Nursing is focused on providing quality care to individuals regardless of personal attributes. The document discusses trends in the nursing profession globally and in Nepal. Key trends include increased education levels, specialization, and the use of new technologies. Nursing faces challenges from aging populations and resource constraints. In Nepal, issues include low funding for education, lack of faculty, and limited leadership opportunities for nurses in the health system. The profession aims to improve training, standards of care, and recognition of nursing's role.

1. Prepared by
Chanak Trikhatri

3. Introduction
“Nursing is a healthcare profession focused on the
detail-oriented care of individuals, families, and
communities in attaining, maintaining, and
recovering optimal health and functioning” (1998
in Royal College of Nursing, 2003).
According to International Council of Nurses
(ICN) Code of Ethics nurses are the individual
who need to provide unbiased, quality care to
individual and nurses are responsible for devoting
themselves to serve quality care regardless of age,
sex, race, nationality, culture, socio-economic
status, disability or illness and politics

4. Introduction
Health care is changing dramatically due to
advancement of medical sciences and technology,
the abundance of clinical research and higher
demands of consumers (Chan, S. 2002).
As a key profession of healthcare, these changes
represent a significant challenge to the nursing
profession and nursing education (Paterson, C.,
2009).

5. TRENDS AND ISSUES
• TRENDS
▫ Movement in a particular direction
▫ Trends in nursing: Development of new direction in any
particular phenomena or discipline according to time,
environment and situation (Bhattarai, S., 2010).
• ISSUES
▫ Different opinions of a particular subject
▫ Various health issues in nursing world- abstract and critical-
different critical diseases, violence against women,
women’s health , status and rights (Bhattarai, S., 2010).

6. Worldwide Major Advancement in
Nursing
• 2000 - Review of undergraduate nursing education by
New Zealand Nursing Council
• 2002 – The Nursing and Midwifery Council takes over
from the UKCC as the UK's regulatory body
• 2004 – The American Association of Colleges of Nursing
(AACN) recommends that all advanced practice nurses
earn a Doctor of Nursing Practice degree.
• 2004 - The Health Practitioners Competence Assurance
(2003) Act comes into full power on the 18 September, in
New Zealand, these cover the requirements for nurses to
have current competences relating to their scope of
practice (Bhattarai, S., 2010).

7. Advancement of Nursing Profession in Nepal
• Tribhuvan University – IOM (Maharajgunj Nursing
Campus)-
▫ MN (Adult) - 2001
▫ MN (Pediatric) - 2002
▫ Bsc-2005
▫ PhD- 2012
• Lalitpur Nursing Campus-
▫ Become independent from UMN – Jan. 2004
▫ Started MN (WHD) – 2009
▫ Started MN (Adult) –
▫ Started B. Sc. Nursing - 2011 (Bhattarai, S., 2010).

8. • Pokhara Nursing Campus
▫ BN 2006
▫ MN-
• Chitwan Medical College
▫ BN, B. Sc. Nursing, MN – 2009
• Biratnagar, Birgunj and Nepalgunj Nursing Campus
▫ BN- 2011
• Birgunj- MN- 2012
• National Academy of Health Sciences- BN-
• Purvanchal University- BN- 2001, BSC- 2005
• Pokhara University-
• BPKIHS- MN- , BN- 2012 (Bhattarai, S., 2010).
Advancement of Nursing Profession in Nepal

9. • Kathmandu University
▫ Bsc Nursing- 2005
▫ BNS- 2010
• CTEVT- PCL 2000
• Licensure Examination- 2012 (2069)
• Midwifery Association-
• Skill Birth Attendance-2006
• UGC/ NHRC- Support and Fund Provided for
promoting and motivating Nursing Research
(Bhattarai, S., 2010).
Advancement of Nursing Profession in Nepal

10. Contemporary Nursing
Currently, volatility in nursing profession is being
huge challenge itself.
 Challenges for Nursing profession are:
• Aging population
• Complex consumer health values
• Scientific advances and specialization
• Limited resources
• Health as a fundamental right
• Changing duties and responsibilities
(Bhattarai, S., 2010)

11. Global Trends and Issues in Nursing
Profession
 Evidence based practice
 Community based nursing
 Decreased length of hospital stay
 Independent nursing practice
 Cultural transitional Nursing care
 Rapid advancement in New technology
 Nursing shortage
 Increasing chronic health conditions (Bhattarai,
S., 2010).

