A NATION OF NURSES – THE FUTURE OF PHILIPPINE NURSING
By: Alvin Cloyd Dakis, RN
Featured Article in Mulat Pinoy
Filipino nurses have been known to be one of the most caring nurses in the world – one that many foreign nationals would prefer and trust. This brand of excellence became the Philippines’ banner for sending its nurses to the world market. This made the Bachelor of Science in Nursing an instant National College Course of the country.
The nursing profession in the Philippines stemmed way back where Filipinos are very superstitious and their practice of health & sickness were often associated with mysticism, spirits, witchcraft and herbal medicines of which some still exist. During the Spanish regime hospitals and schools of nursing were fist built and during the Spanish Revolution, prominent personages became nurses to their wounded comrades such as Trinidad Tecson famously known as Ina ng Biak na Bato, Agueda Kahabagan of Laguna, Melchora Aquino also known as Tandang Sora and Josephine Bracken, the wife of Dr. Jose Rizal, who installed a field hospital in their estate in Tejeros.
The National Course
From its silent beginnings, the Philippine nursing profession grew to become a major player in the global healthcare market where it became the biggest supplier of registered nurses in the international nursing labor force due to the global nursing shortage. Schools of Nursing grew tremendously from 17 schools in the 1950’s to a soaring 491 in 2010 with recently 40,000 passers averaging each year. The number of registered nurses in the country is now reaching a sky-rocketing 600,000 registered health care professionals – more than thrice the number of other health professionals in the country combined.
If you will ask students, what they would want to become during those times is to be a nurse. Parents once dreamed of their children to be doctors, lawyers and engineers – now they choose their children to become nurses. Global market for foreign nurses increased drastically and the demand for Filipino nurses to serve soared. It was in 2005 when the demand for Filipino nurses reached its highest.
Abundance in Scarcity
Outstandingly we produced thousands of nurses but have only employed less than 50,000 nationwide and a growing 287,000 of it are now unemployed or underemployed in the country. The Department of Health recommends that 1 nurse serve 10 patients but looking into our current health system, 1 nurse would serve more than 50 patients in a public hospital. Now this ratio becomes even worse in the public health community setting where 1 nurse would serve more than 50,000 residents.
We have produced more than 40,000 nurses compared to 2,000 midwives every year, and the numbers continue to pile the already hundreds of thousands of nurses eagerly waiting to land a nursing job or career in the country. This kind of abundance however contradicts the other view of the lenses where the public health only has a meager number of health professionals. This scarcity in health professionals especially among nurses is so vast that only around half of the ideal human workforce is filled to do the job, depreciating the quality of nursing service each nurse render to his or her patients.
January of 2011 marked another expose that brought controversy to the Philippine nursing profession after the global stain brought about by the 2006 nursing board exam leakage scandal. This time, the issue revolved around professional, registered nurses who volunteer their professional services to some hospitals, clinics and centers to gain “working experience” with the hope of landing a proper job, getting certificates of volunteer work thought to help them gain more possibility of leaving the country for work overseas.
The allegation of different nursing organizations to different hospitals & institutions exploiting nurses by means of charging fees for volunteering their professional services in their facilities sparked an issue that caught the attention of the media & the legislators. The mainstream media aired the throwing of different allegations, justifications & statements for about two weeks.
The Philippine Senate, through its Committee on Health & Demography, deputized the Department of Health (DOH) to conduct a thorough investigation on the matter. DOH then created the Ad Hoc Committee composed of DOH Health Human Resource Development Bureau and other invited nursing organizations who were present during the Senate Inquiry Hearing. The Ad Hoc committee recently finalized its recommendations and passed these to DOH. The House of Representatives on the other hand also made its parallel Congressional Hearing. Gabriela Women’s Party representatives also filed a call to action to the Philippine President to immediately act on the issue and call the current practice as exploitative & to halt its current operations.
The Government’s Aid
The Arroyo government came up with a stopgap project called NARS or Nurses Assigned in Rural Service which deploys around 10,000 nurses in underserved local areas in the country for six (6) months. Each deployed nurse would get an allowance of around P8, 000 and another additional budget from the local government where he or she is deployed. This project seemed to be good in its initial running though critics argue that this kind of project is not sustainable enough to answer the growing crisis in nursing employment. Before the project concludes in 2010, a nurse-participant of the NARS project got raped in Maguindanao, which got another media attention & a call to protect the nurses being deployed in rural areas.
