This piece won Second Place in the Open Institute's 2026 New Ethnographic Writing Prize competition. https://theopen.institute/ethnography

To be a nurse is to live inside empathy’s fracture- to stand between what is human and what is professionally tolerated. Drawing on the 62 weeks of clinical posting of sustained participant observation at a tertiary hospital in Chitwan, College of Medical Sciences Teaching Hospital, situated in Bharatpur-11, this essay argues how the nursing profession disciplines empathy at the expense of emotional agency, that care becomes a gendered labour and that socio-economic pressure shapes the precarity of lives befallen at medical mercy. These dimensions remain braided intricately in routines, shifts, crises, negotiations and consolations within and outside the wards.

My fieldwork shows how a nurse is stranded between certainty and reappraisal, between demand and dismantling of care, where expressiveness and professional boundaries often strangle what is most human. Compassion becomes a fluctuating compass needle, not because it’s faulty but because it loses its sense of direction during the crisis inherent to radical decision-making. In Nepal, where nursing is overwhelmingly performed by women, the expectation to nurture and endure circulates unostentatiously beneath the unchecked body of underpayment, overwork and dismissal of intentional care as a feminine trait rather than an earned skill.

As a female nursing student, I partly fall into the gendered stereotype but also become an agent to eradicate these dissections for the sake of professional stance and personal identity. I remain as a part of the skeleton of what the nursing profession would have embodied if the manpower had been valued, retained and sustained within the country.

It's the early morning on September 24, 2025, Wednesday, and the entrance perimeter of the hospital flashes blue and white with rallying nurses. Still in their hospital uniform, they carry posters and a plaque card demanding a pay rise. The hospital wall hums with teeming people. At the end of my shift, the chlorine smell claws at my throat, monitors beep as if it were the pulse of the hospital keeping it alive. Alarm simmers inside the wards of the hospital with us student nurses mobilizing in place of the protesting staff nurses.

Reaching the ground, I recognize the faces and voices with whom I had shared countless learning and acquiring shifts. Their sharp gazes glinting under daylight tell me that they are more than determined to subdue the forces working against their demands, something we nurses deserved without having to ask in the first place.

Unlike the usual composed demeanor, they were under an umbrella of dissatisfaction, frustration, and even rage. It was an unsightly scene, the image of calm and composed nurses dispelled by the reality of undercompensation and workload.

The idealistic and honorary vision about the nurses sustains the silent mental suffering of nurses. This reveals how the unaddressed burden is passed down the generations, a learned inheritance, which is precipitated further by lax financial compensation and a stagnant work environment.

Around the various wards and departments of the hospital, my nursing classmates and I have become a testament to the lives transiting around struggles of deaths, diseases, stigmas, socio-economic disparity and financial influences. Amidst the disarray, we make an effort to carve a dignified profession of nursing that doesn’t centre around arrogant attitude, selfless actions or selective knowledge.

Nurses have what the care culture and contact can elevate the health status of people from mere prevention to promotion. Emotionality is an issue as vague yet tangible, encircling gender and socio-economic stratum, as I argue it through the lens of both a participant and an observer.

I realised the significance of my role; the act of saving and letting go, demanded in situations that transgress the boundary between the living and the dead. This occurred when I was posted in the ICU for two weeks.

From 9th March to 22nd March, I was placed in a sensitive unit of the hospital, the ICU. There, I performed my first CPR on a near-dying patient. That was the experience that elevated me from understanding to actually living the moment of exercising emotional control and moral discretion.

A 55-year-old male patient diagnosed with heart failure was admitted to the ICU. The patient lay on his back, and the flat heart line glared on from the monitor. I flared my right palm over my left fist and pushed into his chest. They sank deep. The wires attached to him jolted, and I kept going until the monitor showed his heart beat climbed up to 130 beats per minute.

Under the guidance of the anaesthetist, the resident doctors and the nursing staff, we could revive his heart muscle, and he was put on a ventilator shortly after. The silent credit that I was of help in saving a life gave me an immense sense of purpose. But it was short-lived.

For two days, drowning in the relentless beeping of the monitor, hectic paperwork, medication administration for each patient, and wandering watchful eyes, I watched the patient’s condition deteriorate slowly. There were never enough nurses for an equitable nurse: patient ratio, and we students were proportioned half of the staff’s duty on shift.

“A lot of work gets done on time because of you guys,” one of the staff members said when we were gathered around the medicine cubicle.

“In our student days, we were always standing by the patient’s bedside and supervised by the teacher every minute. We couldn’t even sit on the chair. Even if there hadn’t been anything to do with the patient, another staff member reminisced quietly under her breath.”

“Yeah, and one time, I had been on sick leave, the teacher visited my home to see if I was truly sick.”

The staff added on about their misery during their student time and how drastic it was for us. We didn’t have to stick to my patient’s side for 7 hours, nor did we have to arduously prove our ill days, but we did have the ingrained sense of over-responsibility, over-working, over-giving, and still under-paying from the student time.

This kind of undermining that still seeped through the generations of students in the form of unpaid duty time, constant bedside supervision and exhaustive nursing etiquette continues to haunt the registered nurses still: being underpaid, patient ratio burden and monotonous overwork. This disproportionate distribution that I was a part of gave me an early insight into what I should expect working in hospitals.

