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Exodus of nurses still triggers touchy debate

Exodus of nurses still triggers touchy debate

By Francis Cueto, Researcher

Second of two parts

IT may not have reached the higher levels of the decibel scale yet, but there is an ongoing debate on what to do with the exodus of nurses and other health workers for better paying jobs abroad.

On the one hand, you have the nurses themselves, as well as leaders of the profession, who say “hey, last we looked, this was still a democratic country, and anybody is free to travel and work elsewhere, if employers will take him in.”

On the other, you have lawmakers and other government officials who have expressed alarm over the diaspora, fearing the development—and the resulting dearth of such professionals will exact a heavy toll on the health of the population.

And for good reason, says Dr. Jaime Z. Galvez Tan, former health secretary and now vice chancellor for research at the University of the Philippines in Manila and executive director of the National Institute of Health.

The annual outflow of Filipino nurses for jobs abroad is now three times greater than the number the country issues licenses to yearly.

The Professional Regulation Commission (PRC), through its Board of Nursing, issues licenses to 6,500 to 7,000 nurses annually.

Brain hemorrhage

“Sadly, this is no longer [a case of] brain drain, but more appropriately, brain hemorrhage of nurses,” says Dr. Tan. “Very soon, the Philippines will be bled dry of nurses.”

Dr. Tan’s dire prognosis is shared by Dean Glenda Vargas of the University of Santo Tomas College of Nursing.

In a recent issue of the Varsitarian, the UST student organ, Dean

Vargas had said that if the government would not institute measures to prevent nurses from leaving the country would inevitably suffer.

“The government and other health-care agencies should ensure that the needs of the local population will be met first before the needs of others abroad,” Vargas said.

She fears that the Philippines would continue losing its health workers to more affluent nations in the coming years as the demand for nurses abroad soar.

“The demand for Filipino nurses this time will be a persistent to meet the global shortage of nurses,” Vargas said. “Enrollment in nursing schools [in developed countries] is declining because [foreigners] are not interested in the job.”

Vargas said that the demand for nurses abroad began in year 2000 due to the low number of enrollees in nursing schools of developing nations. She added that the US Department of Health and Human Services projected that the demand for nurses in the US will continue to rise to 1 million by the year 2020.

According to the data from the Commission on Higher Education, in the academic year 2000-01, enrolment in nursing schools stood at 28,095. It nearly doubled to 50,390 after just a year. The trend continued as it continued to peak with the continued demand of nurses abroad. In the school year 2004-05, CHED recorded a grand total of 292,240, the majority of the increase coming from the National Capital Region (80,187), followed by the Western Visayas region (28,138) and the Ilocos region (27,739).

The same data also showed that for school year 2000-01, the number of nursing graduates reached only 4,428. Close to 10,000 were added in school year 2004-05, with 14,123 finishing the course.

From 2001 to 2005 the number of nursing schools ballooned from 183 to more than 400.

Vargas said developed countries such as the US, the United Kingdom and Ireland offer higher salaries to lure nurses from Third-World nations to work there. She cited an Asia Times report in 2003 to show that the monthly pay for nurses abroad range from US$3,000 to US$4,000 (P159,000 to P212,000) compared with the average monthly pay of most nurses in the Philippines which is US$169 (P8,980).

Vargas said the big disparity in the salaries is enough to lure lawyers, businessmen and, lately, soldiers to enroll in nursing programs schools. Vargas also pointed out that Filipino doctors leave their jobs to enroll in nursing schools so they can work overseas. About 3,000 doctors are currently enrolled in nursing programs, she added.

The demand for nurses in other countries has also spawned a boom in nursing schools, most of which do not have adequate programs, Vargas said.

Vargas added that there are 450 registered nursing schools in the Philippines, many of which are unregulated. As a result, many schools produce half-baked students.

“There is a big number of examinees in the nursing board examinations, but the national passing rate ranged only from 44 percent to 58 percent,” she said.

The UST College of Nursing is, itself, a victim of the exodus of nurses.

Over the past four years college lost 16 faculty members who have opted to work abroad.

