Friday, November 23, 2012

[Vital Signs Column] What is wrong with RNHEALS?

Vital Signs Column
By: Alvin Cloyd Dakis, RN
December 01-15 Issue

The nursing profession is facing with a lot of troubling issues recently - from poor regulation of nursing schools, to overproduction of nurse graduates, to nurses volunteering in the hospitals to get that much anticipated certificate, to proliferation of training centers and post-graduate courses, to increase in unemployment rate etcetera, etcetera, etcetera. Many are our problem, yet we resolve to the most effective way to solve things - blame others.

It is quite easy to blame others for anything really. All you need to do is to put your pointer to someone else aside yourself and pour out all the misery you or anyone has experienced and say that this person has caused this misery, lack of judgment, miscalculated action, negligence or whatever you might want to call it. And yet, taking responsibility and accountability are the hardest thing to do.

Let me be honest about this - but many of the problems of nurses now are also because of the nurses, directly or indirectly. And many chose to be silent, to shrug the issue and dream that one day a "knight in shining armor" shall save the day. While waiting, some opt to blame others for the misery they have. 

Is this the kind of nurses we have become? 

Why the blaming? Why the name calling? Have we forgotten that each of us has a role to play in this crisis? Pointing fingers would not solve anything - but only makes matters worse. 

We kept saying the government has not done anything to help the nursing crisis, I say, should did we. We haven't started asking 'how to help' or 'is there any way we could assist?'. I ask you colleagues to assess yourselves and ask if you truly have contributed to the solutions in this crisis we are facing.

One clear example is when DOH created RNHEALS. Sure thing it was meant to patch some leaks but it sure is not the sustainable solution we have. But that is what we have right now. I wasn't there when RNHEALS was created, and I have seen how it operates and its flaws as well. I have to engage and send DOH letter and reports of inconsistencies and sometimes abuses from the ground so they would know what is happening. I didn't stop there and continued discussing with them why RNHEALS needs to be evaluated and reformed. Abolishing it would not be a good advice if DOH hasn't come up with a better plan yet - one that is more sustainable.

You just don't call for abolishing something once we haven't found a solution that would cater to the needs of those who need it. If we see inconsistencies in the implementation of the program, then report it and don't stop until we see positive changes in its policies. That is the essence of advocacy - we don't cease and keep trying to find other means to troubleshoot. 

But why is RNHEALS facing a lot of problems anyway?

There are three things I see why this program gets bitchslapped always:

1. Wrong Orientation - many of the implementers of the project seemed not to fully understand the guidelines. Still up to this date many of them say RNHEALS is an employment program and where participants get a Certificate of Employment rather than Certificate of Completion or Training. I just received a copy of a certificate this certain institution/hospital gives to its RNHEALS nurses and it is a COE. Goodness! What have you people become? What was so unclear in the guidelines for you not to comprehend that RNHEALS is not meant for employment. And this one act tends to become "the standard" where nurses would say "eh si ganitong hospital COE nga binibibigay eh, so tayo din dapat...". 

Many nurses under the program would still use the term "salary" or "sweldo" instead of "allowance" and still some would expect that they should be getting the benefits similar to a regular, paid and full-time staff nurse. There is really something wrong with how people perceive and understand the program. Wrong orientation leads to wrong expectations.

2. Wrong Expectations - expectations are important in any program. It levels off different personal biases and in this process, every player in the game would have oriented how things will be running. High expectations lead to frustration. That is why a lot of nurses get frustrated with the program because they expected it to be employment. If you are seeking employment, surely RNHEALS is not for you. You are not forced in to the program, so you always have the upper hand in choosing it or not. 

Knowing what program you are entering in to would also prevent you from any potential harm - most especially the harm from ignorance. 