Almost every day had the same routine. I kept brushing his teeth for a smile he never gave afterwards, and kept making the bed that was his final resting place. It made me realise that dying in a cold medical room would have been lonely if it weren’t for his unconsciousness. We were briefly holding off his demise, but his heart had already been irreversibly damaged by previous cardiac arrest episodes.

It was 2 pm when his monitor rang an alarm. The plateau of his heart line was falling flat quickly, without a pause or regard for the efforts that had been made till then. His family had consented to a DNR, Do Not Resuscitate, beforehand and did not allow us to revive him.

For his family, he was a person gone too soon, but for us nurses, every breath he was taking from the ventilator, every omniscient pulse had condensed seconds into hours in a clock. Our patience and resilience ticked in silence, because our emotions and rationality worked in part-time with the donning and doffing of our scrubs. It wasn’t only our bodies that worked in shifts; our hearts did too.

Sometimes, seeing the patient’s life unfold before you in the guise of professionalism feels like watching through a coloured lens. The empathy evoked and the detachment we show may come off as pretentious, but it’s a dilemma that students like me go through at times.

I stood in front of the monitor, numb and fatigued. My throat threatened to close down, and the sense of purpose I had gained began fizzling out. His family stayed outside the glass door throughout this ordeal with a silent acceptance that this was the right and final effort of life he had to go through.

When my eyes met the staff’s, we knew our grief had no place to rest here. The space around us was vacated, but the burden stayed on following the event.

To any ordinary eyes, we are a passage through which ominous news. My colleagues and I did not speak because the silence from the disconnected monitor was loud and declarative.

The doctors delivered the news to the family. Muffled sobs and trembling voices encased the mourning atmosphere grimly. His death came slowly, with minimal glances of consciousness in between. The nurses gave them space and a soft condolence because it wasn’t only his family that needed closure.

In the ICU, where the nurses take care of patients not only medically but with everything rightful to a human, these acts — brushing teeth, combing hair, making their bed, changing their sleep or resting position, and their elimination needs, never become any less than that of administering medicine or performing CPR. As I stood at the front of the ICU door, a threshold between the world awaiting outcomes and the battlefield where patients fought for their lives, I learned that the greatness of an act lies behind the intent and not the face value of an impression.

This need for closure and the atmosphere of detachment, show how the unbeckoned actions nurses perform are rendered impassive under a professional lens.

There should be a breathing space, a lobby to what if it’s not the resemblance or familiarity we seek, between the nurses and patients. Then, the answer leans more towards faith and validation that nurses want through soft behaviour and health improvement.

In settings like the ICU, Oncology, terminal care and even geriatric wards, there doesn’t need to be a mentally exhausted and disproportionately professionalised nurse, if there is space for recalibration in both the system and society.

It becomes important to understand that responsibility with authority is important for nurses as well as patients. Also, equally important is the acceptance that death and survival are sometimes a gamble, and we don’t always get the upper hand.

I understood that with patience and mournful glances exchanged with the staff. The surgical mask on our faces obscured half of our expression, but our eyes remained honest throughout. And, it was the same look I shared with my friend.

As students, we learn that if we nurses are not mindful, we might let emotions act in place of rationality. Suppose we project our sense of familiarity into the patients or let them be projected into us. In that case, the therapeutic relationship we should build fails because the nurses who are trained to be empathic machines and unaccounted leaders in a flawed system must have an inbuilt switch that controls the extent to which we take responsibility for our actions.

We appear on the front line, devising each step, word and action carefully. Unlike procedures or theories we learn in books, the skill of dealing with people and the resources at hand are gained through practice. There is no rule book to guide our dedication, and yet, when we are blamed and oppressed constantly for organisational sleight of hand: staffing ratios, mismatched workflows, missing equipment, delayed medical orders, or a supply system held together with tapes, it breaks a professional conviction.

Some might get less triggered as they learn about and get accustomed to the ordeals of numerous patients in the ward. Some are at the brink of emotional exhaustion, while some remain unfazed throughout their student years and career. Despite that, the brief snippets of interaction with those whose final moments we had to witness remain as a soft memory, an indent in the carved marble, but the marble is a pliable, pumping heart of us nurses.

Later during the medication round, the staff shared their stories over the breaking ampules and loading syringes, of what they faced over the course of their work.

“When I first joined the hospital, I was placed in the general medicine ward. There were three staffs for 36 in-patients and amidst a crowd of visitors, doctors, HA and physiotherapists in the ward, the patients were actually looked after by only us nurses.” A staff member told about loading a medicine.

“If a patient slipped out of the ward premises, it would be the nurse’s fault. If a paper went missing during the doctor’s round, it would be us being called upon,” another staff member huffed.

“I was shifted to work in the ICU during the coronavirus pandemic because of being short-staffed. I was not given a choice but a statement that the nurse should adjust anywhere.” There was a clear agitation in her voice.

“Daily, we had at least 1 person dying right before us, and it was never certain that the next person wouldn’t have been you.” She shuddered as she added,” We were short-staffed, and machines could not cover the patients. We would be barely standing at the end of our shifts.”

“That, and my friend was kicked out of her rented house because her landlords didn’t want the infection to spread inside the house,” another staff member added.

