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By Patricia L. Adversario, Senior Reporter
Conclusion
Hospital officials admit that they are forced to
lower admission standards when hiring replacements. It’s a tough
choice–hospitals could insist on maintaining standards when hiring
new nurses, or kill their remaining staff with overwork.
The Philippine General Hospital, the country’s
premier training hospital, used to take applicants with a minimum
grade of 90, but now a 75 will do, said Maria Rita Tamse, chief
nurse with the hospital’s department of psychiatry and behavioral
medicine.
As Dr. Gerardo D. Cunanan, hospital chief at the
Davao Medical Center (DMC), also puts it: “When hiring to replace,
we decide not by choice but by chance. It depends on what’s
available.” The DMC is Mindanao’s leading government
tertiary hospital.
For his part, Dr. Herminio A. Villano Sr.,
president of the private Davao Doctor’s Hospital in Davao City,
said the hospital used to hire only the excellent ones from its
training program. “Now we’re content with just getting those who
pass,” he said.
In a survey of eight hospitals in Southern
Mindanao from 1998 to 2001, some hospitals reported that they had to
hire unlicensed nurses or fresh nursing graduates to replace the
experienced ones who had resigned. Other hospitals covered by the
survey reported that even erring nurses, who would otherwise be
suspended, were tolerated.
Southern Mindanao comprises the provinces of
Davao Oriental, Davao del Sur, Davao del Norte, Compostela and Davao
City.
Endless training
Hospital administrators agree that the problem
is not the lack of nurses but the lack of skilled nurses to replace
the experienced ones who have left.
To cope, hospital officials spend an inordinate
time interviewing and screening replacements, orienting and training
them, only to receive their resignation letters after training.
Then, it’s another round of interviews and screening applicants
again.
Vilma Comoda, chief nurse at the Davao Medical
Center, said hospital operations are bogged down by the staff’s
“lack of commitment.” The hospital sent for training a head
nurse for the Mindanao Burn Center, but four weeks after training,
she left.
“We train but others benefit,” she said,
throwing up her hands in resignation. She recalled another example:
The Davao Medical Center also sent 10 of its best nurses to two
months’ training in critical care nursing at the Philippine Heart
Center in Manila. After the training period, eight left to work
abroad and only two came back.
“It’s a drain. We invest in training only to
see them leave. Most of them could commit only a year with us.
Sometimes, they just give a day’s notice when they leave,” she
said.
Villano of the Davao Doctor’s Hospital said
that after training with the hospital for one and a half months,
nurses sign a contract to stay for at least three months. After
three months, most of them promptly leave, he said.
Villano, however, takes a practical view on the
high turnover. “We realize we’re a training ground of nurses for
export, and that they stay with us for only a short while. We
don’t mind, because we can’t employ them at the salaries they
hope to earn abroad.” The hospital pays its nurses get a minimum
of P6,000 a month.
“If we don’t train them, they won’t be
hired. We help the country by training nurses so they can find work
abroad,” he said.
Dr. Romulo A. Busuego, chief of hospital at the
Davao Regional Hospital in Apokon, Tagum City, said, “The constant
retraining and reorientation of replacements affect the care of
patients. We don’t have all the time to train. This is a 200-bed
hospital that has been stretched to accommodate 350 beds, so
there’s just not enough time.”
Dr. Dolores C. Castillo, regional health
director for Southern Mindanao, said that unlike hospitals, rural
health units have not experienced significant numbers of nurses
leaving to work abroad–“but it will only take one recruiter to
subsidize the cost of meeting the exam requirements and soon our
nurses will also leave.”
Before the barangays start losing doctors,
nurses and midwives to better offers abroad, the government has a
long-term strategy to organize communities and train them to take
care of themselves, she said.
Local residents are taught basic preventive care
through home remedies, proper diet and good sanitation. Community
health workers are also given training on immunization, early
detection of diseases like malaria, and prenatal care.
They are also taught how to get blood samples
and dispense drugs. Traditional birth methods like hilot are
encouraged, said Castillo.
She added that the regional health office has
begun what she called the “corporatization of hospitals” to wean
the public hospital’s dependence from government subsidy. These
include installing private rooms in public hospitals to generate
income. The additional income could be used to increase the salaries
of nurses, she said.
Strategies
As things are, government hospitals like DMC and
the Davao Regional Hospital are constantly constrained by lack of
funds. Comoda said that even if DMC needs 50 percent more nurses, it
can’t create new positions and hire more nurses.
To ease the shortage, it hires “emergency
replacements on contractual basis.” The temporary measure has
ironically worked well for DMC, which has employed a number of
skilled nurses who prefer to work on short-term contracts, said
Comoda.
These nurses had worked abroad and came back
after their contracts expired. Most of them stay for a year while
they wait for a new contract for another destination to be
processed.
Other hospitals cope by delegating some of the
nurses’ tasks to other health-care staff like midwives and nursing
attendants, instead of hiring more nurses. Head nurses also double
as staff nurses to ease the shortage.
Davao Doctor’s has been training midwives for
certain nursing work. The hospital has also been training
operating-room technicians, and nurse’s aides in the wards instead
of hiring nurses.
The Davao Regional Hospital also proposes to
hire more nursing attendants and midwives to assist nurses in the
delivery rooms and in the general wards. Busuego expects to have
only one nurse with three to four nursing attendants to man the
wards on each shift.
Even with the high turnover of nurses, hospitals
have to provide continuous care at the same level of competent
service, said Busuego. “There’s no problem with sourcing nurses
who will replace the ones who leave. The problem is there are not
enough skilled nurses to occupy positions that were vacated by the
experienced ones.”
The Davao Regional Hospital experienced a
manpower crisis last year when half of its 12 operating-room nurses
left for work abroad. But that crisis taught officials that instead
of harping on the shortage of nursing staff, they had to look
elsewhere.
Senior nurses began training utility men and
nursing attendants to assist as operating-room technicians and
assume the functions of a scrub nurse. That meant fewer nurses were
needed to assist during operations.
Busuego has struck gold. He proposes to train
more nursing attendants as operating-room technicians. “The
replacement plan worked because after being promoted to technicians,
the nursing attendants became more motivated.”
He is also convinced that the attendants will
help stabilize operations. “Unlike nurses, they have no plans to
leave,” he said. Well, at least, not yet.
Part 1
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