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Leakage leaves examinees sitting on pins and needles

Leakage leaves examinees sitting on pins and needles
By Francis Cueto

For two successive days last June, some 43,000 graduates of various nursing schools in the Philippines trooped to the testing centers throughout the country to take the board examinations supervised by the Professional Regulation Commission (PRC). The PRC announced the results of the exams on July 19. Only 17,871 passed.

While the 41.56-percent passing rate was probably par for the course in recent years—there was a time when the mortality rate was less than 10 percent—the euphoria of those who made the cut was short-lived. It was not long after that allegations of leakage of the exam questions at a testing center in Baguio City came to light.

After the PRC confirmed—following an in-house probe—that there was indeed a leakage in two of the five-subject board exams, it decided to postpone the oathtaking of the new nurses (originally scheduled for August 22) “until further notice.” Moreover, the PRC originally traced the leakage to two members of its five-man Board of Nursing, who are now facing administrative charges.

The PRC referred the irregularity to the National Bureau of Investigation “for its own probe and determination of all persons and parties involved and their criminal prosecution under the law.”

The postponement left the new nurses—so used to wielding the hypodermic needle during their hospital stint—sitting on pins and needles until the controversy is resolved.

Thus far, this much is confirmed:

• The leak came from the R.A. Gapuz Review Center, which admitted that it gave its reviewers a document containing many of the questions in the exams. Dr. Rey Gapuz, founder of the center, later played down what happened as “an honest mistake.” He said the questions were faxed to the center by a “source,” and the center distributed them to its students, mistakenly thinking they were review material.

• A statistician hired by the PRC to determine the harm caused by the leaked questions recommended that the PRC invalidate 25 questions in Test III (medical surgical nursing) and the entire Test V (psychiatric nursing). Those who passed the exam, minus those parts, were to be given their licenses as nurses on August 22. (Observers noted the impact of failing the test on psychiatric nursing, saying a nurse who flunks the subject is bound to send a patient who has gone bonkers deeper into the loony bin.)

• After the release of the results on July 19, PRC Board of Nursing chair Euphemia Octaviano said the successful examinees could take their oath on August 22 even before the NBI finishes its inquiry. But she added that once a leakage is determined, the licenses of the examinees could be suspended or revoked.

On July 28 Leonor T. Rosero, chair of the Professional Regulation Commission, ordered the indefinite postponement of the oathtaking. She said she made the decision after meeting with the deans of prominent nursing schools in order to allow the PRC to hear their concerns and await the results of the NBI probe. That the controversial leakage has tarnished the image of Filipino nurses was enough reason for both houses of Congress to call for separate inquiries.

In a Senate resolution Sen. Richard Gordon said the allegations “could taint the credibility of the entire government-sponsored testing system and affect the image of all Filipino professionals going out of the country.”

He said developed nations look to the Philippines to fill their nursing shortages owing to the reputation of Filipino nurses for their competence, diligence and compassion for their patients.

“The nursing board leakage is just the latest scandal that undermines public trust in the nurses produced by Philippine schools, following allegations of loose accreditation of nursing schools and the Commission on Higher Education’s feeble enforcement of academic standards in nursing schools,” the resolution said.

“Since nurses are charged with the health, medical needs and life of their patients, here and abroad, it is essential that the PRC ensure that licensed nurses are competent and fully equipped to perform the responsibilities of their profession,” Gordon said.

In the House of Representatives, Congressman Joseph Santiago had a more draconian proposal. The three remaining members of the PRC’s Board of Nursing should resign voluntarily, he said.

“Even if they had absolutely nothing to do with the irregularity, it was on their watch that the anomaly happened,” he said.

Santiago is also urging the PRC to decide promptly whether or not to require candidates to retake the licensure examinations in the two subjects where the leaks took place.

Santiago has found allies in his “retake” proposal in officials of the University of Santo Tomas, who took his suggestion one big step further.

In a letter to the PRC, Susan Maravilla, Thelma Abelardo and Rene Tadle, UST assistant dean, treasurer of the UST Nursing Alumni Association, and president of the UST Faculty Association of the College or Nursing, respectively, took issue with the PRC’s position on the areas where the leakage took place. At the very least, they said, how did the PRC determine that only 25 questions in Test III and all the ones in Test V were leaked? At the very most, they said, even if that were so, why pass candidates whom you had no way of knowing were competent in psychiatric nursing?