12. Global Trends in Nursing Education
• Demands for more and higher levels of education
▫ Increased student numbers , programmes, diversity.
• Technologically sound and Knowledge based
• Abroad study certificates and distance learning
facilities
• Career oriented and focused n higher education
system
▫ Finances , Faculties ,curriculum and facilities
(Willetts, A., & Martineau, T., 2004).

13. Global Trends Contd.....
Simplification of comparison and transfer of credit
among educational programs .
Continuous professional development by changing
student profile, trend to lifelong learning
Privatization of higher education: Competition between
public and private institutions to attract students is
increasing (Willetts, A., & Martineau, T., 2004).

14. Global Trends Contd.....
Methodological advancement in teaching-learning
activities
• Practical and clinical based learning
• Promotion of self directed /active learning
• More creative and interactive models
• Assessment of learning is made more diverse and multiple
• Integration of educational technology and the use of
distance learning

15. Nursing TRENDS in Nepal
Strength
Improved image of nursing:
▫ Enrollment of students in nursing with secondary
school education and with better SLC results in
English, Mathematics and Science is increasing
▫ One of the most desired female profession (for
example in 2007, BPKIHS received 1900 applicants,
Bir Hospital nursing Campus received over 3000
applicants for 40 places...)
▫ Promising career

16. Nursing TRENDS in Nepal contd.....
Expansion of employment opportunities for nurses
Changing roles
Advancement in nursing and biomedical research
Advancement in nursing education: PhD in
IOM,2012.
Use of more sophisticated equipment for diagnosis
and therapy
Innovation in Teaching and Learning Methods:
• Interactive, student centred, impact of technology ,
skill/ simulation lab, web module, PBL etc.

17. Nursing TRENDS in Nepal contd...
Preparation of Global Nurse
Emergence of New Specialties
Increased awareness among people
New start in nursing research
Allocation of budget in health :
2009/10- 5.8%
2011/12-6.2%

18. Nursing TRENDS in Nepal cont....
 Migration of nurses outside the country:
▫ According to NNC record a total of 3461 Nepalese nurses have
gone abroad for nursing work from 2002 to October 2011
 Shortage of nurses:
• Rural areas
• Qualified nurses
• Extended, overtime shift
 Aging population:
• Population is aging
• Unique needs of the elderly- Gerontological nursing
 Changing environment and disease pattern
• Non-communicable diseases: Heart disease, Cancer, Diabetes, Renal
failure, etc. are increasing
 Tutors working half day in public and half day in private
institution: shortage , low pay scale

19. Critical Issues in Nursing Profession of Nepal in
Education
Under financing of nursing education:
▫ Poor provision of residence
▫ Poor library facilities
▫ Migration of expert faculties
Enrolment issues:
▫ Difference in total academic years of various course.
▫ Implementation is being done to make 3 years BN
course.
▫ Plan is to shift PCl Nursing course from University level
to CTEVT

20. Critical issues contd....
Nursing curriculum:
▫ Gap between theories taught and actual practice
Lack of doctorial preparation faculty to teach master’s
level
▫ Less competent –unable to guide and supervise
subordinates
▫ Educational level of many senior nurses is below or at
the bachelor level only.
▫ Emphasis on the years of experience for promotion
requirement increases the possibility of occupying
higher leadership nursing positions by nurses with less
educational qualifications and less competence.
▫ This ultimately, denies young capable nurses
opportunity to provide dynamic leadership.

