Short Communication Private and Public Nursing Schools in Karachi , Pakistan

Nursing is a field which is directly affecting patients’ quality of life. For this, there is a dire need to bring competent and professional nurses who pass on the dignity of their nursing profession. This heavy responsibility to produce such competent and professional nurses lies on educational institutions and nursing schools. Educational institutions play a vital role in offering a standard of education for future nurses. Hence, it is essential or educational institutions of nursing to undergo a quality assurance process in order to monitor their efficiency and standards of nursing education. While comparing two nursing institutions, we found some issues and challenges in both private and public institutions. Public institution has the resources, but poor strategic planning for initiating the new programs; while private institute cannot expand their programs due to lack of resources. Private institute has a better education system as compared to the public institute despite of limited possessions.


Introduction
In order to provide quality patient care, the profession of nursing requires sound knowledge and skill competency (Timby, 2009); therefore nursing institutions play a significant role in preparing students. To monitor the efficiency and quality of these schools, we visited two institutions i.e. private and government. This paper compares and contrasts both institutions, identify their strengths and limitations along with the recommendations.

Background
The private institution was a donor funded institution, which was built by the trustees. The school initially started a three year diploma program. Student selection was on merit basis, and all facilities were free of cost, i.e., tuition fee, hostel, transport, stipend and meal services. Within a period of one year, the institution faced financial constraints, but with the help of supporters, it again revived. Later, they started four year generic BScN program. The school progressed further, and post RN, BScN program was started as per need. Presently, it is implementing different programs to the diversified backgrounds of students. These include a diploma in nursing, midwifery, bachelors of Science in nursing, and post RN BScN.
On the other hand, the government nursing school was founded with the help of higher education commission Pakistan. Initially, it started working in the renovated building of the university and within two years, a new building was constructed. Currently, it is offering graduate and undergraduate programs, including Midwifery program, Post RN, BScN, Generic BScN and MScN.
Before making this comparative analysis report, the authors first visited both the nursing institutions, observed the physical layout and reviewed the institutions academic policies and records. The authors also collected some information for the institutions 'leaders. Some information is also gained from the institutions' websites

Philosophy, vision and mission
The statement of philosophy, vision and mission are the basics that guide and run institutions in a goal directed manner. The philosophy of private institution is to produce a free academic atmosphere of continuous teaching learning process. Its vision is to produce graduates and post graduate nurses in order to take responsibility in the noble profession of nursing. It also envisions the initiatives of introducing exchange programs with other institutions (Nursing Director, personal communication, May 10, 2015). According to Billings and Halstead (2005), a mission statement defines primary objectives and purpose of an organization. The mission of this institution is the growth, and upliftment of institution through the introduction of graduate programs in the area of higher level of education and research.
The mission of public institution is also to promote and uplift the nursing profession through higher education and skill building. However, their vision statement is to become a center of research and academic excellence, prepare the leaders in nursing, and produce a sufficient number of highly skilled and trained nursing professionals, in order to face the challenges of modern preventive and curative health care. In addition, it trance to have at least two research publications annually from per faculty in the national or international or in their own journal (Nursing Director, personal communication, May 10, 2015). This shows that this particular public institute has more focus on the research as compared to the private one.

Governance and administrative structure
The private institute since its commencement is recognized by the Pakistan Nursing Council (PNC) for the diploma program. The institution is centrally governed by the board of governors, who are the major decision making authority. For planning and running the school more efficiently and proficiently, the board of governors has constituted an advisory academic council. The governor is followed by Vice president (VP), honorary secretary, management committee, and the director as per institution's Organogram. The director is also the principle of the school, holds two positions simultaneously. The hierarchy further followed by vice principle, program coordinator, instructor, and finally students.
For student admission, public institute follows PNC criteria for undergraduate and HEC criteria for graduate studies (Pakistan Nursing Council, 2013). The hierarchy of it starts with university vice chancellor. The Organogram is further followed by the pro-vice vice chancellor, registrar, and then director. The director looks after academia and administration. He also supervises 36 faculty members in various positions as well as 10 supporting staff. These faculty positions range from associate professor to junior faculty, visiting faculty and adjunct faculty (Nursing Director, personal communication, May10, 2015). The public institute is certified by the International organization of standardization (ISO). Whereas, private institute does not have such external certification, despite, director institution does selfinspection (Nursing Director, personal communication, May 10, 2015).

Student admission process
Both of the institution admission criteria are in line with PNC (Pakistan Nursing Council, 2013). Both institutions announce program's admissions on social media and also on their respective website. Private institute particularly conduct open house sessions about admissions at nearby female degree colleges. In both institutions, applications are only received from those candidates who are eligible according to PNC guidelines (Pakistan Nursing Council, 2013). Student selection is on merit basis and successful students are called for interview after which the final results are announced. The private institute face challenges while rejecting the students, as most of the students come and request for admission as they are very passionate to get enrolled in nursing and want to serve humanity. In this case, the admission committee gives them a chance to get them enroll as per PNC eligibility criteria and institution's rules and procedures (Pakistan Nursing Council, 2013). For government institution, on admission, students need to submit Sindh domicile certificate (Pakistan Nursing Council, 2013).