These weren’t just stories to nod away, but the reality of how stranded the nurses were inside the damaged structure of the hospital and the Nepali society at the time of the pandemic. When the certainty of their own lives quaked, the health workers, especially nurses who stayed by the patients despite their fear, held on not only with novelty but also with altruism. From the conversations

and the environment of nursing in Nepal, it shows that in these desperate times, an emergency coalition and fulfillment of duty gave momentum to their dedication. Many of them even quit in between because the cost of living was greater than the sense of fulfillment and meagre wage.

These become a reminder that nursing is not all white canvas of heroic sacrifices or automated switch in emotions deemed right. This is a canvas with defined outlines that has to be coloured within the lines so as not to smear the white background. But these lines are getting painted over with criticism for the current nursing system and institution exploitation, creating an unprecedented painting.

This painting sometimes could get glazed over with deceitful reductant or get elevated with a neglected catalyst. These were the gendered tags that I encountered during my clinical regarding the discipline of the nursing profession and how the singularity of a profession was rendered untrue when it comes to which gender performs it.

I was posted for two weeks in the emergency department, 12th- 25th January 2025, where there had been a case of unanticipated death of a patient. He was brought in, wheeled on a stretcher. His sunken eyes were taking in the environment, and he had been complaining of a backache for a month. I assessed his vital signs, which were fairly normal. His heartbeat was in bradycardia, meaning it was beating slower than the normal rate, but no visible distress signs were shown. He was a chronic alcoholic with liver damage.

The patient was under the comfort of oxygen, and his blood test was taken to the lab.

A few minutes passed, and I was attending to an elderly patient when that patient suddenly started thrashing in his bed, his limbs sweeping equipment off to the floor, including his own mask. A bunch of us rushed to his side and held him as his convulsion passed.

I was calm but was startled by the patient’s sudden episode, who, a few minutes earlier, had been well with no premonition of such episodes.

“It’s okay, you go to the other patient.” I was instructed by the staff.

I nodded and returned to the elderly patient. But, it wasn’t this that was the event of my life. A few minutes later, he convulsed again. This time strongly. I held his right arm and helped him to lie down. Just then, red bathed all over my eyesight. The patient began vomiting a profuse amount of thick red blood, clotted and large in volume, that coated his entire mask red. I, too, would have been in the trajectory of blood had his mask not been there.

I called out,” Doctor, it’s blood.” My tone was monotonous and calm, contrary to the scene unfolding before me.

Everyone rushed again. The rush was palpable, touching and tingling my nerves into action. The blood trickled out of his mask, onto the bed and the floor. It was like a massacre, but the patient was his own opponent.

His spilt blood was suctioned from his mouth, and the staff opened a large bore IV, ventilated him, and arranged the emergency medications beside the bed. A thick, unapologetic line of blood trailed his final moments there.

Behind the blue curtains and hushed rush of doctors and nurses, the two sons were left stranded as their eyes trembled, his lips quivered, and they paced inside the room.

A doctor stood at his bedside and pumped an airbag to give oxygen, but I could already see his saturation dropping rapidly, just as his heart line ran a straight line. Then my face flushed, and my body heat rose. My sight was suddenly cleared, and ever the voices were sharper in my ears.

Another doctor went up to the son and said,” The life of your father is in an extremely critical state now. We need you to consent for us to use means to revive him.”

Those two sons who didn’t look a day older than 25 looked at the doctor, panicked and nodded quietly.

The doctor began to perform the CPR, along with three interns and four nurses. They were drenched in sweat and anticipation, pushing their fists into the patient’s chest.

The doctor went up to the defibrillator machine and turned it on. Up to now, almost half an hour had passed, but no sign of returning pulse or respiration was seen.

The chest jolted up a little every time the defibrillator was placed over his chest. It wasn’t as dramatic as depicted by the dramas and media shows. Because this was real.

Still, no sign of pulse. The patient had started turning pale. CPR was resumed and halted when the defibrillator was used. Again and again. But no sign of returning life.

The doctor pushed off and, with a final sigh, shook his head and declared him dead. There was nothing that could have been done anymore after. An hour had passed since he had vomited blood. It was over. I looked down at the patient and his caved-in chest.

To me, it still looked like his chest was heaving up and down, like he was breathing. My intuition and rationality were up against each other over the body. His T-shirt was long gone, drenched in stiff blood. The curtains were pulled up tight, and an ECG was required to show that his heart had stopped.

I was ice cold outside, unknown if it was the weather, AC or the reality, but burning on the inside. The news that his father had passed away despite their efforts was relayed to his sons, who slowly broke down. Their eyes began rimming red and brimmed with silent tears. There was a death, but no loud

crying was heard. I went along with a nurse to take his ECG and passed one of the male nurses there, sitting exhausted and dark-eyed.

“Only because his sons were here, there was no loud crying in here”, one of my friends said as we placed the lead to the deceased patient’s chest.

“Uh huh..” I agreed. I realised that this wasn’t an anomaly but an accepted societal term. The restrained tears of the sons and the unspoken breakdown of the male nurse disclose how the genders are brought up and taught a different kind of emotional spectrum. Toughness, not a crack in their exterior, made them even vulnerable to disregard.

The flat line ECG was taken and attached to a death certificate. The death certificate read “Death due to massive upper GI haemorrhage”. His liver was damaged, so it was probably his oesophageal varices that burst, and he died instantly. Varices are bulging veins due to the immense blood force acting against their wall.

