Nurses in distress

These life savers may soon need aid themselves if substandard practices continue unabated…

MANILA, Philippines — Several years ago, the nursing profession was a flourishing industry and Nursing as a course was most in demand.

Not anymore today.

In fact, the future is uncertain for the 409,917 nurses who recently graduated and for the thousands of unemployed Registered Nurses (RNs).

Blame it on the oversupply of nurses, the recession, the limited jobs, the proliferation of nursing schools, the abusive practices, and the deteriorating quality of nursing education.

Painful truth

Commission of Higher Education (CHED) chair Dr. Patricia Licuanan reported these issues and challenges during the “i.NARS” nursing summit at the Asian Institute of Management held last Friday in Makati City.

CHED reported that the number of nursing schools grew from 231 in 2003, to 491 today. Fifty percent of these schools are said to be low performing. Licuanan said only 231 of the 470 nursing schools had a passing rate of 30 percent and below. The December 2010 Philippine Nursing Licensure Exam (PNLE) registered a 35.25 percent passing rate, reported to be the lowest in the period from 2006 to 2010.

Only 409,917 of the 2,036,441 who enrolled in Nursing from 2005 to 2010 graduated. About 287,000 unemployed and underemployed RNs are recorded as of February this year. The Professional Regulation Commission also reported that only 198,727 out of the 273,373 RNs from 1998 to 2009 are employed.

Some 136,727 of these landed jobs abroad.

On top of these, newly-licensed nurses are also being abused and exploited by some hospitals that collect fees for internship programs, despite the existence of a law that prohibits it.

Abusive practices

Kim Paulino graduated in 2009, passed the Nursing board exams, and underwent several trainings for IV insertion, basic life support and basic skills which she paid for. She remains jobless until today.

“May bayad bawat training. Some trainings last for two months or more. There are also short trainings for the additional skills you want to learn like the IV training, basic skills and basic life support trainings,” says Paulino. “The head nurse said that for me to be considered for RN trainee in the hospital, I should be in the top 10 of those who took their training. I also have to pay P6,500 for my volunteer work but that doesn’t guarantee a permanent job.’’

Vivienne Salazar graduated in 2009 but couldn’t find a job as a nurse. She ended up working as a call center agent, a web content writer, and parttime children story writer.

Salazar took a Professional Nurse Training Program (PNTP) at a hospital and was fortunate to work as a trainee but also paid for it. The program was enriching for her.

“Sa ibang hospitals, ginagawang student nurses pa rin ang mga RN trainees. They give out assignments, case presentations, reports which we already learned in college. During my training, I learned many clinical skills because seniors treated us as fresh RNs, not as nursing students. What I didn’t like though was the bad treatment of some hospital staff. There are instances when trainees are being taken for granted and given orders that are not part of their “job description” anymore. My contract is only for two months. After that you will be evaluated if you qualify for employment or re-enrollment,” reveals Salazar.

Sadly, Salazar didn’t continue pursuing her dream to work as a nurse. “I didn’t push through anymore because you have to spend money on food and fare, serve for a period of time, hope, pray, and wait to get noticed to be a contractual employee. One staff nurse told us that she was in the training program for about a year and a half and spent P16,000 before she became contractual. Really, I’m embarrassed with my parents for asking allowance when I should be the one helping them with expenses. I needed a paying job,” laments Salazar.

Pay before volunteer

Teresita Barcelo, president of the Philippine Nurses Association (PNA), says this abusive practice which she calls “volunteerism for a fee,” has been going on since 2008 but has become more rampant now as nurses can no longer apply directly in a hospital without undergoing volunteer training. PNA is part of a Department of Health-led team that is investigating the matter.

“This is exploitation. These hospitals have created all kinds of training. There is a law (Volunteer Act of 2007) that prohibits charging or collecting fees from volunteers. But never in the past have nurses undergone additional training and paid just to get hired. It’s ok if it’s for a specialty to be an ICU nurse, a Renal or a pediatric specialist,” points out Barcelo.

But in most cases, Barcelo says these hospitals do not offer any structured program, except that they make these trainees do the work of the regular staff nurses.

“Some RN trainees are even made to rotate at night shift when they’re only supposed to work at daytime and not more than eight hours. In some hospitals where there is no reliever, they’re made to work 12 hours. That can be very traumatic for a young nurse who has paid to be trained and then be left alone to handle a big number of patients. In some hospitals, they are asked to sign a contract, a waiver, which says there is no employee-employer relationship so if a nurse makes a mistake, they are on their own. So the patient who does not know this is really put at risk. To us that’s a safety issue. It’s not just about the nurse, it’s also about the patient,” stresses Barcelo.

Barcelo believes a solution is to follow the proper nurse-patient ratio which is one nurse for 12 patients in the general ward, as this is where vacancies will come out.

“If you have a 200-bed capacity and you only have 18 nurses that will rotate for 24 hours, the ratio of patient to nurse is too big. But if you use the 1 is to 12 maximum, mag hahire ka, may bakante ka. Hindi ka lang nag hahire kasi may volunteer ka.”

Barcelo also admonishes CHED to regulate nursing schools, and monitor qualified and competent faculty to upgrade the quality of teaching.

What is CHED doing?

CHED’s Licuanan says her department is working to address these issues.

First, it has imposed a moratorium on the opening of all undergraduate and graduate programs in Nursing, Business Administration, Education, Hotel and Restaurant Management, and Information and Technology Education effective academic year 2011-2012.

Institutions with BS Nursing programs that have an average percentage of 30 percent and below for a three-year period (starting 2008, 2009, 2010 and thereafter) in the PNLE will be immediately phased out. Those with above 30 percent passing rate for three consecutive years but are non-compliant with the minimum requirements set by CHED will be reevaluated and monitored.

CHED and DoH will also develop joint guidelines on the accreditation of health facilities for the Related Learning Experience (RLE) of nursing students, and formulate appropriate rules and regulations for RA 9418 or Volunteer Act of 2007, and the EO 897 or “Allowing/Permitting the Recognition of Registered Nurses’ Training and Practice as Equivalent Hospital Work Experience for Employment Purposes.”

Some 10,000 nurses are also reported to be hired by the DoH under its RNHELS (Registered Nurse Health Enhancement and Local Services) program and are now deployed in the provinces. –RACHEL C. BARAWID, Manila Bulletin