Updated Aug 29, 2015 by adding photos. Also, be sure to click on the hypertext. Sept 8th update: In May I wrote a companion piece, be sure to read that one too! Click here
What are the titles given to “nurses” in Nepal?
A.N.M. – Associate Nurse Midwife. analogous to a Licensed Practical Nurse (LPN) in USA. this was a one-year program for nurses, (help me: is it one or is it two?) and there are fewer of these programs than there used to be, which is why most A.N.M.s seem to be “older.”
PCL – Proficiency Certificate Level – the basic preparation. This is a 3-year program, usually sponsored by a hospital. The curriculum for PCL level nursing is thoroughly regulated and centralized by C.T.E.V.T. – the government agency that controls vocational education. Historically, CTEVT serves a useful function in standardizing nursing education. Also, CTEVT schools adopted a policy to support enrollment of minority students into PCL level, essentially a quota system. At the CTEVT site is a database of all CTEVT schools including address and contact information.
The language of instruction in many schools is English. the texts are generally from India or U.K.
There is a different agency that coordinates college-based education.
To get admitted to PCL nursing, a young woman needs the School Leaving Certificate – also known as “SLC” – given around age 16. the SLC exams are a big source of anxiety, because the results dictate your future. There is also such a thing as “SLC +2” – which is essentially the equivalent of a high school diploma. the +2 component adds some science and math classes.
A student can get admitted to PCL nursing at age 16, and graduate at age 19. Every nurse with PCL is also automatically a qualified midwife and usually has delivered 10 or so babies. The curriculum includes community health classes.
Most often, PCL students live in a hostel provided by the school. On the CTEVT site, one school listed the typical tuition as about 224,000 Nepal Rupees (nrs). at the current exchange rate of 87.2 rupees to the US Dollar, that is $2,563.03 which may not seem like much to an American, but which is substantial for a Nepali.
The PCL student gets a lot of clinical practice, and in fact, is used as a cheap source of labor by the hospitals. Hospitals in Nepal tend to follow a “functional nursing” pattern, and this is what is taught at PCL level. The functional system is the most successful when the charge nurse – the “didi” – is effective. The didi is the one person on the nursing staff who knows the whole picture of the patient; other staff mainly function in the role of task workers.
faculty at PCL level are often around 20 years of age – it is not unusual for a faculty to be a recent graduate of the same school where she now teaches. Such a person often relies on perpetuating the same system that was learned and has no further training in teaching pedagogy. The assessment skills are not necessarily any more sophisticated than those of the students. Usually the “Principal Ma’am” is older and more experienced in administration.
B.N. – after two years of clinical practice, the PCL nurse is eligible to enroll in a B.N. class, and this also involves clinical practice along with coursework in research and community health and teaching projects. The B.N. curriculum is two years in length. So in other words, a BN nurse has three years of education, two years of practice, and two years of additional school (seven years!)
For those thinking of going to USA? might as well answer this one right here. If you are thinking of coming to USA to work as a nurse, you will need to complete many many steps. If you only have SLC and PCL, it is very unlikely that you will get a USA license. The minimum is SLC+2 and PCL; but it is much better to get BN or B SC. I have done other blogs on this topic . I get asked about this over and over.
B. Sc. – This is new in Nepal. In the past five years there are more programs in which a woman who has SLC+2 can go to a college course for nursing. This trend mirrors the trend in international nursing education. At present, there is considerable controversy within Nepal about the B. Sc. nurses. the problem seems to be that they are viewed as not having enough clinical experience; some people think that the real problem is that the B Sc nurse is more likely to question the doctors and be assertive, which presents a challenge to the patriarchical system of medicine in Nepal. In general, the schools do not have well -equipped libraries or learning labs with manikins and simulated learning the way USA schools do. Click here for the graduation video of one of the B Sc schools.
BS degree – this is new. The problem with the BN degree as designed, is that it promotes “Churn” – the person taking it has to leave their job, just as they are getting good. The BS degree will remedy this.
Trends: One interesting trend which is still developing is that of young Nepalese citizens who go abroad for further study and get a basic nursing education with a BSN in UK, USA, Aus or India then return to Nepal. To re-adjust to the Nepali system of clinical practice after only working in a USA hospital is not an easy feat. Likewise, with the growing number of Nepalese nurses practicing abroad due to poor economic outlook of Nepal, there is a question of how these nurses would change Nepal if they ever returned in large numbers when the economy improves.
Future of PCL education is something that is under discussion. There are rumors that all nursing education will be re-designed into some other system but I do not have firm information about this.
M.N., M. Sc, and PhD in Nepal – I will save discussion of this because I do not know enough about trends in this level. I don’t pretend that I am expert on basic nursing for that matter – if you think I have missed something, then help me!
In any case, there are a number of nurses in Nepal who have obtained graduate degrees outside the country, usually in other Asian countries such as Japan, Thailand or the Philippines. Some go to Europe or Australia.
Nurse manpower – It is a paradox in Nepal that many of the nurses use their education to leave the country and seek employment in Australia, India or the U.K. or use it to bolster their chances of getting a more desirable husband via the system of arranged marriage in Nepal. The health sector in the country is heavily dependent on foreign charitable support.
– there is a government body known as the Nepali Nursing Council – NNC – which serves as the governing body. This group oversees the system of licensure. At this time, they are implementing a mandatory license exam for new graduate nurses. This is given twice a year. The NNC site provides data as to the number of nurses in Nepal:
Current Registration Status Up to 31 January, 2013
NURSES : 19098
ANM : 19851
FOREIGN NURSES : 739
TOTAL : 39688
(please note that the total of “foreign nurses” includes those from India, usually working in Terai. It is very rare indeed to see a “foreign nurse” from a western country who has a Nepali license.)
Nursing Association of Nepal
New Nursing Schools and New Hospitals
There has been a recent surge in applications to create new nursing schools, just as there has been a surge in new hospital construction. In the opinion of this writer, this presents a challenge to the health establishment of Nepal – balancing the need for the student to expect a quality education with the need of the hospitals to exploit inexpensive labor sources.
Issues, Opportunities and Challenges
This is the subject for ten future blogs. Nepal is a country of 26 million people and the government is evolving after years of instability.