After that, the body was quietly wrapped and moved to the black room before it was delivered back to their family. For me, the emergency room seemed unusually quiet that entire day; the cacophony failed to strike as intended into my tympanum.

Regardless of the ward or department, there was a common phrase shared among the female nurses, especially those who were married. “ No matter how tired or at what time the duty’s over, I have to do the entire household work. It exhausts me sometimes.”

It’s where the society and cultural bandwidth halt to work, and this unfolded right before me. The male gender, capable of equal nurture to befit the profession, is made to be emotionally aloof to react to such situations. The same profession that requires nurses to remain an ever calm person with no emotional drain to continuously care, is considered inferior for males when it comes to empathetic care and too superior towards emotional regulation.

It is equally bizarre for the male counterpart nurses in Nepal, where the women are expected by all households; they are given little to no time to collect themselves at the end of the day. While society restrains no emotional outflow and professional constraints blur the line between empathy and coldness for females, it places no such idea for males, because males were never provided an outlet in the beginning.

There was little difference between those two bereaved sons and our exhausted male nurses. They were never included in professional emotions in Nepal. This society where a man finds it difficult to shed tears for another human being.

Death is a complete ceasing of life, and nothing beyond that remains of that person physically. But when the body is suspended on a bridge midway between the demise and a healthy life, that’s when the person really starts to suffer.

While the ICU revealed my scorching vulnerability, the maternity ward, dealing with the birth and continuation of life itself, carried the negotiation of tradition and reformation over the families and the medical system.

Every day interaction with patients may differ, and what regulates me? My moral conduct under supervision? My empathy needs professional validation? My dismissal dulls my human senses? Why are characteristics “gendered” rather than established as a profession in society to affect a career choice? Were all my successes and failures only mine to keep?

Carrying and juggling these questions was only natural if one was to challenge the deformity within the nursing structure.

During the third year, I was posted in the maternity and postnatal ward. There were numerous cases of women arriving and being escorted into the labour room. Some underwent vaginal delivery, while some had to go through caesarean section. Their families waiting outside were sharing the same space of anticipation, excitement and worry. None of these cases were as simple as they sounded because they were exhaustive, strenuous and not all had favourable outcomes.

I was with a patient, a 24-year-old, first-time mother. As I held her hands, she said, “It’s my first, and I can’t imagine how women like my mother were giving birth to 6 7 children during their time.” She was sweating profusely.

“Exactly, and medicines like today weren’t even available for them,” I replied as I dabbed sweat off her forehead.

“How many siblings do you have?” I asked to distract her from the pain. “We are three sisters and two brothers.”

As her uterus contracted, I felt her abdomen and watched the time. When it passed after 2 minutes, she was heaving sighs of relief.

“I am the oldest, followed by her,” she added, pointing at her sister beside her. In between the contractions, I fed her fluids, kept up her morale and encouraged her to stay calm. She and her baby were my primary focus amidst the rush of the ward.

“I was afraid to come here because I had heard how cruel nurses could be to women in labour pain. But that’s not the case here,” she said to me.

“I also have heard about it, but my seniors and staff here never do that. Times and regulations have changed for the better,” I smiled at her.

The hustle inside the ward, the anxious look of first-time mothers, her concern about the treatment she could be facing against her own pain was valid.

Ironically, nurses were indeed harsh towards the labouring mother a few years back. They would use physical force, crude verbal words, and crudely not sympathize with their pain when they wouldn’t listen to the nurses. The new regulations and ethical care brought forward have drastically improved the nurses’ attitude.

Respectful maternity care is a policy for mothers and their predicaments whose main objective is to emphasize that health workers, including nurses, should be more compassionate towards the mother. Somehow, care and empathy weren’t as intrinsic in nursing as they seemed.

Throughout my shift, I assisted the patients and mothers in their birthing journey. It was fulfilling, red, raw and evocative. I witnessed the changes in women as their swollen stomachs gave way to a new life.

My assigned patient was now being wheeled into the labour room. I followed. One of the SBA nurses looked at me, and I nodded at her. She looked indifferently at me.

SBA, as in Skilled Birth Attendants, are those professionals–doctors, nurses or midwives who are trained to proficiency to handle normal pregnancy and deliveries. It meant that an SBA-trained nurse was independent to perform a vaginal delivery herself and give a verdict of the condition of the patient, including referrals and discharge.

“That poor thing has been on it for a while.”, the nurse said to an attendant in the room. I was helping the patient into the labour table.

“Ah, yes, she seems to have a low pain tolerance.”

“Hmm.”

“If it were someone from Matwali Jaat, then she would have borne through and given birth in fewer cries. Bahun, Chettris, Madhesi already let out cries even in the smallest pain.” 

The attender scrunched her nose behind her mask, and her eyes squinted.

These remarks show how society stratifies qualities like pain to different castes and even genders. Even if there were reforms made in the medical field, they had yet to reach society.

The nurse just chuckled and proceeded to prepare for the birth. She went on to explain how to position them, what to keep on the sterile table, and what to expect, as I listened intently.

A few minutes later, the patient’s legs were wide open with her orifice painted dark with betadine. Patches of blood were oozing, and I could clearly see her stomach tightening as waves of contraction passed through her body.

