Nurse Migration from a Source Country
Perspective: Philippine Country Case
Study
Fely Marilyn E. Lorenzo, Jaime Galvez-Tan, Kriselle Icamina,
and Lara Javier

This article focuses more on to describe nurse migration patterns in the Philippines and their benefits and costs. Its aim is to identify different strategies that will ensure that international nurse migration is beneficial for both sending and receiving countries.

Our country, as we all know is a job-scarce environment. Not all of us are given a big opportunity to work or even practice our own profession on which often motivate nurses to seek employment overseas. However, shortage of skilled nurses and massive retraining of physicians to become nurses has created severe problems for the Filipino health system on which policymakers are debating the need of for new policies/strategies to manage migration on such that both sending and receiving countries are receiving benefits.

According to the study, Philippines is the largest exporter of nurses worldwide. It has consistently supplied Nurses to the United States and Saudi Arabia for many decades. In recent years, other markets have emerged and opened for nurses including United Kingdom, the Netherlands and Ireland.

It is also stated in the study that there are no precise figures obtained on nurse migration for the reasons that workers are recruited privately and not officially documented by Philippines Overseas Employment Agency (POEA). Moreover, The Department of Foreign Affairs data are also incomplete because many people leave as tourists and subsequently become overseas workers. So authors concluded that the data being presented on both migration of all occupations and nurse migration specifically are generally underreported.

The Philippines has too few jobs for its population. Conditions are difficult even for those who have their jobs. Filipino labor migration was originally intended to serve as a measure to ease unemployment and employment abroad provides work to job-seeking Filipinos and is a major generator of foreign exchange. (Villalba.2002)

Also on this study tackles the nurse migration pattern wherein respondents are able to create pushing factors such as low salary, no overtime or hazard pay, limited opportunities for employment, decreased health budget and economic instability in the Philippines and Pulling factors such as higher income, better benefits, lower nurse to patient ratio, more options on working hours, opportunity for family to upgrade and advance technology as well why they have the reasons to leave.

Migration according to the study was perceived to impact nursing in the Philippines negatively by depleting the pool of skilled and experienced health workers thus compromising the quality of care in the health care system. Example: Who among those people who are intended to migrate or to work overseas? Commonly are the more experienced workers like our senior nurses etc wherein I agree to the authors that it can probably affect the quality care because they can’t do the continuing investment in the training of staff replacements. As a result of these, flurry of policy debate has developed. Labor and employment sector, trade sector, health sector are the three major spheres of policy which can relate to the topic.

Attached also to the study is the series of proposals that are considered part of the Philippine Nursing Development Plan on which according (WHO.2006) while the outcome of this process is unfolding, it is encouraging that the health sector has taken the lead to shift the terms of the debate.

I agree that if the Philippines were able to produce and retain enough nurses to serve its own population, there would be widespread support for additional quality nurse production and migration.

Questions:

