When A Dream Turns Into A Labyrinthine Nightmare

12 min read
20 May 2016
12 min read
2199 words
Most nursing grads are not getting hired by hospitals. Many have to work for years as volunteers. and they may still never get a full-time job
Most nursing grads are not getting hired by hospitals. Many have to work for years as volunteers. and they may still never get a full-time job

Such certificates have become merely pieces of paper for many nurses like her who are struggling to get hired. And yet, every year more and more students keep getting enrolled in the mushrooming nursing institutes in the country—because most of them hope to find jobs in countries such as Australia, Canada, the UK and the US. “Or because they are forced by their families to study nursing in the hope that they can get married to a Nepali there who is seeking to marry a nurse,” says Sagun Bhandari, BSc Nursing Coordinator at Yeti Health Science Academy.

The pull of the West is obvious. In the US, Registered Nurses earn on average USD 58,372 a year, and in Australia, they make AUD 55,017. Thus many students get lured into joining nursing programmes without first understanding the reality of what they are getting into. Finding work abroad is not as easy as the grapevine makes it to be. And the reality of the market here is that it is saturated with nursing school grads who can’t find work.

Most newly minted nurses have to work as volunteers in private hospitals for six months, a year, or sometimes even longer, as they are made to wait for a permanent slot that never seems to open up. “Some volunteer nurses are either paid half the salary, or are maybe provided with lunch. But most of them are working without pay,” says Bhandari. There is no guarantee that they will be hired as a full-time employee later on because hospitals can easily get another volunteer from the ever-expanding pool. And so the cycle goes on.

Even for a seasoned nurse educator like Bhandari, no matter how familiar she is with the problem, it’s still difficult for her to wrap her head around it. “I graduated in 1999 from Lalitpur Nursing Campus, and I started working as a staff nurse right away, the day after my results were published,” says Bhandari. For today’s graduates, however, the market fundamentals are markedly different. In the last two years, Joshi has applied for a job at more than 20 institutes, including private hospitals and NGOs—wherever she thinks she might be able to get a leg in the door. When she graduated, she had dropped her CV at more than ten hospitals. She was told she would hear from them when a vacancy came along. But she never did. She consoled herself by thinking that she was just biding her time. That in time, she would be able to find a way to the US.

“The starting premise that nursing can help you go abroad is a faulty one,” says Bhandari. “When I first started practising as a nurse 17 years ago, many of my fellow nurses went abroad because the passage was easier.” In the late 90s and around early 2000, countries such as the US who faced a shortage of nurses, opened their doors to nurses from around the world. Their governments issued work visas to foreign nurses, and the US even offered green cards to competent foreign nurses if hospitals could hire them first.

But because of the economic downturn in the US—the great recession—in 2007-09, more and more American citizens who couldn’t find a job in other sectors enrolled in nursing schools and entered the hospitality sector. The US government has regularly tweaked visa regulations and requirements according to how many of its own citizens have been filling the demand. But Nepali nurses still think that there is a bright future in the US and other first world nations awaiting them.

That dream of a better future has led nurses to firmly place their belief in their degree. After her +2, Joshi came to Kathmandu from her hometown of Kanchanpur to pursue a bachelor’s degree in public health. “But the institutes that I consulted only wanted to talk about nursing and its ‘ever-increasing’ scope,” she says. It took a whole year for Joshi to convince her parents, and as she waited for her parents to make up their mind, she enrolled in a BSc Physics back home in Kanchanpur. A year later, with her parents finally on board, she dropped out of the Physics programme and finally came to Kathmandu, again, for good, to become a nurse. “I think about that bus ride every day,” she says.

Sagun Bhandari, BSc Nursing Coordinator at Yeti Health Science Academy

But by the time Joshi came to understand the employment problems that plagued the nursing sector, she had already graduated. When she had enrolled for her nursing course, besides the marketing pitch that the educational institutes had made to her, she had been swayed by the stories that were making the rounds among her neighbours and relatives: that nursing students fresh out of schools could easily land jobs abroad and everyone knew so and so who had found such jobs. What she didn’t have a clue about—as an 18-year-old with scant information about visas, green cards, the ever-changing job market abroad—were the challenges that students had to overcome to get to the promised land.