The UST officials conceded that they were aware of the cost in time, money and energy taking the exam would be for the innocent, but they were also aware of the humongous cost in reputation, credibility and employability of those who would pass under these terms. “The cloud of doubt cast on their competence by these flawed exams would hound them forever.”

Commenting on the issue, Conrad DeQuiros, columnist of the Philippine Daily Inquirer, said the cost of the examinees’ not taking the tests again is steeper. “Not just for themselves but for the nation as well. It won’t just damage their reputations—hospital patients might wish to inquire if they were being nursed by someone from Batch 2006—it will damage the reputation of the whole profession.”

Assuming that members of Batch 2006 are finally given their professional licenses, will it be clear sailing for these Florence Nightingales and Walt Whitmans (the poet served as a nurse with the Union Army during the American Civil War) to those jobs abroad?

Not by a long shot.

The PRC exams are just the first hurdle for nurses planning to work overseas. To qualify for jobs in the US, for instance, they have to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) in addition to the State Board exams.

And when it comes to the NCLEX, candidates will have to make the cut not only in bedpan manners but in written and spoken English as well.

Citing the performance of foreign-educated nurses in the NCLEX-RN, former Sen. Ernesto Herrera noted that the proportion of Indians and South Koreans passing the test increased remarkably in the past two years, while the percentage of Filipinos making the grade improved at a slower pace.

Herrera, secretary-general of the Trade Union Congress of the Philippines, said nursing students must consciously improve their mastery of English, and regulators must check the proliferation of substandard nursing schools in order for Philippine-educated nurses to stay globally competitive.

According to statistics from the US National Council of State Boards of Nursing, Herrera said, a total of 14,022 nurses educated in the Philippines who took the NCLEX-RN from 2001 to 2005, only 7,238, or 51.61 percent, passed.

Over the same five-year period, 11,717 nurses educated in India took the exams, and 54.87 percent, or 942, passed.

A total of 1,666 nurses trained in South Korea took the exams over the same period, and 59.98 percent, or 958, made the grade.

Herrera attributed the performance of Indians and South Koreans to:

• The enhancement of nursing education in India and South Korea, while substandard nursing “diploma mills” have proliferated practically unchecked in the Philippines.

• The resolve of India and South Korea to embrace English, while the Philippines has been slow to revive the language in schools.

• The advantage of Indian and South Korean examinees being able to take the exams in testing centers in their home countries, while Filipino examinees have to take the test abroad.

Herrera also says that in addition to the Indians and South Koreans, Canadians and Cubans have emerged as the chief rivals of Filipinos in the nursing labor market in the United States. He added, however, that the Philippines remains the US principal supplier of foreign nurses.

The NCLEX is the final step in the nurse licensure process in the US. The number of NCLEX examinees is “a good indicator” of how many American as well as foreign nursing graduates are trying to enter the profession in that country, according to Herrera.

Herrera said NCLEX statistics also indicate that the US is producing its own nurses by the thousand. But the numbers are still not enough to cope with the growing health-care needs of the aging US population.

He played down reports suggesting that the leakage in last June’s nursing licensure examination would affect the deployment of Filipino nurses abroad.

“That is not true. Hospitals abroad will keep on hiring qualified Filipino nurses as long as their services are needed. Besides, professional regulators overseas have their own means of determining the eligibility of foreign nurses, such as through the NCLEX in the case of the US,” Herrera pointed out.

“This is not to say that the our regulators should not take decisive corrective measures. Those responsible for the anomaly should be punished swiftly and adequate steps should be taken to prevent a repeat of the leakage,” Herrera said.

The country has 460 nursing schools, of which only 12 are considered by the Commission on Higher Education as outstanding due to their 90-percent passing rate in national licen-sure examinations. Forty of the schools have zero passing rate even though they are required by law to ensure a minimum of 5-percent passing rate.

Annual enrollment at nursing schools stands at 100,000 with 15,000 to 25,000 graduates yearly.


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