Nepal honoured its nurses for their contribution and service to society with various ceremonies on Nepal Nursing Day on January 29, but the annual ritual rarely touches on the challenges in their daily lives, the health professionals say.

Nisha Pandey, who holds a BSc in Nursing from the Nepal Army Institute of Health Sciences, says she sees her future in the United States because the pay here is so low.

The monthly salary of nurses in most private hospitals in Nepal is in the range of Rs10,000 to Rs15,000, insiders say.

“I spent more than Rs1 million to complete my BSc Nursing,” said Pandey. “But in Nepal, there is no decent pay. When will I recover the investment I made in my studies by working for Rs15,000 a month ?” she asked. “The best option is to apply for a foreign job.”

According to Pandey, nurses in the US receive $38 an hour on average, and there are better opportunities for overall professional growth than in Nepal.

Pandey isn’t the only nurse who’s thinking of going abroad. Hordes of nurses are leaving the country primarily due to labour exploitation here.

Shreejana Baniya works as a nurse in a reputed private hospital in Kathmandu. She gets a salary of Rs15,000 per month. “I work overtime and earn Rs20,000 to cover my basic expenses.”

A senior nurse at the hospital earns up to Rs35,000 per month. Baniya too has decided to go abroad.

Nurses in Nepali hospitals complain that they are not paid as per their qualifications.

“They pay me Rs12,000 a month,” said an unnamed nurse who works at a private hospital in Kathmandu. “I had to wait for two to three months to get my salary.”

In 2021, the government fixed the minimum monthly salary at Rs15,000 for all categories of workers, except those in the tea sector.

But nurses in many private hospitals are exploited. At least four nurses whom the Post talked to said they were made to work a 12-hour night shift without overtime pay.

According to the Labour Act 2017, employers cannot make their labourers work for more than eight hours a day and 48 hours a week.

An employee who is asked to work overtime should be paid time and a half their regular wage.

The law also states that employers shall procure annual medical insurance of at least Rs100,000 for each worker. The premium should be paid by the employer and the employee on a pro-rata basis.

The employer also has to procure accident insurance worth Rs700,000 for each employee and pay the entire insurance premium.

Nurses also complain that private hospitals make them work in unsafe conditions.

“The patient-to-nurse ratio in the ICU of my hospital is 5:2, and in the general ward, it's more than 30:2,” said a nurse who works in a private hospital in Jhapa. “The tasks we do are above the prescribed limit. It’s overload.”

Government hospitals are better, but it is difficult to get in because of few vacancies.

The minimum pay of staff nurses in government-owned hospitals starts at Rs34,730 per month. An officer level employee gets Rs41,678 per month.

Private hospitals admit that the issues raised by nurses are genuine.

Mira Pokharel, the nurse in charge at Everest Hospital, Baneshwor, says the major problem in nursing in Nepal is lack of motivation and appreciation.

Pokharel fears that the alarming rate of nurses leaving the country might lead to a scarcity in Nepal in the next five years. "The main reason for this is low pay and fewer career growth opportunities in Nepal," she said.

“I have heard that some hospitals even pay as little as Rs8,000 to Rs10,000 per month,” said Pokharel. “But we have a starting salary of Rs15,000 for freshers. We also have insurance, overtime pay and flexible working hours to allow further studies.”

Nurses and private hospitals blame the government for not doing enough to improve the nursing profession in Nepal by providing adequate tax concessions, scholarship opportunities and safety at the workplace.

“Nepali nurses are skilled and well qualified, so they are quickly accepted in any foreign country,” added Pokharel. “It's really challenging for us to retain them with what we are offering with our limited resources.”

The government blames the private sector for exploiting nurses by underpaying them.

Speaking at a programme on Nepal Nursing Day, Health Minister Padam Giri said, “It’s a matter of concern to know that private hospitals have been employing nurses for Rs8,000 to Rs10,000 without meeting even the minimum criteria.”

Minister Giri directed private hospitals to open online accounts for their nurses and deposit the salaries into them so that the government could check the accounts whenever required.

“We will investigate this issue seriously,” said Minister Giri. “If required, we will even revoke their licences.”

According to Prof Sarala KC, president of the Nepal Nursing Council, the problem of underpayment is rampant. “Even nurses in expensive and famous private hospitals are underpaid.

“The hospitals that charge their patients hundreds of thousands of rupees are the ones that aren’t paying their nurses fairly,” said Prof KC. “These hospitals are also employing fewer nurses which directly increases their workload.”

The government liberalised nursing education in Nepal in the mid-1990s, and promoted the entry of the private sector into nursing education. Before that, only government-owned institutions provided nursing education, and the government had tight control over the quality and quantity of the nurses produced.

“The unhealthy competition among private institutions since the 1990s caused the imbalance between demand and supply of quality and quantity of nurses,” said Prof KC. “Its direct impact can be seen on the salary of nurses.”

According to the council, the World Health Organisation has listed Nepal in the red zone due to the scarcity of adequate medical workers in proportion to the total population.

The International Nursing Council, the global regulatory body of nursing, has also been pressuring the Nepal Nursing Council to prevent the outflow of nurses from the country.

According to the data of the Nepal Nursing Council, there are around 110,000 nurses in Nepal, and 73,514 among them are registered with the council.

Around 22,000 nurses are employed in government hospitals and 35,000 in private hospitals.