Nursing News:
Filipino nurses are leaving the Philippines in search of better pay, opportunities, working conditions and respect

By Patricia L. Adversario
Rose Gonzalez, a nursing graduate turned public relations practitioner for seven years, is leaving in a few weeks to work at the Johns Hopkins University Hospital in Maryland, USA. Having returned to her original profession, she is one of the scores of Filipinas who find that nursing is now the ³sure² ticket for a better-paying job abroad‹and the shortest route to immigrant status. Figures from the International Union of Nurses said that close to 10,000 Filipino nurses were directly hired by US-based hospitals in 2001.
The annual outflow of Filipino nurses is now three times greater than the annual production of licensed nurses, said Dr. Jaime Z. Galvez-Tan, executive director of the National Institutes of Health Philippines. Global need Tan said the shortage of nurses in the developed countries would not just be for a year or two, but for at least the next 10 to 15 years.
He explains: The developed countries are experiencing a longer lifespan and the ³graying of their population.² But their youth population is not interested in the nursing profession because of the difficult and risky work. More options are also available to them to take on other professions that offer better pay and working conditions. The solution for these countries: hire foreign nurses to do the job. Based on statements made by their respective governments, the US would need around 10,000 nurses a year, while the UK, Ireland, the Netherlands and other European countries would need another 10,000 nurses a year.
Push factors
Ma Linda Buhat, president of the Association of Nursing Service Administrators of the Philippines, said the most common reasons nurses leave the country are the low salary, lack of professional opportunities, the need for adventure, sense of obligation to family, desire to seek foreign citizenship and health reasons. The Philippines will never be able to compete with the salaries offered to nurses in the developed countries. Basic monthly pay abroad ranges from $3,000 to $4,000 compared to the $169 average monthly pay in most cities here.
Lydia M. Vengzon, a retired nurse who worked as nursing director for years, recalled an exit interview she conducted with one of her staff nurses. The young nurse was leaving for the UK to take on a new job for $2882 a month. ³In all my 31 years as nursing director, my salary didnıt even reach a third of that amount,² Vengzon says. Limited career ladder opportunities here are also a push factor. ³Weıve got a feudal system in our nurse-doctor working relationship. Nurses are not recognized as equal health care partners here. In the US, itıs a collaborative task,² says a nurse from a university hospital.
Dr. Teresita Barcelo, a professor at University of the Philippines College of Nursing, in a speech before a recent nursing congress, decried the governmentıs ³deafening silence to curb the outflow of nurses and the lack of political will to implement the nursing law that hopes to improve the salary of nurses and their working conditions.² While the profession is cognizant of its social responsibility, society also needs to address the reasons why nurses are leaving, said Annabelle R. Borromeo, vice president for patient care services at the Asian Hospital and Medical Center.
³Why, for instance, are nurses forced to take care of 60 patients? And why are they not properly compensated? Itıs a social problem.² Borromeo says.
³We want to take care of our people, but we also have families to feed. Sometimes, leaving may be the best way to help‹because by staying here, we wonıt have the means to help. As a society, we all need to alleviate poverty. If we can lick it, maybe weıd have better choices.²
Nursing Schools
The dean of a nursing college in Abra must lead a very active life. An inspection report submitted to the Professional Regulation Commission (PRC) shows she holds the same job in two other schools in Pangasinan. Her academic credentials can also be found in a deanıs office at a Manila school. She is one of many ³portable² deans, who, along with like-minded colleagues in a ³ghost faculty² spread themselves thin, lending their names to as many schools as possible.
The rise in the number of these cases points to the deteriorating quality of nursing education in the country. The increased demand for registered nurses has led to a corresponding rise in the need for nursing education. This year, at least 56 new schools are applying for accreditation. Of these, 16 are in the NCR, while 40 are based in other regions. Nesie B. Dionisio, a member of the Board of Nursing of the PRC said that of the 12 schools that the board visited this year, they have yet to recommend one. ³We found that these schools have no dean and no qualified faculty.² Dionisio said. ³What they have is ghost faculty. The schools claim they have the faculty, but we have yet to meet them, or see their appointment papers.²
The number of qualified faculty members has not kept pace with the increased number of nursing schools and nursing students. Existing faculty members are stretched, and there are few nurses who could serve as faculty members. Most of them have left to work abroad.
Despite the perceived low quality of these schools, not one has been ordered closed. The problem is not limited to the shortage in human resources, said Barcelo. Clinical and laboratory facilities have also not expanded with the increased enrollment. 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. ³Itıs too simplistic to say we open more schools because we need more nurses for local needs and for export,² said Barcelo. This approach proved ineffective during the last two waves of strong demand for nurses in the early seventies and late eighties.
