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By Patricia L. Adversario, Senior Reporter
First of three parts
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
“sure” ticket for a better-paying job abroad—and the shortest
route to immigrant status.
Government figures report that some 2,908
Filipino nurses left for 21 countries in the first quarter of 2002.
In the previous year, some 13,536 Filipino nurses left for 31
countries. Major destinations were the United Kingdom, Saudi Arabia
and Ireland.
The Philippine Overseas Employment
Administration (POEA) said only 304 nurses left for the US in 2001.
This figure, however, is “grossly underreported.”
Figures from the International Union of Nurses
said that close to 10,000 Filipino nurses were directly hired by
US-based hospitals in 2001 through various nursing job fairs held in
the Philippines. Nurses who leave on immigrant visas are not
processed by the POEA.
The annual outflow of Filipino nurses is now
three times greater than the annual production of licensed nurses,
said Dr. Jaime Z. Galvez-Tan, vice chancellor for research at the
University of the Philippines in Manila, and executive director of
the National Institutes of Health Philippines.
The Professional Regulation Commission (PRC),
through the Board of Nursing, issues licenses to only 6,500 to 7,000
nurses a year.
“Sadly, this is no longer brain drain, but
more appropriately, brain hemorrhage of our nurses,” he said.
“Very soon, the Philippines will be bled dry of nurses.”
For some, like Dr. Teresita I. Barcelo, that
situation is already here. Barcelo is vice chancellor for academic
affairs of the UP-Open University, and a professor at the UP College
of Nursing.
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.
“It will no longer be the roller-coaster
demand for foreign graduate nurses that was seen in the last 35
years. This time, it will be a persistent, chronic need.”
He explains: The developed countries are
experiencing a longer lifespan and the “graying of their
population.” But their youth population is not interested in the
nursing profession because of the difficult and risky work
conditions such as evening duties, taking care of the chronically
ill and exposure to HIV/AIDS. 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.
Austria and Norway also announced their need for
foreign nurses this year and Japan, a new market, is expected to
open its doors to foreign nurses this year.
Local shortage?
Here in the Philippines, experts qualify their
answers on whether there is a shortage of nurses here.
Dr. Marilyn E. Lorenzo, director of the
Institute of Health Policy and Development Studies and a professor
at the UP College of Public Health, said “in absolute terms, there
is no shortage. There are enough warm bodies here, but there is a
shortage in terms of quality.”
The ones who have left are the skilled and
experienced nurses. Most of those who are still here are relatively
unskilled and inexperienced, and this poses serious implications on
the quality of health care that they provide.
“Most people think there is a shortage because
of the high staff turnover in hospitals. The truth is, nurses are
now more mobile, because they have more options,” observed Nesie
B. Dionisio, member of the Board of Nursing of the PRC.
Where are the nurses then? They move to urban
areas—where there is higher pay, and better chances to be hired.
After they get enough experience, say, one to two years, they leave
the country to work abroad.
Dionisio adds: “The government contributes to
the artificial shortage because it has not opened new positions. And
the ones who left have not been replaced.”
The government is the single biggest employer of
nurses here. While nurses prefer to work in government hospitals
because of the higher pay than in private hospitals, there are no
openings, said Dionisio.
Health does not seem a priority, and the
government has yet to increase the health budget. Because most
hospitals are understaffed, working conditions are far from
ideal—average nurse-patient ratios range from 1:30 to 1:60.
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. In the rural
areas, nurses receive from $75 to $95 a month.
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 P150,000 a month. “In all my 31 years as
nursing director, my salary didn’t even reach a third of that
amount,” Vengzon says.
Virginia Alinsao, director of international
nursing recruitment of the Johns Hopkins Health System in the US,
spent the last week interviewing applicants in Manila. “It was
heartbreaking to hear some of their stories,” she says.
One young applicant said her mother had worked
as a nursing assistant in Saudi Arabia since she was five years old.
“The applicant said she wanted her mother to rest. Working as a
nurse here won’t allow her to do that,” Alinsao says.
“For career mobility and advancement, leaving
the country to work elsewhere seems to be the answer,” she says.
Alinsao, a graduate of nursing from St. Paul’s
College in Iloilo, left the Philippines when she was 22. She has
been in the US for 30 years. From her batch of 50, only five worked
as nurses here. Most of them, like her, have since become US
citizens.
The Filipino-American recruiter notes with
amazement how even Filipino doctors have been studying to become
nurses, a reverse human resource development phenomenon, that she
thinks, is found only here.
Specialist doctors, in recent months, have been
enrolling in nursing schools mainly to take advantage of the
immigration visas offered to nurses who apply to work in the US.
Doctors in the Philippines earn an average income of $300 to $800 a
month, a pittance compared to the monthly salary of a nurse based in
the US or Europe.
Limited career ladder opportunities here are
also a push factor. “We’ve got a feudal system in our
nurse-doctor working relationship. Nurses are not recognized as
equal health care partners here. In the US, it’s a collaborative
task,” says a nurse from a university hospital.
Barcelo, in a speech before a recent nursing
congress, decried the government’s “deafening 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.”
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.
“Why, for instance, are nurses forced to take
care of 60 patients? And why are they not properly compensated?
It’s a social problem. We talk about taking care of the poor. But
what are the other professions doing to take care of the poor?”
Borromeo says.
“We 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 won’t have the means to
help. As a society, we all need to alleviate poverty. If we can lick
it, maybe we’d have better choices.”
Part 2
| Conclusion
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