1. Which statement strikes you or caught your attention? Give your insights about it.

2. Aside from the push and pull factors given in the study, please give another examples of both on why nurses migrate.

The Nurse Migration Problem has never been an exclusively Philippine problem. Canada also experiences the same problem, with their local nurses migrating to the United States. In Little’s case study (2007), she iterated this finding: ”the current and projected shortage of nurses in Canada is a product of health care cost containment policies that failed to take into account long-term consequences for nurse workforce adequacy. An aging nurse workforce, exacerbated by layoffs of younger nurses with less seniority and increasing demand for nurses contribute to a projection of nurse shortage that is too great to be solved ethically through international nurse recruitment. National policies to increase domestic nurse production and retention are recommended in addition to international collaboration among developed countries to move toward greater national nurse workforce self sufficiency.” [1] However, although there is mitigation in health care costs in Canada, one of our principal “nurse importers”, there is, in my opinion, no cause to believe that there is such a thing as a felt “cost mitigation” in the Philippines, working conditions, especially in public hospitals have never been better, flow of nurses to the importing country is regulated only by the importing country, and we only experience the monetary compensation from being sent with more dollars. There are no real tangible and valuable contributions, only empty promises.
I believe that the push and pull effect should be countered by the government with its own push and pull effect. A study by Aiken (2007), on the US nurse labor market came to a conclusion that the US’ increased reliance on our immigration will severely affect their health care system and our health care system and that it will not solve their shortage problem. [2] There is no winner in this agreement; both the nurse importer and the nurse exporter shall reap the drastic consequences of this problem. To that effect Aiken (2007) suggested the need of the US to move toward greater self-sufficiency in its Nursing force. It will, in the long-run improve on the nurse shortage in the US; to that effect I also recommend the government to start doing the same. It will, in my opinion, also improve our economy and give our sinking health care a much needed boost. Stringently regulate nurse migration and recruitment; we have become a country of nurses, and nobody seems to notice that it’s doing nothing to our already sinking economy other than making the situation worse with unemployment. We have legislation for everything in this country, the only real problem is implementation. If we only implement laws the way they should be implemented than I believe we can finally destroy the myth that going commando abroad as a nurse is the solution to Philippine poverty.

1 - Lisa Little (2007), Nurse Migration: A Canadian Case Study, lifted from the Health Services Research Journal, accessed June 22, 2009 retrieved from www.pubmedcentral.nih.gov
2 - Linda H Aiken (2007), U.S. Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency, lifted from the Health Services Research Journal, accessed June 22, 2009 retrieved from www.pubmedcentral.nih.gov

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1.) Which statement strikes you the most? Give your insights about it.







The journal statement above rings true in the Philippine setting and the effects that job scarcity bring to nurses proved to be a daunting situation especially for new graduate nurses who seek to hone their skills in a clinical set-up. At the same time, the increasing retention in fresh graduate nurses in the country has closed opportunities for these aspiring young nurse professionals to build their work experience in the hospitals. For that reason, the distressing status quo has pushed nurses to look for other career opportunities closely related to nursing or totally beyond their field of expertise.


The Call Center Industry, for instance, is a shining example of an industry Filipino nurses choose as an alternative career to their profession. As cited from Timi Nubla of ABS-CBN News, "Many jobless Filipino nurses work in call centers while awaiting employment, the Philippine Nurses Association (PNA) said Tuesday. PNA president Leah Primitiva Samaco-Paquiz attributed these problems to a surge in supply of Filipino nurses and salaries in both government and private hospitals that are lower than the pay given to call center workers. She said the low salary is driving the licensed nurses to apply in call centers."


The dilemma of Filipino nurses described in the article should therefore be given more attention by the government. If increasing the salaries would lessen the burden of migrating nurses then a bill should already be in the process. "(Nubla, T. 2008) The PNA is now pushing for the implementation of Republic Act 9173 of the Nursing Law that seeks increase the pay scale of nurses working in government hospitals to Salary Grade 15. A government nurse is supposed to get a monthly salary of P16,093.00 but some are still being paid lower than P10,000, the PNA earlier said."




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REFERENCES:


1. Nubla, T. 2008. Many jobless Pinoy nurses work in call centers: PNA. ABS-CBN News. Retrieved June 22, 2009 from http://news.abs-cbn.com/pinoy-migration/09/02/08/many-jobless-pinoy-nurses-work-call-centers-pna

2. Michin. 2008. Nurses in Call Centers. Retrieved June 22, 2009 from http://www.callcenterphilippines.net/newsflashes/news-blog/nurses-in-call-centers.html

Quoting the statement, “respondents are able to create pushing factors such as low salary, no overtime or hazard pay, limited opportunities for employment, decreased health budget and economic instability in the Philippines and Pulling factors such as higher income, better benefits, lower nurse to patient ratio, more options on working hours, opportunity for family to upgrade and advance technology as well why they have the reasons to leave”. Number of reasons why Filipinos leave the country as listed above are nothing but facts that are obviously seen and experienced by lots of Filipinos, specially nurses. Most of “us” who are just neophyte in the field are very much upset on the way how the government fail to manage this kind of problem. In fact, there could be lots of nurses who are competent enough to serve the people but because of the hindrance, they tend to go abroad because much opportunity there is waiting for them. Proficient, Experienced, knowledgeable nurses are now in the different parts of the world to meet their needs and their families. If only the government can do policies, our country should then retain great and skilled professionals.

