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Nursing decline: Heavy toll on nation’s health

SPECIAL REPORT: Nursing

Nursing decline: Heavy toll on nation’s health
By Francis Cueto

THE state of nursing education in the country is a favorite topic among reform-minded government officials, health experts, lawmakers, nurses and the media.

They should listen to Dr. Jaime Galvez Tan, former secretary of health and director of the National Institute of Health, UP, who has made it his lifework to campaign for the arrest of “the deterioration of nursing education.”

At issue is not the quality of nurses who graduate and pass the Philippine licensure examination, which is one of the world’s best and toughest. The issue is the health of nursing education and how this had affected the training of nursing students and the quality of nursing service.

Dr. Tan says one proof of the decline is falling pass percentage in nursing licensure examinations since 1994. (See Table I, from the Professional Regulation Commission Table 1, showing the passing percentages from the June 12, 2001, licensure exam to the June 12, 2006, exam.)




Passing rate fall

Dr. Tan says that figures from the Philippine Regulatory Commission’s Nursing Board and the licensure board-exam passing rate show that the quality of graduate nurses has deteriorated drastically since 1994. He and other experts, as well as the PRC, don’t attribute the consistently diminishing pass rate to the poor nursing education that the failing examinees received from their schools and to the exams’ having been made harder than before by the Nursing Board.

Dr. Tan told The Times: “In the seventies and eighties the passing rate was 80 to 85 percent of all exam takers. There were years when the passing rate was 90 percent. In 1994 the passing rate was only 61 percent. Wow! I thought that was bad. But the succeeding years yielded passing rates of 48, 49 and this year has been the worst so far: 42.42 percent of those who took the June 12, 2006, exam. Mind you, we have a good and respected nursing exam, one of the toughest in the world.”

Dr. Tan explains. “In the 1970s there were only 40 nursing schools in the whole country. Then there were 100 and, later, 129. But in the last seven or five years there has been an increase of more than 200 more schools. There are now about 410 schools.”

He studied a 10-year pattern of nursing schools that have been registering less than 50-percent passes. To him a school with only 50 percent of its graduates passing the board exam shows the school is mediocre. A school with passes of 80 percent and more is good. Schools with less than 50 percent are bad. And those that have less than 10 percent and even zero passing rate, he considers “garbage.”

He compared two five-year periods. He saw that in the nineties, 60 percent of all schools had passing percentages of 50 percent and above. Only 40 percent were “bad schools” and the bottom few were “garbage” schools. But in the last five years it has become the reverse: 60 percent of the schools are “mediocre” to “bad.” In the June 2006 exam, 251—or 69.7 percent nearly 70 percent—of the 360 schools whose graduates took the board exam had passing percentages below 50 percent.

The “good” and the “garbage”

This, Tan says, definitely proves that nursing education—that offered by many of the new schools—needs intensive-care treatment.

He sees something people miss about the latest board failure figures.

“The rapid increase these last five to seven years of nursing schools to the point that we now have a proliferation of them is not doing our country a service,” he points out. “And the fact that out of 41,988 who took the board only 17,821—42.42 percent-passed, shows how low our nursing education has sunk!”

How many of the new schools belong to the garbage group?

Obviously many of the schools that came into being only in the last seven years have contributed to the miserable state of nursing education. But of the 410 nursing schools throughout the archipelago, 100 were opened only in 2004 or later. These obviously did not have graduates who took the June 2006 board exams.

CHED’s Deputy Executive Director, Julito Vitrolo, is not quick to condemn all the newly established schools. Many graduates of the older schools, he rightly observes, also did not pass the June exams.

Schools with 100-percent pass rate

It’s interesting that in the June exam 26 schools had 100-percent passing percentage. Among these is the University of the Philippines, all of whose 46 examinees passed. Funnily, 24 of the other 25 schools registered 100 percent because they each had only one graduate who took and passed the exam. The remaining one had two graduates who took the exam and both passed.

The one-graduate 100 percenters are the Abra Institute of Science and Tchnology, the Albatross Academy of Caloocan, the Bataan Polytechnic State College-Orani, the Central Colleges of the Philippines, the Colegio de San Juan de Letran in Intramuros, the Dipolog Institute of Technology, the East Pacific Computer College, the Lyceum of the Philippines, the Manila Central University-Manila, the Mary Johnston College, the Modern Maritime Technical School, the Pagadian College of Criminology and Sciences, the Pangasinan Merchant Marine Academy, the Ramon Magsaysay Polytechnic College, Saint Anthony’s School, Saint Joseph’s College of Quezon City, the Saint Peter Baptist College, the Secondary School, the Siargao Island Institute of Technology, Sienna College-QC, the Surigao del Sur Institute of Technology, the Tublay School of Fisheries, the University of Northern Philippines-Candon and Xavier University.

The two-graduate 100 percent is the University of the East-Manila.

