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PHILIPPINE NURSING IS DYING!
By Carl E. Balita, EdD, DrHum, RN, RM, RPT, MAN

While the global demand for Filipino nurses is high and that the Filipino nurses are regarded as the best in the world, the nursing profession in the Philippines is dying. And the nurses are in critical situation.

There is no doubt that the world needs nurses, and there is a global preference for the Filipino nurses. It is an undeniable fact that the majority of foreign nurses in developed countries, like USA, UK, UAE, KSA are Filipinos. The aging population and other modern realities increase the demand for quality health care professionals. There is something in the Filipino culture that makes its nurses the best in what nurses do best - that is, caring. Language has become a value-added advantage, not only in caring but in international examinations, which mostly are conducted in English and are easily passed by Filipino nurses. The number of years of basic education has no bearing to the world class readiness of Filipino nurses.

The opportunities for Filipino nurses are vast overseas and its value to our economy is exponential. But we have lost the battle and the war, not because we lack the supply of nurses but because of our government's failure to see it from the global and local points of view.

The Philippine nursing is dying, and here are the issues behind it:

First, it is noteworthy that there is no oversupply of nurses in the Philippines. There is under-utilization! Visit the hospitals, both government and private, and you will discover the overloadig nurse-to-patient ratio. The appropriate DOH ratio of 1:10-15 is violated by the reality that loads the nurses with 1:40 ratio, at the very least. There has been no additional plantilla positions since the 80's in many hospitals. The bed capacities of hospitals have grown but the human resource allocation, which majority are nurses, has not proportionately increased. The implication is certainly poor health care service to the Filipino people.

Secondly, the limited job opportunities for nurses in the hospitals deprive the nurses of the required experiences for them to meet the global requirements. While Filipino nurses may be able to pass any international examination, they lack the 2-year experience which completes their placement prerequisites. This is why many nurses are desperate in working even for free just to be able to obtain a certificate of employment which can somehow open the doors of their overseas opportunities. But this would mean two long years of slavery in the guise of what they call "volunteerism." While not many nurses and parents are willing to take this exploitative road of false volunteerism, some have no better choice.

We are losing to countries like Nepal, India, Vietnam, and even China, as they seem to have positioned their nurses to meet the supply gap.

If the Philippine government can invest on Filipino nurses in its hospitals and impose upon private hospitals to uphold the standards of the nurse-patient ratio, it will provide better health care for the Filipino people and there will be greater competitiveness of our nurses to meet the global demands. The nurses are paid well in many develop countries and their remittances will surely impact the economy.

The third major issue that kills nursing in the Philippines is the salary. In 2002, the Philippine Nursing Law was passed which mandated that nurses in the government should have an entry level salary grade of 15, which should be about P25,000 in the current rates. But 14 years have passed and the law has not been implemented in most government hospitals. The government itself has violated a law that it passed. Worst situation is expected in private hospitals, which some have offered nurses salary way below the minimum wage. And nurses patiently and passively allowed this as "beggars cant be choosers." They patiently succumb to what is actually a degrading offer but is better than not finding one.

This reality brings many nurses elsewhere - from spas to skin clinics and even call centers. Some end up shifting to other careers like teaching, sales, or business. Poor nurses who could have filfilled their noble profession but are pushed into becoming somebody else.

Fourth reality is the poor utlization of nurses in where they can be most useful. This includes public health, schools and occupational health. Imagine if every Barangay has a nurse. They can surely contribute value to health and wellness in the basic unit of our local government. If there is a nurse in every school, the health of the children could be promoted. Industrial and occupational nursing can promote health and wellness in the workplace to make it more productive and safe. This reality deprives the nurses of the opportunity to contribute to society and gain employment for their career fulfillment and advancement.

Fifth is the dying nursing colleges, which hardly can fill up a regular class size. Many Colleges of Nursing have closed and have displaced qualified educators, administrators and researchers. Many of them are now productive professionals overseas benefitting their production of professionals who will soon compete with our own. This reality was primarily due to the public knowledge of the unemployed and underemployed nurses. Even the nursing organizations have contributed to the decline in enrolment by highlighting the unemployed nurses in the country. But what they have not addressed is the fact that the real problem is not the local and global demands but the under-utilization of the precious nursing supply.

Imagine if developed countries open their doors wide for Filipino nurses soon, then, it will take the Philippine nursing education sector not less than four years to prepare nurses. And the graduates and new professionals will still need the valuable clinical experience, as usual.

Sixth issue that is killing Philippine nursing is the nurses disunity for their cause. In the last election, Ang Nars Partylist did not get sufficient votes even from nurses whose number was enough to win at least a legislative seat. Well, it may have been caused by the partylist's failure to make nurses feel its value for three years of its initial term. It is ironic that the only health professional sector in the party list system did not create an impact to sustain its presence in the lower house for its second term.

And also most recently, the Comprehensive Nursing Bill which passed both houses of congress was vetoed by President Noynoy Aquino. Earlier, the Philippine Hospital Association (PHA) has publicly expressed its disagreement with the bill, which to them has health care cost implications. This seem to have reached Malacañang and gained attention leading to the dismayed nurses. The nursing group had the traditional signature campaign that looked more of a campaign strategy than a strategic move to get Malacañang to listen and appreciate its message. The PHA was able to afford paid ads in the newspapers to communicate its message but the rich PNA was communicating in the usual traditional way and certainly did not come across.

As the country awaits for change with President Rody Duterte's phenomenal assumption of the highest post, and with his common-law wife Cieleto "Honeylet" Avancena who is a nurse, the Philippine Nursing may be ressurected from the critical stage of dying, and that the nurses may be given the attention and recognition they have long deserved.

But on top of this opportunity for change is the need for nurses to unite as one voice that will communicate the message loud and clear. Without such unity, we may need to give Philippine nursing a post-mortem care.

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Dr Carl E. Balita is a nurse educator and advocate. He was professor and dean of nursing. He is a bestselling author and reviewer and owns the leading review center in the country, with branches in middle east and expanding in the ASEAN.