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By Patricia L. Adversario, Senior
Reporter
Second of three parts
(Attracted by high-paying jobs in
developed
economies, skilled Philippine nurses are leaving the country in
droves, raising serious concerns about the quality of health care
here. Already, the outflow every year is three times greater than
the annual production of licensed nurses.)
THE dean of a nursing college in Abra must lead
a very active life. An inspection report submitted to the
Professional Regulation Commission (PRC) shows she holds the same
job in two other schools in Pangasinan. Her academic credentials can
also be found in a dean’s office at a Manila school.
She is one of many “portable” deans, who,
along with like-minded colleagues in a “ghost faculty” spread
themselves thin, lending their names to as many schools as possible.
The rise in the number of these cases points to
the deteriorating quality of nursing education in the country.
The increased demand for registered nurses has
led to a corresponding rise in the need for nursing education.
Authorities complain, however, that too many
schools have sprouted too soon, as more and more Filipinos want to
become nurses so they can leave the country and work abroad.
The latest figures show there are 233 nursing
schools in the country, most of them based in the National Capital
Region. A total of 32 new schools were accredited last year.
This year, at least 56 new schools are applying
for accreditation. Of these, 16 are in the NCR, while 40 are based
in other regions.
Nesie B. Dionisio, a member of the Board of
Nursing of the PRC said that of the 12 schools that the board
visited this year, they have yet to recommend one. “We found that
these schools have no dean and no qualified faculty.” Dionisio
said. “What they have is ghost faculty. The schools claim they
have the faculty, but we have yet to meet them, or see their
appointment papers.”
Letty Kuan, also a member of the nursing board,
cited the “lamentable state of the schools’ laboratories, and
the dearth of quality dean and faculty.”
The number of qualified faculty members has not
kept pace with the increased number of nursing schools and nursing
students. Existing faculty members are stretched, and there are few
nurses who could serve as faculty members. Most of them have left to
work abroad.
“One indication that the faculty is far from
what it should be is some nursing graduates learn about diabetes for
the first time in review centers,” said Kuan.
Despite the perceived low quality of these
schools, not one has been ordered closed. The nursing board submits
its findings and recommendations to the Commission on Higher
Education (CHED) but has no authority to issue a decision.
The CHED could only order the closure of a
school if it posted a low 3- to 5-percent passing rate in five
consecutive exams. The board thinks this requirement is too lenient
and is urging CHED to raise the minimum passing rate to 10 percent
to 15 percent, Dionisio said.
Nursing board members add that there is also a
need to monitor closely the number of students for each section and
the number of sections a year. The CHED, however, doesn’t have
enough money to monitor the schools to ensure they comply with the
standards, they said.
Dr. Teresita I. Barcelo, vice chancellor for
academic affairs at the UP-Open University and a professor at the UP
College of Nursing, said many schools have been increasing their
intake of new students. One school was reported to have at least 20
sections of freshmen, she said.
At an interactive forum among nurses at a recent
congress, a nurse voiced his concern: “We are dealing with human
lives here, not paper. We need to assess who are qualified to be
nurses. If not, three to four years from now, our profession will be
doomed.”
The problem is not limited to the shortage in
human resources, said Barcelo. Clinical and laboratory facilities
have also not expanded with the increased enrolment.
All these contribute to a poor quality of
education and consequently, poor quality graduates, who inevitably
have a low chance of passing local and foreign board exams.
Based on figures from the PRC, the percentage of
candidates who pass the board exams has declined in recent years.
Consolidated results from 1994-1998 showed a passing rate of more
than half at 57 percent. In December 2002, those who passed the
board dipped to 43.6 percent, down from 52.58 percent in the same
period in 2001.
Results from the local licensure exam given in
December 2002, showed that out of 223 nursing schools, 136 schools
posted a passing rate of below 50 percent. None of the graduates
from some 39 schools even made it.
“If this continues to happen, the nursing
profession here will die a natural death,” said Lily Ann R.
Baldago, PRC regional director in Iloilo.
With poor quality graduates, fewer nurses are
able to join the profession and provide competent health services.
Nursing graduates who do not pass the board exams, but who still
want to work abroad are likely to take on jobs as domestic care
givers, a job that requires only six months’ training.
Many of those recruited to work abroad are
graduates with one to two years’ work experience. Even if they
pass the local licensure exams and find jobs in the US, they still
have to take the state board exams. If they fail, they are demoted
to nurse assistants in some hospitals.
“This is a waste of human resources and leaves
them vulnerable to exploitation by employers,” said Barcelo.
“It’s too simplistic to say we open more
schools because we need more nurses for local needs and for
export,” said Barcelo. This approach proved ineffective during the
last two waves of strong demand for nurses in the early seventies
and late eighties.
“When external demand slows down, what happens
to the new schools and the surplus graduates? Where will they go?”
she pointed out.
Barcelo believes the demand for Filipino nurses
abroad will drop drastically after about five years, in contrast to
the general belief that the shortage will last for more than a
decade.
She said there is a growing opinion in the US
that the “poaching” of nurses from developing countries is
unethical.
Influential nursing groups in the US have also
lobbied against the “band-aid solution” of hiring foreign
nurses, and are lobbying for long-term solutions.
“I will not be surprised if five years from
now, when their long-term solutions have started to take effect, the
demand for Filipino nurses will drastically reduce. Let us learn
from the past. Let’s not commit the same mistakes for the third
time,” said Barcelo.
Measures
The prudent approach, then, is to stick with the
numbers that we can handle, said nursing leaders at the congress.
CHED and the nursing board need to monitor
nursing schools more strictly. Baldago said the Philippine Nursing
Association could assist in this respect.
Barcelo added that the entry of new colleges or
departments of nursing should be rationalized. Only colleges with a
faculty of qualified nursing educators and adequate clinical
resources should be allowed to open a new nursing program.
Schools also need to review their criteria for
admitting students. The CHED and the nursing board must also
evaluate so-called special programs for second courses. These are
for other professionals, mainly doctors, who are studying to be
nurses.
Barcelo said the nursing curriculum should not
only focus on training nurses to be globally competitive. Equally
important is the need to internalize a sense of a nationalism and
patriotism among nursing students.
The course could include topics like the nursing
shortage and the ethics of migration, the health status and needs of
the country, and the interplay of economic, health, social and
environmental factors on the shortage of nurses and migration.
Students should also be exposed to the health
care situation outside their hospital base by requiring them to
participate in community immersion programs.
An intensive information campaign on the
“perils of the unregulated exodus of nurses to other countries in
terms of social, economic and health costs” should also be
launched, said Barcelo.
To be concluded
Part 1
| Conclusion
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