A new government came in 2011, the Aquino government, and along with it comes a new hope for reforms and social change. The new government faced the same & growing crisis in nursing unemployment unresolved by the then Arroyo government. The Aquino government seemed to have copied the project from his predecessor and installed RN HEALS or Registered Nurses for Health Enhancement & Local Service which is very much similar from the NARS program only that it extends the nurses’ service from 6 months to 1 year, having to rotate half a year in community health and the other half in a public hospital. This program after completion for a year shall gain a certificate of participation, and then back to being unemployed.
There is another project the government is boiling up through the Department of Labor & Employment which they claim is “more sustainable”. Using entrepreneurship as the key ingredient, nurses will be taught how to manage their own businesses through microfinance & cooperative system. However this project needs to have more refining prior to its implementation and was put in the “parking lot”.
Push for Reforms
With the current government having little to no prepared sustainable program to save 287,000 unemployed registered and professional nurses in the country, the country is now experiencing a demoralization of the nursing profession and leaving most of its unemployed nurses to land jobs not found in their curriculum or are totally far out from the nursing practice.
In most of my talks I call that “Professional Poverty” where our country is very rich in health human resource (e.g. nurses) that are unemployed & underemployed & the state fails to see its vast impact in its public health. We still need a lot of nurses in our health system yet the government finds it hard to employ a single nurse. How are reforms for healthcare helping this issue?
The Department of Health has been pushing for its Rationalization Plan for more than five (5) years now. The Rationalization Plan aims to further upgrade/specialize services in the hospitals and increase number of hired staff basing on new standards set by the department. For example, a public hospital’s ward would need 20 nurses working but only employed half of it; the Rationalization Plan will have to mandate the hospital to add more 10 nurses to comply with the new standards. This plan seemed benevolent & outstanding but it will entail billions of pesos of investment from the government’s treasury. That alone became a big concern and got stuck in the bottleneck of the Department of Budget & Management…till now.
Senator Edgardo Angara also pushed for a bill that will develop community health delivery and increase placement of health professionals in rural areas. This bill known as the Community Health Delivery & Health Team Placement Act according to Sen. Angara aims to “elevate the availability of primary health care in the Philippines and the competence of Philippine health care practitioners”. According to the bill, nurses will lead the operations in 4th-6th class municipalities and allow them to conduct ‘telemedicine’ remotely with physicians, who will also conduct periodic visits in the locality.
This act is breakthrough legislation for public health and acknowledges nurses as heads of the operations in public/community health for the first time. This bill needs to be supported and be passed into law. With this we can see an increase in the number of nurses in community/public health. Another reform being pushed is the recommendation of increasing the number of “plantilla” positions or the number of staff in a public hospital or local health unit. The recommendation also include the proper utilization of current plantilla positions & to comply with the Philippine Nursing Law which clearly states that the salary for an entry-level nurse in a public health facility should be in Salary Grade 15, that which is close to around P25, 000.
The Reproductive Health Bill, one of the most contentious legislations in the country, also recognizes the need to increase the number of hired skilled health care professionals to deliver appropriate reproductive & sexual health needs of the people. One of the sections of the RH Bill states that the government must increase number of doctors, nurses and midwives in public hospitals, local health units and EMONC centers so that better health services can be delivered to the people.
So what now?
The continuing push for reforms for health care system and the nursing profession need a huge amount of support from nurses themselves if we want to see these reforms coming to pass. Nursing leaders now convene to finalize the draft amendments to the Philippine Nursing Law (R.A. 9173) and enforce it this year. But more importantly, each nurse, wherever he or she may be must participate in this discourse and actively participate to help make the government know we are guarding our rights and our profession.
Utilizing your social network sites to pass on vital information to other nurses and their significant others can help in maximizing information dissemination. You may also participate in forums, discussions and physical mobilizations to show your support whenever possible. And most of all, as professional nurses, do not let anyone, individual or group, to manipulate and exploit you. It is important to know your rights as a professional and as an individual for claiming one’s rights is not freely given but earned and fought for.
A nation of nurses shouldn’t be something seen negative for our national development. Hence, we should utilize our health human resource properly and maximize our rich resource of health professionals to deliver better health care to our countrymen.
Alvin Dakis is the Founder & President of the Alliance of Young Nurse Leaders & Advocates International Inc. (AYNLA), a national organization of nurse advocates. He is also a blogger & youth leader.Email: Alvin.firstname.lastname@example.org