The Future of PCL nursing education route in Nepal

May 20, 2015 update: I reposted this on Nurses of Nepal and I expect a lot of hits today. Evidently, there is a new exam for the second-years of PCL throughout the country. The vast majority of students, nationwide, failed this exam.  My first reaction is, I hope this exam was not devised by the people who design SLC exam – the SLC exam is extremely poorly conducted. My second reaction is, my opinion about PCL has not changed. We need to only admit students with SLC PLUS TWO.

Update: Within two hours after posting this in Feb 2014, this post got 120 views. I can see that people are interested. If you go to the right, click on “subscribe to this blog.” Go ahead. You know you want to!

There are two present controversies in Nepal regarding nursing education. (okay, there’s probably more, but this is what I want to focus on today).

background: I have taught nursing at a PCL-level program, one of the best in the country. I have visited many schools of nursing and I have also taught my program of critical care nursing to about 700 nurses, from all levels of program. I have a Nepali RN license.

PCL nursing needs to be phased out

The first controversy is whether to continue PCL nursing education.  This is the basic education for a nurse in Nepal. after completing SLC at age sixteen, a young woman goes to a three-year program usually sponsored by a hospital. Any hospital of any size can start a PCL nursing school. The faculty do not need to be very experienced. The main reason the hospitals want these programs is because the students provide free labor to run the hospital.

The drawbacks of this approach are: because there is no “plus two” requirement for admission, if the nurse wishes to go abroad to work, they need to start their nursing education all over again.

Next, these programs emphasize “functional nursing” and the accomplishment of tasks, but do not emphasize the thinking and problem-solving skills needed by nurses when more complicated care in needed.

Third,  when the hospital is small, it can’t afford a basic library, and there are not enough patients to provide a well-rounded exposure to the care of sick people. Many of these schools are not accredited.

For these reasons, mero vicarma is that PCL should be phased out. Nursing candidates absolutely need “Plus Two” before they start.

It should be noted that the Nursing Council has attempted to limit the number of new schools, but has been over-ruled by political entities.  This is intimidating and makes it difficult for Nepali leaders to speak out for fear of losing their jobs. To me, this interference with professional standards is not a good thing. Also, I have heard that one of the major hospitals in Kathmandu (which offers both PCL, B Sc and BN nursing tracks ) tried to phase out PCL education, and there was an “andolan” protesting this decision. ( it did not receive much attention in the press, I was told of this second-hand). The protesters were short-sighted in my view. Why should they protest a raising in standards? they need to know the truth: that PCL graduates are at a tremendous disadvantage in the job market, both in Nepal and abroad. A Nepali PCL graduate who does not have plus two, will never get an RN license in USA unless they re-do their entire education.

Scope of multiple educational tracks

The next problem is the overlapping scope of educational track. This one is a bit more difficult to understand at first. Here is what happens – a staff nurse job is posted, and the nurses who apply will have either a PCL, BN or B Sc degree. They are expected to do the same kind of work regardless of their educational background.  It is because the system has not changed.

This is actually similar to what happens in USA, where we have nurses with Associate Degrees and Bachelor’s Degrees. These days, many USA hospitals are instituting policy to only hire nurses with a BSc.

I am told that when B Sc and BN nursing levels were first developed, these persons were always hired into an in-charge role. Now, my opinion is, even if we phase out the PCL level nurse, we still need to have people in staff nurse roles, and so a new BSc nurse should still start out as a staff nurse in a hospital. That is how it works in USA.

The difference is in the way the nurse carries out their job. A PCL nurse is trained to do the best of “functional nursing” that can be done. A B Sc nurse is taught to think differently about the unique needs of their patient and to apply a higher level of critical thinking. The hospitals with more B Sc nurses will be moving away from just ” functional nursing.”

A related issue is that the new B Sc programs do not offer as much clinical practice time, and the people who hire the nurses do not think they have enough experience. The B Sc programs have learning laboratories, and I think that as they become more experienced with use of the learning laboratory, this aspect will improve.

What do you think?

I know that that there will be people who disagree, and I also know that many people don’t even want to discuss this because it divides the nurses who ought to be more united. I invite feedback from every reader. Please make a comment. If you are not comfortable with making a public comment, send it to me via email and I will publish it after removing your name.

PS if you are not sure about what I mean when I say “functional nursing” you may wish to read up on it before you comment.