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.

About Joe Niemczura, RN, MS

Experienced nursing educator and problem-solver. I have fifteen years of USA nursing faculty background. Add it with fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. I travel outside of Kathmandu Valley as well. When the recent violence happened, I knew the cities - I had trained people in those locations. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011. Global Health Nursing is not all sweetness and light; not solely milk & honey and happy moms and babies.
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19 Responses to The Future of PCL nursing education route in Nepal

  1. sushma dhakal says:

    1stly u r bsc student is dat tru n i m disagre wth ur views u r showing pcl nursing downward.bsc nurse hav poor prctl they cant perform actvity in hosptl wth the cimparsn of pcl student n y u r focusng usa hosptl n eductn system n y u r criticsng nepali eduction system.sry for disagree.

    • thank you for this reply. I know that many will disagree. As to my background: I have been a nurse since 1977. My original education was a BSc in USA. I am very familiar with Nepali education system. we need to focus on how to improve patient care and improve patient outcomes in Nepal. I don’t think it can be done unless we give nurses more authority, which requires more education. I am not writing this for the purpose of making anybody feel bad about their own background, I am writing this with the intent to create a better future. It is easy to tell me that I don’t know anything because I am a videshi, but the fact is, any Nepali person who speaks up is at risk of being labeled a troublemaker. let’s work together to create a better future for patients.

  2. sudha says:

    absolutely right our country needs change. plus two needs to be compulsery. bsc have potentiality to do but the oldies are dominating them they are not letting them to advance moreover our country are not focussing on quality . bsc knowledge and pcl practical i appreciate so rather than saying colapsing pcl its better to give new form of education by mixing both. just we can say b.sc or bn nursing including internship in final with review of curriculum n separating major subject as well. so i would like to say mix pcl and bsc. it would be better.

  3. anjali says:

    I am agree with above article though there is wrong information,that is PCL graduate can get RN license in USA.

    • please give me the names and contact info for any Nepali nurse who got RN license with just a PCL and with no any “plus two” educational background. I often et emails asking for help from nurses who have just a PCL but no any plus two. I simply do not think there is anybody out there who has done it. any body able to help me?

      • Nirmala Duwal says:

        Hello Joe,
        I have completed PCL level this year and also got registers nurse license from Nepal.
        i would appreciate if i could help you.

  4. Gaynor says:

    Just a few random thoughts about the way the Australian system works. I think we can all learn from the health systems of other countries, although it is hard to compare the health system of a wealthy country with a less affluent one.

    Basic nursing is often done by enrolled nurses (Division 2) on the general wards. Enrolled nurses undergo a 2 year course with practical placements in hospitals to gain real patient experience. They would be the equivalent of PCL I imagine but requiring plus 2 and a more academic course before qualifying. There are strict Government regulations regarding the way these courses are run, and colleges must be accredited. Enrolled nurses don’t generally work in specialised areas such as ICU, ED etc. They are medication endorsed.

    Patients (usually a group of 8 – 12) are looked after by a small team made up of both enrolled nurses and junior RNs. Supervising the enrolled nurses would be an experienced Division 1 RN/staff nurse in a senior Team Nursing role. Ratios are ideally 4:1.

    RNs with degrees and either a post grad certificate or sufficient experience can apply for positions called Clinical Nurse Specialist – a senior position with extra responsibilities particularly as mentors for more junior nurses. This means nurses with clinical expertise remain on the floor with direct patient contact rather than only having the option of in-charge positions as the means of advancement/promotion, with the loss of their clinical expertise on the floor.

    RNs straight out of uni usually work as Graduate Nurses on a one year contract – a supervised programme where the nurse rotates through various wards such as gen med, gen surg, ED, theatre – to give them the necessary experience to transition from uni to independent practice. This overcomes the problem, to some extent, of RNs not having sufficient experience at the end of their uni course.

    The Australian system isn’t perfect and unis and colleges struggle to find enough hospitals in which to place students to gain real patient experience. The RNs allocated to supervise these students are often inadequately trained for such a role and frequently too busy to make the experience worth while for the student.

  5. bimala kc says:

    Hi m also so much interest to study bn in abroad so please tell me the process. .With dependent

  6. Sunita says:

    Hi Joe,
    I definitely agree on your thoughts, and I am very glad that you have been so much familiar with Nepalese nursing education system. Nursing education in Nepal certainly needs to raise it’s standard. Yes, PCL nurses are skillful, but I don’t think they have enough critical thinking skills as BSc nurses do. As far as BSc nurse’s skills is concerned I don’t think they lack on skill because they have enough practical hours. If I have to compare US BSC nursing and BSC nursing from Nepal, I think BSc nursing curriculum from Nepal has far more clinical exposure. I have been following your blogs from way before, and I’m very thankful to you on making great impact on Nepalese nursing education system.

  7. Roshana says:

    I agree with your view. It is absolutely true that Plc nursing should be phased out in Nepal. I also did Plc nursing from Nepal and did BN too but I also feel like if I had done BSC nursing. Currently I’m in USA and my BN is not valid as a bachelor so I’m only RN not BSN RN. If I need a bachelor degree u need to study at least 2 more year to get a bachelor degree. So Pcl nursing is just a waste of time and money.

  8. Jiv says:

    Great blog!! I am shocked that PCL nursing wont be valid abroad for example USA. My wife is in Nepal and I am in USA. She is RN through PCL from Manipal in Pokhara. What I am understanding is that she cant get RN license if she just have PCL and Nepali RN license? also does she need to pass GED to get RN in USA? any information will be valuable. Thanks

    • Do not panic yet. there is more than one opinion. guess the bottom line is, each individual is evaluated separately. There are about ten blog entries here that address all the ins and outs, they are listed at right. Also, go to https://youtu.be/0F_oIRNpXm8

    • Sunita says:

      Mr. Jiv, she definitely can get US RN license if she has done PCL nursing in Nepal and has RN license from Nepal. PCL nursing from Nepal is equivalent to Associate Degree of Nursing in USA. She does not need to take GED, but she may need to take additional courses depending on her course evaluation and state Board of nursing requirement. There are tons of Nepalese nursing with PCL nursing degree working as US RN.

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