1) Will the Philippine government just tolerate this trend of health human resource outflows to other countries?
2) Will the people just wait and do nothing about this health threatening situation now?
3) Will the Commission on Higher Education act only when the catastrophe is already beyond resuscitation?
4) As nurses, how are we able to make a difference in this situation individually or as a group?
Nursing education at this century is now being put into question as it has consistently produced overpopulated, unemployed, and underemployed professionals. Many factors are linked with this matter.
Medical Doctors turn into Registered Nurses?
At the velocity, we are losing monthly our highly skilled nurses to Australia, Canada, New Zealand, the United Kingdom, Ireland and the Netherlands. With this event happening, the Philippines is placed into the land of helplessness, offering null strategic solutions in sight, and the result is a catastrophic health crisis that will plague our country. Interestingly and unbelievably, it is not only the nurses that this country is losing, our medical doctors are now enrolling in nursing schools offering an abbreviated course for doctors to become nurses.
This is due to the fact that there is an acute shortage of nurses in the countries mentioned above which became palpable several years ago. The need is expected to be for at least the next ten years. Another reason for the high demands is that the countries mentioned earlier are experiencing longer lifespan and the increasing senescence of their population. These issues create escalating demands on their health systems for greater response mechanisms to the health problems of the rising percentage of the elderly. Their youth population no longer take interest in the nursing profession due to relatively difficult and riskier working conditions such as evening duties, care of the chronically ill and exposure to infectious and communicable diseases. Thus, the emergence of a great demand for foreign graduate nurses (mainly the Filipino nurses).
Schools are quick to meet this rising demand by offering courses tailored for doctors gearing up to challenge or take the nursing licensure examination.
According to Jaime Galvez Tan, a former Philippine health secretary and the current vice-chancellor of the University of the Philippines-Manila, almost 2,000 doctors took up the Nursing Board Exams in 2003 and 2004.
To meet the growing demand, the number of nursing schools in the Philippines increased sharply in the last decade. The Philippine Nursing Association reported that nursing schools rose from 186 in 1999 to 329 in 2004. And according to the Commission oh Higher Education (CHED), there are 456 nursing schools up to date. And more and more private companies offering nursing or other health-related courses are cropping up everywhere, eager to join in the fray of deploying nurses abroad.
Lack of Teachers and facilities
Many of these schools lack up-to-date facilities, qualified faculty or affiliation with a hospital, all of which are supposed to be in place before these institutions are allowed to operate. Depending on the year level of the students, a school is supposed to observe a teacher-student ratio. In the subject on Related Learning Experience, for example, there should be one teacher for just eight students.
Overpopulation of Nursing Students
Today, the Philippines is bloody full of nurses. Many nursing schools have busied themselves adjusting their requirements to fit the needs of a new type of students: middle-age professionals seeking a new career. Called “second-coursers,” they include doctors as well as accountants, clerks, teachers, journalists, government employees and secretaries. All of them hope to become nurses, preferably in a foreign land. More often than not, such students enjoy a shorter term since their basic science subjects in their first course are credited. They accept students beyond their limit and capacity and they compromise the quality of education in return.
Scarcity of Base Hospitals
Qualified training hospitals and base hospitals cannot provide accommodation to the enormous number of nursing schools in line.
Not just any hospital can qualify as a base. It has to have the major departments—surgical, ob-gyn and pediatric wards. It should be a tertiary hospital accredited by the Department of Health. And it must have an occupancy rate of 80 percent, which means it is an active hospital where students can be exposed and properly trained.
Although Filipino nurses are known for being compassionate and caring, these qualities appear to be disappearing because the goals for taking up nursing have changed. From desiring to be of service to another human being, nursing students are now primarily motivated by the need to make money.
Many schools are focusing more on reaping profits from people dreaming of high-earning jobs overseas rather than preparing students for an exacting profession that provides care for ailing patients and technical support for doctors.
