EDITORIAL: Shortage of nurses

There is a huge demand for nurses in the developed world, and it is easy to tempt them with good pay and facilities

A shortage of nurses in state-run hospitals could put the country’s healthcare system under increased strain in the coming days, dampening the government’s effort to provide quality care to its citizens. According to the Nursing and Social Security Division under the Department of Health Services, the government health institutions employ just 15,000 nurses as against a demand for three times that number. This backlog is largely because of the government’s failure to increase the number of posts for nurses in the last 26 years despite an increase in the number of hospital beds and exponential growth in patient numbers. The nurses are thus overloaded and overworked. The widening nurse-to-patient ratio has telling effect on service delivery, with frequent complaints about the nurses’ rude behaviour and poor attendance to patients. Big health institutions, such as the Bir Hospital and TU Teaching Hospital (TUTH) in Kathmandu, for instance, are simply overwhelmed by an influx of patients from every nook and corner of the country. Other specialised hospitals face a similar situation during outbreaks of diseases, which have become commonplace, putting undue stress on the nurses.

While government hospitals are already constrained by a shortage of nurses, retaining them is becoming even more difficult, forcing the health institutions to hire them on short contracts. TUTH is the first choice of most nurses, but it sees them moving out in droves year after year despite the good facilities and perks offered to them. There is a huge demand for nurses in the developed world, and it is easy to tempt such professionals from countries like Nepal with good pay and facilities. About 91,000 nurses, auxiliary nurse midwives and foreign nurses are registered with the Nepal Nursing Council. About 7,500 nurses graduate annually from the 120 nursing colleges in the country.

Managing the huge number of nurses generated annually in the country is a challenge that the government can ill-afford to overlook. A good deal of the problem of underemployment of unemployment of nurses could be resolved if the government were to create posts in the hospitals and recruit them. Ideally, a nurse should be attending to just six patients in a general ward, four in a paediatric ward or one in an intensive care unit. But in Nepal, you might find a nurse tending to twice or even three times the number. With the expansion or addition of new units in government hospitals, such as the Bir Hospital, they will require additional nurses by the hundreds. There must be no procrastination in staffing the state-run health institutions with the required number of nurses so as to maintain the desired nurse-to-patient ratio. It is also desired that the nurses are given appropriate pay, especially in the private health centres. It costs anywhere between Rs 300,000 and Rs 1.2 million, depending upon the level, and a lot of endurance to become a nurse, and it is only right they are well reimbursed for the hard work that they put into taking care of the patients. Only when there is appropriate pay, a secure future and professional security, will the country be able to prevent qualified nurses from seeking greener pastures abroad.

Power for local levels

The central government is gradually handing over power to the provincial and local levels when it comes to sharing natural resources, including water, mines, mountains and forests. Sharing of water resources for building hydel and irrigation projects will help boost economic activities at the local and provincial levels. Recently, the government transferred 25 per cent share of the income from natural resources to the local levels, which they can invest for the well-being of their communities.

In yet another development, the Ministry of Energy, Water Resources and Irrigation is amending the Electricity Act in the current session of the Federal Parliament. Once this Act is amended, the local levels will have the authority to select promoters to develop hydel projects with a capacity of less than 3 megawatts. The draft bill envisages allowing the local levels to award contracts to build such projects. Until now, all types of hydel projects are decided by the central government. The centre will only decide on such projects if they are located in two provinces. This provision will include the three tiers of government in sharing of power and water resources as per the spirit of the federal system.