“…. Chettri?” A scrubbed person entered through the door, calling out the patient’s name. We nodded.

The woman’s face turned red as she kept pushing and bearing down. Her orifice opened like a blooming flower as white gloved hands prodded in. Soon, a black mass was seen at the brim. The head of the baby was crowning. The woman was sweating profusely and breathing heavily. We kept encouraging her to push during her contractions and keep up her efforts.

With her groans, her words that she had uttered hours before going into labour filled my mind.

“I had always wanted a daughter and a son. Having more sons can make family conflict over property shares, but one son is just fine. A daughter will grow up to be my emotional companion later in life.”

I only said,” The gender won’t matter if it’s healthy. It’s okay to desire it, but you should accept the outcome and not be affected by it, okay.”

She nodded. I know she understood me intellectually, but her aspirations were for her to grow and foster.

Soon, mass was pulled out as a face, an oblong head and a swollen face. It was pushed out, and then came a shoulder, the gloved hands pulled under the shoulder, and the body was swiftly taken out. The liquids and blood that were gushing flowed heavily, and they ceased to trickle. The baby was prompted to

cry, and a shrill cry as startling as the clap of thunder in a grey sky rang out around the room.

“Look what you have.” The SBA nurse held the neonate towards the mother. We have to do that to reassure the mother about the gender and avoid accusations of swapping babies later on.

“A girl", she said through her exhausted smile. The baby was wiped and assessed for normal signs by the other nurse. I was also smiling under my mask. I thought that even I could help with the birth now. Her abdomen was palpated to ensure that no other foetuses were present. Sometimes, the technical fault of imaging studies in pregnancy could have surprising results during the delivery.

Within minutes, her placenta was also pulled out. I assessed the placenta, which was a bloody mass of flesh and vessels. I held it by the cord and checked its intactness, size and appearance. It was all normal. The mother and her child were wheeled out to the ward soon after. The mother was exhausted, and the family was joyous over the green bundle cooped up in their arms.

The shrillness in her wailing wasn’t just a cry; it was an urgency to be taken care of, just like the mind set of people and society.

The next afternoon, when I reached the ward, a new patient had been beside my assigned patient. She was a young Madeshi community woman in a pale green hospital gown who wiped off her makeup on her face. She had given birth at home a few days back and had a case of retained placenta. A retained placenta is when the placenta, after birth, fails to be expelled. She had few remnants left inside her and had been immediately wheeled to OT to stop the excess bleeding.

I went to the nursing station as she was my assigned patient. I read her file. She was 18 years old, and this was her second birth. Back at her bedside, an older woman in a bright orange sari was seated with a toddler on her lap. It was a common belief in their community that if they were to tie the iron nail used to tie the cow’s rope to the infant's umbilical cord, it would stop the bleeding.

Unsurprisingly, the neonate developed an alarming infection and was currently in the NICU.

The nurses were talking among themselves inside the station.

“I don’t know what happened. The foetus’s heart had been beating well at the nightly hour, and suddenly at 5, it had stopped. The family was about to crash this place, but we just had the evidence,” one of the night duty nurses was saying.

Poor them. They were having a boy, and the mother was already over 40. Still in want of a boy, they already had 5 daughters. I can’t imagine the pain of the mother.” The supervisor nurse clicked her tongue sympathetically.

Cases such as these are only the surface of what is pervasive in our culture.

Despite the tears of joy as the delivery became successful or the bitter taste of delivering ominous outcomes, nurses always gather their minds and hearts at the end of the day. They come back in their next shift to be delicate but determined hand holders, encouraging mouths or strong eyes, not just for the patient but also for themselves.

Most experiences entail lessons. Some are there to fill in the gaps of moments, while some stay as a reminder, a premonition that will occur in one’s life. As I continually spent my time in the maternity ward, it felt like the edge of an ocean with currents and waves of needs, emotions and experience crashing against me. I held against the wave with my grit and application of my theoretical knowledge to help and educate the women, their partner and their families in the ward.

It wasn’t just because I am a woman that I was giving my all to watch and assist the mother with her delivery. The fervent scene as a fully formed human was pushed out of a body like mine that no human art or synthesis could be as profound, stunned me.

The dynamics of the ward, the lives of people and the hospital currents were ever constant; on the contrary. There are numerous ways we tackle the results of superstition, societal constraints and dogmas, but we reign superior in the aspect of connecting between people. Their joy, sorrow, satisfaction and so on, are never trampled upon, but neither are they elevated.

Nurses counsel and teach all through a connection made with patients, and it becomes an armour, not for protection from outer things but to contain the anonymity brewing within.

With the emotional cost that runs through the nurses, even the cultural and societal considerations we take are equally challenging. In fact, the moral and professional injury is exacerbated by the lack of establishment of nurses in Nepali society.

“I don’t get comfortable showing my body parts even if it's a sister or even a doctor. Only, it’s because I am sick that I have to expose myself.” One patient had told me bashfully when I went to do her chest examination. Her response was a small instance of the significant problems prevalent in people.

“We have to respect the patient’s wishes. Having male nurses here is like overstepping their decisions and tolerance,” one of the staff shared her opinion.

Her words were bringing forth an invisible barrier, and it showed that this profession, which didn't hesitate in the face of death, tragedy, long hours, and exhaustion, frowned at the mention of male nurses. The history of nursing brought through midwives who, back then, were all women, experienced with childbirth and maternity.