21. Critical issues contd....
 Image of nursing itself in the society
• Taken more as an academic programme
• Huge demand all over the world
• Huge number enrolling in nursing
• Readily chosen by girl with high social status
• The entry level qualification to enter nursing is still
considered low as compared to other developing
countries

22. Critical issues In Clinical Practice
 Poor evaluation system:
• Lack of performance appraisal
• Lack of encouragement for sincere workers
 Lack of quality of nursing service
• Provision of affiliation without fulfilling requirements
• Profit based market
 Health service structure:
• Very conservation in nature
• Only doctors are placed in high policy making level in the
health structure
• After government abolished Department of Nursing from The
Ministry of Health in the early 1900s, nurses have been denied
of the right to manage and control nursing services.
• In the absence of common platform where nurse's voice could
be heard collectively, the frustration continues.
• Further, only limited positions are included for nurses in health
structure at the national , regional and district level that allows
to take leadership role

23. Critical Issues in Nursing Administration
 Poor job description and lack of autonomy
• Even having established job description, poor understanding and
execution
• Lack of proper specification and monitoring
 Position of nursing leaders:
• Who are in leadership positions are not given authority
that matches their responsibilities
• Those having the authority sometimes, are unable to use it
adequately and appropriately in lack of managerial skills
that should have been developed through leadership
training and staff development programs
 Lack of supportive legislation: B.Sc. Nursing , H.A and
Staff nurse, affiliation
 Increased work load
 Lack of recognition

24. in Nursing Administration
Apathy prevailing upon both leaders and followers:
• Lack of proper staff development opportunities
• The political scenario of the nation
• Limited scope for holding top positions- Burnout
syndrome
• Excessive absenteeism, rapid turnover, low productivity
and sense of helplessness - apathy and anger.
Lack of assertiveness among nurses:
• Involves thinking through goals and acting consistently
with own values
• Lack of self esteem has contributed to lack of
assertiveness

25. in Nursing Administration
Heavy political influence in nursing:
• Political parties-NAN and NNC
• Political influence affects many facets of education.
Mainly, it is used to start new private nursing
education institutions without qualified faculty and
with little control over quality.
Managerial problems:
• Over centralized decision making and control
• Limited authority to campus –course content , staff
management, limited authority of campus chief and
inadequate teachers.

26. Critical issues in nursing research
Lack of nursing journals and research
• Lack of evidence based practice
Limited publications
Ethical issues in nursing research
Lack of pure nursing research

28. Potential problem
 Shortage of skilled nurses due to migration
and absenteeism (Chaudhary & Hammer,
2003)
 Lack of leadership and initiative (Chan,
2002).
 Dependent profession (Garcia- Prado &
Chawla, 2006).
 Hiring the unskilled nurses due to lack of
skilled nurses (Khowaja, 2009).

29. Potential problem contd.
 Poor health care outcome which ultimately
determined the nursing profession negatively
 Physician dominant medical profession
 Poor salary,
 Risk of having problem in personal life
 Lack of interest, confidence and Continuous
Professional Development (Willetts &
Martineau, 2004).

30. Resources
 Female parliament member (Ahmed & Shaikh,
2008).
 Social inclusion
 Education and interest of education
 Social and non governmental organization
 Skilled nurses

31. Existing Nursing Role
Globally
• Nurse Practitioner
• Clinical Nurse Specialist
• Nurse Midwifery Practitioner
• Certified Registered Nurse
Anesthetist
• RN-First Assistant
• Nurse Case Managers
• Nurse Entrepreneurs –Nurse
Led Clinics
• Forensic Nurse
• Nurse Legal Consultant
• Nurse Educator
• Nurse Scientist
• Nurse Administrator
In Nepal
• Care giver
• Teacher
• Client advocacy
• Change agent
• Counselor
• Leader
• Manager
• Researcher
• Communicator

32. Factors Influencing
contemporary Nursing Practice
• Science and technology
• Legislation
• Public misconception: Low professional status stigma
• Nursing shortages
• Lack or absence of sufficient support of staff
• Inadequate staffing
• Financial constraints: left for better opportunities and
higher paying jobs, underpaid
• Heavy workloads and stressful work

33. Solutions or opportunities
 Proper provision and evolution of the nursing
profession
 Continues Professional Development
 Implementation of multidisciplinary team
 Increment in salary
 Rewarded the personnel for motivation

34. Nursing in future
Nurses’ role will Continue evolve: The evolution is continue
to provide for the foundation for the scope of practice,
education and research necessary for nurses to lead and
manage the health care environment of future.
Science and technology: Nurses will continued to manage
technology. They get Skill in use of more sophisticated
equipment for diagnosis and therapy.It helps:
 Allow easy access to patient information
 Easy recording of patients’ treatment needs, patient’s
progress, medication and diet needs
 Ease of communication with hospital facilities
 Ease in data collecting and obtaining information
 Increase the knowledge and maintain high quality patient
centered self care to individuals , families and communities.
 Increase of health problem to be detected and performed
quickly