The brain drain increases the insufficiency of highly needed skilled labour in developing countries and consequently reduces long-run economic growth and income. In addition, if highly educated workers continue to emigrate to better-off countries, public funds spent on higher education in order to promote growth may be to a large extent inefficiently applied and better spent on sound and widespread basic education to foster domestic economic development. In order to devise policies that create incentives for the highly skilled workers to stay, a clear picture of their reasons for leaving has to be developed first. Part of the explanation may be wage differentials, differences in the quality of life, and educational opportunities for children and job security. Implementing the right policies to counter the brain drain will be of crucial importance for the economic future of the affected countries, and one of their biggest challenges.

The World Economic Forum made a statistic research in 2004 to identify the rate of countries that has the highest number of immigrants who left their respective countries for better job opportunities and those who would rather stay in their homeland. The study had included 32 countries in which United States of America has the highest number of talented people who almost remain in the country. Philippines, on the other hand, are second to Serbia who has the highest number of people who would leave to pursue an opportunity in other countries.

REFERENCE: Research Group on Global Future (2005). Retrieved June 23, 2009, from http://www.cap-lmu.de/fgz/statistics/brain-drain.php

“Which statement strikes you or caught your attention? Give your insights about it.”


I personally agree to this statement.


“…wherein respondents are able to create pushing factors such as low salary, no overtime or hazard pay, limited opportunities for employment, decreased health budget and economic instability in the Philippines and Pulling factors such as higher income, better benefits, lower nurse to patient ratio, more options on working hours, opportunity for family to upgrade and advance technology as well why they have the reasons to leave.”

When nursing has become in demand, many of Filipino’s took the opportunity and studied nursing. The effect of it is too many nursing graduates yet limited opportunities for employment as mentioned above. So, the mind set of the nurses is to go to abroad and earn money. Thus the result, experienced and confident nurses grab the opportunity and migrated abroad. Let’s face the reality that in the Philippines, to be able to be employed in other institution you have to have a backer. Otherwise, they wouldn’t bother to hire you.

“Respondents are able to create pushing factors such as low salary, no overtime or hazard pay, limited opportunities for employment, decreased health budget and economic instability in the Philippines and Pulling factors such as higher income, better benefits, lower nurse to patient ratio, more options on working hours, opportunity for family to upgrade and advance technology as well why they have the reasons to leave”.These factors are obviously the leading reasons why nurses migrate to other countries. If nurses continue to suffer from these factors then the future for their family will be turned down, all the hard works that they have gone through will be useless because they are working hard yet earning a little.

Comparing the salary, benefits and work loads that other countries could offer, it is much far better than the one here in the Philippines, so no wonder one day our country will only serve as a training ground for nurses.

Reference:

1. Lorenzo, Fely Marilyn E (FM); Galvez-Tan, Jaime (J); Icamina, Kriselle (K); Javier, Lara (L); (2007). “Nurse migration from a source country perspective: Philippine country case study”. Retrieved June 23,2009 from http://www.find-health-articles.com/rec_pub_17489922-nurse-migration-source-country-perspective-philippine-country-case.htm.

I believe that the splurge of nurses going abroad will slow down as US President Obama develops the foregoing proposal.