Dr. Teresita I. Barcelo, vice chancellor for academic affairs of the UP-Open University, said nursing schools have sprouted at a very fast rate, taking advantage of the high demand for nurses overseas. Records showed that since 1994 more than 100,000 nurses have left the country with 50,000 leaving from 2000 to 2004. Of the total, 57 percent went to Saudi Arabia, 14 percent to the US and 12 percent to the UK.

This development has alarmed health experts who said that the exodus could severely affect the country’s capability to adequately provide for the medical needs of its growing population. They cited the case of the state-run Philippine General Hospital, which is losing 300 to 500 nurses every year.

Figures from the International Union of Nurses said that close to 10,000 Filipino nurses were directly hired by US-based hospitals in 2001 through nursing job fairs held in the Philippines. Nurses who leave on immigrant visas are not processed by the Philippine Overseas Employment Administration.

At an interactive forum among nurses at a recent congress, a nurse voiced his concern: “We are dealing with human lives here, not paper. We need to assess who are qualified to be nurses. If not, three to four years from now, our profession will be doomed.”

The problem is not limited to the shortage in human resources, said Barcelo. Clinical and laboratory facilities have also not expanded with the increased enrolment.

All these contribute to a poor quality of education and consequently, poor quality graduates, who inevitably have a low chance of passing local and foreign board exams.

With poor quality graduates, fewer nurses are licensed to practice their profession and provide competent health services. Nursing graduates who do not pass the board exams, but who still want to work abroad are likely to take on jobs as domestic care givers, a job that requires only six months’ training.

Many of those recruited to work abroad are graduates with one to two years’ work experience. Even if they pass the local licensure exams and find jobs in the US, they still have to take the state board exams. If they fail, they are demoted to nurse assistants in some hospitals.

Barcelo said the entry of new colleges or departments of nursing should be rationalized. Only colleges with a faculty of qualified nursing educators and adequate clinical resources should be allowed to open a new nursing program.

Schools also need to review their criteria for admitting students. The CHED and the nursing board must also evaluate so-called special programs for second courses. These are for other professionals, mainly doctors, who are studying to be nurses.

Barcelo said the nursing curriculum should not only focus on training nurses to be globally competitive. Equally important is the need to internalize a sense of a nationalism and patriotism among nursing students.

The course could include topics like the nursing shortage and the ethics of migration, the health status and needs of the country, and the interplay of economic, health, social and environmental factors on the shortage of nurses and migration.

Students should also be exposed to the health care situation outside their hospital base by requiring them to participate in community immersion programs.

An intensive information campaign on the “perils of the unregulated exodus of nurses to other countries in terms of social, economic and health costs” should also be launched, said Barcelo.

At the moment, the preferred destination of nurses seeking jobs abroad is the United States because of the possibility of acquiring US citizenship and all its privileges. But 57 percent of Filipino nurses abroad are in Saudi Arabia and only 14 percent are in the United States; 12 percent are in the United Kingdom.

That may soon change. Figures vary but the United States is said to need about a million nurses over the next few years; Canada, 10,000; the Netherlands and the United Kingdom, 7,000; other countries, 27,000.

Dr. Rusty Francisco, a nurse with a doctorate in nursing education and an owner of a training center for nurses bound for abroad, says many students are deluded into thinking that enrolment in a nursing school is a guaranteed passport to a job abroad.

“Passing all examinations does not make them competitive,” he says. Not many Filipino nurses are familiar with the medical equipment being used in US hospitals, he points out. Neither do they know how to operate in an environment where patients are more assertive and aware of their rights. That is why in his training center, Francisco emphasizes what Filipino nurses should expect when they are in the United States.

He adds that while Filipinos are still the preferred health workers, they may soon be facing stiff competition from the Chinese and the Indians who have come to realize the financial windfall from the export of nurses to developed countries.

Although Filipino nurses are known for being compassionate and caring, these qualities appear to be disappearing because the goals for taking up nursing have changed. From desiring to be of service to another human being, nursing students are now primarily motivated by the need to make money.

Francisco argues that even a high-standard school may not be able to change the mindset of those already determined to earn dollars above anything else. “A school curriculum,” he says, “does not automatically turn a person into a caring, compassionate nurse with the ability to be assertive and articulate.”

Too much attention has been on addressing the global shortage, and not enough on the local shortage and improving the working conditions of nurses who are still here, said Maria Isabelita C. Rogado, head of the department of nursing education at the Philippine Heart Center.