According to Bhandari, most of the stories that nurse hopefuls like Joshi hear, goes like this: “If you graduate from a nursing college here and then pass the National Council Licensure Examination, then you can find a job in the US. Many of these hopefuls think that they can then get married to a Nepali working abroad.” But most Nepali nurses who figure in these stories post 2008 actually were already married to a Nepali US citizen. Because the women already had a green card, they could get a nursing education, and then subsequently a job. But the echo chamber here distorted that story: back home in Nepal, hopefuls like Joshi thought that many of these nurses first got a green card through their job and then married a Nepali there.

The stories about Nepali nurses in Australia—another country of opportunity— is slightly different. If a Nepali student has the means to pay between AUD 26,000 to 32,000 (and that’s not even taking into account the living cost) every year for four years, then she can become a nurse down under. That means, only students who can afford to pay such huge sums can become nurses in Australia. For nurse graduates here, they have to go through convoluted processes: they have to first get a good score in the IELTS, and then get registered with the Nursing and Midwifery Board. If the nursing education they had is deemed not to have been up to standard, then they have to enrol in a bridging programme. These examinations  and training programmes require a lot of investment, in terms of effort, time and additional funds. And even after going through all the hoops, many of them end up working as aides in nursing homes.

Then there’s the competition from all the nurses in other third world countries who want a job abroad too. Nepali nurses have to compete with large pools of nurses from the Philippines, the largest exporter of nurses worldwide, where the nursing curriculum dovetails easily with American nursing curricula, and with nurses from India and Sri Lanka, among others.

Laxmi Rai, Registrar of the Nepal Nursing Council

And despite this grim state of affairs, back home in Nepal, nursing institutes keeps proliferating—today, there are in the country 50 Auxiliary Nurse Midwife (ANM), 36 Bachelor’s in Nursing, 107 Proficiency Certificate Level (PCL), 45 BSc Nursing and 6 Master’s in Nursing (MN) institutes. Nepal is thus producing more nurses that the hospitality sector is willing to employ as paid professionals.

It’s not that the sector doesn’t need nurses. “The optimal nurse-to-patient ratio is set at 1:6 for general wards and 1:1 for ICU,” says Bhandari. “In Nepal, however, more than 30 to 40 patients are being taken care of by a single or sometimes two nurses, who are usually just volunteering.”

But because private hospitals are, at the end of the day, motivated to make profits, for them to hire nurses only means additional cost. And that is why they opt for roping in volunteers from the ready pool of recent graduates of the nursing schools. “The Nursing Council doesn’t allow hospitals to get nurses as volunteers anymore,” says Laxmi Rai, Registrar of the Nepal Nursing Council.
“When I Was A +2 Graduate, If Someone Had Provided Me And My Friends Some Counselling, And Had Explained What Was Going On, We Would Have Opted For Another Major”
The problem, however, is that it is difficult for monitoring bodies like the Ministry of Health to regulate the activities in hospitals. Because the Ministry of Health oversees the operation of the hospitals and Ministry of Education regulates the nursing institutes, there is always a huge area that goes unmonitored. “Now, however, Nepal Nursing Council is also planning to oversee, along with academia, the health sector,” says Rai. “But for that the Nepal Nursing Council Act has to be changed.”

To help create jobs for nurses without jobs, the National Planning Commission has already formulated strategies to create openings for nurses even in non-hospital settings such as schools, industries and organisations, the implementation of which is slowly starting. “But will those openings be enough to provide jobs to the unemployed nurses that the country has right now, and to all the nurses who are still being produced,” asks Joshi.

Many of the unemployed nurses could be deployed to Nepal’s rural areas. But even with such proposals, there are problems. Both Bhandari and Rai say that there aren’t enough hospitals in the rural areas that can take them in. Most health workers who do work in these areas only work in health camps conducted by various NGOs. “But to land even those positions, you need to have a public health background, rather than a nursing one,” says Joshi, who has applied for these openings numerous times, to no avail.

“It would perhaps make more sense if the production of nurses was stopped right now, for a few years at least, until the situation becomes a little better,” says Joshi. “That might make it much easier to regulate the supply to match the demand.”

“But that would mean that the government has to figure out what the demand is first, for which there is no proper database or information system yet,” says Rai.

Lack of information or misinformation about options for nurses is what got Joshi into the trouble she is in now in the first place. “When I was a +2 graduate, if someone had provided me and my friends some counselling, and had explained what was going on, we would have opted for another major,” says Joshi. “The health institutes and the government need to give the right information to their incoming students so that they can make an informed decision about their career options. As for me, I am worried that it might already be too late.”