Unsurprisingly, the entire floor only had female nurses, but the male doctors were unflinchingly abundant. While the entire male nurses population in Nepal is already low, there were at least hints of male nurses in other wards, but none in the maternity and gynaecology wards of this hospital.

"Male visitors are hardly tolerated here during the night inside the ward and with the lingering taboos and stigmas, it would be unlikely that a male nurse would be tolerated in here," a senior staff had shared to me.

Even light from Florence Nightangle’s altruistic lamp strongly advocated the qualities of “taking care” and “sacrifice” granted from women with so little as rewards that still holds its outdated concept today.

Men and women had a necessary boundary, and it was drawn in the maternity ward where the gender conformity mattered more than care capacity and professional role.

Contrary to birthing a new life in the maternity, I was confronted with the recess of death in the emergency department, and still lingering in the chasm of nurses’ gender influence.

Chronic diseases are there to stay a lifetime, and no reprise can equal their burden for a lifetime, mentally, physically, socially and financially. Especially for low-income families, it meant giving up a better and longer treatment. From the ICU’s heavy mourning, maternity’s wailing reformation to the emergency unit’s deafening silence, the nephrology ward made me witness a socio-political cycle, engraved inconspicuously in every public service aspect.

A patient, A 45-year-old woman, visited the haemodialysis unit three times a week when I was posted there for a week. I first met her during her 214th dialysis, and I volunteered to be assigned to her.

That morning, I followed the nursing staff closely on operating the dialysis machine.

“You put the red line here and the blue line here. The red is for the artery, and the blue is for the veins. Let the air bubbles escape…”

We ran the machine warm and brought in the patients one at a time.

The patient had hidden her left arm behind a black shawl despite the scorching heat of the day. A younger-looking woman who had accompanied her, and during her turn, the younger woman stayed outside the dialysis room. No visitors were allowed to prevent the risk of infection. After recording the patient’s weight, which was a mandatory procedure, we took her to bed no 4, where her dialyser was to be used for the third time.

By standard protocol, a dialyser was meant to be used only once and then discarded, but the cost of the dialyser was prohibitively high. For middle-class patients, who were the majority and had dialysis up to 5 times a week, this meant a financial disaster. I observed the dialyser being used 4 times, following a set of rules to handle and clean those dialysers, before discarding them.

I put on the gloves and handled the surgical cloth and tray with instruments for placing needles. The patient removed the shawl, and on her left arm was a large pulsing tube protruding beneath her skin like a torturous, inflated vein.

The nurse staff put on her surgical gloves and slathered betadine all over the arm. With slow, deliberate hands and steady impact, she inserted a large-bore needle into the fistula and vein, and the dialyser was started. The roller rotated like an old cassette that played songs, but right now, it was playing a soft song of blood and life, heard only in the rushing in your ear.

Her face was pigmented dark, but when she smiled, her eyes looked bright, and her face betrayed the sorrows that she carried on her body.

Despite that, the patients joke and smile with us, we ease them and make them feel understood, and a pillar of some system to look up to. Though it is not always the case for everyone.

“Have you brought some chocolate or food to eat during the dialysis?” I asked politely.

She nodded. “ My daughter has the tiffin.”

Haemodialysis is exhaustive; the entire blood from your body is pulled into a machine to extract all the waste metabolic products to keep you alive.

I kept her company during her 4-hour dialysis, jotting down her clinical and personal history as routine work.

Not everyone is open about sharing a part of their lifestyle or their view of life that could have guided a lot on how they contracted the ailment.

“My brother died in this hospital a few years ago. He had heart disease,” she said that when I asked her if any of her family members had chronic diseases.

“He had only been having difficulty breathing when he came here. A few days later, he was gone.” She shrugged with a bitter smile at her brother’s reminiscence.

“Heart diseases can be of such a nature. Anything can happen at any moment,” I said.

“Yes, it’s said that, but it’s difficult to trust even hospitals. I also came to this hospital only because it was nearer to my home and the bus directly drops off at this lane.” Her tone was clipped at the end.

I had convinced the patient that for me to obtain such information is necessary, and not obscenely invasive and unnecessary in relevance to their treatment.

The deep immersive observations I had done revealed that care, for most, is not emotional, but political: Behind the scenes, where health workers themselves and their “chineko-manche” receive extra care and facilities, or reserved cabin beds or free medicines or even skip lines to get a benefit of having someone in the medical line, is precarious.

The facade of professionalism over the power, control and influence is how the emotionality and sensitivity of nurses are antagonised against them. Unlike in the ICU, when I was duty-bound to let a patient pass away without interventions, here, I was bound by the patient's own condition to choose a less safe path whose advantage won over the risk. It refrained me from giving the best treatment the patients deserved. It wasn't in an extreme spectrum like euthanizing a helpless patient but it reminded me that the socio-economic status draws the line between the reach and the abandon, between who can live longer and who dies short in pain and forgotten. And these can also be backed up by the instances of cases where families pull out their patients from the ICU or even hospitals when they cannot afford the bills. Even with schemes and packages to console them, they are discharged per their request and even against medical advice.

In truth, some cases of death of patients due to negligence and improper admission to general wards despite their condition demanding the criticality of the ICU are also present.