3. Wrong Implementation - With wrong orientation and with the participants' wrong expectation of the program, surely it will lead to wrong implementation and execution. Before the start of RNHEALS 4 I've been responding to a lot of questions regarding its implementation. Some hospitals have "closed" their recruitment a week earlier than what is declared in the guidelines. Some said they were "full" and do not accept applicants anymore. It was weird to hear those knowing that the official date of recruitment and selection was October 29, and the reports that came in happened days prior to it. Some applicants claimed that these hospitals have closed their doors because they have allocated current RNHEALS nurses a sure spot to the next batch. What is wrong in this picture? Hospitals and RHUs implementing the RNHEALS program should know that the program is only meant for a year. Nurses under the program should only be trained for a year and after that are expected to meet the competencies under the program. You do not need to train them for another year. If you think they are good enough to become staff nurses - hire them.

Wrong orientation would also make these chiefs and trainers treat RNHEALS nurses as one of the staff, even calling them as such, giving them tasks and workloads similar to a regularly paid and full-time staff nurse. What do they understand on the word "trainee" in the guidelines? Nurses under the RNHEALS should be supervised by a staff or training coordinator - not work on their own. But this is not happening in the ground.

Monitoring Needed
RNHEALS has been operational for three years yet we do not see any progress notes, accomplishment reports or scorecards that are available to the public --- because there is none yet. Monitoring and evaluation is needed to ensure that RNHEALS stay true to its mandate and sees if its operations are directed in achieving its goals. 

These wrong impression coupled by wrong orientation and implementation is getting worse because I think RNHEALS is not hitting the spot where it should be: increase "employability" of nurses. Increasing employability would mean that after the program the government specifically DOH would have assessed and tracked their nurses and see who has been absorbed by the Local Government, National Government Agencies, DOH Hospitals or those who have been hired by private employers and still those who are left unemployed. 

Well the good news is that they heeded. A national monitoring and evaluation of RNHEALS implementation will be done starting next year. This is some development knowing that there has been many issues that arose in the past implementation.

Personally, I'm pushing DOH to come up with a centralized webpage for RNHEALS information and wherein these information can be accessed and downloaded. The only way to battle ignorance is to educate people and raising awareness of the issues and concerns. This too they granted, and so is the birth of the DOH RNHEALS & RHMPP's webpage. But honestly, I still find it a bit bland and not interactive. I am pushing for a webpage that is interactive, dynamic and one where nurses can file complaints about non-compliance of RNHEALS implementers. 

I encourage every nurse to be vigilant and to help us in ensuring that RNHEALS truly serves its purpose and that we also vigilantly partner with DOH to come up with a more sustainable program that would, not just train, but eventually employ nurses to serve the Filipino public. Supporting the call to abolish RNHEALS right now would not merit my support - until such time I am assured that there will be a better program to cushion our nurses or if the Rationalization Plan that seeks to increase the hiring of health professionals be approved by the Department of Budget Management. 

Until such time those things I mention are there, I would have to work with DOH in enhancing the RNHEALS project and to help ensure that all concerned agencies, even participating nurses, would have to know and follow the guidelines set by the program. 

The Senate recently passes the Sin Tax Bill in its 2nd and 3rd Reading giving the bill a total push to become a law that would increase tax revenues allocated for universal health care program of the Aquino Administration through increasing the taxes in liquor and cigarettes. I am hoping against hope that this revenue will indeed be given in the health department and that DOH would invest in health promotion. 

Sin Tax was able to move through, this time I am fervently hoping that RH Bill would do the same.

AYNLA was commended by the H&L Magazine as one of the professional organizations that successfully implemented programs promoting healthier lifestyle. AYNLA will be awarded for its outstanding public service programs in the 1st H&L Healthy Lifestyle Exemplar Awards this November 27 at the One Esplanade in the Mall of Asia. Kudos nurses!

This award shall also be presented during the 1st NCR Zonal Conference of Nurse Advocates featuring Universal Health Care Champions this coming December 12-13, 2012 at the Asian Institute of Management. For more information about this conference please

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