions, they should also focus on tying up with various health institutions for job placements after the completion of studies.

Furthermore, according to Shrestha, positive messages about the nursing sector could also help increase student enrolment in the field.

“There is also this concept that the nursing sector is a low-paying job, and much has to do with the negative media coverage regarding the sector. It must change,” she said.