A patient in the general ward had collapsed in the morning. He was convulsing and thrashing in the bed. Nurses paged the neurology doctor immediately, but instead were scolded for the repeated calls. The doctor arrived after 2 hours.

The patient and his family could not even speak proper Nepali, but their own ethnic language.

Their helpless and sunken faces as their eyes stayed glued to the door, and a secluded cocoon of their ethnicity and financial condition rendered them almost invisible to the authority. After their discharge, their absence became frugal.

Their injustice was dismissed early and easily.

The treatment and gamble of life ultimately falls under the thumb of affordability, and the current economy is restrictively intimidating to most Nepali families. These events occurring in the hospital where I studied gave me an insight of what might be happening in other hospitals of Nepal based on the news and events shared on the news and through human networks.

Unlike most of the departments under the medicine ward, the nephrology ward rang a different kind of alarm, something that hushed the inner turmoil in you, so you had to see and listen to the patients admitted there. Some kidney failures were acute and required gruelling, expensive treatment for a very long period of time.

Faces as young as 16 and as old as 70 were admitted to the rows of beds in the ward. Some statements that, if said out of context, seemed insignificant, carried the drenched weight of suffering and acceptance in life in this ward.

“It’s in fate. What else can I even do? The doctor is the best and is doing his best.”

“I want to have good food when I get discharged.”

A patient in his 40s was staying in the hospital to screen for his lower back pain and urination problems. As I entered the ward carrying the test result paper towards his bed, I received looks of anticipation and worry etched into the faces of the patient and his family.

“Sister, how is the test?” the wife stepped towards me and peered into my face.

I sighed and managed in my most soft and neutral voice, “The test shows he has cysts in his kidneys. The doctor will say what to expect from this result.”

The wife’s face went blank as she blinked, once, twice, and it turned towards her husband, whose face was a mask of wall at the brink of crumbling.

I could not assure them nor give words of comfort. I could only ask them to wait for the doctor’s round for the nephrologist.

He had polycystic kidney disease, a genetic disease causing spontaneous cysts to develop and rupture inside the kidneys. From his history, he had led a relatively good life with a government job and a family of his own. The doctor confirmed and counselled about the disease.

The patient’s face darkened, and his wife had a looming look on her face when it was revealed that, since the patient had shown a genetic disease, the possibility of their children inheriting such a disease was high. They had an eight-year-old son, and the other thing was that they had to think really carefully and might even have to refrain from having any other children to avoid the genetic disease and avoid a lifetime of suffering.

The way we nurses stepped back, even with the knowledge of the diagnosis, shows that nurses are only the translators of suffering, yet forbidden to speak with authority. Here, knowledge is both intimate and hierarchical—the nurses know the truth, but it is blunted by duty of scope and needfulness.

The authoritative stratum that is accepted in society despite different objective backgrounds between the medical professions doesn’t allow reprieve of emotional burden and informational restraint.

While the wards become significant of emotional discipline, gendered preoccupancy and socio-economic distress, the ultimate nail to the head is the lack of appreciation for the work of nurses: scarce financial compensation in exchange for skills and time.

A nurse's courteous behaviour or a rude disposition is a matter of the nurse’s mindset and the extent of their cultural and professional training. Besides that, we are always present, giving health education, silent comfort, unwavering resilience and meaning to the struggles of an existential life whilst maintaining professional boundaries and relevance. Making human bonds has never been this daunting and uncredited as in this profession, and yet, the majority of health care success remains because of this contradiction.

While caring for others, we also need to look after our families and the benefactors of our study and career. Those days when I complete a shift without sipping even a drop of water or feel the exhaustion seep into my bones, my mother’s unadorned fingers seem less glaring than on other days.

“In this economy, I might buy myself a scooter if I work to my bones for the next thirty years.” A senior of mine said when we were conversing about her staying as an RN in Nepal and her future plans.

“What can I do with a mere 17k salary in today’s society. I have my family and children’s education to look after.” A dejected reply from a senior staff member who had been working for 8 years in the hospital.

Fresher or veteran, the tag of “non-compliance”, “vague boundaries”, “failed triage” remains on. The system that is meant to delegate, support and stitch together a working system breaks easily at the slightest inconveniences.

I, too, cannot envision a prosperous career enough to hone myself beyond a generic health worker in a stagnant work culture and oppressed financial dependency. These considerations and decisions are precipitated by the current situation for nursing inside the country.

While the western idea of such emotional labour is described by Hochschild as the emotional work that has exchange value in the labour market, both paid and unpaid. In Nepal, this is a ransom paid by the nurses to regain this profession’s dignity in society. And the dignity is defined by wages against the workload.

The quiet choreography between empathy and endurance that nurses perform daily, not for praise but for survival, was a dance for both the self and the patients at hand. While the theories about emotional labour proposed in the West by Hoschild remain true, in Asian countries like Nepal, this labour is further aggravated by the gender biased and oppressive treatment towards women. While the profession itself poses an emotional disciplinary ambiguity, the perpetuation of injustice towards women and the expression of emotion constricts a promising future for the profession in society.

Then arises the prejudiced opinion associated with nursing: Foreign employment. It is because nursing is comparatively better in terms of pay and work environment that the unchartered portion of nursing wants to escape the country. The economic sanction is undeniably an important catalyst, as it is for patients, too.

