KATHMANDU: Nursing is regarded as a prestigious profession in Nepali society. Many parents go to great lengths to help their children pursue a career in nursing.
However, concerns have been growing over increasing government restrictions on nursing colleges, making it harder for students to study nursing in Nepal.
Nepali nurses have long expressed frustration over limited job opportunities and low pay. Complaints are also rising about students being forced to study in India due to challenges in Nepal’s nursing education system.
Yesterday marked World Nurses Day, celebrated annually on May 12 to commemorate the birth of Florence Nightingale, the pioneer of modern nursing. This year’s theme was “Our nurses. Our future. The economic power of care.”
On this occasion, we present an excerpt from an interview with Chandra Kala Sharma, President of the Nepal Nursing Association.
What is the current state of Nepal’s nursing sector as the world celebrated International Nursing Day on May 12?
Florence Nightingale’s birthday, celebrated as International Nursing Day, marks her 205th birth anniversary on May 12. Sadly, the condition of the nursing sector in Nepal is extremely poor. Government hospitals are plagued by problems, and non-government health institutions face a different set of challenges.
While government hospitals may follow service guidelines as per government standards, private institutions often do not. Nurses in private health institutions are compelled to work for salaries ranging from NPR 8,000 to NPR 15,000.
This is despite having spent around NPR 700,000 to 800,000 on their nursing education. With such low wages, it’s nearly impossible for them to afford basic living expenses in cities like Kathmandu.
The salary problem is widespread. Even in civil hospitals under the Ministry of General Administration, technical human resources—nurses included—have been working on a contract basis for the past ten years, which is deeply concerning.
Nurses, who are the backbone of the health system, face numerous professional obstacles. In government hospitals, there is little scope for career growth. Many nurses retire from the same position they were originally appointed to.
Promotion and professional development are often tied to working in remote areas. But without enough positions being opened in such regions, this policy becomes a barrier rather than a support. This has caused significant discontent in the nursing community.
We are currently discussing various options with the government to promote the professional development of nurses—such as defining how many years of service should be spent in remote versus accessible areas. We have already submitted a memorandum to the Ministry of Health outlining these demands.
How many levels are there in Nepal’s nursing sector?
Nursing positions range from level 5 to level 11. Certificate-level graduates start at level 5, and more highly qualified nurses advance up to level 11. Unfortunately, many long-standing posts have not been upgraded, and no new positions are being created. As a result, nurses seeking government appointments find few opportunities.
What salary and benefits do nurses receive?
In government hospitals, nurses receive the basic pay scale set by the government—but allowances such as risk and night differentials are no longer paid. In 2066 BS, nurses struck to secure these allowances, and the government briefly implemented them.
But those payments have since been discontinued. Nurses care for patients 24 hours a day and face the highest occupational risk. We continue to demand restoration of risk and night allowances, along with experience-based increments.
Nurses rarely protest publicly. Why?
When necessary, nurses do take to the streets. In 2066 BS, nationwide nursing strikes won a jump in the annual clothing allowance from NPR 150 to NPR 7,000, plus temporary risk and night allowances.
More recently, nurses at Nepalgunj Medical College successfully petitioned the Ministry of Labour and won reinstatement of promised benefits. We stand ready to strike again if our essential demands are ignored.”
How many nurses are registered and how many are actually working in Nepal?
The Nepal Nursing Council lists about 100,000 registered nurses. Of these, 10–20% have already migrated abroad, and nearly 40,000 hold verification letters for overseas employment.
Domestically, roughly 18,000 nurses work in public health institutions; 30,000–35,000 serve in private or contract roles. The nurse-to-patient ratio remains critically imbalanced—where WHO recommends one nurse for every 5–6 patients, our nurses often manage 35–40 patients. To ensure quality care, vacancies must be created to correct this mismatch.
Why are so many nurses emigrating despite the local shortage?
Low salaries and poor working conditions drive migration. Private hospitals pay only NPR 10,000–15,000, yet nurses invest NPR 700,000–800,000 in their education.
With scant allowances or career advancement, nurses have little motivation to stay. Unless we improve service facilities and create promotional pathways, we will continue to lose skilled staff.
Could the government recruit foreign nurses to fill gaps?
That would only address symptoms, not causes. Instead, the government must enforce its own circular (issued 27 November 2081 BS by Health Minister Pradeep Poudel) requiring private and non-government hospitals to match public-sector service benefits.
We are distributing that circular to every private hospital and urge the government to monitor compliance and penalize violators.”
Has the sector improved in recent years?
Progress has been minimal. A few large hospitals have opened limited vacancies, and some development committees have hired nurses, but government-level postings remain stagnant. We continue to press for nurse-to-patient ratios that meet minimum service standards at all health-care facilities.”
What about the One School, One Nurse program?
The program is rolling out slowly. A handful of provincial governments have placed nurses in schools, with the Nursing and Social Divisions jointly training school nurses. We also propose one nurse per factory employing more than 50 workers to safeguard occupational health. This recommendation is part of our formal demands to the Ministry of Health.
What is the Nepal Nursing Association doing for new graduates’ futures?
In my five months as president, we have submitted demand letters to the Health Minister and Secretary outlining needs such as risk allowances, rank promotions, and parity with doctors in policy-making. We are devising policy proposals to stop excessive private-sector exploitation and create an environment that encourages nurses to build careers here rather than leave.
Why does nursing still lack respect, even among patients and policymakers?
Nurses are the backbone of patient care, providing round-the-clock services. Yet public awareness of their vital role remains low. We are conducting awareness campaigns to elevate the profession’s status among patients, health workers, and government bodies.
What further steps are needed to retain nurses in Nepal?
To retain nurses in Nepal, several key steps must be taken. First, there is an urgent need to restore and standardize risk and night shift allowances, ensuring nurses are fairly compensated for the challenges and demands of their work environment.
Equally important is the expansion of career development opportunities by opening new posts and creating clear promotion tracks up to level 11, which would provide motivation and long-term career prospects for nurses.
The government must also ensure that the Health Minister’s circular regarding nurses’ rights and benefits is uniformly implemented across all hospitals, avoiding discrepancies and unfair treatment.
Additionally, establishing permanent nursing positions in schools and factories would not only expand employment opportunities but also strengthen preventive and community-based healthcare services.
If these measures are effectively implemented, they could significantly reduce the outflow of nursing professionals abroad and help build a more robust and committed nursing workforce for Nepal’s healthcare system.If these measures are enacted, we can curb migration and build a stronger nursing workforce for Nepal’s health system.
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