Deterioration of Quality of Nursing Education
Many substandard schools have been set up, and many of these play on the dreams of those who aspire for a job abroad. Nursing education in fact has been retrofitted to meet the demands of the global market. With the proliferation of nursing schools, the quality of nursing education has shown signs of deterioration as measured by the quantity of nursing graduates who pass the Board of Nursing licensure examinations. In 2001, 54 percent (4,430 nurses) passed the nurse licensure examinations. In 2003, only 45 percent (4, 227 nurses) passed. In 2009, there was a meagre 39.73 percent (36,480 out of 94,462 test takers). Compare this with the average proportion who passed the nurse licensure examinations from 1994-1998 which was 57 percent. The trends of passers each year tend to slide downhill.
CHED Implementation of Policy
According to the former Board of Nursing (BON) member Leah Paquiz, ensuring quality and safety of nursing practice through various nursing education and practice reforms will counteract the unashamed commercialization of certain nursing academes and institutions.
Here in the Philippines, the appointed body by the government in dealing with the quality and integrity of nursing education and curriculum is Commission on Higher Education (CHED). They are responsible for formulating plans, policies, priorities, and programs on nursing education, research and development. Aside from this, it has been the function of CHED to monitor and evaluate the performance of nursing program and institutions for appropriate incentives as well as the imposition of sanctions such as diminution or withdrawal of grant, recommendation on the downgrading or withdrawal of accreditation, and program termination of school course. Under the law, a nursing school must have a passing rate of 30% percent to be able to continue operating.
While there are policies formulated by CHED, the downside is that political and business pressures exerted on CHED have been preventing it from effectively regulating nursing schools and closing down those that perform badly. CHED officials revealed that the commission even allowed more schools to open by continually processing pending applications. As recent as August 2008, CHED exempted certain schools from the suspension through a verbal agreement among the commissioners. This agreement was not made public by CHED. Even now, a number of schools are reportedly applying to open, one of them with up to 17 new campuses. In short, expect that there will often be room for injustices and corruption in the government. This makes it a very huge blockage that obstructs progress and development on the nursing education.
Nurses, whether they like it or not, are directly affected by the problems encountered today. They can propose to CHED a policy to screen students in the pre-entry level more stringently such as taking into consideration the examination of general physical appearance which includes setting a standard height and weight requirement. We also propose that there will be more than one set of entrance examinations and one-on-one interview after passing the exams. With all of this taken into consideration, there will be lesser problem on overpopulated graduate nurses who are unemployed or underemployed. The commercialization of the institutions will be controlled to a certain degree to the point of raising the quality of nursing education and back again to its crowning glory before we know it.
There should be an expansion of Nursing Residency. Patterned after medical specialist residency training programs, all secondary and tertiary hospitals should start a similar one for nurses. These will also be three year residency training focusing on nursing specialties such as intensive care nursing, operating room nursing, emergency nursing, psychiatric nursing, neonatal care nursing, geriatric nursing and nurse counselling, etc. A Board of Nursing Specialties, entirely separate from the Board of Nursing of the Philippine Regulations Commission, should be established to regulate the production and development of these nursing residency and training programs.
Another nursing development program is the offering of nurse practitioner post graduate courses. Nurse practitioners are independent, highly skilled nurses that work in solo, group or networks. While the Philippines produces a lot of graduates of Masters in Nursing which focuses more on nursing management, administration and research, it has been lagging behind in developing a nurse practitioner education program. This will give room for clinical skills in the nursing areas. The course can be offered by colleges of nursing and can also be regulated by the Board of Nursing Specialties or another new board as well. Once this course is available, the time will come when Filipinos can benefit from direct nursing care from stand alone nurse clinics, nurse wellness centers and other modalities of nurse practitioners’ facilities.
The above mentioned developments in nursing education will ensure better nurse holding mechanisms to maintain a steady pool of nurses to stabilize nursing care in our health care delivery system.