The Nepal Nursing Council (NNC) has a larger number of registered nurses, around 115,900 as of early 2024, including those who have retired or left the profession. Despite the total number of registered nurses, there is a severe shortage in the country, with the required number exceeding 65,000, leaving a deficit of around 15,000 nurses. From 2002 to March 2025, approximately 45,400 nurses obtained a No Objection Certificate (NOC) from the Ministry of Health to go abroad. The actual number who have left is likely higher, as many migrate without official council verification through informal channels.

The society’s complex stratification, composed of castes, religion and gender, seems harmonious until its vicious underbellies get exposed. They undermine the cultural and generational progression and distort the work environment, which affects the health workers ultimately.

The nursing institutions and associations remain dormant and docile in their operation: A nurse facing legal or public censure has no protection policy or advocate from these institutions. The unreliability of an actionable body and regulations in the country makes the servitude of this profession more despicable inside the country.

There are remarks about how nurses aim for opportunities abroad and a career. While true to its claim, there were façades underneath such a reason. The most evident was how unfulfilling and minimal the wages were, along with the lack of institutional support. Nursing knowledge and techniques are outdated in Nepal, making us even more incompetent in the global market.

Most days with a heavy, fatigued body and an absorbent mind, I return home only to sit at a desk and write a report of the day. Being a student meant I had my duty towards evaluation and practical marks too. I open my papers and begin jotting down the procedures in handwritten form. My eyes droop, but my consciousness pushes me to finish the assignment before I hit the bed.

Clinical postings are the times when the disarray of managing duty-related assignments, reports, health teaching, case studies, procedures, viva voce and reviewing theoretical knowledge parallel to practice can disrupt a routine life. It demands flexibility and accountability from us students, and at the expense of sleep, rest and meal times sometimes. This shows how demanding this profession is from the student period. It engraves a system that remains whether it's an unpaid student or an underpaid staff.

"I studied nursing because I couldn't get a scholarship in MBBS." This was my friend's response in the first class of the 1st year of Nursing. Some of my friends nodded their heads.

"I joined Nursing because my mother had a dream about becoming one, so, I followed her path," I replied with a slight smile.

I was honest, and so were my friends. In fact, her response revealed how nursing is treated as a backup option, a pitfall catcher in the medical line in case of failure of the initial plan. It showed that nursing wasn't still taken as seriously and dedicated as it is for other medical professions like the MBBS or BDS.

In recent years, the stain of incapability and being a doctor's assistant has faded much, but the outdated tag drags loose behind us like an evening clock shadow. We are independent, capable of acumen for the patient's lives and advocate for them. There needs to be mid-daylight interterms of the nursing profession to pull the shadow back and emerge as a solid body of capability and contribution.

Professional incentive and service orientation alone have become an idealistic preaching. I reflect on how we nurses and nursing students make a significant contribution to saving human lives, whether it be in the ICU or the emergency department. Every nurse reaches the edge of their moral grounds and emotional discretion. Nurses, through varying times and experiences, like me, who remain tied with a medico-legal obligation in front of a dying patient, or the whispering struggles we juggle unaddressed. It’s the nurse’s ability to search for light despite the thunderous cases and challenges that arise.

As a student, I still have a long way to go and learn to keep up with the demands within myself and the society, nation, before I can observe things globally. Nursing, even in a future riddled with AI, shall remain a conservatively humane and emotional profession.

At the end of the day, it is upon us, the new graduating students, who are to make changes and progress for the sake of this profession itself and the lives of infinite people who depend on human care and scientific scrutiny in hopes of either regaining or improving their lives.

Nurses are dispersed all over the country, breathing the same stale breath of stigma, expectations and labour at the breach of culture and care into the medical system. What is most human nature of nurses is butchered at the expense of professional care and agency.

I let myself and other nurses know that this profession is shadowed by gender chastity and ambiguity to give us the emotional and psychological reign. In spite of the politicisation of health care that becomes political, our affirmation to overcome the circumstantial despondence sustains the morale of nurses in Nepal. It’s not paid or taught formally, but laced around interpersonal bonds and interactions made with patients, visitors and colleagues.

It matters how an already oppressed gender in society and their overwhelming involvement in an occupation in Nepal, shortens their progress and independence. The collision of emotional involvement and defective organisational support equates with the lack of reputation and recognition the nursing profession encounters.

The next day, the staff returned to the wards. Their pay had risen, and they laughed about their chant and poster pictures during the breaks, but their faces settled back into the composed neutrality when they appeared in front of the patients. They did not shine like the sun or the moon; they hovered like an eclipse—an alignment held together by temporary compliance rather than change. What my fieldwork revealed is that the deeper fractures remain untouched: nurses haven't taken agency to conduct emotion in the expense of professionalism, to inherit gendered expectations as if they were natural instincts, and to surrender authority in a system that relies on their labour yet withholds recognition. Across wards and crises, I learned that nurses in Nepal survive through endurance, not exemption. We occupy no full identity of our own—only accompanying parts in the performance of care. And yet, within these constraints, we continue to stitch dignity into a profession frayed by politics, precarity, and culture. That quiet insistence to go on—to feel, to decide, to care despite the limits placed upon us—is the most human act we have left, and perhaps the one through which nursing’s future might still be rebuilt.