A key issue is the salary. According to Ruth Padilla, the average pay of nurses in the cities is still P9,000 a month. Nurses in government hospitals are paid slightly higher. In the rural areas, the average pay ranges from P4,000 to P5,500 a month.

The new nursing law (Republic Act 9173) pegs the minimum basic pay of nurses in public health and institutions at P13,300.

National nurses’ groups decry that the law does not provide the same guarantees to nurses who work in private hospitals, who are paid only from P2,500 to P3,000 a month.

At a recent nursing forum an informal survey among nurses said if their salaries are raised to a minimum of P30,000 a month, they will stay. Easier said than done. At current rates, even nursing directors don’t even earn close to that.

Nursing in the Philippines is still seen as a “non-rewarding career choice, a non exciting, risky profession to practice,” said Barcelo.

“This poor image will continue to push young nurses to migrate to other countries. There’s a need to improve this image of nurses so they will be motivated to practice their profession here,” she said.

Lawmakers have tried to stanch the hemorrhage of nurses for jobs abroad. At least two congressmen are pushing for a mandatory domestic service for nurses.

Reps. Tranquilino Carmona Sr. (First District, Negros Occidental) and Janette Garin (First District, Iloilo) have respectively filed House Bills 2700 and 2926 which seek to require Filipino nurses to render service to the country for a certain period of time before they are allowed to work abroad.

The bills are now under joint deliberation by the Committees on Labor and Employment and on Civil Service and Professional Regulation, headed by Reps. Roseller Barinaga (Second District, Zamboanga del Norte) and Francis Nepomuceno (First District, Pampanga), respectively.

The authors explained that their bills aim to address the looming shortage of nurses and deteriorating quality of health care services in the country due to the exodus of experienced nurses to high-paying jobs abroad.

Garin said that the mushrooming of substandard nursing schools naturally will result in poorly trained nurses. By the same token, the demand for experienced nurses in foreign countries has created a shortage of qualified and experienced nurses for local hospitals.

Her HB 2926 seeks a mandatory three-year domestic service for registered nurses (RNs) as a prerequisite for employment in foreign countries.

The proposed domestic nursing service, she added, would provide newly licensed nurses a training ground for them to practice and develop their “clinical eye.”

On the other hand, Carmona’s bill seeks to require nurses to render a two-year service within the country prior to employment abroad.

He clarified that RNs, to be able to fulfill the required domestic service requirement, shall be allowed to either seek employment in local hospitals or do volunteer work in hospitals that lack nurses.

Representatives of the nursing profession, however, objected to the proposals.

Ruth Padilla, president of the Philippine Nurses’ Association (PNA), belied that the country is experiencing a shortage of registered nurses. Numbers show that out of 369,000 RNs, only 35,744 are gainfully employed, she claimed.

What should be addressed, Padilla stressed, is the worsening working condition of nurses in the country. She said very few RNs have acquired nursing jobs, while many have ended up working as sales clerks and on other jobs not related to their profession.

Dr. Maria Linda Buhat of the Nursing Administrators of the Philippines (NAP) confirmed that the main reason for RNs leaving the country is for financial gain.

Buhat informed the committee that RNs in government hospitals earn P10,000 a month and nurses in private hospitals receive only P3,000 to P4,500 a month.

Rep. Maria Milagros Magsaysay (First District, Zambales) also opposed the bills. She cited the government’s failure to carry out laws and policies that protect the welfare of RNs and enable them to make a decent living.

Defending her stand, Garin maintained that the massive “export” of RNs will severely affect local health-care delivery.

Meanwhile, Barinaga said the body has to contend with certain issues in considering the proposed mandatory domestic service for nurses.

First, he pointed out that to encourage nurses to remain in the country, opportunities for gainful employment must be available to them. Second, there is a possibility that the proposal might run aground because of human rights issues, he added.

The last issue, which Barinaga raised, is the need to clarify the main purpose of the bill. “Does it aim to produce quality nurses, avert [a] shortage of nurses, or [an] appeal to nationalism?” he asked.

The committee decided to form a technical working group to further study and subsequently consolidate the two bills.

From : MANILA TIMES
http://www.manilatimes.net/national/2006/aug/07/yehey/top_stories/20060807top4.html



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