Those that had more than 70-percent passes and had comparatively large numbers of examinees are Cebu City Medical Center (formerly Cebu City General Hospital) 71 percent, Cebu Doctors University 92 percent, Cebu Normal University (Ceb State College) 88 percent, Centro Escolar University of Manila 76 percent, Concordia College 70 percent, Divine Word College of Legazpi 75 percent, Far Eastern University-Nicanor Reyes Medical Foundation 75 percent, Manila Doctors College 74 percent, Notre Dame of Dadiangas College 78 percent, Pamantasan ng Lungsod ng Pasig 78 percent, Philippine Christian University-Manila 97 percent, Sacred Heart College of Laoag 70 percent, Saint Louis University 95 percent, Saint Paul College of Manila 73 percent, Universiry of the East Ramon Magsaysay Memorial Medical Center 89 percent, Velez College 82 percent, West Visayas State University-La Paz 95 percent.

Large number of examinees

The June 2006 licensure exam had the largest number of examinees in Philippine history: 41,988 graduates.

The increases have been dramatic since June 2, 2003. Before that the examinee-increase was not phenomenal: the June 12, 2001, exam had 4,430 examinees, of whom 54.29 percent passed; the December 2, 2001, exam had fewer takers, 3,851, of whom 52.58 passed; the June 3, 2002, exam had 4,931 and only 46.54 passed; the December 7, 2003, exam had fewer takers, 4,522, of whom only 42.81 passed.

Then on June 2, 2003, there was a dramatic increase, 7,992 examinees and, happily, 52.77 passed. On December 7, 2003, there were slightly fewer examinees, 7,632, but only 43.38 percent passed.

Six months later, on June 7, 2004, the increase took a leap—almost doubling the previous exam—13,225, of whom 55.74 percent passed. The exam on December 4, 2004, had 12,100 examinees and only 43.06 percent passed.

Another doubling happened on June 6, 2005. The examinees numbered 26,000, and less than half, 12,843, or 49.40 percent, passed. The next exam, on December 4, 2005, had slightly fewer examinees, 24,287 and, happily, 53.97 percent passed.

Then came the June 12, 2006, exam, which saw a very large increase: 42,006, of whom 42.42 percent passed, the lowest ever passing percentage in the history of Philippine licensure examinations.

Hospital training deficiency

Nursing education is not just lectures and school-based laboratory work. The nursing students have to experience real hospital work.

Dr. Tan told The Times how inadequate many nursing schools’ hospital training for their students is.

“Many schools that opened after the boom have no hospitals of their own. There are few good hospitals they can send their students to. So these few hospitals that take in nursing students also become so crowded. Instead of learning the orderly way of a properly run hospital, what do you think do these students learn? We now have more than 400 schools. We have about 2,000 hospitals nationwide. But of that number, only about 1,500 are anything other than 10- to 20-bed hospitals or clinics. Only about 20 percent of the 2,000 are 50- to 100-bed hospitals. Very few are hospitals with more than 100 beds. So where are the patients, beds and hospital rooms for these nursing students to learn their skills and practical training with? Count the number of beds, the total number of beds in the Philippines and the total number of nursing graduates. In this situation, ano ang natututunan [what do they learn]?”

Dr. Tan asserts that the ideal teacher-to-student ratio is 1:20. Many new nursing schools, he told The Times, don’t have this. Besides “hiram na faculty [borrowed faculty]” he blames the overloading of the new schools. The new schools have more students than they can handle, especially clinical instructors. He does not think the departure of nursing teachers for jobs abroad is a very big factor in the deterioration.

“It’s a factor, but not a very big factor,” he stressed.

“Look at Saint Paul, and here is UP. They have the same staff, the same people, though some have grown old and they are dwindling. But they can easily attract new teachers to join them. I don’t quite appreciate the CHED statement that the best schools are also deteriorating; they are not. Their passing rates have remained basically the same for decades. What has made the figures very bad now is the very large increase in total nursing enrollment—and this is in the new schools, because the good old schools will not stretch the limits of their proper capacity.”

Nursing-teacher shortage

It’s not only the nurses hired to work in medical centers, hospitals and clinics who are being drawn away from Third-World Philippines by the developed world, mainly the United States and Europe, and by Saudi Arabia and even China and Nigeria. Nursing college professors have also been lured away. They sometimes end up in nonteaching jobs in the West. But, like their former students abroad, they earn at least 10 times more than they do here.

So what happens to the schools they leave? “Hiram na faculty [borrowed faculty],” said Dr. Tan. “These days, many nursing teachers and lecturers teach in three or four nursing schools. How can they focus on the subject matter and have the energy and zeal to impart all the knowledge and skills to their students?”

“Even deans are shared by at least two schools,” he continued. “A dean must have a Master’s degree or a Ph.D. or at least some doctoral units. How many such nurses with that capacity and qualification are still here in our country? Maybe wala pang 400! So, we now have . . . flying deans. One could be based in Cebu and flies to Leyte, be dean for a day there, then lipat na naman somewhere else. The same thing happens in Luzon. When you look at this lack of focus among nursing-school officials and instructors, does it surprise you that some schools turn out poor nursing graduates?

“Now consider the number of students in each nursing school nowadays. This only began to happen in the years after the nursing boom. Before, the usual, or typical, maximum number of students in a section was 40. And most nursing schools only had four sections. So there were a maximum of 160 students in a typical school. Now, there are some nursing schools with 40 sections—or 1,600 students. Where do they get their teachers?

To be concluded tomorrow


FROM: MANILA TIMES
http://www.manilatimes.net/national/2006/aug/06/yehey/top_stories/20060806top1.html



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