Should Every Nursing College in Nepal build their very own hospital? Of course not!

Swasthya Khabar needs to stop attacking and start helping

So there has been a series of newspaper articles in Swasthya Khabar that investigate issues within the nursing profession of Nepal. These have been written in Nepali language, and I start by admitting my Nepali is poor. I use Google translate to get the idea of what they are saying. I think these articles are prompted by the recent results of the nursing licensure exam in which only about a third of nursing college graduates achieved a passing score. Also, there is a desire to use the press as a way to develop public opinion for a plan that will guide further development of nursing as a worthy profession in Nepal.

Outside a nursing college classroom in Kathmandu. In Asian culture, shoes are removed before entering a room.

Naturally the general public needs to learn about the best way to proceed and that is a noble goal to guide the Nepali press in a democracy. All Nepali families wish to support the success of their younger members, and many young persons see the possession of a nursing degree as a ticket to employment in a Nepali hospital or as a vehicle to go abroad and see the world while sending remittance home. They can do this while serving humanity. There is nothing wrong with these aspirations.

Graffiti from the stairwell of a nursing college in Kathmandu. Nursing students often live in a hostel fro three years while studying. The curriculum is regimented and disciplined. Families often accrue debt to send their daughter to nursing college.

The most recent Shasthya Khabar article is: .

The title is:

नर्सिङ शिक्षामा मनपरी : यी ९३ वटा कलेजका आफ्नै अस्पताल छैनन्

स्वास्थ्य, शिक्षा मन्त्रालय, काउन्सिल, सिटिइभिटी र विश्वविद्यालयकै कर्मचारीको मिलेमतो

This is devoted to a discussion of how many of the nursing colleges in Nepal are associated with a hospital. Oh My God! Ninety three are NOT! Now, the fact is, most major hospitals in Nepal operate their own nursing college in the first place. But there are colleges that would be called “free-standing” if they were located in the USA. In fact, the vast majority of nursing colleges in the USA are “free-standing” and it does not hurt the nursing education offered to students in USA.

The reader is invited to look at the Swasthya Kahbar article. I have written a long comment at the bottom, which I will repeat here, edited to improve formatting:

Here is my specific reply to the article in Swasthya Khabar:

(begin quote) This article has strayed from the real issues in nursing education planning. The direction of the article is to accuse all the 93 nursing colleges of breaking the law and suggesting that these colleges need to be penalized. ( and the list of offenders is included, implying that the leaders lack integrity. Are they trying to shame the colleges or would they do better to find a solution?) That is not the way to proceed.

First, it is simply ridiculous to suggest that any nursing college now open their very own hospital with all that it entails. Will the Campus Chief of each nursing college suddenly become a hospital director, employing Medical Officers and Surgeons and operating an Emergency Room and Operating Theater? That idea in itself is ridiculous – of course not. We already have a situation where any group of doctors that can pool their money to build a “hospital” can do so, without any real planning or oversight by any level of government. Why adopt a policy that requires more building construction without consideration of hospitals that already exist nearby?

“Affiliation Agreements”

In USA, it is the general practice for colleges of nursing to operate independently from owning their own hospital, and this would be okay for Nepal too. Of course, in USA each school is required to have an arrangement with the nearby hospitals to allow their students to go there to learn how to take care of patients. Nepal would do well to adopt that approach. A hospital needs nurses, but staff nurses are expensive because to be paid, so it is typical for many of the hospitals in Nepal to start their own nursing college. The labor of the students substitutes for the paid labor of staff nurses. This is a lesson in “economics 101.” In USA these agreements for students to serve at hospitals not owned by their school are called ” affiliation agreements” and the existence of such an agreement should be the proper subject of investigative journalism, not whether the college owns their own hospital.

A better way to explore the issues in nursing education

If you are searching for ways to inform the public about ways to improve nursing education in Nepal, you might consider other areas of reform, such as rewriting the PCL curriculum; re-assigning the development of the PCL program to the Nursing Council and not CTEVT; establishing a higher level of education as a requirement for entry to nursing college in the first place; reforming the overall education system to support women who wish to study science topics; re-assessing the nurse license exam so as to reflect better measuring techniques, and the like.

As for me, it’s true that I am a videshi, but I write a lot about nursing education in Nepal since twelve years. You are invited to read my blog, . Now, there are areas in which nursing education in Nepal can improve, but this article is simply not helpful in describing what those areas may be. Anybody who wishes to discuss this with me is invited to find my blog and make a comment. (end quote)

Does that make any sense to you?

I do think the concept of affiliation agreements is already part of the system being described, but there seems to be selective choice to focus on some other idea in the current situation, and I think the focus needs to be maintained on the quality of education, not the presence or absence of a shiny new building that lacks a reason to serve the public.

Feel free to comment below.

About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it 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. 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.
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1 Response to Should Every Nursing College in Nepal build their very own hospital? Of course not!

  1. A Nepali nurse now living abroad wrote a reply:

    Firstly, lots of nursing colleges that are affiliated don’t meet the criteria. Even those with their own hospital, don’t meet the standard. I have witnessed both college and hospital inspection (one of reputed one). I am not sure about affiliation for placements of students is on the basis of the related hospital or not, but the college sends students to government hospital, not in the associated hospital.
    Regarding nursing in Nepal, I agree that we need to reform whole education system starting from curriculum, teaching method, practice approach, and evaluation methods. Education system in our country focuses on knowledge and memory rather than ability to tackle the situation and problem solving. Evaluation system seeks for how well a student can memorise books, not how he/she can solve the situation. Accepting students in hospital for practice comes with a great responsibility. Students are new to the hospital environment. But if we look into any government hospital, there will be more than 10 students in a single ward from multiple colleges at the same time with 2-3 RNs to guide them. How students are supposed to learn nursing standards in this environment?
    On the other hand, our nursing profession lacks policies and protocols. While threat of public harassment is increasing, we nurses are not prepared for legal consequences. First reason of this is, we lack our own national guidelines & manuals for nursing procedures. A student nurse can go to hospital and put on cannula just after observing RNS doing the procedure few times. There is no skill test before a student can perform the procedure on actual patients. Second, We still lack proper documentation. Most of them are end of shift reports, not right after the incidents. And third, when such incidents occurs, hospital makes agreement with heavy compensation to the family without even assessing the root of the problem.
    There are lots to change. But if we talk about recent failure in NLEN examination, improvement should be made starting from education system. Then only we can produce quality nurses who can bring revolution in our profession.
    Lastly, All the statements I made may not be true for every nursing colleges and hospitals.
    Its really good to see you raising voices for nurses in our country.

    ( note: I requested permission to use her name but have not heard back yet.)

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