35. Empowerment in Nursing: Greater independence,
autonomy, increasing respect in the profession and
increase in the “power of nursing” also resulted to
expansion in the role of nurses . Their involvement in
decision making of health policy and politics will be
increase more which empower nurses and will also lead to
advancement of nursing profession .
Expansion of employment opportunities for Nurses :
e.g. healing touch, therapeutic massage, use of natural
herbs and vitamins And in outpatient facilities such as day
surgery rehabilitation ,chemotherapy infusion centre,
home care like older persons with disabilities, consumers
preference for care in his/her own home.
Emergence of Complimentary and Alternative
Medicine:
accupuncture etc
Cont……..

36. • Consumerism in Health care:
means different things to different people with different interests. In
its truest sense, consumerism is “a movement seeking to protect the
rights of consumers” and engage the client in health consumption.
like health insurance
• Nursing service should be cost-effective and can be the vital
component of the “alternative setting “ movement
• Web-based Nursing Degrees: Online advanced degree programs
have multiplied rapidly in the past few years. It is now possible to get
a master degree on line.
• Nurses must work to acquire the skills necessary to successfully meet
the demands of these emerging roles

37. • Nursing and Biomedical Research
Scientific and technical research
Evidence-based practice
▫ Integration of best research evidence with clinical expertise and patient
values
▫ Accurate and well-informed decision making
▫ More safe treatment and healthcare information
• Improvement in the standard of the nursing profession
▫ Nursing curricula
▫ Nurses’ and rights
▫ Professional development
▫ Professional organizations

38. • Nurses should practice to the full extent of their education and
training.
• Nurses should achieve higher levels of education and training
through an improved education system that promotes seamless
academic progression.
• Nurses should be full partners, with physicians and other
health care professionals, in redesigning health care in Nepal.
• Effective workforce planning and policy making require better
data collection and information infrastructure.
• As we talk on Modern Nursing ,We the nurses have
misunderstood the scope of our profession .

39. Conclusion
In order to establish the respect for the profession
and quality of the care, the hospitals and
government have rigid authority and regulating
body and should provide CPD (Continuous
Professional Development) program and rewarded
the personnel for motivation.
However, unsafe work environment, lack of
political stability, high workloads, poor payment,
and job dissatisfaction burnout respect of the
nursing profession.

40. References
Ahmed, J. & Shaikh, B. T. (2008). An All Time Low Budget for Healthcare in
Pakistan. Journal of the College of Physicians and Surgeons Pakistan, 18(6),
388-391.
Bhattarai, S (2010). Trends and Issues in Nursing. 1st
Edition. Dillibazaar: Makalu
Publication.
Chan, S. (2002). Health and Nursing Policy Issue: Factor Influencing Nursing
Leadership Effectiveness in Hong Kong. Journal of Advanced Nursing, 38 (6),
615-623.
Garcia- Prado, A. & Chawla, M. (2006). The impact of hospital management
reforms on absenteeism in Costa Rica. Health Policy and Planning, 21(2), 91-
100.
International Council of Nurses (2000). The ICN Code of Ethics for Nurses.
Retrieved on 10 June, 2010, form
http://faculty.uccb.ns.ca/sburrow/courses/resources/icncode.pdf
Paterson, C., (2009). Get a Free Forum at Webs.com! Retrieved 12th
July, 2009, from
http://www.freewebs.com/change-project/apps/forums/topics/show/780576-
attitudes-toward-the-profession-of-nursing
Royal College of Nursing. (2003). Defining Nursing. Retrieved May 23, 2009 from
http://www.rcn.org.uk/__data/assets/pdf_file/0008/78569/001998.pdf
Willetts, A., & Martineau, T. (2004). Ethical international recruitment of health
professionals: Will codes of practice protect developing country health systems?
Liverpool: Liverpool School of Tropical Medicine. Retrieved May 23, 2009
from www.liv.ac.uk/lstm/research/documents/codesofpracticereport.pdf

41. Thank you all !!!
Any Question???