³When external demand slows down, what happens to the new schools and the surplus graduates? Where will they go?² she pointed out. Barcelo believes the demand for Filipino nurses abroad will drop drastically after about five years, in contrast to the general belief that the shortage will last for more than a decade. She said there is a growing opinion in the US that the ³poaching² of nurses from developing countries is unethical. Influential nursing groups in the US have also lobbied against the ³band-aid solution² of hiring foreign nurses, and are lobbying for long-term solutions.
³I will not be surprised if five years from now, when their long-term solutions have started to take effect, the demand for Filipino nurses will drastically reduce,² said Barcelo.
The Government
Confusing policies within the government are impeding any coherent agenda on managing the outflow of health professionals without prejudicing the quality of local health care. ³Agencies like the labor department and the Philippine Overseas Employment Administration want the dollars, while the health department is concerned about human resources and their development,² said Dr. Jaime Z. Galvez Tan.
Tan advocates the creation of a national commission that would develop a human resource development policy for health and a national policy research agenda for human resources in health care. One major task for the proposed commission would be to compile a database of professionals in the health care sector. With regards to the nursing profession, there is a need to determine the current demand and supply, nursing standards and the distribution of nursing personnel.
Thereıs no available information on the number of nurses who are still here, the number of those who have left on immigration visas, said Dr. Marilyn E. Lorenzo, a professor at the UP College of Public Health. ³We canıt stop globalization,² said Lorenzo. ³If we have to participate in it, we should participate meaningfully. Since we have the valuable resource, we should have the say and be in control².
Regulating the departure
In this regard, Tan proposes a National Health Service Act that will enable the country to program the exit of health professionals to ensure a steady pool in all health facilities, rural and urban. Tan says the Philippines is one of the few countries in Southeast Asia that still doesnıt have a National Health Service Act. This is a compulsory requirement for all licensed health professionals to serve anywhere within the country for a specified period thatıs equal to the number of years it took them to finish their degree. He proposes a mandatory service of three years for graduates from state universities Attempts to have such a law passed were met with objections because they were against the individualıs human rights to move freely and practice their profession where they want. ³But with globalization and the active trading of health human resources the countryıs collective interest and collective rights should now prevail,² argued Tan.
Sharing the cost
The government can also initiate high-level bilateral negotiations with countries that import Filipino nurses on how they could share the cost of training these nurses. Tan proposes that the Philippine government hold bilateral discussions with the United States, the United Kingdom, Ireland, The Netherlands, and Saudi Arabia. He said current arrangements on the importation of Filipino nurses have been ³lopsided and advantageous only to such countries.²
Hospital to hospital partnership agreements could also be arranged where recruiting hospital institutions could share the cost of training by providing financial grants for every Filipino nurse that joins its staff. Tan proposes that the grant be used to improve salaries, training and nursing practices as well as upgrade hospital and educational facilities.
³Hospitals from countries of the North do not spend a single centavo in the production, development, education and licensure of Filipino nurses. At the very least, they should be able to pay partially, if not fully, the cost of development since they are going to benefit from the services of that nurse for at least 25 years,² said Tan. Virginia C. Alinsao, US-based director of international nursing recruitment at the Johns Hopkins Health System said in an interview in Manila that ³subsidized training has its merits and weıre willing to explore that proposal.² She said arrangements should not only explore monetary assistance.
³US hospitals could also provide training grants, fellowships, or internships as knowledge transfer to beef up the training here. We could also provide training materials,² said Alinsao.
Salary increase
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 Ma. 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 $173 a month. Nurses in gover
nment hospitals are paid slightly higher. In the rural areas, the average pay ranges from $77 to $105 a month. The new nursing law (Republic Act 9173) pegs the minimum basic pay of nurses in public health and institutions at $255. At a recent nursing forum, an informal survey among nurses said if their salaries are raised to a minimum of $576 a month, they will stay. Easier said than done. At current rates, even nursing directors donıt even earn close to that. Nursing in the Philippines is still seen as a ³non rewarding career choice, a non exciting, risky profession to practice,² said Dr. Teresita I. Barcelo,
³This poor image will continue to push young nurses to migrate to other countries. Thereıs a need to improve this image of nurses so they will be motivated to practice their profession here,² she said. It is ironic that the Philippines, which is one of the worldıs major suppliers of nurses, has yet to give due recognition to those who choose to serve here.