It says in New York Times,


officials in the Obama administration said in April 2009 that the president was developing a set of policy proposals he would unveil in May. Administration officials said that Mr. Obama's plan would not add new workers to the American work force, but that it would recognize millions of illegal immigrants who have already been working here (US). Despite the deep recession, there is no evidence of any wholesale exodus of illegal immigrant workers, independent studies of census data show

This may be true because of the economic downturn the US is experiencing. Another would be the fact that numerous Americans are losing their jobs because of the downturn, and President Obama would reach out to these group first; then employing foreign nurses would be just secondary.

Reference:
Immigration and Emigration. The New York Times. (updated 2009, May 15).

Neither the government nor hospitals are taking the rights of nurses seriously. If they did, issues like low income, poor working conditions, low morale and job dissatisfaction are all things of the past. Even if the pasture is greener abroad, possibly not as many nurses would want to work overseas.
Whether there is an oversupply or shortage of nurses, issues were not solved. Instead, hospitals and other institutions took advantage of the situation. Rather than paying for their services no matter how minimal, new nurses are accepted under the pretense of volunteers and trainees.
Why stay in a country where you will be taken advantage of, when you can actually earn somewhere else?
It's sad that for a profession that should be held in high regard, nurses are seen as dime a dozen.

Kingma, M. (2007). Nurses on the Move: A Global Overview. Health Research and Educational Trust. Retrieved June 23, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1955376&tool=pmcentrez

Valmero, C. (2009). Nurses decry lower salaries in new law . INQUIRER.net. Retrieved June 23, 2009 from http://globalnation.inquirer.net/news/news/view/20090603-208629/Nurses-decry-lower-salaries-in-new-law

When caregivers, nurses and other professionals begin sending dollar remittances to the Philippines, nobody can be happier than the Philippine government and banks which aggressively devise ways to have these remittances filling up their coffers.


Points to a “worrisome trend,” citing statistical records of the Professional Regulation Commission which show an annual reduction in registered nurses in the country from 27,272 in 1995 to only 5,874 in 2000, despite the number of nursing graduates dipping only by a little more than 10 percent.

Summing up the impact of the brain drain in the Philippines, Tujan says: “Deskilling is not just the sacrifice in terms of professional integrity and pride of the migrant worker or the professional challenge and development that work should provide.

“Deskilling becomes more obscene in the context of the brain drain where professionals are lost from developing countries in dire need of their precious services only to be lost forever as they end up working as aides and domestics in the affluent countries.”

Plugging the drain, however, would have to take more than just repealing the undeclared labor export policy of the government.

The solution, says HEAD president Dr. Jojo Carabeo, “lies in changing the system of Philippine society.” With Miriam Anzurin, PMC Reports/Reposted by Bulatlat.com

REFERENCE:
Ely Manalansan
PMC Reports/Reposted by Bulatlat.com

When caregivers, nurses and other professionals begin sending dollar remittances to the Philippines, nobody can be happier than the Philippine government and banks which aggressively devise ways to have these remittances filling up their coffers.


Points to a “worrisome trend,” citing statistical records of the Professional Regulation Commission which show an annual reduction in registered nurses in the country from 27,272 in 1995 to only 5,874 in 2000, despite the number of nursing graduates dipping only by a little more than 10 percent.

Summing up the impact of the brain drain in the Philippines, Tujan says: “Deskilling is not just the sacrifice in terms of professional integrity and pride of the migrant worker or the professional challenge and development that work should provide.

“Deskilling becomes more obscene in the context of the brain drain where professionals are lost from developing countries in dire need of their precious services only to be lost forever as they end up working as aides and domestics in the affluent countries.”

Plugging the drain, however, would have to take more than just repealing the undeclared labor export policy of the government.

The solution, says HEAD president Dr. Jojo Carabeo, “lies in changing the system of Philippine society.” With Miriam Anzurin, PMC Reports/Reposted by Bulatlat.com

REFERENCE:
Ely Manalansan
PMC Reports/Reposted by Bulatlat.com