Monday, November 07, 2011

[Vital Signs Column] Filipino Nurses: Scarcity in Abundance

Issue 5 Vol. 1 |  August 2011 Issue
Vital Signs, is the FIRST newspaper for the medical community. It caters to doctors, health workers and other healthcare professionals, bringing them the latest health news, scientific updates, as well as opinions, and commentaries on current issues impacting healthcare delivery in the country. You can read Alvin Dakis' columns on nursing & social issues in every Vital Signs newspaper published every 1st & 15th of the month. 

I remember one of my friends jokingly said “Nursing is the Philippines’ national course…” and indeed looking past the Philippines’ Bachelor of Science in Nursing, it has grown to be from a silent course on healthcare to a market leader that shaped the country’s health human resource providing the international market demands. The Nursing profession suddenly was in the limelight after the international demand for nurses.

The global nursing market yearns to answer its global cry and the Philippines just instantly became a genie – its wishes are her command. From around 200 nursing schools in the country – it spurred to about 491 from 2004 despite CHED’s Memorandum Order to close down low performing schools. This sporadic increase in nursing schools milled thousands of nurse graduates that reached around half a million a year. Of these graduates around 75-85,000 of them will take the Nursing Licensure Examination (NLE) and about half of them will pass and become registered nurses.

The country milled thousands and thousands of new nurses every year to supply the demand of the foreign market especially those of the US and the UK. But the global financial crisis hit the former gravely that it ceased importing foreign nurses which includes the Philippines. This temporary closure stalled many aspiring Filipino nurses waiting for their chances of working in the US and other countries, leaving behind a ballooning 287,000 unemployed nurses. This is by far, the highest rate of unemployment of Filipino nurses in the country. This does not include the Filipino nurses who are unemployed or underemployed in other countries.

Such number would tell us how the Philippine government handled our nurses in the country and having to wait to gravely increase the number of unemployed and underemployed nurses. We have an overwhelming supply of new nurses – all unemployed.  Now where do these nurses go? And what are we going to do with such abundance in health human resource?

While the Philippine government plans on how to mobilize such abundance in health human resource, the country’s health system is in ruins. In the public hospitals, 1 nurse serves 40-50 patients while in the rural areas & communities 1 nurse serves around 20-50,000 residents. The nurse serving 40-50 patients is a total far out from the DOH’s ideal Nurse-Patient Ratio (NPR) of 1:10 – and this is not that even close to what we commonly see in public hospitals. How do we expect a nurse to serve 50 with the same quality of care? Evolution of species might happen right in front of our eyes, our nurses will mutate to have more than 8 hands and 4 eyes to cater to all these patients.

We have milled an excess of close to 300,000 nurses in the country while in reality we need more nurses to cater to the fast-growing Philippine populace. We need more nurses to deploy in many areas poorly served of health services or where people cannot access it. But we can’t hire them – because of as expected, lack of resources. Because of these series of unfortunate events of our nurses – they worked without pay to get clinical experiences and hope to land a job really, really soon.

Some hospitals took our desperate nurses’ line to “pay just to get clinical experience” too seriously and indeed charged fees on our nurses for volunteering their services. Many nurses, out of desperation, took this bate with the expectations of landing a job or to increase their “marketability” in the now, heavy competition to super scarce job vacancies. Some hospitals then charge them for their use of electricity & other equipment. Some hospitals scrapped the name of “volunteer” and changed it to “training” to avoid being scrutinized by nurses groups for exploiting our nurses.

To respond to this growing concern of the nurses, the government through the Arroyo Administration created a stopgap measure known as NARS or Nurses Assigned in Rural Service which deployed 10,000 nurses in unserved areas and where they get a stipend of around 8,000. These 10,000 nurses shall be deployed for a span of 6 months. Personally, I think formulating short-term programs to address the issue like this one, without medium and long term ones are doomed to fail. Shortly the program ceased after the ascendancy of a new administration – the Aquino government. Under his term, he revived the NARS program and renamed it RN HEALS or Registered Nurses for Health Enhancement And Local Service with some changes such as increasing the length of duty from 6 – 12 months with hospital exposure but the rest are identical. RN HEALS still deployed 10,000 nurses to unserved and underserved areas in the country.

The two governments created a program to address the gap needed to employ full-time nurses and the scarcity of healthcare providers in marginalized & depressed areas but only made programs that would scratch the surface of a deep-rooted tree. What we actually need is to have medium and long term programs to address the growing number of unemployed nurses, increase the number of plantilla positions, utilize and fill plantilla positions which have been unused or misused, and to close down low performing schools of nursing.

But how can the government do those things? The Department of Health’s Rationalization Plan – a five-year stalled plan is still at the parking lot of the Department of Budget & Management. This has not moved since then. The Rationalization Plan intends to increase the number of health professionals in the areas where are lacking in health human resources. If a medical ward would need 10 nurses and the actual is 5, the Rationalization Plan will supply the rest of the 5. But this is costly and therefore was put in the parking lot – slowly degrading.

A pending bill in the House of Representatives dubbed as the “Rural Health Bill” of Senator Angara which aimed to “improve the accessibility and delivery of primary health services will inevitably create employment for our health care practitioners and hone their skills in the process” needs to be passed. This bill can help address the increasing of jobs and skills level of health professionals will render more public health care & services readily accessible to the public. Even the contentious, Reproductive Health Bill pending in Congress aims to increase the number of hired nurses to cater to the public health.

The country needs to have long-term goals and not just relying on stopgap measures for this will not help our professional nurses develop. We also call for our legislators to see the need for legislation and abolition of all forms of exploitable acts in the nursing and health care professions. Let us also not see our nurses as mere commodities and export products, but rather, let us see them as worthy providers of health are caring to all Filipinos – a vital force in the Philippine’s ailing health situation and the attainment of our united vision to Universal Health Care.

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