Student progression process
Student evaluation plays a significant role in recognizing student's progress and advancement in the particular program (Lewallen, 2015). Performance of student in private institutions is evaluated by internal institution, on a test basis, through assignment and class participation as per institutions' policy document. Whereas, public institution has centralized examination system. In public institute, 80% of the assessment are done externally, while the rest is done by internal faculty members. In both institutions Student's performance is evaluated by grades and cumulative GPA.
Evaluation records should be well documented, and distinctly mention positive and negative viewpoints of a student's academic performance (Billings & Halstead, 2005). All the students are provided with a student handbook/prospectus at the time of induction, which contains all policies of code of conduct, examination, grading criteria, etc. Also, at the start of the semester, student orientation to the course and expectation is provided by the faculty members. Billing and Halstead (2005) concur with this thought that students should be given prehand written information regarding grading system. At private institutions, extra classes are offered if the student's performance is not up to the mark (Nursing Director, personal communication, May 10, 2015).

Student code of conduct
In private institution, dishonesty and disciplinary issues are handled by the disciplinary committee whereby three warning letters are issued to the students. But as per the student code of conduct policy, if the issue persistently follows, then the student is terminated. While, public institute follows the code of conduct guidelines of the university and these are mentioned in detail on the university website. For each separate misconduct act, a particular code of action is mentioned and if the student is not satisfied with the decision of the committee then he can appeal to the vice chancellor.

Official record keeping
Maintaining the privacy of the student records is the institution's prime responsibility. In both the institution, the records are maintained by separate personnel. Few records are present in the form of hard copy, while others are hoarded in electronic version. For the faculty members of public institution, it is obligatory to maintain portfolios as per Quality Enhancement Cell (QEC) requirement. Both institutions have a manual record for their alumni tracking system. Private institution once planned for making alumni association but did not succeed, since the majority of students enrolled are from different areas.

Curriculum and curriculum review
Private and public institutions, both follows PNC curriculum for the Diploma, program and HEC curriculum for the degree program (Higher Education Commission Pakistan, 2012). Since institution has no direct affiliation with HEC, therefore it relies on government institute of nursing.

Institutional layout and facilities
The buildings of both the institutions have a computer lab with internet facility, a well-equipped library, wellfurnished class rooms with teaching and learning equipment, skill lab and female residency. In addition to this, public institution has the facility to access to subscribe online journals and well equipped sports complex facility which is currently lacking in private institute. For clinical, students of both institutions are sent to different hospitals, and in communities. On clinical, they are often being supervised by clinical faculty. Caliskan and Tabancali (2009) emphasizes the importance of a faculty development model that it aims to train and prepare nursing instructors, so that curriculum would be effectively delivered to the students with encouraging learning environment. Both institutions provide opportunities for faculty members to pursue higher education. In the private nursing institute, five faculty are enrolled in MScN, but there is no such contract or bond system. In private institution, faculty evaluation, their salary increment and promotion is based on student's, peer and director's feedback. Whereas, in public institution, the increment is announced by the government, which is same for all governmental organizations (Government of Pakistan Finance Circular, 2005).While, both institutions evaluate faculty performance through appraisal system.

Support services
The private nursing school is funded by the Islamic concept of Zakat and sharing of excess wealth with the Ummah. As per institution's finance document, the students who are not able to bear their educational expenses are required to request for Zakat whereas scholarships are granted to Non-Muslims. Since public nursing school is a governmental institution, the students who are not able to pay their fees are required to appeal for a scholarship from HEC (Higher Education Commission Pakistan, 2012).

Faculty profile and ratio
The private nursing institute has only one MScN faculty, while the remaining are BScN or Post RN BScN. The ratio of faculty, student is 1:20. The public nursing institute have faculty student ratio is 1:15. It is in the process of hiring Nursing PHD faculties and are planning to start a PHD program.

Strengths
In private institution, leadership is committed and enthusiastic in looking forward the school at the advanced level. In a limited resources they are trying their level best to provide quality education. Moreover, the neediest students are granted scholarship or their educational expenses are paid through Zakat, which enable students to continue their studies without any financial burden. They also fund the educational expenses of their faculty members without any bond. Since public institute is a government institute, so it has sufficient resources and facilities. Addition to that, it is also focused on launching various other programs, e.g. they have planned community midwifery program and diploma in the post basic nursing specialty.

Areas of improvement and recommendations
Along with strengths, both institutions have some areas for improvement. One of the gaps that were identified in public institute, was the lack of strategic planning. The MScN program started without the approval of HEC. To start a high level program, it is important to get a professional body approval to ascertain quality assurance (Kranenburg, 2003). This leads graduates to be unrecognized in the market as well as create problems in pursuing higher education. Here the student's career and their trust with the organization are also at risk. According to Higher Education Commission Pakistan (2012), the institution should have at least two nursing PhD faculty members to run their MScN program, but until now they have no qualified faculty. Other than this, financial support for students is not appropriately available. There should be some percentage of scholarships allocated the students. This will encourage the students of lower income groups to pursue their education with less financial burden.
In the private nursing institute, the scope of education is limited as the diploma is still running and MScN has not started. Therefore, it is recommended to start the MScN program with partial fee compensation. Private institution also faces the issue of lack of qualified faculty which is well supported by the fact that currently there is only one MScN faculty in the entire campus. It is important and recommended for private institute that it retains the staff on which they spend their time and resources through bonds. Also, private institute has the lack of availability of resources in order to improve the existing services and infrastructure. This could be achieved by having collaboration with NGOs and multinational companies who spend a heavy amount on corporate social responsibility (CSR) activities. Also, they can market their services and ask for more donation form the general public.

Conclusion
Though both private and public institutions are trying to upgrade their standards of nursing education, however, they have their own limitations. Therefore, the above mentioned recommendations can be possible to implement to make an educational system more effective and efficient.